Screening for gender violence in Primary: why its application is delayed and which communities are more advanced

• Only four of the fatalities due to gender violence in 2022 had protection measures in force despite the fact that 40% reported

The Ministry of Equality presented this Tuesday the State Strategy to combat Sexist Violence 2022-2025, which was approved by the Council of Ministers last November.

It includes

, of which 148 are aimed at raising awareness, prevention and detection.

The

appears as a "key agent in the detection and eradication of sexist violence" and the 280-page text of the Strategy refers to the "development, updating and dissemination of common specialized health detection and care protocols for

" and, especially, in

consultations .

Former Government delegate for gender violence and forensic doctor Miguel Lorente reasons in this direction: "

, because gender violence has an effect on health. In fact ,

, and it is, not because of the aggression, but because of the metabolic and vascular problems caused by living under the threat that at any moment you could be attacked by a person who lives with you or who is in your environment. This creates a problem that makes battered women go to the health services more frequently".

Also the Minister of Equality, Irene Montero, in the first weeks of this year, before the trickle of women killed by their partners, alluded to the

.

She pointed out that in 2021, in another peak of cases, the training of health professionals in raising awareness and training in this area was urged.

's office, which is sometimes the only place where they do not have the eye of the abuser on them."

But this is nothing new.

The Ministry of Carolina Darias already gave the green light in December 2021 to a document approved within the Interterritorial Health Council that included just that: the implementation of

.

It was called:

.

This protocol was to be implemented throughout 2022

, and with it the aim was to detect possible cases of gender violence early from primary care consultations, even in its

or control violence through three questions that would serve to assess suspicion.

The questions are based on the WAST questionnaire (

) and the AAS questionnaire (

) and are recommended for women over 14 years of age at the time of opening the story. clinic or in any consultation if there is no response on the matter in the last two years.

Screening questions

How would you describe your relationship as a couple?

And, on some occasion: Have you suffered emotional, physical or sexual abuse by your partner or by a person important to you?

These questions would help to make decisions about the level of suspicion to rule out or confirm a case and

to assess the woman's risk if there is a confirmed suspicion.

The decision is preceded by years in which the privileged role of medical consultations for the detection of cases of gender violence was already assumed.

, demanding that they get involved in the fight against this public health problem: "Don't be afraid to ask. Contrary to popular belief, most women are willing to reveal the abuse when asked in a direct and non-evaluative way. In reality, many are silently waiting for someone to ask them, "said one of the WHO reports decades ago.

From medical societies, such as the Spanish Society of General and Family Physicians (SEMG) and the Spanish Society of Family and Community Medicine (Semfyc), they are clear

.

Most usually alternate periods of absence with others of hyper-frequency of the health system, which, once again, places medical consultations in a

Thus, many tend to develop "physical symptoms, headaches, neck

, dizziness, digestive symptoms (diarrhea, constipation, abdominal pain, etc.), respiratory distress or pelvic discomfort. As psychological symptoms, insomnia, depression are very frequent , anxiety,

irritability, emotional lability, eating disorders and even suicide attempts.

The persistence of these clinical signs should lead health professionals to investigate

in the clinical interview, given the possibility that the origin of this pathology is within an environment of violence.

Then, after this detection of a woman who has suffered abuse, the doctor would have to refer a multidisciplinary team of professionals where the woman can find support to get out of the situation.

But, before seeing that second part, it is necessary to know

The question has been asked to all the communities and several have responded.

official response

The official response is that, according to the Ministry of Health,

are already working with the WAST questionnaire in its simple and extended versions.

Beyond these autonomies,

has responded that they are preparing a document that "is very advanced, incorporates all the improvement measures for the early detection of cases of gender violence in primary school, also includes the instruments that the Ministry has validated for help healthcare professionals to make this detection".

Madrid

affirms that since 2005 training on gender violence has been carried out within the continuous training plan of the Ministry of Health, outside the State Pact.

In 2008, the General Directorate of Public Health (DGSP) produced a guide for the prevention of intimate partner violence whose target population is primary care professionals and, two years later, the guide for hospital professionals was developed.

The DGSP has developed all the training activities and guidelines in coordination with the primary care and hospital management.

In addition,

have elaborated, through their scientific societies, their own guides taking as reference those elaborated by the DGSP.

Currently, they report that the DGSP is working on an

for the prevention of gender violence,

.

The Canary Islands

already had an action protocol for the care of victims of gender violence in the hospital setting in line with what was worked on in the Ministry group with the autonomous communities, which was recognized as

.

It has also updated the action protocol in the field of primary care that includes the indicators provided by the working group at the national level and which

.

"The 2003 protocols have been updated to the needs raised in 2021," as they acknowledge.

Cantabria

responds that gender violence screening is carried out according to protocol, with questions open to all women aged 14 and over, but that the standardized instrument approved by the CISNS in 2021 is not yet included. "We are in the phase of training of key professionals in these instruments to modify the current protocol and introduce screening tests", they pointed out.

With the responses from the health administrations, an "acceptable" panorama could be drawn with a general picture of the communities in which things seem to be being done in the field of early detection of violence in Primary, although most do not include the approved protocol in the 2021 Interterritorial.

The reality of primary care, according to doctors

But, this image contrasts with the one offered by the Spanish Society of General and Family Physicians (SEMG).

Lorenzo Armenteros del Olmo, head of the Women's Health area within the SEMG, has also asked the doctors who make up the scientific society throughout Spain.

The review by autonomies that Armenteros del Olmo does, with the information of the associated doctors, offers the following image.

into the clinical history.

In

they have

.

"They take 20 minutes to do so, which means that it is not operational, because nobody is willing to undergo a 20-minute interrogation. Because, in addition, what is intended with the screenings is that they are short questions, with a very clear and direct message so that, from that screening, to be able to make a selection where more influence can be made on an issue".

In

explains the doctor - they work for health centers that are the ones that have developed the protocols, so some have it and others do not.

It

happens to

Castilla y León has the WAST test and they use the long version

.

"More than a screening, the doctor who is interested does the test, but it does not become a routine, which happens to all women, as we ask questions about depression or other types of pathologies that with very few questions you have great information."

In Asturias

there is a protocol that is uploaded in the medical record, "but it is a 2016 system that

."

In relation to the communities, of which Health says that they already have the screening protocol installed, Armenteros del Olmo responds: "

, for the detection of abuse.

. In

they talk about the WAST questionnaire, but I can assure you [Armenteros del Olmo is a primary care doctor in Galicia] that

in this regard, beyond preparing documents".

La Rioja

also "has the WAST not included in the medical history, but they use it, the same as in the Basque Country and Murcia".

Lots of lyrics and little reality

In summary, the professional assures that "if you look at what has been written about gender violence, it is tremendous and each autonomous community has made true compendiums on this, but, none, applicability."

Regarding what was approved at the Interterritorial Council in December 2021, that is, the

SEMG's associated doctors have responded that they have nothing.

Nothing has been publicized. No effort has been made at all."

"Something that, for a long time, has been requested is that the prevention of gender violence in primary consultations

. That it be done with effective action, which can be useful and transmitted in the culture of the clinical history, that we can do it with any woman. In the same way that we can ask her if she has menstrual disorders. That has not been established and what has been done in that strategy [that of the Interterritorial protocol of 2021] there is nothing. No autonomy has communications regarding that, nor has it been worked on, nor has anything been done. In other words,

"concludes Armenteros the Elm.

An overflowing Primary, can you do that screening?

Now, taking into account the reality of Primary Care in Spain, where strikes at this first level of care are shaking the entire country,

The specialist replies: "

, just like any new activity. Primary is taking on multiple new activities without receiving anything in return. But a strategy as important and with as much seriousness as the detection of gender violence should be possible, even if , being pragmatic, in reality, we would find difficulties, like anything that

".

But, the person in charge of the SEMG considers that "we must not blame time. We

, because if they wanted they could be included in the agenda. They could reduce all the amount of useless bureaucracy that we do, that occupies 20% of the consultation and, in this way, go to the practical, to the useful, to what is really clinical and prevention. Then, it could be done".

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