Perinatal care and service delivery for survivors of gender-based violence
Survivors of sexual violence face unique risks and needs during the perinatal period. Incidence of low-birth weight babies, postpartum infection, mastitis, postpartum depression, and breastfeeding challenges all increase. Furthermore, survivors of sexual violence can be more reluctant to seek gynecologic and/or obstetrical & midwifery care due to anxiety around physical exams or contact with male providers.
In contrast, the peri-partum period also offers unique opportunities to mitigate these risks and to provide an empowering and ultimately healing experience for survivors. Job aids, modifications to standard exam and other routine procedures, as well as increased psycho-social support can enable survivors to experience their pregnancy, birth, and postpartum with comparable risk levels to the general population.
Furthermore, antenatal care may be a rare occasion in which a survivor seeks medical care and provides a critical opportunity to facilitate safe space for disclosure and initiate referrals to other services that survivors may need.
Health sector response to violence against women
1 in 3 women have experience gender-based violence around the world. Nearly 1 in 15 have experienced sexual violence by a non-partner. Intimate partners are responsible for nearly 40% of homicides against women. The health impacts of violence against women are far ranging--including depression, physical injury, HIV and other sexually transmitted infections, and second generation morbidity in the form of low-birth weight and higher incidence of failure to thrive infants.
Mainstreaming health sector response to violence against women has been identified by the World Health Organization as an urgent step in addressing the global pandemic of gender-based violence. Core components of health sector response include:
women-centered primary care, particularly sexual and reproductive health care;
voluntary disclosure and response for women living with intimate partner violence;
clinical treatment and response for sexual violence; and
system strengthening to enable multi-sectoral referrals and support.
Interventions can be mainstreamed in small or large scale health programs at community, facility, and/or policy level.
Community-based maternal and neonatal health
Early identification, rapid response, and robust psycho-social support are critical components of promoting and achieving maternal and neonatal health. Community-based solutions for primary maternal and neonatal health services are instrumental in reaching marginalized populations. Community-based solutions are also critical within efforts to maximize a health systems' capacity to meet the physical, social, and emotional needs of its women and young infants.
Creative solutions such as group antenatal care, medication solutions for at-home abortion, community emergency transport systems, home-based breastfeeding support, and community education for neonatal care and risk identification can be integrated into maternal and newborn health programs to increase impact and respond to the priority needs of women.
Ms. Herman is currently also providing home-based direct care in the NE Massachusetts and Seacoast NH areas of the United States. Visit our community midwifery page for more information.