Facts on Gender Based Violence Forms of Violence against Women

211 Pages·2011·9.4 MB·English

The Health System Response to Gender-Based Violence in EECA: A programmatic package

Facts on Gender Based Violence
Forms of Violence against Women
DOMESTIC VIOLENCE is not an isolated, individual event, but rather a pattern of
perpetrator behaviors used against a victim. The pattern consists of a variety of abusive acts,
occurring in multiple episodes over the course of the relationship. Some episodes consist of a
sustained attack with one tactic repeated many times (e.g., punching), combined with a
variety of other tactics (such as name calling, threats, or attacks against property). Other
episodes consist of a single act (e.g., a slap, a “certain look”). One tactic (e.g., physical assault)
may be used infrequently, while other types of abuse (such as name calling or intimidating
gestures) may be used daily. Some parts of the pattern are crimes in most countries (e.g.,
physical assault, sexual assault, menacing, arson, kidnapping, harassment) while other
battering acts are not illegal (e.g., name calling, interrogating children, denying the victim
access to the family automobile). All parts of the pattern interact with each other and can
have profound physical and emotional effects on victims. Victims respond to the entire
pattern of perpetrators’ abuse rather than simply to one episode or one tactic.

PHYSICAL VIOLENCE
Physical abuse may include spitting, scratching, biting, grabbing, shaking, shoving, pushing,
restraining, throwing, twisting, slapping (with open or closed hand), punching, choking,
burning, and/or use of weapons (e.g., household objects, knives, guns) against the victim.
The physical assaults may or may not cause injuries.

TYPES OF SEXUAL VIOLENCE
Sexual violence can take many forms and take place under very different circumstances. A
person can be sexually violated by one individual or several people (e.g. gang-rapes); the
incident may be planned or a surprise attack. Although sexual violence occurs most
commonly in the victim’s home (or in the perpetrator’s home), it also takes place in many
other settings, such as the workplace, at school, in prisons, cars, the streets or open spaces
(e.g. parks, farmland). The perpetrator of a sexual assault may be a date, an acquaintance, a
friend, a family member, an intimate partner or former intimate partner, or a complete
stranger, but more often than not, is someone known to the victim. There is no stereotypical
perpetrator; sexually violent men come from all backgrounds, rich and poor, academic and
uneducated, religious and non-religious. Perpetrators may be persons in positions of
authority who are respected and trusted (e.g. a doctor, teacher, tourist guide, priest, police
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The Health System Response to Gender-Based Violence in EECA: A programmatic package

officer) and thus less likely to be suspected of sexual violence. Sexual violence is common in
situations of war and armed conflict. Specifically, rape and sexual torture are frequently used
as weapons to demoralize the enemy; women are sometimes forced into “temporary
marriages” with enemy soldiers. Women who are incarcerated may be subjected to sexual
violence by prison guards and police officers. Other forms of sexual violence include, but are
not limited to:
sexual slavery; sexual harassment (including demands for sex in exchange for job promotion
or advancement or higher school marks or grades); trafficking for purposes of forced
prostitution; forced exposure to pornography; forced pregnancy; forced sterilization; forced
abortion; forced marriage; female genital mutilation;
(WHO Guidelines for Medico-legal care of victims of Sexual Violence, page 7 to 8)

PSYCHOLOGICAL VIOLENCE
There are different types of psychological assaults.
Threats of violence and harm
The perpetrator’s threats of violence or harm may be directed against the victim or others
important to the victim or they may be suicide threats. Sometimes the threat includes killing
the victim and others and then committing suicide. The threats may be made directly with
words (e.g., “I’m going to kill you,” “No one is going to have you,” “Your mother is going to
pay,” “I cannot live without you”) or with actions (e.g., stalking, displaying weapons, hostage
taking, suicide attempts).
Emotional violence
Emotional abuse is a tactic of control that consists of a wide variety of verbal attacks and
humiliations, including repeated verbal attacks against the victim’s worth as an individual or
role as a parent, family member, friend, co-worker, or community member. In domestic
violence, verbal attacks and other tactics of control are intertwined with the threat of harm in
order to maintain the perpetrator’s dominance through fear. While repeated verbal abuse is
damaging to partners and relationships over time, it alone does not establish the same
climate of fear as verbal abuse combined with the use or threat of physical harm.
Emotional abuse may also include humiliating the victim in front of family, friends or
strangers. Perpetrators may repeatedly claim that victims are crazy, incompetent, and unable
“to do anything right.” Not all verbal insults between partners are acts of violence. In order
for verbal abuse to be considered domestic violence, it must be part of a pattern of coercive
behaviors in which the perpetrator uses or threatens to use physical force.
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The Health System Response to Gender-Based Violence in EECA: A programmatic package

Isolation
Perpetrators often try to control victims’ time, activities and contact with others. They gain
control over them through a combination of isolating and disinformation tactics. Isolating
tactics may become more overtly abusive over time. Through incremental isolation, some
perpetrators increase their psychological control to the point where they determine reality for
the victims. Perpetrators’ use of disinformation tactics such as distorting what is real through
lying, providing contradictory information, or withholding information is compounded by the
forced isolation of the victims. For example, perpetrators may lie to victims about their legal
rights or the outcomes of medical interventions. While many victims are able to maintain
their independent thoughts and actions, others believe what the perpetrators say because the
victims are isolated from contrary information. Through his victim’s isolation, the
perpetrator prevents discovery of the abuse and avoids being held responsible for it.
Use of children
Some abusive acts are directed against or involve children in order to control or punish the
adult victim (e.g., physical attacks against a child, sexual use of children, forcing children to
watch the abuse of the victim, engaging children in the abuse of the victim). A perpetrator
may use children to maintain control over his partner by not paying child support,
threatening to take children away from her, involving her in long legal fights over custody, or
kidnapping or taking the children hostage as a way to force the victim’s compliance. Children
are also drawn into the assaults and are sometimes injured simply because they are present
(e.g., the victim is holding an infant when pushed against the wall) or because the child
attempts to intervene in the fight.

USE OF ECONOMICS
Perpetrators control victims by controlling their access to all of the family resources: time,
transportation, food, clothing, shelter, insurance, and money. He may actively resist the
victim becoming financially self-sufficient as a way to maintain power and control.
Conversely, he may refuse to work and insist that she support the family. He may expect her
to be the family “bookkeeper,” requiring that she keep all records and write all checks, or he
may keep financial information away from her. In all instances he alone makes the decisions.
Victims are put in the position of having to get “permission” to spend money on basic family
needs. When the victim leaves the battering relationship, the perpetrator may use economics
as a way to maintain control or force her to return: refusing to pay bills, instituting legal
procedures costly to the victim, destroying assets in which she has a share, or refusing to
work “on the books” where there would be legal access to his income. All of these tactics may
be used regardless of the economic class of the family.
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The Health System Response to Gender-Based Violence in EECA: A programmatic package

Source: Ganley, Anne L.(1998): Understanding domestic violence. In: Warshaw, C., &
Ganley, A. (1998): Improving the health care response to domestic violence: a resource
manual for health care providers. Futures Without Violence: Health Care,
http://www.futureswithoutviolence.org/section/our_work/health/_health_ma...

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ARTIGO / ARTICLE
Gender-based Abuse: The Global Epidemic 1
Violência e Genêro: Uma Epidemia Global
Lori Heise 2
HEISE, L. Gender-based Abuse: The Global Epidemic. Cad. Saúde Públ., Rio de Janeiro, 10
(supplement 1): 135-145, 1994.
Gender Based violence-including rape, domestic violence, murder and sexual abuse-is a profund
health problem for women across the globe. Although a significant cause of female morbidity
and mortality, violence against women has only recently begun to be recognized as an issue for
public health. This paper draws together existing data on the dimensions of violence against
women worldwide and reviews available literature on the health consequences of abuse. It
argues that the health sector has an important role to play in combatting violence against
women through increased research, screening and referral of victims, and behavioral
interventions. Any strategy to confrnt violence must address the root causes of abuse in addition
to meeting the immediate needs of victims. This means challenging the social attitudes and
beliefs that undergird men’s violence and renegotiating the balance of power between women
and men at all levels of society.
Key words: Violence and Women; Reproductive Health; Sexual Abuse; International
Development
INTRODUCTION world, the percentage attributable to gender-
based victimization is smaller (World Bank,
Gender-based violence - including rape, 1993). Nonetheless, on a global basis, the
domestic violence, mutilation, murder, and health burden among reproductive age women
sexual abuse — is a profound health problem of gender-based victimization is comparable
for women across the globe. Although a to that posed by other conditions already high
significant cause of female morbidity and on the world agenda (Table 1).
mortality, gender violence is almost never Female-focused violence also represents a
seen as a public health issue. Recent World hidden obstacle to economic and social
Bank estimates of the global burden of development. By sapping women’s energy,
disease indicate that in Established Market undermining their confidence, and
Economies, gender-based victimization is compromising their health, gender violence
responsible for one out of every five healthy deprives society of women’s full participation.
days of life lost to women of reproductive As the United Nations Fund for Women
age. On a per capita basis, the health burden (UNIFEM) recently observed, “Women cannot
imposed by rape and domestic violence is lend their labor or creative ideas fully if they
roughly equivalent in both the industrial and are burdened with the physical and
developing world, but because the overall psychological scars of abuse” (Carrillo, 1992).
burden is so much greater in the developing In recent years, the world community has
taken some tentative, yet important, steps
toward urging greater attention to the issue of
1 Part of the research for this article was pursued under gender-based abuse. Various United Nations
contract with the United Nation’s Statistical Office and bodies, including the General Assembly
the World Bank. Additional support was provided by the (Resolution 48/104), the Economic and Social
Ford Foundation.
Council, and the Committee on Crime
2 Pacific Institute for Women’s Health 1730 Rhode Island
Prevention and Control, have all passed
Ave. NW, Suite 712, Washington D. C. 20036.
Cad. Saúde Públ., Rio de Janeiro, 10 (supl. 1): 135-145, 1994 135
Heise, L.
resolutions recognizing violence against THE MAGNITUDE OF THE PROBLEM
women as an issue of grave concern.
Negotiations are also underway through the Gender-based violence includes a host of
Organization of American States to draft a harmful behaviors that are directed at women
Pan American Treaty Against Violence and girls because of their sex, including wife
Against Women. abuse, sexual assault, dowry-related murder,
This international attention, however,
marital rape, selective malnourishment of
comes on the heels of over two decades of
female children, forced prostitution, female
organizing by women’s groups around the
genital mutilation, and sexual abuse of female
world to combat gender-based abuse. In
children. Specifically, violence against women
country after country, women have started
includes any act of verbal or physical force,
crisis centers, passed laws, and worked to
coercion or life-threatening deprivation,
change the cultural beliefs and attitudes that
directed at an individual woman or girl that
undergird men’s violence. A recent directory
causes physical or psychological harm,
published by the Santiago-based ISIS
humiliation, or arbitrary deprivation of liberty
International, lists 379 separate organizations
and that perpetuates female subordination
working against gender violence in latin
(Heise et al., 1994).
America alone (ISIS, 1990).
Domestic Violence
TABLE 1. Estimated Health Burden of Various
Conditions for Women Aged 15 To
44, Globally The most pervasive form of gender
violence is abuse of women by intimate male
partners. Over 30 well-designed surveys are
now available from a wide range of countries
DALYSa
showing that between one-fifth to over half of
(in
women interviewed have been beaten by a
millions)
male partner (Table 2). The majority of these
Maternal Conditions 29.0
women are beaten at least three times a year
STDs excluding HIV 15.8
with many experiencing persistent
Tuberculosis 10.9
psychological and sexual abuse as well.
HIV 10.6
According to a recent review in the
Cardiovascular Disease 10.5
Journal of the American Medical Association,
Rape and Domestic Violenceb 9.5
“Women in the United States are more likely
All Cancers 9.0
to be assaulted and injured, raped or killed
Motor Vehicle Accidents 4.2
by a current or ex-male partner than all other
War 2.7
assailants combined” (American Medical
Malaria 2.3
Association, 1992). The same could be said of
women elsewhere in the world. In Papua New
Guinea, 18 percent of all urban wives
surveyed had received hospital treatment for
a DALY (Disability Adjusted Life Year) = a measure of
healthy years of life lost due to health-related injuries inflicted by their husbands (Toft,
morbidity or premature death. Every year lost to death 1986). In Alexandria, Egypt, domestic
is counted as 1 DALY and every year spent sick or
violence is the leading cause of injury to
incapacitated is counted as a fraction of a DALY,
women, accounting for 28 percent of all visits
based on the severity of the disability. Four further
explanation see (World Bank, 1993). to area trauma units (Graitcer, 1994). And in
countries as diverse as Brazil, Israel, Canada,
b Rape and domestic violence, which are included in this
and Papua New Guinea, over half of all
table for illustrative purposes, are risk factors for
disease conditions, such as STDs, depression, and women murdered are killed by a current or
injuries. They are not diseases in and of themselves. former partner (Heise et al., 1994).
136 Cad. Saúde Públ., Rio de Janeiro, 10 (supl. 1): 135-145, 1994
Gender-based Abuse
TABLE 2. Prevalence of Wife Abuse, Selected Countries
Country, Year (ref. no.) Sample Size and Type Findings: Comments
Barbados, 1993 (1) island-wide national probability 30% of women battered as adults; women and men
sample; 264 women and 243 men report 50% of their mothers beaten
aged 20-45
Antigua, 1993 (2) random subset of national probability 30% of women battered as adults; women and men
sample; 97 women aged 20-45 report that 50% of mothers beaten
Uganda, 1991 (3) house to house written survey; 16 46% of women responding (n=73) reported being
women from each of Kampala's five physically abused by a partner; additional 7
division (i.e. 80 in all) women reported beatings by family members and
another 5 assaults or rapes by outsiders
Kenya, 1990 (4) district-wide cluster sample from 42% "beaten regularly"
contraceptive prevalence survey; 733
women from Kissi District
Tanzania, 1990 (5) convenience sample from Ilala, 60% had been "physically abused" by a partner
Temeke and Kinondoni districts; 300
women from Dar es Salaam
Zambia, 1992 (6) convenience sample of women from 40% "beaten" by a partner; another 40% "mentally
shanty compounds, medium and high abused"; 17% considered physical or mental abuse
density suburbs of Lusaka and Kafue a normal part of marriage
Rural; 171 women aged 20-40
Papua New Guinea rural survey in 19 villages in all 67% rural, 56% low income urban and 62% elite
1987 (7) regions and provinces (736 men; 715 urban women "beaten"; good agreement between
women); urban survey with percent of women who claim to have been beaten
oversample of elites ( low income: and percent of men who admit to abuse
368 men; 298 women; elite: 178 men;
99 women)
Sri Lanka, 1990 (8) convenience sample from low income 60% had been beaten; 51% of those beaten said
neighborhood of Colombo; 200 husbands used weapons
mixed ethnic women
Korea, 1992 (9) three-stage, stratified random sample 37.5% of wives reported "being battered" by
of entire country; face to face spouse in last year; 12% reported serious physical
interviews with 707 women and 609 abuse in last year (N to R on CTS scale)
men who had lived with a partner for
at least two years
Korea, 1988 (10) convenience sample; based on 42% had been "beaten by husband after marriage";
distributed questionnaires, 708 14% reported being "beaten by their husband"
women in Suwon and Seoul within the last year
India, 1993 (11) 100% sample of potter community in 22% of women reported being "physically
each village based on previous assaulted" by their husbands; 12% reported being
census; 170 women of childbearing beaten within the last month (average 2.65 times);
age in 3 villages in rural southern ethnographic data indicate that prevalence rates are
Karnataka "vastly under reported"
India, 1990 (12) 50% sample of all scheduled caste 75% of scheduled (lower) caste men admit beating
households and 50% of non- their wives; 22% of higher caste men admit to
scheduled caste houses; 109 men and beatings; 75% of scheduled caste wives report
109 women from village in Jullundur being beaten "frequently"
District, Punjab
Malaysia, 1992 (13) national random sample of Peninsular 39% of women "physically beaten" by a partner in
Malaysia; 713 women and 508 males 1989, 15% of adults consider wife beating
over 15 years old acceptable (22% of Malays)
Cad. Saúde Públ., Rio de Janeiro, 10 (supl. 1): 135-145, 1994 137
Heise, L.
Country, Year (ref. no.) Sample Size and Type Findings: Comments
Colombia, 1992 (14) national random sample (part of 20% physically and 33% psychologically abused;
DHS); 3,272 urban and 2,118 rural 10% raped by husband
women
Guatemala, 1990 (15) random sample of 1000 women in 49% abused, 74% by an intimate male partner;
Sacatepequez includes physical, emotional and sexual abuse in
adulthood
Mexico, 1993 (16) random household survey of women 57% of urban and 44% of rural women had
on DIF (social welfare) register; 1163 experienced "interpersonal violence"; husband was
rural women and 427 urban women principal aggressor in more than 60% of cases
in state of Jalisco
Ecuador, 1992 (17) convenience sample of Quito barrio; 60% had been "beaten" by a partner; 37% of those
200 low income women beaten were assaulted once a month or more
Chile, 1993 (18) stratified random sample; 1,000 60% abused by a male intimate; 26% physically
women in Santiago aged 22-55 years abused (severe violence on CTS, i.e. more severe
involved in a relationship of 2 years than pushes, slaps or having object thrown at you);
or more 70% of those abused are abused more than once a
year
United States, 1986 (19) national probability sample of 2,143 28% report at least one episode of physical
married or co-habitating couples violence; 11% report abuse within last year
Netherlands, 1989 (20) random sample of 1,016 women aged 21% experienced physical violence in a
20-60 years heterosexual relationship; half (11%) experienced
severe, repeated violence
Canada, 1994 (21) nationally representative sample of 29% of ever-married women report being
12,300 women aged 18 and older physically assaulted by an intimate partner since
the age of 16; 32% of victims were assaulted more
than 11 times
New Zealand, in press (22) random sample of 3000 women in 22% had been physically abused since age 16;
Otago 76% by a male intimate (i.e. 17% of total); 21% of
those physically abused by a partner were also
sexually abused in the relationship
Rape and Sexual Abuse Indeed, surveys reveal that young girl
children are particularly at risk of sexual
Regrettably, statistics suggest that sexual abuse. National random surveys from
coercion is a also a common reality in the Barbados, Canada, the Netherlands, New
lives of women and girls. Surveys from the Zealand, Norway and the United States reveal
United States reveal that between one in five that 27 to 34 percent of women interviewed
and one in seven American women over the have been sexually abused during childhood
age of 18 has been the victim of a completed (Handwerker, 1993; Haskell & Randall, 1993;
rape in her lifetime (Koss, 1993; Kilpatrick et Draaijer, 1988; Martin et al., 1993; Schei,
al., 1992). International data also explode the 1990; Lewis, 1986; Finkelhor et al., 1990).
myth of rape as a stranger perpetrated crime. Lower but nonetheless significant rates of
Data from countries as diverse as Chile, Peru, abuse have been measured in Great Britain
Malaysia, Mexico, Panama, Papua New (12 percent) (Baker et al., 1985) and Germany
Guinea, and the United States all confirm that (16 percent) (Schotensack et al., 1992).
the majority of perpetrators (60-78 percent) Elsewhere, data from small-scale surveys give
are people known to the victim, and that a cause for concern. A study of 160 Egyptian
substantial subset of victims are very young girls and women revealed that sexual
girls (Heise et al., 1994). aggression by adult men toward young girls
138 Cad. Saúde Públ., Rio de Janeiro, 10 (supl. 1): 135-145, 1994
Gender-based Abuse
occurred in 45 percent of lower alcohol abuse, STDs, hypertension, chronic
socioeconomic status (SES) families and 34 pelvic pain, irritable bowel syndrome, asthma,
percent of higher SES families (Meursing et gynecological problems, and a variety of
al., 1993). psychiatric disorders. Most victims of
Sexual abuse and rape survivors exhibit a violence first seek medical care for the
variety of trauma-induced symptoms including secondary sequelae of abuse, rather than for
sleep and eating disturbances, depression, the initial abuse-related trauma (Heise et al.,
feelings of humiliation, anger and self blame, 1994; Koss & Heslet, 1992).
fear of sex, and inability to concentrate (Koss, Not surprisingly, victims of violence
1990). Survivors also run the risk of require a significant portion of scarce health
becoming pregnant or contracting STDs, resources. Studies reveal that 22 to 35 percent
including HIV. A rape crisis center in of women presenting with any complaint to
Bangkok, Thailand reports that 10 percent of U.S emergency rooms are there because of
their clients contract STDs as a result of rape symptoms related to partner abuse (American
and 15 to 18 percent become pregnant, a Medical Association, 1992). Another study at
figure consistent with data from Mexico and a major U.S. Health Maintenance
Korea (Archavanitkui & Pramualratana, 1990; Organization (HMO), found that a history of
COVAC, 1990; Shim, 1992). In countries rape or assault was a stronger predictor of
where abortion is illegal or unavailable, physician visits and outpatient costs among
victims often resort to illegal abortion, greatly women than were age or other health risks,
increasing their chance of future infertility or such as smoking. Women who had been raped
even death. or assaulted had medical costs two and half
times higher in the index year than
WHY FOCUS SPECIFICALLY nonvictimized women, even after controlling
ON VIOLENCE AGAINST WOMEN? for other health, stress and demographic
factors (Koss et al., 1991). A similar study by
Although men are victims of street Felitti (1991) found that among women
violence, brawls, homicide, and crime, enrolled in an HMO plan, 22 percent of those
violence directed at women is a distinctly who had a history of childhood molestation or
different phenomenon. Men tend to be rape had visited a physician 10 or more times
attacked and killed by strangers or casual a year compared to 6 percent of
acquaintances, whereas women are most at nonvictimized women. Such expenditures
risk at home from men whom they trust could be drastically reduced through
(Kellerman & Mercy, 1992). Violence against preventive actions.
women is grounded in power imbalances
between men and women and is caused and IMPLICATIONS FOR INTERNATIONAL
perpetuated by factors different than violence DEVELOPMENT
against men. As such, it must be analyzed and
addressed differently. While women are Violence presents a powerful obstacle to
occasionally violent against intimates, achieving other goals high on the
research has shown that female violence is development agenda. Violence during
usually in self-defense and that it is women pregnancy, for example, threatens the goal of
who suffer the bulk of injury (Dobash, 1992). “Safe Motherhood” for all women. Among 80
battered women seeking judicial intervention
IMPACT ON HEALTH CARE in San Jose, Costa Rica, 49 percent report
UTILIZATION being beaten during pregnancy (Ugalde,
1988). Battered women run twice the risk of
In addition to injury, physical and sexual miscarriage and four times the risk of having
abuse provide the primary context for many a low birth-weight infant (Stark et al., 1981;
other health problems. Victims of sexual Bullock & McFarlane, 1989). In some
abuse, rape and domestic violence are at regions, violence also accounts for a sizeable
increased risk of suicide, depression, drug and portion of maternal mortality. In Matlab
Cad. Saúde Públ., Rio de Janeiro, 10 (supl. 1): 135-145, 1994 139
Heise, L.
Thana, Bangladesh, intentional injury — island of Barbados, sexual abuse in childhood
motivated by dowry disputes or stigma over emerged as the single most important
rape and unwed pregnancy — accounted for 6 determinant of high risk sexual activity during
percent of all maternal deaths between 1976 adolescence for both women and men
and 1986 (Faveau & Blanchet, 1989). (Handwerker, 1993). After controlling for a
New evidence from the United States wide-range of socio-economic and home-
suggests that sexual abuse may serve as a environment variables (e.g. absent father),
direct break on socio-economic development sexual abuse remains strongly linked to both
by affecting a woman’s educational and the number of partners adolescents have and
income level. A recent study shows that to their age at first intercourse. For men,
women who have been sexually abused physical, emotional and/or sexual abuse in
during childhood achieve an annual income 3 childhood is also highly correlated with lack
to 20 percent lower than women who have of condom use in adulthood, after controlling
not been abused depending on the type of for many other variables.
abuse experienced and the number of Victimization may also lead indirectly to
perpetrators (after controlling for all known teen pregnancy through the unresolved
income factors) (Hyman, 1993). Violence has feelings and behavior patterns that past abuse
also been shown to interfere with women’s sets up. Some of the most commonly
participation in development projects. A study documented consequences of sexual abuse are
commissioned by UNIFEM/Mexico found that early onset of sexual activity and an inability
a primary reason women dropped out of to distinguish sexual from affectionate
projects was due to threats and violence by behavior (Donaldson et al., 1989; Browne &,
husbands who disapproved of their wive’s 1986; Riggs et al., 1990). Frequently, the
empowerment (cited in Carrillo, 1992). shame and stigma that abuse survivors
Likewise, fear of male violence can experience leave them feeling vulnerable,
interfere with efforts to curb population unloved, and unable to say “no” to things they
growth and to control the spread of AIDS. do not want to do such as having sex or using
According to research generated by USAID’s drugs. Moreover, as “damaged goods” they
Women and HIV project, women are do not feel worthy or capable of undertaking
frequently afraid to raise the issue of condom self-protective behavior, such as
use for fear of abandonment, accusations of contraception.
infidelity or physical reprisal (Rao Gupta, A recent study of adolescent mothers in
1993). In some cultures, men assert that use Washington State found that young women
of any birth control implies promiscuity or a who had been sexually abused during
women’s desire to be unfaithful. In Kenya, childhood began intercourse on average a year
women regularly forge their partner’s earlier than nonvictimized mothers, were more
signature on spousal consent forms for likely to have used drugs and alcohol and less
contraception rather than ask their partner’s likely to practice contraception. Only 28
permission (Banwell, 1990). When family percent of the victimized teens used birth
planning clinics in Ethiopia removed their control at first intercourse compared to 49
requirement for spousal consent, clinic use percent of their non-victimized peers (Boyer
rose 26 percent in just a few months (Cook & & Fine, 1992). Another U.S. study confirmed
Maine, 1987). that women survivors of childhood sexual
Through its impact on future sexual and abuse are nearly three times more likely than
drug using behavior, sexual abuse in non-victimized youth to become pregnant
childhood also appears to increase an before the age of 18 (Zierler et al., 1991).
individual’s risk of contracting STDs and HIV
in adulthood (Boyer & Fine, 1992; Zierler et RESPONSE OF THE HEALTH SECTOR
al., 1991; Finkelhor, 1987; Cassese, 1993;
Paone & Chavkin, 1993). In one study of 407 As the only public institution likely to
randomly selected men and women on the interact with all women at some point in their
140 Cad. Saúde Públ., Rio de Janeiro, 10 (supl. 1): 135-145, 1994