Authors Claudia García-Moreno, Kelsey Hegarty, Ana Flavia Lucas d'Oliveira, Jane Koziol- MacLain, Manuela Colombini, Gene Feder Case studies: Padma Deosthali, Maria Carmen Fernandez, Ruxana Jina, Jinan Ustun

Violence is widely prevalent and is an underlying cause of injury and ill health Globally 1 in 3 women (30%) will experience physical and/or sexual violence by an intimate partner

Health impact: Women exposed to intimate partner violence are…

Abused women more likely to seek health services Most women attend health services at some point, especially sexual and reproductive health If health workers know about a history of violence they can give better services for women Identify women in danger before violence escalates Provide appropriate clinical care Reduce negative health outcomes of VAW Assist survivors to access help / services/ protections Improve sexual, reproductive health and HIV outcomes Human rights obligations to the highest standard of health care Background: Why should the health sector get involved?

Sometimes when I ask a woman about violence, she dissolves in a sea of tears… then I think now how am I going to get rid of her? Doctor in El Salvador

Aim of the paper To highlight the role of the health sector in a multi-sectoral response. Review the evidence and experience of delivering health care for women subjected to violence Review health system elements that need to be in place for health care response Make recommendations to strengthen health sector response

Methods Based on systematic reviews

Methods: Country case studies

Key findings: What about the identification of women with intimate partner violence? Evidence does not support 'screening' and where prevalence is high and referral options limited may bring little benefit to women and overwhelm providers but… Certain sites may want to consider it provided certain requirements are met, including mental health, HIV testing and counselling, antenatal care Clinical enquiry is recommended – providers should know when and how to ask

Key findings: Clinical care Evidence of effective interventions in health-care services still limited, but consensus on need of first- line supportive care (empathetic listening, addressing key needs), ongoing psychological support, referral to other services, comprehensive post-rape care for sexual assault An empathetic and supportive response from a well trained provider can act as a turning point on the pathway to safety and healing Specific interventions: support/advocacy interventions, motivational interviewing, safety planning, cognitive behaviour therapies and other mental health interventions

Key findings: Health systems System wide changes and budgetary allocation are critical No one model of health care delivery fits all: countries should take into account resources and availability of specialized services Institutional commitment necessary: procedures around patient flow, documentation, privacy and confidentiality, feedback to health workers, referral networks All building blocks of health systems implicated

Role of the health sector in a multi-sectoral response

Conclusions Violence against women needs to have a higher priority in health policies, budget allocations and in training/capacity building of providers Need to integrate into undergraduate curricula and also in service, with ongoing support and supervision Sexual and reproductive health services offer a unique entry point to address violence against women Use existing opportunities to integrate programming to address violence, e.g. sexual and reproductive health, adolescent SRH, maternal and child health, HIV Strengthen mental health programmes/capacities Health policy makers need to show leadership and raise awareness of the health burden and cost