Health Services for Gender-Based Violence: Médecins Sans Frontières Experience Caring for Survivors in Urban Papua New Guinea

BACKGROUND: Levels of gender-based violence in Papua New Guinea (PNG) are high; health services for survivors are limited. Evidence from the few existing health services for survivors can inform improvements in care in this and similar settings. METHODS: Médecins Sans Frontières supported health services for survivors in Lae, PNG from 2008-2013. Routine monitoring data from August 2010-April 2013 were used to describe patient and service characteristics. RESULTS: 5,892 individuals received care over 6,860 presentations, the majority self-referred or referred by friends and family. Presentations were attributed to intimate partner violence(62%), non-partner sexual violence(15%), other forms of violence(3%), and past (but not current) violence(21%). 97% were female; an estimated 4.9% (95%CI:4.8-5.0%) of females resident in the catchment area presented to the programme during the 2.8years analysed. Of presentations for non-partner sexual violence, 79% knew their abuser and 50% were children <16 years. 92% of presentations reporting current violence received medical treatment for injuries. The majority of patients who received multiple counselling sessions reported improved functioning and decreased severity of psycho-social complaints. CONCLUSIONS: Community awareness of the availability of free, best-practice, accessible, confidential medical and counselling services for sexual and gender-based violence in Lae, PNG resulted in many survivors presenting for care. High levels of ongoing intimate partner violence and child sexual abuse by known abusers indicates that alongside comprehensive medical care, access to effective services in non-health sectors such as policing, protection and legal services are needed if survivors are to escape the cycle of violence

Health Services for Gender-Based Violence: Médecins Sans Frontières Experience Caring for Survivors in Urban Papua New Guinea.

Levels of gender-based violence in Papua New Guinea (PNG) are high; health services for survivors are limited. Evidence from the few existing health services for survivors can inform improvements in care in this and similar settings.Médecins Sans Frontières supported health services for survivors in Lae, PNG from 2008-2013. Routine monitoring data from August 2010-April 2013 were used to describe patient and service characteristics.5,892 individuals received care over 6,860 presentations, the majority self-referred or referred by friends and family. Presentations were attributed to intimate partner violence(62%), non-partner sexual violence(15%), other forms of violence(3%), and past (but not current) violence(21%). 97% were female; an estimated 4.9% (95%CI:4.8-5.0%) of females resident in the catchment area presented to the programme during the 2.8years analysed. Of presentations for non-partner sexual violence, 79% knew their abuser and 50% were children <16 years. 92% of presentations reporting current violence received medical treatment for injuries. The majority of patients who received multiple counselling sessions reported improved functioning and decreased severity of psycho-social complaints.Community awareness of the availability of free, best-practice, accessible, confidential medical and counselling services for sexual and gender-based violence in Lae, PNG resulted in many survivors presenting for care. High levels of ongoing intimate partner violence and child sexual abuse by known abusers indicates that alongside comprehensive medical care, access to effective services in non-health sectors such as policing, protection and legal services are needed if survivors are to escape the cycle of violence

Number of counselling sessions and change in functional capacity and severity of presenting complaint, by type of precipitating event, for presentations by patients over 16 years receiving counselling August 2010 to April 2013.

<p>Number of counselling sessions and change in functional capacity and severity of presenting complaint, by type of precipitating event, for presentations by patients over 16 years receiving counselling August 2010 to April 2013.</p

Characteristics of presentations, by type of violence, for presentations August 2010 to April 2013.

<p>Characteristics of presentations, by type of violence, for presentations August 2010 to April 2013.</p

Characteristics of non-partner sexual violence, by age group, for presentations August 2010 to April 2013.

<p>Characteristics of non-partner sexual violence, by age group, for presentations August 2010 to April 2013.</p

Factors associated with presenting more than once vs once, for presentations associated with intimate partner violence or non-partner sexual violence.^†

<p>^† Patients presenting more than once since Jan 2008, for those presentations from Aug 2010 to April 2013 to the FSC. *Multiple variable analyses of presentations to the Family Support Centre adjusted for age, sex, type of violence, type of medical care, source of referral, and year. Patients presenting for past violence were not included as data were not included on referral source. These analyses were conducted on the sample of 4,903 presentations with complete data on these variables. **Horizontal bars indicate 95% confidence intervals.</p

Proportion of female population presenting to programme at least once, by age group within the period August 2010-April 2013.

<p>Proportion of female population presenting to programme at least once, by age group within the period August 2010-April 2013.</p

Factors associated with presentation <72 hours vs ≥72 hours after sexual violence.

<p>* Multiple variable analyses of timely for presentations following sexual violence (both non-partner and intimate partner violence) adjusted for age, sex, first or repeat presentation, perpetrator, place of residence, source of referral, treatment facility, and year. These analyses were conducted on the sample of 1,355 presentations with complete data on these variables. **Horizontal bars indicate 95% confidence intervals.</p

Characteristics of medical care (excluding counselling care) provided, by type of violence (excludes past violence), for presentations August 2010 to April 2013.

<p>Characteristics of medical care (excluding counselling care) provided, by type of violence (excludes past violence), for presentations August 2010 to April 2013.</p