Voices from the Field: Improving Providers' Response To Violence Against Women

“The violence against women program has had a great influence on our health providers. They now understand that many complications occur as a result of violence, problems that cannot be treated or prevented without addressing the issue of violence upfront.”

Dr. Efrosya Nahapetyan, head of women’s consultation at Polyclinic 8 in Yerevan, Armenia, has witnessed changes among her facility’s providers as the result of a pilot program to expand the role of the reproductive health sector in helping Armenian women overcome violence.

Launched by the PRIME II Project in 2002, the program in Polyclinic 8 has demonstrated a model for reproductive health providers to effectively screen, educate and refer women who experience violence. The program has also influenced national health policy to recognize violence against women (VAW) as a public health concern and helped providers collaborate with others working at the community level against VAW.

VAW includes the physical, sexual, psychological and economic abuse of women and girls. Global research suggests that one out of every three or four women experiences violence from an intimate partner at some point in their lives. In Armenia, national research indicates that both men and women have attitudes of tolerance toward “wife-beating” and smaller qualitative studies uncover alarming levels of VAW. Of 1457 women screened for VAW at Polyclinic 8 between December 2003 and May 2004, 30% had suffered from VAW at some point in their lives.

“Discrimination against women and girls in Armenia starts practically at birth,” relates one client. “A boy-child is celebrated as the heir of the family name and a girl-child is perceived as one who will move to her husband’s home to become a future wife and mother. From a very early age, a girl is treated like a guest in her own home... We need to bring up children with a real respect toward women, not the traditional worshipping in words but humiliation in action.”

According to Dr. Nahapetyan, the VAW program has had a positive influence on clients as well as providers. “Patients understand the concept of violence now—its consequences, how to prevent it, and in which institutions you can receive relevant care.”

As psychological abuse is frequently reported by the women screened at Polyclinic 8, Dr. Nahapetyan hired a resident psychologist, Irina Bagdasaryan, to offer services to both women and men free of charge. “I help people obtain a new vision of their future,” says Ms. Bagdasaryan. “I also assist them in maintaining their families.” In addition to psychological services, providers refer women for other appropriate services including legal counseling, social support, hot-line services and shelter.

To gauge the effectiveness of the pilot program, PRIME observed providers conducting VAW screening and counseling during prenatal care in simulated cases at Polyclinic 8 and two other reproductive health clinics in Yerevan. Observation scores show significantly higher levels of performance for physicians who benefited from the program. Polyclinic 8 physicians scored 88.5% in counseling skills versus 33.5% and 17% for control facility physicians. The average score on frequency of performing critical tasks was 93% for Polyclinic 8 physicians as opposed to 41% and 30% among physicians at the other clinics. Critical tasks include such steps as ensuring privacy and confidentiality, explaining procedures, and making sure women are aware of laws that protect them against violence.

While the pilot program ended in June, Dr. Nahapetyan and her staff plan to continue screening for VAW and providing related services. As one physician affirms, “This has become our new style of working and cannot be changed.”

The PRIME II Project, funded by USAID and implemented by IntraHealth International and the PRIME partners, works around the world to strengthen the performance of primary providers as they strive to improve family planning and reproductive health services in their communities.

PRIME Voices #31, Armenia: Improving Providers’ Response to Violence against Women, 6/22/04.