Barriers to routine screening for intimate partner violence in health care settings in Haiti

Background: Although many health professional organizations and practitioners endorse universal screening of clients for intimate partner violence (IPV), little is known about barriers to the practice in low-income countries.  This study examined barriers to IPV universal screening among health care providers, female clients and community members in the Department of Artibonite, Haiti. 

Methods: Semi-structured face-to-face in-depth interviews were conducted with 41 health care providers and 43 female clients  in family planning/reproductive health services in six health facilities, and  21 community members.  The sampling design was purposeful and included a mix of education and age groups.  Transcripts were analyzed using NVivo version 10.

Results: More than half of the participants supported a policy of routine screening for IPV in health care settings. Four categories of IPV-screening barriers were identified: provider, health system, community, and patient. Provider-related barriers included fear of offending or stigmatizing patients, concern for personal and patient safety, fear of unintended psychological impacts of disclosure on victims, and lack of basic training in routine screening and counseling of violence victims.  Health system-related barriers included lack of tools and materials for conducting routine screening.  Community- and client-related barriers included the culture of silence around and lack of knowledge of IPV, privacy and confidentiality concerns, women’s economic dependence on male partners, lack of services for victims and punishment of perpetrators, embarassment, shame, humiliation, fear, and attitudes.

Conclusions: Barriers to IPV screening were numerous. Community awareness raising and health care provider training are necessary to improve the health care response to IPV.