the reason i am in inda

many people have asked what i am doing in India. so i thought i might explain. i am on a three phased trip. i will explain each phase as it goes along. so, right now i am in mumbai. i am at a nice airport in a disappointing part of town. i am at least an hour from the cool, hip, energized part of mumbai. a colleague who lives here described our location as pittsburgh. i am in india’s pittsburgh. the hotel is nice (lalit intercontinental). for some reason i have a suite. so my hotel room is about the size of dianna’s apartment. but has 1 more bathroom. it is ridiculous. especially because there are slums outside my window.

so that's where i am, but why am i here? i am here for my work on the gender technical working group with PEPFAR. i am attending the International Conference on Gender-based Violence and Sexual and Reproductive Health. it is super duper interesting. though i admit i have stepped out during the 1:30 minute presentation of an award. the honorifics are a bit overdone.

obviously, violence creates health risks. homocide, femicide (the killing of women because they are women), broken bones, internal injuries, suicide, etc. but there is much much more to the story.

some interesting things i have learned so far.

• 10 years ago the international center for research on women announced that 1 in 3 women in the world had been a victim of gender based violence. they now admit that they were really just guessing. and now that number is known to be quite conservative. in fact, in some populations it is now known that 70-80% of women are victims of intimate partner violence.
• one researcher asked participants to remember the women in their lives. then asked if any of them had been victims of intimate partner (IPV) or gender-based violence (GBV). then just stated: “if it is so prevalent, why is so little being done to stop it?”
• unintended pregnancy rates are higher in women who have been victims of IPV at an adjusted odd ratio (AOR) of 1.7. which means almost twice as likely
• and victims of IPV are MORE than twice as likely to have an abortion (2.1 AOR)
• if IPV was completely eliminated there would be a 15% reduction in unintended pregnancy and a 17% reduction of pregnancy loss
• men who perpetrate violence are twice as likely to be HIV infected. men who engage in HIV risk behaviours are more abusive.
• abused women have a 7 fold greater risk of contracting HIV
• IPV during pregnancy is as common or more so than many conditions that are commonly screened during pre-natal care. this violence is associated with a variety of obstetrical risks including: late entry into pre-natal care; increased smoking and substance abuse; history of STIs; vaginal and cervical infections; kidney infections; miscarriages/abortions; premature labor; fetal distress; bleeding in pregnancy; in adequate weight gain; and low birth weight
• IPV increases risk of infant mortality 3 fold
• abused women have increased physical symptoms of illness. severity of abuse correlates to severity of illness. experience of abuse could have occurred many years previous, but still affects physical health. treatment of PTSD is vital to increased health of women.
• there is a synergistic effect of maternal depression, IPV and child mortality. this includes mental, emotional, and physical abuse
• in a small study in hong kong, pregnant women were screened for IPV. they created a control group who was simply provided information on how to get help. the test group received 30 minutes of counseling. within 4 weeks the health of the expectant mother improved 4 fold. the mothers indicated that just having someone listen to them and not make fun of them made them feel better. violence against women can be reduced by proper screening and intervention in health care settings, and is very inexpensive.
• the stress of violence seems to increase the production of cortisol in pregnant women which can then lead to babies born with hormonal issues.

sometimes it is frustrating, because we know a lot about improving health. we know that screening for mental/emotional health issues in primary care settings can help improve health. using a simple screening tool taking the “mental health vital signs” can help alert primary care providers to other concerns. when the tool indicates that there is need for mental health intervention, a brief therapy session with an on-site social worker helps to reduce the severity of physical symptoms; amount of time out of work; reduces patient visits and length of time with the physician; and improved health outcomes. obviously, this type of screening can also help reduce violence against women by creating a haven for intervention and empowerment.

acting on this knowledge could reduce health-care costs AND increase health and safety. but we don’t do it.

additionally, i believe that many of the male perpetrators of this violence are themselves in need of mental health intervention. depression is expressed differently in men than in women. the current DSM definition seems quite feminine: it is all internal. women tend to internalize while men tend to externalize. men become more violent and participate in high risk behavours. women become more withdrawn, sullen, etc (the stuff you think about when you think depressed).

though men don’t access health care much, it does seem like having them screened for mental health issues will also help protect women from violence, because they would then be able to access help for their own emotional stress.

this is not well thought out, and mostly just a bunch of thoughts from a few days of lectures, but i hope to turn this into something that i can propose as part of our health care reform conversations domestically.