Gender Based Violence and the Role of the Health Sector

Gender Based Violence and the Role of the Health Sector

Pia AxemoSenior Health Advisor-Reproductive Health

World Bank, September 30, 2008.

Gender Based Violence : Any act of gender based violence that results in, or is likely to results in,Physical, Sexual or Psychological harm or suffering to women including treats of such acts, coersion or arbitrary deprivations of liberty, whether occuring in public or private.

Intimate Partner Violence (IPV):Physical, Sexual or Psycological harm by a current or former partner or spouse

Source: United Nations. Declaration on the elimination of violence against women.UN General Assembly,1993.

Definition of GBV and IPV

Global Magnitude of IPV

WHO study 2002-2003, from 10 countries and 15 sites (urban/rural).

15 -71 % of women reported life-time prevalence of physical or sexual intimate partner violence or both.(WHO)

4% - 15% of women reported physical or sexual partner violence the last 12 months.

World Bank, 1993- 9 million DALYs are lost each year as a result of IPV

Why should Health Sector be involved

Most women will enter in contact with health service several times in life

IVP is an important risk factor for a range of health problems

Women may suffer from Health consequences long after the violence ended

Health practitioners can advocate for improved protection of those at risk of violence

Why should Health Sector be Involved

Promote awareness of violence as a community issue not a private concern

Help identify victims of violence

Can refer victims to specialized services

Common presenting conditions

Physical Injuries/Outcomes:

Fractures,stab wounds, cuts,ear /eye /teeth injuries, dislocations, burns,

Suicide, homicide.

Common presenting conditions-contd

Reproductive Health consequences miscarriage,preterm delivery, STI, pelvic inflammatory diseasepregnancy complications ;low-weight babies, unsafe abortion,ante-partum bleeding, fetal injuries,HIV,

Mental Health Consequences Anxiety,depression,PTSD, panic disorders eating ,sleeping

disorders,harmful health behavior

Conditions contd

Chronic Health consequences

Chronic pain, pelvic pain, headaches, hypertension, irritable bowel syndrome, PTSD, fatigue, gynecological problems,cervical cancer

Entry Points for Service Provision

Hospital Emergency Sevices

Gynecological Emergency Services

Primary Health Care level

ANC, Family Planning clinic, STI clinic, Delivery Ward, Post-abortion care Ward

Mental Health Services

Evidence on promising Health Sector interventions

Literature review 1995 -2005 by LSHTM (2008)

5 Latin America ;

PROFAMILIA - Dominican Republic, CONFAD -Brazil, Inppares-Peru, Plafam-Venezuela, Family Counselling Centers - Honduras

3 Asia ;

OSCC- Malaysia, Bangladesh,Thailand; and Women’s Friendly Hospital Bangladesh

2 Africa;

OSCC-Namibia, Gender Recovery Center- Kenya

Health Sector Response

-- Provider-level integrationThe same provider offers a range of services during the same consultations;Screen for violence, treat injuries ,provide counselling and refer to special services such as legal,police etc.Brazil; a counselling program (CONFAD) integrated into a medical school health center and provide basic and therapeutic counsellingHonduras:Regional family counselling centers at regional mental health centers provide individual and group counselling, no referrals

--

Health Sector Response cont

Facility-level integrationA range of services available at the same facility through different providers;

One stop crisies centers OSCC; Malaysia, Bangladesh, Namibia, Thailand

Profamilia Dominican Republic ( Family Planning Clinics)

Offers a wide range of services including health, legal, social welfare, counselling in one location, often urban hospital settings, emergency or accident ward

Health Sector Response cont

Multi-site System Integration :A coherent referral system between facilities is in place. Screening and medical care delivered in one facility and

then specialized referrals to legal, social/ psychological services .Plafam Venezuela running FP services

Integrated into Maternal services example Bangladesh Women’s Friendly Hospital with medical care, documentation of injuries and external referrals for legal and social support.

Kenya Gender Recovery Center at a Private Hospital referral for legal, social services, police investigation and NGO’s for shelter

What is needed?

Health staff must be appropriately trained.

Introduce protocols and guidelines for early identification and referrals

. Record keeping, documentation system and supervision

Introduce information on the dynamics of abuse in the pre service training for doctors,nurses,midwives,social workers and community based health promotors/workers.

What is needed?cont

Partnering with local NGO’s such as women’s support groups,legal support groups, religious groups

Clear policies on IPV Financial constraint to be solved especially for

hospitalbased OSCC Solutions to Poor infrastructure Coordination of various actors and departments involved

in planning integrated services.

Options for the WB

Participate in evaluation of existing programs

Encourage a better Health Sector response to IPV/GBV through national, regional and municipal policies regarding training, screening, referral, documentation and counselling for survivors of violence.

Ensure survivors right to services such as emergency contraception, STI/HIV testing and treatment, post abortion care – should be a part of country level dialogue

WB Options cont.

Build the knowledge base, together with researchers/NGO’s, on evidence based methods to prevent GBV- both primary and secondary prevention .

Commission country –level studies and research on prevalence of GBV especially in Fragile /Post-conflict states

Demonstrate the social/development/economic impact of GBV. DALY (disability- adjusted life years ) for GBV

Create partnership between stakeholders- government and non- governmental agencies and the private sector

WB cont.

Work for curricular change to integrate GBV into the pre-service training of health professionals( also other professionals)

Address Gender based violence prevention within HIV/AIDS programmes and Adolescent reproductive health programs

Incorporate discussions on GBV into country policy dialogue and PRSP

Thank You