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Domestic violence (DV) is one of the most pervasive forms
of violence in South Africa, with multiple, complex physical
and psychological consequences. This places an
overwhelming health burden on women, their families and
the health care system. Local and international literature
suggests that DV is one of the most common reasons for
women to present at health care facilities (HCFs), making
the healthcare system an important entry point (Watts &
Mayhew, 2004).
Women experiencing DV often do not seek help, for a a
variety of complex reasons including stigma, and financial
dependence on the abuser. However, because DV has
severe health consequences it is likely that at some point,
women experiencing DV will consult a healthcare provider,
placing health care practitioners (HCPs) in a unique position
to identify abuse and intervene.
However, existing screening practices are often
discretionary, and inconsistent.
As widespread as it is, DV is not a recognised public health
concern and thus suffers from poor, almost non-existent,
resource allocation and health policy development. The
Domestic Violence Act 116 of 1998 (DVA), the only
legislative attempt to recognise DV victims’ rights to seek
immediate medical assistance, does not impose any positive
legal duties on HCPs to inquire about, screen, make referrals
or holistically treat health-related consequences of DV.
Despite this, the existing legal and policy framework is pitted
with opportunities for DV screening, and empirical evidence
suggests that further policy measures would go a long way
toward facilitating DV screening and treatment in health
contexts. Various pieces of South African legislation either
provide the opportunities for health care practitioners to
screen patients for domestic violence, or in themselves
imply domestic violence screening. These include:
•Mental health Act, (Act No. 17 of 2002)
•National Health Act (Act No. 61 of 2003)
•International Health Regulations Act (Act No. 28 of 1974)
•Traditional Health Practitioners Act (Act No. 22 of 2007)
•Choice on Termination of Pregnancy Act (Act No. 92 of
1996)
This exploratory study gives a descriptive overview of
DV screening practices in healthcare settings in Cape
Town, South Africa. It evidences the need for
comprehensive screening protocols and training.
The study used a mixed-methods design: quantitative
primary method and a qualitative secondary method. The
PREMIS instrument (Short, Alpert, Harris & Surprenant,
2006) is adapted for the South African context. It displays
satisfactory psychometric properties. The questionnaire was
via SurveyMonkey and a paper-based version. The
complementary qualitative measure consists of in-depth
semi-structured follow-up interviews with questionnaire
respondents.
The study yielded a convenience sample of 49 HCPs. The
sample consists of 55.1% doctors (27/49) and 44.9% nurses
(22/49). Of these, 77.6% are female (38/49); 18,4% are male
(9/49); and 4,1% identify as ‘other’ (2/49). The sample is
made up of 46.9% white respondents (23/49); 24.5%
coloured respondents (12/49); 22.4% black/African
respondents (11/49); and 4.1% Indian/Asian respondents
(2/49). Ages range from 28 to 60+ with an average age of 42
years. Experience in years range from two to 44 years with
an average experience of 17 years. Of the respondents,
71.4% works in the public sector (35/49); 32.7% work in the
private sector (16/49); and 8.2% work in the NGO-based
sector (4/49). Some respondents work in multiple sectors.
In-depth semi-structured follow-up interviews have been
conducted with four questionnaire respondents.
• 53.1% (26/49) of HCPs screen for DV only when there are abuse indicators on a patient’s history or exam - 34.7% do not.
• However, 71.4% (35/49) agrees that initiating a discussion about DV with a patient is her/his responsibility.
• 36.7% (18/49) have not had any prior training about DV.
• A fear of testifying prevents others from screening: 32.7% (16/49)
• 63.3% (31/49) believes patients are generally unwilling to discuss DV.
• 22.4% (11/49) believes that screening is offending to patients. Others believe that screening is like ‘opening Pandora’s box’
• Time constraints and a high workload are mentioned by 44.9% (22/49) as important barriers to DV screening.
• 61.2% (30/49) feels their facility does not allow them adequate time to respond to DV survivors.
• According to 51% (25/49) there is also a lack of private space to discuss DV with a patient.
• Only 8.2% (4/49) feel they have adequate knowledge of referral resources in the community.
 The availability of a short and easy-to-use DV screening tool would encourage HCPs to screen and integrate DV screening in
routine questioning, like asking a patient about her/his HIV status.
 A focus on DV within healthcare facilities, e.g., by having patient materials, screening requirements by management, or DV
champions, would encourage HCPs to screen for DV. Furthermore, the availability of protocols/ policies/ guidelines/ SOPs
guiding the identification, management and the referral of DV survivors step-by-step would facilitate screening in healthcare
facilities.
HCP Knowledge HCP Skills
Symptom-based (Selective) Screening Availability and Use of Policy
Rosanne Anholt (Vrije Universiteit Amsterdam) &
Lillian Artz, Talia Meer, Gray Aschman (Gender Health & Justice Research Unit, UCT)
Literature cited
Devries, K. M., Mak, J. Y. T., García-Moreno, C., Petzold, M., Child, J. C., Falder, G., Lim, S., Bacchus, L.
J., Engell, R. E., Rosenfeld, L., Pallitto, C., Vos, T., Abrahams, N. & Watts, C. H. (2013). The global
prevalence of intimate partner violence against women. Science, 340, 1527-1528.
Short, L. M., Alpert, E., Harris, J. M. & Surprenant, Z. J. (2006). A tool for measuring physician
readiness to manage intimate partner violence. American Journal of Preventive Medicine, 30,
173-215.
Watts, C. & Mayhew, S. (2004). Reproductive health services and intimate partner violence: Shaping
a pragmatic response in Sub-Saharan Africa. International Family Planning Perspectives, 30,
207-213.