Date Published: April 29, 2013
Publisher: Hindawi Publishing Corporation
Author(s): Janet M. Turan, Abigail M. Hatcher, Merab Odero, Maricianah Onono, Jannes Kodero, Patrizia Romito, Emily Mangone, Elizabeth A. Bukusi.
Objective. Pregnant women are especially vulnerable to adverse outcomes related to HIV infection and gender-based violence (GBV). We aimed at developing a program for prevention and mitigation of the effects of GBV among pregnant women at an antenatal clinic in rural Kenya. Methods. Based on formative research with pregnant women, male partners, and service providers, we developed a GBV program including comprehensive clinic training, risk assessments in the clinic, referrals supported by community volunteers, and community mobilization. To evaluate the program, we analyzed data from risk assessment forms and conducted focus groups (n = 2 groups) and in-depth interviews (n = 25) with healthcare workers and community members. Results. A total of 134 pregnant women were assessed during a 5-month period: 49 (37%) reported violence and of those 53% accepted referrals to local support resources. Qualitative findings suggested that the program was acceptable and feasible, as it aided pregnant women in accessing GBV services and raised awareness of GBV. Community collaboration was crucial in this low-resource setting. Conclusion. Integrating GBV programs into rural antenatal clinics has potential to contribute to both primary and secondary GBV prevention. Following further evaluation, this model may be deemed applicable for rural communities in Kenya and elsewhere in East Africa.
Gender-based violence (GBV) is a major source of preventable mortality and morbidity for women globally [1–3]. In Kenya, 47% of ever-married women report having ever experienced emotional, physical, and/or sexual violence from their spouse—among the highest rates in the world [4, 5]. Violence towards pregnant women in Kenya is estimated to be 13.5% , a higher prevalence than many conditions routinely screened for during pregnancy . Global research suggests that when pregnant women experience GBV, there is a higher likelihood of miscarriage [3, 8], premature labor , low birthweight [8, 10, 11], and infant death . Demographic Health Survey data from Kenya suggests that experiencing lifetime GBV is associated with child stunting and under-2 mortality .
The current study suggests that an integrated program in a rural primary healthcare setting in Kenya is acceptable and feasible to both healthcare providers and the surrounding community. Initial assessment suggests that the program has potential to contribute to both primary and secondary prevention of GBV. The program addressed many of the barriers that have been cited as inhibiting the health sector response to GBV, including lack of provider knowledge, insufficient staff training, few existing policies, poor management support for GBV response, and a lack of coordination between the health sector and other services [24, 45]. We found that healthcare providers and community members were motivated to address the issue of GBV and the program was perceived as a positive contribution to their community.
We integrated a GBV program into a rural antenatal clinic that also provides HIV testing and PMTCT services with the participation of the community and primary healthcare workers. This program was found to be acceptable and feasible and has potential to contribute to primary and secondary prevention of GBV. This model may be applicable to address GBV in the multitude of rural communities in Kenya and elsewhere in sub-Saharan Africa, where the majority of the African population live . If this strategy can be scaled up to other primary healthcare clinics, it has potential to impact on the intersecting epidemics of GBV and HIV.