Kadına Yönelik Şiddetin Birinci Basamakta Yönetimi
Özet
Kadına yönelik şiddet (KYŞ), toplumsal cinsiyet eşitsizliğinden kaynaklanan ve dünya genelinde kadınların üçte birinden fazlasını etkileyen küresel bir halk sağlığı sorunudur. Bu bölüm, KYŞ'nin birinci basamak sağlık hizmetlerinde yönetimini kapsamlı bir şekilde ele alarak, aile hekimlerinin sağlık sistemiyle ilk temas noktası olmaları nedeniyle üstlendikleri kritik rolü vurgulamaktadır. Güncel ulusal ve uluslararası kılavuzlar (DSÖ, NICE, USPSTF) doğrultusunda erken tanı, tıbbi ve psikososyal yönetim, uygun belgelendirme ve yönlendirme süreçlerine ilişkin kanıta dayalı rehberlik sunmak amaçlanmıştır. Bölümde KYŞ'nin tanımı, epidemiyolojisi, sağlık üzerine etkileri ve Türkiye'deki hukuki çerçeve sistematik olarak incelenmekte; uygulanabilir klinik yönetim protokolleri sunulmaktadır. Yapılandırılmış tarama yaklaşımları, travma bilgili bakım ilkeleri, multidisipliner iş birliği ve kadın merkezli hizmet sunumu ayrıntılı biçimde ele alınmaktadır. Zaman kısıtı, mahrem alan eksikliği ve adli süreç belirsizliği gibi sağlık yanıtını zayıflatan sistemsel engellerin aşılmasına özel önem verilmektedir. Bu bölüm; birinci basamağın erişilebilirlik, süreklilik, bütüncül değerlendirme ve bağlamsal anlayış gibi özgün güçlerinin, aile hekimlerini KYŞ ile mücadelede merkezi konuma getirdiğini vurgulamaktadır. Yüksek kanıt değerli belgeleme standartları, adli raporlama prosedürleri ve güvenli yönlendirme yollarının uygulanmasına yönelik eylem odaklı öneriler sunularak, Türkiye'deki birinci basamak uygulamasında kadınların sağlık haklarını ve güvenliğini önceliklendirmektedir.
Violence against women (VAW) is a global public health issue stemming from gender inequality and affecting more than one-third of women worldwide. This section comprehensively addresses the management of VAW in primary health care, emphasizing the critical role of family physicians as the first point of contact with the health system. The aim is to provide evidence-based guidance on early diagnosis, medical and psychosocial management, appropriate documentation, and referral processes in line with current national and international guidelines (WHO, NICE, USPSTF). This section systematically examines the definition, epidemiology, health effects, and legal structure of VAW in Turkey; applicable clinical management protocols are presented. Structured screening approaches, trauma-informed care principles, multidisciplinary collaboration and women-centered service delivery are discussed in detail. Special emphasis is placed on overcoming systemic barriers that weaken the health response, such as time constraints, lack of privacy and uncertainty in the legal process. The section emphasizes that the unique strengths of primary care—accessibility, continuity, comprehensive assessment, and contextual understanding—place family physicians in a central position in combating VAW. It prioritizes women's health rights and safety in primary care practice in Turkey by presenting action-oriented recommendations for implementing high-evidence documentation standards, forensic reporting procedures, and safe referral pathways.
Referanslar
Ay, R., & Kılınçel, Ş. (2020). Hekimlerin kadına yönelik şiddet ile ilgili bilgi ve tutumlarının değerlendirilmesi. Journal of Contemporary Medicine, 10(4), 600–608. https://doi.org/10.16899/jcm.723415
Campbell, J. C. (2003). Prediction of homicide of and by battered women. NIJ Journal, 250, 14–19.
García-Moreno, C., Pallitto, C., Devries, K., Stöckl, H., Watts, C., & Abrahams, N. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization.
García-Moreno, C., Hegarty, K., d’Oliveira, A. F. L., Koziol-McLain, J., Colombini, M., & Feder, G. (2015). The health-systems response to violence against women. The Lancet, 385(9977), 1567–1579. https://doi.org/10.1016/S0140-6736(14)61837-7
Gündüz, N. (2019). The relationship of intimate partner violence with mood and anxiety disorders in fibromyalgia syndrome patients. Archives of Rheumatology, 34(4), 472–479.
Hacettepe University Institute of Population Studies. (2015). Türkiye’de Kadına Yönelik Aile İçi Şiddet Araştırması. T.C. Aile ve Sosyal Politikalar Bakanlığı.
Hayran, O. (2018). Bütünleşik sağlık hizmeti ve birinci basamak. Türkiye Aile Hekimliği Dergisi, 22(3), 133–137.
Howard, L. M., Trevillion, K., & Agnew-Davies, R. (2013). Domestic violence and mental health. International Review of Psychiatry, 25(5), 613–619. https://doi.org/10.3109/09540261.2013.873985
Krug, E. G., Mercy, J. A., Dahlberg, L. L., & Zwi, A. B. (2002). The world report on violence and health. The Lancet, 360(9339), 1083–1088. https://doi.org/10.1016/S0140-6736(02)11133-0
Miller, E., McCaw, B., Humphreys, B. L., & Mitchell, C. (2015). Integrating intimate partner violence assessment and intervention into health care in the United States: A systems approach. Journal of Women’s Health, 24(1), 92–99.
National Institute for Health and Care Excellence. (2024). Domestic violence and abuse: Multi-agency working (PH50). NICE.
National Institute for Health and Care Excellence. (2024). Domestic violence and abuse: Multi-agency working. NICE Guideline [NG225]. https://www.nice.org.uk/guidance/ng225
O’Doherty, L. J., Taft, A., Hegarty, K., Ramsay, J., Davidson, L. L., & Feder, G. (2015). Screening women for intimate partner violence in healthcare settings. Cochrane Database of Systematic Reviews, 2015(7), CD011790. https://doi.org/10.1002/14651858.CD011790.pub2
Özcan, A., & İnan Ceviz, A. (2022). Birinci basamak sağlık çalışanlarının kadına yönelik şiddete ilişkin bilgi ve tutumları. Sürekli Tıp Eğitimi Dergisi (STED), 31(4), 281–288. https://doi.org/10.17942/sted.1094161
Royal Australian College of General Practitioners. (2022). Intimate partner violence: Identification and response in general practice. RACGP.
Saletti-Cuesta, L., Aizenberg, L., & Ricci-Cabello, I. (2018). Women’s perceptions of intimate partner violence in primary care: A meta-synthesis. International Journal of Environmental Research and Public Health, 15(12), 1–15. https://doi.org/10.3390/ijerph15122705
Sardinha, L., Maheu-Giroux, M., Stöckl, H., Meyer, S. R., & García-Moreno, C. (2022). Global prevalence estimates of intimate partner violence against women, 1990–2018. The Lancet, 399(10327), 803–813. https://doi.org/10.1016/S0140-6736(21)02719-3
Starfield, B. (1998). Primary care: Balancing health needs, services, and technology (2nd ed.). Oxford University Press.
Taşkıran, A. Ç., Özşahin, A., & Edirne, T. (2019). Intimate partner violence management and referral practices of primary care workers in Turkey. Primary Health Care Research & Development, 20, e96. https://doi.org/10.1017/S1463423619000288
Türk Ceza Kanunu. (2004). Kanun No. 5237, Madde 280. Resmî Gazete, 12.10.2004, Sayı: 25611.
Türkiye Cumhuriyeti. (2011). Kadına yönelik şiddet ve aile içi şiddetin önlenmesi ve bunlarla mücadeleye ilişkin Avrupa Konseyi Sözleşmesi (İstanbul Sözleşmesi). Resmî Gazete, 8 Mart 2012.
United Nations. (1979). Convention on the elimination of all forms of discrimination against women (CEDAW). United Nations.
United Nations. (1993). Declaration on the elimination of violence against women. United Nations.
U.S. Preventive Services Task Force. (2025). Intimate partner violence, elder abuse, and abuse of vulnerable adults: Screening. JAMA, 333(4), 345–353. https://doi.org/10.1001/jama.2024.29308
U.S. Preventive Services Task Force. (2025). Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: Recommendation statement. JAMA, 333(4), 371–380. https://doi.org/10.1001/jama.2024.28412
World Health Organization. (2008). Primary health care: Now more than ever. World health report 2008. WHO Press.
World Health Organization. (2014). Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook. WHO.
World Health Organization. (2019). RESPECT women: Preventing violence against women. WHO.
World Health Organization. (2021). Violence against women prevalence estimates, 2018. WHO.
Yastıbaş-Kaçar, C. (2024). Mental health outcomes of physical, sexual, and psychological intimate partner violence clusters in Turkish women. Aggressive Behavior. Advance online publication. https://doi.org/10.1002/ab.22114
Referanslar
Ay, R., & Kılınçel, Ş. (2020). Hekimlerin kadına yönelik şiddet ile ilgili bilgi ve tutumlarının değerlendirilmesi. Journal of Contemporary Medicine, 10(4), 600–608. https://doi.org/10.16899/jcm.723415
Campbell, J. C. (2003). Prediction of homicide of and by battered women. NIJ Journal, 250, 14–19.
García-Moreno, C., Pallitto, C., Devries, K., Stöckl, H., Watts, C., & Abrahams, N. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization.
García-Moreno, C., Hegarty, K., d’Oliveira, A. F. L., Koziol-McLain, J., Colombini, M., & Feder, G. (2015). The health-systems response to violence against women. The Lancet, 385(9977), 1567–1579. https://doi.org/10.1016/S0140-6736(14)61837-7
Gündüz, N. (2019). The relationship of intimate partner violence with mood and anxiety disorders in fibromyalgia syndrome patients. Archives of Rheumatology, 34(4), 472–479.
Hacettepe University Institute of Population Studies. (2015). Türkiye’de Kadına Yönelik Aile İçi Şiddet Araştırması. T.C. Aile ve Sosyal Politikalar Bakanlığı.
Hayran, O. (2018). Bütünleşik sağlık hizmeti ve birinci basamak. Türkiye Aile Hekimliği Dergisi, 22(3), 133–137.
Howard, L. M., Trevillion, K., & Agnew-Davies, R. (2013). Domestic violence and mental health. International Review of Psychiatry, 25(5), 613–619. https://doi.org/10.3109/09540261.2013.873985
Krug, E. G., Mercy, J. A., Dahlberg, L. L., & Zwi, A. B. (2002). The world report on violence and health. The Lancet, 360(9339), 1083–1088. https://doi.org/10.1016/S0140-6736(02)11133-0
Miller, E., McCaw, B., Humphreys, B. L., & Mitchell, C. (2015). Integrating intimate partner violence assessment and intervention into health care in the United States: A systems approach. Journal of Women’s Health, 24(1), 92–99.
National Institute for Health and Care Excellence. (2024). Domestic violence and abuse: Multi-agency working (PH50). NICE.
National Institute for Health and Care Excellence. (2024). Domestic violence and abuse: Multi-agency working. NICE Guideline [NG225]. https://www.nice.org.uk/guidance/ng225
O’Doherty, L. J., Taft, A., Hegarty, K., Ramsay, J., Davidson, L. L., & Feder, G. (2015). Screening women for intimate partner violence in healthcare settings. Cochrane Database of Systematic Reviews, 2015(7), CD011790. https://doi.org/10.1002/14651858.CD011790.pub2
Özcan, A., & İnan Ceviz, A. (2022). Birinci basamak sağlık çalışanlarının kadına yönelik şiddete ilişkin bilgi ve tutumları. Sürekli Tıp Eğitimi Dergisi (STED), 31(4), 281–288. https://doi.org/10.17942/sted.1094161
Royal Australian College of General Practitioners. (2022). Intimate partner violence: Identification and response in general practice. RACGP.
Saletti-Cuesta, L., Aizenberg, L., & Ricci-Cabello, I. (2018). Women’s perceptions of intimate partner violence in primary care: A meta-synthesis. International Journal of Environmental Research and Public Health, 15(12), 1–15. https://doi.org/10.3390/ijerph15122705
Sardinha, L., Maheu-Giroux, M., Stöckl, H., Meyer, S. R., & García-Moreno, C. (2022). Global prevalence estimates of intimate partner violence against women, 1990–2018. The Lancet, 399(10327), 803–813. https://doi.org/10.1016/S0140-6736(21)02719-3
Starfield, B. (1998). Primary care: Balancing health needs, services, and technology (2nd ed.). Oxford University Press.
Taşkıran, A. Ç., Özşahin, A., & Edirne, T. (2019). Intimate partner violence management and referral practices of primary care workers in Turkey. Primary Health Care Research & Development, 20, e96. https://doi.org/10.1017/S1463423619000288
Türk Ceza Kanunu. (2004). Kanun No. 5237, Madde 280. Resmî Gazete, 12.10.2004, Sayı: 25611.
Türkiye Cumhuriyeti. (2011). Kadına yönelik şiddet ve aile içi şiddetin önlenmesi ve bunlarla mücadeleye ilişkin Avrupa Konseyi Sözleşmesi (İstanbul Sözleşmesi). Resmî Gazete, 8 Mart 2012.
United Nations. (1979). Convention on the elimination of all forms of discrimination against women (CEDAW). United Nations.
United Nations. (1993). Declaration on the elimination of violence against women. United Nations.
U.S. Preventive Services Task Force. (2025). Intimate partner violence, elder abuse, and abuse of vulnerable adults: Screening. JAMA, 333(4), 345–353. https://doi.org/10.1001/jama.2024.29308
U.S. Preventive Services Task Force. (2025). Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: Recommendation statement. JAMA, 333(4), 371–380. https://doi.org/10.1001/jama.2024.28412
World Health Organization. (2008). Primary health care: Now more than ever. World health report 2008. WHO Press.
World Health Organization. (2014). Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook. WHO.
World Health Organization. (2019). RESPECT women: Preventing violence against women. WHO.
World Health Organization. (2021). Violence against women prevalence estimates, 2018. WHO.
Yastıbaş-Kaçar, C. (2024). Mental health outcomes of physical, sexual, and psychological intimate partner violence clusters in Turkish women. Aggressive Behavior. Advance online publication. https://doi.org/10.1002/ab.22114
