Health effects of violence against women

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Violence against women

The United Nations describes 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 (United Nations General Assembly, 1993, Article 1). Globally, 30% of women aged 15 years and over will experience physical or sexual violence from an intimate partner in their lifetime (Devries et al., 2013, WHO, 2016). In New Zealand one in three (33%) women will experience domestic violence (physical or sexual) from their male partner during their lifetime (Fanslow & Robinson, 2004). Research into same sex violence indicates that violence also occurs in lesbian and gay relationships – so in these circumstances men and women are both victims and perpetrators of violence (Brown & James, 2014).

Models and discourses of violence

In New Zealand, domestic and sexual violence are understood from a number of perspectives. There are a number of versions of feminist theory relating to domestic violence. Elements common to them all include an understanding of societal attitudes that position men as the dominant class with greater access to material and symbolic resources in relation to women; women being perceived as subservient or inferior to men; domestic violence as a common dimension of family life; and a feminist perspective that prioritises women and advocates for women’s rights (Loue, 2001). Related to this is patriarchy theory – the concept that some men believe that patriarchal dominance and control of women is their right and that this dominance can be enforced by violence. It also assumes that patriarchy, and the use of violence to maintain women’s subordination, is acceptable to society (Loue, 2001; Walsh et al., 2015). There are a number of models of domestic violence that operate from the individual/couple perspective. These investigate individual pathology; substance use; stress; levels of testosterone; cost benefit analysis of relationships and using violence; social learning theory – which is used to explain intergenerational abuse; theories of power and powerlessness within relationships; and the concept of traumatic bonding – used to describe why women do not leave abusive relationships (Loue, 2001).

Why these models are insufficient at the intersection of violence and abuse

The various models of violence and disability examined above are useful to understand current thinking about the sectors and why there is so little congruence between people who subscribe to the various discourses and models. The medical model of disability and individual/couple perspective of violence both take a behaviourist focus and emphasise individual deficit and/or pathology. Within these models, responsibility for action is either sited within the person with impairment being abused, or from outside intervention in order to fix or remediate the identified individual deficit. From my methodological and health promotion perspective these are not useful models as they fail to consider structural, political, attitudinal and social barriers and enablers to community and individual action. I believe the use of these models can result in practices that, for example, build dependence and increase powerlessness, and place individuals and communities in unwinnable situations where the choices they have continue to be constrained by unaddressed societal barriers. In contrast, the social/rights model of disability sits well with a health promotion understanding of, for example, the social and structural barriers to integration and acceptance of disabled women.

Health promotion

The Ottawa Charter (WHO, 1986) definition of health promotion has been further defined in the Bangkok Charter by adding the word determinants to the original definition; “Health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health” (WHO, 2005, para.7). There are a number of critical concepts in this definition. Health promotion does not use a construction of health that is binary (sickness/health) (Michailakis, 2003) as the medical perspective does, but constructs health as “a state of complete mental and physical wellbeing” (WHO, 1986, para.3). This is a state that everyone, regardless of her medically defined state of wellness, can aspire to. The definition stresses people having control over the determinants of health. From a health promotion perspective, the social determinants of health are the structural determinants and conditions of daily life (Committee on the Social Determinants of Health [CSDH], 2008) such as the gradient between rich and poor within and between countries; the “unequal distribution of power, income, goods, and services, globally and nationally” (CSDH, 2008, p14); and equitable or inequitable access to education, housing, income and employment, cultural identity and acceptance, and social cohesion (National Advisory Committee on Health and Disability, 1998).

Intersectionality

“… violence against women with disabilities is understood to be the result of complex, interlocking systems of gender-based discrimination, disabilitybased discrimination and other forms of exclusion and domination” (Healey, 2013). Intersectionality is another way of describing the contextual and diverse components of women’s lives, including the overlapping power relationships that enable or constrain individuals and groups of women. Intersectionality has been described as a tool for analysis (Dhamoon, 2011), advocacy and policy development that “addresses multiple discriminations and helps us understand how different sets of identities impact on access to rights and opportunities” (AWID, 2007, p1). More recently it has been described as a theory (Carbin & Edenheim, 2013; McKibbin, Duncan, Hamilton, Humphreys, Kellett, 2015) which McKibbin et al., (2015, p101) have named as ‘intersectional feminism’. This theory can be used as “a methodology, a tool for data analysis, a nodal point in feminist theory, a feminist project or platform, and a framework for social policy development” (McKibbin et al., 2015, p100).

Paradigms that marginalise and devalue disabled women

This section investigates paradigms that marginalise and devalue dis/abled women. This is investigated in order to understand the attitudinal and paradigmal barriers to effective policy and practice to prevent and respond to violence against disabled women. Morris (2008) has identified two paradigms that oppress and exclude disabled women. One is the universality of the male perspective and the other is the rightness of the able-bodied experience. Both being male and being able-bodied are treated as universally positive positions from which all other experiences are perceived as other, limiting, and negative – and against which all other experiences are compared. This research examines the values, theories and models that people use to explain their work and their understandings of their sector, in order to uncover the paradigms they work from and how this in turn influences their motivation to respond to the abuse of dis/abled women. Existing paradigms that are relevant to this investigation are ableism, the concept of rape culture and hegemonic masculinity.

Contents :

  • ABSTRACT
  • ACKNOWLEDGEMENTS
  • LIST OF FIGURES
  • LIST OF TABLES
  • CHAPTER 1 OVERVIEW
    • Introduction
    • Violence against women
    • Violence against disabled women
    • Aims and research question
    • Health promotion paradigm
    • Definitions
    • Structure of the thesis
  • CHAPTER 2 VIOLENCE AGAINST DISABLED WOMEN
    • Introduction
    • Sources of literature
    • Violence against women
    • Domestic and sexual violence
    • Health effects of violence against women
    • Gender and power
    • Data collection and cohesion
    • Violence against disabled women
    • Settings and perpetrators
    • Forms of violence
    • Difficulties in quantifying the prevalence of abuse
    • Current gaps in service provision and alignment of sectors
    • Gaps in service provision and best practice
    • Why this lack of service provision needs to be addressed
    • Incorporating women’s voices in policy and practice
    • Violence against disabled women in New Zealand
    • NZ literature
    • Prevalence
    • National legislation and policy
    • National practice policies
    • Nationally specified qualifications required for working in the violence or
    • disability sector
    • Accessible services
    • Government responsibility
    • Incorporating women’s voices in policy and practice
    • Structure of the domestic and sexual violence, elder care and disability sectors
    • in New Zealand
    • Overall findings – an absence of information and integration
    • Conclusion
  • CHAPTER 3 SITUATING THE RESEARCH AND EXAMINING
    • PARADIGMS AT THE INTERSECTION OF VIOLENCE AGAINST
    • DISABLED WOMEN
    • Using paradigms, models and theory to investigate violence against disabled
    • women
    • Models/discourses of disability
    • Models and discourses of violence
    • Why these models are insufficient at the intersection of violence and abuse
    • Theories to situate and connect the research
    • Health promotion
    • Intersectionality
    • Paradigms that marginalise and devalue disabled women
    • Ableism
    • Rape culture
    • Hegemonic masculinity
    • How are these paradigms manifest and perpetuated?
    • Issues at the intersection of violence and disability
    • Myths, stigma and blame
    • ‘Real’ victims – complicit victims
    • Expectations of independence or dependence rather than interdependence
    • Conclusion
  • CHAPTER 4 RESEARCH METHODOLOGY AND METHODS
    • Introduction
    • Overall research approach
  • CHAPTER 5 TOO HARD, NOT MY PROBLEM, NOT A PROBLEM: PRAGMATIC REASONS FOR NON-COLLABORATION
  • CHAPTER 6 PARADIGMS OF PRACTICE
  • CHAPTER 7 EXCLUSION NOT INCLUSION – THE PROCESSES OF EXCLUSION AND INVISIBILITY
  • CHAPTER 8 VULNERABLE

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Not inherently vulnerable: An examination of paradigms, attitudes and systems that enable the abuse of dis/abled women

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