Women’s Day: Health can reduce gender violence – 08/03/2023 – Health

Violence against women is underreported in public health services. While about a fifth (19.5%) of cases are registered in basic health services, the majority (80%) only appear in hospital services or emergency rooms, when there is a worsening of the health condition.

With late notification, many occurrences miss the so-called window of opportunity to act and prevent the hospitalization or death of that woman.

There are still a much larger number of cases that go unreported. This underreporting can be around 52% to 94% of incidents, when considering the different types of violence submitted by women, such as physical, sexual and psychological.

The data are from an unprecedented study carried out by the global public health organization Vital Strategies, in partnership with UFMG (Federal University of Minas Gerais), to be released this Wednesday (8) at a special Women’s Day event at the Faculdade de Saúde Pública from USP, in São Paulo. The final version for publication is still in the process of being finalized.

The study analyzed data from 2011 to 2021 from three different databases: the PNS (National Health Survey), which is carried out every five years by the IBGE; the PenSe (National School Health Survey); and data from SIM (Mortality System) and Sinan (Information System for Notifiable Diseases) of the Ministry of Health.

About 4 million deaths were analyzed over a ten-year period and more than 812,000 notifications of violence. As a result, the research found an eight times greater risk of death for a woman who suffered an assault without notification having been made.

For death from an external cause, such as an accident (or injury), the same risk found is about 50 times greater when the notification of violence was not registered.

For Deborah Malta, professor at the UFMG School of Nursing and one of the authors of the research, the data show a cruel reality of violence against women: while prior notification of aggression can be a protective factor, underreporting and late reporting often lead to to an increased risk of death in women.

“The 2019 PNS survey identified that about 19.4% of women have already suffered violence, or 16 million, but when we analyze the notification records it is much smaller. So it was demonstrated that there is underreporting, but we did not know the dimension of this gap “, he explains.

She also points out that the notification systems came with an increase in new inclusions until 2020, the first year of the pandemic, but that in the last two years there was a reduction in new records.

“The fact that a smaller number of notifications were made in the last two years of violence shows that the surveillance systems are working, but as the woman suffers the aggression largely at home, she does not seek the health service in a situation of vulnerability,” he says.

Although the research sought to cross-reference the databases, Malta recalls that there are challenges for this type of analysis due to gaps in many stages of completing the notification. “Psychological violence, which in the perception of women in the PNS was around 18.5%, in most states the record in Sinan is less than 1%. This represents an even greater difficulty in facing violence.”

In a second study conducted by Vital Strategies, in partnership with the Municipal Health Department of Goiânia, the analysis sought to detail the cases of violence. Similar to the national picture, there was also the identification of a problem of underreporting of violence against women.

About 25% of cases were notified, against 75% without notification. Of those with registration, more than 80% were in emergency rooms or hospitals. What drew attention in the Goiânia study was the median time since the notification of violence and death due to external causes (accident), 32 days, with 1 in 4 deaths (25%) occurring in the first days after notification.

“Today, in Brazil, to reconstruct the history of a woman victim of violence, we need analysis of integrated databases, but in many cases there are no details”, says Sofia Reinach, senior program manager at Vital Strategies.

An example was a case of the death of a woman, classified as “occupant cause (any) of a vehicle in an unspecified traffic accident”, but whose observation on Sinan said that the victim was thrown out of the truck by her partner.

One way to combat these difficulties would be to train health professionals who could indicate signs of violence suffered. “In many cases, that woman victim of violence has already undergone some medical care. This needs to be clear when tracing the notifications”, explains Fátima Marinho, senior technical advisor at Vital Strategies.

Among black women, with low education and with some type of disability or disorder, the worsening of violence is even greater, as they are subject to a greater risk of death from external causes. “It is important to understand the impact that violence against women has on health, and that it needs to be understood as a way to reduce female mortality. Intersectoral action is important, bringing together health, public safety, the Judiciary and the Legislature”, adds Marinho.

APPLICATION HELP HEALTH PROFESSIONALS IN NOTIFYING

As a way to reduce underreporting and help health professionals, UFMG and the Ministry of Health launched an application developed by the School of Nursing for use by these professionals.

The app is free and available on Android and Apple platforms.

Called Notiviva, it brings suggestions on how to identify reported cases of violence against women, how to register such occurrences and why.

“Especially in cases of psychological violence, the discovery of what that woman suffered is more in the conversation, in the anamnesis, than in a report that she will give in detail. The lack of knowledge of the violence suffered is also a barrier, and it is important that the health professional is able to recognize these signs”, explains Malta.

For Reinach, the training of professionals is essential, but that is not all. “Awareness also helps in investigating history every time we have a record of violence against women,” she adds.