Vaw Lecture Ms Belinda Santos

Violence Against Women (VAW) Presented by: Belinda Jubilo-Santos UP-PGH Women’s Desk

A Background on Violence Against Women (VAW) Here and Abroad 

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According to UNICEF, more than a million infant girls die on account of being female. Female genital mutilation is still a prevalent practice in African countries. Approximately 90 million women are affected by this practice. In Burma, 10,000 women and girls are trafficked into slavery in Thai brothels. 6 studies in the US suggest that between one in five to one in seven US women will be the victim of a completed rape in her lifetime.

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In recent years, mass rape in war-torn countries have been documented. More than 20,000 women have been raped in Bosnia since the fighting began in 1992. In the Philippines, PNP statistics in 1994 reveal the occurrence of rape at one every six hours.

Manifestations of Gender Bias      

Marginalization Subordination Multiple Burden Gender Stereotyping Personal Dehumanization Violence Against Women

Recognition of VAW by the International Community 

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1993 World Conference on Human Rights-Vienna, Austria- VAW was internationally recognized as a grave form of human rights violation and such, a serious obstacle to development and peace. 1995 World Conference on Women-Beijing, China- Beijing Declaration: All States are obligated to prevent and eliminate all forms of violence against women and girls. This gave rise to  

UN Declaration on the elimination of Violence Against Women Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW)

VIOLENCE AGAINST WOMEN (VAW) 

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transcends culture, socio-economic strata, ethnicity/race, religious background manifestations of historically unequal power relations between men and women leading to domination over and discrimination against women by men. -Breaking the Silence, Sylvia H. Guerrero

UN Declaration on the Elimination of Violence Against Women   

act of gender-based violence physical, sexual or psychological harm or suffering to women in private or public life  coercion  threats  arbitrary deprivation of liberty

Philippine Response to the Call for Action 

Republic Act No. 8805 of 1997- This made provisions for the assistance and protection of abused women by establishing a crisis center in every province and city.

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RA 7877: The Anti-Sexual Harassment Act of 1995

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RA 8353: The Rape Law of 1997

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RA 9262: Violence Against Women and Their Children Act of 2004

Health professionals are in a strategic position to be of service to victims of abuse and violence.  Detect victimization    

Assess risk of vulnerable groups Prevent further violence Provide health services for survivors Assist in the reintegration of rehabilitated victims and survivors into the family and community.

3 MAIN ROLES OF HEALTH PROFESSIONALS IN THE MANAGEMENT OF ABUSE CASES  Detection/Recognition  Medical/Crisis  Referral

Intervention

Physician Barriers to Recognition •

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Lack of awareness of prevalence, means of identification, severity of the problem, and social and psychological costs of abuse Believing that recognition, identification, referral of abuse is not part of the physician’s roles Not knowing how to intervene or help “Blaming the woman” and feeling angry why the woman does not leave her abusive partner

Physician Barriers to Recognition 

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Disbelief because the assailant is present and seemed very concerned and pleasant Concern that discussing psychosocial issues will take time Difficulty in dealing with feelings evoked by the interview

“It’s never easy…” Patient Barriers in Disclosing Abuse 

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Held captives with no means of transportation Childhood experience of violence and abuse Fear of jeopardizing her safety Shame and humiliation in the way she is being treated Still protective of their partner Lack of awareness

Clinical Recognition

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Consider the possibility of abuse in the following: The patient’s PE findings are incongruent with the explanation of the injury If there was a delay in seeking medical attention Pregnant woman with injuries

WHO Suggested Questions 

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Are you ( Have you ever been ) in a relationship in which you have been physically hurt or threatened by your partner? Are you ( Have you ever been ) in a relationship in which you were treated badly? In what ways?

WHO Suggested Questions   

Has your partner ever destroyed things that you cared about? Has your partner ever threatened or abused your children? We all fight at home. What happens when you and your partner fight or disagree?

WHO Suggested Questions  

Has your partner ever forced you to have sex when you did not want to? Does he ever force you to engage in sex that makes you feel uncomfortable?

Framing clauses 

Violence in the home is very common and can be very serious. Therefore, I routinely ask my patients whether they are experiencing domestic violence, because no one should ever have to live in fear and because there is help available.

Framing clauses 

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Whenever I see injuries of this type, it is often because someone hit them with a fist. Is that what happened to you? Many women experience some type of physical abuse in their lives. Has this ever happened to you?

Responsibilities of the Medical Staff The physician will review with the patient the history of her complaints and previous medical history  The physician will assess the patient’s physical & emotional status & document findings  Follow-up is provided 

Responsibilities of the Medical Staff The physician will clearly document all injuries & complete the Assault Diagram  Describe the size, shape & location  only one PE is made  Report objectively. Do not give summary statements, inferences or conclusions about the circumstances of the assault.The record should quote the patient when possible.

Essential Information for Battered Women She needs to know that: 

she is not alone there is help available for her

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she does not deserve to be beaten

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The UP-PGH Women’s Desk

Republic Act No. 8805 of 1997 

The UP-PGH Women’s Desk was established in 1998 to address the need for a help desk to assist women survivors of violence seen in the hospital.

Referring a VAW Survivor to the Women’s Desk

FLOW CHART FOR CASE HANDLING Victim of abuse referred by: • Community • NGO • Self or family

Walk-in patient to PGH ER

Victim of abuse Consults at ER Patient as possible victim of abuse detected at ER Patient presents with a life threatening medical or surgical condition Appropriate medical or surgical service for emergency management given Referral to Women’s Desk

Patient does not present with a life threatening medical or surgical condition Referral to Women’s Desk Appropriate medical or surgical service for emergency management given

Women’s Desk Management: HOLISTIC CARE Physician Complete History & PE Physical Evidence & Specimen Collection Continuation of Medical/Surgical Care

Admission to Appropriate Ward

Counselor/Social Worker •Crisis Intervention •Family Counseling •Debriefing of Family Members •Psychiatric Evaluation •Spiritual Counseling

Activation of Support Group/Organization

Medical/Psychosocial Follow-up

Assessment by Police Legal Services given if needed

Transfer to a Shelter

When you encounter the Survivor on your ER Rotation...    

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Avoid judging the patient. Be discreet in your dealings with the patient. Provide as much privacy as is allowed during PE. Fill up all necessary fields in the chart, the Women’s Desk form, and the anatomical diagram. Provide the patient with a Provisional Slip if applicable. Make sure that the patient has a Patient’s Intake Chart. Please refer to Medical Social Service-DEM if the case was seen on holidays, weekends, and after office hours.

Thank You Very Much!