Study by POP Council 2012/2013 Margaret Mak’anyengo , Kenyatta National Hospital

1. Screening for INTIMATE PARTNER VIOLENCE in public health care settings in KenyaMental health SymposiumKNH/UON Collaboration27/3/14 Study by POP Council 2012/2013 Margaret Mak’anyengo, Kenyatta National Hospital Chi-Chi Undie, Population Council Catherine Maternowska, UNICEF

2. Intimate Partner Violence (IPV):What is it, anyway? • Historically called ‘domestic violence,’ ‘intimate partner violence’ describes physical, sexual, or psychological harm by a current or former intimate partner or spouse. This type of violence can occur among heterosexual or same-sex couples. National Institute of Justice http://www.nij.gov/topics/crime/intimate-partner-violence/welcome.htm

3. Background • Intimate Partner Violence (IPV) … • most common form of violence against women world-wide. % of women who have experienced different forms of violence tends to increase with women’s age and number of children. more common during pregnancy than some maternal health conditions routinely screened for in ANC. prevalence appears to be higher in African countries relative to European countries

4. Why consider screening for IPV? “[IPV screening] … will have a positive impact overall. Because if we start to do something about [IPV], it will reduce the number of psychiatric patients we have over here, or the number of substance abuse patients we have, and so on. So rather than stay blindly because we fear the increased numbers, let’s do something.” -- Provider

5. Why consider screening for IPV? “[IPV screening] …needs to be incorporated in health care services. Because I feel that sometimes, IPV may be responsible for some of these conditions we treat: HIV, substance abuse, depression, etc. And you have to screen because people won’t come to tell you that ‘I’m a victim.’” -- Provider

6. Overall Project Aim • To assess the acceptability and feasibility of routine screening for IPV in Kenyan public health care settings • To test the utility of a screening tool for IPV identification, referral, and response • To share lessons learned under an IPV screening program in a dev country setting and describe the ‘how-to’ of screening in such contexts

7. Project Overview • Routine screening and referral for IPV at Kenyatta National Hospital • Women aged 18 and above

8. Intervention Methods • IPV Screening Taskforce established at Kenyatta National Hospital • Screening tool developed with Taskforce • Training of (and planning with) providers from March-May 2012; n=121 • Periodic monitoring/learning visits to sites • Informal conversational interviews with providers during monitoring/learning visits

9. GBVRC/KNH: A provider training session

10. GBVRC/KNH: A provider training session Photo by Ollivier Girard, courtesy of the Population Council.

11. IPV Screening Questions • Are you currently in a relationship with a person who physically hurts you? Yes __ No __ [physical] • Are you currently in a relationship with a person who threatens, frightens, or insults you, or treats you badly? Yes __ No __ [psychological] • Are you currently in a relationship with a person who forces you to participate in sexual activities that make you feel uncomfortable? Yes __ No __[sexual]

12. Lessons:Practical Issues for Consideration • Who should do the screening? • Where to screen? • When to screen (how routine is ‘routine’)? • What timing (of violence) is of interest? • Which type of violence to screen for? • How to ask about IPV experiences, and refer if necessary?

13. Conclusion • Screening for IPV in public health care settings in the East African region is doable. However, the who, where, when, what, which, and how questions must be addressed and used to inform proper intervention planning.

14. So, where do we go from here?Informing policy & practice • KNH/GBVRC’s survivor in-take form now includes IPV screening questions; other organizations and Ministries have adapted the questions, too. • Potential for scalability: various other, provider-identified screening points exist (e.g., pediatrics); scalability through new county structure in Kenya • ECSA-HC resolution on IPV screening (Dec 2012) • Lessons learned being used to inform dev’t of a WHO Handbook on IPV screening in low-income country ANC settings.

15. References • Devries KM, Kishor S, Johnson H, Stöckl H, Bacchus LJ, Garcia-Moreno C, Watts C (2010). Intimate partner violence during pregnancy: analysis of prevalence data from 19 countries. Reproductive Health Matters 18(36):158–170. • García-Moreno C, Jansen HA, Ellsberg M, et al. (2005). WHO Multi-Country Study on Women's Health and Domestic Violence against Women: Initial results on prevalence, health outcomes and women's responses. Geneva: World Health Organization. • Jewkes R (2002). Intimate partner violence: causes and prevention. Lancet 359(9315):1423–29. • Johnson H, Ollus N, Nevala S. (2007). Violence against Women: An International Perspective. New York: Springer. • Kenya Demographic & Health Survey (2008-9). • Kishor S, Johnson K (2004). Profiling domestic violence: a multi-country study. Calverton MD: ORC Macro.

16. Thank you