AFRO-NETS> Hopkins Report: Violence Against Women Widespread

[Stephen Goldstein <Sgoldste@welchlink.welch.jhu.edu>]

Hopkins Report: Violence Against Women Widespread
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Around the world at least one woman in every three has been beaten, 
coerced into sex, or otherwise abused in her lifetime, according to a 
new report from the Johns Hopkins School of Public Health and the 
Center for Health and Gender Equity (CHANGE). Based on the most com-
prehensive overview to date, the report calls on the world's health 
care community to respond to physical and sexual abuse as "a major 
public health concern and a violation of human rights."

"What is striking is how similar the problem is around the world," 
says Lori Heise, Co-Director of CHANGE and lead author of the Popula-
tion Reports issue, Ending Violence Against Women, published by the 
Johns Hopkins Population Information Program. "Without exception, 
women's greatest risk of violence comes not from 'stranger danger' 
but from men they know, often male family members or husbands." To 
see the full text of this report go to: 

http://www.jhuccp.org/pr/l11edsum.stm

Over 50 population-based surveys indicate that 10 percent to over 50 
percent of adult women have been physically assaulted by an intimate 
male partner. Psychological abuse almost always accompanies physical 
abuse. One-third to over one-half of cases also involve sexual abuse. 
Most women who suffer any physical aggression are abused repeatedly.

In countries as different as Bangladesh, Cambodia, Mexico, and Zim-
babwe, many people see wife-beating as justified - a husband's right 
to "correct" an erring wife. "Women often share this notion," note 
Heise and co-authors Mary Ellsberg and Megan Gottemoeller. "For exam-
ple, in rural Egypt up to 81 percent of women say that wife-beating 
is justified under certain circumstances." Among findings culled from 
over 500 studies of domestic abuse:

* Many women conceal their plight. In surveys 22% to almost 70% of
  abused women said that they had never told anyone about their abuse
  before being asked in the interview.

* Rates of abuse can vary greatly in neighbouring areas. Differences
  among regions, towns, or villages in the same country can be greater
  than differences among countries.

* Beyond immediate injury, violence often leads to serious long-term
  health problems, including chronic pain, physical disability, drug
  and alcohol abuse, depression, and suicide attempts.

* The physical and psychological impact of different types of abuse
  and multiple episodes over time appears to be cumulative and can
  persist long after the violence has stopped.

* Children of battered women face a greater risk of low birth weight,
  malnutrition, behavioral problems, and infant death in some set-
  tings. 

Gender-based violence and fear of physical and sexual abuse also has 
an enormous impact on women's reproductive health. Such violence has 
been linked to gynecological disorders, unsafe abortion, pregnancy 
complications, miscarriage, low birth weight, and pelvic inflammatory 
disease. In addition, women living in abusive relationships often 
have difficulty refusing unwanted sex, negotiating condom use, or us-
ing many other types of family planning methods. Thus they risk un-
wanted pregnancy and sexually transmitted diseases including 
HIV/AIDS.

Health workers must address violence against women, say the authors. 
"In most countries the health care system is the only institution 
that interacts with almost every woman at some point in her life." 
With training and institutional support, health workers can identify 
abuse victims, offer empathy and support, provide medical care, and 
refer clients to legal assistance and support services.

"Although health workers should be part of the solution, at this 
point they are often part of the problem," notes co-author Ellsberg. 
"They often violate confidentiality, trivialize the abuse, or blame 
the victim." Bureaucratic delays and indifference add to the problem. 
"Frequently, women feel re-victimized by the very system that is sup-
posed to help them."

To make health systems more responsive, activists have begun pilot 
programs in Brazil, Canada, Ireland, Malaysia, Mexico, Nicaragua, and 
the United States to train health workers and reform institutional 
policy. "We are heartened by the efforts of activists and committed 
health care providers to make the health system sensitive and atten-
tive to the needs of abuse victims," says Heise. "Many developing 
countries are taking up this challenge far quicker than Western coun-
tries did."

Training programs for health workers, regardless of their primary fo-
cus, should cover gender, sexuality, healthy relationships, and 
abuse. The Population Reports issue includes a 4-page pullout to help 
health workers in training or on the job, suggesting how to ask women 
about violence, how to spot symptoms of violence, and how to help 
women develop a personal safety plan.

While health workers can help, ending violence against women requires 
strategies and communication that reach across society. "An agenda 
for change must include: empowering women and girls; raising the cost 
of abusive behaviour; providing for the needs of victims; coordinating 
institutional and individual responses; involving youth; reaching out 
to men; and changing community norms," the report concludes. 

Ending Violence Against Women was prepared by Lori Heise, Mary Ells-
berg, Lic. Med. Sci, and Megan Gottemoeller, MPH, of the Center for 
Health and Gender Equity (CHANGE). 

Population Reports is an international review journal of important 
issues in population, family planning, and related health matters. It 
is published four times a year in four languages by the Population 
Information Program at the Johns Hopkins Center for Communication 
Programs (JHU/CCP) with support from the US Agency for International 
Development (USAID). USAID administers the US foreign assistance pro-
gram, providing economic and humanitarian assistance in more than 80 
countries worldwide.


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DEVELOPING A SAFETY PLAN

A safety plan can help a woman protect herself in a violent situa-
tion. Advocates against domestic violence suggest the following tips 
for developing a personal plan in advance:

* Identify one or more neighbours you can tell about the violence,
  and ask them to seek help if they hear a disturbance in your home.

* If an argument seem unavoidable, try to have it in a room or an
  area that you can leave easily. Stay away from any room where weap-
  ons may be available. 

* Practice how to get out of your home safely. Identify which doors,
  windows, elevator, or stairwell would be best.

* Have a packed bag ready, containing spare keys, money, important
  documents, and clothes. Keep it at the home of a relative or friend
  in case you need to leave your own home in a hurry.

* Devise a code word to use with your children, family, friends, and
  neighbours when you need emergency help or want them to call the po-
  lice. 

* Decide where you will go if you have to leave home, and have a plan
  to get there (even if you do not think you will need to leave).

* Use your instincts and judgment. If the situation is dangerous,
  consider giving the abuser what he is demanding to calm him down.
  You have the right to protect yourself and your children.

* Remember: you do not deserve to be hit or threatened. 

Source: 
Center for Health and Gender Equity (CHANGE) in Population Reports

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For more information, interviews with the authors, or printed copies 
of the full report contact: 

Stephen M. Goldstein
Johns Hopkins Center for Communication Programs
111 Market Place, Suite 310
Baltimore, Maryland 21202, USA
Tel: +1-410-659-6300 
(After hours: +1-301-984-1470; cell phone: +1-301-633-4380)
Fax: +1-410-659-2645
mailto:PopRepts@jhuccp.org
http://www.jhuccp.org/pr/l11edsum.stm


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