Title: Do health sector measures of violence against women at different levels of severity
correlate? Evidence from Brazil
Version: 1 Date: 10 Feb 2022
Reviewer's report:
The manuscript addresses a topic of relevance, especially in the context of Brazil and South and
Central America, and the Caribbean. However, it has some weaknesses:
1) In the Introduction there is no contextualization of the phenomenon of violence in Brazil or
even in South, Central America, and the Caribbean. The author uses a survey from the United
States as a reference. There are a number of particularities of data production that feed the
databases used by the author that are not addressed in the text, such as regional specificities that
often result in the low number of reports of interpersonal violence. I suggest reading the text
by Brazilian authors Stela Nazareth Meneghel and Ana Paula Portella – Femicides: concepts,
types, and scenarios (https://www.scielosp.org/article/csc/2017.v22n9/3077-3086/);
2) The lack of correlation pointed out in the text at the municipal level has already been discussed
in a study in Brazilian capitals and cities with large populations (see Stela Nazareth Meneghel
and authors in Femicides: a study in Brazilian state capital cities and large municipalities
available at https ://www.scielosp.org/pdf/csc/2017.v22n9/2963-2970/em).
3) A critical point of the manuscript is the fact that the reader does not know, at any time, the
population size of the municipalities where the analyzes were carried out if they are capitals of
federative units and which Brazilian region they belong to. Here, I repeat that the quality of the
information in Brazil is closely related to the robustness of the health services that carry out the
notification and there is a disparity when comparing municipalities and states in the north and
northeast and in the south and southeast of Brazil;
4) The author, in the Methodology, mentions the use of “The Hospital and Outpatient
Information Communication System (CIHA - System of Communication of Hospital and
Outpatient Information)”, would it be the Outpatient Information System (SIA)? There is no
health information system in Brazil with the acronym CIHA as far as I am aware;
5) The author states in relation to reports of interpersonal violence that “However, the follow-
through of contacting the police or social workers, for example, is only required for children and
elderly.”. This is not a rule because, again, it is important to understand which municipality we
are discussing. In some municipalities in Brazil, there are clear protocols that the notification to
the police must occur (the case of Curitiba, capital of the state of Paraná). Often this will depend
on the team of health professionals and the socio-cultural and geographical context.
6) The author states that “I divided the SINAN data into less severe and more severe reports. The
more severe reports were those from hospitals and emergency rooms while the less severe were
those reported by clinics and other establishments (eg. psychiatry or dentistry)”. This division
does not correspond exactly to reality, as a woman may have gone to the hospital and emergency
room due to the time and day of the incident (the service closest to her home may be closed
at night and on weekends). As the notification of interpersonal violence in Brazil is recent, it
does not make sense to give the example of a psychiatry or dentistry office, especially since
notifications are mostly made in hospitals, emergencies, and health units ("unidades basicas de
saude");
7) Regarding the selected municipal variables, the source of the information “if the municipality
has local police (in contrast to being policed solely by the military police)” was not clear. Does
the author refer to the municipal guard? Municipal guards are different from police officers.
8) In the conclusion the author states that “Less severe levels of violence are not yet widely
monitored.”. The statement is not true since SINAN exactly uses the notification of interpersonal
and self-inflicted violence to monitor all cases of violence, including those suspected and
unconfirmed, that is, the data available in the notifications of violence in SINAN may not have
occurred as the information indicated, as there is no investigation into the event.
Finally, I suggest that the author does not use the SINAN notification data in the analysis
(following the trend of other publications on the same topic), use the separate racial categories:
whites, blacks, and indigenous people, considering the complexity of violence against women
existing in different regions of Brazil and reflect on the potential of also including the variable
of religion, available in the census, GDP and Gini Index to look for possible correlations.