Violence against women

Violence Against Women

Abigail S. Polintan, MDResident-Lecturer

Nonie Dalisay, MD, FPOGSConsultant-MOderator

RAPE• The sexual assault of children, women

and men

Sexual Violence• Any sexual act performed by one person

on another without the person’s consent

Incidence• 10.6% of women reported a sexual

assault at some time in their lives• 11% of High School adolescents

reported to have been forced to have sex

• 20-25% of College women have been victims of actual or attempted sexual assault during College

Incidence• This crime remains to be underreported– Embarassment– Fear of retribution– Feeling sof guilt–Assumptions that little will be done– Lack of knowledge of their rights

Who are susceptible?

• Very Young• Very Old• Homeless women• Women with mental illness

Sexual assault happens to people of all ages and races in all socioeconomic groups

Forms Sexual Violence• Unwanted touching• Rape• Non-physical distressing acts of sexual

harassment:–Threats–Peeping–Taking nude photos without consent

The perpetrator may be a stranger, he or she is OFTEN an individual well known to the victim

Marital Rape• Involves forced coitus or related acts

without consent but within the marital relationship

Date Rape• The women may voluntarily participate in

sexual play, but coitus is performed, often forcibly, without her consent

• Often not reported• A traumatic event that scars a woman’s self-

esteem

Statutory Rape• Coitus with a women under a specific

age, irrelevant of consent; because the female is defined by statute as being incapable of consenting

RAPE-TRAUMA SYNDROME

Rape Trauma Syndrome

• Phase 1: Immediate or Acute Phase– Lasts for hours to days–May be associated with paralysis of the

individual’s coping mechanisms• Complete loss of emotional control• Well-controlled behavior pattern–Reaction depends on: Relationship of the

attacker to the victim, whether force was used, length of time the victim was held against her will


• Phase 1: Immediate or Acute Phase–Generally disorganized–Complain of both physical and emotional

symptoms


• Phase 1: Immediate or Acute Phase–Physical symptoms:• Specific Injury• Generalized soreness• Eating problems• Headaches• Sleep disturbances


• Phase 1: Immediate or Acute Phase– Emotional symptoms:• Fear• Mood swings• Irritability• Guilt• Anger• Depression• Difficulties in concentrating• Flashbacks

Medical care is often sought during the acute period, and at this point it is the physician’s responsibility to assess the specific medical problem and also to offer a program of emotional support and reassurance.


• Phase 2: Reorganization Phase• Flashback and nightmares may continue• Phobias may develop:–Towards the members of the offending sex–The sex act itself–Non-related circumstances: Fear of

crowded places or height


• Phase 2: Reorganization Phase• Victim may institute a number of important

lifestyle changes: job, residence, friends, significant others

• If major complications (STD or Pregnancy) occur, resolution may be more difficult

• Lasts from months to years


• Phase 2: Reorganization Phase• Medical care and couseling must be non-

jugdgemental, sensitive and anticipatory.• Point out why a contemplated change is

being contemplated and the complicating effects it may have on the patient’s overall well being

PHYSICIAN’S RESPONSIBILITIES IN THE CARE OF RAPE VICTIMS

Medical Responsibilities

• Treat injuries• Diagnose and treat STD• Prevent pregnancy

Medicolegal Responsibilities

• Document history carefully• Examine patients thoroughly and

specifically note injuries• Collect articles of clothing• Collect vaginal (rectal and

pharyngeal) samples for sperm• Comb pubic hair for hair samples


• Collect fingernail scrapings where appropriate• Collect saliva for secretion

substance• Turn specimens over to forensic

authorities and receive receipts for chart


Source Motile Sperm

Sperm Acid Phosphatase

Vagina Up to 8 hours

Up to 7-9days

Variable (Up to 48 hours)

Pharynx 6 hours Unknown 100IURectum Undetermin

ed20-24 hours 100IU

Cervix Up to 5 days Up to 17 days

Similar to vagina

Emotional Support• Discuss degree on injury, probability of

infection, and possibility of pregnancy• Discuss the general course that can be

predicted• Consult with rape-trauma counselor• Arrange a follow-up visit for a medical and

emotional evaluation in 1-4weeks• Reassure as far as possible

INTIMATE PARTNER VIOLENCE

Abuse• Domestic violence, partner abuse,

intimate partner violence, the battered woman, and spouse abuse• Refer to violence occuring between

partners in an ongoing relationship even if they are not married

Battered Woman• Any woman over the age of 16 with

evidence of physical abuse on at least one occasion at the hands of an intimate partner

Battered Wife Syndrome

• Symptom complex occurring as a result of violence in which a woman has at any time received deliberate, severe, or repeated (>3x) physical abuse from her husband or significant male partner in which the minimal injury is bruising.

Intimate Partner Violence

• Actual or threatened physical, sexual, or psychological abuse by a current or former spouse (including common-law spouses), dating partner, boyfriend or girlfriend.

Intimate Partner Violence

• Pattern of coercive behaviors that may include repeated battering and injury, psychological or emotional abuse, sexual assault, progressive societal isolation, economic deprivation, intimidation and stalking. (American Medical Association)

Partner abuse is often seen in conjunction with abuse of children and elderly persons in the same household

Incidence• 14.5% reported threatened physical violence• 20.2% reported completed physical violence• 10.2% unwanted sex with an intimate partner• 47% of husband who beat their wives, do so

3 or more times per year• Rape is a major form on abuse in 54% of

violent marriages

Common sites of Injuries

• Head• Neck• Chest• Abdomen• Breast• Upper extremities

Common Forms of Injuries

• Scratches and Bruises

• Sore muscles• Welts• Fractures• Broken teeth

• Burns• Lacerations• Head injury• Strangulation

Murder and Suicide are frequent components of domestic violence problems

It is important that physician’s increase their ability to recognize the signs of domestic violence and spouse abuse

Patient’s Appearance at the ER

• Shy• Frightened• Embarassed• Evasive• Anxious

• Passive• Often cries• Batterer may

accompany the patient

• Drug or alcohol abuse

Somatic Complaints of Abuse Women

• Headache• Insomnia• Choking sensation• Hyperventilation• Chest, back or pelvic pain

BATTERING ACT

First Phase

• Tension building• Manifested by discrete acts that cause

family friction• Name calling, intimidating remarks,

meanness, mild physical abuse such as pushing

• Victim believes at this point that she has the power to avoid aggravating the situation

Second Phase

• Uncontrolled discharge of tension that has built up through the first phase

• Attacks may take form of both verbal and physical abuse

• Victim is often left injured• In self-defense, victim may actually

injure or kill the batterer

Third Phase

• Batterer apologizes, asks forgiveness, and frequently shows kindness and remorse

• Showers the victims with gifts and promises

• Victim begins to hope the relationship can be saved and the violence will not recur

• The batterer learns that he can control the victim

PHYSICIAN’S RESPONSIBILITIES IN INTIMATE PARTNER ABUSE

• Acknowledge to the patient the seriousness of the situation

• Attend to the patient’s injuries• Assess the patient’s emotional status

from the stand point of psychiatric condition such as suicidal ideation, depression, anxiety, or signs of abuse of drugs, alcohol, or other medications

• Attempt to estimate the woman’s ability to assess her own situation and her readiness to take appropriate action

• Determine the community resource available for handling family violence

• Recognize the problem and either offer counseling or get counseling for the patient

EXIT PLAN

EXIT PLAN• Have a change of clothes packed for

both her and her children; including toilet articles, necessary medications, and an extra set of keys to the house and car (may be left with a friend of family member)

• Keep some cash, a checkbook, and a savings account book with a friend or family member

EXIT PLAN• Other ID papers, such a birth

certificates, social security cards, voters registration cards, utility bills, and driver’s license, should be kept available

• Hove something special, such as a toy or book, for each children

• Have financial records available, such as mortgage papers, rent receipt, and an automobile title

EXIT PLAN• Determine a place on exactly where to

go regardless of the time of the day• Ask neighbors to call police if violence

begins• Remove weapons• Teach children to call emergency

numbers

Intimate partner violence is a common problem that affects the family unit in particular and society in general

VIOENCE AGAINST WOMEN IN THE PHILIPPINE SETTING

Republic Act No. 9262

• An act defining violence against women and their children, providing for protective measures for victims, prescribing penalties therefor and for other purposes

Republic Act No. 9262

• Section 3. Definition of Terms– Violence against women and their children” refers to

any act or series of acts committed by any person against a woman who is his wife, former wife, or against a women with whom the person has a common child, or against her child whether legitimate or illegitimate, within or without the family abode, which results in or is likely to result in physical, sexual, psychological harm or suffering, or economic abuse including threats of such acts, battery, assault, coercion, harassment or arbitrary deprivation of liberty.

Includes, but it not limited to the following acts:

• “Physical violence”• “Sexual violence”• “Psychological violence”• “Economic abuse”

Definition of Terms:

• Battery– Refers to an act of inflicting physical harm upon a

woman or her child resulting to physical and psychological or emotional distress

• Battered Woman Syndrome– Refers to a scientifically defined pattern of

psychological and behavioral symptoms found in women living in battering relationships as result of cumulative abuse


• Stalking– Refers to an intentional act committed by a person

who, knowingly and without lawful justification follows the woman or her child or places the woman or her child under surveillance directly or indirectly or a combination thereof


• Dating Relationship– Refers to a situation wherein the parties live as

husband and wife without the benefit of marriage or are romantically involved over time and on a continuing basis during the course of the relationship. A casual acquaintance or ordinary socialization between two individuals in a business or social context is not dating relationship.

Definition of Terms:• Sexual Relations– Refers to a single sexual act which may or may not

result in bearing of a common child.

• Safe Place or Shelter– Refers to any home or institution maintained or

managed by th eDepartment of Social Welfare and Development (DSWD) or by any other agnecy or voluntary organization accredited by the DSWD for the purpose of this Act or any other suitable place the resident of which is willing temporarily to receive the victim.

Definition of Terms:• Children– Refers to those beollow eighteen (18) years of age

of older but are incapable of taking care of themselves as defined under Republic Act 7610. As used in this Act, it includes the biological children of the victim and other children under her care.

Sec. 5. Acts of Violence Against Women

• (a) Causing physical harm to the woman or her child

• (b) Threatening to cause the woman or her child physicla harm

• (c) Attempting to cause the woman or her children physical harm

• (d) Placing the women of her child in fear of imminent physical harm

Sec. 5Acts of Violence Against Women• (e) Attempting to compel or compelling the woman or

her child to engage in conduct which the woman or her child has the right to desist from or to desist from conduct which the woman or her child has the right to engage in, or attempting to restrict or restricting the woman’s or her child’s freedom of movement or condcut by force or threat of force, physical or other harm or threat of physical or other harm or intimidation directed against the woman or her child. This shall include, but not limited to the following acts commited with the purpose of effect of controlling or resisting the woman’s or her child’s movement or conduct.


• (1) Threatening to deprive or actually depriving the woman or her child of custody or access to her/his family;

• (2) Depriving or threatening to deprive the woman or her children of financial support legally due her or her family, or deliberately providing the woman’s children insufficient financial support


• (3) Depriving or threatening to deprive the woman or her child of a legal right;

• (4) preventing the woman in engaging in any legitimate profession, occupation, business or activity, or controlling the victim’s own money or properties, or solely controlling the conjugal or common money, or properties;


• (f) Inflicting or threatening to inflict physical harm on oneself for the purpose of controlling her actions or decisions

• (g) Causing or attempting to cause the woman or her child to engage in any sexual activity which does not constitute rape, by force or threat of force, physical harm, or through intimidating directed against the woman or her child or her/his immediate family


• (h) Engaging in purposeful, knowing, or reckless conduct personally or through another, that alarms or causes substantial emotional or psychological distress to the woman or her child, this shall include but not be limited to the following acts;


• (1) Staling or followingth ewoman or her child in public or private places;

• (2) Peering in the window or lingering outside the residence of the woman or her child;

• (3) Entering or remaining on the dwelling or on the property of the woman or her child against her/his will;


• (4) Destroying the property and personal belongings or inflicting harm to animals or pets of the woman or her child; and

• (5) Engaging in any form of harassment or violence


• (i) Causing mental or emotional anguish, public ridicule or humiliation to the woman or her child, including, but not limited to, repeated verbal and emotional abuse, and denial of financial support or custody of minor children or denial of access to the woman’s child/children

Penalties• Those constituting serious physical injuries shall

have the penalty of prison mayor• Those constituting less serious physical injuries

shall be punished by prison correctional• Those constituting slight physical injuries shall

be punished by arresto mayor

Penalties• In addition to imprisonment, the perpetrator

shall• (a) pay a fine in amount of not less than one

hundred thousand pesos (P100,000.00) but not more than Three hundred thousand pesos (P300,000.00);

• (b) undergo mandatory psychological counseling or psychiatric treatment and shall report compliance to the court

Protection Orders• An order issued under this Act for the purpose

of preventing further acts of violence, against a woman or her child specified in Section 5 of this Act and granting other necessary relief.

Protection Orders• Who may file for a protection order?– The offended party–Parents, guardians of the offended party–Ascendants, descendants or collateral

relatives within the fourth degree of consanguinity or affinity–Officers or social workers of the DSWD or

social workers of local government units (LGUs)

Protection Orders• Who may file for a protection order?–Punong Barangay or Barangay Kagawad– Lawyers, counselor, therapist, or healthcare

provider of the pettioner;–At leats (2) concerned responsible citizens of

the city or municipality where the violence against woman and their children occurred and who has personal knowledge of the offense committed.

Protection Orders• Barangay Protection Orders (BPOs) refer

to the protection order issued by the Punong Barangay ordering the perpetrator to desist from committing acts under Section 5(a) and (b) of this Act.

• 15 days, non extendible

Protection Orders• Temporary Protection Orders (TPOs) refer

to the protection order issued by the court on the date of filing of the application after ex parte determination that such order should be issued

• 30 days + (Shall be renewed by court)

Protection Orders• Permanent Protection Orders (PPOs) refer

to the protection order issued by the court after notice and hearing

Violence against women

Health & Medicine

Transcript of Violence against women