Addressing Domestic Violence in Antenatal Care Environments 2 (ADVANCE 2)

Addressing Domestic Violence in Antenatal Care Environments 2 (ADVANCE 2)

ADVANCE 2 (2020-2025) builds on the accomplishments of the original ADVANCE study (2013-2018) which established an international collaboration of researchers and health providers addressing the field of domestic violence.

Our focus is on reducing domestic violence in pregnancy in Nepal, an important cause of poor pregnancy outcomes.

Domestic violence is highest in low-income countries, yet the scientific evidence for interventions in antenatal care is most lacking in these contexts. Our study will remedy this gap in four complementary work packages (sub-studies), employing interdisciplinary research methods.

We aim to enable antenatal care providers in Nepal to identify effectively and assist pregnant women living with domestic violence. 

pregnant woman
Illustration photo: iStock

Domestic violence in pregnancy is associated with a variety of adverse maternal health and pregnancy outcomes, as well as poor perinatal outcomes. The burden of domestic violence in pregnancy faced by women in Nepal is high. A variety of screening instruments and safety-promoting interventions are available for use in health care settings to identify and assist women experiencing domestic violence, but most of which have been developed in high-income country contexts.

In this project, we will validate a culturally-sensitive, Nepalese language clinical screening instrument for identifying women living with domestic violence and a safety-promoting intervention intended for routine clinical use. We will conduct a randomised clinical trial to test the effectiveness of screening for domestic violence and implementing a safety intervention compared with standard antenatal care for improving maternal mental health and pregnancy outcomes. We will carry out a process evaluation of the implementation of the clinical trial to better understand the contextual factors influencing women's abilities to attain effective help from intervention. Finally, we will assess the feasibility of use and relevance of the screening tool and intervention in remote and rural settings of Nepal.

Following this project, our linguistically and culturally-relevant instruments will have the potential to set the standards for effective clinical intervention to reduce the harmful impacts of domestic violence in Nepalese antenatal care contexts.

The interdisciplinary partnerships in our study collaboration will facilitate

  • uptake of the study findings into clinical practice
  • integration into the education of health providers in Nepal, and
  • applications of the instruments and methodology in other regional or low-income country contexts where our team members are working. 


Funding ADVANCE2

ADVANCE is funded by the Research Council of Norway from 2020-2025.

Logo The Research Council of Norway


Partners and collaboration

Partners and collaboration

ADVANCE was initiated by partners in Nepal and Sri Lanka and is now a research collaboration of five scientific institutions. The coordinating institution is the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. The collaborating institutions in Nepal are Dhulikhel Hospital-Kathmandu University School of Medical Sciences (DH-KUSMS) and Kathmandu Medical College and Teaching Hospital (KMC). The collaborating institutions in Scandinavia are Linnaeus University in Kalmar (Sweden) and University of South-Eastern Norway in Oslo (Norway). The research team also includes advisors and researcher associates from the Johns Hopkins School of Nursing in Baltimore (USA), the University of Sri Jayewardenepura in Colombo (Sri Lanka), and Oslo Metropolitan University in Oslo (Norway).