Violence against women is now well recognised as a public health problem and human rights violation of worldwide significance. It is an important risk factor for women’s ill health, with far reaching consequences for both their physical and mental health. This glossary aims to describe various forms of interpersonal violence that are directed towards women and girls. Terms and basic concepts used in research and policy on this public health problem will be explained.
- interpersonal violence
- women’s health
- intimate partner violence
- public health
- human rights
- domestic violence
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- interpersonal violence
- women’s health
- intimate partner violence
- public health
- human rights
- domestic violence
Violence against women is now well recognised as a public health problem and human rights violation of worldwide significance. It is an important risk factor for women’s ill health, with far reaching consequences for both their physical and mental health.1 There is a need to understand better the magnitude and nature of the different forms of violence against women. Clear definitions are needed to be able to compare information across studies and to generate a knowledge base that will allow us to identify the various and overlapping ways in which violence against women occurs and what actions may serve to prevent it and respond to its consequences.
This glossary aims to describe various forms of interpersonal violence that are directed towards women and girls. Terms and basic concepts used in research and policy on this public health problem will be explained.
DEFINING VIOLENCE AGAINST WOMEN
The term violence against women encompasses a multitude of abuses directed at women and girls over the life span. The UN Declaration on the Elimination of Violence against Women (defines violence against women 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”.2 This statement defines violence as acts that cause, or have the potential to cause harm, and by introducing the term “gender based” emphasises that it is rooted in inequality between women and men.
The term gender based violence has been defined as “acts or threats of acts intended to hurt or make women suffer physically, sexually or psychologically, and which affect women because they are women or affect women dis-proportionally”.3 Thus, gender based violence is often used interchangeably with violence against women. Both these definitions point at violence against women as a result of gender inequality. This inequality can be described as discrimination in opportunities and responsibilities and in access to and control of resources that is rooted in the socioculturally ascribed notion of masculinity as superior to femininity.
A FRAMEWORK FOR UNDERSTANDING VIOLENCE AGAINST WOMEN
A typology of violence presented in the world report on violence and health divides violence into three broad categories according to who commits the violent act: self directed violence, interpersonal violence, and collective violence.4 It further captures the nature of the violent acts that can be physical, sexual, or psychological, including deprivation and neglect.
This typology gives a comprehensive overview of the violence present in society and is relevant for both women and men and for different age groups. Women experience all forms of violence, however, interpersonal violence—that is, violence inflicted by another person or by a small group of people on the woman is the most universal form of violence against women, as it takes place in all societies. It is in turn divided into two subcategories: family/intimate partner violence and community violence. Family/partner violence describes violence between family members (often taking place in the home), while community violence describes violence between people who are unrelated and who may or may not know each other, and it generally takes place outside the home.
This glossary will concentrate on various forms of interpersonal violence that strike young girls, adolescents, and women at reproductive age and beyond, showing also how the type of violence changes over the life course. The rationale behind this limitation is that family/partner violence is the kind of violence that strikes women most, while community violence is more common among men. Some culture specific forms of violence will also be described as they fall into this categorisation.
The nature of the violence
Violent acts—irrespective of whether they are self directed, interpersonal, or collective—are commonly categorised as physical, sexual, or psychological. Deprivation and neglect can be considered as forms of psychological abuse. However, these different forms often interact with each other, and form a complex pattern of behaviour where psychological violence is combined with physical and/or sexual abuse for some settings. Coker and colleagues found that women who experienced both physical and sexual violence scored higher on scales measuring ill health than did women who experienced physical violence alone. They conclude that sexual violence might be a marker of more severe violence and perhaps also of violence escalation.5
Physical violence is exercised through physically aggressive acts such as kicking, biting, slapping, beating, or even strangling. Intentionally inflicted injuries are often disguised as accidents. At times, women are seriously injured and in some cases die as a result of their injuries.6
Findings from a number of recent studies from various parts of the world show that between 10% and 60% of the women had been hit or otherwise physically assaulted by an intimate male partner at some point in their lives4 and between 3% and 52% of the women reported physical violence in the previous year.7 The range in these figures illustrates not only possible real differences in prevalence rates among settings but also differences in research methods and in definitions of violence that make comparisons difficult. Furthermore, cultural differences affecting respondents’ willingness to disclose intimate partner abuse also contribute to making the figures difficult to compare.
Psychological, mental, or emotional violence describe acts such as preventing a woman from seeing family and friends, ongoing belittlement or humiliation, economic restrictions, violence or threats against cherished objects and other forms of controlling behaviours. This form of violence is more difficult to define across cultures and countries as it can take different forms. In a study from Vietnam, emotional violence included acts such as a husband forcing his wife to have sex the day before she prepares to go to pray in the pagoda, thus forcing her to break the taboo of being clean and continent.8 In studies from Africa, such acts as bringing girlfriends home, being locked out of the home, or refusing sex were more commonly identified as emotional violence.9,10
Sexual violence includes forced sex through the use of physical force, threats, and intimidation, forced participation in degrading sexual acts as well as acts such as the denial of the right to use contraceptives or to adopt measures to protect against sexually transmitted diseases.
Although much sexual violence occurs in the context of intimate partner violence it can also take place in many other settings. Sexual violence can be exercised by another family member, a dating partner, acquaintance or stranger, striking young girls and adolescents as well as grown up women. A woman can be sexually violated by one or several people as in gang rapes.
The terms rape, sexual assault, sexual abuse, and sexual violence are often used interchangeably. However, these terms may have very different meanings and implications in varying situations and locations.11 The first two tend to be defined legally, with rape often being more narrowly defined than sexual assault. Legal definitions may vary from medical and social definitions and can also vary between countries.
This section describes interpersonal violence directed at young girls, adolescents, and women of reproductive age, exercised by the husband/partner/former partner or other family members and follows the outlined and indicated structure in figure 1. Various types of violence will be described following the life course perspective—that is, starting with young girls, where some types of violence are culturally specific and others are universal.
Types of violence striking young girls and adolescents
Child abuse and neglect
Some children are abused and neglected by their parents and other care givers in all countries in the world. This kind of violence includes physical, sexual, and psychological abuse as well as neglect. The outcome might be fatal with the most common causes of death being head injuries, abdominal injuries, and intentional suffocation.12 Non-fatal outcomes have been described as various forms of abuse and neglect that require medical care and intervention by social services.
Sex and age are important factors in determining the kind of violence exercised. Young children and boys are more at risk of physical abuse while older girls, having reached puberty and adolescence, risk sexual abuse, neglect, and being forced into prostitution.13
It has been suggested that women use physical punishment against their children more than men, but when the outcome is fatal men are more often the perpetrators. Men are also more likely to sexually abuse young girls.14 Studies show that child abuse is related to parental stress, poor impulse control, and social isolation, as well as to factors such as poverty and lack of social capital.15
Incest is the term used to describe rape or sexual assault that is perpetuated by close blood relatives, and in most cases refers to when a father or brother exploit their young daughter or sister sexually. In the past 10–15 years, the awareness of child sexual abuse, including incest, has increased as girls and young women have been encouraged to reveal this kind of family violence. The phenomenon of mothers abusing their sons sexually also exists, although less common. This kind of violence exists in many countries and cultures, although up to now it has mainly been described in high income countries.
Gender based abuse of infants and female children
In some countries/regions of the world there is a social preference for boys, leading to the neglect of girls, in response to longstanding cultural traditions favouring males. This gives rise to, for example, sex selective abortions of females where the sex of the fetus is identified through the use of ultrasound technique, malnourishment of girls, or even infanticide—that is, the deliberate killing of female infants soon after birth. In countries where this is common (China, Taiwan, South Korea, India, Pakistan, and some sub-Saharan African countries), the female to male ratio is lower than expected, pointing to violation of the natural course of events.16
This was highlighted at the UN Conference on Women in Beijing in 1995 as a serious public health problem striking women, but also men. There was the fear that it would lead to women becoming a commodity to trade (trafficking), but also to an increase in prostitution and a risk of a considerable amount of men moving to other regions in search of a wife, resulting in a refugee problem, in many cases leading to poverty and bereavement.
Female genital mutilation
Female genital mutilation (FGM), is defined by WHO as the partial or total removal of the external genitalia or other injury to the female genital organs whether for cultural, religious, or other non-therapeutic reasons.17 The terms female genital cutting (FGC) and female circumcision have also been used to describe this procedure. FGM is performed at different times in a girls’ life depending on the setting. WHO estimates that between 100 to 140 million girls and women have undergone some type of FGM. Most of those affected live in 28 countries in Africa, although there are some in the Middle East and it also happens among immigrant communities in some countries in Western Europe.
Types of violence striking women of reproductive age and beyond
Intimate partner violence
One of the most common types of violence against women that exists in all societies and among rich as well as poor women is violence by an intimate male partner or former partner. The term intimate partner violence refers to the abuse taking place usually between husband and wife, or between other present or former cohabiting partners, and some also include boyfriends and girlfriends in this definition. Other terms that are often used to describe intimate partner violence include: domestic violence, battering, wife/spouse/partner abuse. Intimate partner violence is the preferred term as it is more descriptive in defining the type of relationship the subjects are involved in—however, it says nothing about the direction of this violence. Even though this is one of the most common forms of violence directed at women, the term intimate partner violence needs to be made specific by adding “against women” to exactly describe the phenomenon.
Intimate partner violence against women can be exercised either as physical, sexual, psychological violence, or any combination of these.9 Studies from USA and Mexico, for example, estimate that 40%–52% of women experiencing physical violence by an intimate partner have also been sexually coerced by that partner.18
Wife battering has been used to describe a chronic syndrome characterised not by single episodes of violence but by repeated acts of physical, psychological, and emotional abuse used by men to control their female partners.19 Some authors include battering as a separate category of partner abuse distinguished from physical assault by its longstanding, continuous nature, and battering has been defined as “a process whereby one member of an intimate relationship experiences psychological vulnerability, loss of power and control, and entrapment as a consequence of the other member’s exercise of power through the patterned use of physical, sexual, psychological and/or moral force”.5
Violence against women is an important public health problem, and an obvious violation of women’s human rights.
Clear definitions are needed to be able to compare information across studies and to generate a knowledge base that will allow us to identify the various and overlapping ways in which violence against women occurs.
There are many myths about rape—to have sex against one’s will—which are based on stereotypes about what is appropriate sexual behaviour for men and women. For example, most people associate rape with a violent attack by a stranger, but rape is most often perpetrated by someone known to the victim. There is also an assumption that rape leaves obvious signs of injury, which is often not the case. Only around one third of rape victims sustain visible physical injuries.11 Physical violence or pressure in the form of blackmail or threats might occur simultaneously with the rape, or is the violence carried out while the woman is asleep or under the influence of alcohol or other drugs, unable to defend herself. Rape is often not reported to the police and existing statistics greatly underestimate the magnitude of the problem.
Sexual coercion was defined by Heise et al as “the act of forcing (or attempting to force) another individual through violence, threats, verbal insistence, deception, cultural expectations or economic circumstances to engage in sexual behaviour against her/his will.”20 This definition emphasises the many forms beyond the physical form in which another person can be made to have sex against their will.
Dowry related violence
Dowry is the payment to be made to the groom’s family to marry away a daughter, and it takes different forms in different cultures. However, the size of the dowry is a common reason for disputes between the families, with the groom’s family demanding more than the bride’s family can offer, resulting in harassment of brides and also dowry related deaths, particularly in certain parts of India and other southern Asian countries.21 This violence is exercised not only by the husband but also by the husbands’ close relatives (mother, brothers, sisters).
To fight intimate partner violence, preventive strategies that challenge present gender stereotypes are required.
Health care staff, district and community leaders are key persons in building knowledge, shaping opinions, and showing the way forward and therefore shoulder a responsibility to address the subject of violence against women.
Documentation and evaluation are key elements in building such knowledge and clear definitions are an important element to achieve this.
In some Asian countries such as Bangladesh, India, and Pakistan, the disfiguring of women by throwing acid or burning them are forms of violence rooted in gender inequality, but the immediate reason for this is often disputes concerning marriage and dowry.22 While this is not one of the most prevalent forms of violence against women, its consequences are dire for those women subjected to it.
This is the murder of a woman, usually by a brother, father, or other male family member, because she has allegedly brought shame to her family. This phenomenon is rooted in the notion of male honour and female chastity that prevails in many countries in the Eastern Mediterranean region. It means a man’s honour is linked to the perceived sexual purity of the women in his family. If a woman engages in sex outside marriage or even if she is raped, she is thought to disgrace the family honour. In some societies, the only way to cleanse the family honour is by killing the woman/girl.4 This kind of violence against women and girls is exercised also in western European countries within immigrant families. It is generally referred to as “honour” killings—a rather misleading term as the connection with honour is difficult to understand in most cultures. The term “murder in the name of honour” has been suggested.
Mistreatment of older people, taking place in the home or at care institutions, is being referred to as elder abuse and has been defined as: “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person”.23 Elder abuse was first identified in developed countries, where most of the existing research has been conducted but reports from developing countries have shown that it is a universal phenomenon. This kind of mistreatment takes the form of physical, psychological, or sexual abuse as well as financial or material abuse or as pure neglect—that is, the failure to fulfil a care giving obligation.
Violence against women is a serious violation of women’s human rights and of direct concern to the public health sector because of the significant contributions that public health workers could do if properly trained, as they are placed close to the victims, and possibly well acquainted with the community and its inhabitants. Thus, local health services and communities could play a central part in raising awareness among the public to prevent this violence. To openly debate this subject is a way to reduce society’s tolerance towards violence against women.
There is still limited knowledge about what interventions are most effective for the prevention of gender based violence, however documentation and evaluation are key elements in building this knowledge and clear definitions are an important element in this.
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