Adolescent and Youth Reproductive Health: 6. Gender Based Violence

Session 6  Gender-Based Violence

Introduction

Violence against women is a very common problem in Ethiopia and can happen to any woman in any culture. It is a violation of human rights. It is also a public health problem, though it has not been given due considerations as a public health problem. It affects every aspect of the woman’s life and has many complex sexual and reproductive health consequences. In this session, you will learn about the consequences of the major forms of violence against women. You will also learn how you can help girls and women who are victims of violence.

Learning Outcomes for Study Session 6

When you have studied this session, you should be able to:

6.1  Define and use correctly all of the key words printed in bold. (SAQs 6.1, 6.2, 6.3 and 6.6)

6.2 Describe types of gender-based violence. (SAQs 6.1, 6.2, 6.3 and 6.6)

6.3  Explain some of the factors that contribute to gender-based violence. (SAQs 6.1, 6.2 and 6.3 )

6.4  Discuss barriers to reporting sexual violence. (SAQs 6.1 and 6.3)

6.5  Describe the sexual and reproductive health consequences of gender-based violence. (SAQs 6.1 and 6.4)

6.6 Describe your role in the prevention and management of gender-based violence. (SAQs 6.1 and 6.5)

6.1  Gender related terminologies

Figure 6.1  The boys play while the girls work in this Ethiopian village.

Gender refers to socially and culturally defined roles for males and females. These roles are learned over time, can change from time to time, and vary widely within and between cultures. Gender is not only about girls/women. However, the traditionally defined gender roles in Ethiopia disadvantage girls and women (see Figure 6.1). Now that you understand that gender roles can be changed you will learn what types of gender-based violence may be occurring in your community.

6.2  Gender-based violence

Gender-based violence (GBV) is any form of deliberate physical, psychological or sexual harm, or threat of harm, directed against a person on the basis of their gender.

Figure 6.2  Woman attempting to escape from a man who is trying to throw her to the ground and rape her.

Although gender-based violence is not exclusively directed against females, they do suffer from it the most, which is why the focus of this study session is on women and girls (see Figure 6.2). GBV is a violation of fundamental human rights. Violence against girls and women prevents them from enjoying their rights, such as those shown in Box 6. 1.

When violence occurs against girls and women, it is usually committed by boys or men. Violence against women stems from the unequal power relations between men and women. A person with more power has many choices, while a person with less power has few choices. There are many types of power, such as economic power (control or access to money and other resources) and physical power (strength or weapons). The person with less power is vulnerable in many ways. Women have less power than men and as a consequence are more vulnerable to violence (see Figure 6.3).

Figure 6.3  Women discussing rights and violence.

The most common form of violence is the violence against girls and women at the household level. In most communities in Ethiopia, this GBV is accepted as normal behaviour and there is little awareness of GBV as an issue that needs attention. It is not treated as a serious crime but as a private matter even though it has serious consequences for girls and women.

Violence against women and girls takes place throughout their lives, starting in infancy and continuing to old age. Examples include the preference for a male child, trafficking for labour and sexual abuse, rape, wife beating, food restriction, early marriage, marriage to a man who already has a wife, abduction, female genital mutilation and wife inheritance.

There are various factors that make girls and women vulnerable to acts of violence, such as:

• They lack power
• They have low status
• They are often less educated
• They are often poor and economically dependent on men and this inequality places them in a situation where they are easily abused
• Cultural beliefs and values reinforce rigid gender roles and the low status of women. Most of the violence against girls and women is perpetrated under the cover of culture
• Limited awareness (among both females and males) about the rights of girls and women
• Boys and men commonly drink alcohol and use other mind-altering substances which impair judgement and/or make them violent.

6.3  Types of gender-based violence

Table 6.1 shows that GBV can be physical, psychological or sexual.

Although same-sex physical violence (even including stabbing) can be common among adolescents, the unequal power relationship results in most physical violence being directed at girls by boys.

Psychological GBV can be hidden, but you might uncover it if you ask some questions, for example, you could ask a very under-confident young girl whether she is receiving a lot of criticism from her family for being a girl.

You can see from Table 6.1 that sexual violence includes a wide variety of undesired sexual acts, ranging from sexual harassment, which includes unpleasant sexual comments or physical gestures, to sexual abuse, which is any type of unwanted sexual contact (Figure 6.4) and includes all forms of sexual coercion (emotional, physical, and economic) against an individual.

Figure 6.4  An example of sexual abuse: young woman receiving unwanted sexual contact.

Rape is defined by the Ethiopian law as having sex with a woman or girl without her consent or with consent obtained under threat, force, intimidation, fear of bodily harm or misrepresentation. Many adolescents are forced to have sexual relations with men or boys they know and are assaulted if they refuse to have sex. If a boyfriend forces his girlfriend to have sex against her will this is called date rape while acquaintance rape is committed by someone who is known to the girl, such as a neighbour, teacher, religious leader, family friend or relative. But sometimes a stranger commits an act of sexual violence.

All types of GBV can have damaging consequences, as you will learn in the next section.

6.4  Consequences of gender-based violence

GBV that involves physical violence could lead to a physical injury, from a simple wound to loss of body parts and even death. There are lots of reported cases of deaths due to GBV in Ethiopia so you may have thought about such a case from within your own community.

GBV also causes psychological trauma such as fear, anxiety, self-blame, depression and suicidal thoughts. It is not usually visible (unlike physical trauma) but girls/women suffer a great deal from it and the effects can be longer-lasting than a physical injury (see Figure 6.5) and affect behaviour and interpersonal relationships. For example, women who are sexually abused during their childhood tend to feel guilty about the abuse. They develop negative feelings about themselves and lose self-esteem. These bad feelings about themselves often causes them to engage in high-risk behaviours and practices. This makes them more vulnerable to STIs including HIV, unwanted pregnancies and infertility.

Figure 6.5  This woman has become depressed after being raped. She feels isolated and that she has no one who understands her situation.

Sexual violence also contributes to the spread of STIs. For example, a girl or woman who is raped by an infected person can get infected. She could also have an unwanted pregnancy leading to a number of negative outcomes including unsafe abortion. Girls who have experience GBV (particularly when physical and sexual violence is involved) may make frequent visits to health facilities with various complaints which could include escalating pain, pelvic and back pain, gastrointestinal problems, and repetitive episodes of STIs or unintended pregnancies (Table 6.2). But they may not tell health workers of the sexual violence they have experienced and health workers fail to recognise that undiagnosed GBV is underlying all these complaints and problems, so they do not ask about violence. Thus, these girls and women do not get the help that they need from the health facilities.

GBV has various interrelated effects on health, so it seems strange that girls and young women do not report the GBV when they come to the health facility.

6.5  Barriers to reporting sexual violence

Reasons for not reporting GBV include:

Fear of stigma and discrimination. Someone who has been raped may be seen by others as unclean. She will be blamed for what has happened to her and may experience discrimination.

Blame. Society expects girls and women to be able to avoid sexual violence including rape. If any form of sexual violence occurs, society often blames the woman for the way she behaves and dresses, saying that the rape is her fault because she has provoked sexual desires in boys and men.

Fear of disbelief. Many girls do not think anyone will believe them, particularly if they have been abused by someone they know. For this reason, many people who have experienced sexual violence, including children, remain silent.

Fear of revenge. Many girls and women who are raped are intimidated by their attacker, who threatens that he and his family and friends will cause her further harm if she makes a police report. They may even make death threats.

Ineffective policing. Even when young women who have been raped do report the case to the police they may not achieve much. They are not often protected by the police and if the wrong doer is not imprisoned they may be in greater danger than before.

Health workers’ attitudes. People who have experienced sexual violence can recover from the trauma if they find someone who will acknowledge their experience and provide support. One way they could heal is through hearing encouraging words from healthcare providers. However, health workers are not usually understanding and supportive when someone who has been raped seeks care from health facilities. They often tend to be judgemental. This is why many girls who experience GBV will seek practical help for health issues but will not talk about the violence that has caused them to attend at the health post.

It is important that you as a Health Extension Practitioner recognise these effects and offer help. In the next section, you will learn what roles you can play to prevent and manage GBV in your community.

6.6  Your role in preventing gender-based violence

Educated women are less likely to have undesired life outcomes. Providing girls with educational opportunities improves their status in the community. You can help by encouraging parents to send their daughters to school and by encouraging girls to go to school and to continue with their schooling. Girls and women often lack information on reproductive health issues, but education gives them necessary knowledge. You could also involve women as members and leaders of community-based health committees.

Involving boys and men in fighting GBV will have a lasting effect. As you have already learned, it is usually boys and men who inflict violence on girls and women, so any effort to abolish GBV without their engagement will not be successful. Ensure that you talk to them about GBV (Figure 6.6). Help young boys to understand that boys and girls are different but equal and everyone deserves equal respect.

Figure 6.6  A Health Extension Practitioner talking to a group of girls and boys about GBV.

As most types of GBV are carried out under the cover of culture and tradition, and are deeply rooted in the community, addressing this issue requires engagement of the community as a whole. You can use various methods to mobilise the community and improve their awareness and behaviour. Community conversation is a good medium to fight GBV. It is also useful to get an influential community or kebele leader to tell community members of the advantages of improving women’s health by fighting GBV and to explain that Ethiopia’s ministers and religious leaders want all Ethiopians to have full and equal rights (Figure 6.7).

Figure 6.7  A village meeting to discuss the importance of respecting the rights of girls and women. (Photo: Basiro Davey)

In the next section, you will learn about the care that should be given to victims of sexual abuse.

6.7  Care and support for survivors of sexual abuse

Survivors of sexual abuse are persons who have lived through sexual violence. Table 6.2 showed the effects that they might experience as a result of the abuse. Immediately after a violent act there may be physical indicators which show that a girl has just been sexually abused (see Box 6.2).

As the girl is likely to have washed and changed her clothes before coming to see you, most of these physical signs that could indicate the presence of sexual abuse will not be there. However, if you do suspect GBV, ask in a straightforward way ‘Have you been forced to have sexual intercourse when you did not want it?’ If you say ‘Have you suffered GBV’ the girl may not understand what you mean.

Addressing sexual abuse may seem overwhelming to you, but there are a lot of things you can do. Many adolescents are reluctant to acknowledge a history of abuse. Some of them may only disclose their experience over a period of time. You need to ensure confidentiality and reassure the girl that any course of action will only be taken with her permission. Ensuring confidentiality, listening and asking questions in a non-judgemental way encourages the girl to reveal if there is a history of sexual abuse. If there is, ask whether it is still going on. Does she still have contact with the abuser? How old is he and what is his relationship to her? What is the nature of the abuse? What type of coercion was used?

If she says she was raped, give her emergency contraception if it has been less than 120 hours since the rape occurred. Rape is a medicolegal case. It needs investigation and care at a health centre or hospital. Anyone who has been raped should seek care within five days of the violence so that good quality and strong evidence can be collected for the legal process. A complete medical history and physical examination is needed for every rape case. In addition, evidence collection and laboratory investigation for both the legal process and the provision of medical care is required. Depending on their condition, someone who has been raped may need the following: care for acute injures, psychosocial care and support, prevention of pregnancy after rape through emergency contraception, post-exposure prophylaxis for HIV, prophylaxis for STIs, and a follow-up. You should counsel anyone who has been raped to the best of your ability but if possible refer her to legal or social services that deal with sexual abuse.

Evidence needs to be well recorded and reported to the police. This should be done by a skilled person. For this reason, it is important that you refer a rape case to the nearest health centre or hospital. However, this doesn’t mean that there is nothing you can do about it yourself. In addition to emergency contraception you may be able to give a screen for STIs and a pregnancy test.

Figure 6.8  It is important to counsel anyone who has experienced GBV in a non-judgemental manner.

Under Ethiopian law, rape is a crime and not only the person who has been raped but also their relatives and any other knowledgeable person has a duty to report it. Therefore, you have a duty to encourage and help them to report the case to the police, in addition to the care and support you give them.

Summary of Study Session 6

In Study Session 6, you have learned that:

1. Sex is the biological characteristic that defines humans as female or male, while gender refers to socially and culturally defined roles for males and females.
2. Gender-based violence is any form of deliberate physical, psychological, or sexual harm or threat of harm directed against a person on the basis of their gender.
3. The consequences of gender-based violence could include increased risk of STIs including HIV, unwanted pregnancy and unsafe abortions, physical injuries, and psychosocial trauma including fear, anxiety and depression.
4. The community should be mobilised and educated; and males and females should be equally engaged in the fight against GBV.
5. Anyone who has experienced GBV, particularly rape, should be counselled, referred to health centres or hospitals and supported to report to the police.

Self -Assessment Questions (SAQs) for Study Session 6

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the questions below. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

First read Case Study 6.1 and then answer the questions that follow it.