Clinical overview
Gender-based violence (GBV) is violence directed at a person because of their gender or that affects one gender disproportionately. In South Africa it is endemic: intimate-partner violence, sexual assault, and femicide occur at rates among the highest recorded anywhere, and the clinic or labour ward is frequently the first — sometimes the only — point of contact a survivor has with a service that can name what is happening, treat it, document it, and open a door to safety. For the O&G registrar this is not a peripheral social problem; it is core clinical work. GBV presents as recurrent sexually transmitted infection, unwanted or concealed pregnancy, antepartum or postpartum haemorrhage from abdominal trauma, miscarriage, genital injury, chronic pelvic pain, "non-specific" gynaecological complaints, late or absent antenatal booking, depression, and self-harm. Pregnancy is itself a recognised period of heightened risk: violence may begin or escalate in pregnancy, and homicide is a meaningful contributor to maternal mortality.
To appraise a survivor — the verb that defines this objective — is to do considerably more than treat the presenting injury. It means recognising GBV behind a vague presentation, conducting a safe and trauma-informed enquiry, assessing acute medical and forensic priorities, weighing immediate danger to life, gathering and preserving evidence to a medico-legal standard, applying the correct South African statutory framework, and judging what each individual survivor actually needs — clinical, legal, psychological, and protective. The registrar must hold the clinical and the medico-legal in the same hand, never sacrificing safe care for paperwork, nor neglecting documentation that may later be the only objective record of the assault. Throughout, the survivor's autonomy and dignity are paramount: she decides, you enable. See Informed consent and SA O&G law for the statutory and consent scaffolding this chapter sits within.
Core knowledge
Defining the field
GBV is an umbrella term. The clinically relevant categories overlap and co-occur:
- Intimate-partner violence (IPV) — physical, sexual, emotional/psychological, or economic abuse by a current or former partner. It is typically chronic and escalating, with coercive control as its engine. It is the commonest form of GBV the gynaecologist meets.
- Sexual assault / rape — non-consensual penetration or sexual contact. May be a single acute event (the survivor presenting acutely) or part of ongoing IPV.
- Femicide — the gender-motivated killing of a woman, the lethal end of the GBV spectrum; intimate-partner femicide is the most common subtype in South Africa.
- Female genital mutilation (FGM) — partial or total removal of external genitalia for non-medical reasons; uncommon in South-African-born women but seen in migrant populations.
Why pregnancy matters
Violence and reproduction are bound together. Coerced sex causes unwanted pregnancy; pregnancy can trigger or intensify abuse; abuse causes obstetric harm (placental abruption from blunt trauma, preterm birth, low birth weight, miscarriage). Forced or coerced reproductive control — sabotaging contraception, forcing pregnancy or forcing termination — is itself a form of GBV. A woman who books late, conceals her pregnancy, attends antenatal visits accompanied by a partner who answers for her, or has injuries inconsistent with her account, warrants quiet consideration of IPV. The psychiatric sequelae in pregnancy (depression, anxiety, PTSD, suicidality) are substantial — see GBV and mental health in pregnancy.
The South African statutory and service architecture
This is examinable and you must know it cold:
- Criminal Law (Sexual Offences and Related Matters) Amendment Act 32 of 2007 — the governing sexual-offences statute. It defines rape broadly and gender-neutrally, regulates compelled HIV testing of alleged offenders, and entrenches the survivor's right to post-exposure prophylaxis (PEP) and to be informed of it.
- Domestic Violence Act 116 of 1998 — provides for protection orders against an abuser; clinicians may need to support a survivor seeking one.
- Children's Act 38 of 2005 — abuse or neglect of a child is a mandatory report.
- The J88 — the statutory medico-legal form on which the clinical findings of a forensic examination are recorded for court.
- Thuthuzela Care Centres (TCCs) — one-stop, survivor-centred rape-care sites (typically attached to a designated hospital) integrating medical care, forensic examination, counselling, and the criminal-justice interface to reduce secondary trauma.
- National Department of Health Maternity / clinical service guidance — the National Integrated Maternal and Perinatal Care Guideline (NDoH, 2024), and the EML frame antenatal screening and the obstetric care that GBV survivors need; HIV PEP and STI management sit within the national HIV/ART and STI guideline framework.