Health Care Workers Matter for Gender Based Violence

It was 10:30 pm on a Monday night.

After a long day at work, I was preparing to go to bed. I usually read before I go to sleep and I’d been trying to finish one book for ages but other things kept coming up. I hoped and prayed tonight would be the night, but the universe had other plans – as always.

My cell phone beeped: “Doctor, it’s an emergency.’’ 

I flung myself out of the bed and tried to reach the hospital as quickly as I could. The patient was a married 27-year-old woman who had sustained major injuries after accidentally burning herself while cooking.

“60 percentage burn,” I deduced, after taking the patient’s history and a physical assessment. But somewhere inside, I knew this wasn’t an accident and I felt sure there was more to the story.

I started with the patient’s family members. Unsurprisingly, upon enquiry they maintained their stance and kept trying to convince me that their daughter-in-law burned herself while preparing the meal for the family. I decided to talk in confidence with the victim, but she was hesitant to break her silence too.

One day, over the course of providing her with routine care, the woman broke down into tears and alleged that her in-laws had set her on fire for dowry.

In a country like Nepal, speaking out about gender-based violence (GBV) is exceptionally difficult because of the shame, stigma and pressure from families and communities preventing victims from reporting abuse and seeking appropriate services.

Victims are often afraid of disclosing or reporting violence because of the consequences they fear will follow.

In turn, silence can aggravate the situation for survivors, leaving them with prolonged mental and physical suffering.

Nepal has a very high incidence of gender-based violence. And while everyone – regardless of gender – can be affected, women remain the main victims. It is difficult to understand the gravity of GBV in Nepal as many of these cases go unreported due to the silence maintained by victims and perpetrators.

GBV remains one of the most rigorous challenges to women’s health and well-being. It can take many different forms, like physical, sexual, emotional or psychological. The causes of gender based violence are multi-dimensional, and include social, political, economic, cultural and religious factors.

Dealing with survivors of GBV can be a very challenging and sensitive task; starting from acknowledging and identifying the violence to asking relevant questions, without being too intrusive or judgmental at all.

Like me, a wide range of health professionals are likely to come into contact with individuals who have experienced GBV. Health workers are in a unique position to help and heal the survivors of GBV, provided they have the knowledge to recognize the signs. Most of the time, health professionals are likely to be the first point of contact for GBV victims.

But are we, as health workers, equipped with the necessary skills to deal with GBV?

While staff and facilities play a key role in health delivery systems for GBV victims, their efforts will have limited impact unless there are specific policies on the issue of GBV to guide the integration of the response to GBV into health care.

One important approach is to specify the role of health care professionals, and to provide guidance and tools. For instance, the World Health Organization has developed guidelines for in-service training of health care providers on intimate partner and sexual violence against women, specifically. The guidelines are based on systematic reviews of evidence, and cover:

• identification and clinical care for intimate partner violence
• clinical care for sexual assault
• training relating to intimate partner violence and sexual assault against women
• policy and programmatic approaches to delivering services
• mandatory reporting of intimate partner violence

The guidelines aim to raise awareness of violence against women among health-care providers and policy-makers, so that they better understand the need for an appropriate health-sector response. They provide standards that can form the basis for national guidelines, and for integrating these issues into health-care provider education.

Sensitizing staff and building their skills on how to recognize and respond to GBV is crucial. Ensuring that services follow human rights-based and gender specific approaches, and are guided at all times by the preferences, rights and dignity of the victim, is important.

Providing adequate infrastructure to ensure the patient’s privacy, safety and confidentiality is also essential. This can be done by providing a private room for consultations, requiring that consultations are held without presence of a partner, putting in place a system for keeping records confidential or giving instructions to staff on explaining legal limits of confidentiality, if any.

Not only are health workers the ones to fix a fracture or heal a burn injury, they can also play the role of advocate by speaking up against injustice in the course of providing routine care.

Health professionals can also assist victims by making them aware of the counselling and legal services available, which is often a part of the recovery process. Gaining the trust of victims is important in this scenario. Community health care workers and midwives, who are often the most trusted members of societies, can use their power to reach women and vulnerable groups to encourage them to break their silence, and to make informed decisions about their bodies and lives.

The role of health professionals goes beyond simply treating and healing a survivor of gender bases violence – we can empower them, too.

Burn the Dowry, Spare the Bride

India – a country of contrasts – shows you a myriad of colours. It is home to many highly educated and intelligent people, as well as to many who are illiterate, poor, hungry and troubled. India boasts the beautiful Himalayas, deep blue seas, green forests and glistening rivers, but also acres of slums and dry and parched lands.

The country is also famous for its big, fat Indian weddings – a major and thriving industry. But in India, the dowry system is an ever-present menace which frequently changes shape to adapt to society. Increasingly, dowry is being masked by more socially acceptable norms, such as gift-giving.

A car for your daughter to travel in.

A house for your daughter to live comfortably in.

Gold jewellery to give her security in the future.

These lines by a groom’s family mask dowry demands as gifts. How difficult would it be to understand that this was extortion? The bride’s family had no intention of giving such ‘gifts’ to their daughter. But now they have been made to make them!

The girl’s family may find it easy to turn a blind eye, and to tell themselves that they are simply gifting their daughter. Who else did they earn money for all their life? Their daughter needs to get married after all! It is the most important identity for a woman. She may be well educated, earning enough to feed an entire family, raising the bar at her workplace, but if she’s unmarried she is viewed by many as incomplete.

For some, it ends on the wedding day. The groom and his family’s ego have been appeased. The newlyweds go on to live a happy life. But for some others, the demands continue. The first festival, the first child, the naming ceremony, the first house that the new couple build, and at every other occasion – the bride’s family must gift again. Sweets, clothes, gold, cash – the list is endless. If the parents are unable to provide, the woman is often packed off back to her mother’s house, not to return till the demands are met. Some are physically and emotionally abused; beaten, starved and even burnt.

India has had a long battle against dowry – an unsuccessful one. Legislations have been made and amended. But the practice seems to be growing. It has spared no economic or social group. The battle lines must now be altered. What can be done when law has not eradicated the problem? Why not focus on the one link that can be our biggest asset? The bride’s parents!

This is a call to parents of every girl child in every country where the dowry system is flourishing. Why should we not say no? It starts with the birth of our daughters. Let us give them a good education, a good upbringing, a happy and safe environment at home and combine all this with a good dose of self confidence and self esteem. Let us say no to any potential groom and his family who talk about marriage like a business transaction. Let us stand strong and firm so our daughters learn from us to say no.

Let us teach them that life throws us many challenges. That we are all supposed to enjoy the journey of life – marriage is never the final destination. It is one part of our journey. Let us give our daughters the confidence to walk out of a marriage where they are being abused and harassed for dowry, knowing that it is not the end of the world. Let there be no more burned brides, hanged brides, poisoned brides or strangulated brides.

Maybe the power has been with us all along. It is time to exercise it. To show the world that every single woman’s life matters. Let us bring forth a change, and let us start at home.

Repercussions of Dowries and Arranged Marriages in India

In India, the caste system, dowries, and arranged marriages are sustaining a hostile environment for women in the country.

Immersing yourself in a culture or population to find out its needs and not imposing your beliefs upon others are lessons that have been vital in my study and practice of public service and public health. As cultures come together and the world grows smaller, this is not the time to abandon tradition, pass judgment, or foster hatred. Throughout history, fear and misunderstanding of differences have cost our world far too much. However, the shrinking of the world has also created an opportunity to investigate the fine line between tradition and injustice. Injustices can be passed on under the guise of tradition, and are costing individuals opportunities, health, and in some cases even their lives. These things need to be talked about.

It is an accepted practice for men of India’s Perna caste to “pimp” their wives as a way to earn income for the family. A detailed article in the Pacific Standard examines the lives of Perna women and includes the following quotes:

“She met her husband on the day of her wedding, becoming his second wife at the age of 17…two years later, his prostitute”.

“I knew it would happen, it’s very normal,” she said. “I do it to earn for my family.”

“It happens to every girl.”

“You get used to it.”

The article also explains why an entire village was absent of women ages 15-45. “They are all in Bombay…” Families are paid, sometimes as little as $50 for their daughters. In Calcutta (also known as Kolkata) and Bombay (also known as Mumbai), the girls are priced according to beauty and age. “Pimps (give) them to brothel managers for “seasoning”—repeated rape—and the girls, many between 9 and 13 years old, (are) then kept in bonded labor, expected to service 10 or more customers a night for an average of $3 each.”

A recent BBC article revealed that women in Kerala, India, are being abandoned by their husbands at an alarming rate. Due to economic hardship in the area, men are getting married, taking their dowries, and moving elsewhere to find work, often times never returning. The women of Kerala, who are told that the most important aspect of their lives is to become a wife, have now lost everything. These women lack opportunity to create a life independent of their husbands, and  are currently facing high rates of depression.

To me, the dowry suggests that women are inferior to men, and it often costs women much more than its monetary worth.

Outright violence such as dowry killings that occur if a man believes he should have been paid a larger dowry, or families being torn apart because of dowry discrepancies, are some of the severe consequences of dowry practice. What I hope to present here, is the problem with a tradition that creates a lack of opportunity and independence for women and sends out the message that prostituting and abandoning your wife is acceptable. This is the underlying dilemma.

Buying and selling of women is a global phenomenon. As we work to eradicate this problem, usually occurring behind closed doors, we must remember that it is also occurring in plain sight. Women are bought and sold in broad day light under the guise of marriage.

Rukshira Gupta, the founder of Apne Aap, an organization that creates alternative opportunities for children of sex workers in New Dehli, explains that women in India are in danger from conception to death. “They could be victims of sex-selective abortion, if they are born they may be left out to die, if they survive they’ll get less food than their brothers, be pulled out of school to help with chores at home, be married early, risk death during pregnancy, be sold into prostitution, or die begging as widows.”

A ‘Women in the World’ article outlines inadequacies in current legislation aimed at protecting women in India, and how the caste system is playing a role in its failures.

What will it take to improve the status of women in India? Where should the line be drawn between custom and injustice?

*All images by Liz Fortier. People portrayed in the images are not related to the post.

 

The Lost Daughters

I have now spent three weeks in India. It has been three weeks of an endless number of impressions, which have made me feel both inspired and frustrated, sometimes at the same time. The main reason for that is because of all the women’s activists I have met who are dedicated to change the future for the small girls of the nation. Because if it doesn’t change, there won’t be many girls left in India.

Sex-selective abortion is illegal in India but widely common. A daughter is far too often considered to be a burden and is therefore aborted in favor of a son. Why? Lack of education is usually the answer to most of the problems we are facing in the world (“If people only knew how to read / take care of their garbage / have a good health”) but female feticide seems to have other explanations. In Goa, one of the states in India with the highest standard of living and literacy rates, there are only 920 girls per 1000 boys in the range between 0-6 years. This means that despite a growing wealth the proportion of females has reduced drastically in the last 50 years.

As a response to this alarming trend the chief minister of Goa has designed a scheme which is supposed to stop female feticide, the so called Laadli Laxmi scheme. The idea is to provide 100 000 rupees to every girl child to use for her wedding ceremony. Women’s activists in Goa are furious. Dowry – the idea that the bride’s family should pay money to the family of the groom – has been illegal in India since 1961 but is still a reason to why daughters are unwanted. With the chief minister’s so-called solution the tradition is however encouraged – what else can these 100 000 rupees be called? The women I’ve met have been frustrated – isn’t it the responsibility of any progressive government to completely eliminate such traditions?

Rajeshree Nagarsekar, is one of them who believes that a solution only can be reached through a change in people’s mindset. In 2012 she started Evescape, Goa’s first women’s magazine, which she now is the chief editor of. In every issue of the magazine one picture spread is dedicated to celebrate the girl child. Parents send in photos of their daughter and write a short note about why they love them.

Meeting women such as Rajeshree makes me believe that a real solution actually can be reached, despite politicians who dodge the question and perpetuate gender discriminatory traditions.