According to a WHO report, more than a third of women experience sexual or physical violence around the world. At such pandemic proportions, violence against women is a serious global health and public policy problem.
In addition to increasing a women’s vulnerability to depression, alcohol use disorders, pregnancy-related complications, and STIs, including HIV, intimate partner violence is a significant cause of death and injury:
- 42% of women experience injuries from physical or sexual violence by partners, and
- 38% of murdered women are reported as being killed by partners.
The WHO report offers detailed recommendations for health providers on what to do when a woman that has experienced violence presents at their clinic. They should begin by assessing whether the woman is presenting with injuries that require urgent treatment (see Figure 2 on page 34). If her injuries require urgent treatment, the report recommends the health provider to, simply: Treat injuries.
The problem is, the WHO report just stops there. It seems to assume that women in resource-poor settings will have access to trained health providers and health facilities with the capacity to treat their injuries, and it offers no further clinical or policy guidelines about treating women’s life-threatening needs.
A review by Sakran et al explains the realities on the ground. Surgical disease, which includes traumatic injury, is among the top causes of death and disability worldwide. Traumatic injury is the leading cause of death for people under the age of 45 in the US and globally, and it accounts for 10% of the world’s deaths, more than the number of deaths from malaria, tuberculosis, and HIV/AIDS combined. Most disturbing of all is the disparity in access to care for the poor: 90% of injury deaths occur in low- or middle- income countries (LMICs).
The world’s poorest people, particularly vulnerable women experiencing violence, face the greatest barriers to accessing life-saving emergency and essential surgical care. According to Sakran et al and others, the reasons why this is the case boils down to insufficient political advocacy and investment in training frontline health providers and building capacity in primary health facilities.
Surgery is a cost-effective public health intervention to reduce preventable death and disability in low-income countries according to the Disease Control Priorities Project, but there may still be an erroneous perception that providing emergency and essential surgical interventions is too expensive or complex by population-based measures.
The WHO report on violence against women has gotten tremendous attention by mass media, health providers, and policymakers around the globe. People are feeling the urgency of addressing violence against women, as they should. It is just unfortunate that the WHO report neglected to offer clinical or policy guidelines on how health providers and policymakers in low-resource settings should actually go about treating and saving women from death and disability from violence.
Clinical and policy guidelines to respond to violence against women cannot just focus on prevention, mental health services, and STI management. All of these are important, of course, but equipping frontline health providers with the training and tools to detect and treat women that experienced injuries from violence is also critical. Access to trauma care is what women that are becoming victims at this very minute need most.
The WHO report’s neglect to recommend or even note the importance of ensuring women have access to life-saving and disability-preventing care is a major missed opportunity to have a significant impact on policymakers and health ministries in LMICs. They too want to address violence against their mothers, sisters, wives, daughters, and citizens, in general. Health ministries are searching for ways to integrate these efforts into ongoing national health plans to strengthen health systems.
The Director General of the WHO, Dr. Margaret Chan, said in a recent statement, “We see that the world’s health systems can and must do more for women who experience violence.”
Indeed, it is time we all do more to support health systems in caring for women.
Mona Singh is a medical student.
