Violence against women: Central role of health workers
It is our conviction that strong support by the health sector, ensuring competent, confidential, respectful services and effective referral must be a cornerstone in Nepal’s response to gender based violence
Some 22 per cent of Nepali women aged 15-49 experience domestic violence at least once in their lifetimes, according to the National Demographic and Health Survey (2011).
For most, speaking out is exceptionally difficult: shame, stigma and pressure from families and communities may prevent them from reporting abuse.
Further, many women have conflicting emotions: domestic abuse is challenging to report because it is perpetrated by those they are closest to.
As a result, only one in four women who have ever experienced any form of physical or sexual violence have sought any help at all. Very few have reported to the police.
Most live with the mental and physical injuries, unable to break the silence.
But health workers are in a unique position to identify and support women who have experienced violence, provided they have the knowledge to recognize the symptoms of gender based violence.
Many women might come to the doctor repeatedly with injuries for which they have vague explanations, or mental health issues that are consistent with domestic abuse, for example.
It is therefore imperative that the health workers know when and how to ask further questions. As one doctor from BPKHIS said to us recently during a consultation on gender based violence:
“Survivors are often afraid of disclosing or reporting violence because of the consequences that might come up. If health care providers do not ask about or do not recognize symptoms of GBV, they may misdiagnose or offer inappropriate care.”
It is essential, therefore, that health workers at all levels are aware of the symptoms and signs that may indicate that a patient is experiencing violence.
It is also important that health care providers follow human-rights based, gender-specific approaches, guided at all times by the preferences, rights, and dignity of the survivor.
Gender based violence (GBV) can cause serious health problems that compromise physical and mental health, and erode self-esteem. Health consequences of such violence can be both immediate and acute as well as long lasting and chronic; indeed, negative health consequences may persist long after the violence has stopped.
A study published by WHO in 2013 points to a myriad of negative health consequences. Globally 38 per cent of murders of women are reportedly committed by intimate partners.
Out of all women who experienced physical and/or sexual violence by an intimate partner, 42 per cent experienced injuries. They have a 16 per cent higher risk of having a low-birth weight baby, and are more than twice as likely to have an induced abortion.
The legal and policy framework in Nepal is strong.
The most significant initiatives are the enactment of the Domestic Violence Act 2066 and Regulations 2067; the National Action Plan Against Gender- Based Violence 2010, which was further developed as the National Strategy and Action Plan on Gender Empowerment and Ending Gender-Based Violence (2069/2070-2073/2074); including the establishment of the Gender-Based Violence Elimination Fund, and setting up a hotline service for registering complaints.
And yet, gender based violence continues to be prevalent. Reporting continues to be low. And many women continue to suffer in silence.
It is our conviction that strong support by the health sector, ensuring competent, confidential and respectful services, effective referral and consistent funding of the health sector response, must be a cornerstone in Nepal’s response to gender based violence.
The Government of Nepal has identified the Ministry of Health as the responsible executive body to provide health services to survivors of gender-based violence by establishing a hospital based One-Stop Crisis Management Center (OCMC) in 21 districts to date.
These OCMCs have been instrumental in creating a safe and supportive environment for women and girls to seek health services, grounded in the Clinical protocol on the management of Gender Based Violence which was endorsed in 2015.
Beyond clinical care, OCMCsprovide immediate protection, counselling, legal assistance, and referral to other services.
Raj Kumari Chaudhary, a government staff nurse working in Hanumannagar Health Post in Saptari district, told our team earlier this year that identifying women who had suffered from gender-based violence, knowing clinical symptoms, providing the patient with information about its consequences on women’s health, and providing appropriate psychological care were challenging tasks for her without a proper guidance.
“The protocol has made life easier for us,” she says, well aware that she, and other health workers like her, are likely to be the first point of contact for GBV survivors.
When the health care providers like Chaudhary can aptly deal with GBV cases in a health setting across Nepal, no doubt the country will make fast progress towards achieving the Sustainable Development Goals (SDGs), particularly Goal 3 on Health and Goal 5 on Gender Equality and Women Empowerment.
Ending violence against women is key to building a more equitable, fair and healthy society. The health sector can and must play a central role in achieving this.
Vallese and Vandelaer are Country Representatives of UNFPA and WHO respectively in Nepal