HEALTH SYSTEM READINESS TO ADDRESS THE NEEDS OF SURVIVORS OF DOMESTIC AND SEXUALIZED VIOLENCE DURING AND BEYOND PREGNANCY: A MIXED-METHODS STUDY OF SURVIVORS AND REPRODUCTIVE HEALTHCARE PROVIDERS IN NOVA SCOTIA, CANADA

Abstract

Background: Intimate partner violence, the most common form of violence against women, was declared an epidemic in Nova Scotia in September 2024. The perinatal period is a time of heightened vulnerability to IPV and its health impacts, making reproductive healthcare (RHC) an opportune intervention point. However, the capacity to manage VAW across RHC in Nova Scotia is unknown. Objectives: (1) To describe the health status, experiences of violence, and characteristics of service access among survivors of domestic and sexualized violence (DV/SV) with recent pregnancies across Eastern Canada, and (2) to describe the readiness (including knowledge, opinions, and practices) of RHC professionals (RHCPs) in Nova Scotia to manage DV/SV. Methods: This convergent mixed-methods study used data from The Interprovincial Violence Against Women Project, which conducted online surveys with survivors who sought supportive services since the onset of the COVID-19 pandemic in March 2020 and health professionals working across Nova Scotia. Two study samples and subsamples were included in the present study: (1) 188 survivors, including 63 survivors with recent pregnancies; and (2) 1,649 healthcare providers, including 206 RHCPs. I descriptively analyzed quantitative data, applied reflexive thematic analysis to qualitative data, and then integrated each strand to address each of my objectives. Results: Survivors with recent pregnancies reported increased exposure to physical IPV and substantial barriers to care, including fear of police and child protective services, which were expanded upon in the first qualitative theme “control exerted by justice-related bodies.” They often reported chronic illness and heightened vulnerability to physical IPV, which the second qualitative theme, “the impact of COVID-19 restrictions on survivor-mothers” demonstrated were intensified during the COVID-19 pandemic. RHCPs reported limited preparedness to assess the safety of a survivor’s child, which contrasted the third theme, “centering the family and child impacts of DV”, where child safety was highlighted as a priority of their role. Lastly, they also reported a limited capacity to address DV/SV among patients, which the final qualitative theme “responding to perinatal DV/SV through a trauma-informed lens” contextualized as a lack of capacity to provide trauma and violence-informed care, a key strategy used by RHCPs to address DV/SV. Conclusions: This thesis is the first Canadian mixed-methods study to investigate both the needs of perinatal survivors and the capacity of RHC to attend to these needs. Findings reinforce the unique needs of survivors in and around pregnancy, including experiences of more severe intimate partner violence and considerable barriers to care, often centred around inadequate childcare support and fear of justice involvement. RHC should adapt intervention strategies for addressing DV/SV among patients that attends to these unique needs, including tailored training for providers and appropriate resourcing for safe and effective identification and response, including referral supports.