Intimate Partner Violence: Filling Up The Cracks as Health Care Professionals
All over the world, millions of women are suffering regardless of their age, race, religion, economic status and educational background as a consequence of one of the most common forms of violence—intimate partner violence.
The United Nations defines violence against women as ‘an act of a husband or a partner which causes physical, sexual or mental harm to the woman, such as threats of such acts, coercion, or deprivation of liberty (whether in public or private life),’ (WHO, 2014).
It has also been defined as ‘behavior which is performed by a partner to cause physical and mental harm to the woman, including physical aggression, sexual coercion, psychological abuse, and separating them from their family,’ (WHO,2014).
Intimate partner violence can take shape as a variety of abusive behaviour—physical violence which may include slapping, beating and hitting, sexual violence in the form of forced sexual intercourse, emotional abuse such as belittling, insulting and threatening harm, and controlling behavior such as separating a person from their family, not allowing them to avail resources like education, and monitoring their actions (WHO, 2012).
In a sociocultural context, intimate partner violence against women is a serious worldwide public health issue faced by women in both developing and high income areas. As the most common form of violence, it persists in all countries. ‘One in three women worldwide experience intimate partner violence at some point of their lives,’ (Ali, Asad, Mogren & Krantz, 2011).
Pakistan is a developing country with a male-dominant society. Due to its male dominance, people accept intimate partner violence as a social and cultural norm and consider it normal behavior. Whenever women face violence, they don’t report it because they don’t consider violence a crime. Global prevalence figures indicate that 35% of women worldwide have experienced intimate partner violence in their lifetime (WHO, 2014).
There are multiple risk factors of intimate partner violence including poverty, gender inequality, marital conflicts, and a male-dominant society. The major contributor of violence is poverty which may be due to unemployment or low income/socioeconomic status.
This creates stress in an individual and this associated stress increases the risk of violence. ‘Poverty is inherently stressful, it has been argued that intimate partner violence may result from stress and the poorer man has fewer resources to reduce stress,’ (Jewkes, 2002). Particularly in a male-dominant society, a lack of equality between men and women allows men the power to control women, because of which some societies accept violence as normal behavior.
In 1998, Heise proposed the Integrated Ecological Framework. According to this framework, the causative factors of violence are defined at four levels: the first level focuses on individual behavior and characteristics (e.g. age, education, income, history of involvement in violence).
The second level defines relationships with family and friends (family conflicts and relation with those friends who are already involved in violence). The third level focuses on community (schools, workplace, offices, neighbourhood, drug trade and poverty.) Finally, the last level is based on society.
There are certain social and cultural norms in society; some accept violence as their social norms and create an environment which encourages violence. Some cases may include other violence-inducing factors such as low socioeconomic status, poverty, or income inequality (Krug, Mercy, Dahlberg & Zwi, 2002). If a person has low income and less resources, he will be to abuse his wife due to associated stress.
Intimate partner violence can have a devastating negative impact on the physical and mental health of women. Physical effects can include injuries, bruises, lacerations and fractures, but the most enduring effects of violence against women are mental health problems after victimization by intimate partner violence.
The most prevalent mental health problem is post traumatic stress disorder, caused by threat of injury, fear of death, traumatic events and hopelessness. As a result of post traumatic stress disorder, women often became socially isolated and helpless. They refuse to report and hide the abuse out of a feeling of helplessness. Other mental health issues include depression, anxiety disorder, eating disorders, insomnia, and emotional distress (Campbell, 2002).
In view of intimate partner violence being serious public health issue, effective strategies should be taken across different levels to overcome this hurdle. Firstly, primary prevention is necessary—efforts to prevent violence before it occurs, identification of risk factors and their eradication to prevent violence.
As health care providers we can overcome the psychological impact on victims by exposing them to coping strategies to reduce the stress, to reduce negative thoughts, and to enhance their self-esteem by applying cognitive behavioural therapy.
We can teach family members of the victim about communication skills necessary to promote their relationship. Health care professionals should also conduct preventive sessions about violence with the collaboration of other health care systems.
Secondly, public awareness sessions about violence should be held on a community level to emphasize gender equality and ensure its position as asocial and cultural norm. Women should be encouraged to participate in academic fields.
At government level, policies must be constructed to safeguard women’s rights and to provide a source of empowerment. At the very least, this should include strict rules against culprits and a penalty given to them to eradicate this social issue from the country (Jewkes, 2002).
In conclusion, intimate partner violence is a severe breach of human rights and public health, and it has a major impact on physical, emotional and mental health. It should be eradicated by applying effective strategies. As health care professionals, we must have full awareness of intimate partner violence and its risk factors and we must cultivate the potential to handle this issue when encountered in common society.
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