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 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

A working Muslim lady? Who owns the income…

Written and Narrated by: Rabia Nazir

Men and women have been created to run the cycle of life in harmony yet with diversity. While a Muslim woman has been freed from the obligation of breadwinning for the family, her core role is to strengthen the family ties; most importantly raising the off springs as good human beings as her contribution to the society as well as Islam. However, Islam does not restrict the women inside the four walls of the house. We can find many examples of working ladies from early era of Islamic revolution. Hazrat Khadeeja (R.A), the first wife of Prophet Mohammad (peace and blessings be upon him), was a successful and in fact the wealthiest businesswoman in the Makkah at that time. Thus, Muslim women have right to get a degree, have a career choice, run a business, and own a property. They are also entitled for inheritances in the property of guardian. I shall try to cover all aspects (focusing on the false believes) associated with the financial standing of women in Islam in my upcoming podcasts. Today, I want to dust off massive misunderstanding about the right of a woman on her own income.
A Muslim women, no matter how rich she is, is NOT responsible for spending her income on her family. It is solely man’s responsibility to provide for the life essentials for his family (parents, wife, and children). While wife in principle is not obliged to spend, she can with her free will and if she does, it will be regarded as favour (ehsaan) for her husband. I will narrate an incident here for endorsement from the wife of `Abdullah ibn Masud (may Allah be pleased with him). She used to work and earn a living. On one occasion, she asked the Prophet (peace and blessings be upon him) if she could donate her money to her poor husband, to which the Prophet (peace and blessings be upon him) replied, “Yes, and you will be rewarded twice.”(An-Nasa’i). In addition, wife is always entitled for the monthly pocket money from her husband even if she is working herself unless she willingly gives up on it or the marriage itself dissolves. It is also clearly having been said is Quran:

“Whatever men earn, they have a share of that and whatever women earn, they have a share in that.” (Quran 4:32]

Here our society shows a disappointing face where apparently, even in conservative families, women are supported to seek degrees and work but not many of them actually sum up the courage to speak about their access to their own salaries. I personally know many examples where all their income is snatched or at least she faces restriction on spending her money out of free will. The worst case scenario is physical and mental torture in case of refusal and making her to beg for each penny for basic personal needs. It is mostly practiced in labour class and lower middle class where family is financially dependent on few earning hands (including a women in many cases) but mature working couples are no exception to it. In my acquaintances, I have also known to examples where wife’s salary is credited in husband’s account and she is not allowed to maintain her own bank account. Limited income resources coupled with the intense desire to win the race of ‘social status’ lead to the need of controlling the spending rights of woman in poor. While the ‘so-called open-minded’ men are also afraid of financial independency of a woman. It makes me even sadder when I see well-educated men treating their daughter and wives like a dumb cow. While an educated working wife is a nice show-off to the society, at the same time they hypocritically believe that financially independency makes women strong in head. Such a women becomes difficult to control and hard to please. A girl who has earned a degree after spending at least 16-18 years and who have tasted out-door life during education and work should not be trusted enough to spend her money wisely?
This clarification comes with some other aspects too. Of course, the decision of pursuing a career is based on the understanding between husband and wife; it should be a good-will gesture from husband to his lady that he respects her desire to grow intellectually and financially. While many of men might not be ‘narrow-minded’, the fear of disapproval from friends and family greatly affects their thinking pattern. The career choice also matters a lot; academia and health industry based professions are happily acceptable for women in our society, whereas women in technical and trade oriented careers struggle much more and face greater challenges from male fellow colleagues and family members.
I have dared to open up the discussion on this sensitive aspect of a working lady. I have witnessed sufferings happening to my colleagues/friends and stayed silent thinking in my head that ‘It is someone’s personal matter’ or ‘It is their right way to fix their girls’. In my opinion, the real issue is the lack of authentic knowledge as well as the cultural acceptance of the rights for women that Allah has granted those 14 centuries ago. Not raising my finger to anyone but I simply accept my responsibility to raise my son(s) with respect for a women’s right and be a real man who is not afraid of his wife’s or daughter’s independence. If you are a young educated girl too, would you promise me the same?
We, at Meer-e-Karwan, thrive to ‘change the thinking’ about the least cared or talked about social aspects affecting our everyday lives. Please be open to share your experiences and opinions about today’s topic with us!!