Girls, adolescents and women in Mexico have been developing for decades in a context in which context hostile context The fact that in addition to facing multiple obstacles to building the life they want to live, they are subjected to multiple aggressions and expressions of violence because they are women is no coincidence. It is no coincidence that 7 out of every 10 Mexican women have suffered at least one incident of violence in their lifetime, according to 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 Official Mexican Standard NOM-046-SSA2-2005. Violencia familiar, sexual y contra las mujeres. Criterios para la prevención y atención (NOM-046). Con su aplicación se busca restaurar, al máximo nivel posible, la salud física y mental de las sobrevivientes de violencia sexual, familiar y de cualquier agresión que ponga en riesgo la vida o integridad.
NOM-046 establishes obligations for health professionals regarding health promotion and prevention, detection and diagnosis of probable cases, treatment and rehabilitation, counseling and follow-up, as well as 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 must be conducted with the affected person in a space of trust, respect, privacy and confidentiality, in which value judgments and prejudices that could lead to the re-victimization of survivors must not be made.
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 Mexican official standard begins by stating that rape should be considered a medical emergencyrequiring immediate attention. Las acciones de las y los profesionales de la salud deben estar encaminadas a:
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Stabilize, repair damage and prevent complications through clinical evaluation and treatment.
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Promote the emotional stability of the person, which implies guaranteeing crisis intervention and post-discharge psychological care.
Also, in cases of rape, health professionals, always with the free and informed consent of the survivors, can offer emergency contraception immediately and up to 120 hours after the event. Similarly, to prevent sexually transmitted infections (STIs), health personnel should provide prophylaxis against HIV/AIDS and other STIs.
In the event that a pregnancy has been caused by rape and the survivor of sexual violence 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 the abortion in the local legal system. The only requirements to perform the procedure is that the survivor, under oath and in writing, request the termination stating that the pregnancy is the result of rape; in the case of minors under 12 years of age, the request must be made by the mother, the father or the person in charge of their care.
It should not be forgotten that, in the case of rape, termination of pregnancy is permitted in all states of the country and there is no gestational week limit to perform the procedure. Health professionals also do not require, in order to perform an abortion, a prior report to the Public Prosecutor’s Office, since it is not necessary.
In order for survivors of sexual and family violence to receive prompt, timely and non-revictimizing care, NOM-046 establishes general principles of action for public health institutions, such as:
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Provide medical care with a gender perspective.
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In the event that the treatment needed by the survivor cannot be provided, the survivor should be referred to specialized agencies.
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Have trained physicians and nurses who are not conscientious objectors. If, upon requesting the abortion, care cannot be provided, the client should be referred immediately to a unit with non-objecting staff and quality care infrastructure.
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To have the free and informed consent of the person for any procedure.
NOM-046 protects the clinical practice of health professionals by allowing them, at transcendental moments, 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, nor with their professional ethics and their commitment to guarantee women’s sexual and reproductive rights.
For the full text of NOM-046 click here.
The Mexican State has failed to guarantee the right of survivors of sexual and domestic violence, or of any aggression that originates from the mere fact of being a woman, to have access to a life free of violence. However, NOM-046 is an instrument that allows access to justice and reparation of damages that survivors of violence are entitled to.
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