Report: Female health workers suffer violence at work

Women in Global Health (WGH) says female health workers continue to face sexual exploitation, abuse and harassment (SEAH).

According to its latest report, titled Her Story: Ending Sexual Violence and Harassment of Women Health Workers, whose lead authors are Mahua Chatterjee and Ann Keeling assisted by Dr Kalkidan Lakew, Farheen Nahvi and Rachel Thompson, SEAH is perpetrated primarily by male colleagues, male patients and men in the community.

The report says too often SEAH experienced by women in the health sector is unreported and unrecorded, hence not sanctioned.

"Where data is collected, it is often not comprehensive or comparable. Despite anecdotal reports from women in the health sector that such abuse is significant and widespread, the safety and well-being of women health workers are not given sufficient priority to drive routine collection of sex-disaggregated data on SEAH,” reads the report.

The stories of the women health workers are harrowing to read.

“I was afraid nobody would believe me since he is well-loved by his colleagues and appreciated for his hard work by his supervisors. So I kept quiet. Even if I report, it will lead to a drama with no concrete outcome so why bother? I kept silent for three months and waited it out. It was the most frustrating experience of my life," a doctor from Ethiopia is quoted as having said.

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"He told me that I need to show him good nightlife in Nairobi. When I declined, he said, 'How can we work together with this attitude of yours? It means you don't want your promotion that much which I can give you in 5 minutes. I still said no. Then after a couple of days, he informed me that I didn't qualify for the role and that I had performed poorly over the past couple of months," said a Health Administrator in Kenya

"As far as I know nobody has told him anything and when I tried to raise the issue with some colleagues they laughed and said they had experienced the same but 'poor him, he can't resist," said a health researcher in Spain.

Different forms of SEAH

The findings indicate that women in all parts of the global health sector experience work-related SEAH that includes sexualised verbal abuse, sexual assault and rape.

The report further reveals vertical occupational segregation (the clustering of women in lower status, lower paid roles) by gender, with women being 70 per cent of health workers and men holding leadership roles, creates an enabling environment for SEAH.

"It's a problem rooted in the abuse of power, more than it is motivated by sexual attraction. If the men in question knew they would be sanctioned and lose their jobs; that they would be publicly shamed, they almost certainly wouldn't do this. They know they can get away with it,” said Dr Roopa Dhatt, the executive director of Women in Global Health.

The report says the risk of SEAH is increased by wider gender inequities in the health workforce where women are marginalised in leadership, earn less than men on average and are in less powerful roles.

The report, which analysed 235 stories from women in the health sector from 40 countries, received only one case of a woman employee sexually harassed by a senior woman colleague. It says there is a worrying pattern of men in higher positions abusing power to coerce female employees into unwanted sexual contact in a cycle of 'grooming', threats and retaliation.

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The report raises the red flag where many male perpetrators appear to be serial abusers, enabled by 'silent bystanders' supporting a patriarchal culture that legitimises, downplays and perpetuates SEAH against women. However, the report states that certain groups of women – trainees, interns, migrant women, and women of marginalised races, castes and ethnicities – are at higher risk due to unequal power dynamics.

The women's stories painted a grim picture of sexist behaviour that belittles and demeans women, motivated by reinforcing power differentials and stereotypes of women's subordinate position, and less by sexual desire. The authors say women's experience and trauma is downplayed and even normalised.

No reporting mechanism

Many women lacked a reporting mechanism, others feared disbelief, stigma or retaliation and without victim-centred reporting mechanisms, SEAH is unrecorded, unsanctioned, and has a cost primarily for the victim, while the perpetrator is enabled to continue the misbehaviour.

Some of the health conditions the women face because of sexual exploitation include trauma, post-traumatic stress disorder and suicidal thoughts. SEAH also hinders women's career progression and retention in the health workforce, affecting morale, mental health, sickness, absenteeism, and turnover, thus increasing staff shortages.

However, as SEAH continues, it improves the career progression opportunities for men, creating a toxic working environment and reducing competition from women who may leave the role or the workforce.

“Personal stories are harder to ignore. They describe the compliance of colleagues, the lack of reporting, the fear of reprisal and job loss, the lack of mechanisms for receiving complaints, and the absence of laws to prosecute. The testimonies present a clear view of an enabling environment for perpetrators," said Dr Dhatt.

World Health Organisation (WHO) describes violence against women as a major public health problem and rights abuse and estimates that globally, 30 per cent of women have been subjected to either physical or sexual intimate partner violence or non-partner sexual violence in their lifetime.

Lack of comprehensive data

The report says there is not enough comprehensive data on women's experience

"Until governments and employers routinely collect such data, we will not know how representative our stories are of the health sector globally or locally. It is unacceptable, however, that even one woman health worker should experience such abuse," said the report.

"Women health workers are trained and skilled professionals. They go to work to save lives and deliver health services and should be able to do their jobs free from unwanted sexual advances and violence. The alarming level of abuse faced in the health workforce is a serious human rights violation for women who make up 70 per cent of the overall health workforce and 90 per cent of frontline staff."

The report recommends that organisations listen to women and take a survivor-centred approach to ensure the rights of survivors are clear and well known and that they are protected from retaliation.

"We must ensure survivors have access to legal, mental health and other services they need to rebuild their lives and careers."

To make this abuse visible, set baselines and measure progress the report further recommends that international agencies such as WHO and ILO should work with member states, women's organizations, trade unions and professional organizations to set a standard for collecting sex-disaggregated data.

"Ending SEAH is everybody's business because health services are largely delivered by women and health is everybody's business."

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