Proposal from HE, who must not be Remembered

Written by: Fozia Tahir for anonymous!

Sending a marriage proposal in Pakistan is like playing darts at home elsewhere.

Give it a go, if it works very well, after all it was meant to be…
If it doesn’t work, God forbid!! how could she ever say NO!!! (that characterless *************** -put as many stars as you can imagine-)

As one of my cousins had once asked me, “what is wrong with our boy?”. Now, why must I look for a fault in your boy to say no. I want to say no and it is my right to say no (FULL STOP). Who gives so many people the licence to ask me why I said no? especially when our beloved religion gives women the right to marry as well as other marital rights (see previous articles in the blog about marriage, dowry and divorce). But very often in such cases culture card is played to endorse oppression of baby girls.

Funnily enough, when a women wants to say yes to a proposal, no further discussion is allowed on the topic. On the other hand when she wants to say no, the whole family sits her down and schools her on how amazing the boy and the family is and what benefits the matrimony could bring for Indo-Pak relationship (quite literally!).

I wish I could write more about the art, science and philosophy of marriage proposals in Pakistan but this post is not meant for that. It is actually based on a true story, where a boy, who had harassed a little girl at a very young age, decades later sent her a proposal and was very cross at getting ‘NO’ for an answer. I hope that this can shake people to be mindful about staying away from silly and irresponsible behaviour at a younger age and being mature enough when they ask for a girls hand later in their lives.

I am not saying that men don’t have problems when it comes to relationships and proposals, but the scale at which young girls and women suffer in this regard is incomparable to those of our fellow brethren, so I am really sorry that I will completely ignore your problems in this case.

The story is as under

‘Once upon a time there was a young girl in a place that allowed her to be wild and free. Despite many a lectures from her mother on why she should not go to her friends place and why she must be accompanied with an elder when leaving home, she did what she liked, which was to play outside with the kids from her street and come back home hours later. One day she was walking in the street alone and she encountered her cousin who was only a year or two older than hers. He took advantage of the opportunity and touched her every now and then while walking with her. Her mouth dried up. No one had told her what to do, if she ever encountered a situation like this. She wanted to shout but couldn’t so she ended up dodging him, running away until she got to her door. The touching did not stop in the mean time. She went in, without making any noise and raised no further discussion on the topic. That boy and his face meant nothing to her. He deserved no emotion from her. Hate seemed too honourable for a little boy of his sort. That young cousin was dead, right there and right then for her.

Decades later, her mother called her to tell her that she has a proposal. when she took his name, her ears deafened for a while. Seconds later, she asked her mother to say no as soon as possible without any further explanation. Fortunately, her parents weren’t too keen on the boy either so she got away with this one. The boy and his mother were cross about this (ofcourse). She has forgotten her place and how dare she say no to one of the finest boys in the family.

She hadn’t forgotten her place. In reality He had forgotten his. How dare he send that proposal? did his mouth not burn with wildest of fire when he took her holy name with his filthy mouth? does he even remember what he had done to this girl or has he become holy and pious himself?

The biggest question,

Are women too emotional and worry too much about molestation and harassment while the accused man forgets it soon after committing it?

and, why must women forget such monsters? is there room for forgiveness in this case?

This doesn’t end here. This is a never ending problem of our society and we don’t really discuss it in organisations or at homes. Changing mindsets has become a must for our society and we have observed that education alone is not enough to change mindsets as the region that this lady is from claims to have highest literacy rate and an open mindset and so on…

P.s. I cried while writing this and I hope that it touches your hearts the way it has touched mine.

P.P.s. Momma dears..Please Raise careful daughters and respectful sons!

Violence against women and girls

An eighteen-year-old woman chronically raped by her father, brother and uncles since she was eight.
A nineteen-year-old girl having chronic pelvic and genital pain secondary to genital mutilation.
A twelve-year-old female child being sold and married off to a forty two year old man in her village.
A twenty-eight-year old woman physically beaten by her husband regularly when he is intoxicated.
A forty–ear old woman who was kidnapped and sold to her former husband when she was nineteen.

These are just examples of women and female children whom I have come into contact with through my clinical practice, outreach work and in my social life. I have found these women in the emergency rooms, in psychiatric facilities, in the genitourinary medicine & contraception clinics. I have found these women not only as a doctor in the corridors of hospitals – I have found these women in the lanes of my life.

All of these women, as you may have guessed by now, have been subject to violence. Violence against women takes place in several forms – physical violence by intimate partners, sexual harassment, sexual violence, female genital mutilation, trafficking, child marriages etc.

Although there is an increased awareness of the violence suffered by women and female children, we still live in a society where violence is horrifically rampant. We live in a world where a third of the countries have NOT outlawed domestic violence. We live in a world where 1 in 7 girls are married in Central and West Africa before they are 15 years of age. We live in a world where 1 in 2 women were killed by their partners and/or families in 2012. We live in a country where up to a third of adolescent women describe their first sexual experience as rape/sexual abuse. We live in a world where thirty-seven countries exempt rape perpetrators from prosecution if they are married or marry the victim after the event¹.

The purpose of this article is to educate and discuss the nature of violence experienced by women, to understand the extent of the problem, and finally, what to expect from our health professionals and our governments.

The vast majority of the statistics and information is taken from the World Health Organisation and the United Nations websites, which I implore you to read. All of the factual information, which is present in this article, from the aforementioned institutions is listed at the end.

Background and definitions

Violence against women is a global public health problem and a violation of human rights. The United Nations defines violence against women as “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 deprivation of liberty, whether occurring in public or in private life”² .

A 2013 analysis conduct by WHO with the London School of Hygiene and Tropical Medicine and the South Africa Medical Research Council, used existing data from over 80 countries and found that worldwide, 1 in 3 women have experienced physical and/or sexual violence by an intimate partner or non-partner sexual violence³.

Risk factors⁴

The risk factors for women experiencing intimate partner violence include low education, exposure to mothers being abused, abuse during childhood, attitudes accepting violence, male privilege and women’s subordinate status.

Equally, men are more likely to perpetrate violence if they have low education, a history of child maltreatments, exposure to domestic violence against their mothers, alcohol dependence, unequal gender norms, attitudes accepting violence and privilege over women.

Factors associated with sexual violence perpetration include beliefs in family honour, sexual purity, ideologies of male sexual entitlement and weak legal sanctions for sexual violence.

Impacts on health, children and socioeconomics

Physical and sexual violence against women has led to physical, mental, reproductive and sexual health issues of victims. Some of these include unwanted pregnancies, sexually transmitted infections and other gynaecological problems. Specifically, in pregnancies, the risks include miscarriage, pre-term labour and the babies being at significant risks related to low birth weight.

Women exposed to partner violence as twice as likely to experience depression; almost twice as likely to have alcohol use disorders; 1.5 times more likely to acquire HIV, syphilis, chlamydia or gonorrhoea and 16% more likely to have a low birth weight baby. Furthermore, 42% of women who have experienced physical/sexual violence at the hands of a partner have experienced further injuries as a result and 38% of all murders of women, globally, were committed by their intimate partners^1,3.

Children who witness such violence can display behavioural and emotional disturbances as well as being at risk of being perpetrators of violence themselves. Intimate partner violence has also been linked with higher rates of infant and child morbidity and mortality³.

The social and economic costs include women being at risk of suffering isolation, not being able to work, losing wages, not participating in regular activities and being unable to care for their children.

Prevention and response⁵

There are a number of guidelines as to how health professionals can train, prepare and respond for issues in violence against women. These include:

Providing women centred care – professionals offering first-line support when violence is disclosed i.e. empathy, non-judgemental attitude, privacy, confidentiality and access to relevant services.
Identifying and caring for survivors of intimate partner violence – Professionals should ask about exposure to violence with the aim to improve diagnosis, identification and subsequent care. First line clinical care should include emergency contraception, STI and HIV with relevant follow up.
Mandatory reporting of intimate partner violence to the police is NOT recommended. Professionals should offer support to report the incident if the woman chooses. It is important to know the legal framework of reporting in each state/country. Usually if an incident is to be reported, the professionals should NOT carry out an intimate examination.
Training of healthcare providers – Adequate history taking, risk management, investigations and planning management should be done at a pre-qualification level.
Healthcare policy and provision – Care for women experience violence and sexual assault should be, where possible, integrated into existing health services as opposed to a stand alone service. In the UK, this can include presenting to a General Practice, GUM services and if required, A&E.

Prevention is a powerful tool and evidence base from high-income countries has suggested that advocacy and counselling improve access to services for victims and are effective in reducing violence. In low resource countries, prevention strategies that have shown some effectivity include programs that empower women economically and socially through a combination of microfinance and skills training related to gender equality; that promote communication and relationship skills within couples and communities; transform harmful gender and social norms through education⁶.

Legislation is another key aspect, which can help achieve change. There is a need to implement policies that promote gender equality by ending discrimination against women in marriage, divorce and custody laws; ending discrimination in inheritance laws; improving women’s access to employment and developing national policies to address violence against women^5,6.

References and further reading

1. United Nations. Declaration on the elimination of violence against women. New York : UN, 1993.

2. United Nations. Fact and figures: Ending violence against women. http://www.unwomen.org/en/what-we-do/ending-violence-against-women/facts-and-figures

3. World Health Organisation. Global and regional estimates of violence against women. Prevalence and health effects of intimate partner violence and non-partner sexual violence. http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/

4. World Health Organisation. Violence against women and children: facts. http://www.who.int/news-room/fact-sheets/detail/violence-against-women

5. World Health Organisation. Primary prevention of intimate-partner violence and sexual violence: Background paper for WHO expert meeting May 2–3, 2007
6. World Health Organisation. Infographics: Violence against women infographic. http://www.who.int/reproductivehealth/publications/violence/VAW_infographic.pdf

Written by: Dr Huma R Khan

Sexual Violence against Children

Written by: Huma Khan

Narrated by: Fozia Tahir

Zainab Ansari, a 7 year old child was on her way to Quran recitation classes in Kasur,
Pakistan, when she was abducted, raped, strangled and left in a dumpster. Her body was
discovered on the 9th January 2018. Autopsy has yielded that she was most likely held in captivity, where she was tortured. Criminal proceedings are underway and someone has yet to be charged for this. [update: The culprit has now been arrested]
Child sexual abuse is a horrific reality of the society we live in and Zainab’s case is just one of the few most recent reminders of this. Today’s podcast will focus on definitions, the extent of the problem, signs exhibited by children and further complications secondary to the abuse as well as a brief reflection on prevention and control strategies.
Definition
Child sexual has differing dynamics to those of adult sexual abuse in many parameters
ranging from disclosure differences to the symptoms exhibited. Lets begin by defining the problem. The World Health Organisation’s definition of child sexual abuse is:
 The involvement of a child in sexual activity that he or she does not fully comprehend
 Is unable to give informed consent to
 For which the child is not developmentally prepared for
 Or that violates the laws or social taboos of a society
Sexual abuse in the case of minors is evidenced by any of the above activity between a child and an adult, or another child who by age or development is in a relationship of
responsibility, trust or power with the activity being intended to gratify or satisfy the needs of the other people. This may include but is not limited to activities like “intercourse, attempted intercourse, oral-genital contact, fondling of genitals directly or through clothing, exhibitionism or exposing children to adult sexual activity or pornography, and the use of the child for prostitution or pornography.”
Statistics
It is a challenging task to find out the actual number of sexually victimized children due to the fact that the prevalence reported varies across studies and data sources. The WHO in 2002 estimated that 73 million boys and 150 million girls under the age of 18 years had
experienced various forms of sexual violence. A meta-analysis conducted in the year 2009 analysed 65 studies in 22 countries and estimated an “overall international figure.” The main findings of the study were:
 An estimated 7.9% of males and 19.7% of females universally faced sexual abuse
before the age of 18 years
 The highest prevalence rate of CSA was seen in Africa (34.4%)
 Europe, America, and Asia had prevalence rate of 9.2%, 10.1%, and 23.9%,
respectively.
CSA has found to be associated with physical abuse at both younger and older ages and alone is accountable for about one per cent of the global burden of disease, but it is likely to be a risk factor for several other conditions like alcohol consumption, illegal drug usage, development of mental disorders, and spread of sexually transmitted diseases, which when pooled, are accountable for over 20% of the global burden.

India
India has a huge problem of child sexual abuse, in fact, it is home to 19% of the world’s
children as well as home to the worlds largest number of abused children. For every
155th minute a child, less than 16 years is raped, for every 13th hour child under 10, and one in every 10 children sexually abused at any point of time. Studies propose that over 7,200 children, including infants, are raped every year and it is believed that several cases go unreported. It is estimated by the government that 40% of India’s children are susceptible to threats like being homeless, trafficking, drug abuse, forced labour, and crime.

United Kingdom
It would be false to believe that the problem exists in poor and developing countries only.
Unfortunately, child sexual abuse is found across international borders as well delving deep within all socioeconomic boundaries.
 1 in 20 children in the UK have been sexually abused
 54,000 sexual offences against children recorded in 2015/6
 Over 90% of the abused children’s perpetrator was someone they knew
 Over 2900 children were identified as needing protection from sexual abuse in 2015

Risk factors
Risk factors have been identified, which can make children more vulnerable to abuse. These include:
1. Unaccompanied children
2. Children in foster or adopted care
3. Physically or mentally less abled children
4. Poverty
5. Armed conflict
6. Social isolation
7. Dysfunctional family life e.g. alcohol, drug dependency

Health consequences
The aftermath of child sexual abuse includes physical and mental complications. The
physical issues range from genital injury, genital discharge, bedwetting/soiling, anal
complaints (e.g. fissures, pain, bleeding), UTIs and STIs. Psychological and behavioural
issues can include behavioural regression, delayed developmental milestones, sleep
disturbances, depression, PTSD, poor self-esteem and/or inappropriate sexualised behaviours.
So what is the cause of the problem? Child sexual abuse is multi-dimensional in its cause and complexity, however, cultural and social norms supporting violence are a major issue. These can include the following:

a. Sexual violence being an acceptable way of punishment/power assertion
b. Sexual activity (including rape) being a marker of masculinity
c. Sex and sexuality being taboo as well as shameful for the victim, thus preventing
disclosure
d. Perpetrators having had a history of longstanding sexual abuse
Prevention and control of child sexual abuse
Management of victims of sexual abuse is also, therefore, quite complex and
multidimensional. It is important to remember, however, that sexual abuse is preventable and there are a number of steps that can be taken to keeping children safe. On individual levels this includes giving safe spaces to children (online and offline), equipping adults with knowledge and understanding to take action and empowering children to speak out about sexual abuse.
For children already having a history of abuse, there needs to be adequate support. This
includes the treatment of physical injuries, STI treatment, HIV prophylaxis, long term
counselling and/or psycho-educational intervention. Similarly, the frontline health staff need training in order to pick up the signs of sexual abuse, ask about it in a non-threatening setting and be competent enough to carry out the basic investigations and treatment. Disclosure in children is a multi step process and often is not easy for them to narrate. The health and forensic services must therefore work hand in hand to allow for sensitive information to be gathered from the child.
Education is a key element of control and prevention of child sexual abuse. The learning is imperative for children and families. The children need to be taught in safe environments, which touching and other behaviours are inappropriate and who to report to. They need to be reassured and mentally equipped so that they have a safe person with whom they can communicate.
Implementation of laws and policies is another minefield, which has to be taken into
consideration. Control and prevention of abuse cannot work if the laws and policies are not in place, and if society as a whole does not believe in the legal enforceability of these.

References
1. Guidelines for medico-legal care for victims of sexual abuse. World Health
Organisation. http://apps.who.int/iris/bitstream/10665/42788/1/924154628X.pdf
2. Changing social and cultural norms that support violence. World Health
Organisation. http://www.who.int/violence_injury_prevention/violence/norms.pdf
3. Child sexual abuse. National Society for the Prevention of Cruelty to Children.
https://www.nspcc.org.uk/preventing-abuse/child- abuse-and- neglect/child-sexual-
abuse/
4. Singh et al. An epidemiological overview of child sexual abuse. J Family Med Prim
Care 2014; 3(4): 430-435.
5. Wihbey J. Global prevalence of child sexual abuse. Journalist Resource.
http://www.journalistsresource.org/studies/./global-prevalence- child-sexual- abuse.

Sexual Harrasment: Me too

Written and Narrated by: Fozia Tahir

The recent #metoo campaign against sexual harassment was an eye opening social campaign for me. Nearly 80% of the women in my friend list reached out to the world by saying they have been sexually harassed at work on in closely knit family and community setups. While a couple of my male friends showed their support not a single one of them said they had been affected by sexual harassment too. This shows that violence against women is worth all the feminist debates that ever existed.
What was also super inspirational about these young ladies in my friend list is that they have grown up to become stronger women and better people and are contributing towards several gender and world development orientated goals. Some of the stories narrated by my friends gave me Goosebumps. So here I take off my shoes, put my feet in the shoe of sexually harassed and assaulted women and scribble a poem in the first half of the article. In the next half I have tried to academically explain the issue of sexual harassment to inform myself and others about the topic.

I am sending you love, because me too

An old man I respected once cracked a dirty joke,
Day in and day out I received anonymous calls,
I ignored all of this and kept looking away,
Has any of this emotional abuse happened to you?
I am sending you love, because me too

Were you young and naïve playing alone in the wild?
Were you brave enough to stay out late in the dark?
In a family event full of people, did it happen to you?
‘The world is not a safe place’ do you now believe it’s true?
I am sending you love, because me too

How wise, and respected was your molester?
How filthy did you feel with every touch of that monster?
Did you dare protest or in silence choke back?
How guilty, how helpless, how shocked did it leave you?
I am sending you love, because me too

Did you come back home and throw those clothes away?
Did you have anyone to turn to and seek support?
Or were you clueless about how or where to report?
were you worried about how small they would make you feel?
I am sending you love, because me too

Did they ask you, ‘what were you wearing’?
Did they start the victim blaming?
‘You shouldn’t have been there on your own’ did they say?
There is no point in putting pebbles in the mud, stay away!
Is this what happened to you?
I am sending you love, because me too

Do you know of a local authority you could go to?
Or a national law that might support you?
any helpline, number your school or college shared with you?
Or did you survive those days without an idea of what to do?
I am sending you love, because me too

through it all, have you become a stronger person?
Are you worried for the future of your children?
Have you decided to take a stand and speak up?
do you believe in empowerment of men and women’?
I am sending you love because me too.

Sexual harassment is a serious social problem. The strategies most commonly used by women to cope with harassment range from avoiding or ignoring the harasser to reporting the incident.
There isn’t a single agreed upon definition for sexual harassment. Most researchers define it as “a psychological experience based on a sexually unwanted, offensive, and threatening behaviour at work”. Several authors have defined three types of sexual harassment,
Gender harassment
Unwanted sexual attention
Sexual coercion
Gender harassment (hostile, offensive, intimidating, and degrading verbal and nonverbal behaviour against women) is a type of subtle sexual harassment aimed at deterring women from transgressing male domains rather than being an expression of sexual attraction.
Unwanted sexual attention: Most evident types include verbal and nonverbal behaviour, such as persistent nonreciprocal requests for dates, letters, phone calls, deliberate touching, grabbing, sexual advances and propositions, and assault). This behaviour is perceived by the target as unwelcome, unreciprocated, and offensive acts of sexual interest.
Sexual coercion, also known as quid pro quo or sexual blackmail, is the most explicit and recognizable type of sexual harassment, where the harasser, a person in power, demands sexual favours from a subordinate worker in exchange for organizational rewards and benefits or threats of reprisal related to job prospects and conditions (e.g., job security and promotion)
Though both men and women may be exposed to sexual harassment, the literature on harassment is consistent in reporting that an overwhelming number of victims are women, and harassers are men. Thus, one out of every two to three women have experienced some type of sexual harassment or have been subjected to unwanted sexual behaviour.
The strategies most frequently used by women to cope with harassment range from avoiding or ignoring the harasser to reporting the offence. Unfortunately, none of these strategies has proven to be clearly effective in combating harassment at work, nor in raising the confidence of workers (i.e., potential victims) regarding their expectations towards their current employers. Studies have shown that women who report incidents of harassment are often threatened with reprisals for reporting the incident or making it public. A further strategy employed by women in coping with sexual harassment is confronting the harasser. Some studies have found that active confrontation benefited victims by empowering women, and by helping them to expose social inequality. The tendency to respond negatively to any woman who attempt to draw limits as to the behaviours of men, particularly if these infringe traditional gender roles, is enshrined and perpetuated by the sexist ideology. A good example is a study where women who challenged traditional gender roles and undermined male authority were found to be negatively evaluated by men.
Sexism has a role to play in it. The fact that men and women are different and certain acts by men are acceptable because of their gender fuels the issue of harassment. In general, sexism is associated to attitudes legitimizing violence against women, and would explain the nexus between hostile sexism and blaming the victim. Myths of sexual harassment, including beliefs such as self-victimization, that women enjoy acts of violence, these acts are only committed by mentally deranged men, or that women exaggerate their reports are common to all women.

Impact of Sexual Violence:
The impact of sexual violence goes way beyond physical injuries e.g.
The world may not feel like a safe place anymore
You no longer trust others, you don’t even trust yourself
You may question your judgement, your self-worth and even your sanity
You may blame yourself for what happened or believe you are ‘dirty’ or ‘damaged goods’.
You may struggle with anxiety or depression.
It is worth remembering that you are experiencing a normal reaction to trauma. Dispelling the toxic victim blaming myths about sexual violence can help you start healing. Remember that you are not to be blamed for what happened to you and you can regain your sense of safety and trust.
Sexual assault especially rape victims should not be blamed as rape is a crime of opportunity. Rapists choose victims based on their vulnerability and not on how sexy they appear or how flirtatious they are.
Recovery from sexual trauma takes time and healing can be a very painful, but with the right strategies and support, you can move past the trauma, rebuild your sense of control and self-worth and even come out the other side feeling stronger and more resistant.

No matter how hard life is on you, speak up, seek help, heal and help others heal too

P.s. A big shout out to Peter Bickerton for reading the poem and encouraging its publication.

Questions:
1. Could a woman asking a man for coffee be categorised a sexual harassment, specifically if the man is obliged to say yes to a lady?
2. Do men understand what rape does/means to a woman? Is it more than violence for them as it is for women?

References:

Herrera, M. C., Herrera,A., Expósito, F. 2017. To confront versus not to confront: Women’s perception of sexual harassment. The European Journal of Psychology Applied to Legal Context. In press

http://www.helpguide.org

Sapac.umich.edu

http://www.sexualharrasmenttraining.biz