Support needs of survivors of violence against women in urban India: a prospective analysis of client records

Abstract

Background Violence against women harms individuals, communities, and society. Supporting survivors requires a combination of skills and resources and involvement of multiple institutions. We aimed to document the range of responses that a counselling service should be able to provide, based on direct experience of working with survivors predominantly from urban informal settlements. Methods At non-government counselling centres in Mumbai, we analysed unlinked electronic records collected by counsellors supporting survivors of violence. We examined how women knew of the services, how they described their concerns, what they said they expected, and what was provided. We quantified the proportions of clients who required crisis intervention, police action, legal input, and medical, psychological and psychiatric support. Results Counsellors met with 2278 women clients in 2019, almost half of whom had been encouraged to attend through community outreach. Clients described intimate partner violence (37%), domestic violence by a family member other than their partner (22%), or both (27%). Common forms of violence reported were emotional (88%), economic (73%), and physical (71%); 68% of clients reported episodes of neglect, 59% of coercive control, and 36% of sexual violence, while 77% had survived three or more forms of violence. Over a median seven consultations, 32% required crisis intervention, 31% home visits from counsellors, and 17% legal support; 13% saw a clinical psychologist, 7% were assisted in consulting the police, and 5% required medical care. Discussion Demand for services was substantial at 200 new clients each month. Key concerns for counsellors were coping with this heavy workload, skills in responding to women’s experience of multiple forms of violence and their desire to stay in relationships, skills in emotional support, ability to undertake and act on risk and mental health assessment, and effective engagement with health, police, and legal services. Future work Counsellors need to take a systematic approach to interacting with survivors of violence that covers all the considerations and activities needed in order of priority. We have developed a package of guidelines to meet this requirement, including trauma-informed counselling and mental health assessment and support (https://garima.snehamumbai.org/). Limitations The record system may have been subject to errors in data entry or systematic differences between counsellor choices, with the possibility of over- or under-identification of need and different counsellors’ propensities for and choices of referral. The spectrum of concerns relates to women residents of urban informal settlements, and we should be cautious about their application to other populations. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/47. A plain language summary of this research article is available on the NIHR Journals Library Website https://doi.org/10.3310/LKNH2423.