Dr. Suman Raj Tamrakar
Violence against women (VAW) is one of the manifestations of the gender norms and unequal power relations prevalent in the society. It constitutes a breach of fundamental right, liberty, security, dignity and equality between women and men. Domestic violence is the most common form of violence in Nepal with such cases increasing from 30 per cent to as high as 81 per cent. Even the pregnant women are not free from this social problem. Nepal Demographic Health Survey (NDHS), 2016 revealed that six per cent of women had experienced this form of violence during pregnancy.
Amid COVID-19 situation, the Women’s Rehabilitation Centre in Nepal reported as many as 465 cases of Gender Based Violence (GBV) from March 24 to May 29. The number is likely to rise with more organisations making their GBV data public. In every 10 minutes, a woman somewhere in the country dials 1145, the hotline operated by the National Women Commission, seeking assistance. A majority of these calls are made by survivors of domestic violence who are either looking to report incidents of abuse or inquiring about the support services.
GBV has many forms, including rape, sexual assault, physical assault, forced marriage, denial of resources and opportunities, and emotional abuse. In general, young, uneducated, unemployed, rural women are often reported as victims of violence. Alcohol abuse is attributed to violence against women mainly by their husbands.
Intimate partner violence (IPV) is equivocally used for domestic violence. Worldwide, almost one-third women who have been in a relationship have faced physical or sexual violence by their intimate partners. A study conducted in Dhulikhel Hospital found that 21 per cent of pregnant women experienced domestic violence. Majority of them (97.9 per cent) reported their current husband as a perpetrator while in-laws were the main perpetrators of domestic violence (76.2 per cent). Mother-in–laws were particularly seen as perpetrators of culturally specific forms of violence. The reasons are largely attributed to social taboos associated with women and deep-rooted traditional practices.
GBV has resulted in intentional self-harm, delayed prenatal care, bleeding during pregnancy, abortions, preterm labour, low birth weight and fetal trauma, with poor maternal and child health. Children who witness GBV are likely to suffer from emotional damage. Families may break up, leaving the new female-headed households to fight increased poverty and negative social consequences. Some women even try to manage the consequences of abuse through alcohol use, prescription medication, tobacco or other drugs. About 38 per cent of all murders of women are committed by IPV. The Nepal Maternal Mortality Study (2008/09) identified family issues as one of the reasons why women commit suicide during pregnancy.
Another study showed that only 17.7 per cent of the pregnant women had been asked about domestic violence by healthcare personnel, and of them, only 9.5 per cent had disclosed their experiences. A significant number of such abused women experienced such violence in their current pregnancy as well. Of them, 31.7 per cent reported physical while 39.1 per cent said sexual violence recurred during the present pregnancy. This signifies that violence should not be tolerated even if it is perpetrated by the partner.
Similarly, a study conducted on the Sichuan earthquake in 2008 found that women experienced more violence after the natural disaster. Similar experiences were reported in 16 districts of Nepal after the devastating 2015 earthquake and floods in the Terai in 2017. As perpetrators are opportunists, violence against women tends to exacerbate during emergencies, including epidemics.
China, Italy, the UK, and other countries have also recorded a significant rise in cases of domestic violence since the COVID-19 outbreak. In Jingzhou, a city in Hubei Province of China, complaints related to domestic violence tripled in February this year as compared to the same month last year. France also saw a 30 per cent rise in such cases after the outbreak of the virus disease.
In Nepal, cases of domestic violence are underreported due to various reasons. In the past, domestic conflicts were considered as private issues to be kept within the family. That obstructed the abused women from seeking help. And the neighbours who observe the violence within a family consider it as normal and do not intervene.
Antenatal care (ANC) services are a common point of contact between women and healthcare systems, and are, therefore, considered to present a ‘window of opportunity’ for health workers to identify and respond to domestic violence in countries like Nepal. Besides, emergency room, gynecology department, psychiatry department, orthopedic department, and general surgery department could be places to find survivors of gender based violence in the hospital setup.
A study by Stenson et al recommended that health workers should ask about violence in health clinic, in a similar way to how they ask for information about smoking, alcohol, or drug use. In a Swedish study, midwives described their roles as raising awareness of the problem of male violence, reducing the shame surrounding victims of abuse, and informing women and giving them emotional support, as well as mediating help-seeking. If healthcare providers can identify survivors of domestic violence, they may be able to provide immediate and ongoing care, address associated risk factors, and offer suggestions that might prevent the reoccurrence of domestic violence.
Since GBV is a social problem, it is essential to develop a system to avoid this form of violence and provide immediate treatment and justice to the victims. Various modalities of training like health response to GBV survivors and mid-level health workers can be applied to enhance their knowledge and skills. Amid COVID-19, it is possible to conduct such trainings online. In a few group discussions, community members, including elected representatives of local levels have called for reducing the ongoing violence by engaging families and community members in assisting the victims of violence or calling the police and informing people about this through awareness programmes.
It is noteworthy that the health sector response to GBV has begun taking its shape considering the growing public health burden in the country. The most significant initiatives are the enactment of the Domestic Violence Act, 2066 and Regulations 2067, and the National Action Plan against Gender Based Violence, 2010. The latter was further developed as National Strategy and Action Plan on Gender Empowerment and Ending Gender Based Violence (2069/2070–2073/2074). The Gender Empowerment and Ending Gender Based Violence Unit under the Prime Minister’s Office aims to contain the most prevalent form of violence.
(Dr. Tamrakar, a professor and senior gynaecologist in Dhulikhel Hospital, is a master trainer for gender based violence issues. firstname.lastname@example.org)
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