International Perspective on Gender Based Violence
The Medical Women’s International Association (MWIA) is an international non- governmental organization (NGO). Women physicians in more than seventy countries make up the membership. The association was founded in 1919. Embodied in its mission is the objective to raise the health status of the communities in which the members work, especially the health of women and children in those communities.
In December, 2001, MWIA held a conference at the Rockefeller Study and Conference Center in Bellagio, Italy, under the Centre’s International Conference Program. The result was the development of a Training Manual on Gender Mainstreaming in Health, which has been successfully used at workshops throughout the world to educate physicians about the importance of incorporating a gender perspective into health care. Subsequently, MWIA developed a Training Manual for Adolescent Sexuality as it is closely related to gender and health.
As a further connection to gender and health and in celebration of the 2013-2016 triennial theme of “Prevention and Elimination of Domestic and Sexual Violence,” MWIA has developed this training module on Gender Based Violence. By use of illustrative cases, it addresses many of the issues in the Beijing Platform in a manner that is easy for physicians to understand and apply to their everyday practice. It is meant to be a living document to which additional information can continually be added.
The year 2015 marked 20 years since the Fourth World Conference on Women held in Beijing, from which came a commitment to mainstream a gender perspective into all United Nations activities, and particularly to develop gender sensitive initiatives for women’s health. In the Beijing Platform for Action, two of the strategic directions to be taken were Women and Health, and Violence Against Women.
Listed under Violence Against Women were the following strategic objectives:
- Take integrated measures to prevent and eliminate violence against women;
- Study the causes and consequences of violence against women and the effectiveness of preventive measures;
- Eliminate trafficking in women and assist victims of violence due to prostitution and trafficking.
Phumzile Mlambo-Ngcuka, Executive Director of UN Women, in her remarks for the November 25, 2014, International Day for the Elimination of Violence against Women states that globally, one in three women will experience physical or sexual violence at some point in her life. “More often than not, violence against women is committed by an intimate partner. Of all women killed in 2012, almost half died at the hands of a partner or family member. It is no exaggeration that the overall greatest threat to women’s lives is men, and often the men they love.”
The UN Secretary General, Ban-ki Moon, launched HeForShe, a global campaign to engage men and boys as advocates and agents of change for the achievement of gender equality and women’s rights. Dr. Florence Manguyu, well known ambassador for women’s rights and Past President of MWIA, once stated that women make up half the world’s population and produce the other half. Now HeForShe is bringing together that other half—the male half of humanity in support of the female half of humanity, for the benefit of all.
In its World Report on Violence, WHO recognizes that violence against women has profound implications for health but is often ignored. To take a quote from the report, “one of the most common forms of violence against women is that performed by a husband or male partner.” This type of violence is frequently invisible since it happens behind closed doors, and effectively, when legal systems and cultural norms do not treat as a crime, but rather as a “private” family matter, or a normal part of life.
As a non-governmental organization in official relations with the World Health Organization (WHO), MWIA makes reference to the excellent work done by Dr. Claudia Garcia Moreno and her team at WHO. The groundbreaking research of The WHO Multi-Country Study on Women’s Health and Domestic Violence Against Women gathered comparable data on the prevalence and frequency of different forms of violence, its effect on women’s lives and health, and risk factors for domestic violence from eight countries around the world. Dr. Garcia Moreno’s team has developed a Clinical Handbook entitled, Health care for women subjected to intimate partner violence or sexual violence. Another aspect of WHO’s work is the Sexual Violence Research Initiative (SVRI), which is designed to increase information about, awareness of, and capacity to address sexual violence around the globe, and particularly in the developing world. Work is being done between the Departments of Gender Women and Human Rights and the Department of Injuries and Violence Prevention on a project to strengthen the health the health sector response to sexual violence.
Following the Beijing Conference there was a shift to a gender approach which realized three important aspects to gender and health:
- the biological differences between men and women;
- the societal and cultural factors that determine what societies consider as the norm;
- power relations between men and women.
Progress has been made in many areas in the last 20 years, but this is not the case when you look at Violence Against Women. However, times are changing. You have only to look in the news to see the high profile cases where violence is being brought to the forefront with the message that this is no longer acceptable and it is time to change. Sports figures, media celebrities and high ranking executives are being taken to task for the treatment of the women in their lives. The time is now.
With the passing of the 20th anniversary of the Beijing Conference, MWIA feels that its Module on Violence Against Women is timely. As female physicians, victims of domestic and sexual violence often present to our offices. They may come and outright state that they are victims of such violence or often as not they will come with symptoms that they hope will make you ask about violence. As physicians we often feel that we do not have the knowledge of what to do for these patients or what is meant by a trauma-informed approach, so shy away from asking. This module is developed to make sure that we are offering patients evidence based best practice and do not let them down in their time of need. Their time of need varies as well. A woman presenting to emergency with a broken arm is in need of immediate attention. Another presenting to your office with recent abuse needs urgent attention. However the woman whose entire life has been adversely affected by abuse is in no less in need of your help for her chronic suffering.
To review some basic terms, gender based violence refers to violence directed at an individual because of their gender. This includes acts that cause physical, mental or sexual suffering, coercion or other acts that threaten liberty. The Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) defines it as violence against a woman because she is a woman or that affects women disproportionately. The terms gender based violence, sexual violence and violence against women are often used interchangeably.
When referring back to the three aspects of gender and health, violence against women is an example of how power relations between men and women disadvantage women and where societal norms dictate that this behaviour is acceptable.
Gender based violence covers a wide range of activities, including:
domestic violence, sexual harassment, rape, sexual violence during conflict and harmful customary or traditional practices such as female genital mutilation, forced marriages and honour crimes;
trafficking in women, forced prostitution and violations of human rights in armed conflict (in particular murder, systematic rape, sexual slavery and forced pregnancy);
forced sterilisation, forced abortion, coercive use of contraceptives, female infanticide and prenatal sex selection.
Sexual Violence itself varies in scope:
- Rape and marital rape
- Child sexual abuse, defilement and incest
- Forced sodomy/anal rape
- Attempted rape or attempted forced sodomy/anal rape
- Sexual abuse
- Sexual exploitation
- Sexual harassment
- Sexual violence as a weapon of war and torture
Dealing with domestic and sexual violence is a multidisciplinary and multisectoral effort. Ensuring that the patient is safe is top priority and once that has been assured, some of the best treatment physicians can offer is connecting our patient to services that reach beyond her medical needs in a seamless manner.
MWIA encourages its members to step up to the plate and ensure that victims of gender based violence receive the care they so greatly deserve.
Dr. Shelley Ross
Secretary General, Medical Women’s International Association