title: Latin American and Caribbean countries' baseline clinical and policy guidelines for responding to intimate partner violence and sexual violence against women.
abstract: BACKGROUND
  Violence against women is a global public health problem with negative effects on physical, mental, and reproductive health. The World Health Organization (WHO) has identified intimate partner violence (IPV) and sexual violence (SV) as major targets for prevention and amelioration and recently developed clinical and policy guidelines to assist healthcare providers. This project was undertaken to determine the 2013 baseline national policies and clinical guidelines on IPV and SV within the Latin American and Caribbean (LAC) region to identify strengths and gaps requiring action.
  
  
  METHODS
  Each Pan American Health Organization/World Health Organization Regional Office for the Americas (PAHO/WHO) country focal point was contacted to request their current national policy and clinical guidelines (protocol) on IPV/SV. We augmented this by searching the internet and the United Nations Women website. Each country's policy and clinical guideline (where available) was reviewed and entered into a scoring matrix based on WHO Clinical and Policy Guidelines. A total score for each heading and subheading was developed by adding positive responses to identify LAC regional strengths and gaps.
  
  
  RESULTS
  We obtained 15 national policies and 12 national clinical guidelines (protocols) from a total of 18 countries ("response" rate 66.7%). National policies were comprehensive in terms of physical, emotional, and sexual violence and recommended good intersectoral collaboration. The greatest gap was in the training of health-care providers. National Guidelines for women-centered care for IPV/SV survivors were strong in the vital areas of privacy, confidentiality, danger assessment, safety planning, and supportive reactions to disclosure. The largest gaps noted were again in training healthcare professionals and strengthening monitoring and evaluation of services.
  
  
  CONCLUSIONS
  Baseline measurement of policy and clinical guidelines for IPV/SV in LAC PAHO/WHO member countries at the time of issuing the 2013 WHO Clinical and Policy Guidelines reveals some important strengths, but also serious gaps that need to be addressed. The most pressing needs are for concerted training initiatives for healthcare providers and strengthening multisectoral monitoring and evaluation of services. A future evaluation of national policies, clinical guidelines, monitoring and evaluation will need to be conducted to measure the progress of the required scaling-up process.
authors.affiliation: University Health Network, Centre for Mental Health, University of Toronto, Toronto, Canada. donna.stewart@uhn.ca.
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
authors.affiliation: University Health Network, Toronto, Canada. rakel.aviles@gmail.com.
authors.forename: Raquel
authors.initials: R
authors.lastname: Aviles
authors.affiliation: Pan American Health Organization/World Health Organization Regional Office for the Americas, Washington, DC, USA. guedesal@paho.org.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Guedes
authors.affiliation: University Health Network, Toronto, Canada. ekaterina.riazantseva@uhn.ca.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Riazantseva
authors.affiliation: Offord Centre for Child Studies, McMaster University, Hamilton, Canada. macmilnh@mcmaster.ca.
authors.forename: Harriet
authors.initials: H
authors.lastname: MacMillan
mesh_terms: D000328:Adult; D017691:Caribbean Region; D003219:Confidentiality; D005260:Female; D014943:Global Health; D006282:Health Personnel / Q000191:economics; D006801:Humans; D000066511:Intimate Partner Violence / Q000706:statistics & numerical data*; D007843:Latin America; D008875:Middle Aged; D057766:Policy; D017410:Practice Guidelines as Topic; D011634:Public Health; D012449:Safety; D012742:Sex Offenses / Q000706:statistics & numerical data*; D014481:United States; D016387:Women's Health; D014944:World Health Organization