Confronting intimate partner violence: a global health priority.

Intimate partner violence--physical, psychological, or sexual abuse of women perpetrated by intimate partners--is one of the most common forms of violence against women, and is associated with adverse women's reproductive and maternal health outcomes. We review the opportunities for addressing intimate partner violence by the health system, examine promising approaches, and outline future challenges for developing effective health-systems responses to violence. Evidence shows that women seldom approach support services in response to violence, but do seek health care at some point in their lives. In fact, women's utilization of reproductive-health services in particular has been increasing globally. These services have a broad reach and represent an important opportunity to engage in violence prevention. Although health systems-based responses to intimate partner violence have emerged, rigorous evaluations to guide program planning and policy efforts to reduce violence are limited. Programs in the United States have expanded from improving individual provider prevention practices to instituting system-wide changes to ensure sustainability of these practices. Developing-country program responses, though limited, have been system-wide and multisectoral right from the start. Our review highlights 3 challenges for developing and expanding health-systems responses to violence. First, interventions should focus on creating a supportive environment within the health system and strengthening linkages across health care and allied sectors. Second, rigorous evaluations of health sector-based interventions are needed for a sound evidence base to guide programmatic and policy decisions. Finally, research is needed to identify the entry points for engaging men on violence prevention, and to examine the feasibility and effectiveness of such interventions.