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Quantitative data on health consequences in developing countries are less available, but abundant evidence from crisis centers, police reports, and ethnographic research shows that in these countries, too, violence is a significant cause of injury and ill health. The case study presented by China to the United Nations Expert Group Meeting on Violence in the Family reports that domestic violence caused 6 percent of Baths and serious injuries in Shanghai in 1984 (Wu 1986). A three-month surveillance survey in Alexandria, Egypt, indicated that domestic violence was the leading cause of injury to women, accounting for 27.9 percent of all visits by women to area trauma units (Graitcer, personal communication, 1994). And 18 percent of married women surveyed in urban areas of Papua New Guinea (PNG) had received hospital treatment for injuries inflicted by their husbands. As Christine Bradley of the country’s law reform committee observes: “In PNG, where many women have enlarged spleens due to malaria, a single blow can kill them. (1988, p. 3).
For many women, however, the psychological effects of abuse are more debilitating than the physical effects. Fear, anxiety, fatigue, post-traumatic stress disorder (PTSD), and sleeping and eating disturbances are common long-term reactions to violence. Abused women may become dependent and suggestible, and they may find it difficult to make decisions done. Compounding the psychological consequences that women suffer from abuse is their relationship to the abuser. The legal, financial and emotional ties that the victims of marital violence often have to the perpetrator enhance their feelings of vulnerability, loss, betrayal and hopelessness. Abused women frequently become isolated and withdrawn as they try to hide the evidence of their abuse.
Box 3 Health consequences of genderbased violence.
Physical health consequences.
Pelvic inflammatory disease.
Chronic pelvic pain.
Irritable bowel syndrome.
Injurious health behaviors.
(smoking, unprotected sex)
Partial or permanent disability.
Mental health consequences.
Post-traumatic stress disorder Depression Anxiety Sexual dysfunction Eating disorders Multiple personality disorder Obsessive compulsive disorder.
Not surprisingly, these effects make wife abuse a primary context for many other health problems. Battered women in the United States are four to five times more likely than nonbattered women to require psychiatric treatment and five times more likely to attempt suicide (Stark and Flitcraft 1991). About a third of battered women suffer major depressions, and some go on to abuse alcohol or drugs. Miller(1990) reports that spousal violence is the strongest predictor of alcoholism in women, even after controlling for income, violence in the family of origin, and having an alcoholic husband. Moreover, studies show that most battered women who drink begin drinking excessively only after the onset of abuse (Amaro and others 1990; Stark and others 1981).
The relation between battering and psychological dysfunction also has important implications for women’s mortality, because of increased risk of suicide. After reviewing evidence from the United States, Stark and Flitcraft concluded that “abuse may be the single most important precipitant for female suicide attempts yet identified (1991, p. 141). One-fourth of suicide attempts by American women-and half of all attempts by African American women-are preceded by abuse (Stark 1984).
A cross cultural survey of suicide by Counts draws the same conclusion, positing that in some African, Oceanic, and South American societies, female suicide operates as a culturally recognized behavior that enables the “politically powerless. to revenge themselves on those who have made their lives intolerable. (1987, p. 195). Counts finds support for her argument in cultures from Africa, Peru, Papua New Guinea, and the Melanesian islands. Among Fijian Indian families in which someone has committed suicide, 41 percent cite marital violence ax the cause (Haynes 1984).
Suicide is not an inconsequential form of death. The World Bank estimates that of the healthy years of life lost to women in rural Chins, 30 percent are lost due to suicide (Bobadilla, personal communication, 1993). This finding is consistent with reports of mass suicides in rural China among women forced or sold into unwanted (and often violent) marriages (name withheld 1991). In Sri Lanka, a country with reasonably accurate mortality statistics, the rate of death due to suicide among young women age 15 to 24 is five times that due to infectious diseases and 55 times the rate due to obstetric-related causes (WHO 1985).
Three studies from India almost suggest a similar link between marital violence and female suicide. A one-year study of completed suicides in Delhi revealed that 46 percent were committed by males and 54 percent by females. It cited marital discord and ill treatment by husbands and in-laws as the most common precipitating factor among women. Another study analyzed all cases of suicide in 1978 known to the Madras Police Department. The peak ages for women committing suicide were 15 to 20, Among the two-thirds of the women who were married, the principal cause cited for suicide was “maladjustment with an alcoholic or drug-addict husband. “The third study, on suicide deaths in Daspur, found that the peak a” for women were 15 to 24 and the most common precipitating factor was “quarrel with spouse” (as cited in Paltiel 1987).