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Violence Against Women

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Title: Violence Against Women


1
Violence Against Women
  • Martin Donohoe, M.D., F.A.C.P.

2
Violence Against WomenOverview
  • Definitions
  • Epidemiology
  • Sexual Assault/Rape
  • Sequelae of Domestic Violence

3
Violence Against WomenOverview
  • Recognition and Management
  • The Developing World
  • human rights abuses
  • female genital mutilation

4
Objectives
  • Understand common forms of violence against women
  • Learn to recognize and manage violence against
    women
  • Exposure to international issues related to
    violence against women

5
Definitions of Violence Against Women
  • Individual
  • Any act of verbal or physical force, coercion,
    or life-threatening deprivation that causes
    physical or psychological harm, humiliation, or
    arbitrary deprivation of liberty, or that
    perpetuates female subordination

6
Individual Violence Against Women(examples)
  • partner abuse
  • sexual assault/marital rape
  • forced prostitution
  • forced noncompliance with contraception
  • female genital mutilation
  • slavery

7
Definitions of Violence Against Women
  • Societal
  • Structural forms of discrimination or
    deprivation that affect women as a class

8
Societal Violence Against Women(examples)
  • poverty
  • impaired access to employment or education
  • divorce restrictions
  • salary inequalities
  • political marginalization
  • impaired access to reproductive health services

9
Epidemiology of VAW
  • Lifetime prevalence of assault/sexual abuse
  • 12 of adolescent girls
  • 15 of college women
  • 20 of adult women

10
Epidemiology of VAW
  • 2 - 4 million women assaulted per year
  • every 15 seconds a woman is beaten
  • 5 of partner abuse is female on male
  • (homosexual/bisexual abuse also exists)

11
Prevalence of Domestic Violence
  • P-care
  • 1/4 women abused at some point in her life
  • 1/7 women abused within preceding 12 months
  • ER
  • 1/4 of women seeking care (any reason)
  • 35 of women treated for trauma

12
Prevalence of Domestic Violence
  • Psych
  • 1/4 women who attempt suicide
  • 1/4 women treated for psychiatric symptoms
  • 55 lifetime prevalence for women with depression

13
Abuse in Pregnancy
  • Incidence 8 - 20
  • Most common sites of beating are abdomen, head
    and breasts
  • Increases risk of low birth weight/pre-term
    labor/delayed prenatal care

14
Prevalence of Domestic Violence
  • OB/Gyn
  • 1/6 women during pregnancy
  • Peds
  • 50 - 70 of mothers of abused children

15
High Risk Occupations Prostitutes
  • 80 have been physically assaulted
  • 80 have been threatened with a knife, gun, or
    other weapon
  • 67 have been raped

16
Prostitution in the U.S.
  • 0.6 of men admit to paying for sex in the last
    year
  • 17 at some point in their lives (actual
    percentage likely higher)
  • 694 clients/prostitute/year average
  • 1.6 of women admitted they had sex with a
    person they paid, or who paid them for sex
    since age 18

17
High Risk Occupations The Military
  • Completed and attempted sexual assaults 20 times
    more common among female soldiers than among
    other government employees
  • higher rates of chronic pelvic pain,
    dysmenorrhea, abnormal periods, PMS, and
    dissatisfaction with sexual relations
  • correlate with military sexual trauma history

18
The Military
  • VA Study (191 inpatients 411 outpatients)
  • 24 under age 50 report domestic violence in the
    past year (7 over age 50)
  • 90 under age 50 report a history of sexual
    harassment (37 over age 50)

19
High Risk GroupsRunaway and Homeless Youth
  • Survival sex
  • the exchange of sex for shelter, food, drugs or
    money
  • 28 of street youths, 10 of shelter youth (out
    of 1 - 2 million runaway adolescents/year)
  • association with violence, victimization, STDs,
    and pregnancy

20
High Risk Perpetrators
  • Male college athletes
  • constitute 3.3 of male student body
  • involved in 19 of sexual assaults
  • Fraternities
  • individual and gang rapes more common

21
Deaths from Domestic Violence
  • 4,000 domestic violence deaths/year
  • over 1/2 of women murdered in U.S. are killed by
    a current or former partner
  • 1/2 to 3/4 of the 1,000 - 1,500 murder suicides
    per year involve domestic violence

22
Victims Who Kill Their Abusers
  • Between 2,000 and 4,000 women imprisoned for
    murdering their abusers
  • Battered women who claim self-defense (the only
    legally justifiable reason for murder) in
    criminal trials are acquitted only 25 of the
    time
  • 63 of young men aged 11-20 serving time for
    homicide have killed their mothers abuser

23
Race/SES and Domestic Violence
  • Seen in all age, race, and SES brackets
  • May be more common in African-American, but
  • confounders lower SES, fewer resources, more
    likely to be seen in ER or to use public shelters
  • May be more common in Latinos, but
  • confounders as above
  • However, more women hold more traditional ideas
    regarding spousal roles...

24
Common Characteristics ofAbuse Victims
  • low self-esteem
  • guilt
  • self-blame
  • denial
  • traditional attitudes regarding womens roles
  • have children
  • poor financial resources
  • few job skills
  • less education
  • few friends
  • history of childhood abuse

25
Common Characteristicsof Abusers
  • low self-esteem
  • dependency
  • jealousy
  • poor communication skills
  • unemployed/underemployed

26
Common Characteristicsof Abusers
  • abuse alcohol/other drugs
  • have witnessed or experienced abuse as children
  • If immigrants, are more likely to have been
    victims of political violence
  • abuse their own children

27
Men with Restraining Orders
  • 75 have criminal record
  • 50 have history of violent crime
  • 15 violated R.O. over 6 months
  • 30 arraigned for a violent crime over 6 months

28
Child Abuse
  • seen in 1/3 - 1/2 of families where partner abuse
    occurs
  • in one 3 month study of 146 children who
    witnessed partner abuse
  • all sons over age 14 attempted to protect their
    mothers
  • 62 were physically injured in the process

29
Children and Partner Abuse
  • Children witness up to 85 of episodes of partner
    abuse
  • child abuse
  • Children of abuse victims show decrements in
    academic and emotional development and are more
    likely to become abusers themselves

30
Rape
  • Unwanted, forced penetration (oral/vaginal/anal)
  • reported by 33 -46 of women who are physically
    abused
  • annual incidence ³ 80/100,000 women
  • 7 of all violent crimes
  • lifetime prevalence up to 25

31
Date Rape
  • 40 of college women report forced sexual
    contact, attempted rape, or completed rape
  • most common ignoring victims protests
  • independent of school demographics
  • gt25 of college males admit to using sexually
    coercive behaviors
  • 2/3 of college males report engaging in unwanted
    sexual intercourse
  • reasons peer pressure, desire to be liked

32
Spousal Rape
  • occurs in 10 - 15 of all marriage
  • more violent, less frequently reported then
    non-spousal rape
  • not illegal in many U.S. states/other countries

33
Rape
  • 5 chance of pregnancy
  • 25 chance of acquiring STD
  • GC 6 - 12
  • Chlamydia 4 - 17
  • Syphilis 0.5 - 3
  • 1 -2/1,000 odds of acquiring HIV
  • varies

34
Rape
  • Underreported
  • Less than 1 of rapists convicted
  • Large backlog of untested rape kits
  • Average prison time for those convicted
  • rape 1 year
  • armed robbery 3 - 5 years
  • murder 8 years
  • Chemical Castration Laws

35
How We View Women
  • Montana
  • 2nd violation of animal abuse statute
  • 1,000 fine 2 years in jail
  • 2nd violation spousal abuse
  • 500 6 months in jail

36
Public Policy
  • Some health insurers refuse to cover abuse
    victims (pre-existing condition)
  • states legislating against this practice
  • 2002 Federal funds to fight abuse and neglect
  • Elder abuse - 153 million
  • Domestic abuse - 520 million
  • Child abuse - 6.7 billion

37
The Physicians Duties in Caring for Victims of
Sexual Assaults
  • Medical
  • obtain medical history
  • evaluate and treat physical injuries
  • obtain cultures
  • treat any pre-existing infection
  • NEJM 1995 332234-7

38
The Physicians Duties in Caring for Victims of
Sexual Assaults
  • Medical
  • offer post-exposure HIV prophylaxis
  • offer post-coital contraception (vs. in utero
    paternity testing f/b selective abortion)
  • arrange medical followup
  • provide counseling
  • NEJM 1995 332234-7

39
Physical Examination ofSexual Assault Victims
  • Collection of clothing
  • External evaluation
  • abrasions, lacerations, ecchymoses, bite marks
  • Oral cavity
  • secretions, injuries, collection of samples for
    culture
  • NEJM 1995 332234-7

40
Physical Examination ofSexual Assault Victims
  • Genitalia
  • hair combing, hair sampling, vaginal secretions,
    collection of samples for culture, injuries
  • Rectum
  • injuries, collection of samples for culture
  • NEJM 1995 332234-7

41
Prophylaxis for Adult Victims ofSexual
AssaultAntibiotic Prophylaxis
  • Ceftriaxone (250 mg IM) or Spectinomycin (2 g IM)
  • PLUS
  • Doxycycline (100 mg po bid x 7d) or Azithromycin
    (1 g po x 1)
  • PLUS
  • Metronidazole ( 2 g po x 1)

42
Prophylaxis for Adult Victims ofSexual
AssaultPrevention of Pregnancy
  • 2 OCP tablets (each with 50 mcg ethinyl
    estradiol) po q12 x 2
  • OR
  • 3 OCP tablets (each with 35 mcg ethinyl
    estradiol) po q12 x 2
  • PLUS
  • Antiemetic

43
Prophylaxis for Adult Victims ofSexual Assault
  • HIV Prophylaxis (studies ongoing)
  • Consult ID
  • start up to 72 after rape
  • Other (as indicated)
  • tetanus toxoid
  • Hep B vax/HBIG

44
Factors That Perpetuate Gender-Based
ViolenceCultural
  • Gender-specific socialization
  • Cultural definitions of appropriate sex roles
  • Expectations of roles with relationships
  • Belief in the inherent superiority of males
  • Values that give men proprietary rights over
    women
  • Notions of the family as private/under male
    control
  • Customs of marriage (bride price/dowry/exogamy)
  • Acceptability/glorification of violence as a
    means to resolve conflict
  • Soc Sci Med 1994 391165-79

45
Factors That Perpetuate Gender-Based
ViolenceEconomic
  • Womens economic dependence on men
  • Limited access to cash and credit
  • Discriminatory laws regarding inheritance,
    property rights, use of communal lands and
    maintenance after divorce
  • Limited access to employment in formal and
    informal sector
  • Limited access to education and training for
    women
  • Soc Sci Med 1994 391165-79

46
Factors That Perpetuate Gender-Based
ViolenceLegal
  • Plural systems of law customary, common,
    religious
  • Lesser legal status of women
  • Laws regarding divorce, child custody,
    maintenance and inheritance
  • Legal definitions of rape and domestic abuse
  • Low levels of legal literacy among women
  • Insensitive treatment of women by police and
    judiciary
  • Soc Sci Med 1994 391165-79

47
Factors That Perpetuate Gender-Based
ViolencePolitical
  • Under-representation of women in power, politics
    and in legal and medical professions
  • Domestic violence not taken seriously
  • Notions of family being private and beyond the
    control of the state
  • Risk of challenge to status quo/religious laws
  • Limited organization of women as a political
    force (e.g. through autonomous womens
    organizations)
  • Limited participation of women in
    organized/formal political system Soc Sci Med
    1994 391165-79

48
Economic Gender DisparitiesThe Bad News
  • Worldwide, women do 2/3 of the worlds paid and
    unpaid work (1/3 paid, 2/3 unpaid)
  • receive 10 of global income
  • hold less than 10 of legislative seats
  • own 1 of global property

49
Economic Gender DisparitiesThe Bad News
  • Women in the U.S. working full-time make
    0.75/1.00 males
  • Those in unions have higher salaries, better
    benefits
  • Women make up 46 of the U.S. workforce, but hold
    lt 2 of senior-level management positions in
    Fortune 500 companies
  • 2002 5/50 governors are female, 13 of
    Congresspersons, 4 of the top 21 university
    presidents

50
Economic Gender Disparities
  • Ledbetter v Goodyear - US Supreme Court, 2006
    While the Civil Rights Act forbids pay
    discrimination on the basis of race, gender or
    religion, all employees have to lodge a formal
    complaint within 180 days of the initial
    discriminatory paycheck Supreme Court upholds
    this requirement
  • Lilly Ledbetter Fair Pay Restoration Act of 2009
    Now complaint can be filed within 180 of most
    recent paycheck

51
Economic Gender DisparitiesThe Bad News
  • Women make up 46 of the U.S. workforce, but hold
    lt 2 of senior-level management positions in
    Fortune 500 companies
  • 2002 5/50 governors are female, 13 of
    Congresspersons, 4 of the top 21 university
    presidents

52
Economic Gender DisparitiesHealth Insurance
  • Gender rating in 38 states allows insurance
    companies to charge men and women different rates
    for the same coverage
  • Maternity care often excluded
  • 11 states had no private plans that came with
    maternity coverage
  • Women pay for additional coverage, which amounts
    to a few thousand dollars, vs. 7000, the average
    cost of an uncomplicated birth

53
Economic Gender DisparitiesHealth Insurance
  • C/S can cause rejection of coverage unless woman
    is subsequently sterilized
  • Survivors of domestic violence can be rejected in
    nine states and DC

54
Economic Gender DisparitiesThe Good News (U.S.)
  • From 1987 - 1999
  • of female-owned firms has doubled (9.1 million)
  • of workers employed by such firms has
    quadrupled (27.5 million)

55
Gender DisparitiesMixed News (U.S.)
  • High school sports
  • 2.5 million female athletes (1999) vs. 300,000
    (early 1970s)
  • But 90 of womens college sports teams were
    coached by women when Title IX enacted (1972)
    2007 - 42

56
Gender DisparitiesMixed News (U.S.) 2006/7
  • Women 49 of medical school applicants, 49 of
    medical students, 44 of residents
  • Women in academic medicine
  • 17 of full professors
  • 21 of division chiefs
  • 11 of department chairs
  • 33 of associate deans
  • 12 of deans

57
Pornography
  • 4 billion adult entertainment business
  • Per day
  • 23-60 million unique visitors to pornography
    websites
  • 2-3 million unique visitors to the five largest
    news sites

58
Pornography and Violence Against Women
  • After viewing pornography, males show
  • heightened levels of aggression and arousal
  • increased likelihood of saying that rape is OK
    under certain circumstances (e.g. woman in sexy
    clothing, man being led on, etc.)

59
Violence Against Homosexuals
  • GSA
  • Gay marriages / civil unions
  • Discrimination legal
  • Causes..

60
Health Consequences of ViolenceAgainst
WomenPhysical Sequelae
  • Trauma bruises, fractures, lacerations
  • Chronic pain headaches, AP, pelvic pain,
    myalgias, LBP, CP
  • Hyperventilation Syndrome
  • Eating and sleeping disorders

61
Health Consequences of ViolenceAgainst
WomenPhysical Sequelae
  • Alcoholism and Drug Abuse
  • e.g. rape victims 10x prevalence of general
    population
  • begins after abuse
  • Tobacco abuse
  • High risk sexual behaviors, STDs, recurrent
    vaginal yeast infections

62
Health Consequences of ViolenceAgainst
WomenPhysical Sequelae
  • Delayed risk of obesity, HTN, hyperlipidemia,
    arthritis, asthma, stroke, heart disease,
    fibromyalgia, psychogenic seizures
  • IBS
  • symptom severity correlates with severity and
    duration of abuse
  • GERD
  • Other functional GI disorders

63
Health Consequences of ViolenceAgainst
WomenPsychological Sequelae - Early
  • shock
  • denial
  • distrust of others
  • withdrawal
  • confusion
  • psychological numbing
  • sense of vulnerability/hopelessness/loss/betrayal

64
Health Consequences of ViolenceAgainst
WomenPsychological Sequelae - Long Term
  • depression
  • anxiety disorders
  • phobias
  • anorexia/bulimia
  • substance abuse

65
Health Consequences of ViolenceAgainst
WomenPsychological Sequelae - Long Term
  • PMDD
  • PTSD (nightmares/hypervigilance/etc.)
  • Fivefold increased risk of developing a
    psychiatric disorder
  • 10 of domestic violence victims attempt suicide
  • possible recurrence of symptoms in later, healthy
    relationships

66
Health Consequences of ViolenceAgainst Women
  • Interference with health care
  • Delayed health care

67
Health Consequences of ViolenceAgainst
WomenResponse to Rape
  • Initial
  • unnaturally calm/detached OR crying/angry
  • Denial phase
  • approx. 2 months
  • Increasing psychological symptoms over several
    months
  • Gradual psychological healing

68
Recognition and Management ofDomestic Violence
  • Routine, repeated assessments in all settings
    (ER, clinic, wards)
  • Maintain supportive, nonjudgmental attitude
    avoid victim-blaming
  • Validate the womans experiences, building on her
    strengths, transfer power and control to her
  • Be available, provide frequent followup
  • Involve social work

69
Recognition and Management
  • Discover nature and duration of abuse
  • Assess for child abuse
  • ensure childrens safety/mandated reporting
  • Keep detailed records, including photographs
  • Testify in court prn
  • Do not recommend marriage counseling

70
Public Health Approaches to Violence Against Women
  • Restraining orders prevent recurrent abuse
  • Batterer treatment programs have had mixed, but
    generally negative, results

71
Public Health Approaches to Violence Against
Women Alcohol
  • Evidence-based prevention of familial violence
  • Increased excise taxes on alcohol
  • Restricting physical access to alcoholic
    beverages
  • Screening and brief intervention for alcohol abuse

72
Screening Practices of PCPs
  • Self-assessment (1999)
  • routine screening - 79
  • first visit - 10
  • periodic checkups - 99
  • prenatal care - 11

73
Screening Practices of PCPs
  • Screening new patients
  • OB/Gyns - 17
  • Internists - 6
  • Physicians practicing in HMOs - 1
  • Physicians practicing in public clinics - 37
  • no difference by sex

74
Assess Patient for Acutely Increased Danger
  • Abuser
  • criminal record
  • alcohol/substance abuse problem
  • gambling problem
  • psychiatric disorder
  • Situational Trigger
  • job loss
  • death in family

75
Assess for Acutely Increased Danger
  • Nature of Abuse
  • increased severity and frequency of beatings
  • escalation in threats
  • stalking
  • violent or forced sex
  • destruction of property

76
Ensure Victims Safety
  • Social worker involvement
  • Restraining order
  • Phone numbers of shelters, hotlines
  • Safe place to go

77
Domestic Violence Shelters
  • Availability poor
  • up to 70 - 80 of women and 80 of children
    turned away on any given night
  • Woefully underfunded
  • Average length of stay 14 days most allow 30
    day max stay
  • Over 50 of all homeless women and children are
    fleeing domestic violence

78
Physician Failure to RecognizeViolence Against
Women
  • Fear of offending
  • feelings of powerlessness
  • time constraints
  • Pandoras Box
  • low confidence in ability to affect change
  • sense of own vulnerability
  • deficits in education and training

79
Physician Failure to RecognizeViolence Against
Women
  • Doctors underestimate the prevalence of domestic
    violence in their patients/communities
  • similar to teen sexual activity
  • Female MDs may be better than male MDs in
    detecting domestic violence and in taking a more
    thorough history

80
Violence Against Womenin The Developing World
  • verbal, physical, and sexual abuse
  • 4 witnesses required for rape conviction in
    Pakistan
  • dowry-related murder
  • bride-burning

81
Violence Against Womenin The Developing World
  • forced abortion and sterilization
  • divorce restrictions
  • forced prostitution
  • child prostitution

82
Violence Against Womenin The Developing World
  • Selective abortion, malnutrition or killing of
    female children
  • MF ratio of births in China 119/100
  • suicide as vengeance against an abusive spouse
  • post-rape suicide (or homicide)
  • to cleanse family honor
  • 47 of homicides in Alexandria, Egypt

83
Female Genital Mutilation
  • Not female circumcision
  • i.e., male equivalent would be penectomy
  • Ranges from clitoridectomy to total infibulation
    (removal of clitoris and labia minora, stitching
    labia majora together, and leaving a small
    opening posterior for urine and menstral blood)
  • surgical chastity belt

84
Female Genital Mutilation
  • 100 million women affected worldwide (2 million
    girls/year)
  • mostly in Africa (e.g. 98 of women in Somalia,
    80 in Egypt, 50 in Kenya)
  • Outlawed in Egypt - 2007
  • rare in Asia
  • Found across all socioeconomic strata and in all
    major religions

85
Female Genital Mutilation
  • Formerly used in U.S. and U.K. as treatment for
    hysteria (floating womb), epilepsy,
    melancholia, lesbianism, and excessive
    masturbation
  • Represents cultural control of womens sexual
    pleasure and reproductive capabilities
  • c.f. virginity exams by physicians in Turkey

86
Female Genital Mutilation
  • Type I - removal of clitoris
  • Type II - removal of clitoris and part of labia
    minora
  • Type III - modified infibulation - 2/3 of labia
    majora sewn together
  • Type IV - total infibulation

87
Female Genital Mutilation
  • Most commonly carried out between ages 4 and 10
  • physicians perform about 12 of operations
  • Often done under non-sterile conditions and
    without anesthesia

88
Female Genital MutilationComplications/Sequelae
  • bleeding
  • infection
  • dysparevnia
  • painful neuromas
  • keloids
  • dysmenorrhea
  • infertility
  • decreased sexual responsiveness
  • shame
  • fear
  • depression

89
Management of Female Genital Mutilation
  • Sensitivity/understand cultural identity issues
  • Deinfibulation
  • Immigration Issues

90
Female Genital Mutilation
  • UN, WHO, and FIGO have condemned
  • Illegal to perform in U.S. under child abuse
    statutes
  • called cultural imperialism by some, although
    we have also outlawed other cultural practices
  • slavery
  • polygamy
  • child labor
  • denial of appropriate, life-saving medical care
    to sick children

91
Polygamy
  • Utah/Mormons
  • introduced by Joseph Smith (1805-1844) who had 50
    wives
  • theological justification based on Abrahams wife
    Rachel giving him her servant Hagar as a sister
    wife (Genesis)
  • Est. 30,000 people in multi-wife families one
    generation ago
  • Est. 60,000 - 90,000 today
  • polygamist clans (e.g. the 1,500 member Kingston
    clan)

92
Polygamy
  • Utah outlawed plural marriage in 1890 in
    exchange for statehood
  • Not one prosecution in the last 50 years
  • Former EPA Administrator (and former Utah
    governor) Mike Leavitt (a Mormon descended from a
    polygamous family) declared constitutional under
    the U.S. Constitution freedom of speech/religion
    guarantee (it is not)

93
PolygamyRelated Offenses
  • welfare fraud by sister wives claiming single
    motherhood
  • lapses in medication attention (including lack of
    prenatal care)
  • incest and underage sex
  • girls age 10 forced into marriage
  • women existing in limbo
  • no birth certificates, drivers licenses, or
    voter registration

94
Covenant Marriages
  • Can be dissolved only in the case of infidelity,
    abuse or felony conviction
  • Offered since 1997 in Louisiana and Arkansas
  • similar measures introduced in 17 other states

95
Rape in War
  • Used for domination, humiliation, control,
    soldierly bonding, and ethnic cleansing
  • often occurs in front of family members
  • recognized as a War Crime since Nuremberg

96
International IssuesAfghanistan
  • Taliban militia took over in 1996
  • Human rights abuses
  • gender-based violence
  • women denied access to education and health care
  • female employment rate decreased from 62 to 12
  • Maternal mortality among worlds highest
  • Lowest ranking on U.N. Development and Gender
    Disparity Indices

97
International IssuesSouth Africas Rape Epidemic
  • Official Rape Rate 104/100,000 people (vs.
    34.4/100,000 in the U.S.)
  • highest rate in the world
  • ¼ South African men say they have committed rape
  • Official annual total 50,000, but est. only
    1/35 reported
  • New latex vaginal insert that latches onto a
    rapists penis and requires surgical removal
    available for 35

98
International IssuesSouth Africas Rape Epidemic
  • HIV risk
  • in Johannesburg, 40 of men aged 20 - 29 are HIV
  • post-rape antiretroviral drugs are not available
    in government hospitals

99
Other International Issues
  • 80 of refugees and internally-displaced persons
    worldwide are female
  • Mexico City (the most heavily populated city in
    the world) has one shelter for battered women
  • Wives of the gods
  • sex slaves at animist shrine in Ghana, Benin and
    Togo

100
Trafficking
  • Tens of thousands of women and girls trafficked
    into US annually to work in sweatshops
  • Others pay for transport to US, end up in
    Northern Marianas Islands
  • International sex trade, sex tourism strong US
    government programs to help victims of sex- and
    labor-trafficking doled out by US Conference of
    Catholic Bishops, and do not cover reproductive
    care

101
Child Marriage
  • Marriage before age 18
  • Affects 60 million women worldwide
  • Half occur in south Asia

102
Child Marriage
  • Associated with no contraceptive use before first
    childbirth, high fertility, multiple unwanted
    pregnancies, pregnancy termination, and female
    sterilization
  • A human rights violation

103
Legal approaches
  • Mandatory reporting
  • History of mandatory reporting (child and elder
    abuse)
  • Benefits
  • Risks
  • Effectiveness
  • International Violence Against Women Act
  • Would require US government to prevent and
    respond to violence against women and girls as a
    part of US foreign policy and aid programs
  • Stalled in Congress

104
Conclusions
  • Awareness of scope of problem of violence against
    women
  • Screen regularly and repeatedly document treat
    support
  • Support womens rights issues, which are health
    care issues

105
References
  • Donohoe MT. Violence against women Partner abuse
    and sexual assault. Hospital Physician
    200440(10)24-31.
  • Donohoe MT. Individual and societal forms of
    violence against women in the United States and
    the developing world an overview. Curr Womens
    Hlth Reports 20022(5)313-319.

106
References
  • Donohoe MT. Violence and human rights abuses
    against women in the developing world. Medscape
    Ob/Gyn and Womens Health 20038(2) posted
    11/26/03. http//www.medscape.com/viewarticle/4642
    55
  • Donohoe MT. Violence against women in the
    military. Medscape Ob/Gyn and Womens Health
    200510(2) posted 9/13/05. Available at
    http//www.medscape.com/viewarticle/512380

107
References
  • Donohoe MT. War, rape and genocide Never again?
    Medscape Ob/Gyn and Womens Health 20049(2)
    posted 10/22/04. http//www.medscape.com/viewartic
    le/491147

108
Contact Information
  • Public Health and Social Justice Website
  • http//www.phsj.org
  • martindonohoe_at_phsj.org
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