Health equity, consensual care and the work that survivors of violence do to navigate healthcare services

This article responds to the need for research examining the experiences of survivors of violence in navigating health care services in Canada. Backed by neoliberal government agendas and public sector shortages, responsibilities for healthcare provision have shifted from the state to individuals, including to those who provide and rely on care. This article focuses on the healthcare experiences of survivors of violence, as they navigate and negotiate their own care needs in relation to Canadian healthcare services. We extend previous research that, to date, focuses on how experiences of violence impact survivors' short-term and long-term health, on what factors lead to survivors of violence seeking out healthcare, and on how the system can best address their needs. Drawing on qualitative findings from an online survey (N = 435) and semi-structured interviews (N = 71) with survivors based in Canada, our study makes three key contributions. First, we explicate inaccessible, inadequate or fragmented services, and the improper provision of care by workers who are themselves constrained. Second, we elaborate the ‘work’ that survivors themselves do to navigate their care, including to monitor changes in their health, access quality healthcare, advocate for their own needs, and educate themselves. Attending to this brings organizational relations and neoliberal logics of care into view. Third, we identify promising practices and organizational conditions to improve healthcare services, with insights that underscore the importance of consensual care and that offer a fuller conception of “health equity” that recognizes the importance of consent.