title: Addressing domestic violence through antenatal care in Sri Lanka's plantation estates: Contributions of public health midwives.
abstract: Domestic violence in pregnancy is a significant health concern for women around the world. Globally, much has been written about how the health sector can respond effectively and comprehensively to domestic violence during pregnancy via antenatal services. The evidence from low-income settings is, however, limited. Sri Lanka is internationally acknowledged as a model amongst low-income countries for its maternal and child health statistics. Yet, very little research has considered the perspectives and experiences of the key front line health providers for pregnant women in Sri Lanka, public health midwives (PHMs). We address this gap by consulting PHMs about their experiences identifying and responding to pregnant women affected by domestic violence in an underserved area: the tea estate sector of Badulla district. Over two months in late 2014, our interdisciplinary team of social scientists and medical doctors met with 31 estate PHMs for group interviews and a participatory workshop at health clinics across Badulla district. In the paper, we propose a modified livelihoods model to conceptualise the physical, social and symbolic assets, strategies and constraints that simultaneously enable and limit the effectiveness of community-based health care responses to domestic violence. Our findings also highlight conceptual and practical strategies identified by PHMs to ensure improvements in this complex landscape of care. Such strategies include estate-based counselling services; basic training in family counselling and mediation for PHMs; greater surveillance of abusive men's behaviours by male community leaders; and performance evaluation and incentives for work undertaken to respond to domestic violence. The study contributes to international discussions on the meanings, frameworks, and identities constructed at the local levels of health care delivery in the global challenge to end domestic violence. In turn, such knowledge adds to international debates on the roles and responsibilities of health care professionals in responding to and preventing domestic violence.
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Postbox 8905, NO-7491 Trondheim, Norway. Electronic address: jennifer.infanti@ntnu.no.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Infanti
authors.affiliation: Department of Geography, Dragvoll Campus, Building 7, Level 4, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway. Electronic address: ragnhild.lund@svt.ntnu.no.
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Lund
authors.affiliation: Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka. Electronic address: muzrif@gmail.com.
authors.forename: Munas M
authors.initials: MM
authors.lastname: Muzrif
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Postbox 8905, NO-7491 Trondheim, Norway. Electronic address: berit.schei@ntnu.no.
authors.forename: Berit
authors.initials: B
authors.lastname: Schei
authors.affiliation: Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka. Electronic address: kumuduwije@gmail.com.
authors.forename: Kumudu
authors.initials: K
authors.lastname: Wijewardena
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003153:Community Health Services; D003695:Delivery of Health Care; D017579:Domestic Violence / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D008880:Midwifery / Q000193:education*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D036301:Qualitative Research; D013188:Sri Lanka; D014933:Women's Rights
keywords: Domestic violence; Landscape of care; Livelihoods framework; Public health midwives; Qualitative methods; Sri Lanka; Tea plantation sector