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One in six women and one in 17 men have experienced domestic violence, with sexual violence occurring against one in six women and one in 25 men, according to the authors of a Narrative Review published by the Medical Journal of Australia.

Health practitioners play a key role in addressing gender-based violence, particularly domestic and sexual violence, but the system is not adequately resourced to respond in a way that benefits victims/survivors and children, according to the authors.

鈥淕ender-based violence includes physical, psychological, sexual or economic behaviour causing harm for reasons associated with people鈥檚 gender,鈥� wrote the authors, led by Professor Kelsey Hegarty, Chair of Family Violence Prevention at the University of Melbourne鈥檚 Safer Families Centre and Royal Women鈥檚 黑料吃瓜群网.

Australian Indigenous women鈥檚 experiences are 35鈥�80 times the national average, according to the authors. 鈥淎 violation of human rights, women are disproportionately affected by gender-based violence, with Indigenous women and girls facing particularly high risk.

鈥淰ictims/survivors are more likely to access health services (eg, general practice, sexual health, mental health, emergency care, Aboriginal community-controlled health services and maternity services) than any other professional help,鈥� they wrote.

鈥淗ealth practitioners are ideally placed to identify domestic and sexual violence, provide a first line response, and refer on to support services.

鈥淗owever, domestic and sexual violence continue to be under-recognised and poorly addressed by health practitioners. It is essential for practitioners to have the skills to ask and respond to domestic and sexual violence, given that victims/survivors who receive positive reactions are more likely to accept help.鈥�

Personal barriers to health practitioners bringing up gender-based violence with their patients include 鈥渇eeling they 鈥榗an鈥檛 interfere鈥� as domestic and sexual violence are private issues, 鈥榙on鈥檛 have control鈥� over outcomes for victims/survivors, and 鈥榳on鈥檛 take responsibility鈥� as it is someone else鈥檚 role鈥�.

鈥淎t the structural level, practitioners perceive that 鈥榯he environment works against us鈥� with lack of time and spaces, they are 鈥榯rying to tackle the problem on their own鈥� without a team behind them, and 鈥榮ocietal beliefs enable us to blame the victim鈥�.

鈥淪ystem-level barriers, such as the presence of the partner in consultations or a lack of training or referral services, can impede practitioners even further,鈥� wrote Hegarty and colleagues.

There are barriers to disclosure for patients as well, including fears about consequences of disclosing (eg, children being removed), judgemental responses, confidentiality being broken, not trusting practitioners, limited time, negative responses, perception that practitioners were not competent, shame, unawareness that what they were experiencing was abuse, or being socially entrapped.

鈥淔or too long,鈥� Hegarty and colleagues wrote, 鈥渢his social condition has been seen as the domain of social services or justice, with policy failing to resource an integrated response by the health system.

鈥淭he unfortunate consequences of this lack of recognition and resourcing of health settings is that many victims/survivors, children exposed to domestic violence, and people who use domestic or sexual violence have remained unidentified or inadequately supported.

鈥淗ealth practitioners are in an ideal position to recognise gender-based violence, ask through sensitive inquiry, assess risk, provide a first line response, and contribute to ongoing responses to enable pathways to safety, health and wellbeing.

鈥淪ystem support through committed leadership, specific policies and protocols tailored to context, clinical champions, infrastructure, and quality improvement activities is essential.

鈥淲e still have a long way to go before these evidence-based recommendations, comprehensively outlined in the Royal Australian College of General Practitioners鈥� White Book, are implemented in practice,鈥� Hegarty and colleagues concluded.

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