Background: 

The nationwide Women’s Wellbeing Survey of 2019 found that 18.9% of women in Sri Lanka have experienced physical violence in their lifetime, and 4.8% have experienced this in the last 12 months. In the Western Province, a populated urban area of Sri Lanka, it has been reported that 34% of ever-married women had experienced violence from an intimate partner, and more than half of these women experienced severe violence.

Sri Lankan studies and surveys have repeatedly indicated women experiencing violence often do not seek help.  When these do seek help, it’s most often from family members or friends, rather than from services or institutions. A nationwide survey in 2016 found that even if women do seek help from services or institutions, they most commonly sought help from, first the police, or second, from their public health midwife or local medical officer. 

Sri Lanka has a widespread primary health care service, which includes sexual and reproductive health care services.  A study conducted among nurses suggests that limited training and skill, as well as lack of institutional support, were barriers towards identifying and supporting these women. A study in the Central Province of Sri Lanka found that improving the skills of public health midwives in the detection and support of women facing intimate partner violence, led to increased identification of women facing such difficulties.

Aims: 

The aim of this study was to develop an intervention to improve awareness, knowledge and skill, among healthcare professionals, regarding responding to women facing domestic violence who present to healthcare services, and thereby facilitate provision of better services.

What we did

From the start of our work, we engaged with the Family Health Bureau (FHB), of the Ministry of Health in Sri Lanka, which is the main administrative body that organizes service provision for women facing domestic violence, within the Sri Lankan health sector.

In collaboration with the FHB we developed a multi-component training program to improve awareness and skills in responding to women who are experiencing domestic violence, aimed at doctors and nurses working in outpatient and primary care settings.  The intervention was developed based on findings from qualitative interviews with healthcare professionals, and from interviews with women who have experienced violence, and with input from experts in the FHB.

The training intervention was then delivered and evaluated using mixed methods, at two hospitals in the Kandy district.  The training consisted of several components, conducted over several three sessions, and was delivered by experts from the FHB.  The program was well received with good participation, particularly from nurses.  We are now in the process of analyzing the findings of this program, with regards to acceptability, feasibility and efficacy.

Key findings so far:

• Healthcare workers identified lack of knowledge, skills and time as challenges to providing support to women experiencing domestic violence, who present to healthcare services
• Healthcare workers requested that any training programs should use innovative, interactive methods rather than lectures
• Women who experience domestic violence presenting to healthcare services requested a chance to talk about their problems confidentially, and support for their partners
• Women also requested that a healthcare professional should talk to both their partner and themselves, to help solve their problems
• Delivery of an interactive multi-component training program on responding to women facing domestic violence, to healthcare professionals, was found to be feasible and acceptable.