Violence against Women: Epidemiological & Psychosocial Perspectives Violence against women and girls has become a global

epidemic. It is present in every country, cutting across boundaries of culture, socio-economic class, education, ethnicity and age It is one of the most pervasive human rights violations, denying women and girls equality, security, dignity, self-worth and the right to enjoy fundamental freedoms Violence against women occur throughout the life cycle:

Phase Pre-birth Infancy Girlhood

Type of Violence Sex-related abortion; effects of battering during pregnancy on birth outcomes Female infanticide; Shaken Baby Syndrome Child marriage; female genital mutilation; physical, sexual, & psychological abuse; incest; child prostitution & pornography Adolescence & Dating & courtship violence (e.g. acid throwing & date rape), economically coerced sex (e.g. Adulthood school girls having sex with sugar daddies in return for school fees); incest; sexual abuse in the workplace; rape; sexual harassment; forced prostitution & pornography; trafficking in women; partner violence; marital rape; dowry abuse & murders; partner homicide; psychological abuse; abuse of women with disabilities; forced pregnancy Old age Forced suicide or homicide of widows for economic reasons; physical, psychological & economic abuse - Violence against women can be experienced anywhere, anytime: in the home or outside the home, 24/7 - Violence that occurs in the home is called domestic violence. It can have different forms: family violence, household violence, intimate partner violence or spousal violence, violence against children (child abuse & neglect) & elderly abuse How big is the magnitude of Violence against Women? In 48 population-based surveys from around the world, between 10% and 69% of women reported being physically assaulted by an intimate male partner at some point in their lives (World Report on Violence and Health, 2003) In a 10-country study on womens health and domestic violence conducted by the -15% and 71% of women reported physical or sexual violence by a husband or partner (World Health Organization, 2000)

How big is the magnitude of Violence against Women (prevalence)? In a multi-country domestic violence study by WorldSAFE in 2000, the prevalence of lifetime IPV (physical assault) ranged from 11% in Egypt to 43% in India with Philippines (21.2%).

Source: Hassan, et al (2004). Physical intimate violence in Chile, Egypt, India and the Philippines. Inj Control and Saf Promot 11 (2), 111-116 For severe psychological abuse, lifetime prevalence was 10.5% in Egypt and 50.7% in Chile, Philippines (19.3%)

Source: Ramiro LS et al (2004). Risk Markers of Severe Psychological Violence against Women: A WorldSAFE Multi-Country Study. Injury Control and Safety Promotion 11 (2), 131-139 How big is the magnitude of Violence against Women (local studies)?

Source: Baseline Surveys for the National Objectives for Health (BSNOH, 2000): Physical Violence 67.1% lifetime prevalence of adult women (urban women > rural women) 84.5% lifetime prevalence of adolescent girls (urban adolescent girls < rural adolescent girls) 40.1% lifetime prevalence of elderly women Psychological (Verbal) Violence 77.2% lifetime prevalence of adult women (urban women > rural women) 33.3% lifetime prevalence of adolescent girls (urban adolescent girls < rural adolescent girls) 22.8% lifetime prevalence of elderly women mostly old Sexual Abuse 16% lifetime prevalence of adult women (urban women < rural women) 11.2% lifetime prevalence of adolescent girls (urban adolescent girls = rural adolescent girls) - Most common penetrator: other people Intimate Partner Violence (IPV) One of the most common forms of violence against women is that performed by a husband or an intimate male partner Although women can also be violent in their relationships with men, and violence is also sometimes found in same-sex relationships, studies show that the overwhelming burden of partner violence is borne by women in the hands of men Defined as any act of gender-based violence that results in, or is likely to result in physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life. (United Nations Declaration on the Elimination of Violence against Women, 1993) Acts of physical aggression such as slapping, beating, arm twisting, stabbing, strangling, burning, choking, kicking, threats with an object or weapon, and murder. It also includes traditional practices harmful to women such as female genital mutilation and wife inheritance (the practice of passing a widow, and her property, to her dead husbands brother). Psychological abuse includes behaviors that are intended to intimidate and persecute, and may take the form of threats of abandonment or abuse, confinement to the home, surveillance, threats to take away custody of the children, destruction of objects, verbal aggression and constant humiliation. Sexual abuse such as coerced sex through threats, intimidation or physical force, forcing unwarranted sexual acts, and forcing sex with others. Economic abuse includes acts such as the denial of funds, refusal to contribute financially, denial of food and basic needs, and controlling access to health care, employment, etc.

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5. Various controlling behaviors such as isolating a person from their family and friends, monitoring their movements, and restricting their access to information or assistance *it should be noted that often, these forms of abuse go hand in hand. Prevalence of Partner Violence Source: Ramiro, LS, Madrid B, Amarillo Ma. L (2004). Domestic Violence in Urban Filipino Families, Asian Journal of Women Studies 10 (2), 97-119 47% lifetime violence from their partners/spouse 29% current violence in the past year 32% physical violence (with physical harm) 68% psychological violence (without physical harm) Current Partner Sexual Violence Forced to have sex = 11.8% Frequency in the past year 1-2 times 67.7% 3-4 times 15.2% 5 or more times 16.1% No data 0.9% For many of these women, physical assault was not an isolated event but part of a continuing pattern of abusive behavior (multiple acts of aggression over time).

Cycle of Violence 1. The build up phase this phase may begin with normal relations between the people in the relationship, but involves escalated tension marked by increased verbal, emotional or financial abuse. In non-violent relationships, these issues can normally be resolved between people in the relationship. 2. The stand over phase this phase can be extremely frightening for people affected by domestic and family violence. The behavior of the person who uses violence in relationships escalates to the point that a release of tension is inevitable. The person affected may feel that they are walking on egg shells and fear that anything they do will cause the situation to deteriorate further. 3. Explosion the explosion stage marks the peak of violence in the relationship. It is the height of abuse by the person who uses violence to control and power over others. The person who commits domestic and family violence experiences a release of tension during an explosion phase, which may become addictive. They may be unable to deal with their anger any other way.

4. The remorse phase at the remorse stage, the perpetrators feel ashamed of their behavior. They retreat and become withdrawn from the relationship. They try and justify their actions to themselves and to others, unaware they are actually addicted to the release they have just experienced. 5. The pursuit phase at this stage, the perpetrator promises to the other person never to be violent again. They may try to make up for their past behavior during this period and say that other factors have caused them to be violent, for example, work stress, drugs, or alcohol. The violent offender may purchase gifts, and give the other person attention. Also, the violent offender may go through a dramatic personality change. The person affected by violence will feel hurt, but possibly relieved that the violence is over. 6. The honeymoon phase During the honeymoon phase of violence, both people in the relationship may be in denial as to how bad the abuse and violence was. Both people do not want the relationship to end, so are happy to ignore the possibility that the violence could occur again. After some time, this stage will fade and the cycle may begin again. - Although there is evidence that women engage in common couple violence, there are few indications that women subject men to the same type of severe and escalating violence frequently seen in clinical samples of battered women. What are the risk factors for intimate partner violence? A wide range of studies from both industrialized and developing countries have produced a remarkably consistent list of events that are said to trigger partner violence (WRVI, 2003). These include: Not obeying the man Arguing back Not having food ready on time Not caring adequately for the children or home Questioning the man about money or girlfriends Going somewhere without the mans permission Refusing the man of sex The man suspecting the woman of infidelity Societies often distinguish between just and unjust reasons for abuse and between acceptable and unacceptable levels of violence. In this way, certain individuals usually husbands or older family members are given the right to punish a woman physically, within limits, for certain transgressions. Only if a man oversteps these bounds for example, by becoming too violent or for beating a woman without an accepted cause will others intervene. In many developing countries, women often agree with the idea that men have the right to discipline their wives, if necessary by force. Quotation from an Indian woman: If it is a great mistake, then the husband is justified in beating his wife. Why not? A cow will not be obedient without beatings. In Egypt, over 80% of rural women share the view that beatings are justified in certain circumstances. Significantly, one of the reasons that women cite most often as just cause for beatings is refusing a man sex.

Studies in the Philippines indicated that more women favored being beaten than beating their husbands. This attitude may have been precipitated from womens fear of being socially ostracized for treating their husbands as weak or under the saya. When asked what conditions justified the use of physical force, the female respondents cited infidelity and serious crimes. In some countries, wife beating is also regarded as a consequence of a mans right to inflict physical punishment on his wife. As one of the Pakistani researcher notes, Beating a wife to chastise or to discipline her is seen as culturally and religiously justified Because men are perceived as the owners of their wives, it is necessary to show them who is boss so that future transgressions are discouraged. Young age and low income were consistently found to be factors linked to the likelihood of a man committing physical violence against a partner (Black et al, 1999). Rates of abuse were higher among women whose husbands had either themselves been beaten as children or had witnessed their mother being beaten (Ellsberg, 1999; Johnson, 2006). Alcohol use by the man was found to be highly correlated with a womans risk of suffering violence. In Canada, for example, women who lived with heavy drinkers were five times more likely to be assaulted by their partners than those who lived with non-drinkers (Rodgers, 2004). In the Philippines, heavy drinking and gambling partners as well as the womans physical and mental health were found to be significant predictors of severe physical violence. In addition, the partners womanizing was significantly related to the partner severe psychological violence (Ramiro et al, 2003).

Traditional notions of male honor In many places, notions of male honor and female chastity put women at risk. For example, in parts of the Eastern Mediterranean, a mans honor is often linked to the perceived purity of the women in his family. If a woman is defiled sexually either through rape or by engaging voluntarily in sex outside marriage she is thought to disgrace the family honor. In some societies, the only way to cleanse the family honor is by killing the offending woman or girl. A study of female deaths by murder in Alexandria, Egypt, found that 47% of the women were killed by a relative after they had been raped (Mercy JA et al, 1998). How a community responds to partner violence may affect the overall levels of abuse in that community. In a comparative study of 16 societies with either high or low rates of partner violence, Counts, Brown & Campbell (1998) found that societies with the lowest level of partner violence were those that had community sanctions against partner violence and those where abused women had access to sanctuary, either in the form of shelters or family support. Levinsons analysis (1999) suggests that wife beating occurs more often in societies in which men have economic and decision-making power in the household, where women do not have easy access to divorce, and where adults routinely resort to violence to resolve their conflicts. The second strongest predictor in this study of the frequency of wife beating was the absence of allwomen workgroups.

Consequences of violence against women

Injuries: Physical and sexual abuse by a partner is closely associated with injuries. Violence by an intimate partner is the leading cause of non-fatal injuries to women. Death: Deaths from violence against women include honor killings (by families for cultural reasons); suicide; female infanticide (murder for infant girls); and maternal death from unsafe abortion. In the United States, more murders of women are committed by guns than by all other types of weapons combined. In India, guns are rare but beatings and death by fire are common. A frequent ploy is to douse a woman with kerosene and then to claim that she died in a kitchen accident. One study in the mid-1980s found that among women aged 15-44 years in Greater Bombay and other urban areas of Maharashtra state, one out of five deaths were ascribed to accidental burns (Karkal, 1985). In other developing countries, deaths of women were done through beatings, tying, smothering, or with the use of deadly weapons such as knife or wood. Sexual and reproductive health: Violence against women is associated with sexually transmitted infections such as HIV/AIDS, unintended pregnancies, gynecological problems, induced abortions, and adverse pregnancy outcomes, including miscarriage, low birth weight and fetal death. Risky behaviors: Sexual abuse as a child is associated with higher rates or sexual risk-taking (such as first sex at an early age, multiple partners and unprotected sex), substance use, and additional victimization. Each of these behaviors increases risks of health problems. Mental health: Violence and abuse increase the risk of depression, post-traumatic stress disorder, sleep difficulties, eating disorders and emotional distress. Physical health: Abuse can result in many health problems, including headaches, back pain, abdominal pain, fibromyalgia, gastrointestinal disorders, limited mobility, and poor overall health.

Social and economic costs The social and economic costs of violence against women are enormous and have ripple effects throughout society. Women may suffer isolation, inability to work, loss of wages, lack of participation in regular activities, and limited ability to care for themselves and their children.

How do women respond to abuse? Studies have shown that most abused women are not passive victims but rather adopt active strategies to maximize their safety and that of their children. Some women resist, others flee, while still others attempt to keep the peace by giving in to their husbands demands.

Various factors can keep women in abusive relationships. These include: Fear of retribution Lack of alternative means of economic support Concern for the children Emotional dependence Lack of support from family and friends Abiding hope that the man will change

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Stigmatization associated with being unmarried Fear of being socially ostracized 83% of the women who left their partners eventually returned to them. They were asked to come back by their partners (60.3%) They did not want to leave their children (39.7%) Their own families convinced them to go back (12.7%) Reasons of love and forgiveness (10%) Felt that their partners would eventually change their behavior Perception of not being able to support themselves and their children Their partners threatened them and their children if they did not return

Prevention and interventions Anti-VAW advocacies Woman-focused interventions Family interventions

Republic Act No. 8505 of 1998: Rape Assistance Law This made provisions for the assistance and protection of abused women by establishing a crisis center in every province and city. The UP-PGH Womens desk was established in 1998 to address the need for a help desk to assist women survivors of violence seen in the hospital.

Psychosocial characteristics of violence against women Increasing cost of undue burden on health care Productivity losses limits women in workplace participation; absences from work Mental health consequences PTSD Depression or depressive syndromes Sleep difficulties Alcohol abuse Somatic complaints Behavioral problems (aggressive behavior, truancy) Suicidal thoughts and/or attempts Health consequences: gynecological complications vaginal bleeding, infection, decreased sexual desire, genital irritation, pain during intercourse, chronic pelvic pain, and UTI Social consequences cultural solution: perpetrator marries the victim Obtaining financial damages loss of honor Women cast out

Battered Women Syndrome: scientifically-defined pattern of psychological and behavioral symptoms found in women living in battering relationships as a result of cumulative abuse