GENDER AND HEALTHCARE: CASE STUDY
ON GENDER BASED VIOLENCE
NAIROBI WOMEN’S HOSPITAL/GENDER VIOLENCE
Presented By Teresa Omondi Gvrc Programmes Manager,
At HENNET Health And Human Rights Workshop On 1st April 2008 At
Loreto Mary Ward Centre, Nairobi.
TABLE OF CONTENTS
1.0 GENDER AND HEALTHCARE: CASE STUDY ON GENDER BASED
VIOLENCE INTERVENTION ....................................................................................... 4
1.1 Executive Summary ......................................................................................... 4
1.2 Introduction: Gender and Health Care ..................................................... 5
3.0 GENDER BASED VIOLENCE (GBV) IN RELATION TO HEALTH CARE .. 8
4.0 CASE STUDY: GENDER BASED VIOLENCE INTERVENTIONS .............. 10
4.1 (NAIROBI WOMEN’S HOSPITAL/ GENDER VIOLENCE RECOVERY
CENTRE EXPERIENCE).............................................................................................. 10
4.1.1 About NWH/GVRC .................................................................................. 10
4.1.2 NWH/GVRC Gender Based Violence Experience ......................... 11
5.0 GENDER BASED VIOLENCE INTERVENTIONS .......................................... 12
6.0 CHALLENGES ........................................................................................................ 15
7.0 LESSONS LEARNT ............................................................................................... 16
8.0 OUTCOMES IN RELATION TO HEALTH AND HUMAN RIGHTS ............ 17
9.0 RECOMMENDATIONS ........................................................................................ 19
CLAN - Chilren’s Legal Action Netweork
THE CRADLE - Child’s Rights Advisory Documentation & Legal
COVAW - Coalition on Violence Against Women
FIDA (K) - Federation of Women Lawyers Kenya
GBV - Gender Based Violence
GVRC - Gender Violence Recovery Centre
NWH - Nairobi Women’s Hospital
SGBV - Sexual & Gender Based Violence
VAW - Violence Against Women
WRAP - Women Rights Awareness Programme
1.0 GENDER AND HEALTHCARE: CASE STUDY ON GENDER BASED
1.1 Executive Summary
Every society around the world socially defines tasks, activities, responsibilities or
duties ascribed to women and men on the basis of perceived differences. These
roles direct the behaviour of women and men, girls and boys, affects division of
labour in development and shape women’s access to rights, resources and
opportunities in public and private life. 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. These
roles similary render women vulnerable to Gender based violence a profound
human rights and public health problem. The Criminal justice and health systems
are often unable to effectively respond to the legal and emotional needs of
Gender roles are rooted in rational responses to a lifestyle no longer adapted to
the forces of social change sweeping the contemporary world. The forces of
globalization and urbanization are altering the pace and style of life in even the
remotest corners of the world. This requires role changes and adaptations in
home and working life which have differential gender impacts, particularly as the
changes needed may be significant, and the pace of role adaptation is often
slow. This disjunction has a tendency to leave resource-poor women caught
between two worlds, the new and the old, with responsibilities in both.
This paper discusses effects of gender based violence on health and
interventions thereto. NWH/GVRC GBV experience is shared with emphasis that
any attempt to understand the social dimensions of Gender based violence must
include a systematic analysis of the impact of Gender roles on daily life, both
inside and outside the home.
1.2 Introduction: 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 roles and responsibility are always
changing determined at a definite time and place. Social construction of Gender 1
is influenced by the agents of socialization such as family, religion, school,
culture, media and peers.
Health care on the other hand connotes the attention given to ensure the well
being of person weather physically, socially, mentally and emotionally. Right to
Society’s differential valuing and allocation of duties/responsibilities and work to
women ad men)
health provides for the entitlement to available and accessible health care and
higest attainable standards of health.
There are several underlying causes of women health problems in including;
1. Different valuation for different roles resulting to women and men
everywhere in the world to have unequal access to the material and
emotional resources needed to sustain health. There is considerable
evidence of gender differences in access to health care; processes of
pregnancy and childbearing for instance have been turned into medical
events with control taken away from women themselves. Medical
knowledge is usually presented as superior, giving women little
opportunity to speak for themselves or to participate actively in decision-
making about their own bodies. This situation is made worse by the gaps
in the literacy levels in development countries.
2. Gender based violence especially domestic violence, living and working
conditions of women have been ignored.
3. Women additional needs for reproductive health care are not given
priority, many women face serious obstacles in their attempts to meet
these needs. For example affordability of female condoms is NIL for a
majority of women in sub-Saharan Africa.
4. Women remain economically dependent on men and/or men have control
over family resources making it difficult for women to pay for health care
services or transportation costs to health care facilities. In many societies,
cultural norms dictate that males in the household have the principal
share of income and wealth as well as higher status and greater decision-
5. 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. These social- cultural norms have lead
to high child mortality rate in Kenya.
6. 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.
7. Discriminatory legislations examples policies restricting reproductive rights
including right to choose number of children and their spacing. There are
strigent laws against “pro choice” approach to family planning and
women’s right to decisions affecting their reproductive health.
3.0 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 is based on socially ascribed (gender)
differences between male and female. 2 GBV includes any act that results in, or is
likely to result in physical, sexual or psychological harm or suffering to women
including threats of such acts, coercion or arbitrary deprivation of liberty,
whether occurring in public or in private life. It is a violation of human rights
respect to human dignity.
Around the world GBV has a greater impact on women and girls than men and
boys. The term GBV is used interchangeably with the term Violence Agaisnt
Women (VAW). GBV highlights the relationship of female subordinate status in
society and their increased vulnerability to violence.
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. 3 Gender violence is a major public health and human right problem in the
country. 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. Statistics also reflect the ways in which women and men are treated by
Definition by Inter Agency Standing Committee on strenghening humanitarian assistance
Kenya Health demographic Survey, 2003 pg 242
health care systems; a factor leading to the inequality between sexes both in
access to health care and also in outcomes.
There are various forms of Gender violence; Domestic violence, Sexual violence,
Physical assault, Emotional violence, Trafficking in persons, Female Genital
Mutilation (FGM), Forced/Early marriages, Economic violence or Mental
(Psychological) violence. Nature and extent of GBV vary across cultures,
countries or regions.
Some of the major international instruments that provide for human rights
protection and are against GBV include; United Nations Declaration on Human
Rights 1948, United Nations Declaration on Elimination of Violence against
Women (Vienna Declaration 1993), Convention on the Elimination of all forms of
Discrimination Against Women (CEDAW) and Beijing platform for Action.
4.0 CASE STUDY: GENDER BASED VIOLENCE INTERVENTIONS
4.1 (NAIROBI WOMEN’S HOSPITAL/ GENDER VIOLENCE RECOVERY
4.1.1 About NWH/GVRC
The Nairobi Women’s hospital was established in March 2001 with the aim of
providing holistic health care to the women and children though men also benefit
from the health services. The hospital specializes in Obstetrics and Gynecology,
though also competent to handle all other general medical and surgical
conditions that require specialized care.
As a way of giving back to the society Gender Violence Recovery Centre (GVRC)
was launched the same year; a non- profit and non partisan charitable trust of
the Nairobi women’s hospital and immediately took up all the gender based
violence cases providing free specialized medical treatment and psychosocial
support to the survivors of gender based violence.
NWH/GVRC has pioneered several women and children health care services in
Kenya. The hospital is a one stop medical centre that provides comprehensive
medical treatment, psychosocial support, 24hrs accomodation, legal assistance
and referral to shelter homes. The hospital remains the only such facility in East
and Central Africa with no other NGO operating in Gender rights sector matching
the same. Other services include; gynecology services in the out patient
department as a primary health care service which service in most hospitals is
provided on a consultancy basis and as a secondary health service.
The hospital has most of the equipments that pertain to women and children
health are found in the hospital and all forms of treatment including theatre,
ambulance are in the same place making it the most referred to hospital in terms
of critical Gender health conditions. The hospital is a leading example in
provision of emergency health care to sexually violated persons within the
recommended first 72 hours. There is also a breast clinic managed by a
consultant surgeon; a rare service in most hospitals.
4.1.2 NWH/GVRC Gender Based Violence Experience
Since inception the hospital has received over 10,145 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 month old baby girl, the oldest 90 yrs
old woman, both complained of sexual violation.
GBV is either opportunistic or planned. It has been recognized as a weapon of
war and crime against humanity. NWH/GVRC figures intensified during the post
election violence. For the period 27th December 2007 to 31st March 2008, 653
GBV survivors were treated at the hospital, 269 children and 384 adults. 546
were complaints of sexual violence and 107 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 2,812 people were treated through medical camps held in
different crisis centre countrywide and over 150,000 people received
5.0 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.
NWH/GVRC in the past and during the post election violence period has provided
the following interventions;
1. 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
2. Psychosocial support
• Professional counseling of survivors of GBV and their families
(Individuals and support groups)
• Referrals to various likeminded organizations providing other
humanitarian service example shelter homes and legal aid services.
• Distribution of aid materials such as clothes, food, tents, sanitary
towels, condoms, delivery kits etc in humanitarian situations and on a
day to day basis.
3. 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). NWH/GVRC in collaboration with the
Ministry of Health developed the Rape Management Protocol, 2004 used as
guidance on handling survivors of rape.
4. 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.
5. Increase GBV survivors’ access to justice by;
• Providing testimonies and/or evidence in court in favour of the survivors.
NWH/GVRC in collaboration with the Ministry of Health designed a tool kit
providing particulars of GBV survivor, evidence collected, particulars of
the circumstances of the crime and treatment given. This tool kit is very
handy in monitoring the trends of GBV in the country to give testimonies
in court and advice drafting of legislations.
• NWH/GVRC played a significant role in the enactment of the Sexual
Offences Act, 2006 both in drafting the law and provision of statistics for
• NWH/GVRC continues to take an active role in the advocacy for the
passing of gender bills (Domestic Violence (Family Protection) Bill,
Marriage Bill, Matrimonial Property Bill and Equal Opportunities Bill)
6. 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).
1. Limited resources (Human and Financial resources) to support efforts against
GBV. There is great burn out in human resource.(Emotional drain)
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 increased 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.
7.0 LESSONS LEARNT
• There is need to expand medical services to reach the people at the
grassroots level. GVRC has plans to expand its services to other provinces
in the country. A trial was done during the post election violence period
where the hospital entered into memorandum of understanding with
hospitals in Eldoret, Kisumu and Mombasa to enable survivors in their
areas to access free medical and psychosocial treatment.
• 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. Most people
appreciate visible injuries rather than Sexual and Gender Based Violence
(SGBV), the latter hardly given priority yet crucial in health care.
• Need for counseling to also target possible perpetrators to stop the
inhuman acts and also benefit service providers who are vulnerable to
• Need to enhance networks to reach out for emergency response example
contacts for emergency evacuations to reach survivors of humanitarian
crisis, media alerts etc. There is also need for increased number of
organizations with hotline responses.
• Need for adequate supply of prescriptions of other medical conditions
example diabetes, cancer, tuberculosis, high blood pressure, physically
challenged among others. In times of crisis concentrations has often been
placed on pain relievers and common illnesses such as mulnutrition,
common cold, malaria etc
• Political will is inadequate in Kenya. The ministry of health should address
the challenge of inadequate personnel and health facilities. Accessibility to
available health facilities is a challenge due to poor roads and sometimes
security. There is equally the need of the Ministry in charge of Gender to
take the lead roles in gender issues in the country.
8.0 OUTCOMES IN RELATION TO HEALTH AND HUMAN RIGHTS
There are several outcomes advised by statistics collected from NWH/GVRC.
These outcomes are achieved by the collective efforts of Governement, Non
Governmental organisations and development partners these include;
1. Improvement of the physical and psychological health. Over 10,145
survivors of GBV have received comprehensive medical treatment and
psychosocial support at the hospital and over 2,500 through medical
2. Increased appreciation of self-worth (Self esteem) achieved through
counseling. Survivors are able to cope with their situations and where
possible start afresh. An important role of Human rights.
3. 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
• Establishment of the National Aids Control Council which is the national
co-ordinating authority to provide the required leadership and develop
one agreed HIV/AIDS action framework that provides the basis for co-
ordinating the work for all partners, gives a broad-based multi-sectoral
mandate and one agreed upon country level monitoring and evaluation
• 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; the Domestic Violence (Family protection) Bill that
criminalizes domestic violence, the Marriage Bill protecting women
rights in marriages, Matrimonial property Bill which provides for women
rights over family resources, the Equal Opportunity Bill calling for equal
opportunities for both men and women with specific emphasis in public
participation and decision making.
4. Currently the National Commission on Gender and development co-
ordinating the establishment of the national framework on GBV meant to
come up with a national strategy to address GBV in Kenya (Multisectoral
intervention to prevent and respond to GBV).
5. To achieve Millennium Development Goals No. 3 on Gender Equality and
empowerment of women, No. 4 on Reduction of child Mortality rates and
No. 5 on improved maternal health the government of Kenya has put in
efforts to enable free medical care (antenatal care) in public hospitals for
children below 5yrs and for deliveries by mothers.
• 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. As earlier discussed protection & prevetnion of GBV is
a human rights issue which right can not be waived, it is an entitlement to
all human beings.
• It is also important to have a fair grasp of relevant legislations including,
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.Psychosocial support should be extended to service providers
• 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