gender-based gender-based gender-based gender-based violence

145 Pages·2006·0.87 MB·English

SPECIAL ISSUE ON WOMEN’S HEALTH
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IN THE WESTERN PACIFIC REGION:
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INTRODUCTION
SPECIAL ISSUE ON WOMEN’S HEALTH
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IN THE WESTERN PACIFIC REGION:
A HIDDEN EPIDEMIC?
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GENDER-BASED VIOLENCE IN THE WESTERN PACIFIC REGION: A HIDDEN EPIDEMIC
WHO Library Cataloguing in Publication Data
Gender-based violence in the Western Pacific Region : a hidden epidemic?
1.
ISBN (NLM Classification: )
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INTRODUCTION
T C
ABLE OF ONTENTS
Acknowledgements.................................................................................................4
Preface ...............................................................................................................5
Dr Shigeru Omi
Regional Director
World Health Organization, Regional Office for the Western Pacific
Part 1. Introduction........................................................................................7
Associate Professor Liz Eckermann
Deakin University
Part 2. Suicidal behaviour among women of child-bearing .................13
age: Report of an investigative study in Longde County,
Ningxia Hui Autonomous Region, China
Wang Yan, Huang Fei, Shi Ling and An Lin
School of Public Health, Peking University
Part 3. Domestic violence against pregnant women and its.................55
impact: A survey in Northern China
Guo Sufang, Wu Jiuling, Qu Chuanyan, Yan Renying
Research and Training Centre for Women’s and Children’s Health,
Department of Primary Health Care and Maternal and Child Health,
Peking University
Part 4. Medico-legal and health services for victimes of..................... 113
sexual violence: A situational analysis in the Philippines
June Pagaduan-Lopez, MD, Maureen C. Pagaduan, Maria Sheila M. Bazaar,
Charissa Mia D. Salud, Marissa A. Rodriguez, Nancy E. Pareño
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GENDER-BASED VIOLENCE IN THE WESTERN PACIFIC REGION: A HIDDEN EPIDEMIC
A
CKNOWLEDGEMENTS
4
INTRODUCTION
P
REFACE
In 1996, the World Health Assembly declared violence “a leading worldwide public health problem”1
and Murray and Lopez2 reported that the global burden of injury from violence falls disproportionately
on females of all ages. It is this nexus between violence as a key health issue and as a gender issue that
is explored in this publication.
The 2005 WHO Multi-country Study on Women’s Health and Domestic Violence Against Women3 found
that abused women were twice as likely as non-abused women to have poor health and physical and
mental problems, even years after the violent attacks have ceased. The symptoms included suicidal
thoughts and attempts, mental distress and physical symptoms like pain, dizziness and vaginal discharge.
They also had increased risk of sexually transmitted infections, including HIV. Prevalence rates for
domestic violence were higher than expected. In particular, in pregnant women, prevalence rates of
violence by an intimate partner, usually the father of the unborn child, were found to be 4% to 12%.
However, there are still data gaps for the Western Pacific Region, as only two countries from the Region
were represented in the Multi-country Study.
The two countries from the Region which were included in the WHO Study had the lowest (Japan) and
the highest (Samoa) prevalence rates for gender-based violence, including violence against pregnant
women. The alarmingly high rates of non-partner physical and/or sexual gender-based violence (62%
lifetime prevalence) and partner physical and/or sexual gender-based violence (46.1% lifetime
prevalence) in the only country which has been subjected to a total population study, Samoa, suggests
the urgent need to establish reliable data from large-scale prevalence studies in other countries in the
Region to see if they too have a ‘hidden’ epidemic.
In line with the recognition of the WHO Western Pacific Regional Office that gender-based violence is
a major public health issue, it has put together this publication to showcase some of the important
epidemiological and evaluation research on the topic that is being conducted in other parts of the
Region. The three studies contained in this volume provide complementary data for the Western Pacific
Region to support the mission of the Multi-country Study.
The first two studies provide much needed epidemiological data on two aspects of gender-based violence
in China, self-directed violence and intimate partner abuse. The third provides a comprehensive
evaluation of services for abused women in the Philippines. In the Introduction, Liz Eckermann, from
Deakin University in Australia, provides a situational analysis of gender-based violence internationally,
regionally and nationally, identifies where the three studies fit into WHO’s typology of violence4 and
points to the commonalities between the three studies.
In the first study, researchers Wang Yan, Huang Fei, Shi Ling and An Lin, from the School of Public
Health, Peking University, report on an in-depth qualitative survey of suicidal behaviour among women
of child-bearing age in Longde County in the Ningxia Hui Autonomous Region of China. In the second
study, Guo Sufang, Wu Jiuling, Qu Chuanyan and Yan Renying, from Peking University and the Ministry
of Health, provide findings from an extensive survey of intimate partner abuse against pregnant women
and recent parity women in northern China. In the final study, Pagaduan-Lopez, Pagaduan, Bazaar,
Salud, Rodriguez and Pareno undertake a situational analysis of medico-legal and health services for
victims of sexual violence in the Philippines.
1 (WHA49.25)
2 Murray C, Lopez A. (1996) The Global Burden of Disease, Vol.1. Harvard, Harvard School of Public Health, 1996.
3 WHO Multi-country Study on Women’s Health and Domestic Violence Against Women. Geneva, World Health Organization, 2005.
4 World report on violence and health. Geneva, World Health Organization, 2002.
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GENDER-BASED VIOLENCE IN THE WESTERN PACIFIC REGION: A HIDDEN EPIDEMIC
The challenge is to convert the growing recognition of gender-based violence as “a serious human
rights abuse” as well as “an important public health problem that concerns all sectors” 5 into action and
services. All three projects involved action research, whereby training and education about aspects of
gender-based violence is integral to the research process. For example, in the study on prevalence of
gender-based violence against pregnant and recent parity women in northern China, the health
practitioners who helped gather the epidemiological data attended a one-week workshop where they
were trained on research methods as well as gender-based violence theories, diagnosis, treatment, referral
and prevention strategies.
The dearth of prevalence research relates very much to the difficulties of undertaking such studies.
Definitions of domestic violence are slippery, it is still a taboo and a ‘private’ and ‘shameful’ issue in
many cultural contexts, and gender-based violence is such an integral part of so many cultural traditions
that it is often ‘normalized’ and dismissed as ‘just part of life’ 6. These seemingly insurmountable barriers
have not deterred the three groups of researchers whose work appears in this volume. They have
undertaken systematic quantitative and qualitative research on gender-based violence which provides
much needed data to inform service provision as well as health promotion and violence prevention
initiatives in the Region.
Shigeru Omi, M.D., Ph.D.
Regional Director
5 Op cit. Ref 3:1.
6 Op cit. Ref 4.
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INTRODUCTION
1
PART
INTRODUCTION
Associate Professor Liz Eckermann, Deakin University
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GENDER-BASED VIOLENCE IN THE WESTERN PACIFIC REGION: A HIDDEN EPIDEMIC
VIOLENCE AS A MAJOR PUBLIC HEALTH ISSUE: INTERNATIONALLY, REGIONALLY AND
NATIONALLY
The World Development Report 19931 identified violence against women as a major contributor to the
burden of ill-health internationally in terms of “female morbidity and mortality, leading to
psychological trauma and depression, injuries, sexually transmitted diseases, suicide and murder”.
Those conclusions were reinforced in 1996 by Murray and Lopez2 who found that, although injury
from violence of all types was a major contributor to the global burden of disease for both sexes, that
burden falls disproportionately on females of all ages. The health dimensions of violence were confirmed
in 1996 when the World Health Assembly declared violence a “leading public health problem”3. In
1998, the WHO Regional Office for the Western Pacific conducted a review of domestic violence in the
thirty-seven countries and areas of the Region4 and came to the same conclusions.
Comparing prevalence rates for different countries across the Western Pacific Region was difficult
because of varying definitions of what constitutes domestic violence, cultural taboos and the
normalization of violence in many areas, all leading to a lack of political will and the consequent absence
of reliable data. However, very conservative estimates were made suggesting that prevalence rates and
lifetime prevalence rates for domestic physical violence against women in the countries and areas of
the Western Pacific Region were between 5.8% and 61%, and for sexual abuse between 4% and 50%. In
most cases, those figures represent serious underreporting and in many cases de facto indicators of
abuse were used (such as suicide rates and divorce rates) given the reluctance of survivors, perpetrators
and authorities to provide reliable direct data.
As part of its ten-year review of the implementation of the recommendations of the 1994 International
Conference on Population and Development (ICPD,1994), ARROW reviewed progress on reducing
domestic violence for eight countries, four of which fall within the Western Pacific Region: China, the
Philippines, Malaysia and Cambodia5. ARROW argued that “one of the best indicators of real change
in power relations between men and women is a decrease in domestic violence and rape” yet only two
of the ten countries that they reviewed, Cambodia and Malaysia, “had ever had a national prevalence
survey on domestic violence”6. The review found that domestic violence prevalence rates had not
decreased in Cambodia over the ten years since ICPD, despite government-sponsored legal and service
intervention. The lifetime prevalence rate for partner violence in one town, Pursat, had climbed to 47%
given that “perpetrators of sexual exploitation, trafficking and rape of women and children continue to
escape legal punishment because of corruption, lack of legal protection, and ignorance of rights”7. In
Malaysia, best estimates of spousal abuse prevalence in women over 15 years of age were around 39%8
. In China, figures on gender-based violence were so tentative that they were not given. However
gender-based negligence by parents, including malnutrition, is reported as widespread,and 70% of
women have “no insurance cover at all”9. Similarly, the statistics on domestic violence from the
Philippines were too sketchy to come to any clear conclusions about progress.
Thus the three research projects presented in this volume are valuable contributions towards filling
some of the epidemiological gaps in knowledge about the prevalence and incidence rates of self-inflicted
and intimate partner violence in two countries of the Region, China and the Philippines, for which
there are very limited data. They provide a detailed complement to the overview study conducted by
WHO and discussed below.
1 World Bank. World Development Report 1993: Investing in Health, Oxford, Oxford University Press, 1993:50.
2 Murray C, Lopez A. The Global Burden of Disease, Vol.1. Harvard, Harvard School of Public Health, 1996.
3 Resolution WHA49.25
4 Domestic violence: A priority public health issue in the Western Pacific Region, Manila, WHO Western Pacific Regional Office, 1998.
5 ARROW Monitoring Ten Years of ICPD Implementation: The Way Forward to 2015: Asian Country Reports. Kuala Lumpur, ARROW, 2005.
6 Ibid: 43.
7 Ibid: 359.
8 Ibid: 244.
9 Ibid:170.
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INTRODUCTION
Since the end of the twentieth century, WHO has been conducting a multi-country in-depth study of
the health effects of domestic violence against women10. The study has broadened the violence against
women agenda on many fronts. First, the multi-country study acknowledges the “combined efforts of
grass-roots and international women’s organizations, international experts and committed
governments” in producing “a profound transformation of public awareness” about gender-based
violence11. Since the World Conference on Human Rights (1993), the International Conference on
Population and Development (1994) and the Fourth World Conference on Women (1995), the perception
of gender-based violence as purely a welfare and justice issue has changed dramatically in many
quarters. Violence against women is “now widely recognized as a serious human rights abuse” as
well as “an important public health problem that concerns all sectors”12. Second, the indicators used
to measure the impact of gender-based violence have been broadened to encompass quality of life
issues, as well as social indicators. Third, the WHO study has brought to the fore the importance of
focusing on the ethical considerations of any research, and the impact of ethical practice on research
outcomes. The informed consent, safety, privacy and confidentiality of participants are key
methodological considerations. Fourth, the WHO multi-country study has started to change the
terminology that we use to refer to violence against women. The term ‘gender-based violence’ is
increasingly being used to imply that there is a theory that explains violence rather than just using
descriptive terms such as ‘violence against women’.
Japan and Samoa were the only countries from the Western Pacific Region included in the ten-country
WHO study. Japan was chosen for its position on the low end of the violence prevalence scale and
Samoa for its position towards the top of the scale, so neither country is representative of the Region as
a whole. However, in Samoa the whole country was surveyed, so a comprehensive picture of various
forms of violence against women can be constructed.
Of the ten countries, Japan (city location) had the lowest prevalence rates of physical abuse (13%),
sexual abuse (6%) and lifetime physical and/or sexual abuse (15%) by an intimate partner, and also the
lowest rates for non-partner abuse of all kinds. By contrast, Samoa had the highest rates of non-partner
physical violence (62%), and non-partner sexual violence since age 15years (>10%) and high (but not
the highest) rates of all forms of intimate partner abuse. While these data provide some guidelines for
reform in Samoa and a benchmark for good practice in urban Japan, many gaps remain in research on
gender-based violence in the Region.
Despite attempts to change terminology, challenges remain in defining exactly what it is that we are
talking about when we refer to various forms of violence and abuse in establishing accurate
prevalence rates and mobilizing political will for change in some countries. The projects reported in
this publication take on board those challenges for two countries in the Region.
TYPOLOGY OF VIOLENCE
The three research projects reported in this issue use a shared typology to define the aspects of violence
on which they are concentrating. In 1996, the World Health Assembly charged WHO with the
responsibility to develop a typology of violence to encourage a shared understanding of violence and
to start the process of generating research and prevention programmes. The WHO typology was first
used systematically in the World report on violence and health13, which identifies three broad categories of
violence according to the characteristics of those committing the violent act. These are: self-directed
violence, interpersonal violence and collective violence. It must be noted that the typology represents
and 'ideal type' given that in the real world the boundaries between the three categories often blur and
are not as discrete as the typology suggests.
10 Multi-country Study on Women’s Health and Domestic Violence Against Women. Geneva, World Health Organization, 2005.
11 Ibid:1.
12 Ibid:1.
13 World report on violence and health. Geneva, World Health Organization, 2002:6.
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