What do Health Care Workers Need to Know about Gender Based Violence?

1. What do Health Care Workers Need to Know about Gender Based Violence?

2. WHY? • Gender based violence is a major public health issue which causes immense pain, injury and suffering. • Health staff have a unique and crucial role in identifying e.g. during routine enquiry, and supporting all those affected.

3. GENDER refers to the attitudes and behaviour – traits, responsibilities, values, status, influence, relative power; that society expects of men and women. These are often subtle, seen as ‘normal’ and accepted as the ‘way things are’. Despite great progress, many inequalities still exist between men and women such as in the differences in earnings and caring responsibilities.

4. GENDER BASED VIOLENCE • is used to explain the context in which such violence occurs. It highlights the most important fact that cuts across these forms of abuse: that they stem from, or reinforce, gender inequality. It also makes the connections between the different forms of abuse, particularly since many women experience more than one type of violence.

5. WHAT IS IT EXACTLY? • Domestic abuse • Rape and sexual assault • Childhood sexual abuse • Commercial sexual exploitation • Stalking and harassment • Harmful traditional practices

6. WHO IS AT RISK? • Being female is the key risk factor • Age • Financial dependence • Poverty • Disability • Homelessness • Insecure immigration status

7. WHO IS AT RISK? • Men may be at a lesser risk • Men are abused in the same way • Men can be more reluctant to report abuse because of the stigma • 1:8 young men believed it was OK to hit a woman if she was ‘nagging’ • 81% of men and 68% of young women thought that women may provoke violence by ‘flirting’

8. DOMESTIC ABUSE • 'Domestic abuse is any form of physical, non-physical, or sexual abuse which takes place within the context of a close relationship, committed either in the home or elsewhere. This relationship will be between partners (married, co-habiting or otherwise) or ex-partners.‘ • www.gbv.scot.nhs.uk

9. DOMESTIC ABUSE • World Health Organisations Multi-Country study into women's health and domestic violence against women found that between 1 in 2 and 1 in 10 women will experience some form of violence at some point in their lives.

10. DOMESTIC ABUSE • One in 4 women will experience domestic abuse from a partner in her lifetime. • There were 49,655 incidents of domestic abuse in Scotland recorded in 2007/08 (an increase of just under 2% on the previous year). • 54% of cases reported to the police in 2007/08 involved repeat victimisation. • Teenage mothers seem to be particularly likely to experience domestic abuse. An American study found that 70% of teenage mothers at one hospital were in a relationship with a violent partner. • Occurs in 1:3 same sex relationships

11. HOMICIDE • In 53% of homicide cases in Scotland over the last ten years, where a woman aged 16-69 was the victim, the main accused was the woman in question's partner. • Female homicide victims are most commonly killed in a dwelling with the motive being rage/fight with a partner.

12. POSSIBLE INDICATORS/EFFECTS PHYSICAL MENTAL Depression, anxiety Panic attacks Eating disorders Alcohol/ drug abuse Self harm, suicidal thoughts/attempt • Cuts, bruises, sprains, fractures • Injuries to head, neck, breasts, abdomen areas • Internal injuries • Loss of consciousness, hearing, sight, teeth, memory • Disfigurement • Sexual reproductive dysfunction

13. RAPE AND SEXUAL ASSUALT • Rape and sexual acts which take place without someone’s consent • New definition in 2010 to include vaginal, anal and oral sex within the definition. • 4% women and 0.7% men experience rape • In 54% of cases, the perpetrator is the current (45%) or ex (9%) partner of the victim • 1:7 women experience rape in marriage.

14. POSSIBLE INDICATORS/EFFECTS PHYSICAL MENTAL Self harm Depression anxiety Addiction issues Sleep and eating disturbance Panic attacks Flashbacks Suicidal feelings Post Traumatic Stress Disorder • Shock injury, trauma • Possible pregnancy gynaelogical problems • STIs and Urinary Tract Infections • Lower abdominal and back pain • Headaches • Bowel difficulties • Sexual dysfunction

15. HARASSMENT AND STALKING • There is no statutory definition of stalking in Scotland however generally stalking and harassment means ‘intentional behaviour, involving more than one incident, which causes fear, upset or annoyance to the victim’ • Following, surveillance, waiting outside person’s home/work, repeated unwanted phone calls, texts, e-mails, unwanted gifts, cards, damage to property, physical sexual assault, etc

16. HARASSMENT AND STALKING • 19% of women and 12% of men have experienced stalking or harassment • 37% of cases included violence were by an intimate 59% by other known persons and 7% by strangers • In men 7% were by an intimate and 70% by unknown person

17. POSSIBLE INDICATORS/EFFECTS PHYSICAL MENTAL Eating disorders Skin disorders Deterioration in physical health following assault Self harm Post Traumatic Stress Disorder • Anxiety • Depression • Panic attacks • Chronic sleep disturbance • Nightmares • Indigestion nausea

18. COMMERCIAL SEXUAL EXPLOITATION • Includes prostitution, pornography, lap dancing, sex trafficking • Mainly men profit from these activities e.g. Pimps, club owners

19. COMMERCIAL SEXUAL EXPLOITATION • Lack of options, previous experience of sexual abuse, drug misuse, homelessness, • 70% of those involved in street prostitution became involved as children or teenagers • 85% reported physical abuse and 45% reported sexual abuse in their family.

20. CHILDHOOD SEXUAL ABUSE • Exploitation of a child/young person by an adult for their own or other’s sexual gratification. It is physically and emotionally abusive and often involves serious and degrading assault.

21. CHILDHOOD SEXUAL ABUSE • CSA is under reported • Prevalence studies show that 7-30% girls and 3-13% boys • UK show study showed 1:5 girls and 1:4 boys had experienced CSA • Men are the abusers in 90% of cases • One study demonstrated that 72% of sexually abused children did not tell anyone.

22. POSSIBLE INDICATORS PHYSICAL MENTAL Self-harm, suicidal feelings Depression, anxiety Addiction issues Sleep and eating disorders Panic attacks Flashbacks Dissociation Symptoms of Post Traumatic Stress Disorder • Genital and anal damage • Possible pregnancy • STIs and urinary tract infections • Pelvic Inflammatory Disease • Sexual dysfunction • Chronic pain • Irritable Bowel Syndrome

23. HARMFUL TRADITIONAL PRACTICES • Female genital mutilation, ‘honour crimes’ and forced marriage which are culturally condoned as part of tradition

24. It is difficult to quantify the scale of the problem of Female Genital Mutilation in Scotland. A study in 2007 for England and Wales estimated that nearly 66,000 women aged between 15 and 49 living in the UK had undergone FGM and over 20,000 girls were at risk. • Although we recognise that the known cases of forced marriage i.e. brought to the attention of the Forced Marriages Unit will be much smaller than the actual number of incidents, 40 cases from Scotland were notified to FMU during the period January to October 2008.

25. KEY PRINCIPLES IN RESPONDING TO DISCLOSURE • Be non-judgemental and show understanding and empathy • Listen and be respectful • Record • Report • Refer

26. REFERENCES. • Safer Lives: Changed Lives; A Shared Approach to Tackling Violence Against Women in Scotland.