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Second, the U.S. Joint Commission on Hospital Accreditation included emergency mom protocols and training on family violence among the criteria used to evaluate hospitals for accreditation (Heise and Chapman 1992). This policy change should encourage more active screening and referral of abuse victims.
A new project sponsored by the Family Violence Prevention Fund, a private, nonprofit group in San Francisco, and the Pennsylvania Coalition Against Domestic Violence seeks to help institutionalize the new hospital accreditation standards by developing model protocols, training programs, and dissemination strategies that can tee applied throughout the country (Family Violence Prevention Fund 1993).
Training providers is essential not only to increase referral rates, but to ensure that victims are not revictimized by the health care system. Victims of rape and domestic assault frequently report being humiliated and degraded by the very providers who are supposed to help them (Kirk 1993). Providers who fail to collect and record evidence properly in rape and assault cases can jeopardize any legal cases that a victim might bring. And providers ignorant of violence and its sequelae can exacerbate the consequences for women by labeling them hypochondriacs or by treating them for nonexistent mental illnesses. Research from the United S tales shows that emergency room doctors are more likely to prescribe tranquilizers and pain medication to battered women than to trauma victims who are not battered (Stark, Flitcraft, and Frazier 1979). By deadening the pun “d clouding judgment, tranquilizers can prolong the battering relationship and make it more difficult far women to assess their options or take action to protect themselves. It is widely acknowledged that Valium and other tranquilizers are over-prescribed by the medical profession in the developing world as well (Busto 1991).
The issue of violence can and should be incorporated into the training of community health workers as well as professional staff. Project workers report that such issues as domestic violence and men’s alcoholism arise spontaneously during health promoter meetings, especially in all – female groups. Increasingly, NGO-sponsored projects are incorporating themes on gender violence and women’s status into training materials for health promoters. The Women’s Program of Uraco Pueblo in Honduras, for example, includes socio-dramas, discussions, and role playing on domestic violence and sexual harassment in its health promoter training; promoters regularly hold community meetings on domestic violence, inviting lawyers to offer women legal advice and holding joint meetings with husbands and other men from the village (Maher, personal communication, 1993). And female health workers in the SARTHI project in Gujurat, India, consider offering individual and community support to victims of violence an integral part of their job. Health promoters have accompanied women to the police station to register complaints and worked with family members to marshal support for women’s decisions to take action against an abusive husband. Project organizer Renu Khanna notes that the women themselves defined violence as a priority; SARTHI merely supported their leadership on the issue (Khanna, personal communication, 1992).
On the international front tentative progress has also been made toward recognizing violence as an obstacle to women’s health and development. In 1991 the Pan American Health Organization (PAHO) sponsored a conference in Managua enticed “Violence against Women: A Problem of Public Health. (OPS 1°,92). Colombia’s Ministry of Health issued an action agenda for women’s health which included a program on “Prevention of Abuse and Attention to Victims of Violence.. And the United Nations Fund for Women (UNIFEM) published “Battered Dreams: Violence against Women as an Obstacle to Development” (Carrillo 1992). But the World Health Organization has no program or policy related to genderbased violence. In fact, in planning World Health Day 1993-whose theme was Injury and Violence Prevention- officials included no mention of violence against women until women’s health advocates persuaded them to do so.
Although violence is in theory largely preventable, few preventive programs have been undertaken on a wide scale. Among those programs that do exist, many focus on helping adolescents and young children learn nonviolent ways to resolve conflict (box 8). Some concentrate on developing self-esteem and the ability to express emotions in constructive, nonviolent ways. Others work to challenge the gender stereotypes and notions of male prerogative perpetuated in the media and in the culture at large. Programs in some schools encourage children to disclose to an adult unwanted touching by strangers or family members. And on college campuses consciousness-raising programs are being developed to combat acquaintance rape.
Much of the public education and media work by the women’s movement can also be loosely classed as prevention work, although more effort has been directed at reaching potential victims than at changing men’s attitudes. Women’s groups have held hundreds of workshops and produced thousands of pamphlets, comic books, and other consciousness-raising materials to give women basic information about their rights. Although few of these materials have been evaluated, they have clearly been useful in initiating dialogue on this often taboo subject (Zurutuza 1993). Several developing countries, among them Ecuador and Peru, have sponsored national media campaigns to sensitize the public to issues concerning rape and domestic violence (Zurutuza 1993). The Family Violence Prevention Fund in San Francisco is trying to take media-based prevention a step further by doing sophisticated market research to craft messages aimed at changing public attitudes toward violence. This effort represents the first time that the media techniques successfully used to change drinking and smoking behavior in the United States will be applied to domestic violence.
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