maintaining the rage

So even though I haven't set myself any new years resolutions to break, I still feel guilty for not posting sooner. Go figure! But a very belated happy new year to anyone reading! I've been insanely busy with my PhD proposal which is due in about 5 weeks, and those coming 5 weeks are going to be crazily busy! They are the chief cause of my complacency with blogging, taking up not only my time but also most of my mental and emotional energy.

My PhD is essentially how women are treated by staff in an emergency department when they seek help after suffering violence, and whether intoxication at the time of the attack affects the treatment they receive due to the attitudes and beliefs of the staff that are duty bound to provide care to them. I believe clinical staff, particularly doctors and nurses, have a pivotal role to play in not only the care for these women but also in leading and advocating for societal change in how we view these women, given medicine's level of authority and influence in so many spheres of our life.

I wanted to write about why I feel this is such an important issue, and after struggling with where to start I thought that the best way to do that was to use some excerpts from my literature review...

Violence against women, both nationally and globally, is widespread, with the UN indicating up to 70% of women will experience some form of violence in their lifetime (UN Secretary-General’s campaign UNiTE http://www.un.org/en/women/endviolence/situation.shtml). It knows no boundaries of ethnicity, socio-economic status, religion, postcode or education. Not only is it a major public health problem but a violation of human rights (UN universal declaration of human rights http://www.un.org/en/documents/udhr/index.shtml). It takes many forms including physical assault, emotional abuse, rape and sexual assault, stalking, harassment, trafficking, femicide and ‘traditional’ practices such as forced marriage, female genital mutilation and so-called honour killings (WHO fact sheet 239 http://www.who.int/mediacentre/factsheets/fs239/en/). Women aged 15-44 across the world are at greater risk of domestic violence and sexual assault than cancer, car accident, malaria and war (World Bank Discussion Paper 255 1994). Injury from sexual assault and physical assault (including domestic violence) is the most common form of violence against women that results in them seeking help from medical services, particularly emergency departments.

The Women’s Safety Australia survey conducted in 1996 (which sadly has not since been replicated) of 6,300 women provides the most comprehensive picture of violence against women in Australia (Women's Safety Australia 1996). It found that 7.1% of women had experienced violence in the last 12 months (5.9% physical violence and 1.9% sexual violence) which based on the Australian population at the time they extrapolated to equate to 404,400 women who experienced physical violence and 133,100 women who experienced sexual violence (p9). Over their lifetime, 33% of women had experienced physical violence and 18% had experienced sexual violence, which based on population figures at the time equated to 2.2 million women who had experienced physical violence in their lifetime and 1.2 million women who had experienced sexual violence (p12). Data from the Australian Bureau of Statistics indicates that 41% of all physical assault victims were female and that 2.4% of all women respondents had been victims of a physical assault in the past 12 months (ABS 1370.0 – assault 2010). Globally, the World Bank reports that between 11-60% of women report experiencing domestic violence in their lifetime (world bank 1994). Other studies have identified between 24- 52% (Tjaden Thoennes 1998; Martin et al 2008; Moracco et al 2007) of women experience physical assault in their lifetime.

In their seminal study conducted on a national sample of college students, Koss and Cox found that over 15 percent of female respondents, or approximately 1 in 6, identified experiencing behaviour that met the legal definition of rape (Koss Cox 1988), findings that are consistently reflected in other studies (Easteal 1993; Kilpatrick Edmunds Seymour 1992; DeKeseredy and Kelly 1993; Gavey 1991; Beattie 1992; Brener, McMahon, Warren & Douglas, 1999; Elliott Mok Briere 2004). In Australia, one study revealed that 24% of the women in the survey reported experiencing at least one completed rape in their adulthood, and 31% reported experiencing at least one attempted rape (Spangaro 1993), while recent data from the Australian Bureau of Statistics shows that there were 89 victims of sexual assault (including rape) per 100,000 of the population (ABS 4510.0 2010). However, as noted by the ABS, “there are a number of personal, social, cultural and institutional barriers that may prevent people reporting incidents to the police or reporting incidents in surveys, therefore, it is likely that survey reported victimisation rates underestimate the true incidence of sexual assault” (ABS 1370.0 – sexual assault 2010).

Physical and sexual assault can have serious impact on a woman’s physical and mental health. Studies have shown experiencing violence is linked with fatal and non-fatal injury, both trauma-specific and generalised pain, gastrointenstinal disorders, gynaecological problems, sexually transmitted diseases, unwanted pregnancies, disability, disfigurement, sexual dysfunction and mental health problems including post traumatic stress disorder, depression, anxiety and suicidality (Kramer etal 2004; Moracco et al 2007; Resnick et al 2000). This not only affects the quality of life of the victim, but also impacts her family and friends. Experiencing violence also leads to a wide range of emotions including fear, anger, shame, disgust, nervousness, distrust of others, guilt and self-blaming (Campbell 2006). It is unsurprising that even after the physical injuries have healed, the mental and emotional scars can last much longer.

Estimates and studies of the prevalence of alcohol involvement in instances of violence against women vary. Population surveys are one method of gathering prevalence data, and although they rely on self-reporting they provide an important insight. An analysis of the US National Violence Against Women Survey revealed that 19.9% of victims reported intoxication at the time of the assault, and 63.5% perceived that their assailants were intoxicated (Brecklin 2002). In Australia, the Women’s Safety Survey conducted in 1996 revealed that alcohol was present in 41.1% of physical assaults and 38.1% of sexual assaults during the last 12 months (ABS 4128.0). Research studies consistently find that between one third to two thirds of physical or sexual assaults against women involve the perpetrator and/or the victim consuming alcohol (Abbey et al 2003, chase up their refs; Kaysen et al 2010; Brecklin 2002).

Researchers have consistently found that intoxicated victims of physical or sexual assault are deemed more responsible, more blameworthy and having a greater causal role in their victimisation that non-intoxicated victims (Aramburu 1991; Quigley 2006; Cameron 2003). A recent survey conducted by Amnesty International in the UK found that 26% of respondents thought a woman who was drunk when she was raped was partially responsible, and 4% thought that she was totally responsible (Amnesty International 2005). Finch (2007) found that many third party observers hold intoxicated victims at least partially responsible for their victimisation and that these attributions were generally based on different aspects of the victim’s conduct. Quigley and Leonard (2006) argue that this attribution of responsibility for their own victimisation stems from the line of thinking that a person is to blame for choosing to become intoxicated and therefore to blame for their behaviour while intoxicated. Much of the attribution research has been carried out with college students or lay people in mock juror situations. Stewart and Maddren (1997) argued that the findings may not be easily generalised to other groups. They looked at the attributions of blame among police officers, who have specialist knowledge, training and experience in dealing with intoxicated victims of violence, and argued that this specialist knowledge would impact their attributions of blame in such instances. They found that police officers blamed drunk victims more than sober victims, and considered drunk victims “responsible for their victimisation by either provoking the violence or not evading the violence”.(p931) This has significant implications for other professionals with specialist knowledge and skills in dealing with intoxicated victims of violence, particularly health professionals, suggesting that despite the specialist knowledge and training, they may still hold attitudes that seek to blame the victim.

This is clearly a massive problem, both for the victims and for society as a whole that we can foster this level of perpetration and acceptance of violence against women. This is why I'm doing this research. To increase knowledge and change attitudes that will both help the victims and reduce support and acceptance of violence against women across our society. As a survivor. As a woman. And most importantly, as a human being. (I'm happy to provide the full references if anyone would like).