Health centers and hospitals are places 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 were presented on Friday to the autonomous communities of the Interterritorial Council of the National Health System: physical violence is the most detected, because it is obvious (especially in hospitals); the least, by far, is sexual. Even if it is evolving, the information is still incomplete, not all territories apply the same protocols and there is a significant gender gap among professionals trained in the matter, warns the report prepared each year by the Observatory of women’s health.
“This report aims to note progress and gaps; and the reality is that we still detect few, 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 medical history”, analyzes family doctor Carmen Fernández. Alonso, expert in gender violence and member of the Observatory’s advisory groups. “We are missing a lot of things, not only in terms of detection, but also in terms of response capacity. Detect and know what to do,” he continues.
Reports of injuries generally respond to acute crises, and the fact that they are notified means that professionals are complying with what the law says, but the consultation lacks detection of chronic violence beyond the blue.
Anna Pujol Flores, family doctor
In 2022, the latest year for which data exists, 15,301 cases of women over 14 years of age having suffered violence were detected and recorded in the patient’s medical file, in addition to 11,569 other cases from injury reports ( some may be duplicates). . There are, in the first case, 92 women per 100,000; In the second, if we talk about injury declarations – acute episodes, whether physical or psychological – which are submitted to the court, the rate rises to 99.6. Primary care is the level of care that refers the most cases.
“Reports of injuries – which increased by 46%, according to the data – generally respond to acute crises, and the fact that they are reported means that professionals are attentive to what the law says, but we lack detection in the consultation of chronic violence. beyond the hematoma,” explains Anna Pujol, family doctor and coordinator of the women’s care group of the Spanish Society of Family and Community Medicine. “When he leaves because of injuries, I have the impression that we arrived late,” underlines, for her part, the president of the Spanish Society of Primary Care Physicians, Pilar Rodríguez Ledo.
Unequal screenings
The task is not easy. “I’m critical, I think we all need to have the idea that a percentage of the women we serve are experiencing violent situations. We need to train more, know the keys, 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 to all women over 14 in a relationship who visit a health center, even if there is no suspicion of violence: What is your relationship with your partner? How are problems resolved?
We are missing a lot, not only in terms of detection, but also in terms of response capacity. Detect and know what to do
Carmen Fernández, advisor to the Women’s Health Observatory
The annual health report does not assess how well this system works – it leaves it for later study – although it does indicate that there are varying degrees of implementation of “screening” programs like this for early detection and this explains why some communities are seeing 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 little done and more should be done because it can be a good strategy and, however, it is not 100% established,” explains Pujol.
Men are much less trained
Beyond that, there is a problem of holes in the data. More than half of 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 attackers “are difficult to interpret”, explains Health, because of the “large proportion of unknown information”: “The availability of this information in all communities must be guaranteed and redoubled efforts to recover it. For example, information as essential for assessing women’s economic independence as employment status does not appear in more than 70% of 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 certain very specific areas, male participation is less than 20%.
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 certain very specific fields 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 also as students,” the report insists.
Sexual violence, the most invisible
Knowing how to approach suspicion is as essential as knowing how to read signs or symptoms that are less obvious than physical aggression. Sexual violence remains the least detected (10% in primary care and 17% in hospitals), even if the percentages have improved compared to 2021. Psychological violence is collected more frequently than physical violence in outpatient clinics when No party is involved in the injuries. , although these can also include verbal attacks.
Including in the medical history that a person is a victim of gender-based violence is the most recommended, according to the Health Check. However, this faces practical difficulties as some women believe it puts them in danger. Pujol admits that this is “very sensitive data”, although he assures that there are mechanisms so that this information does not appear as another element of the general report. “We must always inform the patient that we are going to record them,” he adds.
