Health Care Interventions for Gender-based Violence: Formative Research with Primary Care Physicians and Young Married Women in Southern India to Explore Feasibility and Specific Needs

The pervasiveness of gender-based violence (GBV) in India is well-known, as is the adverse impact of GBV on women's physical, mental, and reproductive health. Over the last decade, urban Indian women's healthcare utilization rates have increased substantially. These data have prompted researchers to emphasize the role of health care professionals in managing GBV and preventing the escalation of the problem. Yet, little is known about the health sector's response to GBV in India. Similarly, little research in India has examined the risk factors associated with forms of GBV other than physical violence.This dissertation investigated several questions around the feasibility and development of health facility-based GBV interventions in India. Data were collected from two samples in urban Karnataka: Young married women of reproductive age utilizing urban health care services in Mysore, and primary care physicians serving women of similar ages and socioeconomic classes in Bangalore. Mixed methods were used to analyze these data. A grounded theory approach was used to analyze the data from in-depth interviews with physicians. Multivariable logistic regression was conducted on survey data collected from women. The analyses with primary care physicians revealed that even without training and guidelines, many primary care physicians empathized with women who experience GBV and had developed culturally sensitive responses to GBV. Their practices, however, were selective and discretionary, and vulnerable to internalized norms and attitudes. Moreover, primary care physicians favored health facility-based GBV interventions, and provided concrete suggestions on what would be needed to implement such interventions in the Indian urban health-sector context. The analysis with women found that factors relating to their husbands' characteristics--educational status, occupational status, alcohol consumption, and having multiple sex partners--were most significantly associated with women's risk of sexual violence. The risk factors for sexual and physical violence differed in many respects. More importantly, physical violence was found to be a strong predictor of sexual violence, and the determinants of sexual violence differed depending on the presence or absence of physical violence. Study findings provide important information to guide the development of future health facility-based GBV interventions in urban India. A potential starting-point for such interventions is to build on existing positive physician practices, supporting physician efforts with training to enhance their skills and confidence in assisting at-risk patients, and to address the norms and attitudes influencing their practice. More formative research is needed to address such issues as infrastructural needs and private sector respondents' motivations for responding to GBV. These findings could inform the development of large-scale intervention studies to measure the impact of enhancing health care professionals' skills with training and resources, on their actual GBV-related practices, and the long-term impact of these practices on women's health. Furthermore, research with women and men is needed to understand how their conceptualization and response to different types of GBV may vary. This understanding could be of substantial use to health care professionals, as they attempt to screen for various types of GBV, and connect women with the services best suited to meet their individual needs