Originally published in ARROW for Change (AFC) Vol. 11 Bumper Issue 2005

This article is based on a presentation by Dr. Laila Arjumand Banu, Professor of Obstetrics and Gynaecology at Ibrahim Medical College and BIRDEM Hospital at the ARROW-FIGO Parallel Forums at the 18th Congress of the International Federation of Obstetricians and Gynaecologists, Kuala Lumpur, Malaysia, 6-9 November 2006.

Almost twice as many Bangladeshi women die from violence-related causes as from those who die of tuberculosis, leprosy, skin disease, tumours and cancers combined, according to 2004 Bangladesh Bureau of Statistics figures.¹ Another study found that death rates due to violence remained constant between 1982 and 1998, while death rates due to other causes declined during the same period.² In 56% of the violent deaths in 1987-1998, beatings, torture and other forms of physical abuse by husbands or other family members were described as the cause of death. The same study found that rates of suicide are high for women experiencing violence from intimate partners: ill-treatment and oppression by husbands contributed to about 46% of the suicides. Furthermore, gender-based violence, especially domestic violence, contributes significantly to women’s morbidity. Rates of depression are high amongst women experiencing violence from intimate partners.

Reproductive health risks

Many studies have linked gender- based violence with increased reproductive health risks, even though this link has not been given the attention it so rightly deserves. Many victims of gender- based violence are at risk, directly and indirectly, of unintended pregnancies, sexually-transmitted infections (STIs), including HIV/ AIDS and complications during pregnancy. Many women in violent relationships are victims of non- consensual sex, making it difficult to negotiate for contraceptive use. This puts them at greater risk of unintended pregnancies, unsafe abortions, and STIs and HIV/AIDS. In 2000, a study of 1,139 women in Bangladesh aged 15-44 years showed that 63 women died from complications arising from unsafe abortions. In 1998, 248 HIV cases were reported in Bangladesh, 43 cases of which were women and 58.1% of whom had contracted it from their husbands.³

The role of the healthcare sector

Women interact with the health system often, even when they themselves are not sick. As such, the health system can be an important agency to intercept and identify women who are at risk of gender-based violence and take appropriate measures accordingly. In Bangladesh, for example, 25% of pregnant women attend ante-natal care; 94% of children are brought for immunisation, usually by their mothers; and 29% of women use modern contraceptive methods. All these instances afford the opportunity for intervention.

The role of doctors, nurses and other healthcare providers in prevention of gender-based violence includes providing education and counselling. Even as they educate women about the importance of nutrition and immunisation, healthcare providers can raise awareness about gender-based violence
and gender equality, instilling self-respect and reinforcing the idea that women and girls are persons and not the property of men. These sessions can be done, together with counselling, in focus group discussions which may involve all the women, all the men and at a later point, both partners, in the outpatient department in hospitals.

Doctors, nurses and paramedics can also play an active role in being alert to the possibility of violence as a possible cause of illness. Victims of violence may present with varied symptoms such as depression, gastrointestinal disorders, irritable bowel syndrome, history of miscarriage and pelvic inflammatory disease, amongst others. Healthcare workers should not shy away from asking routine questions that would unearth incidence of violence and help women come forward with complaints. An important factor that is often overlooked is documentation of injuries sustained from violence.This would help provide statistics that could help determine violence as a serious health issue. Also, documentation of such injuries would help women when they are seeking legal help and remedies. For this, it is imperative that doctors provide accurate reports without delay.

Healthcare providers can also intervene in gender- based violence cases, possibly preventing further injury, simply by making referrals. Women can be referred to legal aid services, social welfare, the police, women’s groups who may help provide shelter, or even psychologists to help them overcome the trauma of violence. Sometimes, even when the women are not prepared to seek help or to leave the abusive situation, they could use these services to become empowered or to even help in planning for their own safety and that of their children.

The virtuous cycle

The healthcare system intervening with incidence of domestic violence can produce what is called the ‘virtuous cycle.’ This cycle, as opposed to the ‘vicious cycle,’ will ultimately lead to a safe, healed survivor of violence. This cycle involves the hospitals as the primary interface with women suffering domestic violence. The healthcare system would identify these women, provide them with treatment and document the incidence of violence. Documentation will be for the redressal mechanism for women victims. The social welfare system, with the help of women’s groups, would also be on hand to provide psychological support, safety and empowerment skills for the women. In the virtuous cycle, all sectors would work together to raise community awareness on the issue, and the importance of women’s human rights to be free from violence.

Endnotes

1. Bangladesh Bureau of Statistics. 2004. Bangladesh Data Sheet. Available at www.bbs.gov.bd

2. Ahmed, M.K.M. [et al.] 2004. “Violent deaths among women of reproductive age in rural Bangladesh.” Social Science & Medicine. Vol.59, Issue 2, pp. 311-319.

3. Tabassum, S. [et al.] n.d. “The HIV/AIDS Scenario in Bangladesh: A low prevalence high risk country.” Available at http://gateway.nlm.nih.gov/MeetingAbstracts/102263414.html