Addressing Violence Against Women through the Healthcare System

1. Addressing Violence Against Women through the Healthcare System A Practical Approach to Gender Based Violence AIDOS / UNFPA

2. AIDOS experience • Based on the use of UNFPA’s A Practical Approach to GBV: A Programme Guide for Health Care Providers & Managersby Lynne Stevens • offering a step by step guidance in designing and implementing a project to combat GBV

3. GBV: a definition • An act that results, or is likely to result, in physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in private or public life

4. GBV includes • Sexual abuse of women and children • Rape • Domestic violence • Sexual assault and harassment • Trafficking of women and girls • Several harmful traditional practices

5. GBV addressed as • A human rights violation • Inextricably linked to gender based inequalities & power dynamics • A public health problem: physical, psychological, social

6. Women’s advocacy on GBV • To shad light on GBV • …to be treated as a social problem • …rather then as a private problem • Enact and implement legislation criminalizing GBV • Services to address GBV: shelters, medical assistance, counselling

7. Unmet needs around GBV • Culture of silence and denial surrounding GBV • Lack of coordinated services for those who suffer from GBV • GBV not yet addresses in mainstream programmes and policies • Complex legislation • Healthcare providers “unsensitive”

8. SR healthcare & GBV • SR healthcare: often the only healthcare facility that women visit • Despite symptoms, women are not asked about GBV in their lives • GBV not recognized as a “problem” by healthcare staff • Healthcare staff not being able to help (therefore not asking) • Domestic violence: “women deserve it”

9. A 3 Options approach • Option A involves only the distribution of information materials (including referral information) in the public and private rooms of a clinic (emergency room, hospital)

10. A 3 Options approach • Option B includes information material as well as asking patients about gender based violence: the clients responses are then included in their medical histories. If the woman discloses that violence occurred, she is referred to off-site groups for help.

11. A 3 Options approach • Option C includes Option A & Option B, as well as in-depth assessment of each case. Healthcare staff will be trained to conduct the assessment. Patients are then referred to either on-site or off-site treatment.

12. Guidelines for… • choosing the most appropriate option • developing planning and monitoring tools, information material and forms • setting up referral mechanisms, protocols and policies • providing continuity of care & follow up • educating staff, expanding services • educating/sensitizing community

13. Guidelines help to • Sensitize healthcare providers & administrators about the connections between SRH & GBV • Help staff look at their own responses, beliefs & biases is key to an effective programme • Create choices for tailoring programme to organisations’ capacities (realistic size and scope)

14. Key principles • Offer services in facilities that women already use • Choose appropriate option • Involve and sensitize the community • Create environment conducive to disclose GBV (printed/visual material) • Develop GBV protocols and policies • Sensitize and train the whole staff, not only healthcare providers

15. 10 pilot project • Focused mainly on domestic violence • Implemented in Cape Verde, Ecuador, Guatemala, Lebanon, Lithuania, Mozambique, Nepal, Romania, Russian Federation, Sri Lanka • Evaluated in Lebanon, Mozambique, Nepal, Romania • AIDOS continued in Gaza, Venezuela, Jordan

16. Key lessons learned • Integration of the issue: GBV can be effectively introduced as public health issue within regular healthcare facilities • Multidisciplinary approach to healthcare: GBV requires medical and non medical aspects of care. Increasing number of trained psychologists & counsellors is key to success

17. Key lessons learned • No single model: it can be initiated as a community based project, NGO operated intervention or government undertaking. It can move from Option A to Option C over time & scaled up with support of other stakeholders. • Community support / participation is key to address underlying cultural issues & gender power dynamics in which GBV is rooted and gather support for women in need

18. Key lessons learned • Prevention of GBV is a public health issues:detecting + addressing health and social needs of women who suffered GBV should lead to look at GBV in terms of prevention as well • Focus on attitudes and values: not only information about GBV and related services but use Option A, B, C also to bring about attitude & behavioural changes.

19. Key lessons learned • Database development: data are needed not only to better tailor services & referral system …but also to support advocacy for… • Government commitment: mainstream in healthcare system, include appropriate training in healthcare curricula, recruit staff, support GBV ad hoc services (shelters)

20. To conclude • 1. (Women’s) organisation motivated to address GBV • 2. Detection of GBV: capacity building of all healthcare service staff + services for treatment of GBV victims • 3. Community involvement to lead to GBV prevention Thank you! GGGG