WUNRN
The Lancet - http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61837-7/fulltext
Volume
385, No. 9977, p1567–1579, 18 April 2015
See link for study authors’ details. Multiple
text references provided.
The Health-Systems Response to Violence Against Women
Introduction
Violence against women is a global public
health and clinical problem of epidemic proportions. Health-care providers
frequently, and often unknowingly, encounter women affected by violence.
The health-care system can provide women
with a safe environment where they can confidentially disclose experiences of
violence and receive a supportive response. Furthermore, women subjected to
intimate partner violence identify health-care providers as the professionals
that they trust with disclosure of abuse.
This Series paper is based on evidence on
the health-care response to violence against women, experience of the
implementation of services to address violence against women in diverse
countries, and consultations with those involved in the planning or delivery of
services in resource-poor settings. We describe the challenges involved in
engagement of the health sector and make recommendations to integrate effective
care for women experiencing violence.
Figure 1
The role of the health system to address violence against women
Figure 2
Elements of the health system and health-care response necessary to address violence against women
Adapted from Colombini and colleagues,30x30Colombini, M, Mayhew, SH, Ali, SH, Shuib,
R, and Watts, C. An integrated health sector response to violence against women
in Malaysia: lessons for supporting scale up. BMC Public Health. 2012; 12: 548
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References30 by permission of BioMed Central. SA=sexual assault.
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Figure 3
Women's (non-linear) trajectory to safety: health professional's response to women's readiness for action
Women's pathway to safety is not linear and health professionals need to respond at different time points to where a woman is currently at, in terms of her readiness to take action.
Summary
Health systems have a crucial role in a multisector response to violence against women. Some countries have guidelines or protocols articulating this role and health-care workers are trained in some settings, but generally system development and implementation have been slow to progress. Substantial system and behavioural barriers exist, especially in low-income and middle-income countries. Violence against women was identified as a health priority in 2013 guidelines published by WHO and the 67th World Health Assembly resolution on strengthening the role of the health system in addressing violence, particularly against women and girls. In this Series paper, we review the evidence for clinical interventions and discuss components of a comprehensive health-system approach that helps health-care providers to identify and support women subjected to intimate partner or sexual violence. Five country case studies show the diversity of contexts and pathways for development of a health system response to violence against women. Although additional research is needed, strengthening of health systems can enable providers to address violence against women, including protocols, capacity building, effective coordination between agencies, and referral networks.
This is the second in a Series of five papers about violence against women and girls.