Year : 2014 | Volume
: 58 | Issue : 2 | Page : 75--77
Violence against women: Just a social issue or a global public health concern?
Managing Editor, Indian Journal of Public Health, Associate Professor, Department of Community Medicine, Murshidabad Medical College, Berhampore, Murshidabad, West Bengal, India
Managing Editor, Indian Journal of Public Health, Associate Professor, Department of Community Medicine, Murshidabad Medical College, Berhampore, Murshidabad, West Bengal
|How to cite this article:|
Mallik S. Violence against women: Just a social issue or a global public health concern?.Indian J Public Health 2014;58:75-77
|How to cite this URL:|
Mallik S. Violence against women: Just a social issue or a global public health concern?. Indian J Public Health [serial online] 2014 [cited 2019 Sep 18 ];58:75-77
Available from: http://www.ijph.in/text.asp?2014/58/2/75/132276
The Times of India: March 10, 2014: Man kills wife for not adding tomatoes to his dish: In Dehradun in a bizarre incident, a 32-year-old man killed his wife by repeatedly smashing her head against the wall for serving a potato dish without tomatoes.  This is not a rare incident. For such trivial and minor reasons, violence against women (VAW) continues from time immemorial. VAW exists everywhere and there is no region of the world, no country, and no culture where freedom of women against violence has been secured.
Overall 35% women worldwide had experienced either physical and/or sexual intimate partner violence or nonpartner sexual violence and 38% of all murders of women globally are committed by the intimate partners.  In India, overall one-third of women aged 15-49 years had experienced physical violence and one in 10 women had experience of sexual violence as revealed by National Family Health Survey (NFHS-3).  VAW affects all phases of lifecycle of a women, as rightly pointed out by Word Health Organization (WHO),  starting from sex selective abortion in prebirth period; female infanticide, female genital mutilation (FMG), child marriage or prostitution in childhood; physical, sexual, psychological abuse, rape, sexual harassment, dowry murders, forced pregnancy in adolescence and adulthood period; ending in physical and psychological abuse in elderly. Emotional or psychological violence is gaining more recognition in recent times, although acceptable definition is yet to be developed. VAW is mostly unreported or under reported due to societal norms, stigma, taboos, and sensitive nature of the subject, so reliable authentic data are always lacking. Data on sexual violence are mostly available from police, clinical settings, NGO or survey, so obviously it presents the tip of the iceberg.
United Nations (UN) declaration on the elimination of VAW states that "VAW is a manifestation of historically unequal power relations between men and women" and "VAW is one of the crucial social mechanisms by which women are forced into a subordinate position compared with men".  People argued with the available definition of VAW to be unrealistic as it was conceptualized with the vision of society to be patriarchal. Hence, they recommended the term gender based violence as violence against men had not been recognized. However, undoubtedly history of VAW is merged with the history of women viewed as property. Oppression toward women is hidden in Indian societal system from the ancient times like considering the women as Sudra, custom of Debdasi or Sati, burning women as Daayan or witch or even distress of Sita, Droupadi, and Ahalya have been glorified in Indian mythology. VAW is also the outcome of underdevelopment, social unrest and war situations as evidenced by the study in 2000 in Sierra Leone  where more than 50,000 internally displaced women were sexually victimized. It is closely linked with fundamentalism, which pampers honor killing and Khap panchayat and no political party dares to proactively fight against it antagonizing the voters support base. NFHS-3  also showed that poverty, lack of education and effect of alcohol are the crucial factors behind VAW. Ill effects of easily available pornographic sites in the internet cannot also be ruled out. Again it is pointed out that India is sitting on a social time bomb,  as India is having a skewed sex ratio with 37 million more males than females, who are mostly in the marriageable age group and large proportion of them even cannot find partners, thus more likely to engage in high-risk behavior, drug abuse, and VAW. Sex ratio at 6 years is also dropping as merely many poor families cannot even afford the cost of ultrasonogram and abortion facilities, so neglecting the female children toward death.
Violence against women, inflicted by individuals or state, fits into many categories. Customary form of sexual violence is child marriage, which is still rampant in Africa, Middle East and South Asian countries. National Crime Records Bureau reported 8618 dowry deaths in India in 2011 alone,  actual figures may be many times higher. VAW is not a small problem occurring in some pockets of society, rather is a global public health problem in epidemic proportions. Both immediate and long-term health consequences include impact on mental health such as depression, posttraumatic stress disorder, suicidal attempts, substance abuse; physical impact being injuries, murders, unwanted pregnancy, abortion, sexually transmitted infection/HIV, chronic pelvic pain, musculoskeletal disorder, urinary tract infection; social consequences of being ostracized in the society. WHO report  showed that women who have been physically and sexually abused by their partners had 16% more chance of having low birth weight babies, twice chance of having depression and abortion and 1.5 times to acquire HIV infection as compared to women not abused. UNICEF report in 2013  stated that about 125 million women in Africa and Middle East have experienced FMG, a traditional practice without any health benefits, but with serious health implications. Acid throwing causing severe burns and contracture is also rampant in South East Asian countries. Hence, it cannot be denied that VAW puts an undue burden on health care services as abused women need health services more and at a higher cost.
Milestones to combat VAW at international level include the Convention on Elimination of Discrimination against Women in 1979  which recognized the violence as a part of discrimination against women; UN declaration in 1993  considered as the first international instrument addressing VAW; linking of VAW with reproductive health in International Conference of Population Development at Cairo in 1994;  World Health Assembly declaration in 1996 of VAW as a major public health issue.  In 2008, Ban Ki Moon, Secretary General, UN launched the campaign named Unite to End VAW  and called for the initiatives from NGOs, government and private sectors, women's organization to join hands together against again it. In 2013, UN General Assembly had first agreed upon conclusion for prevention of violence against women, passed first resolution for protection of defenders of women's human rights  and pleaded for implementing gender specific policies and laws by different countries. Hence, VAW has been framed not only a health issue, rather a violation of human rights.
Violence against women is a major threat to social and economic development of a country, although most Governments consider it as a minor problem, especially the domestic violence. Millennium Development Goal (MDG) 3 addresses the promotion of gender equity and women empowerment, but continuous occurrence of violence toward women is not consistent with the commitment. Gender equity is recognized to be a key strategy toward achieving all the MDG goals as pointed out in the interim report.  "Development policies that fail to take gender inequality into account or that fails to enable women to the actors in those policies and actions will have limited effectiveness and serious costs to the societies." Associated conditions of violence are incorporated in the targets of MDGs, but VAW has never been highlighted in targets or indicators. This has led to Millennium Project Task Force on Education and Gender Equality  to suggest target to be introduced like reduction of lifetime prevalence of VAW by 50% by 2015. MDG 1 and MDG 2 provide an opportunity to escape from violence in poorest and vulnerable group of women in unorganized employment situations. MDG 4, MDG 5 and combatting HIV/AIDS in MDG 6 as closely associated with women and child health should address interventions to reduce partner violence. For better monitoring of gender discrimination, all data related to health status of under five children should be analyzed by age and sex. Relation of VAW with MDG 7 although seems to be very superficial, but efforts to ensure access to drinking water, basic sanitation, fuel should account for the safety needs of the females in public places. To achieve sustainable development globally as in MDG 8, it will make little sense if half the population is deprived of participating in the development strategies as social, economic, and political partners. Hence, unless prevention and awareness of VAW are integrated with MDGs, sustainable development will continue to remain a dream for national and international community.
Efforts to fight toward this violence is largely dependent on international and regional instruments, for instance, Brazil enacted the first law against domestic violence guided by International American Commission on Human Rights  or South Asian Agreement on Regional Cooperation protocol  to end trafficking of women and children. Marital rape has been illegal in whole USA, but rarely being enforced. Hence, the major challenges ahead faced by women are lack of criminalization or enforcement of laws such as forced marriage or child marriage, lack of awareness about existing laws, challenges in court where victims have to undertake the burden of proof and humiliating cross examination, inefficient, conflicting and impractical laws, measures for victims from legal aid, shelter and hot lines. In India, dowry prohibition act with amendment, anticruelty law, and domestic violence acts are there, but suffer from insufficient enforcement due to ambiguity in law and definitions. In 2013, the new criminal law enacted for protecting the Indian women more effectively from sexual assault also suffers from its limitation.
In many countries data regarding different aspects of VAW are lacking, thus emphasizing need of research everywhere. Interventions are equally important, essentially primary prevention targeting both men and women; supporting the victims; punishing the perpetrators; and strategies for changing the societal norms of gender inequality and raising the status of women. Intervention like reservation of one-third of panchayat seats for women, though implemented, but still superficial in nature considering women empowerment. Health sector has a large role to play in supporting the abused women medico-legally and psychologically and all categories of health personnel from grass root to tertiary care should have a sensitive and positive attitude to handle the cases. We need to have a standard national protocol for examination of victims of sexual violence, which needs to be introduced in medical curriculum. One Stop Crisis Center  for instance is providing excellent integrated services to victims in Kuala Lampur by a team of women groups, psychiatrists, counselors, police, legal aids, and medical social workers. Ultimately, the strong commitment from government and civil society with cooperation of other sectors is required to eradicate this evil element. In the tune of Ban Ki Moon,  we can utter "VAW is never acceptable, never excusable, never tolerable."
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