Transcript GENDER AND HEALTHCARE: CASE STUDY ON GENDER …

GENDER AND HEALTHCARE: CASE
STUDY ON GENDER BASED VIOLENCE
INTERVENTION
By Teresa Omondi Programmes Manager Gender
Violence Recovery Centre Nairobi Women’s Hospital
presented at HENNET Health and Human Rights
Workshop Programme on 1st April 2008 at Mary Ward
Centre, Karen
Gender and Health Care
 Gender refers to the social – cultural attributes associated with being man or
woman, boy or girl. Societies have different roles, responsibilities and
expectations for men and women.
 These gender roles exert various degrees of constraints, the more rigid the
gender role in a society, the sharper the gender division of labour and the
lower the status accorded to women.
 Health care on the other hand connotes the attention given to the well being
of person weather physically, socially, mentally and emotionally.
 Different valuation for different roles means that women and men everywhere
do not have equal access to the material and emotional resources needed to
sustain health. Underlying causes of women health problems such as domestic
violence or examining their living and working conditions have been ignored.
 There is considerable evidence of gender differences in access to health care,
affetced by medical knowledge and Literacy levels . Processes of pregnancy
and childbearing for instance have been turned into medical events with
control taken away from women themselves.
Effects of Gender Roles in Health Sector
 Women remain economically dependent on men and/or men
have control over family resources making it difficult for women
to pay for health care or transportation costs to health care
facilities.
 Social- cultural believes/ norms deny women the right to travel
alone or be in the company of men outside their immediate
family or making the decision to access health facilities. FGM
viewed as an essential for marriage.
 Domestic/household chores which lead to opportunity costs of
medical treatment to be greater example during harvesting
attending to health care concerns would be unacceptable burden
on the household considering that women provide the highest
number of farm labourers.
 Discriminatory
legislations examples policies restricting
reproductive rights, maternity leave and/or sick leaves.
Gender Based Violence (GBV) in relation to
Health Care
 Gender based violence is an umbrella term for any harmful act that is
perpetuated against a person’s will and that is based on socially ascribed
(gender) differences between male and female. The term GBV is used
interchangeably with the term Violence Agaisnt Women (VAW).
 Gender violence is a human rights violation that has serious health
implications example effects of domestic violence. Sadly it’s used as a weapon
of war or dispute resolution.
 Gender roles render women vulnerable to Gender based violence a profound
human rights and public health problem. It is a leading cause of injury and
death of women in Kenya and is also a major cause of HIV/AIDS; fear of
violence prevents women from insisting on safe sex.
Forms/Types of Gender Based violence







Domestic
Sexual
Physical
Cultural
Religious
Socio – economic
Patriarchy
The factors that promote GBV form the basis of the form they
take. They are promulgated by the agents of the society who
include custodian of culture, media, religious leaders,
discriminatory legislations, economic dependency, myths among
others.
Brief Statistics
 The Demographic and Health Survey, 2003 reports that that half (53%)





of all women in their 30’s and 49.4% in their 40’s have experienced
violence since age 15.
15% of married women in Kenya report having experienced marital rape.
One out of every four girls and young women report loosing their
virginity through forces.
Police statistics for 2006 show a 35% increase in child rape cases since
2005.
Women comprise 52% of Kenya’s population. Approximately half of the
poor in Kenay are women in rural areas. Women also make 67% of the
unemployed.
Women and girls education levels are low hence denying them better
economic opportunities and empowerment.
Generally, the statistics of sexual violence more or less represent the rate
of spread of HIV/AIDS. GBV is no longer just a human rights issue but
a national health issue which threatens to set back the multibillion gains
which Kenya has made in fighting HIV/AIDS.
Case Study: Gender Based Violence Interventions
Nairobi Women’s Hospital/ Gender Violence Recovery Centre Experience)
 The Nairobi Women’s hospital was set up in March 2001 with the aim of
providing holistic care to the women and children though men also benefit from
the health services. The hospital specializes in Obstetrics and Gynecology, but is
also competent to handle all other general medical conditions
 As a way of giving back to the society NWH established GVRC as a non- profit
and non partisan charitable trust of the hospital who main mandate is to provide
free specialized medical treatment and psychosocial support to the survivors of
GBV; the only such facility in East and Central Africa and a one stop medical
centre for women and children.
 The hospital provides gynecology services in the out patient department as a
primary health care service, breast clinic managed by a consultant surgeon and is a
leading example in provision of emergency health care to sexually violated persons
within the recommended first 72 hours.
Gender Based Violence Expereince
Since inception the hospital has received over 7,500 GBV Survivors;
 90% of the cases are of Sexual violence (Rape, Defilement & Sexual






assault)
9% are Domestic violence cases
1% Physical violence
49% were children
45% were women
6% were men
The youngest GBV survivor was 1 ½ months old baby, the oldest 87 yrs,
both complained of sexual violation.
 NWH/GVRC figures intensified during the post election violence. For the
period 27th December 2007 to 26th March 2008, 612 GBV survivors were
treated at the hospital, 229 children and 383 adults. 502 were complaints of
sexual violence and 110 Domestic and Physical violence. Most of the sexual
violence was perpetrated by gangs of young men ranging from 2 to 11 men
per act. Over 2,500 people were treated through medical camps held in
different crisis centre countrywide and over 150,000 people received
psychosocial support.
Gender Based Violence Interventions
Gender based violence interventions in healthcare are attempts or efforts to
promote good health behaviour or to prevent bad health behaviour. These
interventions reduce or end suffering.
Types of interventions.
 Comprehensive medical examination and treatment including;
 Provision of post exposure prophylaxis (PEP) – Postinor, Euvax, ARVs etc
 Laboratory tests (Pregnancy, HIV/AIDs, High Vaginal swab, Hepatitis,
Urinalysis, Liver function, Pregnancy),
 Continuous supply of variety of prescriptions & palliative care for terminal
illness
 Reproductive health care including family planning options
 Psychosocial support
 Professional counseling of survivors of GBV and their families (Individuals
and support groups)
 Distribution of aid materials such as clothes, food, sanitary towels etc
Cont…
 Training and capacity building of health workers in other health facilities,
police, prosecutors, magistrates, community based organizations among others
on impact of GBV in the society and how to handle GBV survivors. (Medical
and Psychosocial aspects).
 Referrals for accommodation (Shelter homes) and legal aid services. This is
done through partnerships/networks with other like minded organizations
such as FIDA Kenya, WRAP, Goal Kenya, CLAN, The CRADLE and
COVAW.
 Increase GBV survivors’ access to justice by providing testimonies and/or
evidence in court in favour of the survivors and enactment of favourable
legislations example Sexual opffences Act, Children’s Act and upcoming
Gender Bills(Domestic Violence (Family Protection) Bill, Marriage Bill,
Matrimonial Property Bill and Equal Opportunities Bill), domestication of
human rights instruments.
 Community
awareness programmes (Community trainings and media
coverage) to enhance awareness of the nature, manifestation, dynamics and
impact of GBV & HIV/AIDS with the aim of influencing public opinion and
perceptions on GBV and enroll public to fight GBV and HIV/AIDS (reduce
levels of GBV). Includes Legal awareness.
Challenges
1.
Limited resources (Human and Financial resources) to support efforts
against GBV. There is great burn out in human resource.
1.
Burnout of health service providers
2.
The culture of silence surrounding GBV which makes collection of data on
this sensitive issue particularly challenging. Similarly much of the
information can not be meaningfully compared because of differences in
how intimate partner violence is measured and reported.
3.
Discriminatory Legislations for instance Section 84 of Kenya’s Constitution
still contains discriminatory clauses that promotes personal laws which in
most communities are discriminatory to women thus enhance GBV.
4.
Lack of political will to implement legislations and/or international
conventions example domestication of CEDAW and African Charter on the
rights of women.
Lessons learnt
 There is need to expand medical services to reach the people at the grassroots
level. Includes expansion of personnel and infrustracture.
 Need to enhance community awareness on nature, manifestation, dynamics
and impact of GBV & HIV/AIDs with the aim of influencing public opinion
and perceptions on GBV and HIV/AIDS.
 Need for counseling to also target possible perpetrators to stop the inhuman
acts and also benefit service providers who are vulnerable to burn out.

Need to enhance networks to reach out for emergency response example
contacts for emergency evacuations to reach survivors of humanitarian crisis,
media alerts etc. (hotline responses)
 Need for adequate supply of prescriptions of certain medical conditions
example diabetes, cancer, high blood pressure, physically challenged among
others.
 Political will is inadequate in Kenya.
Outcomes in relation to Health and Human rights
Gender Based Interventions bring out collective results including;
 Improvement of the physical and psychological health.
 Increased appreciation of self-worth (Self esteem) achieved through
counseling.- (Human rights component).
 Legislation reforms which include enactment of;
 The children’s act No. 8 of 2001
 The Sexual Offences Act, 2006 and the establishment of a task force to
ensure implementation of the Act,
 National Action Plan for the eradication of Female Genital Mutilation.
 HIV/AIDS Prevention and Control Act 2006 whose objective is to provide
measures for the prevention, management and control of HIV and AIDS.
 National Policy on Gender Equality and Development, 2000 and Sessional
Paper No. 2 of 2006 on Gender equality and Development.
 Adolescent and Reproductive Health and Development Policy, 2003
 Gender Bills
 National framework on GBV (Multisectoral intervention to prevent and
respond to GBV).
 Millennium Development Goals achievements.
Recommendations
 It is very important that all people working in humanitarian organizations,
public service, health sectors, religious organizations among others to have a
comprehensive understanding of gender, health and human rights, the three
must not be addressed separately. GBV is part and parcel of health care
services and should be in all training institutions and where possible all service
providers be subjected to regular refresher courses on Gender and health.
 It is also important to have a fair grasp of relevant legislations including,
Human rights instruments, the Children’s Act No. 2 of 2001, the Sexual
Offences Act, 2006 and HIV/AIDS Act, 2006.
 Basic counseling and psychological support skills are crucial for any health
care giver or service provider including those working in humanitarian
organizations. Listening is a therapeutic. All health systems must listen to the
woman.
 There is also need to lobby development partners to highlight gender
concerns as one of the conditions of funding in any projects. This will enable
gender to be visible in development plans, policies and legislations
 Lobby for state obligation over human rights.
THANK YOU