In a small town in Maharashtra, the waiting room of Gangapur’s Sub-District Hospital fills early each morning. Patients arrive from nearby villages seeking help with ailments both common and complex. Among them are women whose stories are not written in their medical files. They come with headaches, stomach pain or dizziness, symptoms that sometimes hide something deeper.
Dr Harshal Dhabe, the hospital’s Medical Officer, has learned to listen differently. “We see more than 400 patients a day in the outpatient department. Earlier, we used to just provide treatment,” he says. “Now, when a woman shows certain symptoms or comes to the hospital repeatedly, we consider the possibility that she might be experiencing violence.”
Across the district, at the Primary Health Centre in Nandur, Dr Pratiksha Vijay Gawande sees the same reality. Her centre serves 26 villages and a population of more than 40 000. “Violence against women is not only a medical issue,” she explains. “It is also a human and social problem.”
Training and transformation
Both doctors took part in a World Health Organization (WHO)-supported intervention being led by the NGOs MASUM and CEHAT in Aurangabad district of Maharastra, India and funded by the UK government’s What Works 2 Prevent Violence against women. The study called “Project Uddan” is implementing WHO guidelines on strengthening the health systems approach to responding to violence against women. Project Uddan introduced them to the LIVES job aid – Listen with empathy, Inquire about women’s needs and concerns, Validate their experience, Enhance their safety, and facilitate social Support through a training. The LIVES tool was developed by WHO and the UNDP/UNFPA/UNICEF/World Bank/WHO Special Programme in Human Reproduction (HRP) to guide health workers to offer first-line support for survivors of violence.
Soon after joining the centre, Dr Gawande took part in the WHO-supported training for health care providers. “At first, I wasn’t sure whether women would come forward or share their situation,” she said. “Before, I focused only on the medical treatment part. The training made me realize that there might be other reasons behind why a woman visits the health centre.”
For Dr Dhabe, the training changed how he interacts with his patients. “We were taught how to identify, not only in cases of severe assault, but also through small signs that show that a woman may be a survivor of violence,” he says. “And we learned how to maintain confidentiality and communicate in a way that does not cause further harm or distress.”
In Nandur, Dr Gawande remembers her first encounter with a survivor. “A woman came to me complaining of redness in her eye,” she says. “She said a twig hit her while picking fruit. But I realized something was wrong. I gained her trust and spoke gently. Eventually, she told me she had been beaten.”
Dr Gawande provided LIVES support and referred the woman for counselling. “She was advised on how to improve her safety,” she added.
For both doctors, these experiences mark a profound shift – from treating injuries to addressing the context of women’s health more holistically. They have learned to read between the lines, to create moments of safety even in busy outpatient departments.
“If a woman comes with her in-laws, we find a way to speak to her separately,” Dr Dhabe explains. “We might refer her to the counsellor under the pretext of dietary advice or baby care. During outpatient department hours we are very busy, but if we identify a woman who may need help, we ask her to wait or refer her to our nurse who can provide the LIVES support.”
New evidence and resources
According to the newly released Violence Against Women 2023 Estimates, about 30% of women aged 15 years and older have experienced physical or sexual violence by an intimate partner or non-partner at least once in their lifetime. In the past year alone, 316 million women were subjected to intimate partner violence. These figures have remained largely unchanged for two decades, underscoring the urgency of action.
Yet amid the sobering data lies hope. The new edition of RESPECT Women outlines seven proven strategies to prevent violence; from strengthening relationship skills and empowering women and girls to ensuring multi-sectoral, survivor-centered services, reducing poverty and transforming harmful social norms. The health system has a critical role to play in ensuring survivor-centered services but can also contribute to prevention by countering harmful social norms as health workers are role models in their communities.
Dr Gawande has seen this transformation start within her own practice. “Earlier, women came only for medical treatment. Now they also share their personal problems. This training builds skills in forming an emotional connection. Women realize we will listen without judgment and keep everything confidential. This is the common mentality in rural areas,” she said. “Women are not happy about the violence, but they often think it is something normal that happens in families.”
Both doctors now mentor other staff, encouraging them to adopt the same approach. “Even if through our identification we can simply create a space for a woman to talk, it will have great benefits,” said Dr Dhabe. “Women often just need someone to listen to them.”
“Every treatment lies on the foundation of tender love and care,” says Dr Dhabe. “A warmth of love is what every doctor should give to a patient. That is what builds the bond between doctor and patient, more than any medicine.”
Looking ahead, he hopes more doctors will receive this kind of training and that health policies will reach the people who need them most. “The government has made strong reforms, but there is often a gap between policy and implementation,” he says. “That gap can only be closed through proper training, awareness, and education so that every woman knows her rights, and every health worker knows how to help.”
Every woman deserves to live free from violence. If we, as health workers, can take even a few minutes to listen, we can make a difference.
For Dr Gawande, the most powerful lesson has been about empathy. “When I identified my first survivor, I realized that women do speak up, but only when you talk to them with sensitivity,” she said. “Health workers who have not yet identified a survivor should try once. If through our efforts even one life is saved, the satisfaction is immense.”
Beyond the frameworks and statistics, it is about listening and believing, about creating environments where women can heal and reclaim control over their lives. As the 2023 estimates remind us, the world has made limited progress in reducing violence against women. But stories like those of Dr Dhabe and Dr Gawande show that change begins one conversation at a time, when a woman is heard, respected and supported.
“Every woman deserves to live free from violence,” Dr Dhabe says. “If we, as health workers, can take even a few minutes to listen, we can make a difference.”