Eurohealth OBSERVER 13 VIOLENCE AGAINST WOMEN: THE SPANISH RESPONSE By: Claudia García-Moreno Summary: Violence against women is now well recognised as an urgent public health and women’s health priority, as well as a human rights violation. Evidence across the world demonstrates the short and long-term health effects of intimate partner violence on women. In Spain, important initiatives to raise awareness in the health sector about gender-based violence include the establishment of an epidemiological surveillance system to document women’s health problems; the creation of the Commission Against Gender-based Violence to co-ordinate programmes; National Health Service actions to implement specific commitments made in Spain’s law on gender- based violence, including training for health professionals; and the development of a common protocol for a health care response to gender-based violence. Keywords: Gender-based Violence, Health Effects, Gender Inequality, Spain A sizeable problem violence. 5 In 2011, Spain reported 61 women killed by a partner or ex-partner. 6 Violence against women is now well In Spain, following the passing of the recognised as an urgent public health Law on Gender-based Violence in and women’s health priority, as well December 2004, there has been increased as a human rights violation. It is also awareness of the issue among both the recognised that this violence is rooted general population and professionals in gender inequality and, in turn, serves from all sectors (health, education, justice to perpetuate this inequality. Nationally, and the media). During its tenure of the representative surveys in Europe have European Union Presidency in 2010 Spain estimated the lifetime prevalence of also played a key role in promoting actions physical and/or sexual partner violence to address gender-based violence at the among women. For example, such European level. prevalence rates are 32% in Finland, 1 27% in Norway 2 and 25% in Germany. 3 There is clear evidence across the world In Spain, the prevalence of intimate of the short and long-term health effects Claudia García-Moreno is partner violence is estimated to be 43% of intimate partner violence on women. Team Leader for Sexual Health, for emotional abuse, 8% for physical Gender, Reproductive Rights, These include, for example, physical abuse and 12% for sexual abuse. 4 A recent and Adolescence (GRR) at the health outcomes such as having difficulty Department of Reproductive study from Madrid found that in the last walking, difficulty with daily activities, Health and Research, World Health year 8.6% of women reported that they Organization, Geneva. Email: pain, memory loss, dizziness and vaginal had experienced psychological violence, [email protected] discharge in the previous four weeks, as 2.4% physical violence and 1.1% sexual Eurohealth incorporating Euro Observer — Vol.18 | No.2 | 2012 14 Eurohealth OBSERVER well as mental health outcomes such as Women’s Health Observatory has been and others relating to the demographics significantly more emotional distress, instrumental in collecting data and raising of abused women and the type of care suicidal thoughts, and suicidal attempts, awareness of women’s health problems. received. These served to: facilitate among women who have suffered planning of the health care provided, violence compared to women who have In September 2004, the Spanish National promote improvements in quality not. 7 Intimate partner violence has been Health Service (NHS) approved the and equity in health care provided to associated with injuries, disabilities, creation of the Commission Against survivors of gender-based violence, and unwanted pregnancies, abortions, sexually Gender-based Violence. This was the first to facilitate the exchange of experiences transmitted infections, including HIV/ step towards coordination of programmes and good practice among those involved in AIDS, depression, Post Traumatic Stress and health care actions that were already providing health care for women suffering Disorder and other anxiety disorders, being undertaken in some of Spain’s from violence. and a range of chronic health problems. 8 9 regions (autonomous communities). When it occurs during pregnancy it Subsequently, and over time, the NHS has been associated with miscarriage, took action to implement the specific premature labour and low birth weight commitments made in the 2004 Law on babies. 10 Intimate partner violence has also Gender-based Violence. It was approved been associated with increased infant and by parliament at the end of 2004. The law development of child mortality. 11 included, among other things, training for health professionals. a common Concha Colomer played a critical protocol for a raise role in moving these issues forward within the Ministry of Health, and health care awareness in the more recently she had put in place the strategy for the identification of, and response health sector response to, violence against women in the health system. She brought to this a Moreover, and most importantly, quality about gender- sound public health approach based on criteria for training health professionals ‘‘ 14 surveillance/data collection coupled with on the response to gender-based violence based violence a firm commitment to a gender equality were developed and substantial amounts perspective and to equity. As the Head of of resources were dedicated to building Health sector response to gender- the Women’s Health Observatory and later the capacity of providers in primary based violence in Spain as Deputy Director of Health Planning, health care and in specialist services, Quality and Healthcare of the Ministry such as those for mental health and In spite of‘‘ the growing evidence of the of Health, Social Policy and Equality she emergency care. importance of violence against women oversaw the production of yearly reports for women’s health, the response of the on Gender and Health and on Gender- Concha Colomer’s legacy health sector has been limited. In Spain, based Violence starting in 2007. Reducing however, an important initiative to raise gender-based inequalities in health All of these programmes were dear awareness in the health sector about was the goal, through generating and to Concha’s heart. I last saw her gender-based violence was spearheaded in disseminating knowledge that could enable on 15 March 2011, only a few weeks November 2003 through the establishment a gender analysis of health problems before she died, presiding, along with of an epidemiological surveillance system and promote the integration of equity the Deputy Minister, over a technical to document women’s health problems. and gender equality in health policies workshop to review the progress and Every month the index of deaths (ratio and systems. achievements made in the implementation of deaths that month and median of of the common protocol on the health deaths occurring during the previous five In relation to violence against women, care system response to gender-based years) due to intimate partner violence is important steps were taken to harmonise violence. At the meeting, experiences published on a women’s web page. The actions across all of the autonomous were shared by the different autonomous purpose is to give visibility to the problem communities through the development communities in relation to training, the of violence against women, including of a common protocol for a health care use of the common indicators and the through the media, and in this way to work response to gender-based violence. implementation of the common protocol. towards making it unacceptable. 12 This Similarly, a set of common indicators The tremendous progress made was work is grounded on an understanding of on health care provision in cases of acknowledged while identifying the many the need to integrate gender dimensions gender-based violence were developed things that still needed to be put in place. into research and data analysis and the in the NHS. 13 Indicators included, for We closed the meeting together and she example, the number of cases detected highlighted that the next step would be within primary and specialist care levels, to update the protocol in two ways: first, Eurohealth incorporating Euro Observer — Vol.18 | No.2 | 2012 Eurohealth OBSERVER 15 to include more specific interventions for 3 Müller U, Schröttle M. Health, well-being 10 Altarac M, Strobino D. Abuse during pregnancy the children of women suffering partner and personal safety of women in Germany: A and stress because of abuse during pregnancy and violence, an important step indeed if representative study of violence against women in birthweight. Journal of American Medical Women’s Germany. Baden-Baden: Federal Ministry for Family Association 2002;57(4):208-14. we are to break the cycle of violence; Affairs, Senior Citizens Women and Youth, 2004. and secondly, to include vulnerable 11 Jeejebhoy SJ. Associations between wife beating 4 groups of women, such as immigrants, Medina-Ariza J, Barberet R. Intimate partner and fetal and infant death: impressions from a violence in Spain. Findings from a National Survey. survey in rural India. Studies in Family Planning older women and women in rural areas. Violence Against Women 2003;9(3):302-22. 1998;29(3):300-8. At the moment, the Women’s Health 5 12 Observatory is working on the collection Zorrilla B, Pires M, Lasheras L et al. Intimate Vives-Casas C, Alvarez-Dardet C, Colomer C, partner violence: last year prevalence and association Bertomeu A. Health advocacy in violence against and dissemination of good practices in with socio-economic factors among women in women: an experience. Gaceta Sanitaria SESPAS the prevention and early identification of Madrid, Spain. European Journal of Public Health 2005; 19:262-64. gender-based violence in the NHS. 2010; 20(2):169-75. 13 Commission against Gender Violence of the 6 Instituto de la Mujer. Mujeres muertas por National Health System’s Interterritorial Council, We shall miss Concha’s leadership, vision, violencia de genero a manos de pareja o expareja, Spain.