/ 15 March 2019

Violence raises the urgent need for more health services

An estimated 1.75-million people annually seek healthcare for injuries resulting from physical and sexual violence.
As well as physical violence, domestic abuse can take many different shapes and forms — sexual, emotional, economic or psychological actions or threats of actions — most of which often end up escalating to serious physical aggression, according to experts. (Oupa Nkosi)


Almost daily, our news reports are marred by statistics about gender-based violence, such as one in three women are assaulted, physically or sexually. According to the World Health Organisation (WHO), South Africa has one of the highest rates of violence inflicted on women and girls in the world.

A baseline study with 2 600 men, conducted in Diepsloot by the University of the Witwatersrand’s school of public health as part of the Sonke Change Trial, revealed alarming levels of violence. Fifty-six percent of the men interviewed reported they had either raped or beaten a woman in the preceding 12 months. Of those, 60% also violently assaulted women many times during that period.

This has a devastating effect on the emotional, physical and mental health of people and on the economy and health systems. A KPMG study estimated that gender-based violence cost the economy a minimum of between R28.4-billion and R42.4-billion, or 0.9% and 1.3% of gross domestic product, in the year 2012-2013. An estimated 1.75-million people annually seek healthcare for injuries resulting from physical and sexual violence.

One study also cites how more than a third of women who have been raped develop post-traumatic stress disorder, which, if untreated, persists in the long term and leads to depression, suicide and substance abuse.

An Avert (A Very Early Rehab­ilitation Trial) study estimated that 16% of all HIV infections in women could be prevented if women did not experience domestic violence.

Women and girls bear the brunt of these injustices because of unequal treatment and poor access to quality sexual reproductive health and abortion services in the public healthcare system.

When women face an unwanted pregnancy resulting from rape, they are more than twice as likely to choose to terminate that pregnancy, even if safe and legal abortion options are unavailable. This puts them at a high risk of complications, including injuries and death.

If violence occurs when women are pregnant, there are several potential complications, including an increased likelihood of miscarriage, stillbirth and premature labour. Additionally, violence is a leading cause of injury and death among pregnant women.

To tackle this issue, the government must finalise and implement the recommendations that arose from the gender-based violence and femicide presidential summit held in November last year. It was convened after thousands of women marched under the banner #TotalShutDown to the Union Buildings in August last year to highlight the plight of women and girls.

A declaration was issued by President Cyril Ramaphosa, which included renewed commitments to address and eradicate gender-based violence and the toxic patriarchal structures in our society.

Some of these commitments were repeated in the president’s State of the Nation address on February 7.

Reproductive health services are vital to address gender-based violence. The provision of timely and confidential access to emergency contraceptives can prevent women and girls from becoming pregnant because of sexual violence. Likewise, increasing access to information about HIV and confidential testing, counselling and early treatment services, such as post-exposure prophylaxis, can reduce the risk of infection.

There is a need to improve post-trauma care in public health facilities to address disproportionate access to basic sexual reproductive health services and thwart the perpetuation of gender inequality in our society. Another response should include access to safe abortion should the need arise. Despite a progressive abortion law, many victims of sexual violence resort to unsafe abortion services, which can lead to death or disability.

The government must ensure that a comprehensive bouquet of post-trauma sexual reproductive health services are provided at the primary, secondary and tertiary levels under the proposed National Health Insurance scheme.

It needs to further capacitate and financially support nongovernmental organisations already involved in providing psychosocial services to gender-based violence survivors.

It is also imperative for chapter nine institutions, the custodians of the Constitution, policymakers and citizens, to demand government accountability regarding the implementation of recommendations and related policies.

Civil society, faith-based organisations and traditional leaders also have the responsibility to create more opportunities for dialogue and awareness of gender-based violence issues to destigmatise the shame and guilt experienced by survivors.

Gender-based violence is no longer a private and domestic affair. It has become a human rights violation of national proportions that requires our urgent response.

Angelica Pino is the director of Sonke Gender Justice