Improving the primary health care response to violence against women in low and middle income countries

对妇女的暴力是对人权的侵犯，威胁到妇女的地位、健康和福祉。总体而言，全世界35%的妇女经历过身体和/或性亲密伴侣暴力或非伴侣性暴力，在大多数低收入和中等收入国家(LMIC)发病率较高。对妇女的暴力行为损害妇女的健康。与没有经历过这种暴力的妇女相比，遭受过伴侣身体和/或性虐待的妇女堕胎的可能性增加了一倍，患抑郁症的可能性增加了一倍，在一些地区感染艾滋病毒的可能性增加了1.5倍。她们生下低出生体重儿的可能性也要高出16%。此外，暴露在针对母亲的暴力中的儿童更有可能对其健康和发育造成长期损害。因此，预防对妇女的暴力行为和制定卫生保健对策是全球优先事项。这项研究旨在了解低收入和中等收入国家的初级保健系统如何制定和评估针对暴力侵害妇女行为的干预措施，并将其与社区服务联系起来。这项研究将建立在与巴勒斯坦被占领土和巴西的学者、保健提供者和暴力侵害妇女服务机构的现有研究协作的基础上。这项研究旨在解决以下问题：1)探索巴勒斯坦和巴西的初级卫生保健系统可以在多大程度上识别受暴力和虐待影响的妇女，并向能够帮助她们的服务提供支持和转介。2)借鉴英国行之有效的干预措施，并通过与当地利益攸关方的讨论使其适应巴勒斯坦和巴西的情况。3)对商定的干预措施进行试点测试。研究结果将对暴力侵害妇女行为和世界各地的卫生系统研究人员有所裨益。它还将有益于卫生政策制定者和卫生保健从业者，他们希望制定针对暴力侵害妇女的卫生保健对策。

Violence against women is a violation of human rights and threatens the status, health and well-being of women. Overall, 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence, with a higher prevalence in most low and middle income countries (LMIC). Violence against women damages women's health. Women who have been have been physically and/or sexually abused by their partner are twice as likely to have an abortion, twice as likely to suffer from depression and in some regions 1.5 times more likely to acquire HIV compared to women who have not experienced such violence. They are also 16% more likely to deliver a low birth weight baby. In addition, children who are exposed to violence against their mothers are more likely to experience long term damage to their health and development. Therefore, prevention of violence against women and development of a health care response is a global priority. This study aims to understand how primary healthcare systems in low and middle income countries can develop and evaluate interventions for violence against women that link with community services. The research will build on existing research collaborations with academics, health care providers and violence against women services in the Occupied Palestinian Territories and Brazil. The research aims to address the following:1) Explore to what extent the primary health care system in Palestine and Brazil can identify women who are affected by violence and abuse and offer support and referrals to services that can help them.2) Draw on a proven UK intervention and adapt it to the Palestinian and Brazilian context through discussions with local stakeholders.3) Pilot test the agreed intervention.The findings of the research will be of benefit to violence against women and health systems researchers worldwide. It will also be of benefit to health policy makers and health care practitioners who want to develop a health care response to violence against women.