Managing violence against women is a significant public health issue for any target population. Violence against women is a primary public health issue and violates human rights. Globally, World Health Organization indicated that 1 in 3 (30 %) women are subjected to violence in their life (WHO, 2021). Most of the violence against women is caused by the intimate partner. It is estimated that 27 % of women between 15 and 49 reported being harrassed sexually and physically by their love partners (WHO, 2021). Such violence can affect women’s sexual, mental, physical, and reproductive health and might increase the risk of acquiring HIV in some circumstances. Violence against women is preventable. The health sector has an essential role in offering comprehensive health care to women subjected to violence and an entry point for referring females to other support services they might need.

In Sao Paulo, Brazil, the issue of violence against women is increasing. UN report shows that violence against women in Brazil increased by an alarming rate of 54 % between 2003 and 2013 (SIPA, 2018). At the same time, a broad range of initiatives has been introduced in Brazil from 2006 to 2017. However, most of the established interventions failed to address the issue of violence against women. However, even with the increased interventions, the UN report published that Brazilian states still experience substantial increases in the cases of violence against women. The problem is that most of the violence against women is committed by individuals known by the victims. The perpetrators are usually family members or former or present intimate partners making victims feel guilty to report the cases. At the same time, marginalized communities such as those living in Sao Paulo and other low-income areas are rarely targeted by public efforts to stop violence against women. The situation continues to be worse since the political climate of Brazil has had a substantial impact on organizations working to stop violence against women. For instance, the political crisis that initiated the 2015-2016 impeachment of President Dilma Rousseff led to negative consequences for organizations working to combat violence against women. The 2016 change in presidential administration led to the National Secretariat of Policies for Women to lose its status in the ministry and portion of funding for combatting violence against women. This issue calls for more interventions, particularly those empowering the health sector to fight violence against women.

Proposed Intervention

Violence against women is preventable through the establishment of interventions to initiate change. Education and training are vital interventions to combat violence against women in Brazil. Considering this intervention, existing hospital staff in a large hospital in Sao Paolo, Brazil, were trained to identify and give feedback regarding violence against women among those in inpatient and outpatient consultations in the hospital. The intervention developed protocols for documentation of abuse, collection of evidence, medical support, and the provision of information about local support services. Informational materials such as posters to raise awareness and signposts to support were made available throughout the hospital.

The Model of Health Improvement That Might Underpin the Intervention

A multisectoral model is a valuable tool as it engages all the stakeholders in prevention and response against violence against women (United Nations, 2011). Programming experiences from the multisectoral model reveal that no single agency or sector can efficiently address violence against women. Accordingly, health workers alone cannot reduce violence against women. The multisectoral model allows a holistic inter-agency and inter-organizational aimed at promoting the participation of the victims. Also, the program focuses on organizational, interdisciplinary cooperation, coordination, and collaboration across significant sectors. These key sectors include justice/legal, security, psychosocial, and health. Sectors comprise all agencies, institutions, individuals, and resources targeted towards a particular objective. Therefore, this model involves sectors such as health care training institutions, health care administrators, health care providers, health care centers, and the ministry of health.

The model openly highlights duties that are unique to every sector. Members of the health sector should understand this special role in enhancing a multisectoral framework and develop a basic understanding of other essential industries’ key duties and accountabilities.

The health sector must train hospital workers across various health services to realize and address violence against women. The hospital workers are needed to ensure same-sex interviewers for those exposed to violence. This model requires hospital workers to respond to the exposed women’s immediate psychological and health needs.

The ecological model moves from individual responses to social change. The model is a primary prevention method, providing a way of understanding some of the significant factors contributing to women’s risk of violence. The ecological model is arranged in four risk levels, individuals, relationships, community, and society. The environmental model highlights the essence of understanding the multifaceted interaction of cultural, social, physiological, biological, economic, and political factors that increase women’s likelihood of facing violence.

This model highlights that if the health sector effectively implements violence prevention and response plans, it will have to consider all the factors that contribute to its execution and establish approaches for identifying and caring for the women at risk through a broad-based prevention plan. Applying the ecological model can help health workers shift from individualistic, bio-medical orientation to service delivery to a more holistic method to health intervention that targets individual health needs and addresses the requirements for social change. The model proposes various measures, including safety planning institute protocols for treatment, referral, and documentation that warrants confidentiality. It is also essential for health workers to provide forensic evidence and testimony in court when authorized by the individual.

For the psychosocial sector, the model requires hospital workers to offer immediate support, provide information about the women’s rights, seek recourse if they desire, and support ongoing psychosocial assistance. All these approaches require training and constant supervision of health workers. Income generation and education should be considered under the umbrella of the psychosocial plan within the model.

The justice/ legal sector must offer exposed women free legal representation, counseling, and other court assistance. It is essential to enforce regulations that protect women and punish perpetrators, monitor reported cases and court processes, offer order of protection and other safety mechanisms for survivors, and monitor perpetrators.

In the security sector, essential departments such as the military, police, and other security personnel must be educated about violence against women and be trained to intervene in the arising cases suitably. The security personnel should have private rooms to promote confidentiality and safety of survivors reporting victimization support same-sex interviewers and referrals.

Some of the crosscutting roles of every sector include community engagement and training, confidentiality, and safe data collection, monitoring, and evaluation. Another crucial aspect is intra and intersectoral coordination, including generating and monitoring reporting and referral networks, information sharing, and regular meetings with representatives from various sectors.

A primary principle underlying the multisectoral model is that the needs and rights of survivors are pre-eminent in terms of access to supportive and respective services. All agencies must work collaboratively with local women groups. Women should involve from the beginning of plan design and maintain active roles throughout the model.

Advantages and Disadvantages of Using this Particular Theory or Model


Training is essential in the management of violence against women. Training hospital workers in specific offers a solid knowledge of activating and initiating assistance routes for victims at all levels. At the same time, victims tend to seek help from hospitals more easily than from legal administrations and security forces. Therefore, training hospital workers is advantageous for managing violence against women.


During intervention development, restricted mobility, victims’ inability to obtain essential resources combined with their diminished decision-making power within the household might be significant obstacles to the intervention. In other words, women are characterized by low economic statuses that hinder them from participating fully in the intervention approaches.

Universal Approach the Intervention Takes a Targeted Approach

Training hospital workers in Sao Paolo, Brazil, means that the intervention only targets women living in Sao Paulo. The advantage of having a targeted approach is that working with a small population might make the intervention effective. However, the disadvantage is that supportive model such as the multisectoral model draw from a coordinated community response to domestic violence simulations. Generally, the model is the equivalent of applying a coordinated community response at the national level or globally. Accordingly, it will be hard to support an intervention that focuses on a targeted approach.

The Intervention Takes a Secondary Prevention Approach

            The intervention takes a secondary prevention approach. The intervention empowers hospital workers in Sao Paulo to act as change agents. This approach is practical since hospital workers are closer to the victims. Affected women seek help more from health facilities than security personnel.

Assessment of the Intervention

How the Intervention Might Health Inequalities

Training of the health workers will influence the victims’ comfort and levels of disclosure. Consequently, the hospital workers will find a space to transfer their skills to victims. Through training intervention, the hospital in Sao Paulo will address all forms of violence against women. Significantly, the training emphasized the need for supporting same-sex interviewers to avoid cases of stigmatization. This approach means that the intervention will increase the chances of more victims seeking help from hospitals. The reason is that victims will feel more secure to be interviewed by a fellow woman than men, who are mostly the perpetrators. Accordingly, the intervention will reduce the health inequality within Sao Paulo.

Routine Data for Evaluating this Intervention and Possible Limitations

Evaluation is essential to check the efficiency of any intervention. In this case, this intervention aims at supporting hospital workers to manage violence against women. Since the intervention focuses on the education and training of hospital workers, the evaluation process should identify data on the number of assisted cases. A critical outcome of the intervention should be an increased number of victims seeking help. If the number of victims seeking assistance continues to reduce and at the same time there are reported cases of violence, the evaluators might describe the intervention as ineffective. Additionally, women at risk in the region should be assessed to determine whether they are aware of the collection of evidence, protocols for documentation of abuse, medical support, and the provision of information about a local support service developed in the hospital. Increased levels of awareness will indicate efficient adoption of the intervention.

Political Factors that can Affect Implementation of the Intervention

Structural adjustment policies established by governments and international institutions have disproportionately affected women. Politics have led to displacement and internal strife (Ohman et al., 2020). A lack of political will to build a political plan for change that privileges women’s interests is a primary barrier to implementing change. Political agenda need to look to transform gender and social power relations. Gender equality and law are essential for all work in the public sector to reduce violence against women. The way policies are framed and articulated has consequences for solving the issue of violence against women. In situations where the policy process is not straightforward, suggested intervention might lead to new and unintended issues. Also, political issues are not merely pre-existing outside the policymaking process but are constructed within policy processes. Laws and policies on violence against women can be affected by different competing discourses regarding causes and possible solutions. Rules and procedures that might appear somewhat similar could become fundamentally different, relying on how an issue is framed, named, and made meaningful. Broad struggles are expected when developing the understanding of the issue or finding the most suitable intervention and its implications for the health care sector’s responsiveness. Similarly, this issue leads to different consequences for victims exposed to violence.

Economic Factors that can Affect implementation

Building women’s economic independence while working with both males and females to strengthen an equal and respectful relationship is essential in supporting the intervention (Unidas and Data-pop Alliance, 2021). However, several economic factors affect the implementation of the intervention. Significantly, economic shocks lead to financial dependence and other obstacles to escape violence against women. Women are underrepresented in the economic and other vital sectors. Economical, few women participate in business and organization activities. Accordingly, women undergo financial hardships resulting from other social discrimination such as lack of education, unemployment, and discrimination. These economic factors restrict women from accessing help from trained personnel.

Economic policies play an essential role in enhancing the intervention’s adoption and success. Comprehensive and effective economic policies involving good infrastructure, including sufficient training resources, will support the implementation of the intervention. Economic power helps structural distinction based on sexual orientation, ethnicity, location, income, age, gender identity, and disability, among other characteristics that shape violence against women.

Social and Cultural Factors that can Affect implementation

Social and cultural norms encourage violence against women. The expectations or rules of behavior within a social and cultural group have encouraged violence in many situations (WHO, 2009). The cultural norms work to influence individual behaviors, including violence. In some communities, violence against women is culturally accepted as a traditional method of resolving conflicts or handling a woman as usual. In such communities, tolerance of violent behaviors is probably learned through corporal punishment and how society deals with a small girl. These cultural and social norms persist within a community because of acceptance. Other examples include traditional beliefs that men have the right to discipline or control women through physical means, which has increased women’s vulnerability in many social groups. This belief places women at risk of sexual, mental, and physical abuse.

These culturally accepted beliefs are barriers to any intervention to manage violence against women. Such cultural beliefs prevent the victims of violence from speaking out and gaining support. At the same time, the cultural norms make the victims of violence feel stigmatized inhibiting reporting.

Additionally, there is strong evidence of the relationship between alcohol consumption and violent behavior. This relationship means that social and cultural norms around the use of alcohol and the expected effects can significantly encourage and justify violent acts. Communities that tolerate higher levels of acute alcohol intoxication have reported a stronger connection between alcohol consumption and violence than those where moderately drinking is done. At the same time, alcohol-related violence against women is considered more likely in cultures where many people believe that alcohol plays an essential role by supporting individuals to shed their inhibitions. In such a culture, perpetrators could use alcohol to justify violent acts. Alcohol is even consumed to fuel the courage needed to commit violent acts. Therefore, interventions that do not consider the social and cultural norms can find it hard to prevent violence against women caused by culture.

What Ethical Considerations That the Intervention Raise

This intervention tends to prevent stigmatization and the ability of victims to seek help. Accordingly, the intervention ensures same-sex interviewers for women exposed to violence. Significantly, all these approaches aim to prevent abuse targeted at women. Any form of abuse is unethical and should be controlled by all means.


WHO. 2021. Violence against women. Accessible online at

WHO. 2009. Changing cultural and social norms that support violence. World Health Organization. Accessible online at

Unidas and Data-pop Alliance, 2021. Reporting and registering domestic violence against women and girls in Sao Paulo and Bogota. Accessible at

United Nations, 2011. Key theoretical models for building a comprehensive approach. Virtual Centre to end Violence against Women and Girls. Accessible online at

Ohman, A., Burman, M., Carbin, M., and Edin, K., 2020. ‘The public health turn on violence against women’: analyzing Swedish healthcare law, public health, and gender-equality policies. BMC public health, 20(1), pp.1-12.

SIPA, 2018. Violence against women in Brazil. Exploring the use of Twitter data to inform policy. Accessible online at

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