Health centers and hospitals are a place where all women go more or less frequently. For a decade, the Ministry of Health has had an epidemiological surveillance system, which could be similar to that of the flu or the coronavirus, to record situations of gender violence that health professionals detect in their consultations.
The latest data collected by this system was presented on Friday to the autonomous communities in the Interterritorial Council of the National Health System: physical violence is the most detected, because it is evident (especially in hospitals); the least, by far, is sexual. Although it has been evolving, the information is still incomplete, not all territories apply the same protocols and there is a significant gender gap among professionals who are trained in the matter, warns the report prepared annually by the Women’s Health Observatory. .
“This report aims to see progress and shortcomings; and the reality is that we still detect little, there are many more cases than we see because women do not reveal it or because they do not communicate if the victims do not want to include it in the medical history,” analyzes family doctor Carmen Fernández Alonso, an expert. in gender violence and part of the Observatory’s advisory groups. “We are missing a lot and not only in detection, but also in having response capacity. Detect and know what to do,” he continues.
Injury reports usually respond to acute attacks, and the fact that it is notified means that professionals comply with what the law says, but we lack detection in the consultation of chronic violence beyond the bruise.
Anna Pujol Flores, family doctor
In 2022, the last year for which data exists, 15,301 cases of women over 14 years of age who were suffering violence were detected and were recorded in the patient’s medical history, in addition to another 11,569 from reports of injuries (some may be duplicates). . There are, in the first case, 92 women per 100,000; In the second, if we talk about notifications of injuries – acute episodes, whether physical or psychological – that are submitted to a court, the rate rises to 99.6. Primary care is the level of care that refers the most cases.
“Injury reports – which have increased by 46%, according to the data – usually respond to acute attacks, and the fact that they are notified means that professionals pay attention to what the law says, but we lack detection in the consultation of violence chronicized beyond the hematoma,” says Anna Pujol, family doctor and coordinator of the Women’s Care group of the Spanish Society of Family and Community Medicine. “When he leaves due to injuries, I feel that we have arrived late,” points out, for her part, the president of the Spanish Society of Primary Care Doctors, Pilar Rodríguez Ledo.
Unequal screenings
The task is not easy. “I am critical, I think we all need to have the idea that a percentage of the women we serve are experiencing situations of violence. We have to train ourselves more, know what the keys are, have the tools to approach clinical interviews… If you don’t think about it, you won’t detect it,” Pujol continues.
In 2021, the Interterritorial Health Council approved a new national implementation tool called the WAST questionnaire, recommended by the World Health Organization. According to this system, two questions must be asked of all women over 14 years of age with a partner who go to a health center, even if there is no suspicion of violence: What is your relationship with your partner? How are problems resolved?
We lack a lot, not only in detection, but also in having the capacity to respond. Detect and know what to do
Carmen Fernández, advisor at the Observatory for Women’s Health
The annual Health report does not evaluate how this system is working – it leaves it for a later study – although it does state that there are different degrees of implementation of “screening” programs like this one for early detection and that explains why some Communities see more cases and others less. In addition, there are health systems that only apply them to specific services, such as pregnancy care and not to the rest, warns Health. “Screening is done little and more should be done because it can be a good strategy and, however, it is not 100% established,” says Pujol.
Men are trained much less
Beyond this, there is a problem of holes in the data. More than half of the cases detected in primary care and one in five in hospital care do not report the type of violence suffered by women. And details about the duration of the abuse or the relationship between women and their aggressors “are difficult to interpret,” says Health, due to the “large proportion of unknown information”: “The availability of such information in all communities should be ensured and redoubled the efforts to collect it.” For example, such a key piece of information to assess the economic independence of women as the employment situation does not appear in more than 70% of the reported cases.
There is a gender gap in training: 13,025 women compared to 2,891 men in the National Health System in 2022. Except in some very specific areas, male participation is less than 20%
The training, on the other hand, is very uneven. The gap looks like this: in 2022, a total of 13,025 women were trained in the National Health System compared to 2,891 men. Except in some very specific areas such as gynecology, social work or psychology, male participation is less than 20%. “It is desirable to challenge professional men to participate not only as teaching staff but as students,” the report urges.
Sexual violence, the most invisible
Having knowledge about how to approach suspicion is as essential as knowing how to read signs or symptoms that are less obvious than physical aggression. Sexual violence continues to be the least detected (10% in primary care and 17% in hospitals), although the percentages have improved compared to 2021. Psychological violence is collected more frequently than physical violence in outpatient clinics when no parties are involved. of injuries, although these can include verbal attacks as well.
Introducing in the medical history that someone is a victim of gender violence is the most recommended, according to the Health report. However, there are practical difficulties in doing so because some women think it puts them at risk. Pujol admits that it is “very sensitive data” although he assures that there are mechanisms so that this information does not appear as another element in the general report. “We must always inform the patient that we are going to register it,” he adds.