This is a subject area I have always been passionate about. I found out that the team at CMNH were already undertaking a large multi-country study exploring maternal morbidity, with a particular focus on factors that are harmful to a woman during and after pregnancy, not just physical but including psychological and social factors.
This study comprehensively assessed 11,454 women across four low and middle income countries - India, Pakistan, Kenya and Malawi. Specifically, one of the findings is that women studied in Pakistan reported more domestic violence from husband and family members, compared to the other countries involved in the study.
I was therefore keen to explore these findings to try to understand what the views and perceptions of healthcare providers looking after these women during and after pregnancy in Pakistan were.
As my research proposal took shape, I soon realised that DV is a very sensitive topic, particularly within the cultural settings of Pakistan and discovered that I had a number of obstacles to overcome on the way. Despite this, I managed to complete the project successfully and it really was one of the most eye-opening and fulfilling experiences of my life.
The first obstacle I faced was that of obtaining risk assessment and ethical approval from LSTM and from the research committee Pakistan. The LSTM are rightfully strict in these areas and I was required to apply with a great amount of detail; firstly to ensure the placement was safe in Pakistan and secondly to ensure that no detrimental effects would be encountered by any of the participants in my study. With such a potentially sensitive subject area, but without losing sight of the key information I required, it was difficult to cover all bases. However, thanks to the excellent support of my supervisors (Dr Mary McCauley and Ms Jaki Lambert) and the priceless knowledge of the collaborative team in Pakistan (Professor Shamsa Rizwan), my risk and ethical applications were approved.
My time spent in Pakistan was a challenging, sometimes overwhelming but incredible experience and enhanced my passion to improve the care available for women who report DV during and after pregnancy.
During my research I discovered that the prevalence of domestic violence in Pakistan is very high and that it remains a severe issue throughout pregnancy; yet I could find no indication of any intervention strategies or clear support pathways for victims. This led me to my main aim of investigating the awareness of health care professionals of this problem and whether they believe they could play a part in an intervention strategy for domestic violence. However, as you can imagine, this would involve asking some pretty difficult questions.
The responses I obtained were primarily from doctor training in gynaecology and obstetrics and I also interview some policy makers and people who worked for non-governmental organisations with an emphasis on the detection and prevention of domestic violence.
The overwhelming majority of conversations I had with participants indicated that domestic violence is a huge problem in Pakistan and the most powerful theme that arose was how passionate the participants were about putting an end to this violation of human rights. They were adamant that something should be done. It was inspirational to hear that Pakistani female healthcare providers are passionate to increase the awareness of this issue and to relieve some of the burden of this issue from women in their society. However, the interviews always came to the same frustrating end – as much as their knowledge, passion and willingness was there, many participants could see no avenue for them to help because of the severe lack of infrastructure and support networks. They expressed deep concerns for the lack of disclosure about this problem and could identify no clear referral pathway to offer a women who reports domestic violence.
I walked away from Pakistan with more of an understanding of the complex social barriers within that culture that are preventing healthcare providers from appreciating their potential to be a part of an intervention strategy. It was a truly eye-opening experience exploring solutions to a problem that I would love to further pursue in future research.