Authorities and health professionals in the State of São Paulo have turned their attention to a grave and age long problem: domestic and sexual violence against women. A recent study by the School of Medicine of USP (FMUSP), based on greater São Paulo, demonstrates that between 25% and 30% of women from 15 to 49 years of age are victims of aggression in their own homes; it also that this is the cause of 50% of the homicides of women and of 30% of the female traumas attended to at hospital emergency units (an even higher rate when dealing with pregnant women). This is the theme of the project that professor Lilia Blima Schraiber, of the Department of Preventative Medicine of FMUSP, has been developing in partnership with the State Department of Health and the support of FAPESP.
The goal is to check up on the percentage of women victims of violence who are attended to at health clinics and at Basic Health Units (UBS in the Portuguese acronym) in the metropolitan region of São Paulo, services which are the first steps before being attended to at the Unified Health System (SUS in the Portuguese acronym) and that form part of the so called “primary health attention”. The researchers intend to draw up a proposal about how the SUS professionals should react when dealing with the victims – constantly tormented women who fear the aggressor, in general their husband or companion.
The State has a large interest in this area, but not only because of its social role. “World literature shows that women in situations of violence create a standard of repetitive use of the services and present recurring demands, of difficult resolution, even when they are diagnosed at the early stage. Consequently, the costs are also enormous for the public network”, explains the coordinator of the project. Lilia and her team are carrying out almost 3,100 interviews with the users of the medical service of 14 health clinics and UBSs in the capital, as well as six units in the towns of Santo André, Mogi das Cruzes and Diadema.
Due the adopted methodology, based on home interviews and on the evaluation of hospital records, the work is pioneer in Brazil and could serve as a model for other experiences in the rest of the country. “Up until this moment, there have only been reports about violence against women based on complaints registered at police stations, which give us a true and exact dimension on the problem.”
The first phase of the project began in 1999. At that stage, Lilia updated the service guide – with the addresses of various institutions specializing in advising and assisting the victims of violence – which she herself published in 1999, within a similar project sponsored by the Ford Foundation. In November of 2000, the researchers went on to the second part of the project, the carrying out of field work and the tabulation and analysis of the data, which should be concluded,at the very latest, by the beginning of 2002. “In this phase, we are investigating the registration of cases of violence in medical emergency units; taking interviews from doctors and medical staff, and making focus groups with the service users, as well as individual interviews with the female victims of violence”, she tells.
The USP professor has been working in this area since the 80s. In 1996, Lilia obtained funding from the Ford Foundation for the project “Violence and Gender in Health Practice.” Beginning with the preliminary data of this study, now in its concluding phase, the researcher verified that only 10% of the women who pass through the “primary health attention” (public network or private general practitioners), during the period of one year, had been registered in the medical bulletins as victims of sexual or domestic violence. “In my personal interviews done with the women, this rate rose to 57%, which demonstrates the invisibility of the problem in the health services”, she says.
Parallel to this work, Lilia was recently invited by the World Health Organization (WHO) to represent Brazil in a study on health and violence against women, which is being developed in six Third World countries, always comparing a metropolitan region to a rural region of each country. She is researching in two regions: the municipality of São Paulo and 15 municipalities on the Zona da Mata ( interior) of the State of Pernambuco. She expects to finish up the project at the beginning of 2002.
Republish