All Health Care Providers Should Be Trained to Screen for Gender-Based Violence

By Arianna Nagle and Kaelan Sullivan

Gender-based violence (GBV) is a public health problem with proven costs to the individual and the community on a physical, emotional, and financial level. In addition, GBV is a human rights violation — arguably one of the most frequently perpetrated violations worldwide, with an estimated one in three women experiencing physical or sexual abuse in her lifetime. This issue is not limited to women, and can affect the broader population worldwide, including LGBT individuals. Integrating GBV screening into health systems strengthening presents a unique opportunity to reduce the costs of GBV and ensure that all survivors of GBV receive the physical and psychosocial support they need.

GBV’s place in the continuum of care

When designing programs to strengthen health systems in developing nations, it is essential to integrate GBV screening into the continuum of care rather than setting up parallel or separate services to prevent survivors from slipping through the cracks. Whether a person comes in for malaria testing or nutrition counseling, practitioners should be equipped and trained in a toolkit to understand and identify the signs of gender-based violence, particularly intimate partner violence (IPV), in addition to being able to provide culturally appropriate counseling and referrals to the services available. This requires the health system to reinforce those services as well — many health systems provide physical care without available psychosocial support. Stigma often prevents women and LGBT identifying individuals from reporting GBV and IPV, and in many places worldwide it is seen as acceptable and commonplace, making speaking about violence taboo. This only increases the need for these services in programs that are already working on improving health-seeking behaviors and improving the systems in place to provide services.

Effective GBV screening models

While there are many methods that have been adopted to identify GBV and IPV internationally, any screening can be categorized as one of the following: universal screening, selected integration, high-risk screening, or selective screening. As health systems improve and the quality of care and safety can be assured for those who are screened, universal screening, which involves asking all women about abuse at all first visits, should be adopted in all possible settings. This approach ensures the minimum requirements for safety and care are met. It can be coupled with other methods of screening, such as high risk screening targeted to those who are HIV positive or have disabilities. In addition to screening, health care providers should provide medical and emotional support, document the screening, and provide referral information to the survivor while protecting patient confidentiality. Universal screening integrated into the continuum of care increases practitioners’ ability to conduct routine screening, which enables providers to more accurately identify individuals requiring assistance with physical or sexual abuse.

Tools and training

This screening will only be effective when paired with provider training and proper systems. For example, transgender patients also experience particularly high rates of GBV and IPV. Training for practitioners should provide understanding of the unique aspects of IPV to the LGBT experience, such as outing as a tool of abuse, and the stigma individuals may face when seeking help from the police or even family and friends. Practitioners themselves should be trained in gender sensitivity to create safe spaces in societies that may otherwise marginalize these individuals. Clinical screenings can be coupled with institutional and community materials and events such as pamphlets and role-playing gatherings. Existing education resources on GBV and IPV can be revised to be inclusive of LGBT victims of abuse where needed.

If all health systems strengthening programs integrated universal GBV screening, coupled with practitioner tools and training, the worldwide burden of GBV could be significantly reduced. This will be key in the achievement of the UN Sustainable Development Goals of "Gender Equality" and "Good Health and Well-Being."

Arianna Nagle is a manager in Chemonics' Global Health Division. Kaelan Sullivan is a manager in the Europe and Eurasia Division and a member of the Gender Equality and Social Inclusion Practice

Leave a Comment

Examining Gender Parity on International Women’s Day

By Amelda Zotter and JoAnna Lipari International Women's Day has been celebrated around the world since the early 1900s. Originally, its aim was to provide a forum for women to campaign for equality and guarantee their human rights. Over the years, International Women’s Day has turned into a time to reflect on progress made, continue to call for change, and celebrate acts of courage by ordinary women who have played an extraordinary role in the history of their countries and communities. The theme...

Read More »

The Connection Between International Trade and Women’s Economic Empowerment

The business case for promoting in women’s economic empowerment is clear. According to a recent McKinsey Global Institute Report, expanding and improving women’s economic participation can add as much as $12 trillion to $28 trillion to the global GDP by 2025. In addition, as studies consistently affirm, an investment in a woman’s economic empowerment is an investment in the health, education, and security of her family. With new international trade agreements, such as the Trans Pacific...

Read More »

16 Facts About Gender-Based Violence

By Poulami Banerji and Linda Flynn Today is the International Day for the Elimination of Violence Against Women and the first day of 16 Days of Activism Against Gender-Based Violence. Gender-based violence is often misunderstood as just a “women’s issue” because women and girls are disproportionately affected. In reality, gender-based violence is a vast and intersecting issue that impacts all members of society, including girls and women, boys and men, and members of the LGBT community....

Read More »

Know Your SDGs: Your Guide to What the U.N. Is Doing This Weekend

Today, the United Nations Sustainable Development Summit opens in New York. More than 150 world leaders are expected to gather there to adopt the proposed Sustainable Development Goals (SDGs), an ambitious document meant to define the world’s development agenda for the next 15 years. With 17 goals and 169 individual targets, the SDGs are more numerous and complex than their predecessor, the Millennium Development Goals (MDGs), adopted in 2000. But they are hugely important, both individually and...

Read More »

Know Your SDGs: Reducing Inequality as the Foundation for All Development Work

The other day I saw a homeless man here in Washington, D.C. with a sign that read: “I bet you a dollar that you won’t stop to read this sign.” The message stuck with me because to me it encapsulated what I see as a serious development challenge across the world—our tendency to not address inequality.  At the macro level, the fact that we’re not inclined to stop and respond to his sign is why the global community should not have been surprised at the Boko Haram kidnapping of 276 school girls. Nor...

Read More »

Know Your SDGs: We Can’t Secure Gender Equality Without Addressing Culture

Sustainable Development Goal (SDG) 5, “achieve gender equality and empower all women and girls,” isn’t a new addition in the realm of development goals. It follows on the heels of Millennium Development Goal (MDG) 3, which sought to “promote gender equality and empower women.” However, while the MDG goal focused solely on equality in education, wage labor, and participation in government, proposed Sustainable Development Goal 5 includes six specific targets that address major barriers to gender...

Read More »

A Development Implementer’s Guide to LGBTI Inclusion

As the 2015 landmark U.S. Supreme Court decision allowed lesbian, gay, bisexual, transgender, and intersex (LGBTI)* couples to legally marry, 76 countries continue to uphold laws making homosexual conduct illegal, and at least five countries find execution a reasonable punishment for same-sex acts. Internationally, cultural acts of violence against the LGBTI community are vastly underreported due to distrust of law enforcement, lack of legal protection, or familial exclusion. The human rights...

Read More »

We Can’t Achieve Health Goals for Women Without Women Leaders

For months we have been talking about and planning for the "post-2015 era." Now it is just around the corner, with the Sustainable Development Goals (SDGs) ready to be adopted in September. While discussion thus far has been oriented on the agreement and its parameters, focus is now shifting to the means of implementation. With the structure of the SDGs now clear, the differences between the Millennium Development Goals (MDGs) and the SDGs are now apparent too. For instance, the SDGs more than...

Read More »

One Woman’s Perspectives of International Women’s Day

This year’s International Women’s Day falls on a Sunday. For many people in the United States, it is a typical day off but in many other countries such as those in Eastern Europe and Central Asia, International Women’s Day it is an official holiday each year. I used to be a skeptic of days like this that are dedicated to honoring and appreciating a certain group of people. The cynical side of me wonders, why just this one day of the year? Why do we single out women? And what will happens on...

Read More »

It’s Not the News, It’s You

If you follow media reporting on women in Afghanistan — I do, but only in English — you probably experience a flood of violent emotions. Shock and revulsion at the seemingly endless string of brutal domestic and public attacks against women and girls. Fury that the police and courts often do nothing, or even protect the attackers. Disgust at the government’s capitulation to conservatives who want to roll back legal protections for women. Indignation that women are still a tiny minority of...

Read More »