Girls, adolescents and women in Mexico have spent decades developing in a hostile context towards them, in which in addition to facing multiple obstacles to build the life they want to live, they are subjected to multiple aggressions and expressions of violence for being women. It is no coincidence that 7 out of 10 Mexican women have suffered at least one incident of violence in their lifetime, as indicated by the National Survey on the Dynamics of Household Relationships (ENDIREH) 2021.
Mexico has the first place in sexual abuse of minors among the countries that make up the Organization for Economic Cooperation and Development; of the approximately 5.4 million cases that occur each year, 90% are rapes committed against girls in their homes or family environment. On the other hand, the ENDIREH 2021 reports that, in the twelve months prior to its publication, almost 12 million Mexican women were victims of sexual violence. It is worth noting that sexual violence, after psychological violence, is the most suffered by women in Mexico.
Given the hostile context against girls, adolescents and women, the Mexican State has the Mexican Official Standard NOM-046-SSA2-2005. Family, sexual violence and violence against women. Criteria for prevention and care (NOM-046). Its application seeks to restore, at the highest possible level, the physical and mental health of survivors of sexual and family violence and any aggression that puts their life or integrity at risk.
NOM-046 establishes obligations for health professionals in the areas of health promotion, prevention, detection, diagnosis, treatment, rehabilitation, counseling, follow-up and coordination with other institutions.
Among the main responsibilities that NOM-046 establishes for health workers are to routinely perform the screening procedure, and in probable cases of domestic and/or sexual violence, to carry out the necessary procedures to confirm it. In addition, an interview should be conducted with the affected person in a space of trust, respect, privacy and confidentiality, without value judgments or prejudices that could re-victimize the survivors.
The most relevant and essential aspects of NOM-046 are those that make the rights granted to survivors of sexual violence by the General Victims Law a reality. The standard states that rape should be considered a medical emergency requiring immediate attention. The actions of health personnel should be aimed at:
- Stabilize, repair damage and prevent complications through clinical evaluation and treatment.
- Promote the emotional stability of the person, guaranteeing crisis intervention and post-discharge psychological care.
Also, in cases of rape, health professionals -always with free and informed consent- can offer emergency contraception immediately and up to 120 hours after the event. To prevent sexually transmitted infections (STIs), they should provide prophylaxis against HIV/AIDS and other STIs.
In the event that a pregnancy has been caused by rape and the survivor does not want to continue with the pregnancy, health institutions are obliged to provide the service of voluntary termination of pregnancy (VTP), regardless of the legal status of abortion in the local legislation. The only requirements are:
– The survivor requests the termination in writing, stating that the pregnancy is the result of rape.
– For children under 12 years of age, the application must be made by the mother, father or guardian.
It should not be forgotten that, in case of rape, termination of pregnancy is permitted in all states of the country and there is no gestational week limit. Nor is a prior report to the Public Prosecutor’s Office required.
In order to guarantee prompt, timely and non-revictimizing care, NOM-046 establishes general principles of action for public health institutions, such as:
- Provide medical care with a gender perspective.
- Refer to specialized instances when the necessary treatment cannot be provided.
- Have trained medical and nursing staff who are not conscientious objectors; otherwise, the client should be referred immediately to a unit with non-objecting staff.
- Obtain free and informed consent for any procedure.
NOM-046 protects the clinical practice of health professionals by allowing them to intervene to restore the physical, emotional and social health of girls, adolescents and women who have been assaulted, without coming into conflict with the law or their professional ethics.
For the full text of NOM-046 click here.
The Mexican State has failed to guarantee survivors of sexual and family violence or any other gender-based aggression their right to a life free of violence; however, NOM-046 is an instrument that allows access to justice and reparation for damages.