Aye Thiri Kyaw urges for a comprehensive health sector response to violence against women.
It has been well-documented in Myanmar that violence against women (VAW) affects the overall health of women, yielding a negative impact on their social lives and their ability in domestic and income-generation activities. Women endure severe mental, physical and sexual health consequences as a result of experiencing violence inflicted by partners. It might not be obvious how violence affects women’s mental health, but VAW can trigger depression and emotional stress, which in extreme cases may lead to suicide attempts. Presently, there are few medical support services available for the women who experience such violence because many health services in Myanmar are too focused on sexual and reproductive health, and not attentive to VAW-related health services. A comprehensive health sector strategy— providing services for women who have experienced VAW— is needed as a matter of urgency.
Evidence shows VAW is a public health concern in Myanmar
Recent studies about VAW in Myanmar have highlighted the mental, physical and sexual health consequences women face as a result of violence by their intimate partners and by other men. However, little attention has been paid in terms of recognizing these health consequences as a public health concern by health care professionals in Myanmar.
The Gender Equality Network (GEN), a prominent network in Myanmar which focuses on gender equality and women rights, published a study that revealed verbal, physical, sexual and psychological abuse leads to mental health issues. It is not always obvious but these forms of abuse play significant roles in the overall mental health of women. In some cases, depression and anxiety about life conditions and relationships also lead to severe mental health problems. Six of the women who were interviewed in this study reported suicide attempts or suicidal thoughts. As in other cultures, suicide is highly stigmatized and frowned upon in Myanmar’s multiple religious cultures. Yet these religious cultures do not stop them from attempting suicide, a fact which indicates the depth of the depression and of mental health consequences for women’s will to live.
Findings from the Demographic Health Survey (2015-2016) shows how much women and girls (aged 15-49) were subjected to physical and/or sexual violence by their husband or other men. The results of the violence often leave severe physical and psychological health consequences, but these remain unaddressed. Survivors of VAW utilize the health sector more than others, but often not for the abuse itself.
Health services are not specifically focused on VAW
A recent study in Myanmar also revealed that services are primarily for overall general women’s health, and not specifically for VAW-related cases. In this report, some respondents said they were able to access psychological support, but other women stated they didn’t have access to it, which shows the lack of consistent psychological support. The services from health facilities often lack quality care, for example, providing ineffective psychological support that fails to pay detailed attention to the sensitivity of the abused and to possible post traumatic syndrome disorder (PTSD). There has not been enough psychological support dedicated primarily to VAW survivors. Some women feel very frustrated that the psychological consequences of VAW are not taken seriously by their family members, relatives, and health professionals, whereas physical health consequences, in the form of injuries, are more visible and get sympathy and treatment from family and health professionals.
VAW and health policies in Myanmar
Presently, there is no comprehensive health system in place for women and girls who experience violence. The current health interventions are general health and/or reproductive health services. The Ministry of Social Welfare, Relief and Resettlement is leading the Union Ministry for Women’s Advancement and Empowerment. The ministry, with the help of Gender Equality Network Myanmar, adopted the National Strategic Plan for the Advancement of Women (NSPAW 2013–2022) which includes 12 critical areas aligned with the Beijing Platform for Action. “Violence against Women” and “Women and Health” are two of the 12 priority areas in its 10 year plan. Apart from a mention that gender-sensitive training will be offered to the health professionals, the plan remains unclear as to how it will go about developing the rest of the health mechanisms that would address the need for services to the survivors of any types of violence.
Similarly, the National Health Plan (2017-2021) includes “Gender and Health” as one of the social determinants of health. Yet, it doesn’t explain how exactly VAW strategies will be included in comprehensive health responses. In the National Reproductive Health Plan (2018), one of the key strategic areas is to strengthen health sector responses to survivors, through developing standard operating procedures and protocols. Little is known about what health providers know or how they feel about addressing the survivors of intimate partner and sexual violence.
The way forward
Given the depth of negative consequences of VAW, a comprehensive health sector response to VAW must be developed as soon as possible with policy makers, gender experts and health professionals. Some of the components below should be considered for a holistic approach:
- Long-term psychological support: The current psychological support that survivors are receiving is reported to be ineffective and short-term in its approach. More thorough long-term mental support is a need for the survivors to fully recover from their suffering.
- Awareness: Traditional awareness-raising campaigns are essential for taking messages to the grassroots level. In the age of social media, social influencers also have a critical role to play to raise awareness about violence against women as a public health issue. This is one of the most effective ways to reach Myanmar “netizens,” near and far. Integrating violence prevention information into ongoing and future healthcare campaigns, and working with them to spread information on the health-related consequences of partner abuse and other forms of violence against women, should be part of a VAW strategy.
- Shelters for abused women: It is critical for VAW survivors to have accommodation if they decide to leave a violent relationship. For either medical or legal reasons, it may not be safe for them to stay with the abuser under the same roof. Funding and implementation of shelters will be important for abused women’s transition from an abusive situation towards peaceful independence.
- Health services must practice a women-centered approach: The health sector must ensure that a women-centered approach is adopted— i.e. respecting the dignity of the survivors, and not disclosing confidential information. Health care service providers should be trained to sensitively recognize symptoms or risk factors linked to violence.
- Monitoring: Documenting the prevalence of VAW is useful for any future policy interventions. Therefore, it is important to set up reporting systems between sub-national hospitals and clinics, and national level health statistics offices to monitor domestic violence cases across health care settings. Comparison of the yearly statistics collected through research, judicial courts, and hospitals will point out whether incidences of violence against women are decreasing or increasing.
Aye Thiri Kyaw researches gender, women’s rights, health, and violence against women. She is a co-author of Behind the silence: violence against women and their resilience in Myanmar, and a journal article in Gender and Society. Her opinion pieces can be found in New Mandala and Tea Circle. She studied Health Social Science at Mahidol University, Thailand. She is a US State Department IVLP Alumni.