No open-access location is known for this record yet.
No open-access location is known for this record yet.
The last decade of the 20th century and the beginning of the new millennium saw a number of new FIGO initiatives, through which the Federation quickly became an important and widely recognized advocate of women's health and equity in access to health care and, more recently, a respected player in the fight for women's rights, status in society, and overall role in the communities in which they live. Since the beginning of its transformation, FIGO identified among the major causes of women's suffering the many forms of violence perpetrated against women, because, even today, violence against women (VAW) represents a multifaceted and ever-pervasive evil. Recognizing that childhood sexual abuse, rape, and domestic violence happen in every country of the world and to all types of girls and women; that many victims of VAW suffer serious and long-term physical and psychological effects; and that, unfortunately, victims often suffer in silence, although silence worsens the effects of the abuse and puts victims at increased risk of further violence, the Federation decided to join forces with other international organizations and Non-Government Organizations (NGOs) to change this horrible situation [1,2]. Are respected professionals who are committed to and focused on women's health; Have a special relationship with their patients that goes beyond the 'disease model'; Are dedicated to women's well-being; Are involved with women on both the physical and psychological levels; Are advocates for women. As victims of violence often cannot speak out about what is happening to them, Obstetrician/Gynecologists need to speak for them and encourage them to speak; At the 15th FIGO World Congress in Copenhagen 1997, VAW was brought onto the agenda and a plenary session on the subject organized. The issue was also addressed in the published Proceedings of the Congress. During the presentations, it became clear that VAW had a major impact on reproductive health. VAW was shown to increase the risk of pregnancy complications and to be associated with a range of chronic conditions such as chronic pelvic pain. Obstetrician/Gynecologists were urged to bring VAW to their agenda and include this issue in their daily work. Several recommendations were made: First, and foremost, at each consultation, women should be delicately encouraged to disclose any violence they had suffered; this should be achieved through careful listening in a safe environment. Furthermore, since victims are over-represented among women in several diagnostic groups (e.g. chronic pelvic pain, pelvic inflammatory disease (PID), and sexually transmitted diseases (STDs)), physicians should exercise special care to bring the issue into the open whenever a patient presents with these conditions. Co-morbidities, such as psychological problems, post-traumatic stress, suicidal attempts, injuries, and 'unexplained' somatic conditions should raise the suspicion of abuse. Abused women might have problems with following certain kinds of treatment, such as taking antibiotics, for fear of being beaten for suspected extramarital sex. In dealing with the victims of VAW, Obstetrician/Gynecologists must be aware of a number of problems: memories of severe trauma might be triggered by the gynecologic examination; contraceptive advice should take into account the women's ability to control her sexual life; in antenatal care, the pregnant woman should have the opportunity to communicate with her health care worker without the presence of her spouse, in order to be able to safely disclose abuse; abuse should always be assessed in high-risk women; when medical treatment and advice involve the cooperation of the partner, care should be taken to assess the woman's situation at home; if intimate partner violence is suspected, an assessment should be attempted of the woman's safety and measures should be taken to ensure her safety; and legal actions should be considered when appropriate [3]. To understand the various types of violence. To recognize the factors that influence violence against women and how to minimize exposure and maximize protection within the family unit. To hear first-hand experience from people of different parts of the world, within and outside of the health services, on how to protect the victims seeking help. To plan strategies that FIGO, WHO, and academic organizations can implement to address the issue. Most healthcare professionals, including Obstetrician/Gynecologists, are ignorant of the problem and its extent, its manifestations, and negative consequences in the short term and long term; There is poor linkage between health professionals and social services to aid diagnoses and assist victims; Many healthcare professionals were afraid to become involved with the cases of violence against women because of potential legal ramifications. Dr Van Look called on the delegates to make violence against women unacceptable and emphasized that psychological damage to the victim's personality may be the most difficult to overcome, long after the physical damage has been cured. At the conclusion of Dr Van Look's presentation, the Chair of the General Assembly emphasized how important this type of collaboration with the World Health Organization was, and reiterated that it will continue. He asked the Assembly to adopt a resolution, which was unanimously adopted. The resolution called for reproductive health care providers to develop expertise and specialized care for victims of violence. It recommended that VAW be included in the curricula of all reproductive health care providers. It also called for reproductive health care providers to work with other groups to advocate and support measures to address VAW. To implement the resolution and ensure that action followed words, FIGO decided to organize an international conference in Italy on the Role of Health Professionals in Fighting All Forms of Violence Against Women. The conference, originally proposed for November 1999, was subsequently postponed by one year to enable the participation of Member Societies from the Developing World. This postponement enabled FIGO's Executive Board to allocate funds from the 2000 budget, as well as a proper involvement of the Italian Government and in particular the National Commission for Equal Opportunities; eventually, the Italian National Institute of Health contributed some € 190 000 and the Government of Italy and the City of Naples made substantial 'donations in kind'. The conference was finally held in Naples during October 2000; it was sponsored by FIGO, with the Italian National Institute of Health (ISS) and WHO. Its aim was to evaluate the origin and causes of violence against women and to identify what role health professionals could play in improving this unacceptable situation. The Agenda, finalized during a preparatory meeting held at UNFPA Headquarters during April 1999, called for a program based on 'core group discussions,' addressing specific forms of violence typical of specific geographic areas; at that time it was also decided to publish the proceedings of the Conference in the FIGO Journal [5]; the published material summarized the discussions, printed the main lectures given at the conference (which were kept to a minimum to allow the widest possible dialogue) and also included additional papers by scientists and activists working in the area. Besides FIGO, the ISS and WHO, several United Nations Agencies and FIGO Member Societies granted support for the Conference: UNFPA, UNICEF, UNIFEM, WHO, the World Bank, ACOG, RCOG, SCOG, SIGO. A major feature, approved at the New York preparatory meeting, was to extend an invitation for active participation to representatives (up to 2 or 3) from each FIGO Member Societies. In this way FIGO took the leadership of the entire conference. In coincidence with the organization of the Naples Conference, the idea was launched by the Officers to create a full 'FIGO Initiative' on VAW. At the end of 1999 a tentative plan was drawn up, consisting of three initial steps: (a) the Naples Conference was to examine and evaluate the situation; (b) the publication of the Proceedings was to disseminate information on the subject among FIGO's Member Societies; (c) a Working Group in charge of predisposing a New Vision to place FIGO at the forefront of the battle for women's status and rights; a Strategy to identify the role of medical and paramedical personnel in the fight against violence; and a Program of Action for FIGO and other organizations to actively work towards these goals. The Working Group (WG), composed of Prof. Berit Schei (Oslo), Chair, Prof. Marleen Temmermann (Belgium), Dr Yasmine Ul-Haque (Bangladesh), Dr Ronald Chez (USA), Dr Diana Galimberti (Argentina), and Professor Giuseppe Benagiano (Italy), was formally established in 2000, although a lack of financial resources greatly slowed down the implementation of their work. The following rationale was proposed for the creation of a FIGO Working Group on VAW: Obstetrician/Gynecologists see victims of violence every day, in hospitals, clinics and offices, because they are the doctors that women go to for their primary care. Indeed, they are often the only health care professional a woman sees. It is therefore very unfortunate that few of them are trained to speak about violence with their patients. Under the circumstances, it was felt that FIGO had the responsibility to try to change a situation that, although unwillingly, helps only the perpetrators of violence. In this connection, since VAW has a major impact on women's reproductive health, Obstetrician/Gynecologists in their work run the risk of misdiagnosis and inadequate treatment when not considering violence as a possible cause for their patients suffering. Overlooking VAW might bring unwanted effects, such as increased risk of violence and lack of recovery in spite of adequate medical treatment and advice. As already stated, there are a number of reasons why FIGO is properly suited to advocate change in this area: Obstetrician/Gynecologists are respected professionals who are committed to and focused on women's health; they have a special relationship with their patients that goes beyond the 'disease model'; they are dedicated to women's wellbeing and are involved with women at both the physical and psychological levels. FIGO Member Societies, under guidance from the Working Group, will have an opportunity to address the issue of violence and call for solutions. Member Societies must start from the realization that there are still barriers to addressing issues relating to VAW, because clinicians often fear both being overwhelmed and feeling helpless when they address violence. For this reason FIGO's priority is to deal with how to overcome these barriers by using three interconnected approaches: advocacy, training, and services. FIGO's first goal is therefore to mobilize Obstetrician/Gynecologists worldwide and help them to address VAW through these three interconnected approaches. Today, FIGO is committed to women's health in its totality and advocates for their health; it has the authority to speak on behalf of women because the members of its affiliated national societies have a unique relationship with women and a sense for social responsibility. As victims of violence, women often cannot speak out about what is happening to them; this is why their doctors need to support them, advocate for them and encourage them to speak. There are some areas in which Obstetrician/Gynecologists have special responsibilities. The first is antenatal care, an important preventive intervention in which the opportunity to address violence might have great impact; VAW is associated with low birth weight and other complications in pregnancy and hence not addressing VAW might seriously hinder antenatal care to improve all pregnant women's health and reduce the risk for complications [6]. Indeed, violence in pregnancy is a specific form of violence that FIGO is uniquely suited to address. The WG feels strongly that FIGO Member Societies must educate their members to identify all forms of violence perpetrated against pregnant women and help the victims. Another area in which Obstetrician/Gynecologists have a special responsibility is in the services for victims of rape. Medical, psychosocial and legal assistance is needed and Obstetrician/Gynecologists are involved worldwide in improving the services for these victims [7]. Standards for care and protocols are greatly needed and FIGO and their partners must continue to be involved in this important work. According to the Plan of Action laid down by the WG, FIGO's program will move along five main objectives: First and foremost, the education of its members. As women's doctors, Obstetrician/Gynecologists must become able to recognize VAW and help victims. Second, Member Societies must make policymakers and the public aware of violence and its dire consequences for the health of so many women. Third, the education of medical students to enable them to recognize signs of violence, understand the implications of VAW and become able to talk with their future patients about it. Fourth, FIGO's Member Societies need to sensitize and train doctors, nurse/midwives and other reproductive health care providers in the management of victims of VAW. Fifth, FIGO needs to develop projects to address VAW in countries where member societies are ready to act. These would integrate the assessment and care of VAW into reproductive health services. The plan of action prepared by the WG calls for joining forces and establish a collaboration with other groups such as UN agencies, NGOs, and government organizations. In order to implement the above-mentioned program, a proposal was submitted to the FIGO Executive Board during 2002. The first step in the implementation of the plan is to develop situation analysis instruments that can be sent to each member society, asking them about what they are doing about VAW in terms of advocacy, training and services. This will give the WG a sense of their interest, motivation, and capacity, as well as of what member societies are already doing regarding VAW in their country. The next step will be to raise funds by writing proposals that will support our efforts to mobilize Obstetrician/Gynecologists to address VAW. Naturally, there is a need to involve experts to assist FIGO in preparing proposals, in developing survey instruments, in project designing, in developing training materials, in implementing the project and in monitoring it. In this respect, over the last 2 years, Prof. Marleen Temmermann, of the University of Ghent, Belgium, a member of the Working Group, has been trying to win the support of the European Commission for a project named 'Gender-Based Violence: A Multi-Country Assessment of Health-Sector Response to Violence Against Pregnant Women'. Hopefully, her efforts will soon yield good results. Publish articles in the FIGO Journal, the IJGO. Arrange sessions at its World Congresses. Develop ad hoc materials. Promote national campaigns. Activities have already begun in the first two of these areas: In its role as an advocate, FIGO has, through its official journal, the International Journal of Gynecology and Obstetrics (IJGO) published articles on VAW as well as the proceedings of the Naples Conference as a special supplement [5,8–12]. The IJGO needs to continue publishing articles about VAW, so as to raise the awareness of its readers. As proposed, the Program of the FIGO Congress held in Santiago, Chile in November 2003 included both lectures and sessions on subjects related to the fight against VAW. It is hoped that the new Executive Board will approve the continuing existence of the Working Group and that soon work could begin on the other two major areas envisaged in the original plan of action, as well as in a number of additional areas. The first priority should be the creation of a package of materials that can be used by Member Societies to educate people and advocate for changes in laws, treatment of victims of VAW and services for them. It is hoped that after developing and testing these materials, FIGO can use them to launch national campaigns focused on VAW. Member societies could then select sites and develop service projects based on their capacity, resource level and infrastructure. These projects will offer assistance and services to victims of violence. These VAW interventions can include screening, identifying, educating, treating and referring patients. Service projects should develop tools to collect data, document the violence, assess the needs of the victims, etc. They will also offer materials about VAW to their patients in the form of posters, brochures and pocket-sized cards. There will be a need to evaluate the results obtained in each study and—of course—in the end there should be publication of the outcome. A specific feature of the projects should be that each project should represent a model that can be duplicated or adapted for use in other countries. In order to achieve success, we must look beyond the science of the obstetrics and gynecology practice. The Obstetrician/Gynecologist must also take the opportunity to help someone without necessarily providing treatment related to the disease. What we have in mind is, therefore, a phased strategy for FIGO and member societies. Implementing this plan of action will have positive effects on both victims of violence and Obstetrician/Gynecologists. Acknowledging VAW enhances the relationship between physicians and their patients, but it will also offer the specialist a major means to help victims of violence. With this program, FIGO will be addressing a problem that women have suffered, until now, with little support from the medical world or society at large. FIGO can, through this strategy for action, make a big difference in these women's lives. As already mentioned, a vital area for FIGO's action is the field of training, including pre-service curricula, in-service sensitization, and in-service clinical training. FIGO should make recommendations for the minimum level of care that should be given to victims of violence, and must explicitly define the role of the reproductive healthcare provider when working with victims of violence. In conclusion, FIGO has a golden opportunity to start now to help victims of violence; we simply cannot wait for women to die before recognizing the seriousness of the problem. Any future plan by FIGO should include specific projects aimed at involving Member Societies in educating their members in how to identify this hideous form of violence and to help the victims. In addition, specific projects should be focused on the one form of violence that FIGO can best address: violence in pregnancy. There is one final area in which FIGO should begin to involve itself, and that is the highest form of violence, the one that deprives a woman of the right to life, just because she is female. In this respect, we know that in most of the countries of the world women live longer [13]. However, on scrutinizing the data, one very significant fact stands out: there is at least one geographic area where the differential in life expectancy is negligible, and this area is the Indian subcontinent. In Pakistan, Nepal, and India, the difference is 1 year, and in Bangladesh, it is zero. Only in Sri Lanka do we see a difference that is in keeping with the world average of 5 years. The practice of eliminating female babies is, unfortunately, not limited to South Asia. In China, in recent years, the male to female ratio has increased from 1.05 to 1.20, and in South Korea, where, on the one hand, the male to female sex ratio at birth grew from 1.07 in 1982 to 1.15 in 1991, on the other hand, the male to female sex ratio for children born in sequence to a couple rose from 1.06 for the first child to
Loading…
Stored only when both papers are in the corpus — 14 citations exist upstream.
Papers that cite the same references — the relational fallback while embeddings are still backfilling.
Imported from OpenAlex (CC0) — nothing here is generated.