[Applying consent, in healthcare and beyond]. / Appliquer le consentement, dans les soins et au-delà.

Sexual violence constitutes a form of gender-based violence, to the extent that the victims are mainly women. Other groups of vulnerable people are also more affected, in particular gender and sexual diversity persons. Sexual and gender-based violence can also occur in healthcare. To respect the legal framework and people's rights, but also to promote safety and quality in healthcare, it is essential to obtain and respect consent. Consent must be informed, explicit, freely given, and reiterated throughout the consultation. This article reviews the concept of consent and offers practical tools for its application in healthcare.

Les violences sexuelles constituent une violence de genre, dans la mesure où les victimes sont principalement des femmes et les auteurs des hommes. D'autres groupes de personnes vulnérables sont également davantage concernés, en particulier les personnes de la diversité sexuelle et de genre. Ces violences sexuelles et de genre existent également dans les soins. Afin de respecter le cadre légal et les droits des personnes, mais aussi de favoriser des soins de qualité et en sécurité, il est primordial de recueillir et respecter le consentement. Celui-ci doit être éclairé, explicite, libre et réitéré tout au long de la consultation. Cet article fait le point sur le concept du consentement et offre des outils pratiques pour son application dans les soins.

La urgencia de dar respuesta sanitaria a la violencia de género / The urgency of providing a health response to gender-based violence

La violencia por cuestiones de género es un fenómeno histórico, complejo y prevalente a nivel mundial. Definida por la Organización de las Naciones Unidas como 'todo acto de violencia basado en la pertenencia al sexo femenino, que tenga o pueda tener como resultado un daño o sufrimiento físico, sexual o psicológico para la mujer, así como las amenazas detales actos, la coacción o la privación arbitraria de la libertad, tanto si se producen en la vida pública como en la privada', la violencia contra la mujer constituye una violación de los derechos humanos y por lo tanto, una cuestión de Estado. Las autoras de este artículo repasan el marco legal que aborda este problema en la Argentina, las dificultades del sistema sanitario (a nivel institucional e individual) en la detección y asistencia de las personas que lo padecen y la necesidad desensibilización y capacitación de los profesionales de la salud. (AU)

Gender-based violence is a historical, complex and prevalent phenomenon worldwide. Defined by the United Nations as 'any act of female-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, as well as threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life', violence against women is a violation of human rights, and therefore a matter of State. The authors of this article review the legal frame that addresses this problem in Argentina, the difficulties of the health system (at institutional and individual level) in the detection and care of people who suffer from it, and the need for raising awareness and training healthcare professionals. (AU)

Introducción a la Perspectiva de Género: Cuarto encuentro

En este último encuentro, Leticia Locio, directora provincial de Abordaje Integral de las Violencias por Razones de Género y Norma Giorno, asesora de la Subsecretaría de Políticas contra las Violencias por Razones de Género se centrarán en la incorporación de la perspectiva transversal de género y las políticas públicas implementadas desde el Estado provincial. Los puntos desarrollados en la clase son: Conceptualizaciones sobre las violencias por razones de género según la Ley Nacional n° 26.485; Formas que asumen y acciones del Estado; Consideraciones generales: sociedad patriarcal, relaciones de poder y vínculos interpersonales y, vulneración de los Derechos Humanos. Carácter multicausal y abordajes: integrales, interinstitucionales, intersectoriales e interjurisdiccionales. Tipos de violencia: física, psicológica, sexual, económica, simbólica y política. Modalidades/ámbitos: doméstica, institucional, laboral, contra la libertad reproductiva, obstétrica, mediática, en el espacio publico y política. Multicausalidad. Ciclo de la violencia. Sistema Integrado de Políticas Públicas (SIPP). Principios rectores del SIPP. Políticas Públicas aplicadas desde el Estado.

Community Approaches to Sexual Assault: VAWA's Role and Survivors' Experiences.

This article reviews two types of community-based approaches to addressing sexual assault that survivors may encounter-sexual assault nurse examiners and victim advocates from nonprofit community agencies-and highlights ways that the Violence Against Women Act (VAWA) and its reauthorizations have influenced this work. We also review information on the intersections of the work of these providers with police and prosecutors and include how these relate to survivors' experiences. We conclude with thoughts that look forward to future research on these issues emphasizing authentic engagement of practitioners and survivors in the research process.

Seeking Justice: How VAWA Reduced the Stronghold Over American Indian and Alaska Native Women.

The Violence Against Women Act (VAWA), originally passed in 1994, was successfully reauthorized in 2000, 2005, and 2013. Over time, VAWA altered the environment for many victims who had previously suffered in silence. This article focuses on how VAWA impacted American Indian (AI) and Alaska Native (AN) victims of dating and domestic violence. AI and AN women experience these crimes at a rate higher than the national average, yet they are often denied justice due to the interplay of federal and state laws and tribal sovereignty. VAWA affirmed tribes' sovereign authority to exercise criminal jurisdiction over non-Indians who commit crimes against AI and AN victims on tribal lands. This article also discusses future steps to enhance justice reforms.

Violence Against Women: Reflecting on 25 Years of the Violence Against Women Act and Directions for the Future.

The year 2019 marked the 25th anniversary of the passage of the landmark legislation, the 1994 Violence Against Women Act (VAWA). As we reflect on the Act, it is important to examine how the VAWA influenced the response to violence against women. This guest editors' introduction provides a preview of five articles devoted to a special issue of Violence Against Women. The articles highlight key aspects of VAWA. With H.R. 15851 awaiting consideration by the Senate, we suggest that perhaps now is an appropriate time to assess the Act's impact.

The 1994 Violence Against Women Act: A Historic Response to Gender Violence.

The Violence Against Women Act (VAWA) is frequently questioned about its success, especially during times of its reauthorization. While federal, state, local, and private organizations have funded a significant amount of research through VAWA since its inception, questions remain as to whether the field has the evidence to make a concrete judgment about its success. The purpose of this article is twofold. First, we review the Act and its subsequent reauthorizations. Second, the article addresses issues related to VAWA's success. We consider whether it is possible to answer Moore Parmley's question posed in 2004, p. 1,428: " . . . on the anniversary of the VAWA, will we be able to say with any confidence that the Act helped to prevent violence against women?"

Reimagining VAWA: Why Criminalization Is a Failed Policy and What a Non-Carceral VAWA Could Look Like.

The Violence Against Women Act (VAWA) is the signature federal legislative accomplishment of the anti-violence movement and has ensured that criminalization is the primary response to intimate partner violence in the United States. But at the time of its passage, some anti-violence activists, particularly women of color, warned that criminalization would be problematic for a number of reasons, a caution that has borne fruit in the 25 years since VAWA's passage. This article critiques the effectiveness of criminalization as anti-domestic violence policy and imagines what a non-carceral VAWA could look like.

Sites of Exception: Gender Violence, Digital Activism, and Nirbhaya's Zone of Anomie in India.

Gender violence in India exists as a state of exception for the ways in which it occupies a nonlegal, liminal space of existence as "bare life" or "life itself." The rape and murder of Jyoti Singh Pandey unprecedentedly brought this to the surface. This article aims to highlight the ways in which the movement that emerged out of this case engaged with gender violence as a state of exception while the use of new digital technologies by "digital subjects"/"digital parasites" has constituted "sites of exception," leading to new forms of organizing and creating an emerging politics of gender justice in India.

La interrupción legal del embarazo en Argentina / The legal termination of pregnancy in Argentina

En el contexto de la publicación por parte del Ministerio de Salud de la Nación de Argentina del Protocolo para la atenciónintegral de las personas con derecho a la interrupción legal del embarazo (ILE), resumido y comentado en este mismonúmero de EVIDENCIA, este comentario editorial ofrece: 1) una perspectiva amplia de lo que significa el aborto, desde lamirada estrictamente biologicista hasta definiciones basadas en el enfoque de género; 2) una descripción de los diferentesmarcos jurídicos respecto del aborto que imperan actualmente en Latinoamérica y Argentina, haciendo especial hincapiéen lo concerniente a las ILE; 3) información epidemiológica sobre la mortalidad materna en Argentina y la asociada alaborto inseguro; 4) estadísticas sobre la realización de ILE en la Ciudad Autónoma de Buenos Aires, Argentina.Dada la situación actual de aislamiento social preventivo obligatorio en el marco de la pandemia de Covid-19, conside-ramos quienes integramos equipos de salud debemos estar más atentos/as que nunca a las situaciones de violenciapotencial que podrían suceder en este contexto, para dar las respuestas pertinentes -entre las que se incluyen las ILE-, alas víctimas de embarazos no deseados consecutivos a situaciones de coerción. (AU)

In the context of the publication by the Argentine Ministry of Health of the Protocol for the comprehensive care of people withthe right to legal termination of pregnancy (LTP), summarized and commented on in this same issue of EVIDENCIA, thiseditorial article offers: 1) a broad perspective of what abortion means, from a strictly biological point of view to definitionsbased on the gender approach; 2) a description of the different legal frameworks regarding abortion that currently prevailin Latin America and Argentina, with special emphasis on LTP; 3) epidemiological information on maternal mortality inArgentina and that associated with unsafe abortion; 4) statistics on the realization of LTP in the Autonomous City ofBuenos Aires, Argentina.Given the current situation of mandatory preventive social isolation in the framework of the Covid-19 pandemic, we considerthat those of us who are part of health teams should be more alert than ever to situations of potential violence that couldoccur in this context, to give the relevant responses - including LTP- to victims of unwanted pregnancies following coercivesituations. (AU)

Sexualised violence against children: a review of laws and policies in Kenya.

Child sexual abuse (CSA) is a major global health challenge. Extant literature shows that CSA is prevalent in Kenya. As a signatory of the United Nations Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, the Kenyan government is mandated to ensure that children are protected from sexual abuse through sound laws and policies. This paper reviews existing laws and policies on CSA and highlights their strengths and weaknesses. Our findings indicate that laws on child protection exist and are protective to a large extent, as harsh penalties are outlined for sexual offences. Survivors of CSA are entitled to free legal and medical services. However, there are no reparations offered to survivors in criminal proceedings. Moreover, there is no legislation on age-appropriate comprehensive sexuality education which plays an important role in cultivating positive gender norms and describing what constitutes CSA and reporting procedures. The national standard operating procedures for the management of sexual violence against children lack CSA screening procedures. There is urgent need for review of these laws and policies and development of multisectoral protocols at the national and county level, that outline roles and responsibilities for various service providers, supervisory and accountability measures and referral networks.

Obstetric Violence Observatory: Contributions of Argentina to the International Debate.

In Latin America, over the past decade, the term "obstetric violence" has become part of the legal framework. Specific laws against obstetric violence - gender-based violence and the violation of human rights - exist in Venezuela, Argentina, Mexico, Brazil and Uruguay. In Europe, the issue is raised by human rights organizations, social movements and academics, but no country has yet passed legislation on the matter. In this article, I focus on the contribution of Argentina to this international debate, particularly with respect to the implementation of the Obstetric Violence Observatory.

Action research improves services for child sexual abuse in one Caribbean nation: An example of good practice.

BACKGROUND: Child sexual abuse (CSA) is a multi-dimensional problem. The search for best practice must consider the complexities surrounding CSA and its management in any particular society. OBJECTIVE: Data previously gathered from service providers on CSA service provision in Trinidad and Tobago identified key deficient issues in policy and practice. In this paper, researchers aimed to bridge the gaps identified, and effect changes to improve services for CSA using an action research methodology. PARTICIPANTS AND SETTING: Service providers from all sectors in governmental and non-governmental organizations in Trinidad and Tobago, who work with children at risk of CSA were involved in the process. METHODS: Researchers led the service providers into an awareness of their own practice through critical discussion of, and reflection on, the key deficient issues. The new knowledge generated, with guided input from evidenced-based best practice, led to the development of guidelines for management. Discussion of the practicability of the guidelines by service providers in multiple sectors generated more new knowledge that refined the management approach. RESULTS: The contextual knowledge obtained from service providers resulted in best practice guidelines for service providers that were culturally relevant and context-sensitive, adaptive and implementable, and allowed a seamless multidisciplinary response to CSA in Trinidad and Tobago within prevailing constraints. CONCLUSIONS: Action research offers an effective approach to improve services for CSA through mobilization of service providers and changes in policy and practice. It is applicable in any setting and likely to be effective in any socio-cultural context.

Violence against women: historical trajectory of a care program (Curitiba - 1997-2014).

OBJECTIVE: To analyze the historical trajectory and the contributions of the Programa de Atenção às Mulheres em Situação de Violência (Program of Care to Women Victims of Violence) of Curitiba. METHOD: Research with documentary and local approach, inspired by the Dimension of Political History, to unveil power relations, political representations, symbols and discourses. Eighty-eight sources were used for the period 1997-2014. The data collection was performed in May 2016 and presented in the timeline modality. RESULTS: The historical trajectory of the program indicates intersectoral and interinstitutional experience that has been increasing and originating important innovations in care to women based on humanization and from the perspective of comprehensiveness. FINAL CONSIDERATIONS: Historicizing the Program contributed to the reflection on the construction of practices aimed at confronting violence, the need for intersectoral actions and looks that involve its complexity.

Violence against women: historical trajectory of a care program (Curitiba - 1997-2014) / Violencia contra las mujeres: la trayectoria histórica de un programa de atención (Curitiba - 1997-2014) / Violência contra mulheres: trajetória histórica de um programa de atenção (Curitiba - 1997-2014)

ABSTRACT Objective: To analyze the historical trajectory and the contributions of the Programa de Atenção às Mulheres em Situação de Violência (Program of Care to Women Victims of Violence) of Curitiba. Method: Research with documentary and local approach, inspired by the Dimension of Political History, to unveil power relations, political representations, symbols and discourses. Eighty-eight sources were used for the period 1997-2014. The data collection was performed in May 2016 and presented in the timeline modality. Results: The historical trajectory of the program indicates intersectoral and interinstitutional experience that has been increasing and originating important innovations in care to women based on humanization and from the perspective of comprehensiveness. Final considerations: Historicizing the Program contributed to the reflection on the construction of practices aimed at confronting violence, the need for intersectoral actions and looks that involve its complexity.

RESUMEN Objetivo: Analizar la trayectoria histórica y las contribuciones del Programa de Atención a las Mujeres en Situación de Violencia de Curitiba. Método: Investigación con enfoque documental y local, inspirada en la Dimensión de la Historia Política, para revelar relaciones de poder, representaciones políticas, símbolos y discursos. Se utilizaron 88 fuentes para el período 1997-2014. La recolección de datos fue realizada en mayo de 2016 y presentada en la modalidad línea del tiempo. Resultados: La trayectoria histórica del programa indica una experiencia intersectorial e interinstitucional, que se ha ido ampliando y originando importantes innovaciones en la atención a mujeres pautadas en la humanización y en la perspectiva de la integralidad. Consideraciones finales: Historizar el programa contribuyó a la reflexión acerca de la construcción de prácticas dirigidas al enfrentamiento de la violencia, la necesidad de acciones intersectoriales y miradas que involucren su complejidad.

RESUMO Objetivo: Analisar a trajetória histórica e as contribuições do Programa de Atenção às Mulheres em Situação de Violência de Curitiba. Método: Pesquisa com abordagem documental e local, inspirada na Dimensão da História Política, para descortinar relações de poder, representações políticas, símbolos e discursos. Foram utilizadas 88 fontes referentes ao período de 1997-2014. A coleta de dados foi realizada em maio de 2016 e apresentada na modalidade linha do tempo. Resultados: A trajetória histórica do programa indica experiência intersetorial e interinstitucional que foi se ampliando e originando importantes inovações na atenção às mulheres pautadas na humanização e na perspectiva da integralidade. Considerações finais: Historicizar o Programa contribuiu na reflexão acerca da construção de práticas voltadas ao enfrentamento da violência, a necessidade de ações intersetoriais e olhares que envolvam sua complexidade.

Litigating to ensure access to quality maternal health care for women and girls in Kenya.

Access to comprehensive reproductive health care for women and girls, including access to quality maternal health services remains a challenge in Kenya. A recent government enquiry assessing close to 500 maternal deaths that occurred in 2014 revealed gaps in the quality of maternal care, concluding that more than 90% of the women who had died had received "suboptimal" maternal care. In Kenya, the Center for Reproductive Rights (the Center) has undertaken public interest litigation among other strategies to challenge human rights violations and systematic failures within the health sector. In 2014, before the High Court of Bungoma in Western Kenya, the Center filed a case on behalf of Josephine Majani who had been neglected and abused by the staff of the Bungoma County Referral Hospital, a public health facility where she had gone to deliver in 2013. This commentary addresses the situation of maternal health care in Kenya and the actions leading to litigation that was specifically aimed at enabling access to quality maternal health care. It provides an analysis of some of the outcomes of the litigation and highlights the implications thereof on implementation of maternal health care in Kenya and beyond.

Five years post Nirbhaya: Critical insights into the status of response to sexual assault.

It is five years since the fatal gang rape of Jyothi Singh (Nirbhaya), a physiotherapy student, on December 16, 2012, in New Delhi, the capital of India. The legal and policy reforms triggered by the Nirbhaya case will remain a watershed moment in the history of efforts towards seeking justice for survivors of gender-based violence in India. The Criminal Law (Amendment) Act, 2013 and the "Guidelines and protocols: Medico-legal care for survivors/victims of sexual violence" issued by the Ministry of Health and Family Welfare in March 2014 are two landmark reforms. March 2018 marks four years since the issuance of these Guidelines and five years since the Criminal Law (Amendment) Act, 2013. Any reasonable tribute to Nirbhaya would constitute fair implementation of legal reforms, efforts to strengthen multi-sectoral response and sincere attempts to reduce crimes against women, gender and sexual minorities, and children. This paper reviews the issue, through a close study of recent cases of rape, police responses, court judgements, studies, news reporting and field-based observations. It brings forth the gaps in implementation that persist, and constitute a major obstacle in making these progressive policies and reforms effective. Given the fact that the reforms are intersectoral in nature, implementation has been particularly challenging. Lack of efficient implementation of such policies and reforms amounts to denying survivors their right to justice.

Need for gender sensitive health system responses to violence against women and children.

Five years since Nirbhaya, and nearly as long since the Justice Verma Committee Report, amendments to the Criminal Law Amendment Act 2013, and the National guidelines and protocols on medico-legal care for survivors of sexual violence by the Ministry of Health and Family Welfare (MoHFW) 2014, we, concerned individuals, women's groups, health organisations, ethicists, and academicians, urgently demand the attention of the central and state governments - to the continuing injustice, violations and discrimination against survivors of gender-based violence (GBV).