Interpretation
In our sample, we found that current or past experience with GBV was reported by about 1 in 4 Indian women attending this public hospital setting. This is lower than national averages that range between 37% [
2] and 56% [
8]. The reasons for this are not clear, however, may reflect the wide range of methodologies used or regional variation due to socio-cultural context [
6]. These high rates of GBV require more concerted efforts to identify, screen and facilitate care for affected women, as prior studies have demonstrated significant adverse impact of GBV on health outcomes [
9]. GBV in India has been shown to be associated with sexually transmitted infections, adverse reproductive health outcomes and mental health [
10,
11] making it an important public health concern. Importantly, we found that among Indian women who experienced GBV, only 10% reported that they were asked about GBV when they presented to health care setting. This highlights a critical unmet need for GBV screening, care and referral for women experiencing GBV.
Routine screening for GBV is recommended as part of the standard of care within health care settings in resource rich countries [
8,
12,
13] highlighting the importance of a public health approach in GBV [
14]. Despite this recommendation, the implementation of GBV screening in resource-limited settings has been suboptimal. This has been very well demonstrated by our study where a majority of individuals who reported a history of GBV reported never having been asked about GBV in health care settings.
A qualitative study in US [
15] suggested that women were supportive of being asked about their experience of intimate partner violence, during volunteering counselling and testing (VCT) sessions. Furthermore, a feasibility study in Kenya [
16], Nigeria [
17] and in India [
18] demonstrated that routine GBV screening is feasible and acceptable by women presenting in public health systems. Consistent with these findings, our study demonstrated that over two-thirds of women were willing to be screened for GBV in health care settings.
Further, our results demonstrated the important role for counsellors and secondly nurses in settings like India, as in US counterparts, where over two-thirds of women prefer GBV screening to be done by nurses and doctors [
19]. Nurses are universally accepted as preferred GBV providers. Very few women (3%) in our study want their treating doctor to be the person to screen for GBV. Although doctors have opportunities conduct GBV screening, training about GBV in medical colleges and hospitals is very limited or absent [
20]. Since previous reports in India suggest that reporting of GBV may be lower when screened by the doctors [
4], physician screening may not be optimal for Indian women and this is supported by our study.
Finally, two-thirds of women in our study chose face-to-face interview as the most preferred method for GBV screening. While none of the previous studies inquired on women’s preference for face-to-face versus e-screening options, the clear preference for face-to-face screening in our study are likely due to unfamiliarity with surveys or computerised tools, cultural norms related to stigmatization of GBV and associated shame for the victim or may be personal interaction with same gender is important for such a sensitive topic.
Limitations
A potential limitation of our study includes bias in sample selection as only those women were approached who could give some time for the interview on days where counsellors attended the clinic. It is possible that women may underreport self-reported GBV but generally GBV prevalence is assessed using standardized questionnaire and are subject to perception bias. Moreover, due to limited time per interview, we focused on broad questions related to GBV history and experience, whereas more details may have been elucidated through a larger battery of questions. However, our study identified some key GBV screening strategies that can be employed in public health care settings.
Generalisability
Previous studies in resource rich setting [
15] and resource limited settings [
16,
17] demonstrated that routine GBV screening in health settings is feasible and acceptable among women. Our study findings are in concordance with these findings. However, our study reported face to face interviews by counsellors as most preferred method and most preferred provider for GBV screening. As we did not find any study in resource limited settings that could identify preferred method and provider there is need for further studies to confirm these findings.