gender based violence and the role of the health sector pia axemo senior health advisor-reproductive...
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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.
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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
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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
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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
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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
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Common presenting conditions
Physical Injuries/Outcomes:
Fractures,stab wounds, cuts,ear /eye /teeth injuries, dislocations, burns,
Suicide, homicide.
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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
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Conditions contd
Chronic Health consequences
Chronic pain, pelvic pain, headaches, hypertension, irritable bowel syndrome, PTSD, fatigue, gynecological problems,cervical cancer
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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
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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
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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
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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
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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
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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.
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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.
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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
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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
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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
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Thank You