GBV is preventable

GENDER-based violence (GBV) is an emerging public health problem which is the outcome of human rights violations that impact in social, economic, cultural, psychological dimension.
GBV can apply to both sex, female and male.
Current outrage in the country is specific for violence against women (VAW) and is defined by UN declaration on elimination of VAW in article 1 as any act of gender based violence that results in, or is likely to result in physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.
GBV doubled the risk of abortion and depression in women and linked with unintended pregnancies, STIs including 1.5 times increases the risk of HIV transmission, low birth weight baby, still birth, premature labour and birth, fetal injury, increases infant mortality rate.
Globally, gender-based violence kills and disables more women between the ages of 15 to 44 than cancer does.
And its toll on women’s health surpasses that of traffic accidents and malaria combined (UN Millennium Report 2005a).
The World’s Women, 2015 indicates that one in three women in the world have experienced physical/sexual violence at some point in their lives and that two in three victims of intimate partner/family related homicide are women.
GBV put additional stress on PNG health system that is already overburdened.
The country has the highest rate of STIs in Pacific, females are infected at younger than males, with twice as many women as men infected in the 15-29 age group.
Girls between 15 and 19 have the highest rate of HIV/AIDS; four times that of boys the same age (CEDAW 2009).
PNG demographic and health survey 2016-18 revealed that 59 per cent of women age 15 to 49 have experienced either physical or sexual violence.
Gender-based inequality (GII) is measured in three dimensions – reproductive health, empowerment, and economic activity.
PNG has a gender inequality index value of 0.740, ranking it 161 out of 162 countries in the 2018 index.
In PNG, nil women representation in parliament and 9.9 per cent of adult females have reached at least a secondary level of education compared to 15.2 perc ent of their male counterparts.
For every 100,000 live births, 145 women die from pregnancy related causes (VNR 2020); and the adolescent birth rate is 52.7 births per 1,000 women of ages 15 to 19 (UNDP 2019,).
Health facilities are often the first and sometimes, only one point of contact for survivors to seek help, get support and escape the situation of abuse.
Health sector has highest opportunity to provide aid to victim women who need comprehensive support however multi-sectorial response is required as social services, religious organisations, the judiciary, police, media and business.
The health sector, therefore, needs to play vital role within a multi-sectoral framework and can be key building block for any setting seeking to overcome the devastation of humanitarian emergency due to GBV.
Health facilities need to be equipped for facilitating care for GBV and should be safe transit to/ from the facilities, non-stigmatising and confidential entry point, no cost services.
Health care workers need to be trained to provide five essential services include: medical first aid; psychological first aid; post exposure prophylaxis for prevention of HIV and other STI; vaccination against hepatitis B and tetanus, and emergency contraception to prevent unwanted pregnancies in rape cases and appropriate referrals for legal and other services that can support survivors and prevent their re-victimisation.
Importantly, when health care providers mishandled GBV cases such as breaching of confidentiality, unaware of special needs of children that may increase the risk of being victim of additional violence.
Family support centre (FSC) approach was adopted in 2003 as a ‘one-stop shop’ with in the hospital for effective care and treatment of survivors of family or sexual violence, however national department of health developed a guideline for provincial health authority/ hospital management in 2013.
The 14 FSC which have been providing services since 2016 in 12 provinces, was evaluated by UNICEF (2016) who concluded that service is unique and critical but need to work on long term strategy, staffing and resourcing.
The considerable investment of the Government, civil society, national and international agencies has not changed the indicators of GBV as violence remains pervasive in society. Lack of comprehensive and holistic operational strategy seems as barrier to achieve results.
Awareness programme are primary types of interventions and highly preferred strategy in PNG, however it is only a first step in addressing GBV and alone not effective in reducing rates of violence.
This is because it does not address the root causes of violence such as norms and attitude that perpetuate gender inequalities (UNDP 2016).
Further, support services for survivor of violence are insufficient in quality and quantity, for instance, demographic and health survey 2018-19 shows that 72 per cent of women who experienced either physical or sexual violence sought help from family members and only 10 per cent women get assistance from police.
The practice of seeking help from a social work organisation, lawyers, or medical personnel is not common which indicates the lacunas in operational strategy.
GBV is preventable and is not impossible to do that in PNG.
Zero GBV can be achieved by transformation of community consciousness through multi-sectorial and multi-level intensive interventions with elimination of root causes.

Srinivas Thapa,
Microbiologist, Clinical Manager (under KKB Ltd)