DOMESTIC VIOLENCE DOMESTIC VIOLENCE by by

Naureen Munawar AliNaureen Munawar Ali

VIOLENCEVIOLENCE Violence encompasses “physical, Violence encompasses “physical,

visual, verbal or sexual acts that visual, verbal or sexual acts that are experienced by a woman or are experienced by a woman or girl as threat, invasion, or assault girl as threat, invasion, or assault and that have the effect of hurting and that have the effect of hurting her or degrading her and /or her or degrading her and /or taking away her ability to control taking away her ability to control contact (intimate and otherwise) contact (intimate and otherwise) with another individual”with another individual”

WHAT IS DOMESTIC VIOLENCEWHAT IS DOMESTIC VIOLENCE?? Domestic violence is defined in the law as Domestic violence is defined in the law as

certain criminal acts committed between certain criminal acts committed between persons of opposite sex who live together persons of opposite sex who live together in the same household or who have lived in the same household or who have lived together in the past; or persons who have together in the past; or persons who have a child in common or are expecting a a child in common or are expecting a child (regardless of whether they have child (regardless of whether they have resided in the same household); or resided in the same household); or persons related to one another in the persons related to one another in the following ways: spouse, child, following ways: spouse, child, grandparent, former spouse, brother, grandparent, former spouse, brother, grandchild, parent, sister.grandchild, parent, sister.

The criminal acts specifically defined in The criminal acts specifically defined in the law are: assault, criminal damage, the law are: assault, criminal damage, custodial interference, endangerment, custodial interference, endangerment, imprisonment, intimidation, kid-imprisonment, intimidation, kid-napping, trespass, disorderly conduct napping, trespass, disorderly conduct (by fighting, unreasonable noise, abuse (by fighting, unreasonable noise, abuse language), or reckless display or language), or reckless display or discharge of a deadly weapon or discharge of a deadly weapon or dangerous instrument.dangerous instrument.

TYPES OF VIOLENCETYPES OF VIOLENCE

PhysicalPhysical:: pushing, grabbing, slapping, pushing, grabbing, slapping, kicking, hitting with an object, use of knife kicking, hitting with an object, use of knife or gun, acid throwing, burning.or gun, acid throwing, burning.

Verbal:Verbal: shouting, making threats, calling shouting, making threats, calling names, humiliating remarks (gestures).names, humiliating remarks (gestures).

Sexual:Sexual: forcing intercourse, making her forcing intercourse, making her to do sexual things against her will.to do sexual things against her will.

Exercising control:Exercising control: Isolating her from Isolating her from her family/ friends checking on her, using her family/ friends checking on her, using the children, economic control.the children, economic control.

DOMESTIC VIOLENCEDOMESTIC VIOLENCE Is pervasive and insidious.Is pervasive and insidious. Is carried out in private Is carried out in private

domain.domain. Is inflicted by an intimate Is inflicted by an intimate

partner or as the case may be.partner or as the case may be. Continues over a period of time Continues over a period of time

(chronic)(chronic) Limits avenues of escape for the Limits avenues of escape for the

victim.victim.

WHY IS VICTIMIZATION OF WHY IS VICTIMIZATION OF WOMEN SO COMMONWOMEN SO COMMON

Physically weak.Physically weak. Dependency status.Dependency status. Social tolerance of victimization.Social tolerance of victimization. Little whom they associate with.Little whom they associate with. Limited mobilityLimited mobility

OUTPATIENT DEPARTMENTS OF PSYCHIATRY, OUTPATIENT DEPARTMENTS OF PSYCHIATRY, LIAQAT NATIONAL HOSPITAL, PNS SHIFA AND LIAQAT NATIONAL HOSPITAL, PNS SHIFA AND

SOBRAJ HOSPITAL KARACHI.SOBRAJ HOSPITAL KARACHI. 63% of the participants were identified as victims 63% of the participants were identified as victims

of domestic violence on Karachi Domestic of domestic violence on Karachi Domestic Violence Screening Scale. 36% of the victims Violence Screening Scale. 36% of the victims were males and 64% of the victims were females. were males and 64% of the victims were females. 35% of the victims reported facing physical 35% of the victims reported facing physical abuse, 52% of the victims reported psychological abuse, 52% of the victims reported psychological abuse and 30% of the victims reported sexual abuse and 30% of the victims reported sexual abuse from their partner. 60% of the victims had abuse from their partner. 60% of the victims had depressiondepression and 67% of the victims had anxiety.and 67% of the victims had anxiety.

All the respondents admitted to All the respondents admitted to ever shouting or yelling at their ever shouting or yelling at their wives, including while she was wives, including while she was pregnant. Twenty-three (32.8%) pregnant. Twenty-three (32.8%) respondents admitted to ever respondents admitted to ever having slapped their wives and 54 having slapped their wives and 54 (77.1%) admitted to ever engaging (77.1%) admitted to ever engaging in a non-consensual sex with their in a non-consensual sex with their wives wives

J Pak Med AssocJ Pak Med Assoc

Sep 2000;50(9):312-4Sep 2000;50(9):312-4

HONOR KILLING (KARO-KARI)HONOR KILLING (KARO-KARI) According to the findings of Human Rights and According to the findings of Human Rights and

Legal Aid Centre in Karachi, in the first three Legal Aid Centre in Karachi, in the first three months of 2001, 120 Pakistani women were months of 2001, 120 Pakistani women were murdered in the name of Honor Killing. The murdered in the name of Honor Killing. The majority of women were shot to death. Others majority of women were shot to death. Others were axed, burnt and clubbed to death. were axed, burnt and clubbed to death.

264 honor killings in Sindh province in 1999.264 honor killings in Sindh province in 1999. According to the Human Rights Commission of According to the Human Rights Commission of

Pakistan, “Over 1000 honor killings take place Pakistan, “Over 1000 honor killings take place every year in Pakistan and, in the Punjab every year in Pakistan and, in the Punjab alone, at least 700 women are raped each year,” alone, at least 700 women are raped each year,” and then subsequent honor killing.and then subsequent honor killing.

GANG RAPEGANG RAPE In 1997 the National Assembly passed a law In 1997 the National Assembly passed a law

that provided for the death penalty for persons that provided for the death penalty for persons convicted of gang rape. No executions have convicted of gang rape. No executions have been carried out under this law and conviction been carried out under this law and conviction rates remained low.rates remained low.

It is estimated that less than one-third of all It is estimated that less than one-third of all rapes are reported to the police. The police rapes are reported to the police. The police themselves frequently are charged with raping themselves frequently are charged with raping women. women.

Women are raped to degrade the enemy tribe Women are raped to degrade the enemy tribe and hence they rape the opposite tribe’s women and hence they rape the opposite tribe’s women as an answer. as an answer.

Gang rape in particular, is Gang rape in particular, is commonly used as a means of social commonly used as a means of social control by landlords and local control by landlords and local criminal bosses seeking to humiliate criminal bosses seeking to humiliate and terrorize local residents. and terrorize local residents.

SOUTH ASIASOUTH ASIA In Bangladesh women killed by their In Bangladesh women killed by their

husbands constitutes 50% of all the husbands constitutes 50% of all the homicides in the countryhomicides in the country

In India, by unofficial estimates, as In India, by unofficial estimates, as many as 1,134 dowry deaths took place many as 1,134 dowry deaths took place in first 3 months of marriage (Asia week in first 3 months of marriage (Asia week oct1992)oct1992)

80% of all Pakistani women are 80% of all Pakistani women are subjected to domestic violence informal subjected to domestic violence informal study conducted by (women’s division)study conducted by (women’s division)

77 stove burning cases in 1995 ( a letter from 77 stove burning cases in 1995 ( a letter from Lahore “dawn” January 26Lahore “dawn” January 26thth and 29 and 29thth 1996) 1996)

Human Rights council of Pakistan reported Human Rights council of Pakistan reported 372 deaths of women due to domestic 372 deaths of women due to domestic violence during an 8 month period (The violence during an 8 month period (The News Karachi, Aug 5News Karachi, Aug 5thth 1994) 1994)

Study conducted by final year medical Study conducted by final year medical students at AKU found 34% physical abuse students at AKU found 34% physical abuse in a sample of 150 women.in a sample of 150 women.

Deaths attributed to stove blasts Deaths attributed to stove blasts (informal survey Punjab)(informal survey Punjab)

1988-8001988-800 1989-11001989-1100 1990-18001990-1800 PWA report of 1994 “ Trial by fire” 185 PWA report of 1994 “ Trial by fire” 185

cases some facts:cases some facts: 92% were married.92% were married. 88% were between ages of 16-25yrs88% were between ages of 16-25yrs 54% rural.54% rural. 60% husbands were accused and 21% in 60% husbands were accused and 21% in

laws were accusedlaws were accused

Report of 1998 about Report of 1998 about 706 women raped of 706 women raped of which 385 were which 385 were teenagers or younger teenagers or younger about 885 murdered by about 885 murdered by brother and husbands brother and husbands

(dawn may 30th 1999)(dawn may 30th 1999)

PREVALENCE/ INCIDENCE OF PREVALENCE/ INCIDENCE OF INTIMATE VIOLENCE IN WESTINTIMATE VIOLENCE IN WEST

In the USA, the leading cause of women In the USA, the leading cause of women going to the emergency wards in hospitals going to the emergency wards in hospitals is the wound they get due to domestic is the wound they get due to domestic violence. The number of women wounded violence. The number of women wounded this way is more than the total number ofthis way is more than the total number of women wounded in car accidents, mugging women wounded in car accidents, mugging and rape cases.and rape cases.

In Denmark, 25% of women state physical In Denmark, 25% of women state physical violence to be major cause of divorce.violence to be major cause of divorce.

In Austria, wife abuse was cited as a cause of In Austria, wife abuse was cited as a cause of breakdown in 59% of 1,500 divorced cases breakdown in 59% of 1,500 divorced cases ( United Nations 1991).( United Nations 1991).

In Romania, between march 93 and march 94, In Romania, between march 93 and march 94, 28.55% of women in the hospital were there as a 28.55% of women in the hospital were there as a result of beating by their husbands or boyfriends. result of beating by their husbands or boyfriends. (The Domestic violence in Eastern Europe Project (The Domestic violence in Eastern Europe Project 1995)1995)

In Russia, a formal declaration by In Russia, a formal declaration by the government stated that in 1994, the government stated that in 1994, 15,000 women died as a result of 15,000 women died as a result of their spouse’s violent behavior.their spouse’s violent behavior.

In Papua New guinea, it was shown In Papua New guinea, it was shown that 56% of women in urban areas that 56% of women in urban areas were victims of domestic violence.were victims of domestic violence.

In Canada, one in every 4 women In Canada, one in every 4 women are faced with sexual violence at are faced with sexual violence at one point in their lives and half of one point in their lives and half of these women are exposed to sexual these women are exposed to sexual violence before the age of 16 .violence before the age of 16 .

SOME FACTSSOME FACTS It is estimated that about one third of It is estimated that about one third of

children who are abused or exposed to children who are abused or exposed to violence as children become violent violence as children become violent themselves in later life.themselves in later life.

Boys are at increased risk to abuse an Boys are at increased risk to abuse an intimate partner in adult relationships if intimate partner in adult relationships if they were abused or witnessed abuse they were abused or witnessed abuse between parental figures.between parental figures.

The sons of the most violent parents had The sons of the most violent parents had a rate of wife abuse 100 times higher than a rate of wife abuse 100 times higher than the sons of the nonviolent parents.the sons of the nonviolent parents.

Girls are at increased risk to be abused by Girls are at increased risk to be abused by an intimate male in adulthood, if they an intimate male in adulthood, if they witnessed abuse between parental figures in witnessed abuse between parental figures in childhood.childhood.

Early physical abuse is a strong predictive Early physical abuse is a strong predictive factor of criminal behavior in adulthood.factor of criminal behavior in adulthood.

40-75% of children exposed to marital are 40-75% of children exposed to marital are estimated to be victims of physical child estimated to be victims of physical child abuse also.abuse also.

Alcohol use is frequently associated with Alcohol use is frequently associated with violence between intimate partners.  It is violence between intimate partners.  It is estimated that in 45% of cases of IPV, men estimated that in 45% of cases of IPV, men had been drinking, and in about 20% of had been drinking, and in about 20% of cases, women had been drinking cases, women had been drinking

STUDY BY MEDICAL STUDENTS STUDY BY MEDICAL STUDENTS AKU (CLASS OF 1996)AKU (CLASS OF 1996)

In a sample of 176 males In a sample of 176 males 27% practiced physical abuse.27% practiced physical abuse. 76% recognized it as mistreatment.76% recognized it as mistreatment. 46% felt men have a right to hit women.46% felt men have a right to hit women. 68% practiced isolation.68% practiced isolation. 44% did not see it as abuse.44% did not see it as abuse.

EFFECTS OF DOMESTIC EFFECTS OF DOMESTIC VIOLENCEVIOLENCE

Anxiety Anxiety Chronic depression Chronic depression Chronic pain Chronic pain Death Death Dehydration Dehydration Dissociative states Dissociative states Drug and alcohol dependence Drug and alcohol dependence Eating disorders Eating disorders Emotional "over-reactions" to stimuli Emotional "over-reactions" to stimuli General emotional numbing General emotional numbing Health problems Health problems MalnutritionMalnutrition

Panic attacks Panic attacks Poor adherence to medical recommendations Poor adherence to medical recommendations Repeated self-injury Repeated self-injury Self neglect Self neglect Sexual dysfunction Sexual dysfunction Sleep disorders Sleep disorders Somatization disorders Somatization disorders Strained family relationships Strained family relationships Suicide attempts Suicide attempts Inability to adequately respond to the needs of Inability to adequately respond to the needs of

their childrentheir children

In a 1999 study from Johns Hopkins, it was In a 1999 study from Johns Hopkins, it was reported that abused women are at higher reported that abused women are at higher risk of miscarriages, stillbirths, and infant risk of miscarriages, stillbirths, and infant deaths, and are more likely to give birth to deaths, and are more likely to give birth to low birth weight children, a risk factor for low birth weight children, a risk factor for neonatal and infant deaths.  In addition, neonatal and infant deaths.  In addition, children of abused women were more children of abused women were more likely to be malnourished and were more likely to be malnourished and were more likely to have had a recent untreated case likely to have had a recent untreated case of diarrhea and less likely to have been of diarrhea and less likely to have been immunized against childhood diseases.immunized against childhood diseases.

IT’ S HARD TO STOP BECAUSE IT’ S HARD TO STOP BECAUSE IT’S HARD TO REPORT!! IT’S HARD TO REPORT!!

CHALLENGES AS A PHYSICIANCHALLENGES AS A PHYSICIAN

If a women comes to you with If a women comes to you with bruises or injuries on her body bruises or injuries on her body how would you deal with her ?how would you deal with her ?

As a physician what are our As a physician what are our limitations to deal a domestic limitations to deal a domestic violence case?violence case?

Can we play a significant role in Can we play a significant role in changing the life of the women?changing the life of the women?

RECOMMENDATIONSRECOMMENDATIONS

To improve the status of woman To improve the status of woman within societywithin society

Changing perceptionsChanging perceptions EducationEducation Easy access to law and orderEasy access to law and order Stigma related to violenceStigma related to violence Moral support of the victimMoral support of the victim Emergency managementEmergency management