Gender-based violence (GBV) remains a pervasive public health and human rights crisis across Nigeria. It encompasses any harmful act directed against an individual based on their gender, rooted in unequal power dynamics, cultural norms, and systemic inequalities. In many Nigerian communities, traditional practices, economic dependence, and deeply ingrained patriarchal structures compound the vulnerability of women and girls.
Forms of GBV commonly encountered in clinical and community settings include:
Midwives are often the first healthcare professionals to encounter survivors. Recognizing that GBV transcends social, economic, and religious boundaries is vital for delivering unbiased, compassionate care.
Survivors of gender-based violence frequently present to maternity units, antenatal clinics, or general outpatients with vague physical complaints rather than disclosing the abuse immediately. Midwives must maintain a high index of suspicion, especially when clinical findings do not match the history provided.
Common physical and psychological indicators include:
Assessment requires privacy, active listening, and direct, gentle questioning. Creating a safe physical environment encourages disclosure without forcing the patient to speak before they feel ready.
Trauma-informed care shifts the clinical question from "What is wrong with this patient?" to "What happened to this patient?" This approach minimizes re-traumatization and restores a sense of safety and control to the survivor.
The core principles guiding trauma-informed midwifery practice are:
Communication must be free of judgment. Avoid asking "Why did you stay?" or making statements that imply fault. Instead, use validating phrases like, "I believe you," "It is not your fault," and "You are safe here."
When a survivor of recent sexual assault or physical violence presents for care, clinical interventions must follow a structured, priority-driven pathway. Immediate physical safety and stabilization take precedence.
| Intervention Domain | Key Clinical Actions | Primary Purpose |
|---|---|---|
| Medical Stabilization | Assess ABCs, manage bleeding, treat acute physical trauma. | Prevent life-threatening complications. |
| Forensic Evidence | Obtain consent, document injuries, collect biological samples using an evidence kit. | Preserve legal integrity for future justice. |
| Prophylaxis | Offer emergency contraception, post-exposure prophylaxis (PEP) for HIV, and STI treatment. | Prevent unwanted pregnancy and infections. |
| Psychological First Aid | Listen without pressure, offer immediate comforting presence, avoid interrogation. | Reduce acute stress and stabilize emotional state. |
Careful, accurate documentation in the medical record is essential. Use the patient's exact words regarding the assault rather than interpretations, and sketch or photograph injuries strictly with informed consent.
Midwives working in Nigeria must be familiar with the legislative frameworks designed to protect citizens from gender-based violence. While laws vary across states, key national legislation provides vital avenues for justice and protection.
The Violence Against Persons (Prohibition) (VAPP) Act, signed into law federally in 2015 and subsequently domesticated by numerous states, represents a milestone. It criminalizes various forms of abuse previously unaddressed by the penal and criminal codes, including emotional abuse, harmful widowhood practices, spousal battery, and forceful ejection from a home.
Key legal rights for survivors include:
Midwives facilitate access to these protections by connecting survivors with social workers, legal aid providers, and law enforcement agencies while maintaining strict medical confidentiality.
Effective care for GBV survivors extends far beyond what a single midwife or clinic can provide. A robust multi-sectoral referral pathway links health facilities with legal, social, police, and shelter services to ensure comprehensive recovery.
Key components of the referral network include:
When making a referral, the midwife must obtain informed consent from the survivor, explain where they are being referred, and provide contact details securely. Avoid exposing the survivor to further risk by prematurely contacting third parties without their explicit agreement.
Balancing patient confidentiality with ethical and legal duties presents a delicate challenge in midwifery practice. Confidentiality is a cornerstone of professional ethics, fostering trust between the midwife and the survivor. Breaching confidentiality without legal backing can endanger the survivor and violate their autonomy.
However, exceptions exist in cases involving:
Midwives must understand local statutory requirements regarding mandatory reporting. Where adult competent survivors are concerned, respecting autonomy means the decision to report to police rests with the survivor, unless an immediate, life-threatening danger to others exists. Midwives must document all ethical decision-making processes clearly in the clinical notes.