TM5528 Health Promotion

The scope of health promotion activity within the landscape of intimate partner violence in developing countries-applying the framework for health promotion action.

Assignment Two

Samantha Leggett, SN 124946524/6/2013Word Count: (excluding citations, tables and footnotes): 2940

Contents

Page

3 1: Introduction

4-5 2: The landscape of intimate partner violence in developing countries

6-7 3: The framework for health promotion action explained

7 4: Applying the framework for health promotion action to a health

promotion priority

8 4.1: Disease Prevention

8-9 4.2: Communication Strategies

10 4.3: Health Education and Empowerment

10-11 4.4: Community and Health Development

11-12 4.5: Infrastructure and Systems Changes

13-14 5: Figure 1: the framework applied to intimate partner violence

15 6: Summary

16 7: Appendix A-Framework for Health Promotion Action-template

17-21 8: References

2

1: Introduction

Intimate Partner Violence is one of the most serious and pervasive social and public

health issues facing developing countries, a significant contributor to the ill health of

women and children, and a major threat to social and economic development (Garcia-

Moreno, Jansen, Ellsberg, Heise & Watts, 2005; King and Lupiwa, 2010). Such violence

is interwoven with complex determinants of health such as poverty, lack of education,

gender inequality and HIV/AIDS (World Health Organization [WHO], 2005).

A strong, comprehensive and collaborative public health sector response is required to

help prevent intimate partner violence (IPV). Knowledge of the forms and patterns of

violence within different cultures and across countries has important implications for the

effective prevention, care and mitigation of IPV. It is imperative that health services are

in place where women feel safe, are treated with respect, are not stigmatised and where

they can receive quality, informed treatment and support. Strength within a public health

and in this instance, specifically a health promotion response, can also help to address

the reluctance of abused women to seek help, to raise greater public awareness of this

significant problem and to challenge the social norms that condone and therefore

perpetuate violence against women (Garcia-Moreno et al. 2005).

A further strength of an effective health promotion programme is the implementation of

a range of interventions on a continuum from the individual to population-wide. The

application of the Framework for Health Promotion Action (James Cook University

[JCU], 2013) to a health promotion priority is useful to frame responses to identified

issues and helps to ensure that sustainable approaches are implemented. (State

Government of Victoria, 2012; Devine, Muller & Carter, 2008). Following a more in-

depth examination of intimate partner violence within developing countries, this

framework will be further explained and then applied to the scope of health promotion

activity within the landscape of IPV in developing countries.

3

2: The landscape of intimate partner violence in developing countries

A study across seventeen low, middle and high income countries on the incidence of all

forms of Intimate Partner Violence (IPV) found that between 17-71% of women had

experienced one or more kinds of abuse1 in their lifetime (Garcia-Moreno et al., 2005).

Pregnancy is a particularly vulnerable time for women and the risk of IPV peaks among

women of reproductive age. Recent worldwide studies suggest that at the extreme,

between 1-28% of pregnant women experience IPV but with general averages falling

somewhere between 4-12% (WHO, 2011). These statistics suggest that violence is

more common among pregnant women than conditions such as diabetes or

preeclampsia which are routinely screened for during pregnancy (Parsons, Goodwin &

Peterson, 2000).

Intimate partner violence is a result of factors operating at four levels: individual,

relationship, community and societal. Community and societal drivers that are

consistently associated with an increased likelihood of experiencing IPV are gender-

inequitable social norms, low social and economic status of women, weak legal

sanctions against IPV within marriage, lack of women’s civil rights, weak community

sanctions against IPV and broad social acceptance of violence as a way to resolve

conflict (WHO, 2012). And, although IPV pervades all classes of society, it can ordinarily

be generalized that people with the lowest socio-economic status are at most risk of

violence. This risk is intensified by poverty related factors such as poor housing, lack of

education and unemployment (Vakili, Nadrian, Fathipoor, Boniadi &

Morowatisharifabad, 2010; WHO, 2012; Xu et al., 2005).

1 Physical violence: being hit with a fist, kicked, dragged, choked, burnt, threatened with a weapon or having a weapon used against

them; sexual violence: forced intercourse or any form of sexual coercion or exploitation; emotional abuse: insults, belittling, constant

humiliation, intimidation, threats of harm against partner or children; controlling behaviours: restricting contact with family and

friends, insisting on knowing where she is at all times, controlling access to health care, money, employment or education. (Garcia-

Moreno, C., Jansen, H., Ellsberg, M., Heise, L., & Watts, C. (2005). WHO Multi-country Study on Women’s Health and Domestic

Violence against Women. Initial results on prevalence, health outcomes and women’s responses. Retrieved from

http://whqlibdoc.who.int/publications/2005/924159358X_eng.pdf)

4

IPV undermines family planning initiatives and a woman’s ability to control the number

of children she has, leading to unwanted pregnancies (Bradley, 2001). In many

countries abortion is illegal in cases of rape and in fact only permitted with exception to

save a woman’s life (Centre for Reproductive Rights, 2008). Unsafe abortion is one of

the four main causes of maternal mortality worldwide (WHO, 2010b) and to complete

this cycle of harm IPV also provides an important intersection in the spread of HIV/AIDS

(Jewkes, Dunkle, Nduna & Shai, 2010).

Further, IPV puts women at increased risk of poor physical, mental, sexual and

reproductive health. In addition to direct injuries acquired as a result of physical

violence, women also report memory loss, dizziness, problems walking and carrying out

daily activities, emotional distress, depression, thinking about and attempting suicide,

induced miscarriage from being kicked or punched in the abdomen whilst pregnant and

increased transmission of STI’s. The cumulative effects of ongoing violence should also

not be underestimated (Garcia-Moreno et al., 2005; WHO, 2010a).

Health systems in low and middle income countries tend to be plagued by resource

shortages, inefficient and inequitable use of available resources, poor service quality

and low coverage rates. The poorer sections of societies within these countries seem to

bear the brunt of these problems (Oliveira-Cruz et al., 2003). Current research

demonstrates that although services may exist to support survivors of IPV, they are

often fragmented, under resourced and lack the coordination and capacity to be truly

effective. Little seems to exist in the way of dedicated immediate medical care,

awareness raising, prevention strategies or to address behaviour change (Oxfam, 2010;

Amnesty International, 2006). An effective health promotion intervention is therefore

strongly implicated.

5

3: The framework for health promotion action explained

(A template of the framework can be found in Appendix A)

As previously mentioned, one of the keys to effective and sustainable health promotion

programme delivery is the implementation of a range of interventions on a continuum

from the individual to population-wide. Additionally, health promotion interventions must

work across the downstream, midstream and upstream levels2 and through a range of

action areas to achieve better health outcomes for the population being targeted. (State

Government of Victoria, 2012; Devine et al., 2008; JCU, 2013).

The framework for health promotion action clearly defines the down, mid and upstream

levels through each action area (disease prevention; communication strategies; health

education and empowerment; community and health development and infrastructure

and systems changes). By applying the framework to a problem, challenges can be

identified that need to be overcome in order to pursue the health promotion programme

goal. Multilevel, integrated and complementary interventions can also be more readily

developed. Its effective use also helps professionals to recognise that health is affected

by individual behaviour as well as broader socio-environmental issues, and may aid in

the identification of the broad determinants of health and health inequities. The

Framework can also be used to set out priority objectives and actions within health

promotion initiatives and may serve as a visual demonstration of the relationships

between the health promotion intervention categories (State Government of Victoria,

2012; Devine et al., 2008).

2 Downstream interventions usually target individuals who are already displaying symptoms or who are deemed at high risk of injury or illness in the future. Interventions include screening activities; access to health services; disease self-management and the provision of health information.

Midstream interventions move towards a more population-based approach targeting at risk individuals and populations. The emphasis is on prevention through behavior change strategies and can include programmes that address physical inactivity, smoking and obesity.

Upstream interventions address issues from a broader perspective and focus on achieving population level changes. Interventions target the social, political, economic and cultural determinants of poor health and aim to influence infrastructure, policy and legislative changes (James Cook University. (2013). TM5528 Health Promotion. Queensland, Australia: James Cook University).

6

Further, use of the framework emphasizes how health promotion interventions can trend

in an upstream direction as historically, downstream approaches have done little to

improve the health outcomes of the poorest and most vulnerable people. The

framework can also be used to encourage reflection on current practice and to promote

collaborative working in planning interventions across the downstream, midstream and

upstream spectrum (JCU, 2013).

4: Applying the framework for health promotion action to intimate partner violence

A public health problem on the scale of intimate partner violence requires a major focus

on primary prevention. This means reducing the number of new instances of IPV by

addressing factors that make the first time perpetration of IPV more likely to occur.

Primary prevention relies on an upstream approach, identifying upstream determinants

such as social, political and cultural factors and then taking action to address these.

(WHO, 2010a).

However, current evidence suggests that cultural and social drivers of IPV such as

behaviour change and social constructs of gender norms may take generations to

achieve. Further, while primary prevention strategies are being implemented it is vital

that survivors of IPV are able to access existing services and that capacity is built within

these (Medecins Sans Frontieres [MSF], 2009).

The framework for health promotion action will therefore not only be applied to the

primary prevention of IPV but to the prevention of disease and treatment of injuries

related to experiencing IPV. A completed framework can be found at the end of this

section.

7

4.1: Disease Prevention

Finding immediate medical care is critically important after a sexual or serious physical

assault. The provision of medical care within the first few days after rape is vital to limit

serious physical, sexual and mental health consequences, both immediate and long

term. Post Exposure Prophylaxis for HIV and emergency contraception are needed

within a matter of days and the treatment of STI’s, prevention of tetanus and

psychosocial care are also of importance. Prompt medical and/or surgical treatment

following serious physical assault is important to help prevent long term physical and

sexual disability and the emotional and social consequences that may accompany them

(MSF, 2009).

Follow-up care is an additional and important aspect of disease prevention with regards

to subsequent doses of tetanus and hepatitis B immunisations, HIV testing and follow-

up psychosocial care (MSF, 2011).

4.2: Communication Strategies

Few victims of IPV seek medical care immediately after an episode of physical or sexual

violence. Fear of stigmatisation, shame and the safety of themselves and their children

are common concerns and reasons that prevent them from doing so. A crucial element

of any project working with survivors of IPV is ensuring that they know about the

services available, about the importance of seeking care and how to do so as quickly as

possible. It is highlighted that commonly, services for survivors of IPV are largely based

in urban areas giving the rural population restricted or no access to the medical care

that they need (MSF, 2009).

Awareness-raising may focus on healthcare, cultural issues, prevailing myths in society

or existing legislation. It can also help to facilitate disclosure. Trying to reduce the

barriers women face in accessing services is a crucial element of any programme

attempting to address and prevent IPV. Talking to people door-to-door, using theatre or

drama groups to convey messages at locations such a street markets and cultural

8

events, radio announcements and billboard advertisements are useful tools to

communicate messages and encourage victims to seek help. (MSF, 2009; WHO, 2012)

Additionally, clear, appropriate and accurate information regarding IPV may be put on

prominent display in schools, colleges, churches, workplaces and particularly in places

where women access health care for other reasons; information regarding women’s

rights and why, how, where and when to seek help should also be included. Community

health centres are an ideal place for information, education and discussion as most

women will access them at some point in their lives, particularly for reproductive health

services (Magnussen, Shoultz, Hansen, Sapolu & Samifua, 2008; Garcia-Moreno et al.,

2005). All community health staff should be sensitised regarding IPV and service

provision within the local area, with a flow chart of the referral process available for staff

and patients. A visual map of the locale with available services could also be displayed

in a prominent place (Oxfam, 2010). Further, utilising national television, public

transport, mobile telephone networks and educational curricula to promote awareness

of human rights, IPV and related services is highly recommended (MSF, 2009).

Bradley (2001) points out that the position of women in society does not exist in a

vacuum-it exists relative to that of men. This makes it clear that for any health promotion

intervention to be successful in this area, work with male perpetrators of IPV must be

undertaken. The objectives of working with male perpetrators typically includes

increasing an individuals’ knowledge, changing attitudes towards gender norms and

violence and changing social norms around masculinity, power and violence (WHO,

2010a).

Additionally, media strategies could be employed that reach out to men who are not

violent with the aim of developing their capacity and confidence to speak out against

violence and challenge its acceptability. This may help to counter notions that all men

condone violence, to change the social climate in which it occurs and also serve to

provide alternative role models of masculine behaviour (MSF, 2009; WHO, 2010a;

WHO, 2012).

9

4.3: Health Education and Empowerment

Empowerment approaches in health programmes often utilise combinations of

community led needs assessment, education or training, public awareness campaigns

and community action. Media awareness campaigns are a common approach to the

primary prevention of IPV and have the potential to reach large numbers of people,

challenging the beliefs of both women and men at a societal as well as an individual

level (WHO, 2010a).

Callister (2012) asserts that empowering women to understand that violence is

unacceptable should be a priority but acknowledges that in many cultures this will be

the biggest challenge to overcome. At a community level, the formation of women’s

action groups or strengthening of existing women’s groups to be able to provide support

to women experiencing IPV can strengthen an empowerment agenda. Intra-group

exchange of knowledge about rights, treatment and support are all useful components

(Mahapatro, Gupta, Gupta and Kundu, 2011).

Additionally, peer mentoring support within these women’s groups or in the form of

home visiting shows a promising approach to empowerment. Non-judgemental listening,

support and friendship; maintaining regular contact through visiting, phone calls and

outings; assistance in developing safety strategies appropriate to individual

circumstance and modelling a sense of hope can all be provided (Taft et al., 2009).

WHO (2012) recommend that practitioners identify existing strategies that have

demonstrated promise or effectiveness and build upon these within their own health

promotion intervention.

4.4: Community and Health Development

The statistics regarding the incidence of IPV during pregnancy given in section 2 of this

report highlight the need for the introduction of routine screening for IPV during

reproductive health care encounters for all women of reproductive age, both in clinical

settings and in the community. This implicates appropriate training for both clinical,

10

community and lay health care workers. Screening and referral procedures need to be

sensitive, appropriate, effective and culturally acceptable. Screening alone however, is

inadequate-appropriate onward referral to acute care and community support services

are crucial to aiding the primary prevention of IPV. The need for formal protocols and

guidance documents is also emphasized (Campbell, Moracco & Saltzman, 2000;

Parsons et al., 2000; WHO, 2012).

4.5: Infrastructure and Systems Changes

Continuous surveillance and evaluation are critical elements of any health promotion

programme as they allow trends to be monitored, the impact of interventions to be

assessed and necessary changes to be made in real-time (van Beurden, Kempton,

Sladden & Garner, 1998). The translation of research findings into effective

interventions and dissemination of aggregated data is also important to secure

intersectoral support and funding. In addition, policymakers must be kept up-to-date

with new findings in research and with the results of interventions so that public policy

initiatives can reflect new developments in these areas. This may in turn help to

strengthen national commitment and action (Campbell et al., 2000).

Knowledge of specific service providers, and how or whether agencies are working

together, can reveal inadequacies or gaps in service provision and can assist with

planning better service delivery. Capacity may therefore need to be enhanced for data

collection and sharing within organisations that provide services for survivors of IPV e.g.

clinics, hospitals, shelters, police stations etc (Mays et al., 2009; WHO, 2012).

At a governmental level the United Nations (2006) and WHO (2010) suggest a number

of strategies to strengthen the national contribution to the primary prevention of IPV:

firstly, the recognition that the problem exists and then a commitment made to plan and

implement national programmes that help to avert future violence and respond to it

when it occurs; work with international agencies, offering support to relevant

programmes and investing resources; promote gender equality and women’s human

rights in line with international treaties and human rights mechanisms, including

11

women’s access to property and assets and expanding educational opportunities for

girls and young women; harmonise legislation with international commitments and

finally to challenge obstacles such as political inertia or opposition within differing

government departments. It is also recommended that national progress be monitored

and assistance provided to strengthen efforts to bring about necessary changes in

national laws, policies and programming.

These recommendations regarding surveillance, evaluation and governmental

commitment to the primary prevention of IPV highlight the importance of health

promotion specialists taking a lead role in establishing effective multi-sectoral

collaboration with, for example: legal organisations; advocacy groups; the media; social

workers; community based organisations; shelters; women’s groups; men’s groups;

community groups; faith based organisations; the judicial system; national department

for education; non-governmental organisations (e.g. Medecins Sans Frontieres,

lobbying groups); trade unions; businesses; the media; social, political and religious

leaders and national medical service providers (Parsons et al., 2000; MSF 2009; MSF,

2011).

Evidence suggests that the most effective way to improve the service response to

survivors of IPV is to follow a systems approach, by implementing institution-wide

reforms rather than narrow policy reforms or training alone. It is also stressed that

including women’s perspectives in future research, practice and policy development is

vital to truly effective service provision (WHO, 2012).

12

5: Figure 1: The Framework for Health Promotion Action applied to intimate partner violence in developing countries.

Downstream Midstream Upstream

Individual Focus → → → → Population Focus

Disease Prevention Communication

Strategies

Health Education

and

Empowerment

Community and

Health

Development

Infrastructure

and Systems

Changes

Work in treatment

centres for victims

of physical and

sexual violence to:

Provide

clinical care

Train

healthcare

workers

Ensure

policies and

protocols

are being

adhered to

Ensure

appropriate

referrals

(e.g.

psychologist

, shelter,

social work)

Encourage

Collaborative

working with

media, service

users, human

rights

organisations and

other relevant

parties to design

appropriate

awareness-

raising

campaigns.

Work with

theatre and

drama groups to

ensure

appropriate

health message

content.

Work with

Facilitation of

community led

needs assessment.

Education and

training of health

personnel in all

relevant areas

(clinical,

community and

lay).

Facilitate the

formation of

women’s action

groups or

strengthening of

existing ones and

contribute to the

information

shared within

them.

Assist with the

development of

routine

screening

procedures for

IPV in

reproductive

healthcare

settings.

Contribute to

the training of

clinical,

community and

lay healthcare

workers in

screening

procedures.

Contribute to

and facilitate

the

Take a lead role in

establishing

effective multi-

sectoral

collaboration and

partnership

building by

creating

opportunities for

meetings to

discuss issues and

make plans to

move forwards

with a relevant

agenda.

Participate in the

surveillance and

evaluation of any

intervention.

Assist with

13

and

implement

follow-up

care

Help to design and

implement relevant

policies and

protocols

Work in shelters and

refuges to provide

counselling, referral

and ongoing

treatment. Also

provide appropriate

training and support

to staff.

educational

institutions (both

schools and

health care) to

ensure that IPV is

appropriately

incorporated into

curriculae.

Design flow

charts mapping

the referral

process for

health centres,

emergency

departments,

maternity care

services and

communities etc.

Produce visual

maps detailing

local services.

Work

collaboratively

with men’s

groups or

facilitate the

establishment of

them where

there are none.

Contribute to the

development of a

peer mentoring

system and

training in areas

such as non-

judgmental

listening,

developing safety

strategies and

signposting to

relevant services.

development of

policies and

protocols for

onward referral

in these settings

and deliver

training in their

effective use.

Work

collaboratively

with other

sectors to

address the

barriers to

utilisation of

existing

services.

dissemination of

data to relevant

sectors e.g. health

centres,

governmental

departments,

media etc (what

has worked, what

hasn’t, why,

statistics, service

user feedback).

Help to build

capacity in

surveillance,

evaluation and

data

dissemination

within relevant

participating

organisations.

Write research

papers based on

aggregated data.

Contribute to real

time programme

changes.

14

Primary Care

Approaches

Lifestyle/

behavourist

Approaches

Socio-ecological

Approaches

Source: Modified from Keleher and Murphy (2004) and cited in James Cook University (2013) Module 5,

page 9.

6: Summary

Intimate partner violence is a serious and pervasive public health issue. Its drivers are

complex and multivariate. A strong, comprehensive and collaborative health promotion

response is required to help prevent it and mitigate its physical, psychological, social

and economic consequences.

The application of the Framework for Health Promotion Action to the issue of IPV can

greatly assist in adding strength to such a response from perspectives such as: setting

priorities, aiding recognition of the broad individual and socio-environmental

determinants of health and identifying upstream approaches to the problem. However, it

is also very clear that there is a significant amount of cross-over of interventions within

the health promotion action areas which demonstrates how closely intertwined all areas

of health promotion action can be.

15

7: Appendix A

Framework for Health Promotion Action – template.

Downstream Midstream Upstream

Individual Focus → → → → Population Focus

Disease Prevention Communication

Strategies

Health Education

and

Empowerment

Community and

Health

Development

Infrastructure

and Systems

Changes

Primary Care

Approaches

Lifestyle/

behavourist

Approaches

Socio-ecological

Approaches

16

Source: Modified from Keleher and Murphy, (2004) and cited in James Cook University (2013), Module 5,

page 9.

8: References

Amnesty International. (2006). Papua New Guinea: Violence Against Women: Not

Inevitable, Never Acceptable. Retrieved from

http://www.amnesty.org/en/library/info/ASA34/002/2006/en

Bradley, C. (2001). Family and Sexual Violence in Papua New Guinea: An integrated

long term strategy. Report to the Family Violence Action Committee of the

Consultative Implementation and Monitoring Council. Port Moresby, Papua New

Guinea: Institute of National Affairs.

Callister, L.C. (2012). Childbearing Women and Intimate Partner Violence. American

Journal of Maternal Child Nursing 37(4), 275.

doi:10.1097/NMC.0b013e318254aac2

Campbell, J.C., Moracco, K.E., & Saltzman, L.E. (2000). Future directions for violence

against women and reproductive health: Science, prevention and action.

Maternal and Child Health Journal 4(2), 149-154.

Centre for Reproductive Rights. (2008). The World’s Abortion Laws Factsheet.

Retrieved from http://awro.uneca.org/downloads/World%20Abortion%20Laws

%20Fact%20Sheet%202008.pdf

Devine, S.G., Muller, R., & Carter, A. (2008). Using the Framework for Health Promotion

Action to address staff perceptions of occupational health and safety at a

fly-in/fly-out mine in north-west Queensland. Health Promotion Journal of

Australia, 19, 196-202.

17

Garcia-Moreno, C., Jansen, H., Ellsberg, M., Heise, L., & Watts, C. (2005). WHO Multi-

country Study on Women’s Health and Domestic Violence against Women. Initial

results on prevalence, health outcomes and women’s responses. Retrieved from

http://whqlibdoc.who.int/publications/2005/924159358X_eng.pdf

James Cook University. (2013). TM5528 Health Promotion. Module 5. Queensland,

Australia: James Cook University.

Jewkes, R., Dunkle, K., Nduna, M., & Shai, N. (2010). Intimate partner violence,

relationship power inequity, and incidence of HIV infection in young women in

South Africa: a cohort study. Lancet, 376, 41–48.

King, E., & Lupiwa, T. (2010). A systematic literature review of HIV and AIDS research

in Papua New Guinea 2007-2008. Retrieved from

http://www.nacs.org.pg/resources/documents/Systematic_Literature_Review_of_

HIV_and_AIDS.pdf.

Magnussen, L., Shoultz, J., Hansen, K., Sapolu, M., & Samifua, M. (2008). Intimate

Partner Violence: Perceptions of Samoan Women. Journal of Community Health,

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Mahapatro, M., Gupta, R.N., Gupta, V., & Kundu, A.S. (2011). Domestic Violence

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Mays, G., Smith, S., Ingram, R., Racster, L., Lambert, C., & Lovely, E. (2009). Public

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American Journal of Preventive Medicine, 36 (3), 256-265.

Medecins Sans Frontieres. (2009). Shattered Lives. Immediate medical care vital for

sexual violence victims. Retrieved from

18

http://www.msf.org.uk/sites/uk/files/Shattered_lives_2nd_Ed_June_2009_200907

153112.pdf

Medecins Sans Frontieres. (2011). Hidden and neglected: the medical and emotional

needs of survivors of family and sexual violence in Papua New Guinea.

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neglected

Oliveira-Cruz, V., Hanson, K., & Mills, A. (2003). Approaches to overcoming constraints

to effective health care service delivery: A review of the evidence. Journal of

International Development, 15 (1), 41-65.

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Parsons, L., Goodwin, M.M., & Peterson, R. (2000). Violence against women and

reproductive health: toward defining a role for reproductive health care services.

Maternal and Child Health Care Journal, 4(2), 135-140.

State Government of Victoria (2012). Integrated health promotion: A practice guide for

service providers. Retrieved from:

http://docs.health.vic.gov.au/docs/doc/8196B97B654C907BCA257A7F001DF6E

4/$FILE/integrated_health_promo.pdf

Storey, D. (2010). Urban Poverty in Papua New Guinea. Discussion Paper 109. Port

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description of a cluster randomised trial of mentor mother support to reduce

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19

United Nations. (2006). Ending violence against women: From words to action. Study of

the Secretary General. Retrieved from:

http://www.un.org/womenwatch/daw/vaw/launch/english/v.a.w-exeE-use.pdf.

Vakili, M., Nadrian, H., Fathipoor, M., Boniadi, F., & Morowatisharifabad, M. (2010).

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against women. Taking action and generating evidence. Retrieved from:

http://apps.who.int/iris/bitstream/10665/44350/1/9789241564007_eng.pdf

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http://www.wpro.who.int/NR/rdonlyres/11EE7BCC-0C36-4B66-A6E3-

8075333E34E5/0/29PapuaNewGuinea2009.pdf.

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women. Intimate Partner Violence. Retrieved from:

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http://www.who.int/reproductivehealth/publications/violence/rhr12_36/en/

index.html

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