Violence against women and girls (VAWG) is an international public health concern and a violation of women’s rights. The United Nations defines VAWG as manifesting itself in “physical, sexual and psychological forms, encompassing intimate partner violence; sexual violence and harassment; human trafficking; female genital mutilation; and child marriage.”
Violence against women and girls has many adverse psychological, sexual and reproductive health consequences. At the Centre for Maternal and Newborn Health (CMNH), we aim to improve the health of mothers and babies in low and middle-income countries. We have conducted research which aims to address and explore issues around VAWG during pregnancy and childbirth.
Screening for domestic violence during and after pregnancy
An estimated one in three women worldwide suffer domestic violence during their lifetime (WHO, 2017). Domestic violence can particularly impact pregnant women: it often first occurs, and increases in frequency and severity for women during and after pregnancy. This can lead to poor health outcomes for both the mother and her unborn baby including maternal injury or death and stillbirth. Domestic violence can also have life-long negative implications for a woman’s physical and psychological health.
CMNH has conducted a number of research projects aiming to improve the quality of care for women who report domestic violence during and after pregnancy in low- and middle-income countries (LMIC). For example, we investigated the knowledge and perceptions of domestic violence among doctors who provide routine antenatal and postnatal care at healthcare facilities in Pakistan. This study revealed that doctors and policy advisors are aware of the problems of domestic violence and are open to screening for it during and after pregnancy. However, a lack of resources, consultation time and support can prevent women receiving quality care. The findings suggest that having a speciality trained family liaison officer or healthcare provider and establishing clear referral pathways could improve the quality of care for vulnerable women.
We have also recently conducted a systematic review to explore what interventions are available to women who experience domestic violence during and after pregnancy in LMIC. The review found that whilst intervention programmes are available for these women, strong evidence for their effectiveness is lacking. It highlighted the need for additional large-scale, high-quality studies to investigate the effectiveness of current interventions on maternal and neonatal morbidity and mortality outcomes.
Through our innovative competency-based antenatal and postnatal workshop, we are also delivering training for healthcare providers in LMICs in how to screen for domestic violence during and after pregnancy, and when it is appropriate to do so. This capacity-building programme has already been introduced in Afghanistan, Ghana, Togo and Chad, with plans for further roll out in 2019.
Addressing issues around Female Genital Mutilation/Cutting
Female Genital Mutilation/Cutting (FGM/C) is defined as ‘all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs, whether for cultural or other non-therapeutic reasons’. It is estimated that more than 200 million girls and women worldwide are living with the effects of FGM/C. Of these, 44 million are under 15 years old. FGM/C interferes with normal healthy female genital tissue and sexuality and is a violation of every girl’s and women’s right to the highest attainable standard of health.
Professor Nynke van den Broek, Head of CMNH, and Dr Mary McCauley, Academic Clinical Lecturer at CMNH, wrote an editorial in the journal International Health to set out the challenges of eradicating FGM/C and why it is so important to do so for all aspects of women’s health. In the editorial, they comment:
“Despite over 40 years of discussion and debate regarding FGM/C, this topic remains controversial and emotive, and the practice continues. The eradication of FGM/C can only be achieved through a strong and coordinated approach implemented at local, regional, national and international levels. Supportive education and targeted training are recommended to enable all stakeholders to sensitively and respectfully address this complex and long-standing practice.”
Read more about the 2018 International Day for the Elimination of Violence against Women here: http://www.un.org/en/events/endviolenceday/messages.shtml