A Community-Supported Clinic-Based Program for Prevention of Violence against Pregnant Women in Rural Kenya

Table 1

Approach for implementing an integrated community-supported clinic-based GBV program.

Implementation steps*	Methods	Key findings
(I) Establish relationships with key partners	Conducted initial discussions with key stakeholders	Local Ministry of Health and FACES leadership were interested in developing methods to address GBV within health services
(II) Define the nature of the problem	(i) FGDs^† with pregnant women (𝑛=4 groups) and male partners or relatives of pregnant women (𝑛=4 groups)	(a) Specific types of GBV commonly experienced by women in this setting: beating, forced sex, verbal abuse, denial of reproductive choice, neglect, and being kicked out of their homes
		(b) Triggers for GBV include woman making decisions (e.g., HIV testing) without partner consent, woman failing to perform household duties, man for misallocating money, woman disclosing HIV status, either partner using alcohol, and either partner is suspected of infidelity
	(ii) IDIs^† (𝑛=20) with Ministry of Health, Ministry of Gender and Social Services, NGOs, FBOs, health service providers, police, judiciary, and community leaders	(c) Help-seeking behaviors: women were often reluctant to press formal charges, and in many cases preferred to use more informal community and family mechanisms.
		(d) Local resources do exist for GBV, but those that do exist tend to be weak or inefficient and lack linkages to one another
		(e) Primary healthcare workers are trusted service providers, already being accessed by pregnant women in rural areas, and are a potential resource for primary and secondary prevention of GBV.
(III) Identify potentially effective programs	Convened stakeholders to review existing GBV curricula	Relevant portions of GBV curricula for health workers from Kenya, India, South Africa, and Latin America were identified.
(IV) Develop policies and strategies	Designed locally relevant program using formative research and stakeholder input	Components of an effective program, as defined by stakeholders, were as follows:
		(a) building capacity of health workers,
		(b) bolstering multisectoral linkages,
		(c) enhancing community sensitization and awareness (with a special focus on reaching men)
(V) Create an action plan	Established program model	(See Figure 1)
(VI) Evaluate learning	Conducted a mixed-method evaluation using focus groups (𝑛=2 groups) and clinic data on screening and referral	(See Section 3)

∗Adapted from the WHO [29].
^†FGDs: focus group discussions; IDIs: in-depth interviews; NGOs: nongovernmental organizations; FBOs: faith-based organizations.