Addressing domestic violence through antenatal care in Sri Lanka's plantation estates: Contributions of public health midwives. (November 2015)

• Record Type: Journal Article
• Authors: Infanti, Jennifer J.; Lund, Ragnhild; Muzrif, Munas M.; Schei, Berit; Wijewardena, Kumudu
• Is Part Of: Social science & medicine. Volume 145(2015)
• Page Start: 35
• Page End: 43
• Publication Date: 2015-11
• Subjects: Sri Lanka -- Tea plantation sector -- Public health midwives -- Domestic violence -- Landscape of care -- Livelihoods framework -- Qualitative methods; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2015.09.037
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Domestic violence in pregnancy is a significant health concern for women around the world. Globally, much has been written about how the health sector can respond effectively and comprehensively to domestic violence during pregnancy via antenatal services. The evidence from low-income settings is, however, limited. Sri Lanka is internationally acknowledged as a model amongst low-income countries for its maternal and child health statistics. Yet, very little research has considered the perspectives and experiences of the key front line health providers for pregnant women in Sri Lanka, public health midwives (PHMs). We address this gap by consulting PHMs about their experiences identifying and responding to pregnant women affected by domestic violence in an underserved area: the tea estate sector of Badulla district. Over two months in late 2014, our interdisciplinary team of social scientists and medical doctors met with 31 estate PHMs for group interviews and a participatory workshop at health clinics across Badulla district. In the paper, we propose a modified livelihoods model to conceptualise the physical, social and symbolic assets, strategies and constraints that simultaneously enable and limit the effectiveness of community-based health care responses to domestic violence. Our findings also highlight conceptual and practical strategies identified by PHMs to ensure improvements in this complex landscape of care. Such strategies include estate-based counselling services; basic training in family counselling and mediation for PHMs; greater surveillance of abusive men's behaviours by male community leaders; and performance evaluation and incentives for work undertaken to respond to domestic violence. The study contributes to international discussions on the meanings, frameworks, and identities constructed at the local levels of health care delivery in the global challenge to end domestic violence. In turn, such knowledge adds to international debates on the roles and responsibilities of health care professionals in responding to and preventing domestic violence. Highlights: Locates barriers and opportunities to address domestic violence via antenatal care. Identifies assets, strategies and constraints affecting public health midwives. Develops a model of a community-level landscape of antenatal care. Advances evidence on health response to domestic violence in low-income settings.