WINDHOEK – Women who experience abuse are more likely to go to health facilities than women who do not experience it. 

This is because their chances of acquiring Sexually Transmitted Infections (STIs), including HIV, are almost twice as women who are not in abusive relationships, Dr Avni Amin, a specialist at the World Health Organisation (WHO)’s headquarters in Geneva told the Health Focus. 

“We know that women who experience abuse are more likely to go to health facilities than women who don’t for STIs, unwanted pregnancies, they are also more likely to have miscarriages, in any case, they will present to the health facility,” said Amin who works in the department of reproductive health and research.  Amin was in Namibia to train health care providers on the recently launched clinical handbook for healthcare providers. 

WHO and the United Nations’ Population Fund (UNFPA) supported the Ministry of Health and Social Services to adopt the global clinical handbook for the health care of women subjected to intimate partner violence and or sexual violence.

The handbook was launch in April 2019. Last week, 55 trainers selected from different regions and institutions were trained to help implement the handbook at facility level. The adaptation of the handbook was influenced by the fact that one in three women experience either physical, sexual and emotional abuse from their male partners. Only a fraction of these cases are reported, according to WHO. The majority of these women frequent the facility for different health reasons without disclosing the abuse they are experiencing. The health sector has a critical role to play in early identification and provision of comprehensive clinical care for survivors, according to WHO. 

Amin said women who are in abusive relationships may not disclose that they are experiencing violence in their homes when they seek healthcare services. “So, what we are hoping to train the healthcare providers to do is to pick up these signs and symptoms. For example, if a woman comes in with some strange injuries or injury patterns that are not consistent with her story, then we are training providers to pro-actively ask,” explained Amin. Similarly, healthcare providers are being trained to pick up emotional distress in their patients. “Once they are trained to recognise that this may be linked to violence, then we are asking them to probe. That’s the way we hope that healthcare professionals will be able to more actively ask about violence while also providing psychological support and also treating injuries, STIs and any depression,” said Amin. 

“We found that women who experience abuse would much rather disclose these violence if at all to health professionals. They consider health professionals amongst those professionals that they trust the most but often because health providers are not trained they don’t pick up the symptoms,” she further highlighted.

Part of the training is how to respond with empathy to patients and survivors of Gender-Based Violence (GBV), Amin added. 

Further explaining why GBV is a health issue, Amin said “ from global data, we know that women who are experiencing domestic or intimate partner violence, we know they are twice as likely to experience depression, twice as likely to have alcohol use disorders, they are in some regions, more likely to acquire a sexually transmitted illness or HIV and about 42 percent or so of women who experience partner violence experience injuries as a result.” 

Unfortunately, it is also the case that in extreme cases women die. “Between 38-50 percent of murders of all women are committed by their partners, worldwide,” said Amin.

“In Namibia, the Demographic and Health surveys indicates that 33 percent of Namibian women have experienced physical and or sexual violence, so that’s a pretty large number. What we’re learning on how to prevent this is that we need to strengthen how to communicate between couples and resolve conflicts and anger without resorting to violence. How do we empower women, which includes self-efficacy and self-confidence? We need to make sure that the women who are subjected to violence have access to legal services, social services, counseling or shelter,” said Amin. 

One of the important underlying drivers of violence in households is often stress related to poverty, she highlighted. “And while that’s not a root cause it’s important to make sure that we have programmes that help women cope with poverty.  And we need to educate our children and adolescents from a very young age that violence is not the way to resolve conflicts. This means we must make sure that children are not exposed to violence, not in homes, schools, communities and perhaps we need to promote equitable gender norms that promote equality between women and men. That is one of the root causes of violence, gender inequality,” she noted.