Plantocratic patriarchal culture, violence against women and girls and the failures of the global health system: an interview with Marsha Hinds Myrie and Anya A. A. Lorde

ABSTRACT

Like other parts of the world, women and girls in the Commonwealth Caribbean (CC) experience high and escalating rates of physical and sexual violence. The interview presented outlines some factors that underscore the gendered disparities of violence against women in the Caribbean as well as how healthcare responses are not developed for marginalised women and girls. The interview explores the invisibility of women and girls within healthcare and broader national healthcare structures responses through case details analysis of a Barbadian strategic litigation case. The interview calls for transdisciplinary approaches to analysing the effectiveness of the global health system that make space for not just traditional research approaches but also lived experiences ‘from below’ and input of advocates and activists. Despite Barbados being a signatory to a range of global health initiatives to improve healthcare responses to gender-based violence, the country does not have a formalised, comprehensive national plan to inform prevention and intervention measures. The interview shows the connections between plantocratic patriarchal culture (PPC) and the existing gaps that cause harm to women and girls who experience various types of gendered violence.

KEYWORDS:

• Victim-defined healthcare
• Barbados
• commonwealth Caribbean
• violence against women
• global health system

Introduction

Background to the interview

Violence against women and girls is a global public health problem. Population-based studies demonstrate the rates of violence against women in Barbados and the Commonwealth Caribbean are similar to the trends of gender-based violence across the world (Bott et al., 2012, 2019; Le Franc et al., 2008). While traditional research has provided useful data to inform broader policy positions, the voice of women ‘from below’ is usually obscured from the policy and practice narratives. Further, perspectives of activists and gender justice workers are also not centred in these discussions (see Burton & Ballantyne, 2022 for a definition of ‘from below’). Investigating ‘from below’ or the subaltern is a rejection of dominant narratives to those that enable the action of social justice. Analysis ‘from below’ or the subaltern is necessary to incorporate intersectional and decolonial approaches which reveal unequal power relations that affect the lives of highly marginalised women and girls who experience violence. While there is no doubt that academic journals and manuscripts are important documents, one of the main challenges with academic writing is its circularity (McKittrick, 2021, pp. 18–26). In some ways what is understood, the questions asked and the demand for everything to fit seamlessly into the literature hinders answers beyond the status quo.

To open and create space beyond rigid academic boundaries to evaluate the global health system (GHS) and violence against women (VAW) from the point of view of activists fighting for gender justice in Barbados, this paper presents an interview with an activist and attorney at law. It contends that attention to Barbados’s engrained plantocratic patriarchal culture (PPC) is an important step to addressing the issues that the interview reveals. Anthropologist, Karen Fog Olwig (1995) observes that PPC depends on strict gender roles and hierarchically organised society. PPC is a system of racial/social hierarchies and unchecked patriarchal rights and privileges. Subjugation of women – and other groups of ‘undeserving citizens’ is germinal to PPC and without unequal relations, PPC cannot survive. Control over people, being able to provide finances, jobs and other protection is important to powerholders in PPC to maintain position (Fog Olwig, 1995, p. 105). Women with intersecting identities like blackness, poverty, disability or low educational attainment levels in plantation societies are perceived as citizens who burden/trouble the state/society (see Schneider 1997 and Maki 2021 for a definition of underserving in the context of policy development).

Contextualising violence in Barbados and the Carribean Commonwealth

Violence against women and girls is a global public health problem. According to Davies and Lyon (2013), gender-based violence, violence against women and girls, and domestic violence can be defined as various acts of violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women or other people based on their gender, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or in private life. Globally, gender-based violence is a major issue that poses challenges to the health and well-being of vulnerable populations including women and girls, gender-diverse individuals, disabled people as well as their families (Johnson et al., 2022). Despite the work of advocates and activists to unsettle traditional gender norms and national cultures that uphold the conditions for gender-based violence and VAW, case numbers are not diminishing. In looking for new ways to tackle the problem this interview utilises a transdisciplinary approach to thinking about VAW, because disciplinary boundaries have hindered important interrelations in areas like culture, history and healthcare when addressing the needs of survivors of VAW. Transdisciplinary approaches are invaluable in moving us beyond the gaps in what we know are best practices for managing the needs of survivors of violence based on literature and research and the lived experiences of women and girls as they try to navigate systems. Women’s activist, Marsha Hinds Myrie and attorney at law, Anya A. A. Lorde are working to highlight the gaps and challenges in Barbados though strategic litigation. They work through Operation Safe Space (OSS) which is a survivor-led nongovernmental organisation.

Due to the colonial past in Barbados and the CC, women and girls experience high and escalating rates of violence including physical and sexual violence. As this interview underlines, due to the cultural norms in plantocratic patriarchal culture, the state is a purveyor of violence against women as well. This interview summarises factors that underscore the gendered disparities of violence against women in Barbados. Many of the historical, resource and cultural issues in Barbados are replicated to varying degrees across the CC where healthcare responses are perpetuating harm among some of the most vulnerable women and girls. The interview explores historical perspectives, contemporary cultural challenges resulting, prevalence and risks of violence for women and girls and the invisibility of women and girls within healthcare and broader national healthcare structures. The failures in the national systems are replicated in the Global Health System and in a sense what the case details show up are not isolated restricted to Barbados or the CC. Despite Barbados being a signatory to a range of global health initiatives to improve healthcare responses to gender-based violence women and girls cannot depend on healthcare services that support them. Unlike other Caribbean neighbours like Trinidad and Tobago, Barbados does not have a formalised national plan to inform prevention and intervention measures. In a historical reflection of gender-based violence and intimate partner violence across the Caribbean, Bean (2022) describes the current violence epidemic as a result of the meeting of New and Old Worlds, European Imperialism, the trafficking of people from Africa as enslaved workers, and the development of the plantation economics. In the Caribbean region, violence was used as both a tool of oppression and control as well as a method of self-actualisation and liberty. An example of the complex role of violence in Barbadian society is the investment of Barbadian heterosexual men in upholding rigid, traditional gender norms due to the power and privilege they provide – power not easily available in aspects of the society such as the economic sphere. According to historian, Beckles (1995), plantation societies are built on both racial and gendered oppression. While the CC independence projects sought to dismantle the racial oppression within the class hierarchy of plantation society the gendered oppression was maintained for its value to men – the group disproportionately responsible for crafting the national agendas in the independence movement.

Resultingly, there is reproduction of harmful colonial relics including traditional gender norms, ablism and a hierarchy of race/class relations in Barbados and the broader CC. Women and girls’ vulnerability to violence can be compounded by intersectional identities such as poverty, queerness or disability. Child sexual abuse is pervasive in Barbados and the CC in large part, because of the normalisation and social acceptance of violence against women and girls (Jones, 2021). Despite the high prevalence of sexual abuse, the healthcare system in Barbados has not developed adequate responses to the issue including prevention education or adequate screening and reporting mechanisms for healthcare providers to detect and provide support to victims of abuse. While there is law that requires mandatory reporting of child abuse, the law exists within a wider PPC where children who report abuse are seen as out of place and troublesome and where all attempts are made not to interfere with the private domain of a man and his family. Additionally, reporting mechanisms are underdeveloped. The result is that even in cases where presenting symptoms of patients should raise suspicion in healthcare and other professionals such as teachers and police, victims of childhood sexual abuse are often left without the intervention of the state system and the care they need to move beyond their experiences of violence.

Gender-based violence poses significant impacts to the health and well-being of women and girls as well as their families. Unaddressed experiences of sexual violence have been shown to impact physical, mental, emotional as well as cognitive development in childhood and throughout the life course. The fallout is exacerbated when there is low or no access to healthcare and support service access. Therefore, timely access to healthcare and support services is critically important for rehabilitation and recovery. Despite these findings in the literature, in Barbados the role of the healthcare service sector has been seen as minimal in addressing gender-based violence (United Nations Population Fund, 2009). National healthcare systems are significantly underutilised pathways for assessment and intervention despite the literature on gender-based violence identifying healthcare professionals as being critically positioned to screen and potentially intervene. Such screening and intervention opportunities have the potential to contribute to reduced incidence of gender-based violence, mental health disorders, injury, and mortality (Tower, 2006).

The invisibility of Zara within the Barbados healthcare system – a case study

Interviewer: Can you tell me about yourselves and how you got into advocacy/activism?

Marsha Hinds Myrie: I’ve practised as women and girls advocate in Barbados for twenty-three years. I came to this work because I am a survivor of childhood sexual abuse and family instability and when I tried to seek out assistance from the system as a child I realised how unsafe and broken those systems were. I think when we use terms like ‘violence against women’ and ‘gender-based violence’ some how we still miss the effect on the border family impact. I’ve started to use the term family instability to try to stay focused on the long-term and pervasive impacts of VAW and girls. Family instability includes health, wellness, financial and social impacts that result from a violent event (such as femicide, rape and financial abuse). They alter the human life cycle and may characterise life for months or even years after the initial abusive act. Family instability underlines how vulnerable family members – such as children, the elderly or disabled – may face fallout after significant forms of physical and sexual trauma, that happen to them directly or even a major care provider. The term also is broad enough to cover how families are made unsafe by failures of the state such as the continued patriarchal orientation of the judiciary, social policy and services which make them unable to see the experiences of women and the importance of addressing them in timely ways. The focus on the state is very important because it ties the singular experience of women affected by violence into a national tapestry with historical and cultural aspects. Barbados does not have a national plan to address gender-based violence broadly and violence against women specifically. This makes it very difficult to try to address the perennial issue. Proximity is a kind of expertise in itself. It may not be academic or sanitary, but proximity is important in how questions are both asked and answered. Sometimes theory and rhetoric are ways to silence people’s experiences of a system. If we only listen to Barbadian politicians and proponents of the GHS, we are likely to miss the ways that individual clients of the system experience it. Caring about people’s lived experience of a system is decolonisation practised – it is a way to create connections across the gaps that people often fall into. Alignment between perceptions and experiences is important to challenging oppression. Giving different voices space and starting that process is the broad aim of this paper.

Anya A. A. Lorde: I am an Attorney-at-Law called to the Bar to practice in Barbados since 2016. I became legal counsel for Operation Safe Space Movement for Change Inc. (OSS) in 2022. I was attracted to this group because it was the first time that I saw a group where professional women in Barbados claimed their victimhood and survivorship experiences with VAW publicly. Our stereotyping of the issue has replicated traditional class divisions in society where women who were professional and middle class were the activists and people making policy and poor women were the victims and survivors Operation Safe Space interrupts that and we all just get to be women who live in a plantocratic patriarchal culture and who are affected by that. Although women are generally a subjugated group in PPC, there is need for a class analysis because some women can support or propagate the culture to the detriment of other women and groups (see Manne 2017 on the role of women in upholding misogyny/patriarchy).

I: Why do you think lived experience is an important perspective in thinking about the GHS and women’s experiences of violence?

MHM: Barbados prides itself on the grand narrative that it is a small country punching above its weight. This narrative allows Barbados significant social power. The GHS, like Barbados benefits from, extensive social power. People believe that the GHS and its machinery can help to deliver healthcare to people around the globe. However, when we consider women’s experience of the healthcare system in Barbados and the wider CC, a completely different reality emerges.

AL: I can think of a case we worked on in November 2022. Zara, I will call her, presents as a 19-year-old young adult who is nonverbal. Her birth record reveals that her mother’s pregnancy and Zara’s birth weight are documented as normal. Zara also reached her developmental milestones age appropriately. Zara and her family are low-income with a basic standard of education. They presented as simple people with rudimentary skills in negotiating official systems. When Zara was approximately eleven years of age, her family noticed that she stopped being communicative and no longer liked to bathe herself. Zara’s communication regressed to where she appeared to be experiencing trauma mutism. She only used mono-syllable words (such as no and um hum) and made written scribbles on paper. Within their ability, her parents sought medical care and help for Zara. While healthcare is free in Barbados, Zara’s parents were unable to access healthcare in a timely manner due to extensive waitlists. Even where families do get appointments, the long wait times in the clinic result in families who can least afford to lose income having to choose between care and work. Healthcare professionals are reportedly trained in family violence and providing adequate support for care, yet many cases like Zara’s seem to fall through cracks in the system – several come to me usually as legal aid-supported clients. There are no standard protocols for screening physical and sexual violence in Barbados and healthcare providers do not routinely screen for it. Perhaps it is better done in the private healthcare system, but Zara’s parents were unable to access private healthcare as an alternative due to their financial means. Therefore, there was some delay between Zara’s first symptoms at age 11 and her accessing healthcare. Zara did eventually become a patient of the Psychiatric Hospital. I think she was just treated as a disabled person by that time and no one on the medical team really asked the pertinent questions about her mutism.

The medical team was conducting further testing on an outpatient basis, but they were not the ones who initiated her removal from her home by the police. Due to the lack of a disclosure protocol in these kinds of matters, we probably will never know how the police got involved in this case. Again, this is not unique to Zara’s case. Where disabled people are receiving monetary benefits from the State, this can cause feuds between family members about where a person lives because the pension becomes a coveted economic resource.

On 14 November 2022, the Barbados Police Force removed Zara from her residence without the knowledge or consent of her parents. Zara’s parents visited the station on several occasions requesting information about her well-being and were denied access. They presented her psychiatric medication to the police but were informed they were unable to accept the medication as there was no proof Zara required medication. It didn’t appear as though the police involved anyone from the Psychiatric Hospital in the case although both are government agencies. Zara’s parents did not have the necessary funds to secure legal advice and representation for her but another family member did retain counsel for Zara, that is how I became involved in the case. I first contacted the police about Zara on 15 November 2022. I was told that police were investigating allegations of sexual violence by Zara’s father. I questioned reasons for Zara’s detention and queried measures being taken given Zara’s psychological circumstances. Like Zara’s parents, I was dismissed. I was told that Zara is an adult and therefore there was no legal obligation to communicate with me or her parents.

Clearly, Zara is an adult but one who is non-verbal and unable to adequately negotiate complex systems on her own. But in circumstances like this [removed for the peer review process] is hampered in our efforts to protect clients like Zara because of the gaps in the legal framework of Barbados. The lack of a statutory framework for the protection of adult persons with mental disabilities, who face family instability is the reason why we took this case as a strategic litigation. The only existing piece of legislation, the Mental Health Act, Cap 45 of the Laws of Barbados, provides for the admission and discharge of patients to the Psychiatric Hospital and for management of their assets and financial well-being through application to the High Court. The law does not contemplate the health and well-being of those in need of care in terms of sexual abuse or access to advocacy or legal services.

Even in the new legislation being drafted to establish a bill of rights for persons with disabilities happening literally concurrently with Zara being detained, there was nothing in the proposed bill that I would use in crafting Zara’s case. Zara’s circumstances are not about finances or assets, rather they are about who has control to act on her behalf and to order her in and out of facilities or to consent to medical care on her behalf. Although the police have not charged her father with any wrongdoing, they unilaterally blocked his and her mother’s access and diminished Zara’s parents’ ability to be involved in her care. The very mechanism that is supposed to be used to protect children from abuse, and which is never triggered in Barbados seemed to have been weaponised against this family.

I felt the best remedy available to Zara was to file a habeas corpus. During the first hearing, it was revealed, inter alia by the State’s legal counsel, that Zara was interviewed by Police without a legal representative or advocate present. After these interviews, she was held at the Battered Women’s Shelter for at least three nights. Zara was only transported to the Psychiatric Hospital after I filed the habeas corpus. Additionally, the documents filed by the State’s counsel reveal that Zara was only taken to the Psychiatric Hospital because persons at the Shelter felt that she was ‘acting strange'. Seemingly no case information was transferred to the Shelter with Zara. This case also calls into question the ability of the Shelter – the lone such accommodation on the Island – to cater to diverse needs of all women in Barbados. The family tried the best they could. When her substantive school indicated that they could not care for her needs the family enrolled her in a private school that catered to disabled children. Her ability to stay in this environment was affected by her family’s ability to sustain the private education fees. So, Zara is now a young adult woman with no official educational certification which will have significant further impacts on her life chances.

MHM: I think the critical question we have to ask here is how such a case exists in Barbados, which is a member in good standing within the GHS. Barbados has signed and agreed to several frameworks which should make this case impossible including the global health plan to strengthen the health system in support of women and girls who experience violence (World Health Assembly, 2016). The health systems that execute the GHS are non-homogeneous. Some of them such as those in PPC perpetuate colonial relics. The GHS itself seems to be perpetuating certain colonial approaches in its own organisational structure. For instance, Barbados has headquarters for both the UN and the Pan American Health Organization (PAHO). In a time when Truth and Reconciliation projects such as the one around the Indigenous community and their rights to their unceded land in Canada, we have to admit that the women and girls in Barbados have also made a significant commitment of land resource to these two headquarters on a land-scarce island. Yet the issues that Zara’s case throws up are by no means exceptional. It makes the GHS’ relationship with the women and girls in Barbados seem like one of paternalism and white benevolence. Gebhard et al. (2022) describe white benevolence as ‘a form of paternalistic racism that reinforces, instead of challenges, racial hierarchies'. The GHS is built by former colonisers and health systems are constructed with inbuilt racist and gendered logics. I think we have to bear these realities in mind when considering Zara’s experience of the health system in Barbados.

AL: I know there are some pieces of Zara’s story that seem distorted by I also think this is the very strength of her story. There are spaces because Zara is nonverbal and in many ways we are interpreting her would for her. She cannot tell us what happened to her or how she felt when she was taken away from her home by police. The damage of the lack of structures within social services in Barbados is really underlined in this case. Take for example the Shelter that Zara was housed at after the matter was taken to court. There is no legislation in Barbados that guides the establishment of shelter for some of the most vulnerable people like the homeless or women affected by family instability. To fix a case like Zara’s requires the kind of screening in the healthcare system that flags mutism and a possible symptom of sexual violence when an otherwise normal child develops it but it is more than that. Zara is at a number of complex intersections which the adherence to PPC causes. The question is does the GHS want to uphold that or be an agent for change?

I: If the Global Health System wanted to be an agent for change what would that look like?

MHM: This issue is so complex, there is so much that needs fixing and as Anya mentioned Zara’s case is not unique. PPC creates a number of deserving and undeserving groups in society (see Schneider, 1997 and Maki 2021 for definitions of the term ‘undeserving’ in the context of social groups and public policy). I think one of the main ways that the GHS can help is to recognise that a health system is made up of a series of connectors. Go back to Zara’s case. There are police actors, civil society actors along with more traditional healthcare actors. Creating a system that does not do more harm to survivors of violence has to be an integrated system that has timely access for clients. It cannot be a system rooted in capitalism because the poorest in society will never be able to afford that. Very importantly we have to ensure that we open space for cases like Zara’s to be the ones we use to troubleshoot the effectiveness of the global health system and its functioning. I think the answers to Zara’s case lie in a transdisciplinary conversation between the GHS, history and cultural studies for instance. Yes, we do need stronger mechanism to screen for sexual violence in Barbados because of the high prevalence but PPC is going to stop any protocol or policy from working the way it is designed to. To create a solution that works for Zara we have to accept that culture plays an important role in how healthcare is designed, experienced and functions.

I think another important part of this is ascertaining whether the GHS is capable of being the entity to steward conversations about changing healthcare systems in Barbados and the CC and the global south more broadly. The GHS is complicit with patronage systems and the upholding of PPC by the state in Barbados. Sives (2010), in analysing the system of patronage at work in the Caribbean notes that it is a complex of both economic gains that people receive for supporting a party and identity/belonging. We have instances of high-level appointments based on patronage in the UN and in PAHO in Barbados. Regardless of how qualified the recipients may be, because of blind loyalty to problematic states the motives of the GHS are questioned. There is an impression of collusion between the state that people mistrust – due partly to how it treats certain citizens – and global systems that uphold and support state disregard for citizens. Public suspicion/distrust of the GHS may not seem justified from official positionality, but it is real and experienced at the national level by family and friends of people like Zara.

AL: In addition to that, legislative upgrades are very needed to deliver appropriate healthcare to vulnerable people in Barbados. A plantation society works because certain people, seen as undeserving, are not recognised in the law. Barbados has significant gaps in its legislative framework, all of which may not seem obviously connected to healthcare delivery but due to how the connectors in the system work as Marsha outlined are. Another thing that I think can really shift the needle is for the GHS to make more time and space for meaningful conversations with those of us who are engaged in activism and advocacy. I think we have a unique vantage of the situation that can be useful in building solutions. The conversations will only be useful though if we are willing to recalibrate the system to the needs of people like Zara and how always require those people to fit seamlessly with in the system. Zara is nonverbal. Due to the gaps in her experiences of healthcare that may now never change. Do we need a whole story for any part of her story to be valuable? Her story is not just research – research can be very disembodied and can lose the very aspects of the case that provide the context and challenges that need to be fixed. There needs to be room for lived experience – it allows for what bell hooks envisions knowledge making as ‘place where life could be lived differently' (1991, p. 2).

MHM: Different. Very important. I mean as much as we say that the GHS needs some shifts their very research is signalling that. The most recent global estimates show that the prevalence of violence against women has remained largely unchanged over the last decade with one in three women experiencing physical and /or sexual violence at least once in their lifetime (World Health Organization, 2021). So, we cannot keep addressing this issue in traditional ways. Given the figures of sexual violence against girls in PPC, for example, why can’t we change the schedule of visits for health visits in Barbados and the Caribbean? We stop vaccinations at eleven but then girls are negotiating adolescents and puberty – a time where Itzin et al. (2010) note they are learning to negotiate sexuality and risks of abuse escalate. We should add wellness visits into the schedule between 12 and 18 to screen for abuse. We should make screening for abuse mandatory in shelters and police services and other places where victims make their first interaction with the system but none of this is new or groundbreaking that I am saying – it just does not happen in Barbados due to our pervasive and unchallenged PPC and so we end where we started. While we try to figure it out, this is not an academic exercise for Zara. This is her real life, her real trauma. This situation is not unique to Barbados or the broader CC, because screening for violence and related injuries among highly marginalised women is not a standardised practice in healthcare and support systems (Fitts et al., 2024). I do want to see change so that women and girls in Barbados do not have to suffer anymore and closing any piece in an academic journal with recommendations is a requirement. I just want to say that until the PPC in Barbados is addressed the recommendations will always fall short of offering the care and support they are meant to for women and girls.

Recommendations to strengthen healthcare responses to women and girls living with disability experiencing violence

As highlighted in this paper, women and girls encounter several failures during the process of seeking help from healthcare services when they experience violence. The gaps in services as well as attitudes at both national and service provider levels further compounds the violence faced by women and girls. Intersecting identities of poverty and disability can exacerbate the ways that women and girls are treated by healthcare systems. While there are more studies available for other parts of the Caribbean (Lacey et al., 2021), the literature about women and girls in Barbados requires and deserves significant attention. Although there is some level of co-operation between the CC in areas like economics, education and sports there is no coordinated approach to the issue of VAW. Recognising Caribbean countries are likely to have differing priorities and efforts to address and respond to the needs of women and girls with disability who are experiencing violence, the following suggestions are proposed as viable once PPC is addressed. They offer a suitable foundation for strengthening healthcare and policy responses to women and girls experience violence.

Systematic data collection and analysis

There is a clear need for contemporary analysis of rates of violence for women and girls in Caribbean countries such as Barbados (West, 2021), beginning with systematic collection and monitoring of hospital data to better understand the demographic characteristics most associated with violence-related presentations and identify high-risk regions. Notwithstanding, hospital data alone does not provide the full demographic picture. Not all women and girls attend hospital after experiencing family violence or have the ability to access healthcare, and their first point of contact may instead be community-based service providers, medical and non-medical. A national approach to data collection, both in Barbados and the CC, could inform funding decisions targeting community need and be used to evaluate the success of services and program (Lacey et al., 2021).

Research investment in women’s and girls' lived experiences of healthcare responses

This interview provided a unique look at the complexities that the GHS is seeking to address in relation to women who experience violence. Instead of being the exception, this kind of analysis must become the norm because solving these cases is where the answers needed to address VAW at a global issue lie. Just a small number of studies have been completed with women and girls on their experiences accessing healthcare for physical and sexual violence-related injuries. There is a need for evidence-based research conducted by community-led partnerships with government and non-government organisations and researchers who can target preventive action areas and develop holistic recovery models for women and girls living in Barbados and the CC. Such partnerships must be trans or at least multidisciplinary if they are to recognise the challenges experienced by women who have survived violence, and research resources can be used to improve the knowledge of community members and service-provider staff. Community-based partnerships are shown to be successful.

Decolonial qualitative research which is led by the experts – women with lived knowledge of violence and navigating hostile systems is needed to examine and develop a deeper understanding of the consumer experiences of healthcare systems. Zara’s case profile reveals the healthcare gaps that are present. Weak connectors in the local health system in Barbados, the complicity of the GHS with the PPC in Barbados and the absence of defined policy procedures for screening and managing sexual violence are just some of the detrimental issues outlined, Zara’s case also shows how women and girls on the margins of intersectional identities like poverty, disability and low educational attainment are disproportionately disadvantaged by Barbados’ hostile system. The issues perpetuate uneven distributions of power and resources and preserve existing colonial structures within the delivery of healthcare in a way that recreates un/deserving citizens in Caribbean countries. Failure of the global health systems to keep countries such as Barbados accountable, rather allowing them to maintain their colonial and racist logics continue to reproduce patterns of harm in nation states. For the GHS to have the integrity to hold Barbados and other countries accountable, it must be willing to confront its own racial and gendered biases.

Accountability

Barbados has no problem signing onto conventions. It signed the Global plan of action to strengthen the role of the health system within a national multisectoral response to address interpersonal violence, in particular against women and girls, and against children at the end of 2016. The plan provided member states such as Barbados with a set of practical actions to implement to strengthen health systems responses to prevent and respond to violence against women and girls (World Health Assembly, 2016). A key vision of the plan was for member states to develop or update their national guidelines or protocols for the health system response to women experiencing violence so that it is consistent with international human rights standards and WHO guidelines. In recognition of the profound effects of gender-based violence on women and girls, many Caribbean countries have developed and implemented national plans to operationalise and prioritise efforts to prevent and reduce violence. Importantly these national plans acknowledge the consequences violence has for women and girls and the need for specialised, intersectional strategies for marginalised groups including women with disabilities (Government of the Republic of Trinidad and Tobago, 2024). Barbados is also a signatory to the United Nations (UN) Convention on the Rights of Persons with Disabilities, CEDAW and Balem de Paro. PPC intervenes to block the benefits of signatory status for women and girls in Barbados. A part of the role of the GHS will have to be figuring out how to close the gap between signing conventions and cultural change on the ground that protects women and girls.

Aside from measures surrounding data collection, there are important suggestions for multi-level interventions to address violence in Barbados and the Caribbean region more broadly. Countries who are signatories to global health initiatives must be required to demonstrate minimum standards towards preventing and addressing gender-based violence. For example, governments must be responsible for having national mechanisms for recording and reporting on gender-based violence as well as having a formalised national framework that is community informed on the strategies to prevent and respond to the needs of women and girls who experience violence. At present, Barbados does not have a comprehensive, dedicated national plan to end violence against women and children.

Acknowledgements

We would like to thank Dr. Michelle Fitts for her insightful and helpful comments on the manuscript.

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The author(s) reported there is no funding associated with the work featured in this article.