Reducing violence against women and children

Leading change on violence against women through the health sector in Timor-Leste

This three year project is funded through an ARC Discovery Early Career Researcher Award (2017-2019) to Dr. Kayli Wild. This project aims to understand the role of the health sector in ending violence against women in low-resource settings. Timor-Leste, Australia’s nearest and most fragile neighbour, has an extremely high rate of violence against women. This research draws on the perspectives of health professionals, policy-makers and women's experiences to study challenges facing the health sector and how it responds to domestic and sexual violence. Expected outcomes include models of care that can be tested in other post-conflict, remote and low-income settings in the region. Details and research outputs from the studies conducted as part of this project can be found below.

Building a primary health care response to violence against women: The knowledge and needs of midwives in three municipalities of Timor-Leste

In Timor-Leste around half the women of reproductive age have experienced physical or sexual violence in the past 12 months. As front-line health providers for women across the country, midwives are a key access point in rural and remote areas. This research explores midwives’ knowledge and needs in responding to violence against women in three districts of Timor-Leste. Funded by a La Trobe Transforming Human Societies Research Focus Area grant, interviews were conducted from May to July 2016, and included 48 midwives and community leaders in a variety of health care settings in Timor-Leste. The findings provide rich insights into midwives’ current practices that can be used to tailor training materials which build on midwives’ strengths and help fill gaps in knowledge. A further analysis of factors which enable or constrain the ability of midwives to respond to cases of violence reveals critical health system supports which should be implemented alongside a national training program. This research highlights the potential of a ‘whole health facility’ approach which addresses the capacity of all health centre staff and managers to respond appropriately, supports leadership and links health services with wider social change processes.

Download reports:

*Full report [PDF 4.2MB]

*Executive summary English [PDF 232KB]

*Executive summary Tetun [PDF 200KB]

Midwives Against Violence: Discussion video

Supplementary documents for the video:

Video discussion questions English [DOC 216KB]

Video discussion questions Tetun [DOC 226KB]

Audio

ABC interview with Dr. Kayli Wild


Researchers involved in this work:

Dr. Kayli Wild, LTU
Prof. Angela Taft, LTU
Assoc. Prof. Chris Roche, LTU
Dr. Linda Kelly, LTU
Prof. Susan McDonald,  LTU
Dr. Lidia Gomes, UNTL
Angelina Fernandes
Amina de Araujo
Isabelita Madeira, UNTL
Livio da Conceicao Matos, UNTL

Researching violence against women at La Trobe University

Violence against women is a public health and human rights issue affecting the health and well-being of women across the globe. The La Trobe Violence Against Women Network (LAVAWN) has been established to draw together the breadth of expertise across La Trobe University working on this important issue.

Based at the Judith Lumley Centre and led by Professor Angela Taft, the aim of the network is to encourage collaboration and partnerships, with the aim of fostering innovation in violence against women research, evaluation and knowledge translation.

Members of the LAVAWN group contributed to a submission to the Victorian Royal Commission into Family Violence [PDF 550KB].

For more information about the network, contact Ingrid Wilson, LAVAWN coordinator, by telephone on 9479 8805 or by email at imwilson@students.latrobe.edu.au

Harmony: achieving social justice for Indian domestic violence survivors - a pilot study

Angela Taft, Rhonda Small and Mridula Shankar; in collaboration with Kelsey Hegarty, University of Melbourne; Gene Feder, University of Bristol, UK; Suneeta Krishnan, Research Triangle Institute, International

Harmony is an innovative pilot randomised controlled trial in primary care to reduce harm from and prevent domestic violence in Melbourne's Indian diaspora communities.
This pilot project aims to:

  • Pilot resources and training to build the capacity of a larger number of Indian GPs to initiate a targeted healthcare response to domestic violence in the Indian diaspora community
  • Culturally adapt and evaluate a successful UK systems model of identification and referral (Feder et al, The Lancet 2011), by training bilingual Indian GPs and all the clinic staff with the support and collaboration of a bilingual advocate based in a diaspora domestic violence advocacy agency, to enhance the support and safety of culturally diverse (especially Indian) women experiencing domestic violence
  • Develop and refine violence prevention messages in consultation with key stakeholders, for promotion by Indian doctors within the broader Indian community.
FUNDING: Transforming Human Societies RFA

STATUS: pilot study successfully funded in October 2014, commencing in 2015

Harmony website

Improving maternal and child health care for vulnerable mothers (MOVE): an RCT of screening for family violence

Angela Taft, Rhonda Small, Leesa Hooker; in collaboration with Cathy Humphreys and Kelsey Hegarty, University of Melbourne; Catina Adams, Hume City Council; Ruby Walter, Victoria University; Paul Agius, Burnet Institute

Evidence for effectiveness and sustainability of intimate partner/family violence (FV) screening in health care settings is limited. In 2009–10, the Victorian Government introduced a mandatory MCH nurse FV screening policy when babies are four weeks old. We tested whether a theory-informed, MCH nurse-designed model of screening and care increased screening, disclosure, safety planning and referral rates of mothers experiencing FV compared with usual care.

MOVE is a cluster RCT involving eight MCH nurse teams. Normalisation Process Theory (NPT) was incorporated into the design, implementation and evaluation of the MOVE trial to enhance its sustainability. The intervention included: clinical guidelines; a self-completed maternal health screening checklist at 3–4 month consultation; nurse safety; nurse mentors; and strengthened relationships with FV services.

Following 12 months' implementation, we assessed the primary outcomes of FV inquiry, disclosure/safety planning and referral using data from MCHN routine data and a survey to 10,472 women who gave birth ≤8 months. We also undertook process and impact evaluation using online surveys of all nurses and stakeholder interviews.

In 2013, we undertook a two-year follow-up collecting all routine data for 2012 and 2013 and process evaluation involving online MCH nurse surveys and stakeholder interviews.

During the intervention year, MCH nurses (n=~160) saw 15,546 infants ≤12 months. From routine data, MOVE teams did not screen at significantly higher rates at scheduled four-month visits (IG 36.5% versus CG 23.5%). However, when non-routine three-month checklist rates/consultations were added intervention screening rates averaged 63.1%. Safety planning rates were threefold higher (IG 4.2% versus CG 1.42%), but referral rates were negligible. 25% mothers returned surveys, 6.8% reported violence in the previous 12 months (CAS≥7) and 2.8% reported abuse in pregnancy. No adverse events were recorded.

Two years following the intervention, safety-planning rates had increased from 4.2% to 5.9% compared with 1.4% in the comparison arm. There were no differences in referral rates. From nurse surveys, MOVE nurses are still using the MOVE resources.

Nurse-centred screening models can increase discussions with post-partum mothers, leading to more disclosure and safety planning in this vulnerable period.

FUNDING: ARC Linkage Project 2009-2011

STATUS: Intervention and two-year follow-up complete; primary outcomes and process evaluation paper about to be published

PUBLICATIONS:
Taft AJ, Hooker L, Humphreys C, Hegarty KL, Walter R, Adams C, Agius P, Small R. Maternal and child health nurse screening and care for mothers experiencing domestic violence (MOVE): a cluster randomised trial. BMC Med 2015; 13: 150

Hooker L, Small R, Humphreys C, Hegarty K, Taft A. Applying normalization process theory to understand implementation of a family violence screening and care model in maternal and child health nursing practice: a mixed method process evaluation of a randomised controlled trial. Implement Sci 2015; 10:39

James JP, Taft A, Amir LH, Agius P. Does intimate partner violence impact on women's initiation and duration of breastfeeding? Breastfeed Rev 2014; 22(1):11-9

Taft A, Small R, Humphreys C, Hegarty K, Walter R, Adams C, Agius P. Enhanced maternal and child health nurse care for women experiencing intimate partner/family violence: protocol for MOVE, a cluster randomised trial of screening and referral in primary health care. BMC Public Health 2012; 12: 811

MOVE website

Domestic and family violence and parenting

Angela Taft, Leesa Hooker, Jan Nicholson; in collaboration with Rae Kaspiew, Lixia Qu, Ruth Weston, Australian Institute of Family Studies; Cathy Humphreys, University of Melbourne; Fiona Buchanan, University of South Australia

For more information please see the project description in the Transition to Contemporary Parenthood research area.

Collaborative work

I-DECIDE: an internet-based safety decision aid for women experiencing intimate partner violence: a randomised controlled trial

Angela Taft; in collaboration with Kelsey Hegarty, Cathy Humphreys and Lorna O'Doherty, University of Melbourne; Elizabeth Murray, University College London; Nancy Glass, Johns Hopkins Centre for Global Health

Intimate partner violence against women is a major public health problem globally. Interventions for women are urgently needed, with safety planning being one of the most widely recommended. In this study, we test the effectiveness of an interactive internet-based safety decision aid to prioritise safety planning. Three hundred and forty abused women will be assigned by chance to either the safety decision aid or control website. We will measure women's mental health and exposure to repeat violence three, six and 12 months later.

The website was developed in 2014, tested and 60 women recruited.

FUNDING: ARC Discovery Grant 2013-2016

STATUS: recruitment underway

I-Decide website

Management of the whole family when intimate partner violence is present: guidelines for primary physicians

Angela Taft, Kelsey Hegarty and Gene Feder in collaboration with Lorraine Ferris, Kevin Hamberger, Elizabeth Hindmarsh, Sylvia Lo Fo Wong, Harriet MacMillan, Judy Shakespeare, Carol Warshaw and Mary Zachary

Please find the guidelines for the Management of the whole family when intimate partner violence is present: guidelines for primary care physicians [PDF 231KB].