Module 3: Violence and Domestic Violence in Developing Countries

The World Health Organization (WHO) defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.” (1)  It is estimated that 4,400 people die every day because of intentional acts of self-directed, interpersonal, or collective violence, while many more are injured as a result of being victims or witnesses to acts of violence. (2) A study in India found that 42% of all female respondents reported experiencing some type of violence, with 29% reporting physical violence and 69% reporting psychological abuse.(3) Overall, at least one out of three women around the world have been beaten, coerced into sex, or otherwise abused in her lifetime.(4) Domestic violence is a particular type of violence characterized by a pattern of abusive behaviors by one or both partners in a relationship. Domestic violence has many forms and can include physical aggression, sexual abuse, emotional abuse, and controlling behavior, as well as economic deprivation.

The majority of violence towards women is carried out by intimate partners, such as spouses, fathers, or fathers-in-law. For example, intimate partner abuse is a public health problem that affects over four million women in the United States each year. Surveys show that 11 to 13 % of Mexican American women are affected by partner abuse, while surveys of English-speaking Latinos have found similar rates (between 10 to 17 %). (5) Studies from Australia, Canada, Israel, South Africa, and the United States show that between 40% and 70% of female murders were carried out by intimate partners.(6) Similarly, a World Health Organization study on domestic violence carried out in 10 countries found more than 75 % of women who had been physically or sexually abused since the age of 15 years had been abused by a partner.(7) In addition, 48 population-based studies from around the world found that between 10%-69% of women reported having been physically assaulted by an intimate partner during their lifetime.(8)

Rape and Sexual Violence

Rape and sexual aggression may result in physical injuries, such as bruises, stabbings, and fractures. Rape may also cause vaginal tearing, bleeding, infection, or chronic pelvic pain. In extremely brutal cases, the physical harm of rape can lead to an orifice between the vagina and the bladder called a fistula. Women with vaginal fistula tend to be incontinent, isolated, and stigmatized.(9) Some 150 million girls under 18 have experienced forced intercourse or sexual violence. Unfortunately, “many women believe their husbands are justified in beating them even for trivial incidents, and domestic abuse is widely viewed as strictly a family issue.” (10) According to estimates from the UN, between 250,000 and 500,000 women were raped during the 1994 genocide in Rwanda. Although sexual violence is exacerbated by war, it also affects millions of people living in stable contexts.(11) To read more about the effects of war on women and their health please, see http://www.uniteforsight.org/women-children-course/women-war

The psychological impact of sexual violence is devastating and often outlasts the physical injuries. Even with counseling, up to 50% of women retain symptoms of stress. A case of sexual violence may also hinder a person’s ability to form relationships and trust others. Lastly, victims of sexual violence are often stigmatized and rejected by their partners and family. Many times, rape victims are even blamed for the assault. In some cultures, the victim may be killed by male family members in an attempt to restore honor to the family. (12)

Causes

The presence of violence cannot be attributed to a single factor, as biological and personal factors, relationship quality, and community context all play major roles. For intimate partner violence, or domestic violence, the most consistent marker is marital conflict or discord in the relationship. Economic conditions are also causes and effects of violence. Poor people disproportionally account for the public health burden of violence in almost every society. (13) “Strong associations have been found between domestic violence and low household income, low educational level of husband, consumption of alcohol and drugs and witnessing domestic violence during childhood. Researchers have also identified an inverse relationship between a woman’s educational attainment and domestic violence.” (14)

Though some studies have shown that increased status and increased control over resources for women is protective against domestic violence, recently many others have found that employment and increased status “do not necessarily reduce domestic violence and may in culturally conservative areas increase it.”(15) As a study in South India concluded, “programme strategies and policy recommendations often assume that helping women to empower themselves, particularly through female education, vocational training and employment, will provide women with resources that will in turn decrease their risk of adverse reproductive health outcomes. However, there is a growing recognition that these strategies may conflict with prevailing social norms and expectations that are relatively slow to change, and may instead result in increased violence against women.” (16) It is therefore not surprising that a study in India found that 75% of working respondents reported being abused because of their employment status.(17)

Though poverty, education level, and consumption of alcohol and drugs are all associated with domestic violence, the most significant root of domestic violence is gender inequality. “The links between gender-based power and domestic violence are widely recognized, with violence being viewed both as a manifestation of deeply entrenched gender power inequities as well as a mechanism by which such inequities are enforced.” (18) For example, indigenous men often say they feel entitled to use sexual, physical, and/or psychological violence to control their partners’ behavior if they suspect them of having an affair or believe them to be a “bad” wife. This has led to alarming rates of domestic violence and consequently mental health problems. Growing unemployment combined with high fertility rates hinder the ability of men to fulfill their role as financial provider, and violence is reported to give them an opportunity to reaffirm their masculinity. (19) 

Tolerance of Abuse

Since domestic violence tends to be culturally engrained, or derived from culturally-based gender roles, many women are tolerant of the abuse they face. A study on Latina women found that, for many participants, maintaining an intact family took precedence over their personal problems. Their belief that the welfare of their children was dependent upon keeping their family together often led them to tolerate the abuse.  In addition, “the Latina participants discussed the sacredness of marital bonds and the love and loyalty they felt towards their husbands that made them willing to tolerate abuse. Some believed that they did not have the right to complain, protest or seek help because of the self-sacrificing nature of marriage.” (20) In Nicaragua, for example, 32% of rural women say it is acceptable for a husband to beat his wife if he even suspects that she has been cheating on him.(21) In Asia, many women believe that they would bring shame upon themselves, their families, and their communities by disclosing their abusive situation to a medical provider. In addition, they were embarrassed by their husband’s behavior and believed it reflected poorly on them.(22) A study on domestic violence in India reflected this sentiment and found that “among the women who reported violence, 29% had never received medical care after domestic violence, and 10% had never told a health worker about being abused. Only 5% of the women reported speaking to the health worker about problems of violence at home.” (23)

Go To Module 4: Child Labor and Child Abuse in Developing Countries >>

Footnotes

(1) Krug, E., Mercy, J., Dahlberg, L. “The world report on violence and health.”

(2) Ibid.

(3) Chandrasekaran, V., Krupp, K., George, R., et. al. “Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India.” Indian Journal of Medical Sciences. (2007).

(4) “Pathfinder International 2009 Annual Report.” Accessed on 4 February 2011.

(5) Bauer, H., Rodriguez, M., Quiroga, S., and Flores-Ortiz, Y. “Barriers to Health Care for Abused Latina and Asian Immigrant Women.” Journal of Health Care for the Poor and Underserved. 11.1 (2000): 33-44. Accessed on 16 November 2010.

(6) Stephey, M. “Why Sexism Kills.” Time. (2009). Accessed on 4 February 2011.

(7) “Shattered Lives Immediate Medical Care Vital for Sexual Violence Victims.” Accessed on 4 February 2011.

(8) Krug, E., Mercy, J., Dahlberg, L. “The world report on violence and health.”

(9) “Shattered Lives Immediate Medical Care Vital for Sexual Violence Victims.” Accessed on 4 February 2011.

(10) “Pathfinder International 2009 Annual Report.” Accessed on 4 February 2011.

(11) “Shattered Lives Immediate Medical Care Vital for Sexual Violence Victims.” Accessed on 4 February 2011.

(12) Ibid.

(13) Krug, E., Mercy, J., Dahlberg, L. “The world report on violence and health.”

(14) Chandrasekaran, V., Krupp, K., George, R., et. al. “Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India.” Indian Journal of Medical Sciences. (2007).

(15) Ibid.

(16) Rocca, C., Rathod, S., Falle, T., and et. al. “Challenging assumptions about women’s empowerment: social and economic resources and domestic violence among young married women in urban South India.” International Journal of Epidmiology. 38. (2009). Accessed on 3 February 2011.

(17) Chandrasekaran, V., Krupp, K., George, R., et. al. “Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India.” Indian Journal of Medical Sciences. (2007).

(18) Rocca, C., Rathod, S., Falle, T., and et. al. “Challenging assumptions about women’s empowerment: social and economic resources and domestic violence among young married women in urban South India.” International Journal of Epidmiology. 38. (2009). Accessed on 3 February 2011.

(19) Hughes, J. “Gender, Equity, and Indigenous Women’s Health in the Americas.” Accessed on 26 January 2011.

(20) Bauer, H., Rodriguez, M., Quiroga, S., and Flores-Ortiz, Y. “Barriers to Health Care for Abused Latina and Asian Immigrant Women.” Journal of Health Care for the Poor and Underserved. 11.1 (2000): 33-44. Accessed on 16 November 2010.

(21) Hughes, J. “Gender, Equity, and Indigenous Women’s Health in the Americas.” Accessed on 26 January 2011.

(22) Bauer, H., Rodriguez, M., Quiroga, S., and Flores-Ortiz, Y. “Barriers to Health Care for Abused Latina and Asian Immigrant Women.” Journal of Health Care for the Poor and Underserved. 11.1 (2000): 33-44. Accessed on 16 November 2010.

(23) Chandrasekaran, V., Krupp, K., George, R., et. al. “Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India.” Indian Journal of Medical Sciences. (2007).