Violence against women is not a women's issue or a health issue, it is a human rights abuse and development issue for its impact can be crippling to progress, with half the population discriminated against to such a disadvantaged position that they're unable to perform to their full potential.The campaign runs every year from November 25, the International Day for the Elimination of Violence Against Women to December 10, Human Rights Day since its initiation at the Center for Women's Global Leadership (CWGL) in America's Rutgers University.

In Fiji and other Pacific nations, the period has seen various activities organised by line ministries and different organisations, affording ordinary people different perspectives of the impact of violence against women and girls.

The Fiji Midwifery Society 4th Scientific Conference marked their first day, November 25, with the launch of the campaign by the director (of) Nursing Services Selina Waqa-Ledua, on behalf of the Ministry of Health and Medical Services.

The launch of 16 Days of Activism for the Elimination of All Forms of Violence Against Women and Girls at the midwifery conference is just one of the many activities the United Nations family supports with critical partners addressing violence against women and girls, across the Pacific.

Ms Waqa-Ledua focused on an area which is significantly impacted by violence against women and girls although not usually discussed in open forums - that is the impact violence has on women and girls' sexual and reproductive health and its implications on sexual and reproductive rights.

Speaking to about 130 midwives at the Miracle Centre in Labasa, Ms Waqa-Ledua reminded them of their strategic positioning to be effective and positive responders to survivors who come for medical attention in their health centers or hospitals.

"Violence against women and girls includes physical, sexual, psychological and economic abuse. The effects of violence can be devastating to a woman's reproductive health as well as to her physical and mental wellbeing," Ms Waqa-Ledua said.

"Women with a history of physical and sexual abuse are also at increased risk of unintended pregnancy, sexually-transmitted infections and adverse pregnancy outcomes. Yet victims of violence who seek care from health professionals often have needs that providers do not recognise, do not ask about and do not know how to address.

"Reproductive health care providers are strategically placed to help identify victims of violence and connect them with other family support services. Providers can reassure women that violence is not something to be accepted or tolerated and must be condemned and discouraged by all means."

Ms Waqa-Ledua reminded midwives of the enormous negative impact of violence against women and girls' on the safety, dignity and health of people "as well as affecting public health, economic wellbeing and the security of a nation".

"Many cultures have beliefs and norms, and social institutions that legitimise and therefore perpetuate violence against women," she said.

"The same acts that would be punished if directed at any employer, a neighbour or an acquaintance often go unchallenged when men direct them at women, especially within the family."

Research findings have confirmed that majority of women who are abused are abused by their partners and are abused many times which creates an unhealthy atmosphere of terror in homes and costs women's lives.

As health workers, Ms Waqa-Ledua encouraged midwives to support their colleagues to identify and provide effective assistance to survivors of violence as health workers more often than not miss opportunities to help because they are oblivious to signs and symptoms, indifferent and/or are judgmental.

Ms Waqa-Ledua said health care providers could learn how to ask women about violence in ways that survivors would find helpful and a lot more supportive of a positive outcome.

Ms Waqa-Ledua said health workers could provide medical treatment, offer counselling, document injuries and refer their clients to legal assistance and support services.

"Family planning and other reproductive health care providers have particular responsibility to help because abuse has a major although little-recognised impact on women's reproductive health and sexual well-being," she said.

"Providers cannot do their jobs well unless they understand how violence and powerlessness affect women's reproductive health and decision-making ability."

Globally, at least one woman in every three has been beaten, coerced into sex or otherwise abused in her lifetime. In most cases, the perpetrators are known to the victim and its impact becomes a major public health concern and a violation of human rights.

A Fiji Women's Crisis Centre national study on violence against women (2011) revealed Fiji has very high levels of violence, including sexual violence compared to other countries in the world.

The study established that 64 per cent of women who have ever been in an intimate relationship have experienced physical and or sexual violence by a husband or intimate partner in their lifetime.

Two of the most common forms of violence against women are abuse by intimate male partners and sexual violence, whether it takes place in childhood, adolescence or adulthood.

Intimate partner abuse also known as domestic violence, wife beating or battering is almost always accompanied by psychological abuse and in one quarter to one half of cases, by sexual violence as well.

Ms Waqa-Ledua said the Ministry of Health and Medical Services was committed to working with civil society organisations including education institutions to ensure violence against women responses was integrated in the work of different partners.

Today, on the eve of Human Rights Day, let us acknowledge that the fundamental shift needed to address the unacceptably high level of violence against women and girls is really, in our hands. We can and should be the change we want to see in the world, as aptly articulated by Mahatma Gandhi.