I Believe You, with Florence Bauer

Last episode on I Believe You, Dr. Hans Kluge set out why WHO Europe has made violence against women and girls one of its top priorities. This week, what that means in practice. 

When a woman or a girl walks into a clinic, that may be the only moment anyone has a chance to notice what is happening to her, whether the person in front of her is ready to understand that it can change everything.  

Melanie Hyde and Greg Bianchi spoke to Florence Bauer, who runs the UN Sexual and Reproductive Health Agency, UNFPA as Regional director across Eastern Europe and Central Asia. They talk about how that work connects to violence, about the abuse that has moved online, and got very much worse there. 

I Believe You is a three-part mini series for WHO's Health In Europe.  This is episode two. 

Listen to episode one: https://www.buzzsprout.com/1109867/episodes/19542850

Transcript

David Barrett: You're listening to WHO's Health in Europe, and this is episode two of our miniseries, I Believe You. My name is David Barrett. 

Before we start, a warning for our listeners that this episode contains discussion of the rape of a minor. Please consider that before you choose if or where to listen 

Last episode on I Believe You, Dr. Hans Kluge set out why WHO Europe has made violence against women and girls one of its top priorities. This week, what that means in practice. When a woman or a girl walks into a clinic, that may be the only moment anyone has a chance to notice what is happening to her, whether the person in front of her is ready to understand that it can change everything. 

My colleagues Melanie Hyde and Greg Bianchi spoke to Florence Bauer, who runs the UN Sexual and Reproductive Health Agency, UNFPA. She's their regional director across Eastern Europe and Central Asia. They talk about how that work connects to violence, about the abuse that has moved online, and got very much worse there. 

Here's that conversation. 

Melanie Hyde: So Florence, could you describe us a little bit about your upbringing and the journey to your current role at UNFPA? Yeah,  

Florence Bauer: no, thank you. Thank you so much. So nice to see you as well, Melanie, and thank you for the question. I've been working for over 30 years in total, but from them, 25 years in civil society and in the UN, and in particular with UNICEF and UNFPA. 

And over all those years, I've been always focusing on promoting and advocating for human rights, and in particular, for women's rights and for children's rights. And I've done this in in different countries in, in particular, in Latin America and also in in Europe, Eastern Europe, and and Central Asia. 

And what I've always seen is the impact that violence can have on on people in general, but in particular, on women, on girls and the impact it has, on the individuals but also on the communities and the societies. And I've seen that really closely in the different countries that I've been engaging with, and I also saw how the work that UNFPA and other agencies and other actors are doing, it's so fundamental so that we can jointly prevent and also respond to the cases of violence. 

So this is what keeps motivating me and continue to work in this field. Thank you,  

Greg Bianchi: Florence. That's that's really interesting. And the title of this podcast series that we're recording here is I Believe You, and this links very much to WHO Europe special initiative on tackling violence against women and girls. 

And in your work at UNFPA can you perhaps explain a little bit more about how sexual and reproductive health and rights impacts this ability to provide healthcare for survivors of violence?  

Florence Bauer: Yeah. No, thank you. Thank you so much. Now first of all, let me start by reminding all of us that sexual and reproductive health and the ability of to live without any form of violence, it's a, a fundamental human right, and they do have an impact on the wellbeing of people everywhere. 

So that's the first thing. Then I would like to elaborate a bit on on the links that we see between gender equality, sexual reproductive health, and gender-based violence. So first of all, the gender inequality or discrimination against women is clearly one of the root cause for gender-based violence And that's also what's behind the different barriers that also prevent women and girls from accessing health service on sexual reproductive health. 

So that's the first element that we see. Then what is also important is that individuals, and here I'll focus maybe more on, on women and girls, when they don't have access to sexual reproductive health they lose the ability to make the decision about their bodies. They lose what we call the bodily autonomy, which is really deciding what you're going to do with your own body, and it makes them easier targets for any forms of exploitation, of abuse and of violence. 

And for example when a woman cannot make the choices on the number of children that she wants on the spacing between children, she's most likely to exit from the labor market, to exit from education, and this has an impact, of course, of her independence and of her autonomy. And we know how those elements are linked also to gender-based violence. 

So i- it makes it more difficult for her to exit to leave a fam- a household, for example, and the likelihood of staying more time in a violent household is- becomes higher. W- what we also see is that when women, when they don't get the information through sexual reproductive health education, for example, i- it's more difficult to identify what are the red flags and to, to be able, the ability to react when they see that something is going to happen. 

So it has a very strong strong links, the access to sexual reproductive health and gender-based violence. Now, when we also look at, now taking it in, in, in the other direction, let's say, when we look at the links between the survivors of gender-based violence and the access and the impact that it's going to have on sexual reproductive health. 

So we know that survivors of gender based violence, for example they can suffer from different risks related to sexual reproductive health. They can have unintended pregnancies. They can they're more prone to sexual transmitted infe- infection, to HIV, in some cases even to complications on abortion or unsafe abortions. 

And they face barriers as well when they access the health service. And here's when I want to go more specifically into that aspect because we know that and that's particularly worrying when it happens in that in, in, in some cases it's very difficult for them to access the health services. 

It can be from- A, a certain level of discrimination, of harassment, or, asking question, making them uncomfortable. And what we also see in some more extreme case, there can even be risk of tactics being used for limiting her capacity to have children, forced sterilization, or going through medical procedures that they're not very much aware of, or they didn't give their agreement to go through this kind of of medical procedure, for example. 

So that's where the health system is is so important as well to be prepared to identify what is a case of gender-based violence and to respond to them in a way that is going to protect the woman or the girl and to make sure that she feels she feels welcome. And that's why as UNFPA, we do work on on both, on gender-based violence and sexual reproductive health, and they're really at the core, I would say, of our mandate because they're so much interlinked. 

And if I may, I want to take an example Melanie of of Tajikistan, and this is a place that I've been visited, visiting last year. It's in a remote areas. It's in a medical facility. There is a safe space that UNFPA has supported as a maternity to establish, and this is a safe space where women and girl can come and receive all kind of supports. 

It's medical support, psychological support, legal support, and so on. And I was talking to one of the doctors working i- in that safe space, and I was asking her about the cases that she has been facing and she was telling me all kind of stories, but there's one, for example, that really caught my caught my attention. 

She was describing a young girl. She was 14 years old, and she arrived, she was pregnant over 20 weeks already, and her mother under despair because she had been raped by a, by somebody from the family. And so the mother, she tried to proceed to a unsafe abortion. And so when she arrived, she was in an extremely critical state so the good thing is that they went to that safe space, and she was under shock. 

She was from a medical point of view, under high risk, but also talking about suicide and the whole impact it had on that girl who didn't even understand what, what had happened to her. And she received all the support. So she has been surviving. She's safe and the attacker has been also detained. 

So she also received that kind of support. So that just an example of of the kind of intervention that can be undertaken to to prevent, and in this case, to respond to the cases of of gender-based violence. And that's in a medical center, and that's why working with health workers, working with medical centers is absolutely fundamental throughout the cases. 

First on the identification of the red flags or what is happening when somebody comes to a health center, up to the response, up to the more extreme cases like the ones I've been describing where they play such a fundamental role.  

Melanie Hyde: Thanks, Florence. Really helpful example there, and it reminds me also of, I think, working in Poland and other countries in the, the response to the Ukraine crisis, where actually access to emergency contraceptions were very difficult for the populations that were fleeing. 

And I think this also leads well into the next question, which is really one of the questions that we always get, and I think you explained this in your answer already to some degree, is, from a medical perspective, we provide support to all survivors, whether that be, be men or women or girls or boys, but we are focusing on women and girls, and that's for a reason. 

And I think for those of us who work in this space, it's clear. But also for others it might be a little bit difficult to understand why do we focus on this? Why do we have these specific SDGs on eliminating violence against women and girls? And then what's the different framework for children and why the focus? 

So maybe you could help us to understand a little bit more there.  

Florence Bauer: Yeah. No, absolutely. Now I think the first element here is that whe- when we look at the numbers, and here we can take some numbers from WHO still one in three women they are actually survivors of forms of violence, of sexual violence or partner sexual violence. 

That's a n- that's a huge number. It's 840 million people. I- it just by the number itself, it's, it makes it obvious that it has to be a top priority for everywhere and everybody. What is also important when we look at gender-based violence is that i- it impacts as individual, but the impact is much broader. 

It has an impact on the whole family. It has an impact on the children. Been working a lot as well on, on violence against children, and they very often go together. When you have an environment with gender-based violence, the likelihood of having also violence against children is very high, and it goes both ways. 

So the so it's very much linked. And when you have a, a violent a violent household, it's going to impact the whole family. It has all kind of consequences in terms of health, of mental health, and also on labor, on access to education, on suicide and so on. So the, the impact are absolutely fundamental And then the impact, they also, they are much broader than the family or the households. 

The impact, it goes to the whole communities, it goes to the whole to the whole area, to s- and to society in general. Because as I said, we're talking about huge number, one in three women. It basically means that we all know women who have been going through the situation. Independently of where we are, where we work, whatever absolutely, for sure, we have been in contact with one of those with one of those women. 

So we can imagine, and we can see the impact it has underneath, on, on how it also creates an environment of of insecurity an environment of fear, and that has an impact again, on, on mental health and also the ability of those women and girls to to engage and to engage with with education, with the schools, with the university, with with the work environment with friends and so on. 

So it's very much underneath but with a tremendous impact in all part of society. A- and now the question as well is why is it only women and girls? No. We know that violence impacts as well a- as well, men, it impacts boys, it impacts the different parts of society. But what we also see is that the evidence is that the proportion of women and girls is so much bigger and they're so much more profoundly impacted and broadly in, in large numbers than men and boys, for example or other part of society. 

Now, what is important is to make sure that in everything that we do also provide a space for those survivors of of violence beyond women and girls. And also what is important when we work on the prevention is to also work with men and boys. And that's fundamental because we know that one of the root causes for gender-based violence, and I see that, everywhere, but I see that in the countries where where I work, for example, is social norms. 

And social norms, the way also families are organized and and that's something that has an impact on gender-based violence, and that's something that needs to be worked with society as a whole, and also with men and boys. And the dialogues with with them are fundamental to be able to impact on the social norms and to create an environment where violence is less likely less likely to happen. 

Greg Bianchi: Thanks, Florence. Yeah, and I think that, that final point you're making there about the speaking with men and boys particularly as well about addressing these issues as well, not necessarily to point a finger, but to, to explain, I think is really important. And I know last year, I believe it was last year you point- published a joint statement along with OSCE, so that's the Organization for Security and Cooperation in Europe, and they they led a survey which conducted a report with UNFPA and found you've already explained this, but one in three women expected to face physical or sexual violence in her lifetime, and this prompted you to go as far as calling this a a public health crisis. 

But I wanted to turn a little bit, and this perhaps is back to this, this norms matter you were discussing before, which is particularly the role of technology and online tools. We've seen a lot of headlines in the past, past weeks unfortunately, about how artificial intelligence and other online tools are being used to, to, yeah, to within, within this space. 

So what work is UNFPA doing to try and tackle that technology-facilitated violence?  

Florence Bauer: Yeah. Yeah you're so right. What we see actually is that the violence, the gender-based violence that happen within the digital world, let's say, it's very often a continuation of what happens offline. 

So it has to be seen as a, a- as a broader impact, if you want, of an issue that exists offline as well. Now, what technology does and the whole environment, digital environment does, it's just it's, it becomes exponential. Before, when something was happening, you would be exposed maybe to a smaller group if we're talking about harassment or, for example. 

And now it just takes a completely different dimension. It goes potentially to anybody, actually. So the, the impact is absolutely tremendous. But what is important is that it's considered, it's that any response to gender-based violence includes the technical technology-facilitated gender-based violence. 

It should be a component, not something in isolation, but really a part of a, a big component with its particularities of the response, the prevention of the response to to gender-based violence. W- what is also an, an additional challen- challenge in that is that there is a lack of the legal the laws that will regulate the the technology-facilitated gender-based violence and also the systems at, It's a big challenge, let's say, for system to adapt to such a, a changing environment. 

So the social protection system as well need to be adjusted to be able to respond to this new to this new challenges 

Now you were asking what are we doing? There are a number of initiatives. One is the Safety by Design it's called. So that's about working and lobbying with technology companies so that there are features that are included into the platform's architecture from the beginning. So it, it is a challenge. 

You need to really work and advocate for that to happen, but it needs ... a- as soon those barriers, let's say, are included from the beginning, the best, the more effective they're going to be. The other impact is in order to also help young people to protect themselves, it's fundamental to have those aspects that are included in the school curriculum and in the youth program. 

So that's where we come back to all the, the importance of education, of sexual reproductive health education, comprehensive sexuality education, so that young people get, receive the information adapted, of course, to their age, but on how to protect themself. It's 

really a question of protection. When we see when an adolescent is aware of what the risk are of exposing herself, for example, on the web it's the likelihood that she will be able to protect herself or to identify the red flags and not to fall into traps, because there's sometimes very, very professional ways of of of trapping, actually, young people. 

So the better they are prepared, the more likely they are not to fall into the traps and to defend and to protect themselves. And that's of course something that as UNFPA, we're working in many countries to make sure that that children, young people receive age-adequate information mainly to protect themselves. 

Another, another intervention initiatives that I found really powerful, it, it's Body Right. And Body Right is an initiative that has a whole digital component because it's really it includes a campaign about people protecting their body rights and explaining what it means on the digital sphere. 

And that goes together with also programmatic interventions to ensure that there are laws and in place in order to respect to respect the bodily autonomy. So i- it's basically, the whole principle of the campaign is that, we have a copyright to protect intellectual property. 

So the body makes a case about the right to protect your own body. You should be the one who decides about how the image of your body is going to be used and how your body, of course, is going to be used or to be shown. So it makes that parallelism, let's say. And and it is a, a, a powerful campaign to reach young people and with many influencers and people who have been adhering to it and using it as a way of of promoting the concept of of body right, which makes it so clear actually what what we are advocating for. 

It's to be able to decide on your own body in all its dimension, and that's fundamental.  

Greg Bianchi: No, absolutely. And I think it's interesting that you say there about schools. I'm just thinking back to, it's a little while ago now that I was at school, but but smartphones and those sorts of things were very much in their infancy when I was younger. 

And I think one of the... Basically, what I think the point I'm trying to make is that a lot of these norms aren't necessarily new. They've existed for a long time, but certainly something that we didn't have when I was younger was this kind of catalyst, this, this tool in my pocket where somebody, where people are spreading disinformation, misinformation. 

And I think it's really interesting what you say there, particularly about sex education in school. Again, thinking back to my time at school, this, this discussion just wasn't really had, so it's really interesting that's happening. This might be a little bit of a difficult question for you to ask, but just to follow up on, on what you're saying about this. 

But in terms of the, the long-term trends for societies or long-term impact, I should say, for societies on what you've described there, is there anything you'd like to say to that at all?  

Florence Bauer: Yeah. No, the it has an impact in so many dimension. It has an impact a- again, at the individual level i- it really puts barriers to the development of the individual and how the individual will be able to contribute to society. It has also a very strong economical cost, when people go through gender-based violence and the traumas they face, whether it's physical psychological, and and both most often, requires a very professional kind of support by health system, psychologist and so on, and that has a cost for society. 

So it has a tremendous economical cost as well, beyond the whole human impact it has on, on society. That's why i- it has to continue to be recognized as a global objective for everybody, for all societies because of all the impact it has on the social life, on the economical life, and and on other, all other dimension of of development. 

And when you have part of society who gets traumatized sometime very early and feels they ... If they feel at that moment that they don't have the space to receive the support that they need and even to talk about it, then they're put into a situation of silence and isolation, and that can have tremendous impact on their own development. 

And we know how violence sometime reproduce itself. We see that a lot when we talk about violence again- against children. If it's not addressed at that moment it just has an impact as well on the development of the individual, and many perpetrators of violence have them- themselves been actually also survivors of violence. 

So for the long-term development of society, starting from individual family, community, schools l- y- cities, countries, and so on and it's really fundamental to be able to be aware of the issues and to tackle it and to respond to it.  

Melanie Hyde: Thanks, Florence. I think you really tie it all together in really well for us, and I think particularly looking at what's happening today and the kind of cases that we're seeing and the explosion of AI and the use of nudify apps and all sorts of things that are being used and at, at, at a scale that we really can't keep up with it's really concerning and important, I think, the work that you're doing. 

And so I think for us, it's clear, the impacts on individuals, the impacts on societies. But if there's still people listening that perhaps think that these issues that we're talking about today don't impact them, what would you say to those people?  

Florence Bauer: But I would say, first of all, rem- remember is that this impact one out of three women. 

So the probability that anybody who is listening has somebody actually maybe close who has been impacted or can be impacted i- is something that it's important that everybody is aware of, and and that they are prepared also to provide support and to identify any kind of red flags when something occur. 

It's also part of of the elements that are so 

important. I think everybody has a role to play in, in order to identify and to respond to those cases. And the first step is to be aware that each person most likely knows somebody who is going through this kind of situation. 

Greg Bianchi: Melanie, again, I think that was a, a really interesting interesting chat we had with Florence there, building on a little bit on what we spoke with Hans about last time, which is- and it's interesting to also hear her perspectives on the aspect of the, the online harms, which maybe we haven't discussed much in, in this series already and how they're really an extension of what's going on in the offline world in many ways. 

And in particular, this is perhaps something that we cover more in this episode is the role of men and boys addressing violence against women and girls too. So whether that's at school or later in life, obviously in, in that sense. So I guess this also has a resonance for what WHO Europe is doing with the special initiative itself, and how can we ensure that the health system and health workers, regardless of gender are alive to these, and alerts to these issues of gender-based violence. 

Melanie Hyde: Yeah. I think what's important here is also to remember how complex it is to measure all forms of violence. It took so many years to come up and develop comparable measurements on intimate partner violence and sexual violence. And part of the reason for this, and the reason it's remained hidden for so long, is that the surveys really always underestimated the rates due to the normalization of abuse, stigma, victim blaming. 

So for example, if you ask someone that they, if they've been raped in a questionnaire, you'll get far less disclosure than if you ask questions about specific acts, so forced intercourse, unwanted sexual acts. And that's because the use of words like violence and abuse are really open to interpretation, and what comes with interpretation is loaded with social norms and stigma and blame, and ultimately reduces disclosure. 

And for technology-facilitated violence it's even more complex 'cause we really only just had global consensus on what that definition is and what counts. ... So when Florence mentioned that we're really developing and working together to develop this operational framework to measure it with UN partners, which is critical if we want to develop evidence-driven strategies that prevent and respond to it. 

But even though it might have distinct features, I think it's important to remember that's really part of a continuum of multiple and recurring and interrelated forms of gender-based violence, with the same shame, the same victim blaming that we see in the forms that we can already measure. So one thing I see is that when there's image-based abuse and non-consensual sharing of pictures, like nude pictures, for example, often I hear people talking about how girls need to be really careful, they shouldn't share, and again, we're putting the blame and the onus on the girls, right? 

On the victims, and not on the perpetrators, and that's something that we can change today.  

Greg Bianchi: No, absolutely. And I think, again we touched upon that in, in the interview as well, where we're saying a lot of these issues, they're not particularly new in terms of the attitudes. It's just 

And I think I, I mentioned this to Florence as well, is that in recent years it's become catalyzed almost through through different platforms. Whether that's smartphones or social media and stuff. But also as you say, how we frame things, in terms of how you're ans- asking those questions. 

If it's more of a direct point, then it's, as you say, it's less likely to elicit a response. But also how, yeah, how much we're sort, still discovering in that sense, it- the scale kind of isn't completely understood. I know we say it's one in three as an estimate, but it, yeah, it could be potentially more than that in, in lots of ways if we're still only starting to understand the scale of it now. 

Melanie Hyde: Yeah. It's highly likely to be much higher, Greg. But I think from the health perspective, there's clear health impacts that we certainly can and should be addressing.  

Greg Bianchi: I think that was yeah, a good conversation to, to carry on. And next week we'll be hearing from Lisa from UN Women. 

So very much looking forward to having that conversation and speaking again, Melanie.  

Melanie Hyde: Yeah. Thanks, Greg. Me too.