1. Putting Gender-Based Violence on the Healthcare Agenda in Glasgow Katie Cosgrove Corporate Inequalities Manager NHS Greater Glasgow & Clyde

2. “Violence against women and girls is the most pervasive violation of human rights in the world. Its forms are both subtle and blatant and its impact on development profound. But it is so deeply embedded in cultures around the world that it is almost invisible. Once recognised for what it is - a construct of power and a means of maintaining the status quo - it can be dismantled" (‘The Intolerable Status Quo: Violence against Women and Girls; UNICEF)

3. International Response to Violence against women Defined as a human rights violation by UN (1993) UN Declaration on the Elimination of Violence Against Women (1993) Beijing Conference ‘95 WHO defined violence against women as a Public Health problem -1996 WHO recognition as a health problem - ‘96 PAHO initiative; WHO Multi-Country Study on Women’s Health & Domestic Violence (2005,Garcia-Moreno) World Violence & Health Report – (Krug et. al., 10/02) Defined as a human rights violation by UN (1993) UN Declaration on the Elimination of Violence Against Women (1993) Beijing Conference ‘95 WHO defined violence against women as a Public Health problem -1996 WHO recognition as a health problem - ‘96 PAHO initiative; WHO Multi-Country Study on Women’s Health & Domestic Violence (2005,Garcia-Moreno) World Violence & Health Report – (Krug et. al., 10/02)

4. What is Gender-Based Violence? Domestic Violence Rape & Sexual Assault Childhood Sexual Abuse Sexual Harassment Prostitution Forced marriage Female Genital Mutilation

5. Prevalence in UK Between 1in3 and 1in 5 women over life- time Current abuse approx 1:10 Between 15-17% women abused during pregnancy 47% women killed are murdered by partner or ex-partner Domestic abuse = ¼ of all recorded violence crime 1 in 7 women raped by partner

6. Key Features Purposeful, deliberate behaviour Escalates in frequency and severity Often more than one type co-existing Gendered – overwhelmingly male perpetrators against women

7. Health Consequences Poorer health status Injuries Chronic pain Digestive problems Bladder/kidney infections; UTI Pelvic pain Problem pregnancies Gynaecological problems

8. Mental Health Depression Anxiety Post traumatic stress disorder Eating disorders Panic attacks Self-harm Alcohol /drug problems Suicidal ideation

9. Who Is At Risk? Women who experience abuse come from every: - age group - socio-economic level - religion - educational background - ethnic /racial group - rural and urban areas

10. Why is it permitted? Jacky Fleming

11. Role of the Health Sector “ Health services have a pivotal role to play in the identification, assessment and response to domestic violence, in promoting health and through the provision of support and services for women and their children…….Early intervention can prevent an abusive situation becoming worse and the level of violence becoming more intense”. (S E Guidelines)

12. Health care workers have a responsibility to : Be educated and trained in how best to help; Be aware of a woman’s often tentative attempt to seek help – this includes children presenting with a variety of illnesses Be sympathetic, non-judgemental and show empathy; Be responsive within a co-ordinated health service, with links to multi-agency help as required; Value racial, cultural or religious diversity and be sensitive to women’s needs

13. GBV Programme in Glasgow (1) Maternity  Dedicated link midwife service  Routine Enquiry of abuse  Shared protocols  Recording structure Mental Health  Review of Psychology Service  Demonstration projects  Integrated assessments  Training programme  Sexual abuse counselling service for men

14. GBV Programme in Glasgow (2) Addictions  Training programme  Integrated Assessment  Gender toolkit Homelessness  Dedicated Gender-Based Violence team  Trauma & homelessness service  Out of hours service for women fleeing domestic violence Primary Care  Training programme for GPs, Health Visitors etc  Protocol on responding to abuse  Joint protocol on domestic violence and child protection

15. Barriers to change Organisational structures / resistance Dominance of medical model Lack of dedicated resources Not a health priority (or issue?) Leadership / Senior management support Lack of knowledge & skills (perceived)to tackle abuse