Violence against Women and Mental Health

A. Riecher-Rössler, C. García-Moreno

• Publisher: S. Karger
• Year: 2013
• ISBN:
  9783805599894
• Topic: Law
• Subtopic: Medical Law
• Index: Law

Violence against women is a global problem that includes domestic violence, sexual abuse of girls and women, trafficking of women, violence in humanitarian crisis settings, violence against female patients including abuse of doctor-patient relationships, and harassment and discrimination of women at the workplace. The mental sequelae of abused women includes posttraumatic stress syndromes, anxiety and depressive disorders, suicidality, substance abuse, and dissociative and somatoform disorders. However, to date, psychiatry and psychotherapy have widely neglected violence as an influencing factor on mental health. This book, which is the first comprehensive overview, discusses current evidence of the links between violence against women and mental health. It is authored by internationally renowned experts, and is both enlightening and thought-provoking. It reviews violence against women in different parts of the world and discusses its prevalence, nature and underlying causes. It looks at the implications of these findings for mental health policies and programs, and further, it strives to stimulate discussion and debate that will hopefully lead to pro-action not only in the medical but also in the political field. This book is essential reading for therapists and clinicians from varying fields, including psychiatry, psychosomatics, general medicine, and gynecology. It shall also serve as an important reference book for sociologists and policy makers.

Violence against Women Worldwide

García-Moreno C, Riecher-Rössler A (eds): Violence against Women and Mental Health.
Key Issues Ment Health. Basel, Karger, 2013, vol 178, pp 38–53 (DOI: 10.1159/000343696)

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Violence against Women in South Asia

Unaiza Niaz

University of Health Sciences, Lahore, Pakistan

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Abstract

In South Asia, the rigid cultures and discriminatory attitudes towards women have led to the exploitation of women, from individual to community levels. Women and girls in this region are exposed to biased, inequitable practices and violent behaviors at all stages of life. The high incidence of female infanticide in India, the frequent incidence of culture-specific types of violence like honor killings, acid attacks, and stove burnings in Pakistan and Bangladesh, trafficking of women from Nepal, Sri-Lanka and India to other regions of world, forced into prostitution and other forms of sexual violence, as well as the high prevalence of domestic violence in all countries of the region, all constitute examples of violence against women in this region. The deeply entrenched cultural norms, lead to acceptance of violence as ‘normal life experiences for a woman’ and to dispel such cultural myths and norms is a formidable task. In the family unit the man is the undisputed ruler of the household. The ineffective legislations encourage abusers to commit abusive acts against women without any repercussions. To eradicate violence against women in this region there are some fundamental challenges which include: changing existing social and individual attitudes, both at the family and societal levels, as well as implementation of policies for equity and sustaining of the political will to achieve significant results.

Copyright © 2013 S. Karger AG, Basel

Violence against women remains a problem of pandemic proportions. It is prevalent globally at both regional and national levels, as well as at the social, interpersonal and family levels. It is recognized as a global public health and human rights problem affecting women’s physical and mental health and well-being. The globally accepted definition considers as violence ‘any act 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 private life’ [1]. Rates of women experiencing physical violence by an intimate partner at least once in their lifetime vary from several percent to over 59% depending on where they live [2].

Presently, there is still no universal agreement on the terminology referring to violence against women. The most commonly used terms are derived from diverse theoretical perspectives and disciplines and hence have different meanings in various regions. WHO’s World Report on Violence and Health defines violence as the international use of physical force or power, threatened or actual, against oneself, another person or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal development or deprivation [3].

According to the United Nations geographical region classification. Southern Asia comprises the countries of Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka [4]. Afghanistan, Burma, and Tibet are also sometimes included in the region. In South Asia 400 million people are affected by hunger and it has nearly 40% of the total number of people living in poverty. Key statistical indicators for human development for health and education are poor [5]. Besides, in this region gender-based violence has relentlessly narrowed women’s choices in virtually all spheres of life, and has consistently eroded the fundamental rights of women to, for example, bodily integrity, health, security, work, food, shelter and participation in political affairs. This leads to poor gender-related development indices in crucial areas like health, nutrition, education, employment and political participation. The World Bank regional report for South Asia as mentioned in Oxfam (2004) reports that women of these countries, especially Pakistan, are in crisis. According to this report 56% of South Asian women are illiterate, and one third of all maternal deaths in the world occur in the region [6].

Education is a basic tool for the empowerment of women and for the elimination of gender related violence [7]. But the majority of girls in South Asia are deprived of this opportunity. In South Asia only 45% of adult women are literate. About 250 million illiterate women live in South Asia, constituting 47% of the illiterates of the developing world. Women’s work in South Asia is also distinguished by job and income insecurity, as they work mainly in the informal sector characterized by low wages and unsafe and hazardous working conditions. Employer’s mostly prefer women workers as they are ‘easier to handle’, and less demanding in terms of wages or job security. In 2003, less than half the women of the age group 15-64 were economically active in the South-Asian region.

Types of Violence against Women in South Asia Communities

Intimate Partner Violence

The most common form of violence experienced by women globally is physical violence inflicted by an intimate partner, with women beaten, coerced into sex or otherwise abused.

Studies have found that rates of women suffering physical violence perpetrated by a current or former intimate partner range from 6% in China and 7% in Canada to over 48% in Zambia, Ethiopia and Peru [2].

Several global surveys suggest that half of all women who die from homicide are killed by their current or former husbands or partners [8].

• In Australia, Canada, and Israel 40-70% of female murder victims were killed by their partners, according to the World Health Organization [3].

• In the United States, one-third of women murdered each year are killed by intimate partners [Krug et al., WHO, 2002].

• In South Africa, a woman is killed every 6 h by an intimate partner [Mathews et al, 2004].

• In India, 22 women were killed each day in dowry-related murders in 2007.

• In Guatemala, 2 women are murdered, on average, each day [3].

• Violence before and during pregnancy has serious health consequences for both mother and child. It is associated with pregnancy-related problems, including miscarriage, preterm labor and low birth weight.

Sexual Violence

Sexual violence refers to any sexual act without the consent of the woman as well as attempted or completed sexual acts with a woman who is ill, disabled, under pressure or under the influence of alcohol or other drugs. Sexual violence can thus be described as any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality, using coercion, threats of harm or physical force, by any person regardless of relationship to the victim, in any setting, including but not limited to home and work [9].

Rates of sexual violence are difficult to establish because in many societies sexual violence remains an issue of deep shame for women and often their families. Statistics on rape from police records, for example, are notoriously unreliable because of significant underreporting.

According to the World Health Organization, the proportion of women suffering sexual violence by nonpartners after the age of 15 varies from less than 1% in Ethiopia and Bangladesh to between 10 and 12% in Peru, Samoa and the United Republic of Tanzania [8].

In Switzerland, 22.3% of women experience sexual violence by nonpartners in their lifetime [3].

In Canada, a study of adolescents aged 15-19 years found that 54% of girls had experienced ‘sexual coercion’ in a dating relationship [10].

Forced and unregistered marriages can increase the vulnerability of women to violence, including sexual violence [11]. The practice of early marriage - a form of sexual violence - is common worldwide, with more than 60 million girls worldwide married before the age of 18, primarily in South Asia (31.1 million) and Sub-Saharan Africa (14.1 million) [12]. According to UNICEF’s ‘State of the World’s Children - 2009’ report, in India 56% of girls were married before the age of 18 and 45% were married by the age of 15 in Bangladesh. In Afghanistan, half of the marriages involve females under 16 years and in Pakistan the average age of a married girl is 16 years [Child Marriage Restraint Act, 1929].

Young girls forced into marriage and into sexual relations may suffer health risks, including exposure to HIV/AIDS, and limited school attendance. One effect of sexual abuse, particularly of girls and young women is traumatic gynecologic fistula: an injury resulting from severe tearing of the vaginal tissues, often rendering the woman incontinent and socially undesirable.

Dowry Murders

Dowry murder is a brutal practice where a woman is killed by her husband or in-laws because her family cannot meet their demands for dowry - a payment made to a woman’s in-laws upon her marriage as a gift to her new family. While dowries or similar payments are prevalent worldwide, dowry murder occurs predominantly in South Asia [2].

Murders in the Name of Honor (‘Honor Killings’)

In many societies, rape victims, women suspected of engaging in premarital sex, and women accused of adultery have been murdered by their relatives because the violation of a woman’s chastity is viewed as an affront to the family’s honor. The United Nations Population Fund (UNFPA) estimates that the annual worldwide number of so-called ‘honor killing’ victims may be as high as 5,000 women [13].

Human Trafficking

Although the global scale of human trafficking is difficult to quantify, it is estimated that as many as 2.5 million people are trafficked annually into situations including prostitution, forced labor, slavery or servitude. Women and girls account for about 80% of the identified victims [14].

Violence during Pregnancy

Violence before and during pregnancy has serious health consequences for both mother and child. It leads to high-risk pregnancies and pregnancy-related problems, including miscarriage, preterm labor and low birth weight. Female infanticide, and systematic neglect of girls are widespread in South and East Asia, North Africa, and the Middle East [12].

In India and Pakistan, joint family systems are still fairly common, and mother-in-laws often deprive young daughter-in-laws of rest and nutritious food during pregnancy. Physical and verbal abuse is often reported in lower socioeconomic groups. In clinical practice, the author has observed such maltreatment and abuse of women who attend psychiatric outpatient clinics for the treatment of depressive illness or anxiety states, during pregnancy.

Discrimination and Violence

Many women face multiple forms of discrimination and increased risk of violence. Factors such as women’s ethnicity, caste, class, migrant or refugee status, age, religion, sexual orientation, marital status, disability or HIV status will influence what forms of violence they suffer and how they experience it.

• Indigenous women in Canada are five times more likely than other women of the same age to die as the result of violence.

• In India, Dalit women experience high rates of sexual violence committed by men of higher caste.

• In Europe, North America and Australia, over...