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Guideline

Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines

Year of Publication
2013
Issuing Institution
World Health Organization
Links
WHO IRIS

Recommendations

33 included recommendations

Women who disclose any form of violence by an intimate partner (or other family member) or sexual assault by any perpetrator should be offered immediate support. Health-care providers should, as a minimum, offer firstline support when women disclose violence. First-line support includes: • being non-judgemental and supportive and validating what the woman is saying • providing practical care and support that responds to her concerns, but does not intrude • asking about her history of violence, listening carefully, but not pressuring her to talk (care should be taken when discussing sensitive topics when interpreters are involved) • helping her access information about resources, including legal and other services that she might think helpful • assisting her to increase safety for herself and her children, where needed • providing or mobilizing social support. Providers should ensure: • that the consultation is conducted in private • confidentiality, while informing women of the limits of confidentiality (e.g. when there is mandatory reporting) f health-care providers are unable to provide firstline support, they should ensure that someone else (within their health-care setting or another that is easily accessible) is immediately available to do so

Status
Maintained

Recommended in favor

Strong

(Interventions during the first 5 days after the assault) Offer first-line support to women survivors of sexual assault by any perpetrator which includes: • providing practical care and support, which responds to her concerns, but does not intrude on her autonomy • listening without pressuring her to respond or disclose information • offering comfort and help to alleviate or reduce her anxiety • offering information, and helping her to connect to services and social supports

Status
New

Recommended in favor

Strong

(Women survivors of sexual assault, Interventions during the first 5 days after the assault) Health-care providers should offer levonorgestrel, if available. A single dose of 1.5 mg is recommended, since it is as effective as two doses of 0.75 mg given 12–24 hours apart. If levonorgestrel is NOT available, the combined oestrogen–progestogen regimen may be offered, along with anti-emetics if available. If oral emergency contraception is not available and it is feasible, copper-bearing intrauterine devices (IUDs) may be offered to women seeking ongoing pregnancy prevention. Taking into account the risk of sexually transmitted infections (STIs), the IUD may be inserted up to 5 days after sexual assault for those who are medically eligible

Status
New

Recommended in favor

Strong

(Women survivors of sexual assault, Interventions during the first 5 days after the assault) Discuss HIV risk to determine use of HIV post-exposure prophylaxis (PEP) with the survivor, including: • HIV prevalence in the geographic area • limitations of PEP • the HIV status and characteristics of the perpetrator if known • assault characteristics, including the number of perpetrators • side-effects of the antiretroviral drugs used in the PEP regimen • the likelihood of HIV transmission.

Status
New

Recommended in favor

Strong

(Women survivors of sexual assault, Interventions during the first 5 days after the assault) If HIV post-exposure prophylaxis (PEP) is used: • start the regimen as soon as possible and before 72 hours • provide HIV testing and counselling at the initial consultation • ensure patient follow-up at regular intervals • two-drug regimens (using a fixed dose combination) are generally preferred over three-drug regimens, prioritizing drugs with fewer side-effects • the choice of drug and regimens should follow national guidance

Status
New

Recommended in favor

Strong

(Women survivors of sexual assault, Interventions during the first 5 days after the assault) Offer support and care as described in recommendation 10 (Offer first-line support to women survivors of sexual assault by any perpetrator, which includes: • providing practical care and support, which responds to her concerns, but does not intrude on her autonomy • listening without pressuring her to respond or disclose information • offering comfort and help to alleviate or reduce her anxiety • offering information, and helping her to connect to services and social supports)

Status
New

Recommended in favor

Strong

(Women survivors of sexual assault, Interventions up to 3 months post-trauma) Continue to offer support and care as described in recommendation 10 (Offer first-line support to women survivors of sexual assault by any perpetrator, which includes: • providing practical care and support, which responds to her concerns, but does not intrude on her autonomy • listening without pressuring her to respond or disclose information • offering comfort and help to alleviate or reduce her anxiety • offering information, and helping her to connect to services and social supports)

Status
New

Recommended in favor

Strong

(Women survivors of sexual assault, Interventions up to 3 months post-trauma) Unless the person is depressed, has alcohol or drug use problems, psychotic symptoms, is suicidal or selfharming, or has difficulties functioning in day-to-day tasks, apply “watchful waiting” for 1–3 months after the event. Watchful waiting involves explaining to the woman that she is likely to improve over time, and offering the option to come back for further support by making regular follow-up appointments

Status
New

Recommended in favor

Strong

Health-care providers offering care to women should receive in-service training, ensuring it: • enables them to provide first-line support • teaches them appropriate skills, including: – when and how to enquire – the best way to respond to women (refer to sections 2 Identification and care for survivors of intimate partner violence and 3, Clinical care for survivors of sexual assault) – how to conduct forensic evidence collection where appropriatea • addresses: – basic knowledge about violence, including laws that are relevant to victims of intimate partner violence and sexual violence – knowledge of existing services that may offer support to survivors of intimate partner violence and sexual violence (this could be in the form of a directory of community services) – inappropriate attitudes among health-care providers (e.g. blaming women for the violence, expecting them to leave, etc.), as well as their own experiences of partner and sexual violence

Status
Maintained

Recommended in favor

Strong