1. The DVA & Health

2. Mosaic Court Support evidence Mosaic stats confirm DV’s negative impact on women’s physical, mental, sexual health Picture reveals that DV is often noisy with accusations, criticising, name calling, and much psycho- logical manipulation (94%) through threats & abuser behavioural problems such as substance abuse. Economic abuse (58%) poses a serious threat to women’s survival and health. Alarmingly high is physical abuse (63%) and lastly sexual abuse (13%), which includes forced sex

3. Physical violence TYPE Total% BEAT/KICK/HIT10,62529 STAB WITH WEAPON1,3394 CHOKING4,53212 SHOOTING400 SHAKE/PUSH/PULL7,85322 SLAPPING7,91322 BITING9203 BURNT2211 THROW OBJECT2,9668 36,409100 2008/09 stats from 16 DV courts

4. HEALTH CONSEQUENCES POPULATION COUNCIL

5. HEALTH OBLIGATIONS OF THE DVA SAPS to arrest if the victim may suffer imminent harm risking her/his health SAPS to take a survivor for medical treatment Health service provider can also apply for a protection order on behalf of a victim The court may impose additional conditions to provide for the health of the victim (such as seizing weapon)

6. HEALTH ISSUES RE DVA The obligation of the State to prevent, investigate and punish VAW includes the fulfillment of health rights The DVA doesn’t provide for psycho-social support The DVA doesn’t specify the role of the DOH There is no policy framework attached to the DVA that links it to the VEP & role of health sector & other policies Health policies are fragmented (PHC package, insufficient screening, many problems at emergency units, infrequent referrals)

7. ATTRITION Mosaic did pilot research with GHJRU on attrition rates. Of the women who didn’t return for finalisation of their orders, many mentioned reasons which were related to the physical and mental health of victims and/or their children: 18% were threatened with death by their abusive partners/the abusers if they returned to court Threats of further violence occurred in 21% of cases The abuse actually ‘got worse’ in 10% of cases In 7% of cases, the abuser threatened to burn down the applicants house In 10% of cases, applicants were threatened with some form of sexual assault 46% of victims reported the abuse of alcohol or drugs by abusers

8. MENTAL HEALTH ISSUES Shortage of psychologists Basic lay counsellor skills limited to deal with depression, anxiety attacks, etc. Very often only one or two visits, real individual psycho- social support lacking Mental health needs of affected children BUT value of counselling (Vogt research) Shortage of shelters where women & children can have time to recover Ref: GHJRU - 2006

9. SEXUAL & REPRODUCTIVE HEALTH ISSUES Abused women needs special counselling on link between violence and SRH especially ito Treatment of STIs VCT Cervical health & pap smears Pregancy related problems (increased violence) Nutrition (Ungass report should mention)

10. MOSAIC MODEL: Ecological & Integrated DV GBV Social Services Court Support Skills Training Health SRH Biological & pers history Socio-ec env Cultural norms Social structure Immediate context DVAPOLICY

11. HEALTH RECOMMENDATIONS Health Policy on DV Training of all levels of health workers on DV re profile, screening, referral, etc. Assisting DV clients at Thuthuzela Centres too Providing for mental health care through subsidising NGOs Addressing the intersection between DV & HIV Better indicators on DV at all levels