The experiences of nurses during the COVID-19 crisis in India and the role of the state: A qualitative analysis.

OBJECTIVES: The study documents the lived experience of nurses coping with the double burden of external demands and internal stressors while providing care during the COVID-19 pandemic in India. METHODS: This qualitative study interviewed 18 female nurses who worked in the COVID wards of a major hospital in India. The one-on-one telephonic interviews were conducted with respondents based on three broad open-ended questions. Thematic analysis was conducted. RESULTS: Three themes were identified: (i) external demands such as availability, utilization, and management of resources; (ii) internal psychological stressors, such as emotional exhaustion, moral anguish, and social isolation; and (iii) promotive factors such as the roles of the state and society, and of patients and attendants CONCLUSIONS: Findings suggest that despite limited resources and facilities, nurses ploughed through the pandemic with their resilience and the state's and society's promotive factors. To improve health care delivery in this crisis, the role of the state and healthcare system has become important to prevent the workforce from crumbling. The sustained attention of the state and society is required to reinstate motivation among nurses by raising the collective value of their contribution and capability.

Adherence to behavioural intervention in RCT study by the women experiencing domestic violence and attending ANC in a public hospital in India-an analysis.

Background: The paper aims to identify the factors for effective implementation and adherence to the behavioural intervention package by women experiencing domestic violence (DV) and attending ANC in a public hospital. Methods: A qualitative study was undertaken with 211 pregnant women experiencing DV and attending antenatal care (ANC) at the LN Hospital, New Delhi. The intervention was given to women recruited under the RCT study. The narratives were analysed under two broad themes, impeding and facilitating factors, with nine sub-themes. Findings: Impeding factors are external factors generated by the structural interaction of the participants, whereas facilitating factors are supplied internally in the trial to eliminate the influence of impeding factors and singulate the factors under study. Our results show that despite the plethora of impeding factors (nine), the overall sum impact of impeding factors falls short of the positive impact of facilitating factors (nine), which were minor adjustments but reinforce participation in the trial and adherence with 97% follow-up rates. Interpretation: Our study findings are expected to reset the treatment protocol, which entails converting impeding factors into facilitating factors for appropriate adherence and compliance and adequate access and utilization of public services. The sensitization of healthcare providers to the impact of the quality of human interaction on the patient and its impact on the uptake of healthcare services and adherence is needed, particularly in the public hospitals of India. Funding: Funds received for the research are from the Indian Council of Medical Research (ICMR), New Delhi, Government of India.

Domestic Violence during pregnancy as risk factors for stress and depression: The experience of women attending ANC at atertiary care hospital in India.

Domestic Violence (DV) during the antenatal period has major effects on the mother and pregnancy outcome and is associated with stress and mental health problems. The paper aims to examine the association of DV with stress and depression (S&D) during the first trimester of pregnancy attending antenatal care (ANC) at the Lok Nayak (LN) hospital, a tertiary healthcare hospital in New Delhi, India and address the response of the women. A mixed method was used to gain an in-depth understanding of the participants. A total of 921 women were screened from November 2018 to March 2020 using standard tools for the presence of incidents of DV and S&D. 517 pregnant women with up to 20 weeks of pregnancy who met the inclusion criteria and came to receive ANC at the facility were considered. The prevalence of DV in various forms (psychological, physical and sexual) during pregnancy (49.5%), stress (82%), and depression (33%) have an association that reflects the importance of acknowledging both of them as having a significant implication for the health of pregnant women in India. Analysis suggest that women who experienced DV during pregnancy are 4.9 times and 5.3 times more likely to suffer from stress and depressive symptoms than non-victims of DV respectively. The strong association reinforces the need to conduct routine screening during pregnancy to identify and respond to women with DV and S&D.

Domestic Violence and Covid-19: Policy and Pattern Analysis of Reported Cases at the Family Counseling Center (FCC) in Alwar, India.

Introduction: The paper aims to assess the pattern of reporting complaints at the Family Counseling Centre (FCC), the nature and form of domestic violence (DV) during the lockdown, and the challenges addressed by the FCC, located in Alwar, India. Methods: The methodology is considered an event study methodology. The study was conducted using the records available with the FCC. Using monthly time series data for 33 months (from April 2019 to December 2021), the time series analysis was done to bring out the pattern of reporting, nature and form of DV. Interviews were conducted with the counselors to document the challenges faced by them. Results: The analysis shows that the reported DV-cases decreased by 23 percent during the lockdown. Challenges faced during the lockdown by the FCC in the existing policy guideline was that the lockdown disrupted the physical access of the routine complaint system. The COVID-19 lockdown and restrictions on mobility explain why only a portion of the women reach the center. The average decrease in reporting masked significant information about altered patterns and low reporting does not translate to a decline in violence at home. Conclusions: The average change in DV during lockdown can be very misleading when thinking about a reframing policy response in India. Therefore, these findings should not be restricted to lockdown but are viewed broadly in the explanation that can be extended in policy to include the role of chronic stressors in accentuating violence. Policy Implications: The study has significant implications for realigning and redesigning institutional strategies to overcome cultural barriers for seamless access to the FCC. This would enable a transition of counseling from event-based rescue to building resilience by adopting a lifelong learning and well-being approach.

Domestic violence, women's health, and the sustainable development goals: integrating global targets, India's national policies, and local responses.

Domestic violence (DV) is a serious public health concern, affecting women's health and well-being. An international governance framework, through the United Nations' Sustainable Development Goals and national policies in India have committed the country to attempt elimination of violence against women. Even so, efforts remain starkly inadequate for altering conditions under which women experience DV. This review paper aims to develop an evidence-based, integrated life cycle model to alter conditions that perpetuate DV and related vulnerabilities in society. The analyses identify and determine community-based innovative practices and policies. We propose a collaborative 'R5 model' to incorporate a multi-stage response to break the cycle of gendered vulnerability. The model identifies five stages of vulnerability in the lives of victims of violence: rescue, recovery, rehabilitation, resilience, and reform. This approach can result in promoting a proactive state-society engagement to uphold the rights and the welfare of women. We recommend the 'R5 model' to bridge the global SDG targets, national policies, and local practices.

Role of Social Support in Women facing Domestic Violence during Lockdown of Covid-19 while Cohabiting with the Abusers: Analysis of Cases Registered with the Family Counseling Centre, Alwar, India.

The present study aims to analyze the role of social support in the lives of women survivors of domestic violence who filed a complaint with the Mahila Salah and Suraksha Kendra (MSSK) Alwar, India, while residing with the abusive husband and his family during the lockdown period of COVID-19. The study explores the role of MSSK with extended vulnerability of women during the lockdown period at large. This study adopts an exploratory qualitative method. A total of 36 married women who had filed a complaint with MSSK before and during the lockdown were included. Interviews with the women were held through telephonic conversations on vulnerability, coping mechanism and extent and forms of social support. Thematic content analysis was done in a stepwise manner. Results show that degeneration of social support model is time -bound and the accuracy of applying this model wane under extended condition of vulnerability caused due to COVID-19. MSSK can expand support by creating and integrating virtual community networks to detect and deter violence during the lockdown. The study suggests that the government can ensure and empower bystanders with skills of modern communication. The existing physical institutional delivery mechanism need to evolve strategies that are resilient to emerging threats from the vulnerable ecosystem.

Coping strategies of women survivors of domestic violence residing with an abusive partner after registered complaint with the family counseling center at Alwar, India.

Coping is one of the most important and widely studied aspects of domestic violence (DV). Women adopt a wide variety of coping strategies to manage abuse, ranging from individual estrangement to institutional entitlements. The condition of women becomes complex when they seek institutional support while living with an abusive husband and his family under the common hearth. The present study aims to analyze the coping strategy of mediation between informal and formal justice while residing with an abusive husband and his family. Further, the study explores the coping strategy as an outcome of the contextual factor and associated psychological distress. It is a prospective intervention study with a 4-month span building awareness, counseling (individual, couple, and family counseling), and case-specific advice (safety plan, choice-making, and problem-solving). A baseline and endline assessment with SRQ-20 and in-depth interviews were carried out on 299 married women who had registered a complaint with a family counseling center (FCC); Mahila Suraksha Evam Salah Kendra (MSSK) in Alwar district, India. To understand the context and the coping strategy adopted by women, in-depth interviews were carried out. The results show that there is a differential impact of DV, psychological distress, and coping strategy based on contextual factor; women having an informal support system have a better result in coping; and intervention at the formal system resulted in improving coping strategy and simultaneously reducing psychological distress. As the mediation period is interminable and traumatic, the institutional support to women survivors of DV is an important policy alternative for improving survivors' well-being, especially in an unsupportive informal context.

Equity in utilization of health care services: Perspective of pregnant women in southern Odisha, India.

BACKGROUND & OBJECTIVES: Inequity in the use of health care services is an important factor affecting the maternal and child survival. In southern Odisha, India, the health indicators remained below compared to the State and national average. This study identifies various equity issues at individual and community levels that influence women's choice affecting the utilization of maternal health services in a district in southern Odisha. METHODS: A qualitative study was carried out in Gajam district, rural region of south Odisha. Ten in-depth interviews were carried out till data saturation with women having less than one year child and 10 focus group discussions with the average eight women in each group having less than five year old child, community and health care providers separately. A total of 120 respondents were included in the study using in-depth interview and focus group discussions. RESULTS: The important determinants in utilization of health care services by women emerging from the study were transportation and financial constraints. In addition, it was found that divergent aetiological concepts and low perceived hospital benefits of the women and community were equally important determinants. Further, community had different perceptions and interpretations of danger signs influencing the risk approach and health care seeking behaviour. INTERPRETATION & CONCLUSIONS: Our findings show that to increase the utilization of health care services, the grass root health workers should be made aware of specific social determinants of risk, perceptions and preferences. m0 ore attention should be given to the transportation system, and its operational feasibility. The husband of the women and the elders of the family should be considered as an important unit of interjection. A more individualized antenatal consultation could be provided by taking into account women's perception of risk and their explanatory models.

Control and support models of help-seeking behavior in women experiencing domestic violence in India.

In India, there is limited prioritization of domestic violence, which is seen as a private and family matter, and handled as a social responsibility rather than a complaint or crime. Despite the Domestic Violence Act, implemented in 2006, the widespread phenomenon of domestic violence across Indian states goes unreported. Using control and support models, this article aims to examine women's behavior in seeking help while dealing with partner violence. It is a population-based analytical cross-sectional study covering 14,507 married women from 18 states of India, selected through a systematic multistage sampling strategy. Both quantitative and qualitative methods were used to generate data. It was observed that legal complexities combined with social realities make the life of an average Indian woman insecure and miserable. Most women surveyed preferred the social-support model and opined that if they face domestic violence, they would seek help from their parents as the first option in the order of preference. The responses of women while dealing with domestic violence are often spontaneous and determined by the pressing need to resolve matters within the home/community, rather than addressing them in the public domain of state institutions where procedures are cumbersome and lengthy. A new integrated development model proposed by several communities aims to prevent domestic violence through the intervention of health care systems.

The risk factor of domestic violence in India.

BACKGROUND: It is over the last decade that research in this field of domestic violence has led to greater recognition of the issue as public health problem. The paper aims to study the prevalence of physical, psychological, and sexual violence and potential risk factors of the women confronting violence within the home in India. MATERIALS AND METHODS: A multicentric study with analytical cross-sectional design was applied. It covers 18 states in India with 14,507 women respondents. Multistage sampling and probability proportion to size were done. RESULTS: The result shows that overall 39 per cent of women were abused. Women who have a lower household income, illiterate, belonging to lower caste, and have a partner who drinks/bets, etc. found to be important risk factors and place women in India at a greater risk of experiencing domestic violence. CONCLUSION: As India has already passed a bill against domestic violence, the present results on robustness of the problem will be useful to sensitize the concerned agencies to strictly implement the law. This may lead to more constructive and sustainable response to domestic violence in India for improvement of women health and wellbeing.

Domestic violence during pregnancy in India.

Domestic violence can result in many negative health consequences for women's health and well-being. Studies on domestic violence illustrate that abused women in various settings had increased health problems such as injury, chronic pain, gastrointestinal, and gynecological signs including sexually transmitted diseases, depression, and posttraumatic stress disorder. This article tries to understand the association between domestic violence and pregnancy outcomes and other health consequences. The study was carried out in all the six zones of India that is, northern, southern, eastern, western, central, and northeast zones. The study design was conceived as an analytical cross sectional study with multicenter approach. Multistage sampling and then probability proportion to size (PPS) sampling were done. A total of 18 states were taken for the study with a total sample of 14,507 married women and 14,108 married men. Married men were considered from the neighboring villages to understand men's perspective. To understand the situation, women were interviewed using semistructured questionnaire as well as qualitative data like FGD and case studies. The result shows that domestic violence occurs during pregnancy across six zones. The situations become worse for women if her husband or family perceived the pregnancy to be a female child and there is a demand for male child. It has major health implications in accessing and utilizing antenatal care and immunization.