The Crucial Role of Health Services in Responding to Gender-Based Violence

From a policy brief provided by the United States Agency for International Development (USAID), Population Reference Bureau (PRB), and Interagency Gender Working Group (IGWG): "This policy brief examines why health services should address gender-based violence and highlights examples of health programs that have incorporated responses to violence into their work. Program experience reveals that training health care providers and raising awareness about gender-based violence will not be enough. Rather, entire health systems need to respond, with linkages to legal and social services, to support women survivors of violence."

The document addresses questions such as: "What is gender-based violence?" Why is combating it important? "Why are health care professionals central to the response?" "What should health services do to assist women?" Because, as stated here, gender-based violence is a major cause of disability and death among women worldwide, yet is considered a private, domestic matter in some cultures, "[h]ealth care organizations are in a key position to break the silence and offer critical care to women who might otherwise face violence and its health consequences for many years." As early responders and respected members of society, they are in a position to change societal attitudes by reframing violence as a health problem. However, training to recognise abuse, treat immediate complaints, and provide comprehensive care is needed, as well as training in confidentiality so as not to put women and girls at risk of retribution.

"Many health care organizations have attempted to address gender-based violence by conducting a single training event for selected medical staff or making a narrow policy change, such as requiring providers to ask women about violence. Evidence suggests that these strategies have limited success and that the best way to respond to the violence is through a 'systems approach' that promotes broad reforms through a health organization. A systems approach touches on every aspect of health services, from private consultation rooms to staff support, supervision, training, and referral networks. In fact, changing the professional culture of an organization is often necessary to convince health personnel and their managers that responding to violence against women is a health concern and part of their jobs.”

A systems approach implies:

• “Improving health workers’ and managers’ understanding of local and national laws and policies related to violence;
  
• Integrating attention to gender-based violence within health services rather than setting up parallel services;
  
• Supporting long-term efforts to sensitize and train health professionals at all levels about gender-based violence;
  
• Incorporating routine screening [both when signs of abuse are present and as a routine] for violence in health services provided that women’s confidentiality and safety can be ensured; and
  
• Ensuring adequate monitoring and evaluation of services to survivors of violence."
  

In cases of violence, providers can offer women: medical support - including emergency contraception, safe abortion, and post-exposure HIV and sexually transmitted infection (STI) treatments; emotional support; documentation for access to the legal system; and information about and referrals to legal aid, counselling services for survivors of violence, support groups, and places of safety if women cannot return home. Page 3 includes a chart of specific guidelines for health providers once abuse is identified. Linkages between health services and support systems may include psychological support, legal or housing assistance, and access to employment. In order to participate in violence prevention, health organisations can strengthen the alliances or networks working on gender-based violence and raise the visibility of the issue on the national agenda by being engaged in community outreach and advocacy activities. Examples of health services in Mexico, the Dominican Republic, Kenya, and India that have responded to gender-based violence are included. Knowledge gaps about such programmes include a lack of documentation about cost-effective strategies.

Next steps include the following:

• “Policymakers should:
  
  1. Commit publicly to address gender-based violence as a human rights and public health concern and ensure availability of funding;
     
  2. Approve guidelines and protocols for standard treatment of women survivors of violence;
     
  3. Fund training on gender-based violence for health professionals and insist on changes to health education curricula to include gender-based violence; and
     
  4. Support linkages between law enforcement, health services, and other services to support survivors of violence.
     

• Health program managers must:
  
  1. Understand and educate staff on the linkages between gender-based violence and health, particularly reproductive health;
     
  2. Integrate a comprehensive set of responses to violence within health services, including confidential screening, emotional and medical support, and referrals to other services that support survivors;
     
  3. Ensure that women’s privacy and safety can be protected before initiating routine screening; and
  4. Form linkages across sectors (e.g., clinics, shelters, police, and legal networks) to be able to provide comprehensive services to women survivors.
     

• Institutions that train health professionals need to:
  
  1. Revise training curricula for doctors, nurses, and other health personnel to include understanding and responding to gender-based violence. 

• Funding agencies should:
  1. Invest in research to build the evidence base about how best to integrate gender-based violence in health services,” including: pilot interventions; studies that examine the costs of integrating gender-based violence into health services; and evaluations of these programmes.