CONTENTS
- The World Takes Notice
- Intimate Partner Abuse
- Sexual Coercion
- Impact on Reproductive Health
- Threats to Health and Development
- Health Providers Play a Key Role
- An Agenda for Change
HIGHLIGHTS
- What lies behind violence?
- Culture: a double-edged sword
- Child sexual abuse is widespread
- Violence harms women in many different ways
- *Pullout guide: What Health Providers Can Do
- Responding to violence: Lessons learned
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The Center for Health and Gender Equity (CHANGE) is a research and advocacy organization that seeks to integrate concern for gender equity and social justice into international health policy and practice. CHANGE staff can be reached by e-mail at change@genderhealth.org or at http://www.genderhealth.org.
December, 1999
Series L, Number 11
Issues in World Health
Health care providers can play a crucial role in addressing violence against women. In most countries the health care system is the only institution that interacts with almost every woman at some point in her life. Thus health care providers often are well placed to recognize victims of violence and to help them. Moreover, because violence increases the risk of other health problems for women, early help can prevent serious conditions that follow from abuse.
Recently, the health community has begun to mobilize to meet this challenge. In 1993 the Pan American Health Organization (PAHO) became the first international health institution to recognize violence against women as a high-priority concern, when it passed resolution CD39.R8, urging all member governments to establish national policies and plans for the prevention and management of violence against women (344). In 1996 the 49th World Health Assembly followed suit, declaring violence a public health priority (478). Both PAHO and WHO initiated programs on violence against women in the mid-1990s.
Some health care systems have started to address domestic violence as part of clinical practice. In 1992, for example, the American Medical Association published diagnostic and treatment guidelines for domestic violence, and the US Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began including an evaluation of emergency room policies and procedures for dealing with abuse victims in its accreditation reviews (7, 489). More recently, Brazil, Ireland, Malaysia, Mexico, Nicaragua, and the Philippines have developed pilot programs that train health workers to identify and respond to abuse (115, 277, 370). Several Latin American countries also have incorporated guidelines for addressing domestic violence into their national health sector policies (345).
Despite such efforts, progress is slow. In most countries doctors and nurses rarely ask women whether they are being abused, even when there are obvious signs of abuse (71, 161, 347). Facilities that have established guidelines often do not monitor or enforce their implementation (86, 144, 298). US studies have found that few health care facilities have complied with the JCAHO requirements (139).
