Miriam* was seven years old when a group of women came to her home in Somalia, where some 95% of women are subjected to Female Genital Cutting (FGC) (also referred to as Female Genital Mutilation (FGM) or Female Circumcision. She did not know why they were there or what was about to happen. The women removed her clothes, held her tightly by her shoulders and knees and began to cut her between her legs, using scissors and a knife, as she cried and struggled to close them. Her torn flesh was then sewn together and her legs were bound. Miriam remembers a lot of blood, terrible pain, and feelings of deep shame and sadness.
After enduring many years of pain during intercourse, difficulties giving birth, and the threat of her daughters undergoing the same ordeal and suffering terrible consequences, Miriam fled to the U.S. seeking asylum. Miriam is one of many clients assisted by HealthRight International’s Human Rights Clinic (HRC), which operates in 12 locations throughout the United States, who have experienced some form of gender-based violence, including FGC/FGM, sexual assault and exploitation, psychological violence and torture, or intimate partner violence. Through the HRC, those who have suffered these abuses can obtain physical and psychological evaluations and written testimony – key to asylum claims – as well as referrals for additional services.
In the United States and around the world, HealthRight International is committed to addressing gender-based violence among the most vulnerable women and girls. Twenty years after violence against women was highlighted as one of twelve areas of concern in the Beijing Declaration and Platform for Action, the UN Secretary-General’s review and appraisal on its implementation and national reviews show some progress, but not enough. Globally, levels of violence against women and girls remain unacceptably high. UN Women reports that of all women killed globally in 2012, almost half were killed by intimate partners or family members, compared to less than six percent of men killed in the same year. In some countries, up to one third of adolescent girls report their first sexual experience as being forced.
These devastating statistics are a result of slow and inconsistent implementation of national policies and legal frameworks, lack of prevention efforts, discrimination, gender inequality, and persistent gender stereotypes that remain major hurdles to eliminating violence against women and girls. In an effort to call attention to these issues and efforts to end violence against women and girls, HealthRight is joining the 16 Days of Activism to End Gender-Based Violence in solidarity with the United Nations UNiTE to End Violence Against Women Campaign.
In Ukraine, where HealthRight has operated since 2008, the HIV epidemic remains a major public health concern among most at-risk populations. Women, who are particularly vulnerable to HIV due to unequal power dynamics in sexual relationships, face stigma and discrimination when living with HIV and seeking care for pregnancy. In 2012, research on violence against women in Ukraine conducted by HealthRight and its local partner, the Ukrainian Foundation for Public Health (UFPH), found that 100% of women in the sample population had experienced physical abuse and the majority of HIV-positive women reported having suffered violence related to their HIV status.
HealthRight and UFPH support women and girls who have experienced intimate partner violence through case management-based counseling, legal services, and an empowerment education intervention, together with counseling and behavior change education for men and boys who have perpetrated violence. Clients are pregnant or parenting HIV-positive women, including injecting drug users, who seek access to healthcare for themselves and services to prevent mother-to-child transmission. In response to the current armed conflict in eastern Ukraine, HealthRight and UFPH, in partnership with the United Nations Population Fund, are also working to address the needs of gender-based violence survivors and at-risk women and girls in need of sexual and reproductive health services.
In Kenya, HealthRight partners with community-based organizations to improve the health outcomes of mothers and babies. In an effort to achieve Millennium Development Goals 4 and 5 and reduce maternal and child mortality, the Kenyan government has provided free maternal care services in public health facilities. However, overall progress has been minimal and maternal and child mortality rates are particularly pronounced in rural areas; 56% of Kenyan women continue home deliveries, despite the provision of free services in public health facilities, and only 44% of home births are attended by a trained healthcare professional.
Through a project funded by USAID, HealthRight found that factors contributing to women’s inability to seek quality care during childbirth include disrespect and abuse, in both the community in which they live and at neighboring health facilities. Through a baseline Respectful Maternal Care (RMC) survey, the project collected data on mistreatment that occurred in the communities of Marakwet West and East. Of patients being treated in hospitals, 35.1% of women were shouted at by hospital staff; 4.8% were left unattended by medical staff during labor; 2% delivered alone. As part of efforts to reduce disrespect and abuse during facility-based childbirth, HealthRight organized RMC manager workshops targeting those in charge of facilities, followed by service provider training and RMC action plans devised by each facility team. There have been small reductions in incidents; however, continuous efforts to improve reporting mechanisms, increase prevention trainings, and raise awareness among national-level advocates are key to addressing women’s rights to optimal maternity care at all levels of Kenya’s health care system.
We believe that violence against women and girls is a health and a human rights issue. Governments and local communities must uphold the right to protection from, and recourse against, all forms of violence – whether physical, verbal, psychological, economic, or sexual – in order to enable better access to healthcare. Women and girls who have experienced violence urgently need better care, as it often goes unseen, unreported, or inadequately addressed. HealthRight and our local partners recognize the severe impact of violence on clients’ health and work tirelessly to meet their needs through evaluations, prevention training, and service provision. HealthRight is engaged in various forms of activism throughout the 16 Days and is committed to continuing our efforts to end violence against women and girls until lasting change is achieved.
*Client’s name has been changed to maintain confidentiality
Mia Mazer, HealthRight Intern