Gender-based violence is rampant across the globe, and yet governments' responses remain appallingly inadequate. Violence against women is a public health issue and a human rights issue affecting society as a whole.

Progress is visible on a variety of fronts. Representatives from UN member states and civil-society organisations are meeting in New York currently to discuss "the elimination of all forms of discrimination and violence against the girl child" - the theme of this year's Commission on the Status of Women.

A 2006 report published by the UN secretary-general's office acknowledged that "states have an obligation to protect women from violence, to hold perpetrators accountable and to provide justice and remedies to victims". Last month, the Mexican government introduced legislation requiring federal and local authorities to prevent violence against women.

But much remains to be done. The next step is to make health systems accountable for identifying the millions of victims who pass undetected through their doors, and to give them the health care and legal, economic and social support needed to mend their lives.

Health-care providers' failure to help female patients can put them at an increased risk for violence. Thus, an integrated approach is recommended for confronting the issue.

Framing violence against women as a violation of human rights is essential to transforming the health sector's response. Because violence against women commonly occurs behind closed doors and within imbalanced-power relationships, legal systems and cultural norms have defined this as a private family matter and even a normal part of life. Violence against women and its public health implications have long been ignored or minimised in spite of grass roots activism to end gender discrimination and domestic violence.

Despite the growing recognition of the prevalence and damage of gender-based violence, only recently has the link between women's status and the HIV/Aids pandemic gained wider international attention. Physical and sexual violence can limit a woman's ability to negotiate the use of condoms or other contraception, putting her at a higher risk for unintended pregnancies and sexually transmitted infections, including HIV. Fear of violence may also keep women from voluntary HIV/Aids counselling and testing and can even impinge on medical treatments. Health systems should be the main door for detection, treatment and support for victims of violence against women. Victims who are reluctant to openly seek care for the physical and psychological ailments caused by violence frequently seek health services for seemingly unrelated ailments. Family planning clinics are often the primary health care facilities for women, and providers are uniquely positioned to listen to, treat and refer women living in situations of violence.

The International Planned Parenthood Federation, working with other agencies, has demonstrated in its clinics that - given adequate training of health providers - sexual and reproductive health care can be integrated with prevention and treatment of gender-based violence.

When it comes to addressing the global scourge of violence against girls and women, we have a long way to go. But we're finally moving in the right direction.

Carmen Barroso

The Baltimore Sun

BALTIMORE

Carmen Barroso is the director of the International Planned Parenthood Federation's Western Hemisphere region.