Gender-based Violence and Public Health

International perspectives on budgets and policies

Keerty Nakray

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135131050
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Gender-based violence is a multi-faceted public health problem with numerous consequences for an individual's physical and mental health and wellbeing. This collection develops a comprehensive public health approach for working with gender-based violence, paying specific attention to international budgets, policies and practice and drawing on a wide selection of empirical studies.

Divided into two parts, the text looks at how public health budgets and policies can be used to influence a range of risk factors and outcomes, and then outlines a theoretical and conceptual framework. The second section draws on empirical studies to illustrate ways of managing the risks and impacts of, and responses to, the problem. It concludes by summarising those risk factors that can be effectively addressed through appropriately budgeted public health programmes globally. Highlighting ways of bolstering protective and resilience factors and identifying early interventions, it demonstrates the importance of inter-agency interventions through coordinated effort from a wide range of sectors including social services, education, religious organisations, judiciary, police, media and business.

This inter-disciplinary volume will interest students and researchers working on gender-based violence, gender budgeting and public health policy from a range of backgrounds, including public health, sociology, social work, public policy, gender studies, development studies and economics.

1 Introduction

Keerty Nakray

This book encapsulates some of the recent debates on the theoretical and empirical advances in the understanding of gender-based violence as a public health issue. Each chapter in the book systematically presents how gender-based violence undermines the well-being of females across the world and thwarts the development of nations. It requires priority attention from policy-makers across the world, through dedicated financial budgets supporting various interventions which aim to prevent the occurrence of gender-based violence and also provide remedial services to individual victims. The chapters reflect on how gender-based violence remains the primary means to maintain and perpetuate women’s exclusion from social, economic and political participation. A public health approach to gender-based violence is based on explicit recognition of the health consequences of violence to women and the enormous costs to society. It also recognises the vital role that health and social care professionals play in the early recognition of violence, and initiating interventions. However, the approach is less understood and requires serious consideration from policy-makers in developing countries where public health systems are still evolving to respond effectively to gender-based violence.

This decade is marked by several challenges that the global financial crisis has unleashed on several developed economies which have had adverse impacts on health and social services. Economic growth in some developing economies is also marked by a deepening of the existing social exclusion. In this difficult and challenging context feminists need to pointedly articulate the need to address gender-based violence as a serious problem which not only affects individual women but also impacts the overall development of nations. Therefore, it is necessary that commitment to gender equality and the elimination of all forms of violence should not be foregone. As nations march together towards the achievement of the Millennium Development Goals (2015) (United Nations, 2010) it is vital to address gender-based violence, and direct financial and human resources to policies and programmes that will be effective.

Gender-based violence: key developments in the international policy arena

The early advances in addressing gender-based violence as a public health issue include the United Nations Commission on the Status of Women special working group which, in the fall of 1993, drafted a declaration on violence against women which offered the first definition of gender-based violence (Heise et al., 1994). According to Article 1 of the declaration, violence against women includes:

Any act of gender-based violence that results in or is likely to result in physical, sexual or mental harm or suffering to women including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in public or private life.

(United Nations General Assembly, 1993)

The definition was further amended in Article 2 to include:

a Physical, sexual and psychological violence that occurs in the family, including battering; sexual abuse of female children in the household; dowry-related violence; marital rape; female genital mutilation and other traditional practices harmful to women; non-spousal violence; and violence related to exploitation;

b Physical, sexual and psychological violence that occurs within the general community, including rape; sexual abuse; sexual harassment and intimidation at work, in educational institutions and elsewhere; trafficking in women; and forced prostitution;

c Physical, sexual and psychological violence perpetrated or condoned by the State, wherever it occurs.

(United Nations General Assembly, 1993)

The United Nations Population Fund (1998) further expanded the definition as follows:

Gender-based violence is violence involving men and women, in which the female is usually the victim and which is derived from unequal power relationships between men and women. Violence is directed specifically against a woman because she is a woman, or affects women disproportionately. It includes, but is not limited to, physical, sexual and psychological harm (including intimidation, suffering, coercion, and/or deprivation of liberty within the family or within the general community). It also includes that violence which is perpetrated or condoned by the State.

(United Nations Population Fund, 1998)

The Convention on Elimination of All Forms of Discrimination against Women (CEDAW) was adopted by the United Nations General Assembly in 1979 (Division for the Advancement of Women, Department of Economic and Social Affairs, 1979). It is described as the international bill of rights for women and recognised the need for State Parties to eliminate discrimination against women in public life and also recognised a wide range of rights including the right to protection of health and to safety whilst in employment; and the right to choose a spouse and enter into marriage through free and full consent. The World Conference on Human Rights held in 1993 in Vienna also recognised that gender-based violence and all forms of sexual harassment should be eliminated by legal measures and through national action and international cooperation (Office of the United Nations High Commissioner for Human Rights, 1993).

The International Conference on Population Development, Cairo (United Nations, 1994), in their fourth guiding principle, recognised the importance of ‘gender equality and equity and the empowerment of women and elimination of all kinds of violence against women and ensuring women’s ability to control their own fertility as a cornerstone for development’. It also encouraged national policies to prioritise population and development strategies and budget programmes to improve access to information, and high quality health. The Beijing Platform for Action of 1995 has been ratified by 189 states and complements the CEDAW. It recognised that financial and human resources have been insufficient for the advancement of women, and that the key to increased budgetary allocations is rooted in the political commitment of national governments (Beijing Declaration, Ch. IV, para. 345; UN Women, 1995). It also strongly recommended research, data collection and statistical analysis related to the prevalence of different forms of violence against and also analysis of the causes, nature, seriousness and consequences of violence against women, and the effectiveness of measures implemented to prevent and redress it. The absence of data – specifically victimisation surveys and standardised data – is a hindrance to institutional change and evaluation of policy effects (Day et al., 2005). Most recently the Millennium Development Goals (2015) agreed by all members of the UN emphasised the need to address violence against women as being central to women’s empowerment and equality (Garcia-Moreno and Watts, 2011).

Heise et al. (1994) made one of the most important advances in the understanding of the health burdens associated with gender-based violence. They developed the life-cycle approach to include the various practices manifested in communities: female foeticide and infanticide, female genital mutilation (FGM), forced marriages, honour killings, payment of dowry and related harassment, forced pregnancies and abortions, physical beatings and emotional abuse in natal and affinal homes, rape, sexual abuse, prostitution, exclusion from education, employment and property, harassment at the workplace, trafficking and slavery for domestic labour and sex work. In spite of the diversity of contexts and practices in which gender-based violence occurs, one overarching explanation for gender-based violence is rooted in the patriarchal organisation of societies.

Since the first inception of the key definitions on gender-based violence significant changes have occurred across the world which have further deepened and shaped the contemporary practices and contexts in which violence against women occurs such as natural disasters and ‘man- made catastrophes’ related to climate change and environmental degradation; globalisation of labour force with increasing masculinisation of cities and feminisation of villages; disruption of social relationships; prevalence of extreme forms of sexual violence and cannibalism in severely conflict-affected societies; and interactions between gender-based violence and vulnerability to HIV/AIDS or adverse health outcomes amongst female victims of violence. This requires a nuanced public health approach which can systematically address these challenges through effective policies and budgets at international, national, sub-national and community-based levels of intervention.

Table 1.1 Gender violence throughout the life cycle phase: type of violence present

Source: Heise et al., 1994

Theoretical and methodological debates: measurement of prevalence and incidence of violence

One of the main hindrances to an effective response to gender-based violence is the misconception that the parity or symmetry of violence that is perpetrated by males against females is the same as violence perpetrated by females against males (Schwartz, 2005). These perceptions are related to the exaggerated stances that are undertaken by politicians, journalists and the groups claiming greater rights for men (Schwartz, 2005). This flawed assumption of ‘gender symmetry’ has led to increased incarceration of females for assaulting partners (Das Dasgupta, 2002; Osthoff, 2002). It also has implications for the judiciary and child protection services as they need to understand that women are trying to protect their children from abuse and the circumstances in which this violence occurs should be taken into consideration (Downs et al., 2007).

‘Gender symmetry’ is a fallacious assumption and it should not impede the development of a policy response to gender-based violence. First, the health outcomes for women and men in violent relationships are distinctly gendered as women are more likely to suffer from adverse health outcomes as compared to men. Men can use physical strength to hurt women and cause injuries, and can also emotionally control women due to their higher social status (Gordon, 2000). Secondly, the premise that women are as violent as men contradicts the fact that in every other arena of society male violence is dominant (Downs et al., 2007). The differences in contexts are influenced by a wide range of factors, such as socio-historical factors, including the historical use of violence to resolve conflict and power differentials based on gender, culture, economic and physiology (Das Dasgupta, 1999; Das Dasgupta, 2002). Third, it has implications for research and policy development in the field of gender-based violence. One of the common criticisms of the Conflict Tactics Scales (CTS) which is commonly used to measure the incidence and prevalence of gender-based violence leads to specious inferences about gender symmetry in relationships (Walby, 2005; see Williamson in this volume). The Conflict Tactics Scales (CTS) are widely applied across countries to study the prevalence of violence through the Demographic Health Surveys (International Institute for Population Sciences, 2007). The measurement of violence is affected by several limitations (see Williamson; Jewkes; and Coast et al. in this volume). The scale is restricted to measuring domestic violence and omits some important forms of violence such as sexual assault and stalking (Walby, 2005). Sexual violence is in itself a distinct area of study and research in the field is fraught with methodological problems; as a result, the estimates of prevalence and incidence of sexual violence within marriages is not known (Mahoney and Williams, 2007).

Economic costs of gender-based violence: private woes to public troubles

Since the publication of the Commission on Social Determinants of Health report on social determinants of health (2008) increased attention has been drawn to the role of structural factors that shape health inequalities within and between countries. The term ‘social determinants’ denotes a wide range of social, political, economic, environmental and cultural factors that affect the health status of people (Commission on Social Determinants of Health, 2008). One of the paramount concerns within the social determinants of illness is to address gender differences in health outcomes as not merely an outcome of biological differentials but also as a result of social marginalisation and the iniquitous distribution of resources such as employment, property, health care or education between females and males (Sen and Östlin, 2007). Research has clearly illustrated that gender-based violence has deleterious impacts on women’s health, covering physical, reproductive and psychological morbidities such as burns, miscarriages, HIV/AIDS, chronic pains and injuries, depression, anxiety and poor self-esteem (Abramsky et al., 2011; Garcia-Moreno et al., 2005). It requires serious attention from international and national

governmental and non-governmental organisations both in terms of clear policy focus and budgetary expenditure.

One of the overriding factors that has led to the development of a public health approach is related to the economic costs of health outcomes resulting from gender-based violence on individuals, families, communities, societies and as nations as a whole (Gold et al., 2011). Since the 1980s researchers have started documenting the economic costs of various types of violence against females (Helweg-Larsen et al., 2010). Most of this research has indicated that costs are incurred not only by individual women but by the whole of the society, and societies need to identify appropriate p...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents
• List of illustrations
• List of contributors
• Acknowledgements
• List of abbreviations
• 1 Introduction
• Part I Conceptual framework
• Part II Risks, impacts and responses to gender-based violence
• Index