Behind the screens: Domestic violence and health care practices

abstract

Domestic violence (DV) is one of the most pervasive forms of violence in South Africa with numerous physical and psychological consequences that have severe and enduring impacts on health. This takes a significant toll on women, their families and the health care system. Local and international literature suggests that DV is one of the most common reasons for women to present at health care facilities, placing health care practitioners in a unique position to identify abuse and intervene. As widespread as it is, DV is not a specifically prioritised public health concern and thus suffers from vastly inadequate resource allocation.

The Domestic Violence Act, No 116 of 1998, was the first and only South African legislative attempt to recognise DV victims’ rights to seek immediate medical assistance. It did not, however, impose any positive legal duties on health care practitioners to inquire about, screen for or holistically treat DV-related injuries and other health-related consequences of DV or make referrals. The Act only implies that health care practitioners have a duty to attend to DV cases.

International codes delineate duties for health care practitioners in providing care for women in abusive relationships, and South Africa has detailed medico-legal protocols for the examination and treatment of survivors of sexual offences. It is therefore curious that a similar treatment protocol does not exist for DV.

This Article reviews the literature on the health consequences of DV and the need for screening, and recounts the historical attempts of civil society in South Africa to impose legal duties on the state to assist DV victims who present to health care facilities. We argue that it is time that Parliament review the provisions of the Domestic Violence Act to include legal duties on health care practitioners to properly address the health consequences of DV.

Keywords:

• Domestic violence
• Domestic Violence Act
• health care practitioners
• screening

Notes

1. The term ‘domestic violence’ as it is defined in the Domestic Violence Act covers a range of domestic abuses. Due to the prevalence of intimate partner violence (IPV) in South Africa, this Article focuses mainly on IPV, as a starting point for opening the discussion of screening for DV more broadly.

2. While men also experience DV, victims are predominantly women, so for the purposes of this Article we will refer to victims as women.

3. Refers to all state health facilities.

4. Refers to medical officers (doctors) and professional nurses (including Forensic Nurses).

5. Campbell et al (2004:770) found that while the prevalence of abuse during pregnancy ranges from 3.4% to 11.0% in industrialised countries outside of North America, the figures sharply increase in developing countries (from 3.8% to 31.7%).

6. A term used to establish physical assault, of any form, against the applicant, excluding the use of a dangerous weapon.

7. In terms of s.1(xxi) of the DVA, sexual abuse refers to ‘any conduct that abuses, humiliates, degrades or otherwise violates the sexual integrity of the complainant’. Sexual violence in Artz's study specifically refers to rape as defined as: forced or coerced penetration into the vagina, anus or mouth by a penis or into the vagina or anus by an object other than a penis (ie fingers, bottles).

8. The Community Law Centre, Rape Crisis Cape Town Trust and the Institute of Criminology (University of Cape Town) made oral and written submissions in this regard.

9. Interestingly, this argument was also raised in the drafting of the Sexual Offences Act, but the provision of post-exposure prophylaxis to rape survivors was eventually included.

10. This emerged as a restriction to fully implementing the Sexual Offences Act, as doctors often feel inadequately prepared to give expert testimony (Röhrs, 2011).

11. See Röhrs (2011:62–65) for a discussion of some of the barriers to overcome, and for examples of best practice of HCF-SAPS cooperation in rape cases.