Domestic violence against women, public policies and community health workers in Brazilian Primary Health Care.

Marcos Claudio Signorelli,Angela Taft,Pedro Paulo Gomes Pereira

doi:10.1590/1413-81232018231.16562015

Abstract

Domestic violence creates multiple harms for women's health and is a 'wicked problem' for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system.

Highlights

The World Health Organization (WHO) estimates that worldwide one in three women is or has been a victim of domestic violence (DV)[1], generating major challenges for health care systems
This study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy
Within the framework of these recent policies and practices, this study aimed through ethnographic qualitative research within one specific Basic Health Unit (BHU) to describe the intersections between federal policies, the SUS, and professionals who care for women living with DV in PHC settings

Summary

Introduction

The World Health Organization (WHO) estimates that worldwide one in three women is or has been a victim of domestic violence (DV)[1], generating major challenges for health care systems. DV results in significant harms to women’s health[4] and many women seek care in the Brazilian Public Health System, named ‘SUS’ (Sistema Único de Saúde). Similar to women globally, because of the many known barriers to women’s disclosure, they usually do not disclose the cause of their injuries[5,6]. To understand DV against women, the concept of gender is essential, referred in this article as described by Joan Scott[9], who proposes gender as a constitutive element of social relationships built on perceived differences between the sexes, as a primary way to give meaning to relations of power

Objectives

Methods

Results