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

 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
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
   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
   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
      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
    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
 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

 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.
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

 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.
 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

 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.

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