Next week, I’ll be at the Second International Conference on Violence in the Health Sector in Amsterdam to share some of the findings of a study IntraHealth conducted on violence and gender discrimination in the health sector in Rwanda. 

Workplace violence is psychological and physical abuse that affects occupational health worldwide. It takes many forms—physical assault, verbal abuse, sexual or racial harassment, bullying, or mobbing. All studies on the subject have demonstrated serious consequences for individual health workers, for health organizations, and for the larger society.

Violence against health workers undermines fundamental freedoms and rights at work and can lead to depression, anxiety, physical disability, resignation, dismissal, transfer, absenteeism, lowered quality of care, decreased workplace productivity, increased costs to health systems, or even death. Workplace violence has been documented in all sectors, but female-dominated sectors such as health and social services are at particular risk.

In 2002, the World Health Organization, the International Council of Nurses (ICN), the International Labour Organization, and PSI released an influential report, which found that while both men and women are at risk, women were the victims in the majority of cases of workplace violence simply because the majority of workers in the health sector are women. Many experts in the field also acknowledged the role of gender and consider some acts of workplace violence to be “gender-based.” The ICN noted in a brief some years ago that “[n]inety-five percent of nurses around the world are women. Attitudes towards women are often reflected in interactions with the profession.” It went on to say that “women are targets of violence more often than men” and drew parallels between domestic and workplace violence, including physical and verbal abuse, sexual harassment, and bullying. However, until 2005, there had been no studies that measured the relationship between gender discrimination and workplace violence, beyond sexual harassment, or examined possible connections between gender and a health worker’s vulnerability to violence or likelihood of acting violently.

Then in 2006, a Canadian study explored the link between women’s vulnerability to violence and the gendered division of labor in jobs most often filled by women and the links between these types of jobs and greater risk of exposure to violence, such as social service workers who may be at risk of violence from  angry, frustrated, or distressed clients. This study revealed that violence against female workers was sexualized and drew parallels between the gender dynamics of professional caregiving and intimate partner violence [1].

While many recognize the links between gender discrimination and violence against girls and women, the relationship between these two problems in the health sector needs further delineation. The 2006-2008 IntraHealth study of health workplaces in Rwanda attempted to do this. This study found that among the Rwandan health workers interviewed, 39% reported experiencing some form of workplace violence in the last year: 27% had experienced verbal abuse; 16% had been bullied; 7% had encountered sexual harassment; and 4% been physically assaulted. The main perpetrators of violence were colleagues and hierarchical superiors. Sexual harassment was twice as prevalent among female health workers (8%) as male workers (4%); and in 40% of these cases, the victim disclosed the occurrence to no one. Not surprisingly, the experience of violence was associated with psychological health impacts such as obsessive thoughts, fear, and anxiety and absenteeism. 

By examining possible links between gender discrimination and experiences of violence, this study showed that negative stereotypes of female health workers, discrimination based on pregnancy and family responsibilities, and the “glass ceiling” affected female health workers’ work experiences and career paths. Some of the Rwandan survey respondents observed that female health workers “just don’t know how to make decisions in a sure and certain way” and that they “are not even capable of pulling out a tooth.” One key informant noted, “There is a tendency to say that women are weak in the broadest sense (no physical strength, late in execution of work tasks, breastfeeding, giving birth which debilitates them, absences) and in some cases, the violence that women are subjected to stems from this situation.”One of the study’s key findings was that gender equality in the workplace lowers the odds of experiencing violence at work, and conversely, gender inequality at work increases the odds of violence. 

These sobering results were first disseminated internally at the Ministries of Public Service and Labour, Health, Gender and Women’s Promotion, and Justice, and the Rwanda Health Workers Union and then externally in a national results dissemination workshop. The study served as a resource in the revision of the Law Regulating Labor in 2009 and the national policy on preventing gender-based violence. Policy reform is only the first step. Service and human resources managers are on the frontline of making the health sector safer and more equitable for the workforce. They have a key role to play in developing and implementing workplace policies and programs that sensitize and educate staff and clients, make facilities more secure, and create workplace cultures of gender equality, non-discrimination, and non-violence. These types of strong management practices are likely to result in a more productive and satisfied health workforce.

Most research to date has focused on violence against health workers, as our work in Rwanda did, and to a lesser extent, preventing violence against the clients of health institutions. There is pressing need for more research on the needs of health workers living with intimate partner violence, and I hope to hear more about work in this area in Amsterdam.

References
Baines D. 2006. Staying with people who slap us around: gender, juggling responsibilities and violence in paid (and unpaid) care work. Gender, Work and Organization. 213(2):129-51.