The mechanism of violence is what destroys women, controls women, diminishes women and keeps women in their so-called place. ~Eve Ensler, A Memory, a Monologue, a Rant, and a Prayer
The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”. By definition, violence against women is an act that deprives women of their liberty and has served and continues to serve as a means by which to put women in their so-called place. Violence against women has always existed, yet it has only recently been considered a major health problem and a violation of human rights. The second-wave feminists of the 1960’s and 1970’s were the first to view violence against women as an endemic problem. They saw that gendered acts of violence are deeply rooted in American culture, and understood that the behavior of individuals does not exist in a vacuum, but that it exists instead within a “rape culture”: a culture where violence against women and sexual abuses are not only existent, but also commonplace.
Within this culture that deems violence acceptable and even goes so far as to promote it through sexist jokes, misogynistic language and media images, women are all too often blamed for acts of violence committed against their will. Because the thought of an intimate partner or loved one committing an act of violence is shrouded in doubt and because most women who experience violence are afraid to come forward, many people continue to assume that a woman subjects herself to violence because of something she did or did not do or because of “inappropriate” behavior. Statements like “she was depressed” or “she was dressed scandalously” imply that violence against women is acceptable, if not deserved.
The truth is that that no one factor can account for violence perpetrated against women, but that several complex and interconnected social and cultural factors have kept women particularly vulnerable to violence directed against them, all of them manifestations of unequal power relations between men and women. The acceptance of violence as a means by which to solve conflict as well as fear of and control over female independence and female sexuality are just some of the contributing factors that allow violence against women to persist. In addition, research shows that those who grew up in a household in which domestic violence took place are more likely to become either perpetrators or victims of violence as adults. Substance abuse plays a huge role as well. Women are at highest risk for being the victim of violence if they have a male partner who abuses drugs, (especially alcohol) or is unemployed or underemployed. Each of these factors put women at severe risk of depression and anxiety and demoralize women through undermining of self-esteem. Depression is a consequence of violence, but also generates a devastating cycle in which perpetrators may feel more entitled to continue abusive behavior. Depression as a result of violence also increases the silence surrounding the issue and allows it to remain somewhat taboo.
Because there is so much stigma surrounding violence against women, many women’s stories are never told and consequentially violence against women has remained a private affair in most sectors, including that of public health. In many circles, violence against women is a legal issue that requires a legal response, rather than a health issue that requires medical attention, clinical care, and sustainable public health interventions. Uncovering the stories of women, reducing the stigma, and eliminating the blame can no longer be placed in the hands of activists or lawyers alone; dedicated and trained medical professionals and public health workers must also be held accountable and screen women for violence. Though there is no shortage of information concerning what women can do if they are victims of violence, it has been estimated that less than one in 20 doctors screen women routinely. Doctors are trained to see things that others do not notice and have the responsibility to screen their patients if they are suspicious of any acts of wrongdoing committed against them. Furthermore, the health care system is well positioned to play a pivotal role in domestic violence screening and prevention. Virtually every American woman interacts with the health care system at some point in her life-whether it is for routine health check-ups, pregnancy, childbirth, illness, injury or by bringing her child in for health care.
Many women feel discounted and dismissed by the legal system, and screening with a doctor provides women with a valuable opportunity to tell their providers about their experiences with abuse. Battered women report that one of the most important parts of their interactions with their physicians was being listened to about the abuse. Routine screening would also increase opportunities for identification and intervention with patients presenting with symptoms not generally associated with domestic violence. If routine screening for violence was implemented in the health care setting, it would be vital for physicians and nurses to be trained on how best to ask questions and for them be aware of the legal implications if false or mistaken accusations were to be made. It is known that questions that are most effective in screening and assessing domestic violence are open-ended as opposed to those asking for yes or no answers (for example, “How do you and your partner tend to disagree with each other?” versus “Does your spouse hit you?”). Practitioners would also need to be prepared for the fact that screening does not necessarily translate into a woman being ready or willing to actively engage in an intervention.
Screening for violence in a health care setting gives patients the chance to have someone take them seriously from both a physical and emotional standpoint, and provides a critical opportunity for disclosure, giving way to developing a protection plan for ultimate safety and health. Until the medical community embraces violence against women as one of the most pressing health issues of our time, denial will persevere and we will continue to live in a “rape culture”. Medical and public health professionals can help turn this problem around; they can understand women as individuals with different and very real experiences and can help to transform them from victims into strong, able-bodied people in charge of their own destiny.