#MeToo: What Health Systems are Missing

by Alice Han

Dr. Alice Han

The #MeToo campaign has shone a light on violence against women and girls (VAWG) in Hollywood, on Capitol Hill, and in at least 85 countries around the world. Ironically, though, VAWG remains hidden to the systems which are trusted to protect, support, and heal — health systems. Health systems are often not responding adequately to patients experiencing VAWG nor committing to the role critically needed by these systems to address it.

As a medical doctor and epidemiologist, I’ve seen the pandemic scale of VAWG from health centers in Kenya, Israel and Brazil to a refugee camp in Greece. I’ve worked to strengthen health systems in Rwanda and the Philippines and currently practice and teach medicine in the US. Among the many forms of VAWG, I focus here on the most common forms worldwide: sexual violence and intimate partner violence. Despite my credentials, when I have tried to advance research or programming to improve awareness of and response to VAWG in different settings, I’ve noticed a theme in the responses from leadership: “It’s a big problem, but…”

“… it’s really hard to do anything about it.”
“… it’s not a problem related to obstetrics and gynecology”
“… it’s not really a priority”

VAWG is a pandemic that affects over a billion women and girls in the world. Why is this not a priority?

Health leaders are not callous nor uncaring; after all, they have devoted their lives to bettering the lives of others. But there is a pattern to their attitudes, and it is ingrained within health care institutions.

The World Health Organization reports that many women and girls experiencing violence worldwide turn to health services as a first and trusted contact. Health systems can thus play a unique and critical role in supporting these women minimizing the health impacts. But health systems around the world often do not recognize VAWG as a health problem.

image courtesy of www.towerhamlets.gov.uk/

This dismissal manifests at several levels. VAWG is underfunded in health budgets worldwide. Many countries do not develop or implement guidelines for response. Healthcare providers are thus not trained and equipped with knowledge and skills to screen for and detect cases in their patients and appropriately respond by providing comprehensive health services. I slaved through hundreds of sleepless nights during my medical training to learn about many diseases, but like many thousands of doctors, nurses and midwives, I graduated without any formal training on responding to VAWG. This inadequate health response is leaving millions of women and girls at risk for unwanted pregnancy, sexually transmitted infections like HIV, and mental health disorders such as PTSD. Gaps in coordination with legal services also decrease the chance for justice through holding perpetrators accountable.

It’s not just at the institutional level that I encounter resistance. When I talk to individual health providers about my work on VAWG, the responses I get are perhaps less dismissive but equally disturbing. A frequent line of questioning, asked with hesitation, is:

“But why?”
“Were you raped?”
“What’s your personal story of abuse? What happened to you?”

Why is this relevant? In no other area of health policy do we assume so automatically that advocates and researchers are survivors. The implicit judgment is that this is not an issue significant enough to engage the health sector or society at large. This discredits its importance: VAWG must concern everyone, both within and outside of the health sector.

We must reframe the conversation around VAWG.

In the same way that the #MeToo campaign has forced good but unenlightened men to recognize that VAWG is everywhere and must be dealt with, we need a concurrent campaign in healthcare that recognizes and grapples with the extent to which the health of women and girls is compromised by the violence they experience. #MeToo must mean more than recognizing that VAWG happens: it must be a call to action for the health sector to commit to addressing this global pandemic.