According to a recent meta-analysis by the World Health Organization, one in three women worldwide are subject to intimate partner violence (IPV) http://www.sciencemag.org/content/340/6140/1527.short . And it’s not just a third world problem either, as we Canadians with our often parochial outlook would no doubt like to believe. True, some countries seem to be over-represented: ‘East Asia having the lowest incidence, at 16.30% (range, 8.9% – 23.7%), and Central Sub-Saharan Africa having the highest incidence, at 65.64% (range, 53.6% – 77.71)’, but we in Canada are certainly not immune. http://www.huffingtonpost.ca/kirsty-duncan-/harper-womens-rights_b_4435285.html
Recognizing this, there has been a move to screen women for IPV in hopes of decreasing the violence or improving the outcomes for the victims. However, in a review published in the May 13 edition of the British Medical Journal, the lead author, Dr. Lorna O’Doherty from the University of Melbourne ‘Did not detect a decrease in rates of violence in women’s lives as a result of screening nor did it find improved mental and physical health outcomes for women.’ http://bit.ly/1m6Vskr
I have to admit that I had hoped that screening would have had more of an effect than is reported, but maybe on closer examination there are readily identifiable reasons for this. The whole issue seems to involve a complex algorithm with a lot of contextual conditions that have to be considered. First of all, the woman may not yet be ready to admit abuse is taking place; she may not actually see it as ‘abuse’ and so is unlikely to report it as such, even if asked. Or, perhaps she has thought about it, but isn’t yet ready to address or admit the issue –especially to others because of the stigma. There are phases through which she needs to progress in accepting and addressing the abuse. And yet, even if she is ready, her ability to admit it to someone else is going to be predicated on several factors -the WHO report again (and I quote an article in Medscape for the summary):
The report points out that certain healthcare settings (eg, antenatal clinics and HIV screening clinics) offer good opportunities to spot problems and intervene.
However, to be effective in such situations, the recommendations say, certain minimum standards need to be in place. Those include that:
- providers need to be trained on how to ask about violence,
- standard operating procedures need to be in place,
- consultations need to take place in private settings,
- confidentiality needs to be guaranteed,
- referral arrangements need to established and maintained, and
- providers need to be properly equipped to handle the physical and mental consequences of sexual assault.
This sounds reasonable; our obstetrical delivery unit provides universal IPV screening, but I am disappointed with the finding in that study published in the British Medical Journal that even so, the mental and physical outcomes for those women were not improved. And although we are probably missing the vast majority of women who suffer from abuse (and in some cases men as well -but more likely detected in a different venue), one would still like to hope that for those we have found, discovering the problem would be a step towards its solution.
But I think that public recognition of the problem is an equally important, if preliminary step. I sometimes wonder if we inadvertently stigmatize IPV because we, as a society, simply do not acknowledge it. It is something we’d rather not think about, or if we do, we do so judgementally. So, despite various professionals attempting to detect it and thereby (it was hoped) ameliorate the consequences, the victims remain reluctant to admit it is even happening. They, like the rest of us, see it as shameful and perhaps reflecting on their own choices, their own self-worth…
I’m reminded of our Canadian disgrace: the seeming indifference to the disappearance and violence against our Aboriginal women. There is, of course, lip service acknowledgement by the government that there might be a problem, but a rather indignant assurance that they are taking steps to resolve the issue seems to be all they have to offer. One could be forgiven for wondering whether they simply didn’t want any more public attention drawn to the problem. http://www.huffingtonpost.ca/2013/09/19/canada-un-aboriginal-women_n_3952425.html
I see the problem of violence against women differently. I think that the more it is publicized, the more it will be recognized, and the more will be society’s demand that the hitherto secret norm of violence will be seen to be inappropriate –no, not inappropriate, wrong. Think of the changing (I’d like to say changed but I suspect it would be premature) attitude to drinking and driving. As a society, we are realizing it is something to be condemned, not tolerated. Something that can be, and should be, discussed in the open. Something that is no longer acceptable…
It is possible to alter behaviour we have always viewed as undesirable, yet secretly condoned by our unwillingness to confront it. We need to acknowledge and tackle it as a society –and we need confront it often, publically, rationally, doggedly. I am reminded of something Lucretius wrote: The drops of rain make a hole in the stone, not by violence, but by oft falling.