Domestic Violence Attitudes and Culturally Appropriate Prevention in Pakistan

Intimate partner violence (IPV) is a pervasive global health problem and a major source of physical injury and psychological harm to women. It is also increasingly recognized as a significant determinant of poor developmental outcomes among children who witness IPV in early childhood or who are exposed in utero, and pregnancy has been demonstrated to be a period of increased vulnerability to IPV. Prevalence of IPV in Pakistan, as elsewhere in the region, is high yet it is understudied and interventions to prevent or respond to IPV are extremely limited. This project seeks to address the dearth of even formative knowledge needed to provide the basis for effective IPV prevention in this context. Using a rigorous mixed-methods approach, this project will conduct exploratory research designed to a) measure attitudes and perceived norms regarding IPV among male and female community members and female community health workers and b) explore potential culturally-appropriate IPV prevention strategies, including a health-focused intervention targeted at pregnant women and their families and administered through the community health worker infrastructure. Building on a successful collaboration between Columbia University, Duke University, and the Human Development Research Foundation (HDRF) in Islamabad, Pakistan, this project will also have as a key objective the development of capacity within this team, and at HDRF specifically, to conduct in-depth research on the topic of IPV, to develop insights regarding the potential for effective prevention efforts through the extant health care system, and to lay the foundation for successful application for a R01 proposal to formally test the intervention strategies expected to emerge from this project. The combination of exploratory qualitative investigation (focus group discussions) and robust quantitative assessment (individual surveys) using novel instrumentation will enable this project to elicit and better understand both perceptions of and actual IPV attitudes of community members and health workers. It will also facilitate an understanding of the perceived barriers to and opportunities for community-based IPV prevention strategies in rural Pakistan, with relevance for other, comparable settings in which patriarchal norms are still strongly entrenched and programmatic attention to IPV is historically limited.