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.

U.S. Opposes Global Breastfeeding Resolution

If it seems like the world is crying over spilled milk right now, I promise it’s much more than that. In May this year, a global breastfeeding resolution was passed at the World Health Assembly in Geneva, but not without a fight.

What Happened?

As recently reported by the New York Times, the proposed World Health Organization (WHO) resolution aimed to limit the marketing of breastmilk alternatives, and to “protect, promote and support breastfeeding”. An American delegation attempted to block the resolution, and made threats of trade measures and cuts to military aid to countries planning to introduce the measure. This, naturally, made other nations hesitant to support the resolution.

Ultimately, Russia proposed the final resolution, though U.S. delegates successfully had language removed stating the WHO would support nations discouraging misleading promotion by formula companies.

Why It Matters

The American Academy of Pediatrics recommends breastfeeding as the optimal source of nutrition through a baby’s first year of life. Breastfeeding provides benefits for both baby and mother. In fact, breastmilk could lead to lowered risk of asthma, type 2 diabetes, and obesity in babies and lowered risk of breast and ovarian cancers in moms.

A joint investigation by the Guardian and Save the Children in poorer regions of the Philippines found four large formula companies (Nestlé, Abbott, Mead Johnson and Wyeth) to be enticing health workers to promote formula in addition to distributing pamphlets disguised as medical advice to mothers. Although this is an explicit violation of the WHO’s international code, formula promotion persists in poorer countries where mothers are less informed about breastfeeding benefits.

Soon after transitioning in 2017, the new American administration re-enacted the global gag rule, prohibiting international non-profits receiving U.S. government funding from sharing abortion service information. Now the U.S. is supporting pro-formula companies over policies promoting global childhood nutrition.

This is not just another example of prioritizing private profit over public health, but rather, yet another infringement upon women’s rights.

While there are, of course, circumstances where choosing formula over breastmilk may be the best option for mother and child, every mother deserves to make her own informed decision, and country delegations should support that globally.

Global Healthcare: is there a Perfect System?

“It is easier to complain about a problem than it is to create a solution.”

This statement goes against everything I believe in. Yet, the truth is, I am often guilty of shouting into the ether or holding up a sign with words of disdain rather than slogans of hope. Sometimes we need a reminder that advocacy and development are based in the belief that things can, and should, be better. Take the global healthcare system, for example.

Healthcare is a topic capable of evoking a range of emotions. Things can get messy when there are so many categories to address and systems to choose from. April 7 2018 was World Health Day, on which the World Health Organization (WHO) marked its 70th anniversary and reminded us of its work over the past 7 decades – for example, “to rid the world of killer diseases like smallpox and to fight against deadly habits like tobacco use” (WHO). Addressing health needs is important, but so is addressing healthcare systems.

What is a healthcare system, you might ask? Well, the basic goals are to keep people healthy, to treat sickness and to exchange payment for service in some way. To meet those goals, steps are identified in each country and those steps make up a healthcare system.

We asked our network here at Swedish Organization for Global Health to weigh in on what a perfect healthcare system would look like for them. Is it universal health coverage? Single-payer? Everyone receiving healthcare clinician training?

Our main question: what components make up a good healthcare system?

According to the WHO, these 6 components create a well-functioning healthcare system:

  • Healthcare Workforce
  • Health Financing
  • Health Governance
  • Research and Innovation
  • Service Delivery
  • Medical Products

And according to SOGH, these additional components are needed:

  • Affordability, accessibility and quality care
  • Insurance that is affordable, humanized and effective
  • Inclusivity for all people, of all types, for all services (no discrimination)
  • Collaboration between all health care sectors and workers
  • Communication between patient and health care workers
  • Support and access to continuing education for health providers

The above are ingredients of a good healthcare system. After these components are implemented, what’s next? What is needed to ensure quality, strength, and sustainability of good healthcare systems? 

Is there a perfect healthcare system that will work for all countries, everywhere? I would argue, when stripped away of negativity, that yes – there is. Is that system the same for each country? I believe that while some aspects may be the same, there is not one perfect global system. The goal of healthcare for all countries should be the same, though the means to get there can and will differ.

I urge you to examine your own country’s healthcare system, and to think about how it affects or serves you and how you contribute to it. Try doing so from a gendered lens. This is not a hopeless or utopian task! Our lives and the lives of our children depend on how their health is prioritized.

Once you’ve read, considered and formed some of your own opinions, do something about it. Grab some friends, the phone, your computer, and remember that you have power to create solutions. Try reading up on this Health Data site, or click around on other global health platforms. We’d love to hear your thoughts and ideas in the comments section.

“Humankind has become so much one family that we cannot ensure our own prosperity except by ensuring that of everyone else.” – Bertrand Russell

I Demand Justice

Recently, I was walking in my neighborhood in Lagos, Nigeria, with my sister and my father. As we walked, I explained to them my fears of walking through the streets when it was so dark. My sister confidently replied, “We will be safe if anything happens because we have a man to protect us.”

This should not be the case. Men should not have to protect women from violence.

In many communities, women and girls need protection because violence against them is so prevalent. According to the World Health Organisation, 35% of women and girls around the world will experience intimate partner or non-partner violence in their lifetime. Every two minutes, a woman is sexually assaulted in the United States. That equates to 30 women every hour, and 7,200 women every day. In a recent post by blogger Diane, I learnt that some girls in India are born into brothels and are “bred” for a life of abuse, exploitation and violence.

Violence against women and girls must stop.

When I hear stories of girls who experience violence and stigmatization, I am infuriated. In October 2013, a Nigerian girl was gang raped by three unidentified men. This young girl committed suicide because of stigmatization and shame. She was ostracized in her community because she was raped. She did not deserve to experience such pain and trauma. At this moment, 223 school girls are still missing in Nigeria after being kidnapped.

It is for girls in Nigeria and around the world that I demand justice.

I demand justice because:

  • No girl should be raped, sexually abused or exploited
  • No girl should be cut
  • No girl should be trafficked
  • No girl should feel her only option is to commit suicide because of shame and stigmatization.

I demand justice because all human beings were born equal with the same inalienable human rights.

A young girl once told me “to be a woman is to feel pain.” I want this to change. Imagine a world without violence against women and girls. We would be free to walk on the streets without fear. Girls would not experience the pain and trauma of rape, FGM, abuse or neglect.

“There is one universal truth, applicable to all countries, cultures and communities. Violence against women is never acceptable, never excusable, never tolerable.” Ban Ki-moon, Secretary General of the United Nations

I demand justice for the millions of girls who experience violence everyday. Do you?

Share your ideas below or tweet us @GirlsGlobe

Cover Photo Credit: Stefano Peppucci, Flickr Creative Commons

Girls must be central to the Post 2015 Agenda

The health and status of women and girls are inextricably linked to the well-being and prosperity of families, communities, and economies. Yet today, nearly 15 years on from the launch of the MDGs, progress on reproductive health lags seriously behind. Approximately 800 women and girls die every day from complications related to pregnancy or childbirth, and 99 percent of these occur in developing countries.

Infographic c/o Women Deliver

Additionally, over 222 million women have an unmet need for modern contraception. Investing in the sexual and reproductive health and rights of women and girls has never been more critical. The largest-ever cohort of young people is entering their reproductive years, and their access to sexual and reproductive health information and services will have enormous implications for the trajectories of their lives. Advancing the reproductive health of women and girls also pays enormous dividends for development – poverty rates go down, education rates go up and greater prosperity follows.

As the 58th session of the UN Commission on the Status of Women is underway in New York, USA discussions and negotiations are taking place to shape the post-2015 development agenda.   Hence, now is the time to ensure that sexual and reproductive health and rights is a priority in the post-2015 agenda. I think it is essential that we realise that when we talk about sexual reproductive health and rights we are talking about young women and girls.

As a young woman and youth advocate, I am committed to ensuring that young women and girls are central to the Post 2015 agenda. I say this as the Post 2015 agenda must address the most marginalised populations and as girls and young women are two of these key populations they need to be part of the decision making process. In order to do this young women and girls must be empowered and engaged in meaningful participation. Meaningful engagement of young women can be understood as a series of empowering moments that move in the direction of the ‘decision-making table.’ She can advise, share, sing or cry her opinions on political reforms, policies, programmes and development initiatives that directly affect her and will allow for effective use of resources, both human and natural.

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Image c/o Flickr Creative Commons

In a world where ‘one in three women will be beaten or raped in her lifetime,’ successful and sustainable change will require transformative leadership. This means leadership that will challenge and change the status quo and the systems and structures that perpetuate discrimination, inequality and denial of human dignity. In order for this to happen young women and girls need safe spaces to be themselves, share experiences, access information and discuss ‘taboo’ subjects without fear or judgement.

At the World YWCA (where I am lucky enough to work), we have developed a model of safe spaces which has emerged from our programming on sexual reproductive health and rights in Sub-Saharan Africa. Globally there is a frightening unmet need for family planning and as the world’s population saws we must ask ourselves what are we doing to address this? Sub-Saharan Africa has the highest adolescent fertility rate in the world, with girls under the age of 16 years of age facing four times the risk of maternal mortality than women over the age of 20. In Mexico 42% of young men and 26% of young women between 15 and 19 years have had a sexual relationship; only 47% of these young men and 15% of young women had used a condom during their first sexual intercourse. The HIV and AIDS rates are increasing in Eastern Europe. In Nepal 86% of married adolescents aged 15-19 are not using a modern contraceptives, every 4 hours one girl died from pregnancy relation complications. This is a global issue! The lack of adequate, accessible and youth friendly sexual and reproductive health services not only affect the educational and economic opportunities of present and future generations, but threaten their very survival.

Young people, particularly young women, must be educated and empowered on their own sexual reproductive health and rights. Without access to non-judgmental, confidential and evidence-based sexual and reproductive health information and services, young women remain vulnerable to unwanted pregnancies, unsafe abortion and sexually transmitted infections. Many young women are confronted with the consequences of early and forced marriage and child bearing.

Girls' Globe blogger Marcia Banasko at CSW58 in New York City
Girls’ Globe blogger Marcia Banasko at CSW58 in New York City

If we are to achieve a world of peace, equality and justice, we must be accountable to the world’s 860 million young women. We are more than a statistic – we are a valuable asset to nations, a critical population group for achieving sustainable human development and our voices must count in shaping the future of humanity. It is essential gender equality is retained as a stand-alone goal and that gender is mainstreamed across all the targets.

For Information:

World YWCA Global Call for Act: The Future Young Women Want

UNFPA Launches Advocacy Platform for Post-2015 Development Framework

Cover image courtesy of Flickr Creative Commons.

The Partnership for Maternal, Newborn and Child Health 2013 Report

PMNCH Report Pic

To kick off UN General Assembly Week in New York City, Girls’ Globe bloggers attended the launch of the Partnership for Maternal, Newborn and Child Health 2013 Report. Some of the Report’s contributors and reviewers included members of the World Health Organization, Foreign Affairs Canada, India’s Ministry of Health and Family Welfare, SickKids Center for Global Child Health, and the Bloomberg School of Public Health at John Hopkins University. The representatives spoke on the current issues and accomplishments regarding maternal and child health, as well as accountability and moving beyond 2015.

Discussions of the Report show that improvements have been made in several countries regarding maternal, newborn, and child health. Bangladesh was cited as a success story reporting a significant decrease in maternal and child mortality in the past decade. Increased access to modern contraceptives, access to skilled birth attendants and private sector facilities, gains in female education, and better roads and mobile phone use have all contributed to the decrease in maternal and infant mortality rates in Bangladesh.

“Commitments to advance the Global Maternal and Child Health Strategy continue to increase- the number of commitment-makers rose from 111 in 2010 to 293 in 2013, and there is growing evidence that committed funding is being disbursed.”

Although Bangladesh provides the Report with positive statistics, many contributors and reviewers believe although some progress has been made, it is not sufficient to meet goals by 2030. Dr. Richard Horton, co-chair and editor of The Lancet, points out there are still 38 countries that have experienced no reduction in child mortality. Horton believes a need for increased civil society engagement, greater focus on the issue of violence against women, and a more human rights-focused universal approach are necessary factors in the fight to decrease maternal and child mortality rates. Similarly, Dr. Neff Walker, Senior Scientist at John Hopkins University,  recognizes if we continue at this rate of growth, only 9 of the 75 countries will hit the MDG for reducing mortality. A lack of data surrounding adolescent reproductive health was also cited as a hindrance to achieving the goals.

There is an overwhelming sense of urgency to build effective accountability systems for countries, governments and organizations to ensure progress is being achieved. The report recognizes the need for stronger partnerships across a number of sectors in order for fundamental changes to occur. The majority of contributors and reviewers agreed in order to accelerate the goals on maternal and child health development initiatives must go beyond “business as usual.”

If you missed the conversation, check out our recap of the entire session and launch of the Report on Storify.

Blog Post by: Diane Fender and Justine Stacey

Featured Image Courtesy of: DFID