MISSOP - Missed opportunities to responding to violence against women and girls in the health sector
Project Abstract
Violence against women (VAW) remains a critical global issue with significant implications for public health and societal well-being. Effective detection and response by the health sector are essential for mitigating the impacts of VAW, ensuring that survivors receive necessary care, and facilitating access to legal and social services. The MISSOP study aimed to investigate missed opportunities in the health sector's response to VAW in Tirana, Albania, and Belo Horizonte, Brazil, to identify systemic gaps and inform improvements in healthcare practices and policies. Utilizing a participatory action research framework involving key stakeholders and mixed methods, the study aimed to provide a comprehensive understanding of the healthcare sector's response to VAW and identify opportunities for systemic improvement.
In Tirana, we analysed the healthcare journeys of 151 women who sought assistance from the Counselling Line for Women and Girls (CLWG) between 2018 and 2022. A manual review of medical records from hospitals and primary healthcare facilities revealed that over 50% of these women accessed health services. Yet, most were never detected as being in a VAW situation. A comprehensive review of legal frameworks and protocols revealed a comprehensive protocol for attending survivors of VAW, but inconsistencies across protocols, laws and guidelines. Furthermore, our semi-structured interviews with 9 health stakeholders and 7 VAW survivors highlighted that the theory differed from the practice, where barriers such as the perception of VAW as a private issue and unclear referral processes, led to missed opportunities for detection and treatment of VAW.
In Belo Horizonte, we constructed a cohort of 52 women victims of femicide between 2016 and 2020. Through probabilistic linkage of data from five national datasets, we reconstructed detailed healthcare journeys, identifying critical gaps in the system's response, including missed detection, missed notification of VAW and missed referral. Focused ethnographic methods, including participatory observation in health units, more than 70 individual interviews with healthcare 2professionals and survivors, and group interviews, provided deep insights into the operational challenges in identifying and responding to VAW. Significant barriers included a lack of awareness among healthcare providers and a predominantly biomedical approach to health services.
Findings also revealed that healthcare professionals often viewed VAW notification as a bureaucratic task and faced unclear referral processes, impeding effective care. The data from both countries underscore a significant issue at the detection stage, where instances of VAW often go unrecognized despite survivors accessing health services that could address the consequences of such violence. Common challenges identified include limited healthcare access, privacy concerns affecting detection, low awareness among healthcare providers, and unclear referral pathways. These findings emphasize the global nature of missed opportunities and their determinants in the health sector's response to VAW. Our results also underscore the urgent need for comprehensive systemic reforms that consider intersecting identities.
Through collaboration with implementers, policymakers, and healthcare professionals, the MISSOP study has not only generated new insights into missed opportunities but also catalysed systemic changes in both research settings. As we conclude this study and explore avenues for further research, we anticipate ongoing positive impacts and opportunities to enhance the healthcare response to VAW on a broader scale.
