ACTION RESEARCH ON DOMESTIC VIOLENCE DURING PREGNANCY: A STRATEGY FOR QUALIFYING HEALTH PROFESSIONAL

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ACTION RESEARCH ON DOMESTIC VIOLENCE DURING
PREGNANCY A STRATEGY FOR QUALIFYING HEALTH
PROFESSIONALS

• KAREN GIFFIN
• SÔNIA DANTAS BERGER
• TIZUKO SHIRAIWA
• JANAINA AGUIAR
• National School of Public Health
• ENSP/FIOCRUZ
• Rio de Janeiro BRASIL
• Istanbul, 2009

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• 2. OBJECTIVES
• GENERATE KNOWLEDGE FOR DEVELOPING A PROPOSAL FOR
  IDENTIFYING CASES AND SUPPORTING WOMEN
• SUFFERING DOMESTIC VIOLENCE DURING PREGNANCY
  (DVP) INCLUDES INTIMATE PARTNER VIOLENCE (IPV)
• IN ANTE-NATAL AND MATERNITY SERVICES OF A LARGE
  PUBLIC HOSPITAL
• ACTION RESEARCH
• Start from the view of the subjects involved
• Make a difference in their field of action.

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• 3. THEORETICAL PERSPECTIVE ON DOMESTIC VIOLENCE
• RISK SOCIETY Ulrich Beck
• - Highly developed societies that constantly
  generate risks that they are unable to control.
• - Decisions on development of technologies are
  made by those who intend to profit by them.
• GLOBALIZATION OF NEO-LIBERAL POLITICAL ECONOMY
• Retrenchment of social protection, privatization
  of public entities and citizenship goods
• Flexibilization of employment
• Deregulation of financial transactions and
  currency values.
• gt CONCENTRATION OF WEALTH, UNEMPLOYMENT AND
  POVERTY, SOCIAL POLARIZATION
• GREATER INEQUALITY BETWEEN NATIONS AND CLASSES
• ILLEGAL FORMS OF SURVIVAL AND VIOLENCE.

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• 4.GENDER TRANSITION ( a relational perspective)
• - DEMISE OF THE FAMILY WAGE family wage no
  longer a reasonable expectation
• - DUAL EARNING IS THE NORM feminization of the
  international labour force (poor salaries and
  intensified work)
• reorganization of the patriarchal division of
  labour which sustained human reproduction.
• Patriarchal cultural traditions persist
  (domination, sexual objectification)
• but have lost their material base dont sustain
  human reproduction.
• In Brazil, 1/3 of families have female heads (and
  are poor).
• Homicides in males 15-19 yrs. Increased 1800
  1960-95.
• Old and new sources of conflict between men and
  women.
• Pregnancy may increase conflict pressure on
  income/sexuality
• Pregnancy may result from IPV IPV often starts
  during pregnancy.

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• 5. DVP AND HEALTH SERVICES
• VIOLENCE DURING PREGNANCY MAY BE MORE COMMON THAN
  DIABETES AND TOXEMIA
• although a WEB OF SILENCE surrounds it.
• Public health services and health professionals
  are considered strategic actors in identifying
  cases, supporting disclosure, alleviating health
  consequences and facilitating access to social
  and psychological support services.
• Public health services have been degraded and
  underfinanced at the same time as the social
  problems of their users have increased.
• Domestic violence is more complex and harder to
  deal with than sexual violence by strangers
  cannot be treated as an individual problem
  subject to medication.

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• 6. PROJECT ACTIVITIES (during 2 years)
• Mapping of existing network of legal and social
  services and production of a mini-guide
• Observation of 50 ante-natal consultations
• Semi-structured interviews on views and
  experiences of violence with 30 health
  professionals and 57 ante-natal clients. Themes
• Violence as a social and interpersonal problem
• Change and continuity in gender relations
• Relations between violence and pregnancy
• Violence as question for health services.
• Preliminary data were discussed in 7 monthly
  workshops, where proposals for training and
  organizing were developed and implemented with
  staff
• A final Seminar brought together other services
  and professionals.

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• 7. RESULTS
• INTERVIEWS WITH WOMEN
• - 22/50 reported some VD in families of origin
• 26 reported IPV in some relationship 14 during
  pregnancy
• 7 reported IPV during this pregnancy lack of
  support doubts about paternity daily
  criticisms sudden physical aggression sexual
  coercion.
• 7 reported IPV during an earlier pregnancy
• 9 reported committing violence against their
  partners.
• 47/50 reported they would discuss DVP with health
  professionals, depending on how they do it
• Health services could include hearing and
  supporting women in violence counseling for
  couples information on other available services.
  

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• 8. RESULTS
• INTERVIEWS AND WORKSHOPS WITH PROFESSIONALS
• CONSTRUCTING VISIBILITY in 7 monthly workshops
• Early statements tended to refer physical
  violence with discussion, this was broadened to
  include sexual coercion blaming women for daily
  problems in the family and in child-raising
  threat of separation destroying personal or
  family property restrictions on movements lack
  of support and abandoning women and
  institutional violence in health services
• Men are also victims of spousal violence
• Signs and symptoms of women clients suffering
  DVP
• Conditions necessary and barriers to addressing
  this question in these services (privacy,
  preparation for action, physical resources,
  interdisciplinary support, etc.).

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• 9. RESULTS
• 60 professionals prepared and new routines
  established
• Professionals reported greater visibility and
  knowledge of the problem and confidence in their
  role, better relationships among staff and
  greater articulation with other services
• All ante-natal clients receive a mini-guide of
  available services
• A technical group was designated for monitoring
  future processes.