The respondents were health care providers of public sectors from Hlaing Tharyar (13.7%) and Kawhmu townships (24.0%) of Yangon Region and Patheingyi (27.0%) and Singu townships (35.2%) of Mandalay Region. The majority of healthcare providers were from rural health centers (RHCs) (73.8%) and the remaining was from Township Hospitals (6.4%) and Station Hospitals (6.9%), Maternal and Child Health (MCH) clinics (4.3%) and Urban Health Center (UHC) (7.7%).
Background information of respondents
The basic health staff, including Lady Health Visitors (LHV) and Midwives (MW), was mainly involved in the study, representing 88.0% of the total while the remaining was medical doctors, health assistants (HA) and nurses. Majority of healthcare providers was female (96.1%). The average of total service years of participants was 12.7±9.1 years and those who had more than 10 years working experience was 57.9%.
<Table 1 here>
Knowledge and perception of healthcare providers on GBV related issues
About two-thirds of healthcare providers had heard the term of “gender-based violence” without probing and the rest noticed only after probing by interviewers. The common types of GBV that they have heard were physical and sexual violence, 81.1% and 78.5% respectively. Only 39.1% and 22.7% of health care providers had heard on emotional/psychological violence and economic resources/assets related violence respectively.
<Table 2 here>
More than two-third of respondents considered GBV as a common problem by providing agreement on the statement “one of three women suffers GBV worldwide” where the rest responded that the GBV cases were not as common as the statement said. Almost all of healthcare providers (96.1%) agreed women were suffering GBV more than male while others believed both men and women could be the victims of GBV.
Most of healthcare providers (80% and above) regarded the violence against girls/women conflicted by their male partners as GBV, but lesser number of respondents (70% and below) assumed it as GBV if the violence was conflicted by a family member. Many healthcare providers (81.1%) responded that young girls were the vulnerable persons to GBV and 57.9% believed children were vulnerable too. Those who use drugs and alcoholics were the mostly cited potential perpetrators of GBV by healthcare providers (73.4%).
<Figure 1 here>
Identifying the perception of healthcare providers on IPV showed there were some healthcare providers still had misconceptions about GBV. One-third of healthcare providers (36.5%) wanted women to be patient with violence from their intimate partners to maintain a family ties where the remaining responded that women should not be patient to any violence. Nearly two-third of them assumed the conflict between a husband and a wife is not a matter that someone should involve. It seems many healthcare providers accepted intimate partner violence to a certain extent.
<Figure 2 here>
To the question about health-related consequences of GBV which was not specified any type of GBV, most of the healthcare providers could name many consequences. Psychological problem was the most commonly provided response by the healthcare providers, accounting for 70.8%, followed by injuries (47.6%) and unwanted pregnancy (35.2%). Among them, 31.8% answered suicide as one of the health consequences of GBV.
<Figure 3 here>
To the question of what healthcare providers should do when GBV survivors come to their clinic, provision of counseling was the highest number of responses provided by the healthcare providers (65.2%) and it was followed by treatment of injuries (51.5%). Only few of them talked about sexual assault examination (6.9%), sexual assault care (9.4%), and documentation (7.7%). Although a high percentage of healthcare providers named psychological problems as a health-related consequence, only 17% mentioned about mental health assessment and mental health care to GBV survivors.
Experiences of healthcare providers in provision of GBV care
Among 233 participants, 70% (163) reported that they had ever provided care to GBV survivors. Most GBV survivors who came to health facilities were over 20 years of age (62.7%). Most of the victims came to health facilities with physical violence (75.6%), and approximately a quarter of GBV cases were sexual violence. According to the healthcare providers, the cases reached to health facilities were mostly conflicted by the survivors’ intimate partners (73.8%) and a third of violence cases were done by the strangers (28.7%).
<Table 3 here>
The care that healthcare providers provided to GBV survivors was mostly injury treatment (76.1%). Nearly half of healthcare providers gave medicines to survivors. It was found the proportion of healthcare providers who referred cases to somewhere else was not small (40.5%) and the place they mostly referred to was township hospitals. A quarter of healthcare providers said sexual violence cases reached to their health facilities, but only 4.9% and 1.2% of healthcare providers had provided emergency contraception and Sexually Transmitted Infection (STI) treatment. The findings indicated that many sexual violence cases were mostly referred to township hospitals.
While more than half of healthcare providers talked about provision of counselling to GBV survivors in the knowledge and perception section, only one-fifth of respondents said that they provided counseling service to the survivors who came to their health facilities.
<Figure 4 here>
Readiness of care for GBV survivors at health facility
Concerning with readiness in health facilities for provision of care to GBV survivors, almost all of healthcare providers (more than 90%) said there were no standard management guideline, trained and skilled staff, trained medico-social worker and counseling room at the health facilities. However, only half of them responded that there were no adequate medicinal supplies for GBV management.
<Table 4 here>