Violence against women has devastating health consequences on the victims and undermines women’s control over their own reproductive health. In dealing with survivors of violence against women at the Coalition on violence’s Against Women (COVAW) counseling and legal aid clinic, what has emerged is that most women undergoing violence perpetrated by intimate partners also present with reproductive health risks and problems.

These can broadly be categorized into fatal outcomes and non fatal outcomes suffered as a result of violence. The fatal outcomes could be death as a result of homicide, suicide by the victim, maternal mortality and HIV/ AIDS. The non fatal outcomes include poor physical health as a result of the injuries, poor mental health like depression, consequences related to reproductive health like unwanted pregnancies, unsafe abortions and sexually transmitted infections, including HIV/ AIDS.

The psychological consequences are even more long term and devastating. The 2001 world health report identified gender based violence as one of the factors contributing to the disproportionate rates of depression amongst women. It further points out that recurrent abuse can erode women’s resilience and places them at risk of other psychological problems such as post traumatic stress disorder, suicide, and alcohol and substance abuse.

The right to access basic health care services and information is a basic human right enshrined in several international conventions and instruments like the Convention on the Elimination of all Forms of Violence Against Women (CEDAW), the Universal Declaration of Human Rights, and the International Conference for Population and Development (ICPD).

Despite this research from several countries has shown that women in violent relationships often do not have adequate access to reproductive health services yet they are among the most vulnerable and seek health services more frequently than non abused women.

Within the health sector systems violence against women remains highly invisible and there are glaring gaps within the health sector as well at the community level for dealing with violence against women. Most health providers have consistently failed to recognize and consider violence against women an important part of their work. Some health workers, being products of a culture that condones violence against women, view it as a normal way of life and do not feel obligated to pay attention to women who present with signs and symptoms of abuse. They do not feel that caring for women suffering violence is part of their professional profile. Their attitudes about violence are also largely shaped by prevailing cultural norms. Owing to this disinterest, women living in violent situations also rarely reveal their situations to health care providers.

One doctor interviewed in an intimate partner violence survey conducted by Family Health International captured the situation thus:

“Health workers – doctors, nurses clinicians are men first before they are health workers. As a result they cannot escape from the mashismo socialization that all men receive from their environment”.

Many providers also express attitudes that blame the victim rather than the aggressors. Such attitudes pose a serious challenge to transforming the culture of silence and complicity on issues of violence against women. The situation is further compounded by the lack of legislative and policy frameworks that require health programs to integrate policies and national plans to address gender based violence. The establishment of health sector policies on addressing violence is a key step towards institutionalizing violence against women programs and raising awareness amongst health providers on their role in addressing violence. Policy frameworks within the health system are important as they create a mechanism of holding the health sector responsible in addressing violence against women.

Governments are responsible for upholding women’s reproductive health and rights yet they consistently fail to live up to that duty. This has meant the use of international normative frameworks as a strategy to build pressure on governments to abide by universally acceptable standards of promoting women’s rights to reproductive health.

The protocol to the African Charter on women’s rights is one such instrument. Lauded as one of the most progressive instruments of promoting the rights of women on the African continent, it provides a comprehensive and useful framework for safeguarding women’s sexual and reproductive health and rights while upholding the bodily integrity of women. Article 14 of the protocol obligates state parties to undertake several kinds of duties relating to sexual and reproductive health and rights of women. Among the obligations it places on states are:

- The duty to protect the reproductive rights of women which requires states to take all necessary measures to ensure that no acts of omission and commission results in any violation of women’s reproductive rights.

- The duty to fulfil the reproductive rights of women which calls upon states to take all appropriate measures including legislative, administrative, budgetary allocations and other measures that will ensure the realization of women’s reproductive rights.

The duty to respect which entails that the government upholds a woman’s right to choice, information, and control over her sexual autonomy and bodily integrity. It further prohibits states from interfering with the protection and promotion of reproductive health and rights.

It is interesting to note that Article 14 has proved the most contentious in a number of countries yet it is one of the most liberating in terms of providing choice for women in matters of bodily integrity and autonomy. Women on the continent must not let the politics of control gain prominence over their rights to choice.

Once countries sign and ratify the protocol they become duty bound to uphold these rights. With glaring gaps that exist on legislative and policy frameworks in matters of reproductive health, it is necessary to continue building pressure for African governments that have not ratified the protocol to do so. Its passage will stimulate the enactment of national policies on violence which are strategic tools for stimulating greater sensitivity that violence against women is a public health issue. It will also create the political space for dialogue between civil society and the state while at the same time committing governments to a discourse that encourages sanctions against violence.

In a continent characterized by oppressive gender relations the passage of the protocol will anchor issues of women’s health within a human rights framework, thus creating duty bearers who can be held accountable for the realization of rights. Women’s rights activists must therefore not relent in their struggle to have governments move beyond lip service to securing serious commitments on issues of women’s reproductive health and rights.

* Anne Gathumbi is a women's rights activist and the outgoing coordinator of the Coalition on Violence Against Women (COVAW) in Kenya.

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