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Feasibility of Screening and Referring Women Experiencing Marital Violence by Engaging Frontline Workers: Evidence from Rural Bihar

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Feasibility of Screening and Referring Women Experiencing Marital Violence by Engaging Frontline Workers: Evidence from Rural Bihar report Feasibility of screening and referring women experiencing marital violence by engaging frontline workers: Evidence from rural Bihar Shireen J Jejeebhoy Aparajita Gogoi K G Santhya Madhu Joshi Santosh Kumar Singh Sandeep Ojha A J Francis Zavier Neelanjana Pandey Rajib Acharya Komal Saxena March 2017 March The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees. The Centre for Development and Population Activities, India is now the Centre for Catalyzing Change (C3). Over two decades of sustained work to empower and mobilize young people, men and women commemorates the journey of the organisation, that began as one of the first organizations working with life skills education for adolescents through it comprehensive programs. We are a non-governmental organization with the mission to empower women in all sectors of development and to that end we work with young people, including in and out of school adolescent boys and girls in rural and urban India. Our technical expertise extends to incubating, implementing and scaling up programs focused on its thematic areas of youth education, gender and maternal health/reproductive rights, specialising in at- scale programme implementation, monitoring and evaluation. Till date, we have reached more than one million girls and boys in India and equipped them with practical life skills, improved confidence in personal decision-making and increased self-esteem. In the past couple of years we have been using digital technology to build young people’s capacities on health, life skills and gender equity issues. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. Suggested Citation: Jejeebhoy, S. J., K. G. Santhya, S. Singh et al. 2017. Feasibility of screening and referring women experiencing marital violence by engaging frontline workers: Evidence from rural Bihar. New Delhi: Population Council. For additional copies of the report please contact: Population Council Zone 5A, Ground Floor India Habitat Centre, Lodi Road New Delhi, India 110 003 Phone: +91–11–2464 2901 Email: [email protected] Website: www.popcouncil.org The study has been funded by UK aid from the UK Government; however the views expressed do not necessarily reflect the UK Government’s official policies. Printed at : Systems Vision Email:[email protected] Mobile:98102 12565 Feasibility of screening and referring women experiencing marital violence by engaging frontline workers: Evidence from rural Bihar Shireen J Jejeebhoy Aparajita Gogoi K G Santhya Madhu Joshi Santosh Kumar Singh Sandeep Ojha A J Francis Zavier Neelanjana Pandey Rajib Acharya Komal Saxena ii Table of Content Acknowledgements vii Executive summary ix Chapter 1 Introduction 1 Chapter 2 Socio-demographic profile of study participants 10 Chapter 3 Do Kadam Barabari Ki Ore: The intervention 14 Chapter 4 Feasibility and acceptability of the Do Kadam project activities: Women’s perspectives 19 Chapter 5 Perspectives of ASHAs, AWWs and ANMs 35 Chapter 6 Summary and recommendations 49 Appendix Table 1: Construction of the wealth index 53 References 54 Authors 56 List of Investigators 57 iii iv List of Tables Table 1.1: Profile of the study district and state 4 Table 1.2: Response rate at baseline, follow-up rate at endline, and reasons for non-response and loss to follow up 8 Table 1.3: In-depth interview respondents at baseline and endline 9 Table 2.1: Household characteristics of surveyed women Selected household characteristics of pregnant women and women with a 0–5-year-old child, baseline survey, 2015 10 Table 2.2: Socio-demographic characteristics of surveyed women Selected socio-demographic characteristics of pregnant women and women with a 0–5-year-old child, baseline survey, 2015 11 Table 2.3: Childbearing experiences of surveyed women Selected childbearing characteristics of pregnant women and women with a 0–5-year-old child, baseline survey, 2015 12 Table 2.4: Gender role attitudes held by surveyed women Selected indicators of agency of pregnant women and women with a 0–5-year-old child, baseline survey, 2015 12 Table 2.5: Women’s experience of violence perpetrated by their husband and other family members Selected indicators of violence perpetrated by the husband and other family members on pregnant women and women with a 0–5-year-old child in the 12 months preceding the interview, baseline survey, 2015 13 Table 4.1: Acquaintance and interaction with ASHAs, AWWs, and ANMs Percentage of women reporting acquaintance and interaction in preceding six months with ASHA, AWW or ANM, baseline and endline surveys, 2015 and 2016 19 Table 4.2: Interaction on violence-related matters with ASHAs and AWWs Percentage of women reporting violence-related discussion and screening, and receipt of a violence-related brochure in the six months preceding the interview, endline survey, 2016 21 Table 4.3: Characteristics of women reporting violence-related interaction with ASHAs or AWWs at endline Percentage of women according to baseline socio-demographic characteristics and violence experienced in the 12 months preceding the baseline survey, by screening status and reported interaction with ASHAs and AWWs about violence, endline, 2016 22 Table 4.4: Attendance at street plays/nukkad nataks Percentage of women reporting attendance at nukkad nataks and conveying its messages to others in the family in the six months preceding the interview, endline survey, 2016 23 Table 4.5: Disclosure of violence experience at screening to ASHA or AWW by selected characteristics Percentage of screened women who disclosed their marital violence experience to the ASHA or AWW, by selected characteristics, endline survey, 2016 25 v Table 4.6: Reporting of violence experience to survey interviewer and to the ASHA or AWW Percentage of all women screened by their reports (at baseline) of experience of violence perpetrated by their husband or other family members in the 12 months preceding the baseline interview to the survey interviewer and to the ASHA or AWW, endline, 2016 26 Table 4.7: Perceptions about quality of interaction with ASHA or AWW on marital violence Percentage of women who disclosed their experience of marital violence and who reported that the ASHA or AWW had counselled them and paid them repeated visits, and the content of counselling provided, endline survey, 2016 27 Table 4.8: Help-seeking practices of women who experienced physical and/or sexual violence, by interaction on violence-related topics with ASHAs/AWWs and disclosure status Percentage of women reporting experiences of physical and/or sexual violence in the six months prior to the baseline and endline interviews and had sought help from family, friends, or from service providers, 2015 and 2016, baseline and endline survey 30 List of Figures Figure 1: Percentage of women reporting discussion on violence-related matters, screening for violence, and receipt of a violence-related brochure in the six months preceding the interview, endline survey, 2016 xii Figure 2: Percentage of screened women who disclosed their marital violence experience to the ASHA or AWW by selected characteristics, 2016, endline survey xiii Figure 3: Percentage of women who had experienced physical and/or sexual violence in the six months prior to the baseline and endline interviews reporting having sought help from formal or informal sources, baseline and endline surveys, 2015 and 2016 xiv Figure 4: Percentage of women who had experienced physical and/or sexual violence in the six months prior to the endline interview and sought help from formal or informal sources, according to interactions with FLWs on violence-related matters, 2016, endline survey xiv Figure 3.1: Abuse Assessment Screen (AAS) 15 vi Acknowledgements We are grateful to the UK Department for International Development (DFID) for supporting our programme of research, Do Kadam Barabari Ki Ore (Two Steps Towards Equality), to assess what works to address violence against women in Bihar state, India. Under this programme of research and evaluation, a total of five projects were implemented in partnership with the Centre for Catalyzing Change and the London School of Hygiene and Tropical Medicine. One of the five projects, findings of which are presented in this report, tested the feasibility of engaging frontline workers to screen women for their experience of domestic violence, inform them about their options in case of such an experience and provide basic counselling and referral to women who report such experiences. This study has benefitted immeasurably from the inputs of many. In particular, we are grateful to Mamta Kohli, Nupur Barua, Nel Druce, Arundhati Choudhury, and Peter Evans from DFID India Office, for their support and especially to Mamta Kohli, Nupur Barua and Nel Druce for their guidance and insights throughout the course of this project. We are extremely grateful, moreover, to several officials of the Government of Bihar whose encouragement and support made it possible for us to conduct the study in the state of Bihar. We would like to acknowledge support from Shri Sanjay Kumar, former Executive Director, Department of Health, Shri Rahul Kumar, former Additional Executive Director, Department of Health, and Shri Imamuddin Ahmad, Director of Social Welfare and Shri Baidyanath Yadav, former Director, Integrated Child Development Scheme. Lori Heise from the London School of Hygiene and Tropical Medicine and Kelly Hallman from the Population Council, New York provided valuable inputs into the intervention design and the study protocol.
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