Call for greater investment in prevention of VAW

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An editorial in the Bulletin of the World Health Organisation, calling for greater recognition of violence against women as a urgent public health issue, on par with several other more ‘accepted’ health care concerns. The editorial also calls for more investment in prevention strategies, as well as services that respond to women who’ve experienced violence.

Working with the health sector is an important aspect of Prajnya’s work, and this year, we hope to expand our outreach to work with both public and private sector hospitals as well as educational institutions.

Violence against women: an urgent public health priority

Claudia Garcia-Moreno a & Charlotte Watts b

a. Department of Reproductive Health and Research, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.
b. London School of Hygiene and Tropical Medicine, London, England.

Correspondence to Claudia Garcia-Moreno (e-mail: garciamorenoc@who.int).

Bulletin of the World Health Organization 2011;89:2-2. doi: 10.2471/BLT.10.085217

Violence against women has been described as “perhaps the most shameful human rights violation, and the most pervasive.”1 Addressing violence against women is central to the achievement of Millennium Development Goal (MDG) 3 on women’s empowerment and gender equality, as well as MDGs 4, 5 and 6.2 It is also a peace and security issue. In spite of this recognition, investment in prevention and in services for survivors remains woefully inadequate.

Research on violence against women – especially male partner violence – has increased. Since 2005, when the first results of the World Health Organization (WHO) Multi-Country Study on Women’s Health and Domestic Violence3 were launched, the number of intimate partner violence prevalence studies increased fourfold, from 80 to more than 300, in 2008. We now have population-based prevalence data on intimate partner violence from more than 90 countries, although there are still some regions – such as the Middle East and west Africa – where there is relatively limited data. Similarly, there is also a growing body of evidence about the range of negative health and development consequences of this violence.

Women suffer violent deaths either directly – through homicide – or indirectly, through suicide, maternal causes and AIDS. Violence is also an important cause of morbidity from multiple mental, physical, sexual and reproductive health outcomes, and it is also linked with known risk factors for poor health, such as alcohol and drug use, smoking and unsafe sex.4,5 Violence during pregnancy has also been associated with an increased risk of miscarriage, premature delivery and low birth weight.6,7

When the cumulative impacts on mortality and morbidity are assessed, the health burden is often higher than for other, more commonly accepted, public health priorities. In Mexico City, for example, rape and intimate partner violence against women was estimated to be the third most important cause of morbidity and mortality, accounting for 5.6% of all disability-adjusted life years lost.8 In Victoria, Australia, partner violence accounted for 7.9% of the overall disease burden among women of reproductive age and was a larger risk to health than factors such as raised blood pressure, tobacco use and increased body weight.9

In addition to the human costs, research also shows that violence has huge economic costs, including the direct costs to health, legal, police and other services. In 2002, Health Canada estimated that the direct medical costs of all forms of violence against women was 1.1 billion Canadian dollars.10 In low-resource settings, relatively few women may seek help from formal services, but because of the high prevalence of violence, the overall costs are substantial. In Uganda, for example, the cost of domestic violence was estimated at 2.5 million United States dollars in 2007.11

The broader social costs are profound but difficult to quantify.12 Violence against women is likely to constrain poverty reduction efforts by reducing women’s participation in productive employment. Violence also undermines efforts to improve women’s access to education, with violence and the fear of violence contributing to lower school enrolment for girls. Domestic violence has also been shown to affect the welfare and education of children in the family.

This growing understanding of the impact of violence needs to be translated into investment in primary, secondary and tertiary level prevention: including both services that respond to the needs of women living with or who have experienced violence and interventions to prevent violence. WHO has recently published Preventing intimate partner and sexual violence against women: taking action and generating evidence.13 This publication summarizes the existing evidence on strategies for primary prevention, identifying those that have been shown to be effective and those that seem promising or theoretically feasible. The review highlights the urgent need for more evidence on effective prevention interventions and for integrating sound evaluation into new initiatives, both to monitor and improve their impact and to expand the global evidence base in this area. It recognizes how infant and early childhood experiences influence the likelihood of people later becoming perpetrators or victims of intimate partner and sexual violence, as well as the need for early childhood interventions, especially for children growing up in families where there is abuse. It also recognizes the importance of strategies to empower women, financially and personally, and of challenging social norms that perpetuate this violence. Laws and policies that promote and protect the human rights of women are also necessary, if not sufficient, to address violence against women. In addition, health and other services need to be available and responsive to the needs of women suffering abuse. Concerted action is needed in all of these areas, but there is limited research on the most effective approaches.

To help address this gap, the Bulletin would like to invite submissions of papers describing research that addresses violence against women. We are particularly interested in research with a strong intervention focus, including ways to get violence against women onto different policy agendas and lessons about how to address some of the challenges policy-makers face; innovative approaches to prevention or to service provision, including community-based programmes in both conflict- and crises-affected and more stable settings; research to address more neglected forms of violence against women, and evidence on the costs and cost-effectiveness of intervention responses. Descriptive research that contributes to a better understanding of the global prevalence and costs of violence, or that provides evidence about the root causes of such violence will also be considered. Submissions can be made throughout 2011 at: http://submit.bwho.org

 

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Rape law loopholes

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Vinay Sitapati, Who’s afraid of an FIR? Indian Express, July 1, 2009.

The single-page version is available here: http://www.indianexpress.com/news/whos-afraid-of-an-fir/483499/0 and copied below in case the link is broken. It’s not very often gender violence is featured in mainstream op-ed pages! Bravo, Indian Express!

The rape of Mathura, a young tribal woman, by drunken policemen, marked the coming of age of feminist legal activism. The furore that followed the 1979 “not guilty” verdict led to Indian rape laws being eventually strengthened in four major ways: (1) coercion was to be presumed if sexual intercourse was proven in cases of gangrape and custodial rape (2) the raped woman would not be judged on the basis of her ‘character’ or past sexual history, (3) the victim’s identity was to be kept secret; proceedings were in camera and (4) improvements in medical methods can now conclusively identify the rapist. In the wee hours of Saturday in Shopian (Kashmir) 30 years later, these four changes came to nought. The body of Neelofar and her sister-in-law Asiya were found in a shallow stream next to a para-military camp. Their clothes were ripped off, the stream had earlier been searched, and the water-level was low. Yet the police put the death down to drowning and refused to register a first information report (FIR). In the post-mortem that followed, the doctors confirmed the police-version, and the forensic lab took forever to publish its findings. It was only when public anger that lit the entire Valley, that Chief Minister Omar Abdullah ordered an enquiry commission which has since confirmed sexual assault; several local officials have been suspended. Where the law failed, people pressure worked.

 Official callousness in Shopian is partly explained by the culture of impunity that prevails in conflict zones world over. The laws may be the same, but ‘war’ permits a certain license.

 

But the tragedy of Shopian is the tragedy of all of India. The failure to register FIRs is one of the biggest problems that raped women face. The number of rapes reported in India is large enough — 20,737 women reported that they were raped in 2007, about six a day. That’s an 800 per cent increase from 1971, when the National Crimes Records Bureau first began to compile rape statistics. But the real number is likely far higher. One widely quoted (though hard to verify) estimate is that for every one rape reported, 67 are not.

 

Botched medical tests are also deeply pervasive during investigations into rape in India. Outright fraud, like in Shopian, does happen: the post-mortem report of a Dalit woman gangraped in the Khairlanji massacre was famously tampered with. But more pervasive are the subtle humiliations that medical examinations inflict. Pratiksha Baxi, an assistant professor at JNU, has done extensive work on how the Indian legal system deals with rape cases. She points out “even when not fudged, the fact that the doctor does the ‘two-finger test’ to check whether the victim ‘is sexually habituated or not’ is using science to do what is directly banned — pass judgment on the sexual history of the raped woman.”

 

The publicity given to the victims in Shopian — with names and lurid descriptions of the injuries published — was perhaps necessary to establish the most basic of truths: that rape had taken place. But it points to something that Indian law ignores: the insensitivity of the process, making victim and family relive the nightmare of rape. In a Rajasthan trial last year, the cross-examination did this quite literally. As a shocked Rajasthan high court later described it, the raped woman “was made to lie on the bench available in the trial court to demonstrate her posture”!

 

The official response to allegations of rape against Shiney Ahuja offers a study in contrast. Unlike in Shopian, an FIR was swiftly registered and Ahuja taken in for questioning. The maid was medically examined; the report confirmed that sex had taken place. And unlike Shopian, three of the four post-Mathura changes in rape law did kick in. The identity of the maid has been kept secret. In sharp contrast to the appalling jokes on how came a lowly maid to refuse a film star’s advances, the police have made no such assumption — the character of the maid has (so far) not been a factor. Lastly, the advancements of science means that traces of Shiney’s DNA have been found on the maid’s body.

 

Action in the Shiney Ahuja case has perhaps been swift. The Chief Minister of Maharashtra has announced that the case will be tried in a fast-track court. But what about the other five women who reported rape that day in India? Is relentless public (and media) glare the only guarantee of speedy justice?

 

It is hard to form a sweeping indictment of our post-Mathura rape laws from just two cases. In fact, cold statistics indicate that while conviction for rape is low (in 26.4 per cent of cases), it is only slightly less than the conviction rate for violent crime (27 per cent). Besides, the charge sheet rate for rape is a super-high 94.6 per cent, meaning that virtually every complaint ends with the charges being framed by the police (the quality of investigation is quite another matter). Perhaps then, the solution is beyond the scope of any law. The lessons of Shopian — no FIR filing, fudged medical examinations and the public nature of the trial — require institutional sensitivity and honesty that no law can guarantee. The only guarantee of that, for raped women, hinges on one-off acts of paternal pity or the fury of the mob.

Our bodies, your politics

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In one week, two stories about the abuse of power and violence against women and both in Kashmir.

The first is the story of the two girls whose bodies were recovered from the river. Traces of semen were found on the girls, although the doctors doing the post-mortem have ruled out murder. 

People out on streets in Shopian, Kashmir Watch, June 4, 2009. 

The second is of a 15 year old who was repeatedly abused by a constable. 

Ishfaq-ul-Hassan, Another rape, murder rocks Kashmir valley, Daily News and Analysis, June 8, 2009.

Indulge me and let me refer you to an article I wrote last year for New Indian Express and posted on this blog.

Technology aids violence against women

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Google India runs ad for illegal baby sex test kit, AP/Indian Express, September 12, 2008.

Mumbai, September 12: The image seems innocuous enough: A pregnant woman’s belly with a male symbol scrawled in ink to the right of her navel and a female symbol to the left.But in India, where the practice of aborting female fetuses is widespread, such advertisements for prenatal gender selection kits are neither innocuous nor legal.

Last month, activist Sabu George filed a petition against the Indian subsidiaries of Google, Microsoft and Yahoo with the nation’s highest court, asking the companies to pull gender selection advertisements from their Indian search engines. On Aug. 13, the Supreme Court asked the companies to respond to the petition.