Each year from the 25th of November until the 10th of December we observe the 16 days of activism for no violence against women and children campaign. This campaign was initiated at the Women’s Global Leadership Institute in 1991 (UNWomen, 2022) and focuses on raising awareness about the impact of gender-based violence in society (South African government, 2022).
Gender based violence (GBV) in South Africa is comparable to war-torn countries (Ramaphosa, 2019), affects all sectors of society and has been shown to have a generational effect. Children exposed to violence and abuse are at risk of experiencing or perpetrating violence as an adult (Gevers & Dartnall, 2014). In 2018, 2700 women and over 1000 children were killed. Everyday more than 100 rape cases are reported (South African government, 2019) however the actual number of rape cases remains undetermined as many victims do not report (Kim & Motsei, 2002). Although most women do not disclose violence in their relationship, a survey conducted for the American Medical Association found that 65% of respondents would disclose violence to their health care provider, making healthcare professionals the first respondents in many cases. Unfortunately most healthcare workers are ill-equipped in dealing with cases of GBV as they have received little to no professional training in order to intervene (Kim & Motsei, 2002).
Healthcare workers in South Africa are not only untrained in dealing with GBV but, their framing of GBV as only a social issue limits them in attending to it effectively (Joyner & Mash, 2012). GBV is not just a social issue, but a health issue as well. The framing of GBV as a social issue is a resistance stance by healthcare workers that stems from a lack of resources and capacity to address GBV in an under-resourced healthcare system particularly the public sector. Healthcare professionals should be trained to associate presenting signs and symptoms in patients with GBV including picking up psychological symptoms such as anxiety, depression, lack of sleep and alcohol abuse. Especially when chronic, these symptoms should be used as cues for the possibility of GBV experience in patients (Joyner & Mash, 2012).
Supportive care has been purported to be one of the crucial factors that aid victims of GBV in the health-care setting (Garcia-Moreno et al., 2015). “Supportive care can contribute to the prevention of violence recurrence and mitigation of the consequences, address associated problems such as depression. Supportive care includes attentive listening, sensitive non-judgemental enquiry about their needs, validation of women’s disclosure without pressure, enhancement of safety for the woman and her children, and provision of support to access resources”( Garcia-Moreno et al., 2015 p. 1567).
The World Health Organisation (WHO) recommends that all health care professionals be trained in women centred first line support (Garcia-Moreno et al., 2015). This training positions women as autonomous in that they determine their pathway to safety; it is consistent with psychological first-aid. Health-care professionals will then have to be trained in mental health as it relates to responding to GBV, treating the physical manifestation of GBV, healthcare professionals will also address the psychological ailments that are present as well (Gevers & Dartnall, 2002).
The mental health of healthcare professionals responding to GBV should also be factored in as working with GBV victims and survivors may result in emotional distress, cognitive dissonance, defensiveness or disclosure of past traumas and managing these reactions and disclosures can take a heavy toll on healthcare professionals. Compassion fatigue, depression, anxiety or PTSD-type symptoms, and burnout are some of the negative outcomes for healthcare professionals working with GBV victims and survivors. Therefore healthcare professionals who work with GBV victims and survivors should have access to counselling, therapeutic or rehabilitative services.
In going beyond the 16 days of activism a multifaceted approach to GBV is required. Acknowledging the effects of GBV to mental health is crucial to uncovering the various ways that GBV presents. A focus on mental health is pragmatic in re-framing GBV as more than a social issue but as a health issue which healthcare professionals should be equipped to address.
García-Moreno, C., Hegarty, K., d'Oliveira, A. F. L., Koziol-McLain, J., Colombini, M., & Feder, G. (2015). The health-systems response to violence against women. The Lancet, 385, 1567-1579
Gevers, A., & Dartnall, E. (2014). The role of mental health in primary prevention of sexual and gender-based violence. Global health action, 7, 24741.
Joyner, K., & Mash, R. (2012). Recognizing intimate partner violence in primary care: Western Cape, South Africa. PloS one, 7.
.Kim, J., & Motsei, M. (2002). “Women enjoy punishment”: attitudes and experiences of gender-based violence among PHC nurses in rural South Africa. Social Science & Medicine, 54, 1243-1254.