Gender and Health Care - GENDER AND HEALTHCARE_ CASE STUDY ON

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					GENDER AND HEALTHCARE: CASE STUDY

        ON GENDER BASED VIOLENCE

                   INTERVENTION


    NAIROBI WOMEN’S HOSPITAL/GENDER VIOLENCE

                     RECOVERY CENTRE



     Presented By Teresa Omondi Gvrc Programmes Manager,
At HENNET Health And Human Rights Workshop On 1st April 2008 At
                Loreto Mary Ward Centre, Nairobi.




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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




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Acroynms

CLAN         -   Chilren’s Legal Action Netweork


THE CRADLE   -   Child’s Rights Advisory Documentation & Legal


                 Centre


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




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    1.0 GENDER AND HEALTHCARE: CASE STUDY ON GENDER BASED

                           VIOLENCE INTERVENTION

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

survivors.



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


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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




1
 Society’s differential valuing and allocation of duties/responsibilities and work to
women ad men)

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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.

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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-

   making power.


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.




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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


2
    Definition by Inter Agency Standing Committee on strenghening humanitarian assistance
3
    Kenya Health demographic Survey, 2003 pg 242

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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.




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     4.0 CASE STUDY: GENDER BASED VIOLENCE INTERVENTIONS



  4.1 (NAIROBI WOMEN’S HOSPITAL/ GENDER VIOLENCE RECOVERY

                             CENTRE EXPERIENCE)



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


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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

       assault)

   •   9% are Domestic violence cases

   •   1% Physical violence

   •   49% were children


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   •   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

psychosocial support.



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.




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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


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   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

      advocacy.

  •   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)

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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).



6.0 CHALLENGES



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.




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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

      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. 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


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       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

       camps.

   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


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•   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.

•   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

    system.

•   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.




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  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.



9.0 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. 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.




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•   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

    to reduce

•   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




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Description: Sexual health is the desire of people with physical, emotional, intellectual, belief, behavior and social interactions on the health of the sum, it is expressed as a positive good character, rich and mature interpersonal relationships, honest and faithful love and marital relations.