The #MeToo campaign has shed light on sexual harassment and assault in shocking ways. The legal and political fallout, from Harvey Weinstein to convicted US Olympics doctor Larry Nassar, marks a shift in our culture. But noticeably absent from the conversation is how to support women's health and reduce violence against women and girls (VAWG).
VAWG can be physical, emotional or psychological and has many forms, including rape, domestic abuse, child marriage, sex trafficking, and honor killings. As an obstetrician and gynecologist concerned with women's health and an epidemiologist studying patterns of disease, I have come to think of VAWG as a disease pandemic.
Unlike a viral disease, the root causes of VAWG are sociopolitical, like gender inequality. But just like the virus that causes the flu, the ideas that lead to VAWG spread, infect and pose a threat to societies worldwide.
Consider the facts: 1 in 3 women and girls in the world are directly affected by the most common forms of VAWG in their lifetimes -- physical and sexual intimate partner violence and non-partner sexual violence. This increases their risk for many serious health outcomes, including traumatic brain injury, HIV, depression and, at the extreme, death. Violence during pregnancy can also trigger a maternal stress response, increasing risk of preterm birth and low birth weight.
VAWG can elude detection by healthcare providers, as it often leaves no physical marks. And it can devastate economies -- the lifetime cost of rape for all reported survivors in the United States is nearly 3.1 trillion dollars.
Around the world, many women and girls experiencing violence trust health services as a first contact. A number of women have shared their stories with me, including stories of domestic abuse, yet in my efforts to advocate for them, I've received dismissive responses from health authorities; VAWG is "hard to do anything about," or it doesn't have anything to do with medical specialties.
I've seen this dismissive attitude manifest itself in health professionals' attitudes and actions (or lack thereof). Just take the case of MC, a woman who was admitted to a hospital in Los Angeles in danger of miscarrying due to the actions of an abusive husband:
"I told the obstetric nurse that my husband wasn't a good person. ... Nobody asked me if he was violent or referred me to any service. ... In Stockholm a year later, after I left him and he attacked me, I went to the hospital and they just looked at my wounds. ... They didn't put me in contact with anyone or follow up with me. ... They ignored it all," she said.
MC told me her period of abuse might have been shortened if she had received support from the medical professionals she reached out to.
MC's experience is not an isolated story. In regions around the world, I've seen women and girls experiencing VAWG not receive the complete medical care they need. This includes the USA -- a study published in 2013 showed over 80% of emergency departments in the USA did not provide complete medical care after rape.
There is a disturbing pattern here. Health systems around the world are often not recognizing VAWG as a health problem. According to Dr. Claudia Garcia-Moreno, who leads the World Health Organization's work on Violence Against Women, VAWG is underfunded in health budgets worldwide. Countries do not have or are slow to implement guidelines for clinicians on how to provide appropriate care. And thousands of doctors, nurses and midwives are graduating without any formal training on how to provide the care that is needed for VAWG.
So, what should be done? For starters, instead of thinking of VAWG as a problem that's hard to do anything about, let's see it as a preventable disease. Strategies to prevent and reduce the number of cases won't fit into a syringe; rather, they assume the form of interventions like educational and economic empowerment programs aimed at root causes of VAWG, such as gender inequality.
Evidence shows these interventions work to reduce the number of cases of VAWG -- and they don't take generations, but just a few years. For example, a study in Uganda had community leaders work with men and women to learn to equalize power dynamics over 3 years. This cut a woman's risk of physical violence from a partner in half.
Everyone has a role to play in fighting this disease. Health policymakers: prioritize VAWG in budgets and develop and implement guidelines to help health providers to support women and girls. Health educators: provide training at every medical and nursing school on how to treat patients who are experiencing VAWG. Doctors, nurses and midwives: consider VAWG as a health threat to your patients. Philanthropists and funders: support scientists and programs working for gender equality and other root causes to reduce VAWG. And everyone else: voice your support for the efforts being made to eradicate VAWG.
When the human body is infected by a virus, it mounts an immune response to rid the body of the virus. Let's all be a part of the global immune response against VAWG.