Violence against women: theoretical reflections

Abstracts

A violência manifesta-se de diferentes formas, em distintas circunstâncias e com diversos tipos de atos violentos dirigidos a crianças, mulheres, idosos e outros indefesos. Violência doméstica, violência de gênero e violência contra mulheres são termos utilizados para denominar este grave problema que degrada a integridade da mulher. A violência de gênero pode manifestar-se através de violência física, violência psicológica, violência sexual, violência econômica e violência no trabalho. A violência sofrida pela mulher por parte de seu companheiro intimo pode ser analisada através do Modelo Ecológico, que explica a estreita relação entre o indivíduo e seu entorno. Concluiu-se que é importante analisar os fatores que influem no comportamento das pessoas frente à violência para se estabelecer programas de ajuda.

violência; saúde mental; enfermagem; identidade de gênero; mulheres

La violencia se manifiesta de diferentes formas, en distintas circunstancias y con diversos tipos de actos dirigidos a niños, mujeres, ancianos y otras personas indefensas. Violencia domestica, violencia de genero y violencia contra mujeres son términos utilizados para denominar este grave problema que degrada la integridad de la mujer. La violencia de género puede manifestarse a través de violencia física, violencia psicológica, violencia sexual, violencia económica y violencia en el trabajo. La violencia sufrida por la mujer por parte de su compañero íntimo puede ser analizada a través del Modelo Ecológico que explica la estrecha relación entre el individuo y su entorno. Se concluyo que es importante analizar los factores que influyen en el comportamiento de las personas frente a la violencia para establecer programas de ayuda.

violencia; salud mental; enfermería; identidad de género; mujeres

REVIEW ARTICLES

Violence against women: theoretical reflections

Leticia Casique Casique^I; Antonia Regina Ferreira Furegato^II

^IPhD in Nursing, Faculty member at the Celaya Faculty of Nursing and Obstetrics/University of Guanajuato-Mexico

^IIFull Professor, e-mail [e-mail]. University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development.

ABSTRACT

Violence appears in different forms and circumstances and involves distinct kinds of violent acts against children, women, elderly and other defenseless persons. This serious problem, which degrades women's integrity, is denoted by terms like domestic violence, gender violence and violence against women. Gender violence can appear as physical, psychological, sexual, economic violence, as well as violence at work. Violence against women committed by their intimate partners can be analyzed through the Ecological Model, which explains the close relation between individuals and their environment. Factors influencing people's behavior towards this violence should be analyzed with a view to establishing help programs.

Descriptors: violence; mental health; nursing; gender identity; women

THEORETICAL REFLECTIONS

The term violence derives from the Latin word vis, which means force and refers to the notions of constraint and using physical superiority on the other person. Violence is mutant, as it is influenced by very different times, places, circumstances and realities. There is tolerated and condemned violence, as violence has existed on Earth as long as mankind, assuming different, increasingly complex and at the same time more fragmented and articulated forms⁽¹⁾.

Violence is an extremely diffuse and complex phenomenon, whose definition cannot be scientifically exact, since it is a matter of appreciation, it is influenced by culture and submitted to continuous review to the extent that social values and standards evolve⁽²⁾.

The feminist movement in the early second half of the past century stood out because it denounced cases of violence against women, casting light on a reality that, until then, had only been mentioned in the private sphere. Violence in the home context continued without anybody doing or saying anything. Until that time, it had not been openly manifested and was supported by contemporary social conditions⁽¹⁾.

The summary of different international conferences held in the 20^th century contains the propositions and definitions of minimal human rights for all people on the planet, which undoubtedly affected the detection and investigation of gender violence against women. These conventions were: Charter of the United Nations (1945); Convention on genocide (1948); International covenant on civil and political rights (1966); International covenant on economic, social and cultural rights (1966); International convention on the elimination of all forms of racial discrimination (1965); Convention on the elimination of all forms of discrimination against women (1979); Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (1984); Convention on the rights of the child (1989); and the Inter-American Convention on the prevention, punishment and eradication of violence against women - Convention of Belém do Pará (1994)⁽³⁾.

These conventions established legal frameworks to protect human rights, with positive repercussions for the advanced understanding and eradication of violence against women.

Gender violence was influenced by feminist groups from Western countries, which denounced people who degrade women's dignity through violence⁽⁴⁾. As a result of the identification of violence against women, feminist groups have been joined by other actors, such as human rights defense associations and international organizations, who analyze and attempt to help decreasing the problem.

In order to understand the gender violence designation, we need to take into account the social character of traits attributed to men and women. Most female and male traits are cultural constructions. They are products of society and do not necessarily derive from nature⁽⁴⁾.

Gender violence is exercised by men against women, in which the aggressor's and the victim's gender are closely connected with the explanation of this violence. Thus, it affects women due to the simple fact of being women, that is, it is violence perpetrated by men to maintain control and dominion over women.

Men's roles and behaviors are considered socially more valuable. For example, crying is disdained, violent responses are looked upon positively, and housework (although fundamental) remains almost unnoticed to men, although justifying that it is carried out by women⁽⁵⁾.

The gender category presupposes the understanding of relations established between the sexes in society, differentiating between biological and social sex. While biological sex refers to anatomic-physiological differences between men and women, social sex is related to how these differences behave in different societies throughout history⁽⁶⁾.

In all cultures across the world, women live in socially unequal conditions towards men. These inequalities acquire different manifestations and magnitudes.

The definition of gender implies two levels, that is, gender as a constitutive element of social relations, based on perceptible differences between the two sexes; and gender as a basic form of representing power relations, in which dominant actions are presented as natural and unquestionable⁽⁶⁾.

International concerns about the phenomenon of violence against women demand analyses and studies about the issue, as this violence deteriorates women's individual and family health. Women who resist against an abusive relation indefinitely end up losing their individual (physical and mental) health, which consequently affects the family's health.

The United Nations convention on the Eradication of violence against women, which the UN General Assembly adopted in 1993, defined violence as any act of gender-based violence that produces or can produce physical, sexual or mental harm or suffering in women, including threats, coercion or arbitrary privation of freedom in public as well as in private life⁽⁷⁾.

FORMS OF VIOLENCE AGAINST WOMEN

Different forms of gender violence include intrafamily or domestic violence and violence at work, manifested through physical, psychological and social aggressions.

Intrafamily violence is a form many women are submitted to, which originates among family members, independently of whether the aggressor is sharing the same home or not. Aggressions include violation, physical, psychological and economic abuse and can sometimes culminate in the abused woman's death. Habitual psychological, sexual or physical violence occurs among affectively related people, such as husband and wife, or adults against minors or aged people within a family.

Abuse is characterized by the set of conducts that intentionally cause physical harm, pain or injury to another person⁽⁸⁾. It includes acts ranging from slaps to severe injuries that can cause death.

Violence manifests itself physically as well as through all those forms in which people's individual guarantees are oppressed, made impossible or violated. Hence, all definitions agree that violence is any act against women's dignity, independently of its origins.

Domestic violence, gender violence and violence against women are terms used to name a severe problem⁽⁹⁾. In domestic violence, the aggression comes from the partner or another family member, moving beyond house walls and affecting elderly, children and disabled persons. In gender violence, the aggressors are persons close to their victims, and aggressions occur in private or public spaces.

One of the most common forms of violence against women is committed by their husbands or intimate partners⁽¹⁰⁾. The fact is that, generally, women are emotionally involved with their aggressors and economically dependent on them. This violence by intimate partners occurs in all countries, independently of the social, economic, religious or cultural group.

Violence by husbands or intimate partners is committed against the "weak sex". These cases include mishandled women. This type of abuse has also been frequent in homosexual relations. Thus, a large majority of cases of partner abuse has been committed by men against their "partner"⁽¹¹⁾.

Gender violence boils down to the result of male domination and female subordination relations, in which the man intends to avoid the woman's escape because he does not want to divorce her, keeping her subject to a submission she cannot escape from⁽⁴⁾.

Based on experts' affirmations, we can summarize that gender violence is concentrated in individual aggressions that go beyond the social level, undoubtedly reflecting one group's domination and another's subordination.

Studies have emphasized the prevalence of the intrafamily violence phenomenon and associated risk factors. Conditioning factors have been appointed in different levels of analysis, ranging from social and cultural aspects (authoritarian and patriarchal values, acceptance of violence as a way to solve differences, ethnic groups), gender (valuation of violence in male role performance, acceptance of violence and punishment as a way to solve couples' conflicts), psychological aspects (greater impulsiveness, alcohol and drugs use) to (parents', victims' or a mistreated couple's ) childhood experiences of violence⁽¹²⁾.

Violence against women and girls includes physical mistreatment, as well as sexual, psychological and economic abuse. Again, it can be affirmed that "gender-based" violence develops as a result of women's subordinate condition in society⁽¹¹⁾.

Two of the most common forms of violence against women are abuse by intimate partners and forced sexual activity, which occur in childhood as well as adolescence or adult life. Abuse by an intimate partner, also known as domestic violence, mistreatment or aggression against the wife, is almost always accompanied by psychological abuse and, in most cases, by forced sexual relations. A majority of women mistreated by their partners suffer aggressions. In fact, abusive relations usually develop in an atmosphere of fear and even terror.

In industrialized countries, forms of violence are not the same for all couples experiencing violent conflicts⁽¹⁰⁾. There are at least two patterns:

1. A severe and growing form of violence, characterized by different forms of abuse, terror and threats, accompanied by increasingly possessive and controlling behaviors by the abuser.

2. A more moderate form of violence in the relationship, where constant frustration and anger occasionally erupt in physical aggression.

According to the study by Casique⁽¹³⁾, gender violence perpetrated by intimate partners against women can manifest itself through physical acts, psychological violence, as well as social acts involving the violent situations women live in.

Physical aggression

This type of violence against women is the most evident and difficult to hide, as it affects their physical appearance. Women suffering some kind of physical aggression mostly experience numerous acts of violence over time.

Physical violence is understood as any action implying the use of force against women of any age and in any circumstance, which can manifest itself through blows, kicks, pinches, bites, throwing of objects, pushes, slaps, spankings, stab wounds, scratches, hits on the head, injuries, burns, fractures, abdominal injuries and any other act against their physical integrity, producing marks on their body or not^(13,14,15).

Psychological aggression

This type of violence is more difficult to detect, as victims present psychological scare, which are more difficult to observe and prove⁽¹⁶⁾.

Psychological or emotional violence occurs by rejecting caresses, threatening to beat up the woman and her children, impeding the woman to work, have friends or go out; the partner, in turn, tells her about his amorous adventures and, at the same time, accuses her of having lovers.

A study carried out in Chile identified diverse manifestations of psychological violence, classified as follows⁽¹⁶⁾ :

- Verbal abuse: humbling, insulting, ridiculing, humiliating, using mental games and ironies to cause confusion

- Intimidation: scaring with looks, gestures or screams; throwing objects or destroying property

- Threats: to hurt, kill, commit suicide, take the children with him

- Isolation: abusive control of the other person's life by watching over her acts and movements, listening to her conversation, impeding that she makes friends

- Disdain: treating the other person as inferior, making important decisions without consulting the other

- Economic abuse: abusive financial control, imposing monetary rewards or punishments, impeding the woman from going out to work although this is necessary for family maintenance

It is important to highlight that victims of psychological violence often think that what happens to them is not sufficiently severe and important to decide on attitudes to impede these acts, including denouncing them to competent organs. Some victims believe that they would not be creditworthy if they denounced their aggressor. In other cases, someone the woman respect tells her that she should continue in this abusive relation for the good of her children or to guarantee the rights acquired through marriage⁽¹⁶⁾.

Many women do not dare talking or denouncing that they are victims of mistreatment, out of fear of the aggressors' threats against themselves and their relatives.

Many indirect manifestations of violence comprise the so-called "destructive acts", which are forms of aggression or psychological pressure used by a man in a conflicting relationship, making the woman's free circulation impossible.

Social aggression

No consensual definition was found among the main authors studying violence. However, in this study, social violence was considered as any action that impairs women, imposed by conducts or attitudes of acceptance or rejection which society establishes as adequate in view of the violence women suffer, as well as the social conditions involving the situation the violence victim lives in.

The violence women are victims of has not come out into the open, due to the fact that it is considered as something natural and private. Violence is reinforced by religions and governments through standards and codes. This generates myths and beliefs that are not always in conformity with current reality, although society has legitimated them, at some moment, due to not always very clearly known motives⁽¹⁷⁾. Popular myths and beliefs about violence include:

- Violence is natural, it has always existed and will always exist

- Home is a private space, in which nobody should interfere

- Violence occurs in low social classes, where poverty and low education levels prevail

- Alcohol and violence provoke episodes of violence

- The aggressor is violent in all of his actions and interpersonal relations

- If the violent man shows regret or apologizes, this will allow him to change his abusive behavior

- Beating is a proof of love "I spank you because I love you"

- Man can neither control his impulses nor handle his passions

- The aggressor is mentally ill

- Mistreated women can abandon their homes whenever they want to

- Women should stay with their partners under any circumstance, so that their daughters and sons can grow up together with their father

- The situation is going to change for the woman, it is just a matter of waiting, doing one's best and being more comprehensive

- Women like to suffer

- If there is no jealousy, there exists no love in the couple

- Woman cannot escape from violence

Nowadays, women increasingly participate in economic activities. Their insertion into the labor market has provoked social changes in productive institutions and homes. Nevertheless, job discrimination continues, devaluing women and avoiding their ascension. Thus, the family provider role is being changed by women's economic independence, which undoubtedly affects her functions at home, a fact men traditionally are not willing to accept.

Social class is an important factor in the physical aggression phenomenon. This means that the underemployed class should receive special attention in intervention strategies related to the problem, consequently decreasing violence statistics that directly affect women⁽¹⁸⁾.

CONSEQUENCES OF VIOLENCE

The violence practiced by intimate partners affects women's physical and emotional health ^(10,15). Some health consequences need to be mentioned, resulting from violence practiced by intimate partners.

- Physical: abdominal or thoracic injuries, bruises, edemas and hematomas, chronic pain syndrome, invalidity, fibromyalgias, fractures, gastrointestinal disorders, headache, abdominal pain, irritable bowel syndrome, burns, lacerations and abrasions, eye damage, reduced physical functioning, chronic fatigue, abrupt weight changes.

- Sexual and reproductive: gynecological disorders, persistent vaginal flow, genital bleeding, infertility, chronic pelvic inflammatory disease, pregnancy complications, spontaneous abortion, sexual dysfunction, sexually transmissible diseases, including HIV/AIDS, unsafe abortion, unwanted pregnancy, delayed intrauterine development, fetal and maternal death.

- Psychological and behavioral: alcohol and drugs abuse, depression, anxiety, eating and sleep disorders, feelings of shame and guilt, phobic disorders and panic syndrome, physical inactivity, low self-esteem, post-traumatic stress disorders, smoking, suicidal behaviors and self-punishment, unsafe sexual behavior.

Violence against women, especially by their partners, represents a burden to health services due to the costs it generates. This violence does not only cause physical and psychological damage to women, but also implies risks for their children. Witnessing violence inside the family increases probabilities of depression, anxiety, behavioral disorders and delayed cognitive development in children. Moreover, it increases the risk that they will turn into victims of mistreatment or future aggressors themselves.

THE ECOLOGICAL MODEL

One theoretical base to understand violence against women is the Ecological Model⁽¹⁹⁾. This proposal is based on different authors' work and proposes "an integrated ecological framework" with a view to studying and getting to know violence against women.

The ecological model studies factors active in four distinct spheres: individual, family, communitarian and sociocultural, as shown in Figure 1. This model focuses on violence in the interaction among its distinct levels. These are superposing causality levels, in which there is not only single determinant, but an interaction of operating factors, favoring violence or protecting the individual against it. These causal factors and their interactions need to be known in their distinct contexts and cultural environments. This knowledge helps to identify the fragile points and roads to advance in violence prevention and specific interventions⁽⁸⁾.

The main point in the model is that it helps to acknowledge and distinguish between countless factors influencing violence and, at the same time, provides a framework to understand how its different elements interact. The First World Report on Violence and Health tries to understand the multifaceted nature of violence through this model⁽²⁾.

The ecological model, classified in four levels, makes it possible to analyze the factors influencing people's behavior and factors increasing the probabilities of people turning into victims or perpetrators of violent acts.

- The first level identifies biological and personal history factors. Traceable data include personal and demographic characteristics (age, sex, education, income), antecedents of aggressive or self-devaluation behaviors, mental or personality disorders and substance-related disorders.

- The second level includes closer relations, such as those between couples and partners, other family members and friends. It has been observed that these increase the risk of suffering or perpetrating violent acts. Having friends who commit or incite violent acts can increase the risk that young people will suffer or execute these actions.

- The third level explores the community contexts where social relations are developed in, such as schools, work places and neighborhoods. Attempts are made to identify the characteristics of these environments, as they can increase the risk of violent acts. The risk can be influenced by factors like mobility of the place of residence, population density, high unemployment levels and existence of drugs traffic in the region.

- The fourth level is directed at general factors, related to the structure of society. These factors contribute to create a climate that incites or inhibits violence, such as the possibility of obtaining arms due to social and cultural standards. These include standards that prioritize parents' rights over their children's well-being, consider suicide as a personal option more than as a preventable act of violence, reaffirm men's dominion over women and boys, back the excessive use of police force against citizens or support political conflicts. This level also includes other facts, such as sanitary, economic, educative and social policies, which contribute to maintain economic or social inequalities among groups.

Figure 1 shows the superposition of different rings, illustrating how factors at different levels reinforce or modify each other. Thus, for example, the probability that a person with an aggressive personality will act violently inside a family or community that is used to solving conflicts through violence is higher than if he is in a more pacific environment.

Violence against women is increasingly faced as an important public health problem. Thus, there is an urgent need to establish early detection and effective intervention programs.

There is a wider offer of victim support and protection services, providing orientations, legal advice, educative and work training. Some of these develop alternative services, directed at the aggressors, as physical violence exerts economic, morbidity and mortality repercussions in different age groups.

CONCLUSIONS

Violence can be present in all spheres of a woman's life and can manifest itself in different forms and circumstances through its evolutive cycle (physical violence, psychological violence and social violence). It is reinforced by religions and governments through standards and codes.

Many experts analyze violence and all of them agree that this phenomenon deteriorates women's integrity, giving rise to deficient health, family and social group disorder. Among consequences for women's health, physical and psychological complications stand out, which produce important disabilities in women, without forgetting about the social consequences that sometimes make it impossible for her to leave this violent home where her individual guarantees are violated and her individuality is denigrated.

As this phenomenon affects people's health and has repercussions for public health at all levels (regional, national and international), international conferences are held to look for determinants and factors that lead to a better understanding of the violence phenomenon, which hits many women on this planet.

The World Health Organization recommends the Ecological Model to understand violence, hoping to clarify the relation between learned behaviors, man's violent behavior and woman's passive behavior.

It is important to analyze factors influencing people's behavior towards violence with a view to establishing help programs.

Recebido em: 31.5.2005

Aprovado em: 12.7.2006

• 1. Minayo SMC, Souza RE, organizadoras. Violência sob o olhar da saúde. Rio de Janeiro (RJ): Fiocruz; 2003.
• 2. Organización Panamericana de la Salud, Oficina Regional para las Américas. Informe mundial sobre la violencia y la salud. Washington: OMS; 2002.
• 3. Schraiber LB, D'Oliveira AFPL. O que devem saber os profissionais de saúde para promover os direitos e a saúde das mulheres em situação de violência doméstica. Projeto Gênero, violência e Direitos Humanos - Novas Questões para o Campo da Saúde. 2ª ed. São Paulo: Fundação Ford, CREMESP; 2003.
• 4. Alberdi I. Matas N. La violencia doméstica: informe sobre los malos tratos a mujeres en España. Barcelona (ES): Fundación "La Caixa"; 2002.
• ⁵
  Inmujeres 2003: Ley del instituto nacional de las mujeres: poder ejecutivo: secretaria de gobernación. [página da internet]. Mexico: Instituto nacional de las mujeres; [acesso em: 26 maio.2004]. Disponivel em: http://cedoc.inmujeres.gob.mx/documentos_download/100199.pdf
• 6. Fonseca RMGS. Espaço e gênero na compreensão do processo saúde-doença da mulher brasileira. Rev Latino-am Enfermagem 1997; 5(1):5-13.
• 7. García-Moreno C. Violencia contra la mujer: Género y equidad en la salud. Washington (DC): Organización Panamericana de la Salud - Harvard Center for Populations and Development Studies; 2000. Publicación Especial.
• 8. Ramírez DE. Factores psicosociales de la violencia familiar. Rev Enfermeras, México 2001; 37(1-2):8-15.
• 9. Rohlfs I, Valls-Llobet C. Actuar contra la violencia de género: un reto para la salud pública. Gac Sanit 2003; 17(4):263-5.
• 10. García-Moreno C, Heise LL. Violência perpetrada por parceiros íntimos. In: World Health Organization. World Report on violence and Health. Genebra: OMS; 2002; p. 91-121.
• 11. Heise L, Ellsberg M, Gottemoeller M. Ending violence Against Women. Populations Rep 1999; 27(4):1-43.
• 12. Alvarado R, Gutiérrez C. Violencia conyugal según niveles socioeconómicos en Región Metropolitana. Rev Chil Salud Pública 2002; 6(1):27-35.
• 13. Casique, LC. Violência perpetrada por companheiros íntimos às mulheres em Celaya. Tese [Doutorado]. Ribeirão Preto (SP): Escola de Enfermagem de Ribeirão Preto (SP): USP; 2004.
• 14. Pérez RR, Casique LC. Tipos de violencia que sufre la mujer. Guanajuato (MX): Universidad de Guanajuato, Facultad de Enfermería y Obstetricia de Celaya; 2001.
• 15. Aliaga PP, Ahumada GS; Marfull JM. Violencia hacia la mujer: un problema de todos. Rev. Chil. Obstet. Ginecol. 2003; 68(1):75-8.
• 16. Wynter AE. La violencia desde una perspectiva de Género. Rev Enfermeras 2001; 37(1-2):23-6.
• 17. Altamirano RI. La violencia intrafamiliar: Los mitos. Rev Méd de Guanajuato 2000; 10(1-2):206-9.
• 18. Gianini RJ, Litvoc J, Eluf-Neto J. Agressão física por classe social. Rev Saúde Pública 1999; 33(2):180-6.
• 19. Heise L. Violence against women: an integrated, ecological framework. Pop Reports 1998; 4(3):262-90.

Publication Dates

• Publication in this collection
  09 Feb 2007
• Date of issue
  Dec 2006

History

• Received
  31 May 2005
• Accepted
  12 July 2006