Physicians should routinely ask their women patients about domestic abuse where they have reason to suspect violence, a leading doctor said today (May 20th, 2014).
Professor Sir Michael Marmot, speaking in Geneva, said that physicians should ask about domestic abuse more often so that it normalises the question. He said domestic violence was a global public health concern with one in three women throughout the world experiencing physical and/or sexual violence by a partner or sexual violence by a non partner.
Sir Michael, Director of University College London Institute of Health Equity, and chair of the World Medical Association’s Socio-Medical Affairs Committee, was speaking at a luncheon seminar during the World Health Assembly, organised by the WMA and the International Federation of Medical Students’ Associations.
He outlined the extent of domestic violence around the world and said that in many countries married women believed a husband was justified in beating a wife if she refused to have sex. Education, however, is key, he said. The more educated women are the less likely they are to think that violence from a husband is justified.
Sir Michael said that although domestic violence was evident across all classes, economic and ethnic groups, the statistics showed that this pattern of behaviour was more prevalent among the less well educated. A study among nine countries showed that those women most likely to report having experienced violence were married at a young age, had multiple children and a family history of domestic violence between their parents.
As well as resulting in murder and injury, domestic violence also led to suicide, induced abortions, depressive disorders and alcohol problems. And women with mental health disorders were also more likely to have experienced domestic violence.
Sir Michael said that physicians and health professionals had to be more active in this field. Staff training in equality and diversity issues should be improved so that physicians and others could detect more easily cases of abuse among their patients and could ask relevant questions.
‘For instance, much domestic abuse starts during a woman’s pregnancy and physicians should be aware that asking questions during this time is particularly effective. Previously silent women may come forward because of fear of harm to their baby’. In addition, he said, women and girls should be empowered through education and social support.
Dr Margaret Mungherera, WMA President, who also spoke, said: ‘Domestic “Gender Based Violence” is only one of the many forms of violence that women experience worldwide. In conflict situations, sexual violence is common and is often associated with physical violence and abductions. Unwanted pregnancies, HIV/AIDS, mental disorders and traumatic fistula are common complications.
‘In addition, low use of family planning services has also been associated with GBV and hence the need to integrate such services into the reproductive health services. It is also important that GBV is included in the pre-service training and continuing education curricula of physicians and other health workers. GBV services should be integrated into mental health and primary care services and these should be made available universally.
‘The recent kidnapping of young Nigerian girls illustrates in the most horrific way this devastating scourge. It is not enough to deplore the magnitude of the phenomenon. Urgent, strong and concrete policies must be taken now with the participation of all sections of society, including the health sector, to meet this major global public health, gender equality and human rights challenge.’
World Medical Association