PRB

(June 2007) In the fight against gender-based violence, deeply embedded attitudes can pose formidable obstacles to change.

At a May presentation sponsored by the Interagency Gender Working Group’s (IGWG) Gender-Based Violence Task Force Jennifer Wagman, the principal investigator on a World Health Organization (WHO) study that assessed the impact of a community-based intervention designed to reduce physical and sexual domestic violence in Rakai, discussed some of the issues she encountered when working with the SHARE Project, a community-based intervention aimed at preventing domestic violence. The project was started in response to findings from Rakai Health Sciences Program, a research and health service collaboration in Rakai, Uganda.¹

“One of the biggest challenges was teaching locals to see domestic violence as a problem,” says Wagman. “The police seemed to think: ‘So what?’ “

Violence against women is a serious human rights abuse and public health issue. Findings from a 2006 WHO study that surveyed 24,000 women in 10 countries show the pervasiveness and high prevalence of violence against women in a range of cultures and places. The reported lifetime prevalence of physical or sexual partner violence, or both, ranges widely—from 15 percent to 71 percent in 10 countries. The share of women reporting either sexual or physical partner violence, or both, at most survey sites ranged mostly between 29 percent and 62 percent. The lifetime prevalence of physical partner violence for most sites fell between 23 percent and 49 percent.²

In Rakai District in Uganda, 30 percent of women reported male against female domestic violence. While 23 percent said they were ever pushed, slapped, or held down, 9 percent said they were ever punched, beaten, or kicked.³

Domestic violence has health repercussions. The most common injuries resulting from domestic violence in Rakai from 2000-2001 were physical pain lasting more than one day (40 percent); and sprains, bruises, or cuts (19 percent). Of those women surveyed who reported an injury, more than 1 in 5 (22 percent) needed medical attention after domestic violence occurred.⁴

One form of domestic violence, sexual coercion, has been linked to reproductive health problems. Findings from Rakai showed that the share of respondents who reported at least one genital tract symptom was twice as high among those who experienced coerced first sex (42 percent vs. 21 percent).

Women who reported experience with physical violence over the past year were more likely to have received their HIV results, but were less likely to have discussed their HIV status with their current male partner.⁵

Confronting Long-Held Assumptions

There are many challenges to fighting or preventing violence in Rakai. In most cases, women were more likely to believe that violence was justified. In a survey of men and women in Rakai, 90 percent of women and 70 percent of men said that violence against one’s wife or partner was acceptable under certain circumstances (see figure). Whether a majority of those surveyed believed a beating was justified varied widely—depending on the behavior under consideration. The majority (98 percent of women and 60 percent of men) said that it was justifiable where infidelity had occurred. Smaller percentages felt violence was acceptable when a wife or partner refused sex (28 percent of women and 16 percent of men).⁶

The ‘Good’ Wife

In some societies, women and men grow up learning that men are supposed to use violence against their wives/partners to correct bad behavior. In order to live up to ideal standards of being a “good woman” or a “good wife,” this kind of behavior is not only to be endured, but expected, says Wagman. In the Rakai study, sexual coercion was seen as a normal part of intimate relationships based on widely accepted gender norms. “Young women didn’t think they had any power to say no,” said Wagman, “to anything in their marriage.”

Circumstances Under Which Domestic Violence Was Deemed Justifiable, by Sex of Respondent, Rakai District, Uganda, 2000-2001

Source: M.A. Koenig et al., Bulletin of the World Health Organization (2003): figure 2.

When it comes to relationship training, men are neglected, says Wagman. Boys tend to be brought up to be tough and manly. Only 30 percent of men surveyed said that violence against domestic partners was unacceptable. Researchers have yet to discover what insulated these 30 percent from commonly held assumptions, says Wagman.

Changing a culture that largely accepts violence against women can be difficult. Deeply ingrained cultural assumptions pose obstacles to change. Social norms are reinforced by people in positions of power. These include role models, such as paternal aunts, who exert a large influence over the young. Their traditional outlook means they tend to teach young women to do whatever their husbands want. Another group of older women who serve as traditional birth attendants tends also to have deeply embedded ideas about what constitutes normal relations between men and women.

A Different Take on How Men Relate to Women

Reluctance to broach the topic makes confronting domestic violence a challenge. “What we found is that people just don’t talk about it,” said Wagman. Getting them to think through whatever violence is happening is hard. Counselors point to how violence negatively affects women’s ability to perform day-to-day activities. But it’s still uphill work. “There’s really been no magic bullet,” says Wagman.

She and her team found that at least one message seems to break through the wall of entrenched social and cultural assumptions that inform attitudes toward women. When teaching young men and women to think through scenarios about gender equity, she would ask the men how they relate to or treat their siblings, mothers, or daughters. Says Wagman: “You can see the wheels turning.”

Sandra Yin is associate editor at the Population Reference Bureau.

References

1. The Interagency Gender Working Group (IGWG) is a United States Agency for International Development (USAID)-sponsored working group. Its goal is to foster sustainable development and improve reproductive health and HIV/AIDS outcomes. Jennifer Wagman was also principal investigator on a PEPFAR-targeted (President’s Emergency Plan For AIDS Relief) evaluation of the relationship between intimate partner violence and HIV status disclosure in Rakai. The Rakai Health Sciences Program is a reproductive health research and service provision collaboration involving the Rakai District, the Ugandan Ministry of Health, Makerere University, John Hopkins University, and Columbia University.
2. Claudia Garcia-Moreno et al., “Prevalence of Intimate Partner Violence: Findings From the WHO Multi-Country Study on Women’s Health and Domestic Violence,” The Lancet 368, no. 9543 (2006): 1260-69.
3. Michael A. Koenig et al., “Domestic Violence in Rural Uganda: Evidence From a Community-Based Study,” Bulletin of the World Health Organization 81, no. 1 (2003): table 2.
4. Michael A. Koenig et al., “Domestic Violence in Rural Uganda”: table 4.
5. Jennifer Wagman et al., “The Relationship Between Domestic Violence and HIV Results Notification in Rakai District, Uganda” (presentation delivered at the II South African Gender Based Violence and Health Conference, Johannesburg, South Africa, Feb. 7-9, 2003).
6. Koenig et al., “Domestic Violence in Rural Uganda”: figure 2.