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Survivors of sexual and physical abuse need #youtoo

Ian Askew
WHO Director, Department of Reproductive Health and Research

Commentary
24 November 2017

In the past few weeks, the outpouring of #metoo stories in social media has opened the world’s eyes to a significant, yet often hidden public health concern. An estimated 1 in 3 women experience physical and/or sexual abuse by an intimate partner or sexual violence by a non-partner at some point in their life.

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

Violence against women – both physical and sexual – is a gross violation of human rights and results in serious short- and long-term physical, mental, sexual and reproductive health problems.

The statistics cannot be ignored. This is a global issue, which is present in every context, professional sector, and area of life. Survivors of violence are our sisters, wives, daughters, sons, friends, colleagues and patients.

While the outpouring of survivor stories has brought to the fore a collective voice around a huge global issue, survivors often still find it challenging to disclose and may be re-traumatized by telling their stories of abuse. This is where the health system can play a significant role. Health workers: #youtoo can step up to respond to women, and others who have survived violence.

Our duty as health workers

Since violence against women, children and adolescents leads many survivors to seek health services, we must ensure that no matter where care is provided that it is fair, respectful and without discrimination. At WHO, we are working with health systems worldwide to strengthen the care they provide.

Our new manual, Strengthening health systems to respond to women subjected to intimate partner violence or sexual violence, provides practical guidance for what health systems need to do to support trained providers. It outlines the necessary steps for how to strengthen and build infrastructure, service delivery, health information systems and referral networks to support survivors of violence, among others. It complements Responding to intimate partner violence and sexual violence against women: A clinical handbook, which is a training resource for health providers on how to identify and provide support to victims/survivors.

Recognizing the unique needs of children and adolescents, last month, we also launched guidelines on Responding to children and adolescents who have been sexually abused. These guidelines provide recommendations on ensuring care is child or adolescent-centred and focused on their safety and wellbeing. Children and adolescents should also be provided with information and services that allow them to make choices about their treatment, care and support.

Within both of these tools are principles all health workers should follow when providing care to survivors.

"Health workers should minimize the need for survivors to repeatedly tell their history. Always listen attentively when survivors recount their stories, and don’t interpret or judge their account."

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

First, always provide care without discrimination. This means, recognize that a woman may face multiple forms of discrimination – in addition to being a woman; because of her race, ethnicity, class, socio-economic background, caste, sexual orientation, religion, disability, or other characteristics – or because she has been subjected to violence.

Second, never raise the issue of partner violence unless a woman is alone. Even if she is with another woman, that woman could be the mother or sister of an abuser. If you do ask her about violence, do it in an empathic, nonjudgmental manner. Always use language that is appropriate and relevant to the culture and community you are working in, as some women may be uncomfortable with the words “violence” and “abuse”.

Last, remember the principle of “do no harm”. Health workers should minimize the need for survivors to repeatedly tell their history. Always listen attentively when survivors recount their stories, and don’t interpret or judge their account.

Envisioning a world without violence

The Global Plan of Action envisions a world in which women and girls are free from all forms of violence and discrimination, their health and well-being are protected and promoted, their human rights and fundamental freedoms are fully achieved, and gender equality and the empowerment of women and girls are the norm.

Health workers have a duty to protect and support survivors of violence, and to help to prevent further violence. As we continue to hear so many #metoo stories, it’s time for #youtoo to do your part.