IFMSA POLICY STATEMENT Violence against Women Location: Santiago, Chile Date of adoption: August 5th 2013 Date of expiry: August 5th 2016 Summary Violence against women is a violation of inherent basic human rights and fundamental freedoms which inevitably hinders the development capabilities of society. As medical students it is our responsibility to strongly condemn this violence against women in all its forms to provide them the opportunity for a better health and wellness. Introduction The United Nations defines 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 [1], being considered as an hindrance to women s full enjoyment of their human rights and fundamental freedoms [2], and also an obstacle to the achievement of the objectives of equality, development and peace [3]. Violence against women and girls is a global issue, whose base is founded on discrimination and gender inequality [4]. According to the WHO statistics, 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner violence, the first being the most common [5]. Between 15-71% of women aged 15-49 years have experienced physical and/or sexual violence by a partner at some point in their lives [6]. This kind of violence can take many forms, produced by different means and in different settings, both public and private. Violence against women harms families and communities across generations and reinforces other violence prevalent in society. It also impoverishes women, their families, communities and nations. Violence against women is not confined to a specific culture, region or country, or to particular groups of women within a society. The roots of violence against women lie in persistent discrimination against women [7]. Across most of the world, women and girls face discrimination as another way of violence. They have fewer social, economic and legal rights than men [8]. Inequalities abound: In some countries, a man can rape a woman with impunity if he then marries
her. He can be exonerated for beating or killing his wife if he catches her in an act of adultery [9]. Legal systems are permeated by social norms that reinforce gender inequality, foster mistrust by women [10] and leave many women without effective recourse to justice. According to the 1993 United Nations Declaration on the Elimination of Violence against Women in the United Nations, we understand forms of violence against women as: [11] 1. Physical, sexual and psychological violence occurring in the family, including battering, sexual abuse of female children in the household, dowry-related violence, marital rape, female genital mutilation and other traditional practices harmful to women, non-spousal violence and violence related to exploitation; 2. Physical, sexual and psychological violence occurring within the general community, including rape, sexual abuse, sexual harassment and intimidation at work, in educational institutions and elsewhere, trafficking in women and forced prostitution; 3. Physical, sexual and psychological violence perpetrated or condoned by the State, wherever it occurs. Consequences of violence against women Women exposed to violence by their intimate partners are nearly twice as likely than women not exposed to violence to have alcohol abuse and depression [12], as well as 4.5 times as likely of having attempted suicide [13]. If women are victims of physical or sexual violence, 42% will incur injuries as a result of this violence [14] and only 36% will seek medical attention at a health care center [15]. Especially aggressive and/or violent assault by intimate partners may lead to death, resulting in femicide being responsible for 38% of murders against women [14]. HIV/AIDS and other STIs Violence limits a woman's ability to protect herself from HIV. The fear of violence prevents women from: accessing information about HIV/AIDS, undergoing diagnostic tests, disclosing their HIV status, accessing transmission prevention services for infants and receiving treatment and counseling even when they know they are infected [16]. Violence against women presents an obstacle to promoting and increasing safer sex and increases the incidence of non-consensual sex, thus increasing the likelihood of HIV infection by 1.5 times [17] and other STIs by 1.6-1.8 times [18, 19]. In fact, 57% of all people living with HIV in sub-saharan Africa and 49% in the Caribbean are women, with young women facing the highest risks. 77% of all HIVpositive women in the world are African [20]. Maternal and Child Health Gender-based violence significantly limits the ability of women to exercise their reproductive rights, with serious consequences for their sexual and reproductive health. Women who are victims of violence tend not to apply family planning methods, increasing the number of pregnancies [21]. This brings about an increase in unintended pregnancies [22], newborns small for gestational age, low birth weight, premature birth [23] and doubles the likelihood of induced abortion [24].
Childhood As a consequence of violence against women, children that witness violence are at greater risk for anxiety, depression, low self esteem a well as poor school performance;, among other problems that interfere with their well-being and personal development. [25] Human Rights Many countries have enshrined the human rights of women in their national legislation. Several prohibit employment discrimination [25]. A number punish gender-based violence, including domestic abuse, and outlaw child marriage and discrimination against girls within the family [26]. About 25 countries have banned female genital mutilation/cutting [27] and some have taken steps to increase women s awareness of their legal rights and facilitated their access to legal services [28]. More women now serve as judges [29]. Women themselves have been at the forefront of these efforts, galvanizing support and strengthening enforcement. Prevention Many policies fail to address the root causes and prevention of violence against women and girls. Violence is a result of gender-based inequalities that exist within society and according to the United Nations Population Fund (UNFPA)[30], violence against women and girls is linked to the need of the male population to perpetuate male power and control. In order for violence against women and girls to be addressed, it will mean changing cultural concepts about masculinity, and that process must actively engage men, whether they be policy makers, parents, spouses or young boys.'[30] This can be achieved through the implementation of educational programs that target the youth population, that address behaviours and cultivate the essential requirements of a respectful relationship. An example model for these educational programs can be taken from the UN Engaging Schools in Violence Prevention Efforts program.[31] IFMSA's Stance In accordance with the provisions of the Universal Declaration of Human Rights, a woman should not be discriminated against, assaulted, deprived of liberty or subjected to any other form of damage by the mere fact of being a woman [31]. Consequently, the International Federation of Medical Students Associations (IFMSA) strongly condemns violence against women in all its forms. IFMSA believes that this is a threat that must be fought by the people as it prevents the full development of society and the enjoyment of human rights and fundamental freedoms. Therefore, the IFMSA calls upon: 1. Medical students to: a. Train on the issue of violence against women and girls, its implications and consequences, and ways of how to prevent it;
b. Participate and/or develop awareness activities and education campaigns on violence against women and girls; c. Make visible the problems in society and empower youth to be active agents of change in order to eliminate all forms of violence against women and girls; 2. Medical Schools: a. Incorporate within their teaching curriculum and the development of skills needed to recognize a situation of violence against women and girls and optimum handling of the issue, supporting the victim and delivering the tools to overcome the situation; 3. Health sector: a. Train all health care providers who work on this issue on how to effectively to deal with cases of violence against women and girls such as being aware and able to identify cases of violence, as well as prevention, treatment and management; b. Act collectively to stop violence against and girls and promote rehabilitation of the victims comprehensively, incorporating all the necessary professionals; c. Ensure that essential and appropriate referral processes are in place as well as connections with NGOs and community organizations that specialize for violence against women and girls; 4. Governments, NGOs and international agencies: a. Recognize violence against women and girls as a public health issue that affects all areas of society and should be eradicated; b. Public campaigns to reject violence against women and girls in all its forms and alert the public about the importance of eradication; c. Make legally binding recommendations enabling condemnations of all forms of violence against women and girls, including femicide; d. Ensure the availability of and improve access to health services for women and girls who are experiencing violence; e. To implement educational policies that address behaviours of the youth population, as well as the male population in general, such as the UN Engaging Schools in Violence Prevention Efforts program; 5. Media: a. Actively participate in the spread of campaigns that seek to end violence against women and girls. References [1] Declaration on the Elimination of Violence Against Women, article 1. General Assembly resolution 48/104. New York, United Nations General Assembly, 1993. [2] Declaration and Platform for Action, strategic objectives and actions, violence against women, paragraph D.112. Fourth World Conference on Women: Action for Equality, Development and Peace. United Nations, Beijing, 1995. [3] The World s Women: Trends and statistics, Violence against women, chapter 6. Department of Economic and Social Affairs. United Nations, New York, 2010.
[4] Jewkes, R., Editorials: Preventing Domestic Violence, British Medical Journal, vol. 324 (2002), pp. 253-254. [5] Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization, the London School of Hygiene & Tropical Medicine, and the South African Medical Research Council, 2013. [6] Garcia-Moreno C. et al. (2005). WHO Multi-Country study on women s health and domestic violence against women. Geneva, World Health Organization. [7] United Nation Secretary-General s campaign Unite to end violence against women. November 2009. [8] The World Bank. 2001. Engendering Development: Through Gender Equality in Rights, Resources, and Voice, p. 4. New York and Washington, D.C.: Oxford University Press and the World Bank. [9] Equality Now. 2005. Words and Deeds. Holding Governments Accountable in the Beijing + 10 Review Process. Women s Action 16.8: Update: May 2005. New York: Equality Now. [10] United Nations 2005d, paras. 231 and 397. [11] Declaration on the Elimination of Violence Against Women, article 2. General Assembly resolution 48/104. New York, United Nations General Assembly, 1993. [12] Vos T et al. Measuring the impact of intimate partner violence on the health of women in Victoria, Australia. Bulletin of the World Health Organization, 2006, 84:739 744. [13] Devries K et al. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Medicine, 2013, 10(5):e1001439. [14] Stöckl H et al. The global prevalence of intimate partner homicide. The Lancet (forthcoming) [15] Tjaden P, Thoennes N. Extent, nature, and consequences of intimate partner violence: findings from the National Violence against Women Survey. Washington DC, National Institute of Justice, 2000. [16] Violence against women and AIDS, background paper. The Global Coalition on Women and AIDS, 2006. [17] Jewkes RK et al. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. The Lancet, 2010, 376(9734):41 48. [18] Diaz-Olavarrieta C et al. The co-occurrence of intimate partner violence and syphilis among pregnant women in Bolivia. Journal of Women s Health, 2009 18(12):2077 2086. [19] Weiss HA et al. Spousal sexual violence and poverty are risk factors for sexually transmitted infections in women: a longitudinal study of women in Goa, India. Sexually Transmitted Infections, 2008, 84(2):133 139. [20] Ibid., p.2; and UNAIDS, UNFPA, and UNIFEM. 2004. Women and HIV/AIDS: Confronting the Crisis. New York and Geneva: UNAIDS, UNFPA, and UNIFEM.
[21] Moore AM, Frohwirth L, Miller E. Male reproductive control of women who have experienced intimate partner violence in the United States. Social Science and Medicine, 2010, 70(11):1737 1744. [22] Silverman JG et al. Intimate partner violence and unwanted pregnancy, miscarriage, induced abortion, and stillbirth among a national sample of Bangladeshi women. BJOG: An International Journal of Obstetrics and Gynaecology, 2007, 114(10):1246 1252. [23] Hill A, Pallitto C, Garcia-Moreno C. Intimate partner violence during pregnancy as a risk factor for low birth weight, preterm birth, and intrauterine growth restriction: a systematic review and meta-analysis. [24] Pallitto C et al. Intimate partner violence and abortion: results of a meta-analysis. [25] Aguilar Redorta, Mª Dolores. Trastornos mentales y del comportamiento en escolares y exposición a violencia de género en su ámbito familiar. Trabajo Examen Suficiencia Investigadora. Madrid (2004). Universidad de Alcalá. [26] United Nations. 2005d. Review of the Implementation of the Beijing Platform for Action and the Outcome Documents of the Special Session of the General Assembly Entitled Women 2000: Gender Equality, Development and Peace for the Twenty-first Century : Report of the Secretary-General (E/CN.6/2005/2), para. 374. New York: United Nations. [27] Ibid., para. 468. [28] Boland, R. 2004. Legal Progress in Implementing the ICPD Programme of Action. Statement at the 2004 International Parliamentarians Conference on the Implementation of the ICPD Programme of Action, Strasbourg, France, 18-19 October 2004. [29] United Nations 2005d, paras. 383 and 386. [30] United Nations Population Fund n.d. Gender Equality: Ending Widespread Violence Against Women. [31] United Nations Women. 2012. United Nations Trust Fund: Annual Report 2012. [32] The Universal Declaration of Human Rights, article 2. General Assembly resolution 217 A (iii). Paris, United Nations General Assembly, 1948.