J HEALTH POPUL NUTR 2009 Aug;27(4):477-491 ISSN 1606-0997 | $ 5.00+0.20 ©INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH, BANGLADESH Paramedic-conducted Mental Health Counselling for Abused Women in Rural Bangladesh: An Evaluation from the Perspective of Participants Ruchira T. Naved1, Nadia A. Rimi1, Shamshad Jahan1, and Gunilla Lindmark2 1ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh and 2International Maternal and Child Health, Uppsala University, Uppsala, Sweden ABSTRACT This paper reports on evaluation of an initiative to use paramedics as the first-level mental health counsel- lors of abused women in rural Bangladesh (2003-2004) from the perspective of the abused women who participated in one or more counselling sessions. Thirty in-depth interviews, followed by a survey (n=372), targeted to cover all participants, were conducted in 2006. Overall, the arrangement, management of ethi- cal issues, and skills of paramedics were rated favourably. Most (89%) abused women (n=372) considered the session useful; one-fourth of these women considered it very useful; and only a few abused women considered the session useless. Usefulness of the session was expressed mostly in terms of relief attained af- ter talking about the issue. Most (87%) women reported being encouraged to be self-confident. In a context characterized by low self-confidence of women, lack of opportunity to talk about violence, and absence of professional mental health counselling services, this initiative is sufficiently promising to warrant further testing. Key words: Battered women; Counselling; Mental health; Paramedics; Bangladesh INTRODUCTION Nowhere in the world is gender imbalance more present than South Asia. Violence against women is a pervasive problem in this region (1). In addi- tion to physical violence, South Asia documented the highest rates of sexual and emotional violence against women. A population-based study conducted in 2001 in Bangladesh by ICDDR,B and Naripokkho—a wom- en’s activist organization—as part of a World Health Organization (WHO) multi-country study on vio- lence against women (VAW) found that two in ev- ery five women had been physically abused by their husbands in both rural and urban areas of Bangla- desh (2). Sexual violence within marriage was even higher in rural Bangladesh with every second wom- an reporting sexual abuse by her husband (3). Emo- tional violence by a husband was reported by 44% Correspondence and reprint requests should be addressed to: Dr. Ruchira Tabassum Naved Public Health Sciences Division ICDDR,B GPO Box 128, Dhaka 1000 Bangladesh Email: ruchira@icddrb.org of urban women and 31% of rural women (3). Evidence on negative consequences of physical and sexual violence on mental health of women is abundant in literature. Results of studies in North America showed that depression and post-trau- matic stress disorder, which have substantial co- morbidity, are the most prevalent mental health sequelae of intimate partner violence (4-11). The developed world generate most literature on consequences of violence against women. A few studies conducted in developing countries on this issue basically substantiate the findings from de- veloped countries. For example, 70% of emotional distress cases in Nicaragua was attributed to inti- mate partner violence (12), and 72% of physical- ly-abused women in Pakistan were suffering from depression and anxiety (13). In Bangladesh, results of the ICDDR,B-Naripokkho study suggest an as- sociation between physical violence by husbands and mental health problems in women ranging from functional disorders to suicidal intention (14) and attempted suicide (3). Moreover, it indicates a dose effect of the frequency and severity of physical abuse on the level of emotional distress of women. The majority (66%) of urban and rural women