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Health workers: Listening when women need it most

Ian Askew
WHO Director, Department of Reproductive Health and Research

Commentary
25 November 2016

Ian Askew,WHO Director, Department of Reproductive Health and Research
Ian Askew,WHO Director, Department of Reproductive Health and Research
WHO

Active listeners use more than their ears. They also use their eyes and hearts. Active listeners hear beyond the words, show empathy and pay attention to the feelings and body language behind what is being said. They show their support by being respectful and are never judgemental.

As we mark the International Day for the Elimination of Violence Against Women and the 16 ensuing days of activism, it is time to celebrate and promote the potential of health workers to be active listeners. Every day, health providers have a unique view of the lives and health of their patients, and can play a profound role in supporting women who are experiencing violence.

Worldwide, 1 in 3 women will experience either physical and/or sexual violence by an intimate partner or sexual violence by a non-partner at some point in their life. Data show that women who have experienced violence use health services more than non-abused women. While many women may not disclose that they have experienced violence, health providers are often their first point of professional contact. Women also identify health providers as the professionals they can trust with disclosure of violence.

Health professionals are therefore in a unique position to help address the health, psychosocial and legal needs of women who have experienced violence, even where resources are limited.

Health providers must however, be able to provide the right care and support.

Support begins with remembering “LIVES”

WHO’s clinical handbook, Health care for women subjected to intimate partner violence or sexual violence, gives health workers 5 steps they can take to support women suffering from violence. The steps are easy to remember since they form the word ‘LIVES’:

  • Listen to her closely, with empathy and without judgment
  • Inquire about her needs and concerns
  • Validate her experience by showing you understand and believe her
  • Enhance her safety by discussing a plan to protect her from further harm
  • Support her by helping her connect to information, services and social support.

If you are a health provider, ensure you are non-judgmental and supportive. Provide practical care and support that responds to women's concerns without intruding. Listen to women’s story without pressuring them to talk.

This first-line support may be the most important care that a health professional can provide. It may be all the woman needs and it may be your only opportunity to provide care.

Health systems need to empower their workforce

A well trained health provider can be the active listener that helps change the life of a woman who has experienced violence. But training alone is not enough. They need to work in a context in which they can listen and act on what they hear.

That means having a health system that supports and empowers health providers, so they can both acquire and apply skills and knowledge to address violence. Privacy and confidentiality are key.

Tragically, most countries are falling short.

"If you are a health provider, ensure you are non-judgmental and supportive. Provide practical care and support that responds to women's concerns without intruding."

Ian Askew,
WHO Director, Department of Reproductive Health and Research

In most countries, health workers are left without the skills or training they need to appropriately and effectively respond to violence, and the basic infrastructure to ensure privacy and confidentiality may be absent.

Right now, only half of countries report that they have any services in place to support and provide care for survivors of violencr. Even if these are available, these services are frequently not well coordinated, resulting in huge cost and long waits for the women who need them most. And the coverage and quality of the services is limited.

Laws are also inadequate to protect women. While over 130 countries have some laws in place to penalize at least some forms of violence, such as domestic violence or rape, enforcement often lags behind. In many countries, health providers are expected to complete medical reports that can be used as evidence, but are often woefully under-prepared to do so.

In May this year, the World Health Assembly endorsed a Global Plan of Action on strengthening the role of the health system in addressing violence against women and girls, and against children. This plan outlines the many actions that that the health sector can take to scale-up proven interventions, in the context of a multi-sectoral response, to end violence against women and girls by 2030.

One of the four strategies in the plan is to strengthen health service delivery and health providers’ capacity to respond to violence. Countries have committed to integrate violence prevention and response into their national health strategies, allocate both human and financial resources, and increase access to health services for women. However, these actions will only happen if there is political commitment recognizing that violence in all forms is unacceptable.

Health systems need to integrate training on violence against women within pre- and in-service curricula for all health professionals so that they can provide quality care to survivors, in a way that follows the “LIVES” steps as well as the recommendations put forward in the Global Plan of Action.

A world in which women and girls are free from violence and discrimination is within our reach. It starts when people listen. It happens when they are empowered to act.