Transforming health settings to address gender‐based violence in Australia

Abstract

ender-based violence includes physical, psychological, sexual or economic behaviour causing harm for reasons associated with people's gender. 1 A violation of human rights, women are disproportionately affected by gender-based violence, 2 with Indigenous women and girls facing particularly high risk. 3 Globally, the gender-based violence types most widely studied are domestic and sexual violence, with 35% of women worldwide experiencing either or both during their lifetime. 2 Australian national studies show domestic violence occurs against one in six women and one in 17 men, 4 and sexual violence occurs against one in six women (mostly by someone they know) and against one in 25 men. 5 Australian Indigenous women's experiences are 35-80 times the national average. 6 Women victims/survivors experience greater fear, injuries, chronic mental and physical health issues compared with men victims/survivors, resulting in a large burden of disease, especially for childbearing women. 2,7 While national prevalence data and evidence about response for people in same-sex relationships, non-binary or transgender individuals are lacking, 8 global studies suggest high rates of both domestic and sexual violence for these groups. [9][10][11] This narrative review concentrates on domestic and sexual violence against cisgender women by men, with a particular focus on Indigenous women, who the United Nations reports experience the highest levels of violence in Australia. 3 Structural inequities underpin domestic and sexual violence across which a culture of power, control and silence permeates, impeding the safety of women and undervaluing their agency and resistance. 12 Built on a foundation of patriarchal colonialism, Australia's value system and, therefore, its service systems are inextricably bound to structures of power and oppression that subjugate Indigenous women. 12 Across these systems, there remains a deficit-focused victim-blaming narrative regarding women experiencing domestic and/or sexual violence, resulting in women's trust in services being sparse. Racism, lack of genderfocused attention and purposeful othering are additional inequities that Indigenous women face, resulting in their pathologisation and/or criminalisation, and obscuring nuanced aspects of their lived experience. 12 Under-resourcing, lack of research and inadequate legislation, all operate to compound the silencing of women's voices. Indigenous women's voices are the least heard, compromising their safety, and that of their children, at alarming rates. 13 In this narrative review, we focus on the health system, as victims/survivors are more likely to access health services (eg, general practice, sexual health, mental health, emergency care, Aboriginal community-controlled health services and maternity services) than any other professional help. 4,14 Health practitioners are ideally placed to identify domestic and sexual violence, provide a first line response, and refer on to support services. However, domestic and sexual violence continu...

Identifying and responding to family adversity in Australian community and primary health settings: a multi-site cross sectional study

“…Despite both study sites being selected for serving families experiencing disadvantage, the study found different patterns of identification of, and response to, adversity that may be explained by the sociodemographic compositions of each community, service infrastructure and workforce composition. The influence of service context detected in this study also highlights the need to incorporate contextual factors into the implementation of broad programs in health settings (e.g., primary care, antenatal care) around detection and response to family violence ( 42 ) and financial need ( 43 ).…”

“…. primary care, antenatal care) around detection and response to family violence (42) and financial need (43).…”

Multi-Dimensional Impact of Cyber Gender-Based Violence: Examining Physical, Mental, Social, Cultural, and Economic Consequences

“…For example, a study using the disease burden method in Australia found that among women aged 18 to 44 years, GBV is associated with 7% of the disease burden. This violence is more important than the factors usually considered, such as high blood pressure (hypertension), smoking, and being overweight (41).…”

Protocol for a randomised controlled trial of a healthy relationship tool for men who use intimate partner violence (BETTER MAN)

“…Moreover, studies show that IPV is the most common cause of injury for female victims [ 2 , 10 ]. This has led to IPV research in healthcare settings and online focusing on interventions for women survivors [ 11 , 12 ]. Yet, current policy and practice suggest that efforts to end IPV must also target men potentially using IPV in their intimate relationships with female, male and non-binary partners [ 13 ].…”