‘They just walk away’ – women’s perception of being silenced by antenatal health workers: a qualitative study on women survivors of domestic violence in Nepal

Figures & data

Table 1 Socio-demographic characteristics of the study participants (N=12)

Characteristics	n
Age (years)
20–30	5
30–40	6
>40	1
Educational status
No education	6
Did not complete high school	1
Completed high school	3
Graduate or higher	2
Employment status
Currently employed	8
Unemployed	4
Age at marriage (years)
≤16	6
>16	6
Number of ANC
<4	4
>4	8
Acts of DV experienced during pregnancy
Beating; hitting	8
Insults; accusation (seeing another man, being a thief, sleeping with husband's friend, not having children); use of obscene language	12
Sexual violence	3
Infidelity	3
Dowry-related violence	1
Neglect; made to do heavy work	4
Economic violence	5
Perpetrators of DV
Husband	11
Ex-husband	3
Mother in law	5
Father in law	2
Other in laws	4

Table 2 Experiences of domestic violence by women

‘… he [my husband] was a drug addict … he did not earn [money] … we had nothing to eat. We had to sleep on the floor … we had only one mattress. He would be away many days, and he came home drunk. He always had his friend at home … we [I, my husband and his friend] had to share the same mattress. His friend forced me for that [to have sex with him]. The next morning, my husband scolded me and beat me because I slept with his friend … One day, I got pregnant with his [husband's] child. His friends would insult me and say that even they [his friends] have share in my baby … I felt very bad [crying]. One day my husband came home after many days … drunk. I asked for money [to pay the rent] … he asked me for food. I had not cooked anything [because I had nothing at home] … I had not eaten for many days … and we started fighting. He hit me very hard and pushed me. I fell on the basin full of water and pots and pans. I started bleeding … he was afraid that I was bleeding and took me to the hospital’. [Interview 3]

Table 3 Interview guide for in-depth interviews

1. Introduction
2. Marriage/relationship with husband. Probing questions for follow-up information: occupation of the husband, how they met, married life, violence (insulted, shouted, threatened, hit, kicked, slapped, forced to sexual activity)
3. Relationship with the in-laws. Probing questions about violence, ask precise questions about the violence [type, severity, frequency?]
4. Pregnancy. Probing questions: how they felt [physical and emotional health?], place of delivery, antenatal checkups, violence during pregnancy
5. Disclosure about experience(s) of violence. Probing questions: who knew about the violence? Whom did you tell? Did you tell anyone at the health center? How did they respond? Their expectations from the antenatal care providers
6. Recommendations to help improve the quality of care for women who have experienced domestic violence during pregnancy and who come for antenatal care

Table 4 Example of content analysis

Meaning units	Condensed meaning units	Codes	Subcategories	Categories
No, I would not have told them (about abuse). I told you because you seem to understand my pain and you also want to get information from me. Others will think that I am useless and they start judging me, don't they? One has to understand, what pain people can experience, how a person's fate will be	If one does not understand the pain and starts judging women, you do not want to disclose	Judgment as a barrier to disclosure	Barrier to disclosure of domestic violence
There (hospital) health care provider's started telling in the emergency that my case might be a police case if I would tell them that I had been beaten, so I told them that I fell from the ladder while I was carrying a tub and to call the doctor. I felt that if it would been a police case, I would be left alone and I would not have any place to go on top of that I was pregnant, (crying) so I did not tell anyone	Did not disclose and lied about the violence due to fear of being alone if it would become a police case	Concealment of domestic violence due to fear of being alone during the pregnancy	Concealment of domestic violence	Enduring domestic violence – a hidden burden

Table 5 How women with domestic violence evaluate their antenatal care?

1. Enduring domestic violence – a hidden burden
• Concealment
• Barriers to disclosure
2. All we need is an opportunity
• Routine enquiry
• Support focused on women
Other support for family members
3. Making a bad thing worse
• Neglect
• Emotional abuse
• Physical abuse