Title: Access to health services by women subjected to violence: findings from administrative
healthcare data from the metropolitan area of northern Italy
Version: 3 Date: 26 Nov 2024
Reviewer's report:
The text is very well-documented, presented, and structured in its initial part, leaving no room for
criticism. On the contrary, compliments are due for the clarity, organization, and straightforward
yet highly focused presentation. It is rare to come across articles that are so linear and well-
articulated.
However, I have concerns regarding the second part of the manuscript, which is the reason I
recommend major revisions. That said, I also suggest that the authors could simply address my
comments for a potential subsequent round of revisions, should the Editor deem it appropriate
in light of my feedback.
The discussion, in general, appears somewhat unfocused, as if it diverges from the results, which
are, instead, highly compelling and merit a thorough presentation and critical examination.
First and foremost, the socioeconomic stratification needs to be addressed, as it represents
a particularly intriguing aspect that ties directly to the overarching theme of gender-based
violence. This stratification underscores why those who experience such violence often face
multi-level vulnerabilities.
Moreover, gender-based violence manifests differently across social classes. As correctly
presented in the manuscript, physical violence is merely the visible and "easily studyable" tip
of the iceberg, particularly when its consequences can no longer be concealed. This perspective
could be expanded to emphasize the intersection between socioeconomic disparities and the
patterns or types of violence experienced, shedding light on how these dynamics contribute to
the broader systemic challenges surrounding this issue.
I believe this topic warrants further exploration, including a search for references in the
literature, extending beyond the narrow confines of biomedicine. Addressing this aspect would
enrich the discussion, offering a multidisciplinary perspective that incorporates insights from
social sciences, public health, and perhaps even economics. Such an approach would better
contextualize the findings and highlight the complex interplay between socioeconomic factors
and gender-based violence, ultimately strengthening the manuscript’s contribution to the field.
Secondly, the issue of the overrepresentation of foreign women deserves more attention. I
would have expected a more detailed discussion on this, for instance, addressing barriers to
accessing services, the reliance on emergency departments as the primary point of contact rather
than on socio-assistance pathways, and the fact that foreign women, due to their multilayered
vulnerability, often resort to healthcare services only when absolutely necessary (and thus
in more severe cases). Additionally, is there also an overrepresentation of foreign women in
hospitalizations? This aspect could provide further insights into the severity of cases among this
group and highlight systemic gaps in preventive and support services.
This aspect seems particularly important given the strength of the results presented.
Finally, the issue of the support network is crucial. I would like to know more about how (or
if) the Lombardy healthcare system reflects on what to do once these women are identified
by the services. The very high percentage of discharges to home suggests that there may be
significant challenges in understanding these dynamics and in providing a coherent socio-
assistance response. Strengthening this discussion would add great value to the manuscript,
especially in terms of identifying gaps and proposing potential strategies for improving the
integration and effectiveness of healthcare and social services.