Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia

A resource package

2.2. Why do health care professionals play an important role in responding to gender-based violence?

It is widely recognized that the health system has a crucial role in preventing and responding to GBV. At the same time, when health care professionals do not or inadequately address the issue of GBV, such neglect can cause harm to women.

  • GBV is a public health issue, with a significant impact on women’s and girls’ physical, psychological and sexual health. It affects women throughout the entire life cycle and is a major cause for of injury, disability and death among women (see section 1.7.1).
  • Health care professionals are often the first point of contact for women who have experienced violence.Virtually every woman uses the health care system at some point in her life - whether for routine health care, pregnancy and childbirth, illness, injury, or for caring for children or older people (National Assembly for Wales 2001). For women survivors of intimate partner violence who experience isolation and control by a violent partner, health professionals might even be the only point of contact, particularly in a situation where these women do not want to report the violence to the criminal justice authorities. Health professionals enjoy a great degree of trust among women as professionals to whom they disclose abuse. Besides, statistics show that women who have experienced violence use health care services more often than those who have not (WHO 2013).
  • Forensic medicine plays an important role in collecting evidence to support the criminal prosecution of a perpetrator, in particular through recording the history of assault, undertaking a medical and psychological examination, performing different laboratory tests and documenting injuries.
  • Knowing about a woman’s situation of violence may help in diagnosing or treating many conditions, such as chronic pain or reoccurring sexually transmitted diseases (IPPF 2010).
  • Therefore, health care professionals are in a strategic position to identify women who have experienced and/or are at risk of experiencing further violence, to provide them with medical care and to make referrals to other services. While some women may disclose violence experienced, many women do not disclose, or do so only if they are being asked. Therefore, it is important that health professionals are trained on how to recognize signs of GBV and how to communicate with survivors (IPPF 2010). Many different types of health care providers may be confronted with health symptoms of GBV in their daily work and therefore offer a broad range of potential entry points for identifying GBV (see seciton 2.3).
  • Responding to GBV can improve the overall quality of health care. According to International Planned Parenthood Federation data,  strengthening the health service response to GBV leads  to overall better quality of care, promotes privacy and confidentiality, increases respect for women’s rights and encourages a more integrated and holistic vision of women’s health (IPPF 2010).

Health care providers who are knowledgeable and skilled on the appropriate response to GBV can thus make an important contribution to improve the health and wellbeing of the patient. On the other hand, lack of such skills and knowledge can put women at further risk and harm. For instance, when healthcareprofessionals do not ask about or do not recognize symptoms of GBV, they may misdiagnose survivors or offer inappropriate care. Furthermore, health professionals who are uninformed or unprepared may put the patient’s safety, life and wellbeing at risk. For example, health care professionals can unwittingly cause harm by expressing negative attitudes to patients who have been rapedor by discussing women’s injuries in a way that can be overheard by a potentially violent spouse waiting outside (IPPF 2010).

Traditionally, medical training and education have perceived the role of the health care provider as “diagnosing and ‘fixing’ clients” (UNFPA 2001). However, this approach reaches its limits when it comes to providing survivors of GBV the care and support they need. Therefore, health care providers, with institutional support of health facilities, should revisit their role and apply a broader understanding of the practice of medicine, which encompasses “diagnosing, healing, treating, preventing, prescribing or removing any physical, mental or emotional ailment … of an individual” (Civic Research Institute 2000, cited in UNFPA 2001). This broader approach to medical care can serve to improve the process of identification of GBV and of assisting survivors in getting the help they need to address the health consequences of violence (UNFPA 2001).