Improving Capacity to Address Gender-Based Violence: The intersection of Public Health and the Law. A Public Health and Law Evaluation of a GBV Clinic in Kisumu, Kenya

According to a World Bank report, Gender-Based Violence (GBV)  is arguably the most widespread of all human rights violations, a pervasive and systemic public health issue affecting all socio-economic and cultural groups throughout the world at a high cost to the individual and society. Kenya’s Ministry of Health describes GBV as any violence directed against a person based on their gender or sex. Such violent acts include those that cause mental, physical, and sexual harm, as well as other acts that restrict one’s liberty (i.e., threats and coercion).

In Kenya, forty-five percent of women between the ages of 15 and 49 have experienced physical or sexual violence, though this figure may be an underestimation. In most cases, women under-report because they often know the perpetrator, have limited access to health and legal services, and are bound by prevailing gender norms that normalize GBV.

ICAP (International Center for AIDS Care and Treatment Program-Kenya) supports the Kisumu-based Gender-Based Violence Recovery Center (GBVRC) at Jaramogi Odinga Teaching and Referral Hospital (JOOTRH) at Columbia University. The GBVRC provides essential comprehensive health services to survivors of sexual and physical violence in the Nyanza/Western Region of Kenya. These services include a legal component provided by a paralegal and psycho-social support to GBV survivors.  

In 2019, under the leadership of Prof. McGovern- the Harriet and Robert H. Heilbrunn Professor and Chair Population and Family Health at the Columbia University Medical Center and Dr. Hawken, Director ICAP-Kenya, oversaw the PGIF Study ‘Improving Capacity to Address Gender-Based Violence: The intersection of Public Health and the Law. The objective of the study was to explore ways in which the current legal process can improve and how the fundamentals of the public health structure such as cultural norms, practices, and social injustices factor toward GBV as a public health epidemic.  The study seeks to ultimately address the underlying challenges of the prevalence of gender-based incidences.

The research team spent time exploring, listening, and studying the processes while drawing parallels and differences from across the globe. They talked to GBV survivors, whose stories mainly revolved around defilement. They sought to understand how the survivors relayed the information, how evidence was curated, how the police force interacts both with the victims and the alleged perpetrators, and indeed, how justice is ultimately served. On the other side of the coin, the public health perspective sought to understand the psycho-social aspects of GBV from both the victim's and perpetrator's perspective, but also a societal viewpoint, and how to ideally prevent this atrocity. 

The study revealed that though Kenya has excellent and solid laws; like most parts of the world,  they exist on paper and interpretation of the Law lies within the legal system-its execution.  In other forms of gender-based violence such as emotional, verbal, financial, and physical, the requirements may exist on paper, but pursuing such a claim is not realistic. The founded fears of stigmatization, drawn-out proceeding, or merely the lack of understanding of the basis in the forms of abuse signals the negligible reports of the same. For sexual-based abuse, the need for reliable, untainted forensic evidence-‘smoking gun" is critical for convictions. Similarly, the significant reliance on medical to prove penetration by science is still evident. From a Public Health perspective, this, unfortunately, points to some bias that indeed, the male is always the perpetrator.

In the case of minors, who are categorized as the property of the State, the law indicates they cannot consent to sex and thus, parents and guardians are usually the ones who raise the alarm in the cases of abuse. In Kenya, with the ongoing debate on lowering the age of consent, the public health outcry is that this may encourage teens to be more sexually active; however, the law perspective challenges the question, if it is an issue of two minors, the case is considered one of defilement, thus whom do you convict of the two minors? The study shows that according to a recent High court ruling, it says both minors. This begs the response on how punitive the law will be to the two minors who if convicted, serve a minimum sentence of fifteen years in prison.  

How then, can the law work hand in hand with the public health system to achieve justice for the survivors, retribution for the perpetrators as well also ensure the system works in curbing these cases:

Some recommendations include:

1. Increasing witness preparation and connection to legal representation for the victims and their families.
2. Empowering those within the chain of custody of information and evidence not only to preserve the proof but also ensure an 'airtight case.'
3. Explore civil claims and monetary relief and compensation,
4. The law should be less focused on building criminalized populations this is working toward the rehabilitation of the population
5. Seek to have punitive charges on other forms of violence within the community impact of the hyper-focus on defilement by the criminal justice system
6. Wavering cost such as the paperwork such as the  P-3 form for the physical assault that currently cost a minimum  Kshs 1500 shillings and requires unnecessary back and forth looking for a Ministry of Health doctor.  Similarly, the State could provide legal representation to survivors as it doesn't assess routinely legal services for GBV victims  unless through special request

On the health perspective, the study recommends that though our society is still viewed as highly conservative, the need for Comprehensive Sexual Education (CSE) across all age groups and genders is paramount. This will allow both genders to learn and demystify gender understandings and roles. Similarly, create safe spaces that provide psycho-social support for victims and survivors as well as support groups for community members to interact the law enforcement, community leaders, and legal practitioners to sensitize and create accountability. At the policy level, economically empowering communities have shown to decrease GBV across the board generally.

Where is the nexus of public health and law in regards to GBV, it lies in education and sensitization and building valued based communities, whether cultural or applied