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Recommendations

Strengthening the health sector response

Recommendation 10

Develop a comprehensive health sector response to the various impacts of violence against women.

Many health providers see and treat (knowingly or not) millions of women living in violent relationships. Developing a comprehensive health sector response to the various impacts of violence against women is therefore vital, and action by specific health care services is also needed. At the planning level, this will require health officials to identify the sector’s particular role within the wider multisectoral response, in advocating for prevention, and in providing services for women who have experienced violence. In particular, it is important to address the demonstrated reluctance of abused women to seek help. At the service level, responses to violence against women should be integrated into all areas of care (e.g. emergency services, reproductive health services such as antenatal care, family planning, and post-abortion care, mental health services, and HIV and AIDS-related services). It is necessary to improve access to non-stigmatizing mental health services for women that adequately recognize the associations between violence and mental health, in particular depression and suicide ideation. These services need to contribute to empowering women in situations of violence, and to avoid over-medicalizing the problem.

Health providers who see and care for abused women need to coordinate and work with other sectors, particularly the police and social services. This will require the creation of formal referral procedures and protocols.

In addition to more general awareness-raising, the health sector needs to find ways to ensure that: (a) women who have experienced violence are not stigmatized or blamed when they seek help from health institutions, (b) women will receive appropriate medical attention and other assistance, and (c) their confidentiality and security will be ensured. Training should aim, among other things, to ensure that providers are appropriately sensitized to issues of abuse, treat women with respect, maintain confidentiality and do not reinforce women’s feelings of stigma or self-blame, as well as being able to provide appropriate care and referral as needed.

Recommendation 11

Use reproductive health services as entry points for identifying and supporting women in abusive relationships, and for delivering referral or support services.

The availability and widespread use of reproductive health services (including antenatal care, family planning services, post-abortion care and services dealing with sexually transmitted infections) in most countries give these services a potential advantage for identifying women in abusive relationships and offering them referrals or support services. However, unless providers are aware of and willing to address violence and coercion, they will be unable to promote women’s sexual and reproductive health effectively.

Reproductive health providers should be sensitized and trained to recognize and respond to violence, particularly during and after pregnancy. Recognizing that identification is not enough, protocols and referral systems need to be put in place to ensure that appropriate care, follow-up and support services are available. In settings where resources are limited and referral is not possible, health staff should at least be aware of the problem and should provide information about legal and counselling options, as well as supportive messages that emphasize that such violence is wrong, and that it is a widespread problem. Ensuring confidentiality and women’s safety should be paramount. In places where antenatal services involve male partners in parenting classes and similar activities, adding an anti-violence component to such activities may be an avenue for attempting to change male attitudes and prevent violence.