Learning behavioral science is an important part of becoming physicians.More and
more, professional and accrediting organizations are explicitly endorsing the necessity
of physicians being skilled and well trained in these areas.
n the Democratic Republic of Congo (DRC), tens of thousands of girls and women have suffered horrific acts of sexual violence. The government army is one of the main perpetrators. Commanders, even when confronted with abuses, have frequently failed to stop sexual violence and may themselves be guilty of war crimes or crimes against humanity as a consequence. In this report, Human Rights Watch looks at sexual violence committed by the army and more specifically the 14th brigade whose case illustrates the failure to enforce respect for humanitarian law.
Health care workers have the opportunity and the obligation to identify, treat, and
educate women who are being abused. Health care institutions can make significant
contributions to addressing violence against women by supporting clinicians and clients.
Developing and institutionalizing national health-sector policies, protocols, and norms
about violence call attention to the problem of gender-based violence, and help ensure
quality care for survivors of abuse.
This Outlook issue focuses on the reproductive health consequences of violence
At the start of the 21st century, the learning potential of significant numbers of children
and young people in every country in the world is compromised. Hunger, malnutrition,
micronutrient deficiencies, parasite infections, drug and alcohol abuse, violence and injury,
early and unintended pregnancy, and infection with HIV and other sexually transmitted
infections threaten the health and lives of children and youth (UNESCO, 2001). Yet these
conditions and behaviours can be improved.
I am writing this Foreword in my role as the founding editor of
the new Springer Series on Family Violence and editor of Volume
I in the series entitled Battered Women and Their Families: Interven-
tion Strategies and Treatment Programs, 2nd edition (1998).
Thea Brown is Professor of Social Work and Director of the Family Violence and Family Court Research Program at Monash University. She has served on Family Court committees and on the Commonwealth Family Law Pathways Advisory Group. Dr Renata Alexander is Senior Lecturer in Law at Monash University and a member of the Victorian Bar. She was Deputy Registrar in the Family Court and is the author of Domestic Violence in Australia, 3rd edition.
..THEA BROWN RENATA ALEXANDER
Understanding the issues facing human service and legal professionals
It is clear from the pages that follow that the physical abuse of one individual by
another, or by both individuals of each other, is an integral component of some
intimate relationships, perhaps many intimate relationships. This book is not about
the violence as much as it is a reflection on our responses to—or our lack of
responses to—that violation of physical integrity and the accompanying emotional
and mental trauma. As these next pages indicate, we all too often fail to recognize
the signs of physical violence.
A frank discussion alone with the patient before the examination provides op-
portunity to discuss any sexual symptoms or concerns without another
person present. Common reasons for fearing or avoiding pelvic examinations
include embarrassment, lack of information, cultural or language barriers,
pain with previous examinations, or post-traumatic stress related to sexual
abuse. Each of these circumstances requires additional sensitivity and efforts
to minimize emotional or physical discomfort. Often, given an opportunity,
patients can articulate ways to decrease personal discomfort.
According to the focus group study in South
Africa mentioned earlier, much of the abuse – and
particularly domestic violence – occurred as a result
of social disorder, exacerbated by crime, alcohol
and drugs. Similar conclusions came from an
exercise conducted by seven male community
leaders of the Tamaho squatter camp in Katlehong,
South Africa (15).
School-related gender-based violence
remains an obstacle to girls’ education.
Efforts to address school safety are needed
at all levels, including teacher training,
community intervention and ministerial
policy and practice. Ministries of Education
can send a clear message that gender-
based school violence will not be tolerated
by firmly and quickly prosecuting perpetra-
tors. Teacher training should include strong
messages about professional and ethical
Courts are now required to notify all domestic violence offenders of
the two federal domestic violence-related gun prohibitions. Courts
must inform all domestic violence offenders that they may be subject
to federal firearm prohibition(s). The notification should also inform
the abuser of applicable state, tribal, or territorial laws that may limit
purchase or possession of firearms and ammunition. It is important
that offenders are aware of these prohibitions.
This study was conducted within RAND’s Public Safety and Justice program. RAND Public Safety and Justice conducts research and analysis that helps inform policymakers and communities in the areas of public safety, including law enforcement, terrorism preparedness, immigration, emergency response and management, and natural disasters; criminal justice, including sentencing and corrections policy, firearms, and community violence; and drug policy, which focuses on problems related to illegal drugs and substance abuse....
As the NCPCR policy document states, “[...]
civil unrest exposes children to multiple
deprivations. Children are killed, hurt and
maimed as a direct result of violence. Access
to food, water, sanitation, health care and
schooling deteriorates during unrest. Political
insecurity pushes children into situations that
can circumscribe the remainder of their lives.
It disrupts families and social networks that
support children’s physical, emotional and
social development. The NCPCR has
encountered children who are displaced and
forced to drop out of school as a result.
Women who are abused have poorer mental and
physical health, more injuries, and a greater need for
medical resources than non-abused women.
Multi-Country Study on Women’s Health and Domestic
Violence found that abused women in Brazil, Japan, and
Peru are almost twice as likely as non-abused women to
report their current health status as poor or very poor.
The impact of gender-based abuse on physical health
can be immediate and long-term. Women who are abused
rarely seek medical care for acute trauma, however.
Prison policies often overlook the special needs of women and their health. Many women in
prison have high levels of mental illness and drug or alcohol dependence as well as histories of
sexual and physical abuse and violence. Issues arising from gender-specific health care needs
and family responsibilities are also frequently neglected. Although women represent a small
percentage of the total prison population, their numbers are increasing and the rate of increase is
much greater than that of men.
Including urinary issues in the gynecologic evaluation is helpful. Urinary
tract infections (UTIs) are one of the most common reasons to seek medical
care and are sometimes triggered by sexual activity. Urinary incontinence is
an increasingly recognized health problem (see Chapter 10).
Finally, because domestic violence is common (2), screening for current or
previous physical, emotional, or sexual abuse is an important part of the pa-
tient’s history and in some states is mandatory.
The health effects of violence against women are
serious, far-reaching, and intertwined. Health care
providers have the opportunity and the obligation to
identify cases of abuse. For many women in developing
countries, a visit to a health clinic for reproductive or child
health services may be their only contact with the health
care system. The health care sector can capitalize on this
opportunity by ensuring a supportive and safe environment
for clients, helping providers ask about abuse, and helping
women receive the care they need.
Displacing older people as heads of households
and depriving them of their autonomy in the name
of affection are cultural norms even in countries
where the family is the central institution and the
sense of filial obligation is strong (11). Such
infantilization and overprotection can leave the
older person isolated, depressed and demoralized,
and can be considered a form of abuse. In some
traditional societies, older widows are abandoned
and their property seized.
The impact that physical and psychological violence
have on the health of an older person is exacerbated
by the ageing process and diseases of old age. It is
more difficult for the elderly to leave an abusive
relationship or to make correct decisions because of
the physical and cognitive impairments that usually
come with old age. In some places, kinship
obligations and the use of the extended family
network to resolve difficulties may also lessen the
ability of older people, particularly women, to
escape from dangerous situations.
Good Practice in the Law and Safeguarding Adults provides an up-to-date summary of developments in the legislative framework and best practice relevant to the area of adult protection work. It explains legislation that can be used in adult protection work, covering criminal and civil law, and crucial national guidance such as Achieving Best Evidence. Issues covered include confidentiality and information-sharing in adult protection work, capacity issues, police investigations, financial abuse, advocacy, witness support and honour-based violence.