Opinion: The health sector can help address the impact of violence against women, here’s how
At the start of Women’s month this year, the gang rape of eight women at a mine dump in Krugersdorp made headlines in South Africa and abroad, adding to the country’s blood-curdling statistics of femicide and violence against women.
The stark reality behind the #MeToo and #SayHerName movements has left us unsettled, unsafe, and wondering – #AmInext?
The incidence of gender-based violence and femicide is rising in South Africa, where incomprehensibly, it is said that there’s a woman raped every 29 – 36 seconds (reliable estimates are hard to come by). The South African Police Service’s (SAPS) statistics on femicide show that 13 815 women over the age of 18 years were murdered between 2015 and 2020. Based on this SAPS data, an average of 2 763 murders took place per year, which works out to an average of around seven women murdered per day.
These numbers, which are not only numbers but in fact people, are unacceptable when considering the loss of life, the violation of basic human rights and the trauma and devastation it leaves in its wake.
Whilst there are many contributing factors which exacerbate violence against women and femicide, the root causes can no longer be ignored.
Data from the last 12 months show that the rate of gender-based violence (GBV) has increased by 13.7%, suggesting that the collective interventions are not having the intended effect. In this discourse, the perpetrators are all male, and this seems to be historic, deeply ingrained, and marred by patriarchy, and toxic masculinity as well as the degradation of socio-economic circumstances in our communities. Research links the increase in gender-based violence and femicide to cultural, religious, political, and socio-economic factors.
As an activist having participated in these activities, one feels disillusioned by the number of petitions you sign in the name of ending GBV and one gets disheartened by increased reports of yet more violence, inequity, and human rights violations.
Some strides forward
There have been some strides on a policy level. Through donor support and innovation, GBV and intimate partner violence (IPV) programmes and policies, have been more visible over the last three years. This created opportunities for policy development, framing of the problem, and possible interventions of which the impact is yet to be seen.
In 2020, President Cyril Ramaphosa released a National GBV Strategy. Sadly, the lived experience of many women is a far cry from the call to action so many activists and women have asked for, marched for, and protested for. As an activist having participated in these activities, one feels disillusioned by the number of petitions you sign in the name of ending GBV and one gets disheartened by increased reports of yet more violence, inequity, and human rights violations.
Bolder action needed
We need bolder action from our Presidency and government as we are still left with zero accountability and a deeply patriarchal system which further brutalises survivors of gender-based violence.
National policy is a good start but it cannot be our only arsenal in this scourge.
Our collective response to addressing violence against women is critical. Every sector and community member has a role to play.
Violence against women – that is gender-based violence that also means intimate partner violence and femicide – is also a public health issue. The Public Health sector has more to offer than forensic examination and counselling for survivors of violence against women. So, what is the role that the health sector can and should play?
Using what we have: some suggestions
What we need is an integrated, comprehensive health system to ensure that all healthcare workers and allied healthcare workers are upskilled to identify survivors of GBV – also proactively before situations escalate – and also promote a strong support network and seamless referral pathway.
When exploring our primary healthcare model, we could ensure that all community healthcare workers (CHWs), HIV Counsellors and linkage officers are skilled to identify survivors and that each organisation has a well-documented referral pathway to counselling, legal, forensic, and clinical services. CHWs could identify and refer to local clinics or to Thuthuzela Centres appropriately once they have done trauma debriefing or trauma containment. Clinicians could be upskilled to offer much-needed counselling and given access to forensic courses through reputable providers. Community mental healthcare services must be strengthened to support survivors in the long term since GBV is not a once-off incident that clears when perpetrators are brought to book. Victims are often left ill-equipped to deal with the trauma that permeates all aspects of their lives. Health facilities could support the establishment of advisory boards that include GBV survivors and promote advocacy campaigns reflective of the safer environments needed.
Violence against women – that is gender-based violence that also means intimate partner violence and femicide – is also a public health issue.
Another interesting avenue to explore could be to use community pharmacies as a safe space for GBV survivors. The Independent Community Pharmacy Association (ICPA) announced their ‘Pharmacy Safe Space’ Initiative as an innovative response to GBV. The ‘Pharmacy Safe Spaces’ provide smoother referral to much-needed counselling services and shelters and runs in their network of 3200 community pharmacies countrywide.
But there are some questions. For example, what will be their link to Thuthuzela Centres or rape crisis centres, what is the space available and what that space means – is it a physical space a survivor could occupy? Is it time-limited, what referral pathways exist, and how safe will it be if people in the community know it exists?
Still, the thought that others could play a role in promoting access and creating safe spaces for GBV survivors is one that should be welcomed. Each role-player needs to critically evaluate its safety protocols, draft and document its referral pathways, and how they would implement it practically to see if it flows properly.
But why stop there?
We could review every sector’s role or opportunity to support GBV survivors and the call to end GBV if we were to think out of the box.
We could, for example, replicate the avenues for isolation we employed through the COVID-19 pandemic in our tourism sector. With the aid of public-private partnerships, government subsidisation, or donor funding, guest houses or hotels could form part of a referral network, which allows for 24 to 72-hour shelter whilst social services, health services, or police services are activated to respond. This not only serves the survivor but could economically sustain the tourism space and create a stronger local support network and response.
This further provides time for the health, police, and social services actors to prepare and appropriately respond to the needs of the survivor. These carefully screened and identified guest houses or hotels could link to the nearest healthcare facility and create the synergies needed between the realities GBV survivors experience and how the health system and community respond to support and provide much-needed care. Through the current donor funding, first responders could do trauma containment and trauma debriefing in a neutral space and further amplify the referral pathway to rape crisis centres and health facilities.
There are no easy wins or answers in addressing violence against women, but we must start somewhere. We often talk about integrated, comprehensive health and maybe this offers us the opportunity to start small and build our health system in a more collaborative, inclusive manner.
*Sparks is a Public Health Professional, founder of HACCSA (Health Advocacy & Clinical Compliance South Africa), a Senior Aspen New Voices Fellow, and Senior Atlantic Fellow based at Tekano Health Equity South Africa.