A report from Human Rights Watch (HRW) has documented how cases of violence ranging from spousal and child abuse to rape, incest and murders commited under the guise of family ‘honour’ oten go unreported and unpunished. Discriminatory criminal legislation in force in the West Bank and Gaza has led to virtual impunity for perpetrators of sexual violenceand has deterred victims from reporting abuse. These laws include provisions that: reduce penalties for men who kill or atack female relatives who commit adultery; allow rapists who agree to marry their victims to escape criminal prosecution; and allow only male relatives to ile incest charges on behalf of minors.
The south-eastern counties of Grand Gedeh, River Gee, Sinoe, River Cess and Maryland make up much of the hinterland of Liberia. Governed by a diferent set of laws, the area is populated by indigenous Liberians – referred to as the ‘country people’. Infrastructure and health and education services are virtually non- existent in a region long neglected by the Americo-Liberian elite who have traditionally dominated Liberia. Inhabitants of the area hold close to their traditions and culture – including the practice of trials by ordeal, female genital mutilation, ritual killings, witchcrat, sorcery and early marriages. During the many years of protracted war and civil strife, two rebel groups – Liberians United for Restoration of Democracy (LURD) and the Movement for Democracy in Liberia (MODEL) – and government soldiers terrorised the region. Systematised and endemic rape of womenandgirls, gang rape and multiple reoccurrence of sexual abuse were rampant. Many were raped in front of their families, as a sign of victory or ‘conquering’ – an ultimate expression of power over the enemy. Interviews with community members suggest that around two thirds of all womenandgirls experienced some form of sexual and gender-based violence (SGBV).
At this point, overcoming the public/private divide is a crucial aspect, given that the division between which is considered a public or a private matter entails a num- ber of negative consequences for women. By situating the private sphere (and espe- cially the family) outside the reach of the state and exempting it from governmental scrutiny, gender neutral visions of human rights leave uncovered much of the areas where womenandgirls move, making easy for VAWG to happen and remain un- punished (Kelly, 2005). This not only gives stimulus to male power and dominance over women, in several implicit and explicit ways, but it specially encourages male supremacy in the canonical situations of domestic violence, marital rape, and incest, giving practical immunity to the perpetrators, as abuse againstwomenandgirls is concealed under the false holiness of privacy and home (Kabeer, 2014).
All of these recommendations are important and necessary, and getting coun- tries to roll them out and adequately resource them must be a global priority. At the same time, though, we also need to look at the structural and intersecting drivers of violence, including patriarchy. The WHO acknowledges that “violence of all types is strongly associated with social determinants such as weak gover- nance; poor rule of law; cultural, social and gender norms; unemployment; income and gender inequality; rapid social change; and limited educational opportuni- ties.” (WHO, 2014a, p. ix). We need to understand that gender means empowering women socially, economically and politically, and also means empowering speciic groups of young and socially excluded men who are the main victims of extreme income inequality. It means that we need to hold accountable those who build pa- triarchal power structures that allow, encourage and turn a blind eye to the abuses of power against powerless men andwomen.
The power relations between some health professionals andwomen in maternity settings are ones of hegemonic dominance, which strongly parallels the societal position of dominance of men [4,5]. Negative behaviour largely stems from social norms within these environments, which influence both practice and expectations of power and are largely taken for granted . This can lead to the expectation that staff will be in control of women patients and entitled to use a range of strategies, including physical violence, to achieve this control and punish per- ceived disobedience . Female patients largely have little choice but to acquiesce to the power of the professionals in this setting, as they feel very vulnerable, especially without birth com- panions who could be advocates for them. The lack of repercussions for unacceptable health worker behaviour can fuel a sense of entitlement .
The sample size was calculated estimating a conidence level of 95%, with a margin of error of 3.0%, the pres- ence of 200 women enrolled in the service and an esti- mated prevalence of 50.0% for violenceand suicidal ideation. The sample size stipulated was 136 women; information was collected for all women who visited the service during the study period. Thus, 161 users were interviewed, corresponding to 80.5% of the total; 39 women (19.5%) did not visit the service during the data collection period and were not part of the study. A questionnaire was employed for individual inter- views, with questions about sociodemographic char- acteristics (age, marital status, ethnicity, education, religion, per capita household income, and number of children), sexual and reproductive characteristics (age at irst sexual intercourse, affective-sexual partner, condom use, and children with HIV) and clinical char- acteristics (time since HIV diagnosis, antiretroviral treatment, and opportunistic infections), as well as the presence of gender violenceand suicidal ideation. To evaluate the prevalence and types of gender violence, 13 questions were extracted from the Brazilian version of the World Health Organization ViolenceAgainstWomen (WHO VAW) instrument and were used in an international multicenter study coor- dinated by the WHO, 9 validated in Brazil by Schraiber
It must be highlighted, though, that the rights equality shown in this historical context was restricted to the white men, for even though in numerical minority in society, they were and should be seen as the majority under the law and the political power, since rights are products of social struggle and will represent the dominant class (HERRERA FLORES, 2009, p. 18). As the bourgeois needed this cultural and political framework, the white men also needed to remain as the dominant class. The difference now would be that the bourgeois men are society’s main actors, ruling the social system, instead of the men of the nobility. The patriarchal logic remains the same, because they were the only subjects of the law, and therefore affected by these legal and political changes. This shows us that the search for rights, at the time, was targeted to one specific sector of society and not for the search for rights for all people. The Declaration of the Rights of Men and of the Citizen considered the bourgeois men, and not all the people, as citizens. This idea coexisted for years with slavery and the exclusion of a large part of the population from access of rights.
There are numerous gender studies which focus on empathy. Freshbach and Roe (1968) found that girls aged six and seven years old react verbally and with more empathy to a series of slides about girls in happy, sad or frightening situations than boys, indicating that humans tend to empathise more with people of their own sex. This idea was confirmed by Hoffman (2002) for whom, in cases of abuse, the degree of empathy for the victim and the empathetic anger towards the perpetrator both influence the punishment.
In a period of transition to democracy after 20 years of military rule, the rights to citizenship began to be recognized, however, a speech that spoke in equal rights for men andwomen showed to be insuicient to sensitize all - society and government - in the ight toend discrimination againstwomen. Therefore, initially, the speech was articulated around the murders, but soon went on to reveal other forms of violence that were committed againstwomen. The women's movement warned that the murders were not isolated acts, motivated by uncontrolled passion, but the inal act of relationship-based assaults, frequent threats and humiliations and that ends in murder. That way, attacks that were socially accepted and even justiied (sexual violenceandviolence in marital relationships, especially beatings, ill-treatment and threats), from a given time, could be denounced and fought 10 .
Although unknown perpetrators have been reported by most teenagers (Table 2), there were often twice the num- ber of perpetrators identified in this group (27.6%). Fur- thermore in the adolescent group perpetrators related to the victim were reported almost eight times more fre- quently than in the adult group. These features show a similarity to the characteristics of childhood sexual abuse, which is usually perpetrated by adults the child knows and trusts . In Mexico City, 86.7% of known perpetrators were relatives or friends of the family . This privileged position generates different barriers to reporting sexual Table 1 Comparison of characteristics of sexual violenceagainst adolescent and adult women
This conceptualization of abuse is not neces- sarily gender or age specific although it typically is applied to analyses of abuse andviolence toward women of reproductive age. It does not define the victim as incapacitated or care dependent. Financial or material exploitation if included at all is defined as a form of psychological abuse. It assumes a power and control relationship be- tween the victim and perpetrator. According to this definition, sexual abuse could be perpetrated by an acquaintance or stranger; physical abuse could be perpetrated by a one-time date. Study samples based on this conceptualization of abuse generally use age ranges from 18 or younger to 49, presumed to be the end of reproductive age for women. Old age for these studies often start at 50 years of age,
The Court started out by offering a detailed historical account of Operation Condor and some of the human rights violations conducted during its development. Amongst them there was the treatment dispensed to pregnant women, who would be maintained alive until they gave birth and then have their children taken from them to be given to someone in the military or in the police force. Afterward, the mother would be killed or “disappeared”. This is what happened to María Claudia García Iruretagoyena Casinelli, born in Buenos Aires, Argentina, in 1957. She worked in a shoe factory and was studying Philosophy and Letters at the University of Buenos Aires. When she was deprived of her freedom, she was only 19 and 7 months pregnant of her first daughter with Marcelo Arieal Gelman Schubaroff. María and her husband were detained together in August 1976 by the Argentine and Uruguayan military commands and taken to a clandestine detention center, known as “Automotores Orletti”. Her husband was tortured and many years later, more precisely in 1989, his body remains were found, from which it could be determined that he was killed in 1976. María was taken to Montevideo, in Uruguay, and remained in the headquarters of the Uruguayan Information Service until she was taken to the Military Hospital to give birth, in November of the same year. María had her daughter taken from her in the end of the following month. What happened to María afterward is not yet clarified. With a powerful description of the ways in which state violence acted upon women's bodies during the military regimes and, in particular, María's body, the Court recognized the actions performed against her as violenceagainstwomen:
interview 12,795 women aged between 15 and 59 years in 12 rural and urban areas of Turkey, found a prevalence of 39% for physical violenceand 15% for sexual violence, in addition to great variations among the areas studied. In one of the regions, Northeastern Anatolia, prevalences were 53% and 29% for physical and sexual violence, respectively. These prevalences were similar to those found in the present study and seem to draw attention to the interface between human ecology and domains in life marked by the asymmetry of the different spaces occupied by womenand men. Varjão is a place where almost three quarters of the population studied believe that family problems must be discussed with family members exclusively. Moreover, almost half of the interviewees reported not relying on either family support or the local community initiative to stop ights that occur in the neighborhood (Table 1). A previous study described the experience of families in which violenceagainstwomen was associated with the interruption of family dynamics and reduction of support provided by family members. 17
A violência contra as mulheres (VCM) é um problema de saúde pública e uma violação dos direitos humanos. Ele tem uma alta prevalência na América Latina e no Caribe; o Estudo da Violência Contra as Mulheres da Organização Mundial de Saúde (OMS) identificou que as mulheres peruanas sofrem o maior índice de violência. O Perú é signatário da CEDAW e da Convenção de Belém do Pará, com recomendações para resolver este tipo de discriminação e descrever o papel do setor da saúde. A lei peruana define a violência como um problema de saúde mental. Objectivos: As três orientações clínicas do Ministério da Saúde para avaliar a integração da componente de saúde mental no cuidado de mulheres afetadas pela VCM foram revistas. Método: A proteção da saúde mental foi avaliada nas orientações acima mencionadas. A lei peruana relevante para perceber o reconhecimento das consequências de VCM na saúde mental e os cuidados prestados neste contexto foram revistos. Usando esses padrões nacionais e internacionais, foi realizada uma análise de conteúdo dos guias peruanos para a atenção da violência para ver como eles se integram a saúde mental. Resultados: Estas orientações são muito extensas e não definem claramente a responsabilidade dos profissionais de saúde. Não incluem um exame de saúde mental na avaliação da vítima e são vagas na descrição das atividades a serem realizadas pelo prestador dos cuidados de saúde. As orientações recomendam uma triagem universal usando um instrumento com formato antiquado e pesado. Em contrapartida, as orientações da OMS não recomendam qualquer triagem. Conclusão: As várias orientações analisadas não fornecem a informação necessária para o profissional de saúde avaliar o envolvimento da saúde mental e, desnecessariamente, tratam as mulheres sobreviventes de VCM como doentes mentais. Recomenda-se que as orientações recentes da OMS (Responding to intimate partner violenceand sexual violenceagainstwomen: WHO clinical and policy guidelines, 2013) para os cuidados de VCM sejam usadas como um modelo para o desenvolvimento de um único dispositivo técnico que incorpora directrizes com base científica.
It is emphasized that it is impossible to isolate any family member from the impacts of the marital violence, as it leads to a continuous and progressive process of loss of health, with serious consequenc- es for all those involved, especially the children. Researchers from different parts of the world have concluded that growing up in a home filled with vi- olence damages the children’s emotional, social and cognitive development. The repercussions include the following signs: hostile attitudes, aggressive- ness, neurosis, anxiety, depression, attention defi- cit hyperactivity disorder (ADHD) and low school performance. In addition, they are more likely to develop childhood morbidities such as obesity. (32,33)
RESULTS: The following prevalences were found: any type of violence 76% (95% CI: 74.2;77.8); psychological 68.9% (95% CI: 66.4;71.4); physical 49.6% (95% CI: 47.7;51.4); physical and/or sexual 54.8% (95% CI: 53.1;56.6), and sexual 26% (95% CI: 24.4;28.0). The prevalence of physical and/or sexual violence by an intimate partner in their lifetime was 45.3% (95% CI: 43.5;47.1), and by non-partners was 25.7% (95% CI: 25.0;26.5). Only 39.1% of women reporting any episode of violence perceived they had ever experienced violence in their lifetime and 3.8% of them had any reports of violence in their medical records. The prevalences were signiﬁ cantly different between sites as well as the proportion of perception and reports of violence in medical records. CONCLUSIONS: The expected high magnitude of the event and its invisibility was conﬁ rmed by low rate of reports in the medical records. Few perceived abuses as violence. Further studies are recommended taking into account the diversity of service users.
Objectives: to analyse the knowledge, beliefs and perception of the professional role that nursing students have, about exerted violenceagainstwomen in relationships. Method: a descriptive qualitative study following the ecological model through 16 focus groups realized with 112 students from four nursing courses of four Spanish universities. Results: the analytical categories were: knowledge, professional role, and beliefs about ones behaviour before the victim and the abuser. Students are unfamiliar with the characteristics of abuse, guidelines, protocols and screening questions and demand patterns for specific intervention. They do not identify their own professional role, be it delegated or specialized. Beliefs regarding their behaviour with the victim, not guided by professional criteria, perceive violence as a specific situation and disassociate the prevention of health care. They perceive the abuser as mentally ill, justifying the tolerance or delegation of performances. Conclusions: students define preconceived ideas about couples’ violence. Speeches reproduce and reinforce stereotypical myths, values indicative of inadequate training for nursing studies which raises the need to fortify the competencies in relation to intimate couples’ violence in the curriculum.
benefited from the state’s first female Police Com- missioner, who made strengthening police IPV procedures a priority. In consultation with local DV services, she and her staff: increased police training around IPV; brought in an arrest policy for perpetrators; piloted women remaining in the family home and removing the perpetrator; im- proved community policing; data collection; and consultation with DV services. Victoria has spe- cial DV magistrate courts, similar to ‘Delegacias Especializadas de Atendimento à Mulher’ – DEAM, in Brazil, where women can seek urgent interven- tion orders to keep perpetrators away; a Women’s Legal Service; court support for disempowered victims; an Immigrant Women’s DV Service and specialist refuges and services for indigenous wom- en. Nevertheless, these strategies are often imper- fect and perpetrators are not jailed until they breach an intervention order and this is common. A Victorian strategy in the whole of govern- ment approach is an effort to ensure that all ser- vices (legal staff, police, refuge and family vio- lence services staff and health workers) were trained with the same IPV concepts. Also that they understand the evidence about major risk factors and evidence-based strategies, through being involved with the ‘Family Violence Risk Assessment and Risk Management Strategy’ 28 . The
It is clear that professionals with a lower time in the ser- vice had a better understanding of the adequate conduct towards the users, and also felt more comfortable questio- ning them about violence. Half the professionals with more than 10 years in the job believed they should not advise the woman to leave the partner and notify the fact - and this number was even higher among those who received training. This notion can be associated to the idea that no- tifying is the same of denouncing, andto their lack of kno- wledge that notification is mandatory. This situation was evidenced in a study about the primary attention services in Belo Horizonte and Minas Gerais (19) . The professionals’ be-