Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 5. Identifying GBV 1

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Aim of this module To recognize clinical conditions and behaviours that may indicate a patient’s exposure to GBV To understand the minimum requirements for enquiring about GBV, in particular whether it is safe to ask To provide tips for communicating with survivors and formulating questions about GBV 2

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Outlook Routine vs. clinical enquiry Signs of GBV Minimum requirements to ask about GBV How to ask about GBV Resources to facilitate disclosure of GBV 3

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Key Messages Enquiring sensitively about GBV can increase the chances of disclosure, help break the cycle of isolation, guilt and shame experienced by many survivors ofGBV, and convey that help is available. Not enquiring or asking questions in an inappropriate way can create more harm. Before asking about GBV, health professionals need to ensure that it is safe to ask. 4

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Routine vs. clinical enquiry 5

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Ask all or some? Or: Universal Screening Routinely asking ALL women presenting in health care settings about exposure to intimate partner violence WHO does not recommend except in certain situations Routine Enquiry Or: Case-finding Based on their presenting conditions, asking women about exposure to intimate partner violence Clinical Enquiry 6

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Signs of GBV 7

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package About signs of GBV Health professionals should consider asking about GBV when certain symptoms and certain types of behaviour are present. These signs –should raise suspicion –prompt the provider to ask patient in private about violence –are not automatic indications of GBV If patient does not disclose, do not pressure her because she may come back for further help 8 H19

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Minimum requirements to ask about GBV 9

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Minimum requirements to ask 10 A protocol or standard operating procedure is in place Health care providers ensure that it is safe to ask Health care providers are trained –How to ask and respond to women who disclose violence A referral system is in place Health care providers are able to refer women to available resources and services

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Is it safe to ask about GBV? Are you in quiet and confidential space? Is the woman with a partner, family member of a child over 2 years of age? If the woman does not speak the local language –Is there a professional interpreter present? –Does the woman feel comfortable to use this interpreter?  IF YOU HAVE ANSWERED ANY OF THESE QUESTIONS WITH „NO“, IT IS NOT SAFE TO ASK. 11 H20

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Requirements of working with interpreters 12 Avoid using family members as interpreters Ensure that patient is comfortable with using the interpreter Ensure that interpreter is trained to interpret around issues of GBV

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package How to ask about GBV 13

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Guide to ask about GBV Research shows: women don‘t start talking about violence, but most women react positively to being asked. Raise questions appropriate to the patient’s age, education, culture and level of tranquillity at the time. Avoid technical terms like “domestic violence” – women may not know the meaning and therefore not identify with it. 14

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Steps to ask about GBV 1.Start with a more general introductory question –Explain that GBV affects many women and its impact on women’s health –E.g. “We know that many women experience abuse and violence at home and that it impairs their health. I wonder if you’ve ever experienced violence at home?” 2.Then continue with more direct specific questions –“Has your partner or ex-partner ever hit you or physically hurt you or someone close to you?” 15 H21

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Key Do’s & Don’ts to ask about GBV Do’s Show a non-judgemental and supportive attitude Be patient, listen carefully and validate what the patient is saying Do not pressure her to disclose Emphasize that there is help available Don’ts Don’t ask in the presence of a partner, family member, or friend Don’t blame the woman 16 H22 H23

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Resources to facilitate disclosure of GBV 17

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Resources to facilitate disclosure of GBV Resources to encourage women to speak about violence E.g. stationery, posters, pamphlets/leaflets in waiting rooms or women’s washrooms 18

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Resources to facilitate disclosure of GBV (2) Resources to help staff memorize clinical indicators of GBV, tips for asking questions... E.g. laminated handouts/cards or stationery 19 Center ANNA (Russia) designed an office desk organizer that says, “There is NO Excuse for Domestic Violence! You can talk to me about violence.”