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Integration of GBV Prevention Into Group Perinatal Care in Mali

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Integration of GBV Prevention Into Group Perinatal Care in Mali Integration Of GBV � Prevention Into Group � Perinatal Care In Mali MALI CONTEXT: Research Institutions: In Mali, women are at high risk of multiple forms In Mali, the perinatal period specifically confers L’université des Science, des Techniques et of gender-based violence. Just over a third of increased risk for intimate partner violence (IPV) des Technologies de Bamako ; Johns Hopkins women ages 15-49 years in Mali report a lifetime for mothers and requires decisions about female University Bloomberg School of Public Health; experience of physical or sexual intimate partner genital cutting (FGC) for their female children. 1 Johns Hopkins University School of Nursing. violence (IPV) . Additionally, Mali’s prevalence of Simultaneously, pregnancy and postpartum female genital cutting (FGC) is among the highest represent a potential period of family engagement Principal Investigator: in the world at 89% (ibid) and data from the and an inflection point for developmental and Seydou Doumbia, MD PhD (PI). capital suggest most girls are cut before one year familial change. Inclusion of gender-based of age2. Both types of GBV are associated with violence (GBV) prexvention and response Co-investigators: poor health outcomes that threaten the wellbeing within perinatal care therefore presents a vital Aissata Ba; Molly Lasater; of girls, women, and their communities. opportunity to ensure the rights and promote the Sarah Murray; Nicole Warren. health of women and young girls. PROJECT AIM: The overall objective of this study is to develop • Develop an IPV response and FGC • Pilot the G-PNC+ intervention with newly a GBV curriculum to be integrated into an prevention content for integration into integrated GBV content and assess its existing group-antenatal care program that group perinatal care for pregnant women, implementation for pregnant women and new combines evidence-based perinatal health care as we extend the program into the postnatal mothers in Bamako and Kati, Mali. with depression prevention content. The new care period to become group perinatal care plus model, group perinatal care plus (G-PNC+), aims (G-PNC+) in urban and peri-urban health to maximize health and reduce multiple types of centers in Bamako and Kati District of GBV through a new comprehensive antenatal and Koulikoro Region, Mali. postpartum care model. Specifically, we aim to: STUDY CONTRIBUTION: This study builds on an existing group-antenatal care (G-ANC) curriculum designed to give providers more time to create trusting provider-patient relationship and to help pregnant women build strong social connections. This study will train G-ANC workers in appropriate identification and referral for IPV response and to teach safety strategies using a tertiary prevention approach should a woman experience violence3. By going beyond screening and referral, this intervention is not only a novel approach for Mali, but for the field more generally. The G-ANC intervention already addresses prevention of poor mental health which can place women at greater risk of IPV5, revealing the strengths of this integrated care model that improves women’s safety and well-being. Thus, this project advances the theory that mental health interventions may both prevent and improve responses to IPV. In addition, our approach is implicitly intergenerational. Not only does IPV pose risks for pregnancy outcomes but experiencing abuse and witnessing IPV as a child has wide-ranging negative effects on children6. Given that many girls are cut as infants in Mali7, ante- and postnatal care is an ideal vehicle for addressing the prevention of FGC. By addressing FGC decision making among mothers during the ante- and postnatal period, our study is ideally suited for primary prevention. 1. Institut National de la Statistique ICdPedSS, Sante-Developpement, Icf,. Mali Demographic and Health Survey 2018. Bamako, Mali: INSTAT/CPS/SS-DS-PF and ICF; 2019. 2. Sylla M DF, Diakite AA, Toure M, Traore A, Diallo O, Diawara M, Toure A, Sidibe T. Aspects épidémiologiques, cliniques et socioculturels de l’excision dans le district de Bamako. Annales de la Soggo 2015;10(24):32-7 3. Finnbogadóttir H, Dykes A-K. Increasing prevalence and incidence of domestic violence during the pregnancy and one and a half year postpartum, as well as risk factors:-a longitudinal cohort study in Southern Sweden. BMC pregnancy and childbirth. 2016;16(1):327. 4. Sylla M DF, Diakite AA, Toure M, Traore A, Diallo O, Diawara M, Toure A, Sidibe T. Aspects épidémiologiques, cliniques et socioculturels de l’excision dans le district de Bamako. Annales de la Soggo 2015;10(24):32-7. 5. Tol WA, Murray SM, Lund C, Bolton P, Murray LK, Davies T, et al. Can mental health treatments help prevent or reduce intimate partner violence in low- and middle-income countries? A systematic review. BMC Women’s Health. 2019;19(1):34. 6. Irish L, Kobayashi I, Delahanty DL. Long-term physical health consequences of childhood sexual abuse: A meta-analytic review. Journal of pediatric psychology. 2009;35(5):450-61. 7. Cellule de Planification et de Statistique - CPS/SSDSPF/Mali, Institut National de la Statistique - INSTAT/Mali, Centre dí…tudes et díInformation Statistiques - INFO-STAT/Mali, International I. Mali EnquÍte DÈmographique et de SantÈ (EDSM V) 2012-2013. Rockville, Maryland, USA: CPS, INSTAT, INFO-STAT and ICF International; 2013. .
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