The Health System Response to Gender-Based Violence in EECA: A programmatic package Vulnerable Groups & Gender Based Violence

The Health System Response to Gender-Based Violence in EECA: A programmatic package Migrant & Minority Women Multiple discrimination (e.g. housing, labour market, medical services etc.) Limited access to services and protection from violence Dependent on spouse, for resident permit/visa May not have family or friends to rely on Language barrier Stereotyping of migrant groups Two “choices” –Bearing the violence for some years until eligible for independent resident permit –Or risk their very existence in the country Referring to the police might be dangerous for the women (risk of deportation)

The Health System Response to Gender-Based Violence in EECA: A programmatic package Country vs. City Serenity & Safety vs. Violence Reliance on extended family, small community, and places of worship Intensified isolation Lack of anonymity Accessibility issues Source: WV Coalition Against Domestic Violence (NCADV) (1999): DV Awareness in Rural Communities.

The Health System Response to Gender-Based Violence in EECA: A programmatic package Women in Rural Areas Characteristics of rural communities: Limited mobility or capacity to relocate; limited number of options of places to which relocation is possible The family and the community are self-contained, self-sufficient entities, usually needing and desiring little outside help Strong communal identity Role of religion and tradition Institutions Limited access to broad range of goods and services In rural areas, jobs are hard to find for women to support themselves. In order to work for independent subsistence, women depend on sufficient childcare facilities, which are often missing in rural areas. Source: WV Coalition Against Domestic Violence (NCADV) (1999): DV Awareness in Rural Communities.

The Health System Response to Gender-Based Violence in EECA: A programmatic package Pregnant Women Domestic violence often starts during pregnancy or shortly after the child's birth. The prevalence rate of violence during pregnancy ranges up to 19%. Surveys of women at an advanced stage of pregnancy show that prevalence rates increase compared to early stages of pregnancy (Bacchus/Mezey et al. 2004a, Hellbernd/Brzank 2006). Protection & housing services are extremely important, since the pregnant women are not able to work during this time and fully depend on their partners or the state to provide for them. If no services for referral are available, special importance applies to developing a safety plan with the patient and seeing her frequently during pregnancy an shortly after birth.

The Health System Response to Gender-Based Violence in EECA: A programmatic package Diversity: Women with Specific Needs Understanding Diversity: The barriers and pressures lie within society rather than within the woman herself; Women are not a homogeneous group, and categories such as ‘black’ (which includes many ethnicities) and disabled (not just wheelchair users) are also heterogeneous categories; A woman may belong to more than one marginalised group, e.g. both black and lesbian, or both a drug user and a prostitute; A woman might experience additional pressures if her abuser is from a marginalised sector; Source: HEVAN (2006): Domestic Abuse Training Manual for Health Practitioners (Former National Domestic Violence Health Practice Forum).

The Health System Response to Gender-Based Violence in EECA: A programmatic package Exercise: Women with Specific Needs Each participant will receive a strip of paper showing them their identity. Each participant only knows their own ‘identity’, not that of anyone else. Questions will be read out from a list of statements. Participants are only allowed to take a step forward if they can answer ‘yes’ to the statement. (See: Handout Diversity) Source: HEVAN (2006): Domestic Abuse Training Manual for Health Practitioners (Former National Domestic Violence Health Practice Forum).

The Health System Response to Gender-Based Violence in EECA: A programmatic package The Consequences of GBV on Children

The Health System Response to Gender-Based Violence in EECA: A programmatic package Children’s Involvement in GBV Children are exposed to domestic violence in their homes in a variety of ways. Children may: – Be physically abused by the person who also abuses mother, or by both man and mother – Be accidentally injured in attempt to intervene – Be physically abused by battered mother – Witness abuse and suffer psychological effects in form of post- traumatic stress – Be neglected by father or mother due to the adult domestic abuse and its effects

The Health System Response to Gender-Based Violence in EECA: A programmatic package Overlap in Domestic Violence Studies As direct or indirect witnesses of violent acts, children observe or register the events when the are in the same or an adjacent room (Kavemann 2000a). The strains, insecurities & the stress children experience as a result of violence in partnerships interfere with child development (Kindler 2006). 50 to 70% of children exposed to domestic violence suffer from posttraumatic stress disorder (Klotz 2000). Effects of witnessed or directly experienced violence include sleep disorders, bedwetting, problems at school, delayed development, eating disorders, aggression, fearfulness, selfmutilation as well as drug and alcohol abuse (Heynen 2003). In the case of co-experienced violence, studies of child behavior disorders show outward directed reactions such as anxiety and aggressiveness (“Externalization”). However, most of all the show inward directed reactions such as intense depressiveness or fearfulness (“Internalization”) (Kindler 2002).

The Health System Response to Gender-Based Violence in EECA: A programmatic package Behavioral & emotional Problems ExternalizingInternalizing AggressionDepression, Suicidal Impunitive BehaviourHopelessness Noncompliance, Work Refusal at SchoolSadness, Unhappiness Various “Conduct” IssuesLocus of Control (External/Internal) DelinquencySomatic Complaints HelplessnessAnxiety, Fear, Worry Anti-Social BehaviourPTSD Social Withdrawal Source: Minnesota Center Against Violence and Abuse (2003): Collaborating for Woman and Child Safety, Manual.

The Health System Response to Gender-Based Violence in EECA: A programmatic package Exercise: Possible Intervention for Child Safety What can you in your position do to improve the situation of the battered child and her mother? Answers might include: –Filing an order for protection in child’s name in juvenile court to remove child from home –File an exclusion order to keep perpetrator from home –Requiring the mother to file an order for protection in family court –Have them do couples or family counseling –Work with the criminal justice system to arrest and hopefully prosecute the father –Give him jail time –Send him to batterers intervention group –Send mom and kids to shelter or find other safe transitional shelter –Arrange supervised visitation –Help her get a home security system installed –Do safety planning with the mother –Do safety planning with the children –Do some control plan with the father (See also: Handout Effects of Violence)

The Health System Response to Gender-Based Violence in EECA: A programmatic package Exercise: Possible Intervention for Child Safety POSITIVE IMPACTNEGATIVE IMPACT Child’s safety and well- being Adult victim/mother’s safety and well-being Stopping the perpetrator’s use of violence For your intervention, consider the potential impact or consequences of this intervention for each of the following areas.