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.