The 16 Days of Activism against Gender-Based Violence is an international campaign that runs from 25 November, the International Day for the Elimination of Violence against Women, until 10 December, Human Rights Day. Here, Fatia Kiyange of the African Palliative Care Association and Colette Cunningham of the University College Cork, Ireland share their insights from their systematic review on the topic.
Did you know that people with serious chronic or life limiting illnesses suffer Gender Based Violence (GBV), which further exacerbates their vulnerability?
As we all contribute to the global campaign against GBV this year, we wish to highlight a special group of people and bring them to the fore; those suffering from life-threatening illness such as cancer and who are receiving palliative care. Gender based violence is hard for any person to suffer, but far more difficult for people who are already battling with a serious chronic or life limiting disease, such as cancer.
In a Systematic Review undertaken in 2016 (publication in process), we established that people with life-limiting illnesses experience all forms of GBV, including mental, physical, emotional, psychological, financial, verbal and sexual abuse. Acts such as isolation, abandonment, manipulation and deprivation of autonomy over patients are common.
Yet, this is not an issue given attention by healthcare workers in the provision of care, and hardly ever in palliative care services. Vulnerability to the disease and treatment, pre-existing violence, a change in roles and power dynamics that lead to abuse of power and control are all pre-disposing factors to GBV among people with life-limiting illnesses, especially those with cancer. Cancer and other palliative care patients are reluctant to use the justice system because in most instances, they rely heavily on the abusive partner for their care needs especially in the home.
The goal of palliative care is to improve the quality of life of people with life limiting and life threatening illnesses and that of their families, through the relief of pain and other physical, psychosocial and spiritual suffering. However, psychosocial issues such as GBV remain relatively unaddressed to date, despite being central to achieving quality of life.
The Systematic Review revealed that only a few research studies (11) have been undertaken and published on GBV among people with life-limiting illnesses. The studies were all from high income countries with no study undertaken from middle or low-income countries, including sub-Saharan Africa. It was interesting to find that in all eleven studies identified, domestic violence (DV) was perpetuated by male intimate partners, except in one, which revealed that eleven males experienced intimate partner violence (IPV) perpetuated by their wives. Of note too, is that available studies mainly focus on those with cancer, mainly women.
GBV among people with serious chronic or life-limiting illnesses is an important public health issue that needs to be integrated into all healthcare services. We should aim to undertake a comprehensive assessment of all the needs of people with life-limiting illnesses in order to provide holistic care and improve their quality of life.
Gender-based violence can be integrated into routine healthcare, by including it into patient assessment tools and management plans. It is also important to document GBV in this vulnerable population and to undertake more research in order to inform practice, policy and education.