This section hosts guidelines, manuals and toolkits to strengthen public health practice.
Globally, 1 in 3 women
has been subjected to physical, sexual, or emotional violence by an intimate or
a non-intimate partner at least once in their lifetime. The latest NFHS 5 data
places the estimate of women aged 18-49 in India who have experienced spousal
violence at 29.3%, with states like Karnataka having an average of 44.4%. The pandemic, with its
lockdown, has only worsened the problem, with the National Commission for Women
receiving about 23,722 complaints of crimes committed against women in 2020,
the highest in 6 years of which around 5297 complaints were related to domestic
violence. The numbers have only gone up since with around 30,865 complaints of
crimes against women registered in 2021.
Gender-based violence causes serious physical and psychological harm for which health care services are essential. Health services in India are undergoing significant transformation through different schemes like Ayushman Bharat, with an increasing focus being put on making them affordable and accessible to all. The increase in the utilization of services such as RMNCH+A over the years has resulted in more women interacting with healthcare providers. This puts the health system in a good position to identify, manage, and create awareness of gender-based violence. Despite the increased interaction, only a small percentage of women who face violence however seek help from healthcare providers, according to NFHS reports. 
Problems in the healthcare system
Gender inequality due to deep-rooted patriarchal and cultural norms, poverty, employment status, education level, substance abuse, and such factors all play a role in the propagation of gender-based violence. It becomes deeply ingrained that it makes women themselves indifferent to and sometimes perpetrators of abuse. The lower status assigned to women in society and families restricts their ability to make decisions regarding healthcare, finances, and other aspects which also affects their health-seeking behavior. Lack of awareness on services they can avail of, the stigma of reporting, fear of retaliation on reporting, discriminatory attitudes experienced, lack of trust of the health care workers all discourage survivors from seeking help from healthcare providers.
The existing health care system offers little to help. The medical curriculum in India largely leaves out gender-based violence and other gender-based issues, though in recent times some universities are moving towards its inclusion. Gender-based violence is often considered a domestic and private issue that has no place in the medical practice  Inequality in service provision is a major issue that is at the forefront. According to a survey by Oxfam India, 1 in 4 Indians faces discrimination in receiving health care services due to caste and religion. For poor women, women and girls with disabilities and transgender persons, such inequality would be amplified many times. Reports of Asha workers not visiting Dalit households, hospital staff misbehaving towards poor women are commonplace and are deterrents in approaching healthcare providers.
Barriers that healthcare providers face include the absence of private spaces in healthcare facilities where survivors can talk without the fear of being overheard and the lack of time due to the high volume of patients who visit health facilities every day. In most cases of injuries due to violence, health personnel are the earliest point of contact and the lack of training and knowledge to identify, respond and connect with the survivors can result in just treating the symptoms and not the cause. Preset stereotypical notions can prevent healthcare providers from providing empathetic care and direct them to the required service.
Strengthening the health system response
Studies recommend screening for gender-based violence to be part of routine health care. There are tools and guidelines in place developed by the WHO to aid in the development of healthcare capacity and the readiness of health systems to respond to violence against women. They offer health providers evidence-based standards of identification and appropriate responses to gender-based violence including clinical interventions and emotional support.
There is a pressing need to incorporate a broader and more practical-based GBV education in the medical curriculum and training of healthcare providers to go beyond the technical expertise and lead to a change in attitudes and internal biases. Research shows that training interventions along with health system changes result in positive changes in knowledge, stereotypical attitudes, and practices of healthcare personnel in screening, management and prevention of GBV.  There is also a need to lay down or revisit institutional guidelines and protocols for managing cases of gender-based violence at each level of healthcare service provision that can be mainstreamed to a national response. Strong multisectoral partnerships can strengthen the linkages between healthcare providers and support services and ensure collaborative efforts to end gender-based violence. Community awareness on negative cultural norms, empowerment of women, sensitization of healthcare personnel and strong referral systems of counseling, legal and support services are necessary for responding to and preventing gender-based violence.
Gender-based violence is a complex public health concern. It can lead to adverse health outcomes for the survivor as well as leave behind huge economic and social costs. Health systems need to be integrated into the response towards its prevention in ways more than just a policy change.