This course introduces participants from the healthcare sector to gender based violence (GBV), including global epidemiology of GBV; health outcomes; seminal research; and clinical best practices for GBV prevention, support, and management. A core curriculum is supplemented by lectures that contextualize the content with specific examples and programs from around the world. The core curriculum introduces learners to a global perspective on gender based violence (GBV), and includes a review with Dr. Claudia Garcia-Moreno of the new WHO guidelines on responding to violence. Students who wish to receive Honors Recognition will complete the honors module, which expands on the core material and highlights special circumstances and programs. This is an in-depth course with 2 components: 1) Core curriculum introduces GBV from a global perspective, with an emphasis on ensuring a strong health sector response to GBV and teaching key competencies for social workers, physicians, nurses, midwives, community health workers, counselors, and other healthcare workers. Completion of the core content is required for students to pass the course. 2) Honors curriculum offered by experts from around the world helps students dive deeper into certain issues, and touches on unique populations and specialized topics. Completion of Honors curriculum is required for those students who wish to receive a Certificate of Accomplishment with Honors. After taking the course, students will be able to: ● Describe the global epidemiology of leading forms of GBV and the evidence linking GBV to poor health. ● Articulate the challenges, strategies, and WHO guidelines for integrating GBV response within the health sector. ● Describe the components of a comprehensive clinical assessment, treatment, and management of a GBV survivor. ● Describe the appropriate psychosocial support and management of a GBV survivor. Module 1 – Introduction to GBV- Epidemiology and Health Impact GBV comes in a variety of forms, each with health consequences for the survivor. An understanding of these issues helps inform a comprehensive and multi-sectorial response for preventing and responding to GBV. Module 2 – Health Care Response, Screening, and Psychosocial Support Recognition of health impacts of GBV has led to calls to address GBV within the health sector. Support for GBV survivors extends beyond clinical exam and assessment. Safety planning, harm reduction, and access to psychosocial support must be ensured. Module 3 – Clinical Care for GBV Survivors Caring for GBV survivors requires compassionate, confidential, and nondiscriminatory clinical assessment. Competent medical and forensic examination, along with appropriate documentation, is essential. Honors Module – In-Depth Information and Special Topics This module provides additional materials for those who wish to explore specialized topics and gain a more advanced grasp of the complexities of addressing gender-based violence. Core course topics are expanded upon, and special populations and programs are highlighted. Special topics include violence in humanitarian settings, against adolescents and sex workers, and human trafficking. Further information is provided on epidemiology, policy, and ethical guidelines, as well as the use of mHealth in GBV screening and care. We’ll cover the unique challenges of GBV research, and explore programs that encourage men and boys to be engaged in the prevention of violence against women. Acknowledgments This course is a project of the Johns Hopkins Center for Clinical Global Health Education. We would like to gratefully acknowledge the following collaborators: ● Centre for Enquiry into Health and Allied Themes (CEHAT) ● International Center for Research on Women's (ICRW) Asia Regional Office ● Center on Gender Equity and Health at University of California, San Diego ● Division of Global Public Health at University of California, San Diego ● World Health Organization ● RTI International ● Swayam ● Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights ● Johns Hopkins Bloomberg School of Public Health, Department of Population, Family & Reproductive Health ● Johns Hopkins School of Nursing This course is made possible through the generosity of the Ujala Foundation, the Vijay & Marie Goradia Charitable Foundation, and the Wyncote Foundation.
Confronting Gender Based Violence
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From the course by Johns Hopkins University
Confronting Gender Based Violence: Global Lessons for Healthcare Workers
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Johns Hopkins University
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From the lesson
Introduction to GBV - Epidemiology and Health Impact
GBV comes in a variety of forms, each with health consequences for the survivor. An understanding of these issues helps inform a comprehensive and multi-sectorial response in preventing and responding to GBV.
Meet the Instructors
Michele Decker, ScD, MPH
Department of Population, Family and Reproductive Health
Hi I'm Nancy Glass I'm a professor at Johns Hopkins University School
of Nursing, and I'm going to focus today on the issue of confronting gender
based violence as a healthcare professional.
So as an overview of the presentation, we'll first focus on gender based violence
as a human rights violation, from a global perspective.
And we'll use it as an example the case of intimate partner violence.
And then we'll briefly touch on the global prevalence of gender based violence,
which will be followed up on later on in the course.
So let's define gender based violence.
Certainly, we hear it used interchangeably with violence against women.
And mostly that is done because globally, women and
girls are most at risk and most affected by gender based violence.
In 1993, the United Nations General Assembly defined the term violence
against women as any act of gender based violence that results in, or
is likely to result in, physical, sexual or psychological harm.
And that includes the threat of such acts, coercion, deprivation of liberty,
and that means occurring in public life in the larger community or
in private life, oftentimes in the home.
So further with the definition.
So the UN referred to gender based violence because such violence is
often rooted in gender inequality and is often tolerated and
condoned by laws, institutions and community norms.
So we know that there are many countries
that still allow marital rape, and wouldn't prosecute marital rape.
And there's institutions that don't protect the victims or survivors.
And there's also norms such as forced marriage or female genital cutting
that are harmful practices for women, but are often condoned as cultural practices.
So GBV is not only a manifestation of gender inequality in a community,
but often serves to reinforce it.
Gender based violence comes in many forms throughout the life.
It occurs from early childhood, as neglect or abuse.
It can occur as forced early marriage, or other harmful practices,
and certainly in dating or intimate partner relationships.
We know of wife sharing, and then sexual assault or rape, for example,
in the conflict setting.
So, it is important, when we define gender based violence,
to also talk about boys and men.
because certainly boys and men experience diverse forms of physical and
sexual violence in their lifetimes.
But we will pay special attention to women and girls in this presentation.
But as a health care provider,
we need to make sure that we provide services equitably to sexual and
gender minorities, such as men who have sex with men, and transgendered persons.
Because certainly violence exists in those communities as well.
So in framing gender based violence as a human rights violation,
the United Nations Declaration of Human Rights in 1945 declared that
human rights apply to all human beings without distinction of gender.
Although at this time, in the mid 40s, the UN did not specifically
address issues related to women, or violence against women.
It was in 1979, when the Convention on Elimination of All Forms of
Discrimination Against Women that we first really start to talk about women
should be able to live free from trafficking, from prostitution.
But we did not explicitly address issues of intimate partner violence,
sexual abuse, incest, or rape.
So, in the early 90s work continued
in the Declaration on the Elimination of Violence Against Women.
And through to 1995 with the Beijing Declaration and all platforms called for
action and the declaration defined violence against women,
including violence within the family, as a human rights issue.
So as an example, we're going to look at cases of intimate partner violence.
Intimate partner violence,
violence by an intimate partner, exempted intimate partner,
is the violence that is the most common experienced by women in their lifetime.
So, intimate partner violence is defined as any behavior within an intimate
relationship, so a dating relationship, doesn't have to be a marriage,
that causes physical, psychological, or sexual harm to those in the relationship.
So it includes physical aggression, psychological abuse,
such as the threats of physical violence, humiliation in front of others,
forced intercourse or other forms of sexual coercion.
And then controlling behaviors that often include stalking,
harassment, and other forms of coercive control.
So, Dr. Campbell here at Johns Hopkins talks about intimate partner violence is
repeated physical and/or sexual assault within a context of coercive control.
And it's important as health care professionals not to conceptualize
violence as a syndrome or a diagnosis.
But as a risk factor for many health or social problems that women and
girls may experience.
So framing gender based violence within the human rights violation, within a human
rights violation context, let's look at intimate partner violence for example.
And it is clearly a violation of the rights articulated in the UN Article 3,
the right to personal security.
Certainly as a woman or a girl in a family that experiences violence and
abuse, they don't have the right to personal security.
They don't feel safe in their own home.
They don't feel safe reaching out to community members often for security.
And in more severe cases, we've all heard of these cases, women may also
experience violations such as that of Article 4, which defines slavery,
where they're sexual slaves and used by the family or community.
And then there's also torture, where we could
define what women experience in severely abusive relationship as torture.
Because oftentimes the relationship is increasing frequency and
severity across the lifetime, or across the relationship.
So the ongoing patterns of physical and
sexual violence in a woman's life results in the abusive partner or
ex-partner assuming that their rights and their privileges.
And then resulting in lowering the status of women to, within this context,
less than a human being, they're taking her rights away So abusive partners or
ex-partners who inflict physical violence, sexual violence, or emotional abuse.
They can also be coercively controlling the woman's environment, so
depriving her of resources that are critical for survival.
Depriving her of the income she earns.
Requiring her to give her paycheck over.
Refusing to provide safe and secure housing.
Or if she leaves the relationship she won't have the resources to have housing.
Limiting her access to friends and families, which could be her only support
system, or requiring her to work in unsafe environments,
requiring her, or forcing her into prostitution, or a sexual exploitation.
Limiting her food, threatening the children, or
reducing the security of the children also they could also
engage in trafficking or sexual slavery with children.
So there's many ways that the abusive partner,
ex-partner can inflict harm on their partners and their family.
And defining it with the human rights framework is essential.
Also, in our communities we know that there are often time
insufficient governmental and institutional response.
And that can include the healthcare system, the justice system and
the social services system.
And by not responding to the violence in our community, by not protecting
and increasing the safety of children and
adults, and that certainly is women and girls but also men and boys,
then we are denying these people their basic human rights.
And for example, if a woman is attempting to leave an abusive relationship and
she can't meet her basic needs and living needs,
then she is not able to be safe in our community.
And for many women, there are very few options to leave abusive relationships.
And so as a community,
holding perpetrators accountable is critical to enforcing human rights.
So as a global perspective, the vast majority of women, as I noted earlier,
experience violence at the hands of an intimate or and ex-intimate partner.
Or someone they know in the family or an acquaintance.
It's much rarer for a women to report a stranger has assaulted them.
Certainly it occurs, but it's often
men who report that the violence that they experience is from a stranger.
And importantly, one out of every three women worldwide,
30% of women, will be physically or sexually violated, or
psychologically abused during her lifetime by an intimate or ex-intimate partner.
And in some countries, we know that the rate goes up to 70%
women in their lifetime will experience violence by a partner or ex-partner.
So it's critical, as we know women and girls are frequent users of the health
care system, certainly in the childbearing ages, that we as health care providers
are prepared to assess, treat, and refer women for services related to violence.
And also understand that violence is a violation of their rights as humans and
work to establish systems that protect those rights.
Thank you.
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