Thirty percent of women worldwide experience physical and/or sexual intimate partner violence sometime in their lifetime.[1] Research demonstrates that women who experience such violence undergo negative health consequences. Previous studies indicate these women are more likely to experience poor mental health; unwanted pregnancies; vulnerabilities to HIV and sexually transmitted infections; risk of antepartum hemorrhage and miscarriage; depression and suicide. Given the high percentage of women of reproductive age affected by such violence, along with associated negative reproductive health consequences, health care providers can play a critical role in both assessing intimate partner violence in their patients and in mitigating related risks.
While various policies have been implemented to strengthen the health care response to intimate partner violence, most robust designs have been conducted in industrialized countries such as the United States. To date, rigorous evaluations of the few existing health sector intervention efforts have not been conducted in a systematic manner in Mexico. Findings from this study will provide important insights into whether a nurse-delivered program can assist women currently experiencing partner violence in a Latin American context.
Context of the Evaluation:One in four women in Mexico reports experiencing physical and sexual intimate partner violence.[2]For lower income women who experience sexual or physical abuse by a partner in Mexico City, nurses in government clinics are often the their first point of contact with the healthcare sector. Training nurses to respond to cases of intimate partner violence may, therefore, increase midlevel health care providers’ capacity to identify cases and to assist these women with health risk mitigation.
This study will inform partners, who include the Secretariat of Health of Mexico City, the National Institute of Public Health of Mexico, and the Mexican Foundation for Family Planning (MEXFAM), an International Planned Parenthood Federation affiliate, about effective programs and policies in Mexico City’s public health care facilities and at the national level.
Details of the Intervention:To evaluate the impact of nurse-led screening and victim counseling on women who experience intimate partner violence, researchers designed a randomized evaluation, which is being implemented by the study team in government health clinics belonging to the Secretariat of Health of Mexico City. The study includes 952 women from 42 health care clinics. Half of the randomly assigned clinics are serving as the “intervention” group, while the other half are serving as a comparison group.
The female participants are 18-44 years of age, either not pregnant or in their first trimester, and reported experiencing physical and/or sexual violence in the previous year in a heterosexual relationship.
Nurses in the clinics assigned to the intervention group underwent a two-week training with refresher sessions on intimate partner violence, the health impacts of such violence, how to document cases, carry out safety planning and perform supported referrals. The comparison clinics offer a minimum standard of care from Mexico City’s government health facilities (i.e., a referral card for victims only)
Women who agreed to participate in the intervention group completed an initial survey and then received a 30-minute counseling session from a trained nurse. Those participants received a follow-up counseling session three months after the initial survey. Final data collection is taking place fifteen months after the initial survey.
Researchers are asking participants in both groups about occurrence and injuries from severe physical and sexual violence by an intimate partner over the previous year; reproductive coercion; use of community-based resources and safety planning; and quality of life and mental health. Researchers will also conduct in-depth interviews with women and nurses from treatment and comparison clinics to gather qualitative data on which specific aspects of the program triggered any changes.
Results and Policy Lessons:Results forthcoming.
[1]WHO report 2013 http://apps.who.int/iris/bitstream/10665/85239/1/9789241564625_eng.pdf
[2] Avila-Burgos, Leticia, Rosario Valdez-Santiago, Martha Híjar, Aurora del Rio-Zolezzi, Rosalba Rojas-Martínez, and Carlo E. Medina-Solís. "Factors associated with severity of intimate partner abuse in Mexico: results of the first National Survey of Violence Against Women." Can J Public Health 100, no. 6 (2009): 436-41.
