2. Understanding Gender-based Violence

1. 2. Understanding Gender-based Violence

2. Aim of this module • To understand the concept of GBV, its causes and consequences on women’s health • To understand the dynamics of GBV in intimate relationships and the resulting behaviour of patients showing symptoms of GBV • To reflect on common myths surrounding GBV and on how they may influence the health care response to GBV

3. Outlook • Definitions and forms of GBV • Scope of GBV (globally and in EECA) • Causes of GBV • Dynamics of violent relationships • Myths and facts about GBV • GBV and multiple discrimination • Health consequences of GBV

4. Definitions and Forms of GBV 4

5. International definitions (1) Violence against women: “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.”UN Declaration on the Elimination of Violence against Women (DEVAW, 1993) Gender-based violence: “Violence that is directed against a woman because she is a woman or that affects women disproportionately.”CEDAW General Recommendation no. 19 (1992)

6. International definitions (2) Violence against women is • a manifestation of the historically unequal power relations between men and women, which have led to domination over and discrimination against women by men • one of the crucial social mechanisms by which women are forced into a subordinate position compared with men • constitutesa violation of human rights and a form of discrimination against women (DEVAW)

7. International definitions (3) Violence against women includes: • Violence occurring 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; • Violence occurring 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; • Violence perpetrated or condoned by the State, wherever it occurs. (DEVAW)

8. Definition of GBV (1) 1. Violence against women is gender-based – it does not occur to women randomly. • Structural problem embedded in unequal gender power relationships • Gender dimensions of VAW: • GBV mainly affects women and girls • Women and men experience violence differently • Women are more likely to die at the hands of someone they know • Women survivors face specific barriers in accessing services • Fewer resources and options to access justice, care, and support • Laws and implementing authorities often fail to adequately respond to VAW

9. Definition of GBV (2) 2. GBV is a violation of women’s human rights and a form of discrimination against women. • Examples of violated rights: • Right to life • Right to be free from torture and inhuman or degrading treatment of punishment • Right to health • Right to equal protection by the law

10. Definition of GBV (3) 3. Women experience GBV in all areas of life – the private and the public sphere. • BUT most violence occurs in the family: • 30% of all women who ever lived in a partnership experienced physical or sexual violence by a partner (WHO 2013). • Women make up 2/3 of all persons killed by an intimate partner (but only 20% of homicide victims, UNODC 2014).

11. Definition of GBV (4) Domestic violence Physical, sexual, psychological or economic violence, • within the family or domestic unit or between former or current spouses or partners, • whether or not the perpetrator shares or has shared the same residence with the victim (Art. 3 Istanbul Convention) Intimate partner violence Behaviour by an intimate partner, • that causes physical, sexual or psychological harm, • including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours. • It covers violence by both current and former spouses and other intimate partners (WHO et al 2013)

12. Definition of GBV (5) 4. GBV encompasses a broad range of harmful acts: • Physical violence, e.g.: slapping, hitting, pushing, choking, shaking, spitting, restraining, use of weapons. May or may not cause injuries • Sexual violence, e.g. rape, other forms of sexual assault, forced marriage, forced abortion, forced sterilization, female genital mutilation (FGM) • Psychological violence, e.g. threats, emotional violence, use of children • Economic violence, e.g. withholding money, prohibiting the woman to work, excluding her from financial decisions H1 H1

13. Examplesof GBV in EECA H2

14. Examplesof GBV in EECA (2) H2

15. Scope of GBV

16. Global and regional prevalence estimates of GBV (WHO et al 2013) • For examples of country-specificprevalencedata from Eastern Europe and Central Asia, seeHandout 3. * Europe referstolow-and middle-income countries in Europe and Central Asia. H3

17. Causes of GBV

18. The ecologicalframework for undertanding GBV • GBV iscausedby a combinationoffactorsthatincreasetheriskof a man committingviolenceandtheriskof a womanexperiencingviolence. Source: Heise 1998

19. The ecological framework Individual-level factors Relationship-level  Relationships with partners, family, peers Men with multiple partners Partnerships with low martial satisfaction or continuous disagreements Disparities in education status between partners Family blaming the woman instead of the man for sexual violence  Biological, personal history • Low level of education • Young age (early marriage) • Past experiences of violence • Pregnancy • Use of alcohol (weak evidence for causal relationship) • Attitudes of violence as acceptable behavior Source: WHO/LSHTM 2010

20. The ecologicalframework Community-level Society-level factors  Cultural and social norms that shape gender roles Higher IPV when men have economic and decision-making powers in the household Ideologies of male sexual entitlement Social breakdown from conflicts or disasters  Social relationships in school, workplace, and neighbourhood • Societies with community sanctions against violence have the lowest levels of IPV and SV • Poverty – rather a “marker” than a factor increasing risk as such Source: WHO/LSHTM 2010

21. Domestic Violence – Understanding the Dynamics of Violent Relationships

22. Importanceofunderstandingthedynamics • Many health professionals share the norms, beliefs, and attitudes of broader society. • Negative attitudes towards survivors can inflict additional harm on them. • Not understanding the dynamics of violence may cause health professionals to wonder why she doesn‘t leave the abusive relationship and then think that she does not need or deserve help.  Maintain a supportive, non-judgemental and validating attitude towards survivors.

23. Power & Control Wheel Source: Domestic Abuse Intervention Project, Duluth. H4

24. The cycle of violence(Walker 1978) • Over time, phases of aggression increase in severity and duration; “honeymoon” phases become shorter. • Women develop a strategy for survival (denying abuse, refusing help offered, defending the aggressor).

25. Stockholm Syndrome (Grahams, Rawlings 1988) • Explains why women in violent relationships develop close bonds and identify with the abuser • For the first time observed: Stockholm, 1973 (hostage taking) • 4 conditions: • The life of the victim is threatened. • The victim cannot escape or thinks that escape is impossible. • The victim is isolated from people outside. • The captor shows some degree of kindness to the victim. .

26. Concept of normalization of violence (Lundgren, 1993) • Women may understand attacks as manifestation of their own failure. • Many women feel strong inner resistance to identify themselves as “battered women” and their violent partners as “abusers. • Making the violence experienced look less serious can be a coping strategy for women. • It is only when the woman has left the violent relationship that she can describe her experiences as violent (“renormalization process”).

27. Mythsabout GBV

28. Whybeawareof GBV myths? Myths and stereotypical attitudes about GBV • are harmful because they blame the survivor and not the perpetrator • shape society and the health sector‘s perceptions and responses • may prevent health care providers from identifying GBV and providing care  Health care providers need to distinguish between myths and facts and maintain a professional and impartial attitude. H5

29. Examples of myths about GBV • Battering is not a crime. Men have the right to control their wive‘s behaviour and to discipline them. • Some women deserve the violence they experience. • Battered women allow abuse to happen to them. They can leave if they really wanted to. • Conflicts and losing control are a normal part of any relationship. • Domestic violence is a private family matter and therefore the state or service providers have no right to intervene. H6

30. GBV and multiple discrimination

31. Women in conflictand post-conflictsituations

32. Women with disabilities • Stereotypes contribute to sexual violence and lack of credibility when abuse is reported, e.g. • Regarding them as recipients of charity, objects of others’ decisions • Portraying them as non-sexual beings, being compliant and timid • Other forms of violence they experience: • Withholding of medication or communication aids • Refusal of caregivers to assist with bathing, dressing or eating • Restricting access to family, friends or phone calls • Often denied control of sexual/ reproductive choices • Can lead to forced sterilization & forced termination of wanted pregnancies

33. Migrant women • Informal sector- domestic, agricultural, sex work • Lack of legal protection • Limited access to justice and health care • Language barriers • Lack of information on rights & options • Exclusion from national health insurance coverage • Fear of losing residency status • May prevent leaving an abusive partner or employer • Undocumented migrant women: lack of access to protection because of fear of deportation

34. Adolescent girls

35. Older women

36. Rural women

37. Consequences of GBV

38. Health consequences of GBV

39. H7

40. Examples of health consequences of intimate partner violence (WHO 2013)

41. Impact of violence on children (1) • Directly or indirectly affected by domestic violence • Means of discipline: physical, cruel or humiliating punishment • Sexual abuse by family members • Injured (intentionally or unintentionally) during an attack against their mother • Witnessing violence against their mother • Used by the father/husband to coercively control their mother

42. Impact of violence on children (2) • Serious impact on their physical, psychological and sexual health and development • Witnessing intimate partner violence against their mothers – even when the child is not physically targeted • Has negative social and health consequences for children, including anxiety, depression, poor school performance and negative health outcomes • Is a risk factor for experiencing (girls) or perpetrating (boys) intimate partner violence later in life H8