As health providers, violence against women is our problem

Dr Alice Han, a Canadian obstetrician and gynaecologist, who has been working with Monash Health as part of her Emerging Researcher Fellowship, places violence against women as one of the world’s most pressing issues.

Given one in three women worldwide have experienced the most common forms – physical and/or sexual intimate partner violence or non‐partner sexual violence – Alice names it as “one of the most widespread human rights violations in the world”.

She developed this perspective after working in numerous developed and developing countries, and it is driving Alice’s passion to improve women’s health by engaging health providers to embrace the critical role they can play.

“Health systems worldwide are often failing to recognise violence against women as a health problem. No one would ask me what was driving me if I were working on cervical cancer. But with violence against women, instead of seeing it as a problem that warrants attention, people assume there is a personal reason,” Alice said.

Alice started looking into intimate partner violence when she was doing her specialty training. While completing a research project on reproductive health outcomes of intimate partner violence, she was shocked by the scale of the problem and further understood the need for action when she experienced resistance and dismissive attitudes by leadership towards addressing the problem. “It was reflective of the attitudes towards women generally.”

She subsequently worked in Rwanda with Partners in Health as Associate Physician within Harvard Medical School’s Division of Health Equity to deliver high-quality healthcare to vulnerable rural communities. She had a phenomenal experience working as a women’s health clinic advisor for a year, where it was possible to see the public health outcomes improve despite the resource constraints.

Alice says her work across Brazil, Rwanda, the USA, Canada and Australia – where the social and political factors are different – has taught her that it’s crucial to recognise violence against women as a health problem. Ultimately it crosses all political, social and cultural boundaries. She has recently co-authored a textbook chapter on “Health and Human Rights through Development” in the forthcoming Oxford University Press volume on Foundations of Global Health & Human Rights, and emphasises that addressing violence against women is crucial to realising the United Nations Sustainable Development Goal of Gender Equality.

Alice says she’s on a mission to get doctors involved and understanding that addressing violence against women is part of their responsibility too. One current research project, working with Dr Jacqueline Boyle, is examining the health system response to pregnant women experiencing violence who present to antenatal clinics. It aims to encourage maternity health providers to think a bit harder about how the problem impacts their practice and their patients.

“As doctors and health providers, violence against women is our problem. It’s not just for social workers and police.

“What we are seeing is that the rates of violence in our patients is much higher than we thought,” Alice said.

It is known that intimate partner violence, one of the most common forms of violence against women, often commences or escalates during pregnancy; one of the red flag risk factors.

While the focus in women’s health has been on training midwives to have the sensitive conversations about whether their patients feel safe in their relationship, obstetricians and gynaecologists also need to play a role.

“Aside from practical considerations such as time constraints, barriers to getting involved can include fear of not knowing what to do, the confronting nature of the problems, or fear of doing the wrong thing and making the situation worse.

“Fear is a big issue. I have experienced it myself when a client disclosed violence and I had her partner on the phone, angry with me. It’s stressful and there are very real concerns when dealing with this problem. But it is nonetheless essential that doctors and our health systems get comfortable about (family violence) screening and referrals. It is a lost opportunity for our patients if we don’t.”

Alice is moving to The Mercy this month to continue working as a registrar but we can expect to keep hearing more about her work.

Alice will be a keynote speaker at a conference in Melbourne later this month: Advancing the Evidence: Migrant Women’s Sexual and Reproductive Health Conference.

Media coverage

Alice is taking her message far and wide. Here are a couple of her public appearances:

Photo of Alice taken by Matthew Guillory

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