A Four Week Online Certificate Training Course on Healthcare & Gender Equity: Emerging Dimensions, Policies, Impact & Way Forward was organized by the Gender Impact Studies Center (GISC), at the IMPRI Impact and Policy Research Institute, New Delhi and Center for Ethics (CFE), Yenepoya (Deemed to be University), Mangalore.
Day 3 of our event featured Dr Padma Bhate Deosthali, Program Director, Creating Resources for Empowerment in Action (CREA), delivering a comprehensive presentation on “Health Systems Response to Gender-Based Violence.” The discourse encapsulated the role of health systems in policy and legal mandates, the nuanced understanding of responses to sexual violence, and elucidative case studies.
Gender Based Violence Vs Violence Against Women
A fundamental clarification emphasized the distinction between “violence against women” and “gender-based violence.” While the former encompasses intimate partner violence, domestic violence, rape, and sexual violence, the latter is more expansive, encapsulating all forms of violence against diverse genders. The crux of the discussion rested on the pivotal role of health systems as victims or survivors invariably turn to hospitals for treatment due to the health consequences of violence, be it physical, sexual, emotional, or financial abuse.
Dr. Padma underscored the global consensus surrounding health systems’ response to gender-based violence, referencing the WHO clinical and policy guidelines of 2013. These guidelines assert that health systems must provide supportive care, including empathetic listening, ongoing psychological support, and referrals to other services, irrespective of a country’s developmental status. The provision of supportive care is integral to the prevention of violence, the recurrence of incidents, and the mitigation of consequences.
Recognition in Law
In the Indian context, recognition of gender-based violence as a health issue was acknowledged only in 2017 through health policy. However, legal mandates for healthcare providers existed for several years before this acknowledgment. The Protection of Women from Domestic Violence Act of 2005 outlined rules requiring healthcare providers to identify and document abuse, provide immediate medical care free of charge, offer emotional support, and inform survivors about legal provisions, including referral to protection officers.
Several other legal provisions, such as the Dying Declaration under Section 32 (1) of the IEA, the Criminal Law Amendment of 2013, and the Prevention of Child Sexual Offences Act of 2012, demonstrated a legislative framework emphasizing the importance of healthcare providers in addressing gender-based violence.
Despite these legal mandates, the implementation of policies faces substantial challenges. The biomedical model prevalent in health systems often inhibits survivors of domestic violence or violence by intimate partners from speaking about their experiences. There exists a pervasive perception that violence is a social or criminal justice issue, falling outside the purview of medical professionals. This creates barriers to effective response.
Moreover, health systems often fail to understand societal inequalities, restricting their focus to treatment rather than delving into the root causes of injury. Healthcare providers, influenced by dominant social-cultural norms, may inadvertently perpetuate gender norms that normalize sexual violence against women or gender-diverse individuals. Disrespect and abuse, including violence in labor rooms and forced treatment of sexual and gender-diverse persons, further hinder survivors from seeking help.
Role of Health Systems
Dr. Padma highlighted the interconnectedness of health systems with other institutions such as the police, family, community, and the judiciary. In cases of sexual violence, the involvement of these institutions complicates the response and necessitates a multi-faceted approach.
Despite guidelines and protocols issued by the Ministry of Health, challenges persist in the implementation of medico-legal care. Informed consent, comprehensive documentation, and the provision of treatment, including psychological support, are crucial components. Specific guidelines recognize the need to respond to marginalized groups, such as those facing discrimination based on gender identity, engaged in sex work, with physical or intellectual disabilities, or belonging to religious minorities or tribes.
However, mandatory reporting laws pose significant problems, especially when survivors seek treatment but do not wish to report to the police. The violation of privacy laws and trust issues between doctors and patients can impede access to health services. International perspectives suggest that mandatory reporting should support services rather than the police, fostering an environment conducive to seeking care.
In the realm of medical evidence, trace evidence, injuries, and the identification of sexually transmitted diseases are critical. However, limitations, including the time lapse between the incident and documentation, the impact of personal hygiene practices, and the use of condoms, must be acknowledged. Medical evidence should not be essentialized to merely document the incident but should be part of a holistic approach to survivor care.
Dr. Padma concluded the session with a question-and-answer segment, underscoring the need for ongoing discourse, collaboration between institutions, and a paradigm shift in societal perceptions to effectively address gender-based violence through health systems.
Acknowledgement: Tanu Paliwal is a research intern at IMPRI.
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