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GENDER AND HEALTHCARE CASE STUDY ON GENDER BASED VIOLENCE

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GENDER AND HEALTHCARE CASE STUDY ON GENDER BASED VIOLENCE Powered By Docstoc
					Gender, GBV and Health

Dr. Sam Thenya, Group CEO-The Nairobi
           Women’s Hospital
 5th GTZ Health Sector Network Meeting
         Mombasa 25th Feb 2010
Definitions.
 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.

 GBV    results in physical, sexual or
 psychological harm. It includes threats to
 carry out such acts, coercion or arbitrary
 deprivation of liberty, whether occurring in
 public or in private life.
Cont…
 All over 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 Against
 Women (VAW). GBV highlights the relationship of
 female subordinate status in society and their
 increased vulnerability to violence.
CONCEPTS OF GENDER
 Gender


 Human Rights


 Power


 Violence


 Informed Consent
GENDER
• Social differences between males and females that
  are learned

• …though deeply rooted in every culture, are
  changeable over time
• …have wide variations both within and between
  cultures

• Determines the roles, responsibilities, opportunities,
  privileges, expectations, and limitations for males and
  for females in any culture.
Human rights issue
• Acts of GBV violate a number of women’s human
 rights principles enshrined in international human
 rights instruments. These include, amongst others
 the:
 -the right to life, liberty and security of the person;
 -the right to the highest standard of physical and
 mental health;
 -the right to freedom from torture or cruel, inhuman, or
 degrading treatment or punishment;
 -the right to freedom of opinion and expression, to
 education, to social security and to personal
 development
Power
Power is the ability to influence or control. It
 includes access to decision- making processes.

 In most communities, cultures and societies, the
 gender roles assigned to women have less visibility
 and thus less power attributed to them.

 This lack of power and status make women
 vulnerable to acts of violence.
Violence
Violence encompasses, but is not limited to, the
  following:
• physical,
• sexual,
• socio-economic and
• psychological violence occurring within the
  general community
Informed consent
 Consent = agreement
 Informed consent means making an informed choice
  (ie. an individual is aware of all his/her options and is
  able to make a decision without coercion) freely and
  voluntarily by people in an equal power relationship.
  i.e. Reproductive health rights and the number and
  spacing of children.
 Children (people under 18) and individuals who are
  mentally challenged, are deemed unable to give
  informed consent for acts such as FGM, marriage,
  sexual relationships etc..
Concepts cont…
 GENDER MAINSTREAMING
  This is a process that involves ensuring gender
 perspectives and attention to the goal of gender
 equality are central to all activities such as policy
 development, research, advocacy/ dialogue,
 legislation, resource allocation, planning ,
 implementation and monitoring of programs or
 projects.
  This is a globally accepted strategy for promoting
 gender equality which is not an end in itself but
 means to achieving gender equality.
 Provisions
 Refers to policy pronouncements on action to be
 taken.
Concepts cont…
 Affirmative Action
  A policy or Programme of taking steps to increase the
  representation of certain designed groups seeking to
  redress discrimination or bias through active
  measures in education and employment. It is usually
  achieved through discrimination against other groups.
 Empowerment
  A process through which men, women, boys and girls
  acquire knowledge, skills and attitudes to critically
  analyze their situation and take appropriate action to
  change the status quo of the underprivileged and
  other marginalized groups in society.
Cont…
 Engender
 The process of ensuring that planning and
 programming is appropriate for and takes into
 account the female and male differences and
 concerns.
 Gender analysis
 This identifies, analyzes and informs action. It
 addresses inequalities that arise from the
 different roles of men and women; the
 unequal power relations between them; and
 other contextual factors like: ethnicity, sexual
 orientation, employment, citizenship, etc.
Concepts cont…
 Gender awareness
  Is the understanding that there are socially
  determined differences between men and
  women based on learned behavior, which
  affect ability to access and control resources
 Gender blindness
 This is failure to recognize that gender is an
  essential determinant of social outcomes. It
  therefore impacts on project planning and
  implementation.
Concepts cont….
 Gender Discrimination
 Refers to unequal or preferential treatment of
 individuals or groups on the basis of their
 gender that results in reduced access to/ or
 control of resources and opportunities .
 Gender Equality
  Refers to the equal treatment of women and
 men, girls and boys so that they can enjoy the
 benefits of development including equal
 access to and control of opportunities and
 resources.
Cont…
 Gender Equity
  Refers to the practice of fairness and justice
  in the distribution of benefits, access to and
  control of resources, responsibilities, power,
  opportunities and services.
 Gender needs
  Arise from the four components cited above.
  Since men and women have different gender
  roles, do different types of work, have different
  degrees of access to services and resources,
  and experience unequal
Cont…
 Power relations
   Refers to capacity of individual or group to
  initiate action and determine outcomes which
  change existing social, political and economic
  systems and norms, to equalize gender
  relations.
 Patriarchy
   It means ‘Rule of father’ and refers to the
  current male dominated social relations,
  ownership and control of power at many
  levels in society. It is thought to be the root
  cause of the existing system of gender
  discrimination.
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 facilities.

 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.
 Dimensions 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 others.
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
  2005.
 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
  unemployed.
 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 14,000 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
     45% were women
     6% were men
     The youngest GBV survivor was 1 ½ months old baby, the oldest
      106 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 illness
   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
Cont…
 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 COVAW.

 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.
 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 others.

 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.
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.
 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
  woman.
 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.
Supporting survivors and
    families to heal.

				
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