Role of Doctors in Responding to Domestic Violence

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Role of Doctors in Responding to Domestic Violence

• Bishkek, Kyrgyzstan

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There is such an expression that the doctor
sometimes treats with just a word. There are
such situations in real life when I need to shout
at a woman . . . Sometimes I cry with her. I
relieve her stress . . . Therefore, we do not
always treat only with medicine. -
Gynecologist
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Project Goal

• Explore the role of reproductive health care
  providers in responding to domestic violence
  during pregnancy in Bishkek, Kyrgyzstan

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Qualitative In-Depth Interviews
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Research Questions

• What are doctors beliefs and perceptions about
  domestic violence?
• What past experience have doctors had responding
  to suspected cases?
• Do doctors feel they should play a role in
  assisting victims of violence?

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Domestic Violence in the Kyrgyz Context

• Legal protections exist
• 12-bed crisis shelter
• 2 telephone hotlines
• Counseling and legal services

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Key Findings
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Encounters with family violence

• 28 out of 29 doctors described a case involving a
  patient, relative, or friend who had been abused
• 1 doctor self-disclosed she was in an abusive
  relationship

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Domestic Violence Understood as a Physical Act or
the Threat to Use Force

• Threat to use
• Knife
• Gun
• Heavy object

• Hitting
• Beating
• Battering
• Kicking
• Dragged by the hair

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Perpetrators

• Husbands most often perpetrators
• Mother-in-laws and sister-in-laws instigate and
  perpetrate violence

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Women are often blamed for violence
More often they talk badly about the woman.
Even if he cheats and beats her . . . She will be
judged a thousand times. He is not judged . . .
But she will be judged. - Gynecologist
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Patient Cases that Resulted in Injury
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Identification of Cases

• 28 / 29 doctors had confirmed or suspected cases

Sometimes they come with dark glasses on and
its just uncomfortable. I say, take the
glasses offand see a black eye. The husband hit
her. - Gynecologist
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Identification of Cases

• No routine screening or protocols
• Presence of physical signs of injury (black eyes,
  bruises)
• Demeanor of the patient (depression)
• Frequent complaints with no apparent medical
  explanation

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Disclosure of Violence

• One-third of all doctors had discussed family
  violence with a patient

You understand, if a woman trusts the doctor she
will tell everything . . . If the woman tells
lies, it means she does not trust the
doctor. - Gynecologist
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Examples of Interventions

• Confronted, scolded the husband
• Gave advice about how to avoid future abuse
• Prepared sick leave document for patients
  employer

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Views on Future Role

• Most doctors expressed an interest in assisting
  victims
• Few knew about existing services or laws

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Policy Implications Future Role of Doctors

• Define role of health care workers
• Training on violence and health consequences

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Policy Implications Future Role of Doctors

• Institutionalize safety measures
• Develop protocols for suspected cases
• Establish referral network

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Policy Implications

• Additional support for community services for
  victims
• Strengthen enforcement of the law