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In 2003, Sandra Macias, a severely mentally handicapped 31-year-old woman, was raped by a man who lived across the street in the working-class suburb of Irapuato, in the Mexican state of Guanajuato. Although abortion is permitted throughout Mexico for women whose pregnancy is the result of rape, Sandra was refused permission for an abortion by the public prosecutor’s office and threatened with a jail sentence if she resorted to a clandestine one. Her mother continued to demand Sandra’s legal rights, but the state government stalled for months before finally, under additional pressure from women’s and human-rights activists, issuing an arrest warrant for the rapist and offering to provide “medical attention” and “psychological therapy” for Sandra. But by then it was too late to undergo a safe abortion, and Sandra was forced to carry the pregnancy to term. |
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Addressing sexual violence and its consequences is an important focus of Ipas’s global mission and activities. Through advocacy and policy initiatives, research, evaluation and training, Ipas works to promote the recognition of sexual violence as a serious public-health and human-rights problem; to ensure that women and adolescents have access to health care and other services that effectively and compassionately meet their needs; and to create useful tools, including training curricula and an evaluation toolkit, that health services and program managers can use in countries around the world.
The World Health Organization defines sexual violence
as:
any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances,
or acts to traffic women's sexuality, using coercion, threats of harm or physical force, or otherwise directed, by any person regardless of relationship to the victim, in any setting, including but not limited to home and work.
Sexual violence includes rape, sexual harassment, trafficking of persons, incest, forced marriage, forced sterilization, forced prostitution, forced abortion and forced pregnancy. Sexual violence is
both a cause and consequence of gender inequality and gender-based discrimination.
Although sexual violence and exploitation exist in every society and among all social sectors, poor, young and otherwise disenfranchised people are especially vulnerable. Pregnancy does not protect women from sexual violence. In addition, women are particularly vulnerable during and after armed conflict, and after natural disasters, as families become separated and chaos ensues in the community. Sexual violence is highly stigmatized and stigmatizing, which makes the collection of comprehensive, reliable data on its incidence and prevalence very difficult. Nevertheless, studies document that it is frequent, with “nearly one in four women [experiencing] sexual violence by an intimate partner … and up to one-third of adolescent girls [reporting] their first sexual experience as being forced.”
Internationally recognized as a violation of basic human rights, sexual violence can also lead to serious health problems and even death. Non-fatal health consequences may include post-traumatic stress disorder; physical trauma and injury, such as traumatic fistula (tearing); sexually transmitted infections, including HIV; spontaneous abortion (miscarriage); unwanted pregnancy; and unsafe abortion.
While also addressing the political and legal underpinnings that contribute to the perpetuation of sexual violence, Ipas focuses its efforts on the health dimensions of the problem. Programs supported by Ipas and its global partners aim to sensitize health-care providers and policymakers to the magnitude and consequences of sexual violence and to the needs of women who experience it. Ipas also supports the availability of relevant medical technologies, such as emergency contraception to help prevent pregnancy after rape, and manualvacuum aspiration (MVA) and medication abortion for safe abortion where legally permitted. In addition to sensitization efforts, Ipas also trains health-care providers to offer comprehensive services to victims/survivors and works with health systems to ensure that policies and guidelines are in place to provide support for such services.
A literature review of health-sector interventions shows that clinicians often need training in providing care to victims/survivors of sexual assault; and that health care-based, sexual-assault treatment settings attract more women than do forensic-based settings.
- In 1979, the United Nations General Assembly adopted the Convention on the Elimination of All Forms of Discrimination Against Women, which is often described as an international bill of rights for women. The Convention defines what constitutes discrimination against women and frames an agenda for action to end such discrimination.
- In 1993, the UN General Assembly approved the Declaration on the Elimination of Violence Against Women, the first international human-rights document to exclusively address the issue of violence against women. It affirms that violence against women violates, impairs or nullifies women's human rights and their exercise of fundamental freedoms.
- In 1995, the Beijing Platform for Action (from the Fourth World Conference on Women) called on governments to "condemn violence against women and refrain from invoking any custom, tradition or religious consideration to avoid their obligations with respect to its elimination as set out in the Declaration on the Elimination of Violence against Women…"
Model of comprehensive care to violence survivors:
Ipas’s work in recent years on sexual violence includes the following key achievements:
- Organized the first national symposium on sexual violence against women in Bolivia, in collaboration with the Ministry of Gender, to discuss the problem of sexual violence against women, look at existing laws that protect victims and recommend better ways to implement those laws and increase women's access to appropriate services;
- Led the formation and coordination of the Action Committee to Address the Prevention, Detection, and Care of Victims/Survivors of Sexual Violence;
- Worked with various actors in several municipalities to determine the critical pathways that women use to seek care after experiencing sexual violence;
- Developed national norms and guidelines, on behalf of United Nations Population Fund (UNFPA), for the legal and health sectors to improve care for victims/survivors of sexual violence;
- Created an information system to improve data collection;
- Provided training and technical assistance to health personnel in selected municipalities.
Ipas Bolivia is implementing a three-year joint project in collaboration with Marie Stopes Boliviato improve public services and raise awareness among women about their sexual and reproductive rights, including the right to live free of violence and the right to health and legal services. The project has launched a media campaign with radio spots, short programs and radio soaps to increase awareness about the problem.
Ipas is also working with partners to find practical ways to implement legal abortion services. As a first step, Ipas co-sponsored a meeting of a professional obstetrics-gynecology society in Bolivia to address medical responsibility with respect to legal abortion.
- Collaborated with the Mexican Ministry of Health to develop and help implement the Comprehensive Model of Care for Domestic and Sexual Violence;
- Provided clinical training and technical support to providers in Mexico City and several Mexican states to strengthen their skills in providing care for women victims/survivors of sexual violence through provider certificate courses such as Prevention and Care of Gender-Based Violence and Women, Violence, and Health: Alternatives for Prevention and Care;
- Provided technical support for the Ministry of Health in developing procedural guidelines for state hospitals, which clearly establish the roles and responsibilities of hospitals and medical personnel in the provision of abortion for victims/survivors of sexual violence;
- Conducted workshops for health professionals in collaboration with the Ministry of Health and the National Center for Gender Equity and Reproductive Health;
- Developed a training module and educational materials to raise awareness among and train providers to better detect cases of women in need of services; the practical guide Guide for Caring for Women Victims of Violence and Forced Pregnancy contains instructions for detecting cases of violence, risk evaluation, developing security plans, medical care and referral;
- Developed educational materials to enable primary-care providers to orient and refer women victims/survivors to appropriate services; and legal and medical information for women in the general public.
- Developed training and guidance for professionals who work with victims/survivors of sexual violence, including guidelines for offering services and awareness-raising, sensitization, and clinical training materials;
- Carried out interviews with health-care providers and focus groups to identify the structure of and demand for health-care services for women victims/survivors of sexual violence;
- Made research results available to networks of youth advocates working on sexual violence, particularly in the northern region of the country;
- Participated in the development of sexual-violence care referral services for women and adolescents in three cities in northern Brazil, a joint effort involving the Ministry of Health, nongovernmental organizations, universities, members of the women’s movement, and professionals from the fields of health care, social welfare, safety and justice and drew on this dialogue to develop a model of quality care for victims/survivors of sexual violence;
- Evaluated services for women and adolescent victims/survivors of sexual violence and provided technical assistance to health teams to improve care
- Conducted an exploratory study of a sexual-violence referral service to better understand barriers to access created by providers and integrated the findings into the sexual violence training model.
- In 2006, Ipas Brazil launched the “Know Your Rights” campaign in partnership with the Ministry of Women’s Affairs, the Santa Casa de Misericordia (the sexual violence referral service in Belém), and the Santa Clara Public Relations firm. The campaign, which focuses on informing women about their rights with regards to sexual violence, was launched on International Day for the Elimination of Violence Against Women in conjunction with the start of a new sexual-violence hotline developed by the Ministry of Women’s Affairs. The campaign includes posters and print materials, and a radio and television spot featuring information for women on where to go for help in situations of sexual violence. It also highlights the range of health services to which women have a right: emergency contraception, prophylaxis for HIV and sexually transmitted infections (STIs), and legal abortion.
- Fox, Conrad. 2003. The double burden on Mexican rape victims. Panos Features.
- Glasier, Anna, A. Metin Gülmezoglu, George P. Schmid, Claudia Garcia Moreno and Paul F. A. Van Look. 2006. Sexual and reproductive health: A matter of life and death. Lancet, 368:1595-607.
- Krug, Etienne G. et al., eds. 2002. World report on violence and health. Geneva, World Health Organization.
- Martin, Sandra L., Siobhan K. Young, Deborah L. Billings, and C. Christopher Bross. 2007. Health care-based interventions for women who have experienced sexual violence: A review of the literature. Trauma, Violence and Abuse. 8(1):3-18.
- Nduwimana, Françoise. 2004. The right to survive: Sexual violence, women and HIV/AIDS. International Centre for Human Rights and Democratic Development.
- Sexual violence: Weapon of war, impediment to peace. Forced Migration Review. Issue 27, Jan. 2007.
- United Nations (UN) Office for the Coordination of Human Affairs and Integrated Regional Information Networks. 2007. The shame of war: Sexual violence against women and girls in conflict. Nairobi, Kenya, UN.
- UN. 2006. In-depth study on all forms of violence against women: Report of the Secretary-General. New York, UN.
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