Life in bondage

There are grave implications of gender based violence as it has grave effects on the physical, psychosocial/mental and reproductive health
of women and child health.
By Dr Suneela Garg/ Saipriya

Violence against women is recognized as one of the most serious public health issues worldwide. It knows no social, economic or national boundaries. Gender Based Violence (GBV) is any form of intentional physical, psychological, sexual harm, or threat of harm, directed against an individual based on their gender. Although GBV is violence directed against both men and women, it refers mostly to violence directed against women by their men. GBV is a consequence of a patriarchal society at the roots of which lie power inequalities between men and women. GBV is considered as the most pervasive form of violence and is the most prevalent violation of women’s human rights. According to the United Nation’s global estimates, one in three women has experienced physical and/or sexual violence by their intimate partner at least once in their lifetime.
GBV encompasses physical, sexual, emotional, economic and verbal violence. Physical violence includes hitting, beating, slapping, punching and stabbing out of many others. Studies suggest that between 23 to 53 percent of women physically abused by their partners during pregnancy are kicked or punched in the abdomen. Sexual violence includes coerced sex, marital rape, attacks on sexual organs, demeaning the sexuality of partner, treating her in a sexually derogatory manner, criticizing sexual performance and desirability, accusations of disloyalty and withholding sex. Verbal violence includes withholding access to phone and/or transportation, belittling victim’s personal relationships, mental harassment, constant “checking up,” not allowing the victim to go anywhere independently, false accusations, threatening to divorce her and verbal abuse by mother-in-law etc. Emotional violence means deriding the victim’s sense of worth for instance: criticism, undermining victim’s abilities and competency, name-calling, ridiculing her in public and/or private, making the victim feel guilty, threatening victim’s relationship with children and many more. Economic violence means depriving the victim of financial independence. Maintaining total control over financial resources including victim’s earning, withholding money and/or access to money, deny employment, seeking accountability and justification for all money spent, lying about income etc. are examples of economic violence.
Globally, nearly 30% women who have been in a relationship, report suffering from some kind of violence in the course of their relationship. Men who have a low education level, have witnessed child mistreatment or exposure to violence in the family, have attitudes accepting violence, support gender inequality, or are substance abusers (including alcoholics, smokers, or drug addicts), are more likely to commit violence against their wives. On the other hand, a women’s low education level, exposure to violence in family, being abused during childhood and her attitude of accepting violence and gender inequality, increases her risk of being victimised.
GBV has serious deleterious effect on the physical, psychosocial/mental and reproductive health of women. Physical effects include partial or permanent disability, poor nutrition, chronic pain, gastrointestinal problems and organ damage. Psychosocial/mental effects include anxiety, guilt, shame, post-traumatic stress disorder, depression, sleep disorders, suicidal tendencies, substance abuse, social stigma and social isolation. Reproductive effects include sexual disorders, unprotected sex, low birth weight of new-borns, neonatal death, maternal death, suicide, HIV, AIDS and infertility. According to a study, abused women are more likely to have difficulty using contraceptives than non-abused women. As a result, they are more susceptible of having unwanted or unplanned pregnancies, unsafe abortions, and of becoming pregnant as adolescents.
GBV expresses itself in a multitude of dangerous behaviors directed against women and girls. Sadly, this violation of the basic human rights of women and girls does not stop even when a woman is pregnant. In addition to having deleterious effect on maternal health, GBV affects birth outcomes of the new-borns of mothers who are victims of violence at home. For instance, research suggests that new-borns of abused women are more likely to die before the age of 5. Violence during pregnancy is directly associated with low birth weight of babies. Pregnant women who are subject to GBV are more likely to delay seeking antenatal care. There are strong links between GBV and sexually transmitted infections (including HIV) that can negatively impact on not only the mother’s health, but also her newborn’s health and chance of survival.
Further, GBV has far reaching consequences on maternal health of pregnant women. Nearly 1 in 4 women experience physical or sexual violence during pregnancy. Women who suffer from violence during pregnancy exhibit more depression and substance abuse and are less likely to gain needed weight or access to prenatal care, compared with pregnant women who are not exposed to violence. Evidence from Demographic and Health Survey data, reveals that woman who are abused are more than twice as likely to encounter sexually transmitted infections as opposed to non-abused women. A research conducted on married women in India, suggests that women who have suffered both physical and sexual violence from their spouse, are four times more likely of getting HIV infection than non-abused women. Another study in Tanzania shows that young women aged 18 to 29 who have been victims of GBV are 10 times more likely to be HIV positive than women who have not been abused. Having access to family planning reduces maternal mortality by an estimated 20 to 35 percent by reducing women’s exposure to pregnancy-related health risks. Further, women who experience violence tend to have more children than they themselves want.
Unfortunately, this issue has not been given the required attention, primarily because it is rarely reported by women. Reasons for not reporting GBV include: Fear of stigma and discrimination: Women feel uncomfortable to share their experiences since our society wastes no time in stigmatizing these social issues and consider such women unclean. Women are blamed for what has happened and hence may experience discrimination.
Blame: Our society expects women to be able to avoid sexual violence including rape. Fear of disbelief: Women hesitate in disclosing violence against them, thinking that no one will believe them, particularly if their own partner has abused them. Fear of revenge: Mostly married women fear being intimidated or threatened by their husbands that they might harm their family or friends or from the fear of being murdered. GBV, is a grave issue that affects women and girls “by virtue of nothing but their gender.” We as a society need to take appropriate actions to eliminate this serious issue from its root in order to provide a safer, healthier and pleasant life for women.

(The authors are Director Professor and Head Community Medicine Maulana Azad Medical College and Associated Hospitals New Delhi and MPH Candidate’17 Drexel University, Philadelphia, PA, USA)