proliferation of prevention and intervention initiatives, research on their effectiveness is still at an early stage. Few have been able to demonstrate an impact on levels of violence or benefits to survivors, though many appear promising.

|**Table 2.2. Examples of objectives and initiatives from the health sector **|
|---|

|**Level**|**Objectives:**|**Specific Initiatives:**|
|---|---|---|
|**Laws and**<br>**policies**|**To improve laws and policies**<br>• Clarify providers’ legal responsibilities<br>• Encourage a better health sector response to GBV<br>through national, regional, and municipal policies<br>regarding screening, referral, documentation and<br>counseling for victims of violence<br>• Ensure survivors’ rights to services (e.g. emergency<br>contraception, STI prophylaxis, etc.)|• Reforms of laws and policies regulating the medico-legal<br>system (e.g. introduction of forensic nurses)<br>• Reform of laws and policies regulating health care provider’s<br>obligations vis-à-vis victims of gender-based violence<br>• Mandatory reporting laws/policies<br>• National health policies and protocols<br>• Laws/policies governing forensic medicine; provider<br>obligations,abortion,EC andpatient confidentiality|
|**Institutional**<br>**reform**|**To strengthen the response of health care and public**<br>**health institutions to gender based violence**<br>• Raise awareness of the links between violence and<br>health among service providers, managers, and public<br>health policy makers<br>• Improve the quality of care for survivors of violence,<br>including identification, treatment, documentation,<br>information referrals and follow-up<br>• Increase coordination with other sectors that provide<br>services or work on violenceprevention|• Policies, procedures and protocols to improve the health care<br>response<br>• Sensitization and training of health professionals<br>• Routine screening and referral systems<br>• Development of information systems such as epidemiological<br>surveillance, and morbidity statistics on violence<br>• Specialized survivor services (counseling, support groups)<br>• Improved coordination and referrals to NGOs and other sectors<br>• Curricular changes in trainingof nurses and medicalpersonnel|
|**Community**<br>**mobilization**|**To increase community mobilization to address gender-**<br>**based violence as a public health problem**<br>• Strengthen community support for survivor services<br>• Strengthen coalitions and networks<br>• Improve attitudes, norms, practices and resources at the<br>communitylevel|• Coalitions for public health research and advocacy<br>• Community level prevention and mobilization initiatives<br>• Community-based awareness campaigns aimed at mobilizing<br>journalists, policy makers, and opinion leaders|
|**Individual**<br>**behavior**<br>**change**|**To improve knowledge, attitudes and practices of key**<br>**groups and the broader population**<br>• Promote gender-equitable, nonviolent sexual<br>partnerships<br>• Increase women’s ability to make decisions about the<br>timing and nature of sexual relationships<br>• Decrease tolerance for violence by raising awareness of<br>gender-based violence as a public health problem<br>• Encourage victims of abuse to seek help and to disclose<br>violence to serviceproviders|• Clinic and community-based education efforts (theatre, videos,<br>pamphlets, talks, etc.)<br>• Mass and multi-media behavior change campaigns, such as<br>edutainment programs (e.g. Soul city and Sexto Sentido)<br>• Programs for men aimed at promoting gender equitable<br>relationships and changing norms, attitudes and behaviors<br>• Gender-based violence prevention within HIV/AIDS and<br>adolescent reproductive health programs|

# **Reform of laws and policies**

Many governments, particularly in Latin America, have enacted legislation and policies specifying the obligation of the health sector to address violence against women, either through ministerial decrees, or as part of national family violence legislation. These policies are often fairly general; sometimes limited to recognizing violence as a public health problem and outlining basic principles for ensuring an integrated service response to survivors. While these laws and policies may have the potential to raise awareness of gender-based violence among health care providers, a review of Central American countries in 2001-2003 found that the policies had not been widely disseminated, and most health providers were either not aware of the policies, or did not know their contents (Velzeboer et al., 2003).

In some cases, national legislation regarding health care and gender-based violence has occasioned unforeseen problems. For example, several countries have passed laws requiring health providers to report suspected cases of domestic violence to legal authorities. This puts providers in the position of violating the privacy and confidentiality of clients and may reduce women’s willingness to disclose violence. Providers may also be more reluctant to ask women about violence for fear of becoming 26