Nick Thompson reports on ‘Violence Against Women: A Determinant of Health’

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Nick Thompson, Cumberland Lodge Scholar 2016 – 2018

The overarching framework for Cumberland Lodge’s health conference this February was provided by the Chief Medical Officer’s 2014 report The Health of the 51%: Women. While the report itself covered a broad spectrum of female-specific health issues, the conference focused upon the topic of violence against women (VAW). A key objective of the conference was to provide a deeper understanding of the many forms of VAW, their resultant effects on health, and critically, the challenges faced by victims and the professionals who support their journey towards recovery. With speakers and delegates comprising academics, frontline healthcare professionals, police, and policy makers to name just a few, the talks and subsequent group discussions were diverse, far-reaching, and given the topic, at times unnerving.

While prior research has tended to focus primarily on intimate partner violence, it was highlighted that this is in fact not the most common form of VAW. Thus, it was fitting that the conference adopted an expansive perspective, covering many forms of VAW, such as female genital mutilation (FGM), honour-based violence (HBV), sexual assault by non-partners, and non-physical forms of domestic abuse (DA), such as coercive control.

Of the many sobering statistics presented during the conference, particularly hard-hitting were those concerning the prevalence of abuse within adolescent relationships – 41% of females aged 14-17 have experienced some form of sexual violence in an intimate relationship[1]. With such information in mind, it was concerning to learn that efforts to promote the implementation of statutory sex and relationship education within schools have been met with resistance at a range of levels. Thankfully, the work of organisations such as Women’s Aid provide some support within the school system; their ‘Safer Futures’ and ‘Expect Respect’ campaigns aim to identify and challenge some of the gender stereotypes held by the younger generation. While such programmes perform a vital function and represent a positive step in tackling VAW, a key question remains – without government support and significant action at the national level, how much can realistically be achieved, and over what timeframe?

As a delegate at the conference it was difficult to not be troubled by the data presented from a 2014 survey conducted by the Fundamental Rights Agency. The survey explored the prevalence of physical, psychological, and sexual VAW across all EU states – the UK is within the top third of all member states for incidences of VAW; the same is also true for incidences of abuse during childhood. While the broader conclusions one can infer from research into VAW are limited to some degree by methodological limitations (such as the fact that much of the existing work does not give due consideration to the impact of the frequency of incidents), one conclusion can unarguably be drawn from the data – VAW is prevalent to such an extent that it calls into question our perception of the UK as a truly progressive and civilised society.

It was encouraging to hear that victims’ perceptions of specialist VAW support services were consistently positive; however, the same was not true of broader healthcare and law enforcement services, where the experiences of victims were somewhat inconsistent. Throughout the two day conference, there was extensive discourse regarding the key issues that frontline healthcare/law enforcement professionals face when working with victims of VAW. The primary focus was on trying to formulate ways in which these challenges could be overcome. Discussion on this topic was diverse and in-depth; in the interests of brevity, the key points can be categorised here into two core areas: staff education/training and multi-agency working.

The reported evidence would suggest that the level of training and education on VAW provided to frontline healthcare and policing staff lacks consistency and leaves much to be desired. A primary goal should be ensuring that those working in such roles have an appropriate level of awareness regarding the possible indicators of domestic abuse so that they can effectively utilise any potential opportunities for disclosure. It is important to note that the challenges go beyond simply providing training in how to identify the warning signs and how to ask the right questions.  It is crucial that professionals are equipped with a thorough understanding of the nature of different forms of VAW, and have support in the development of core abilities, such as empathy and decision making, to be able to deal effectively with any disclosures of violence. Helping victims to feel secure enough to open up to professionals is one aspect, but perhaps even more crucial is that any disclosures are met with the appropriate validation and emotional/practical support.

With particular reference to police officers dealing with issues such as FGM and HBV, there is a clear need for a deep understanding of the socio-cultural and/or religious context, to allow them to work alongside communities and to address issues from within. While care must always be taken to demonstrate empathy and understanding, strong leadership is necessary to ensure that fears over appearing culturally insensitive do not impede the ability to protect those most vulnerable to abuse. This particular point was stated more elegantly and succinctly by one of the conference speakers than I could hope to myself, and thus it is pertinent to reiterate here their message that ‘cultural acceptance does not mean accepting the unacceptable’.

Appropriate training and support throughout the education/career path (from undergraduate, to postgraduate and beyond) is vital to ensure all relevant staff (whether healthcare, law enforcement or other) have a detailed understanding of VAW, a working knowledge of the appropriate referral pathways, and the core competencies to offer the necessary support and be able to respond effectively to victims’ (and their own) emotional needs. Beyond these fundamental educational requirements, it is also important that the relevant information is easily available to professionals in the moment of need (some of the apps and interactive tools being developed by the General Medical Council represent a significant step in right direction in this regard). On a more practical level it is crucial that the necessary procedures for multi-agency sharing and access are embedded within the system, and that all staff are well equipped to overcome issues related to the complex power dynamics that can occur with such collaborative working.

Thinking back to significant socio-legal milestones in our nation’s history, such as the equal pay act of 1970, and the sex discrimination act of 1975, it is difficult to not experience some degree of ambivalence – there is of course a sense of pride that such laws can and do exist in our country, but any pride we feel must be tempered with some sense of shame and regret that such laws are actually needed. How we reconcile the reality of some of the information discussed with our shared ideals and values, was a fundamental question raised by the conference. It is imperative that we consider the extent to which embedded and tacitly accepted norms concerning gender roles and hierarchical structures within our society may implicitly provide a social environment in which VAW is able to persist. Theresa May’s recent announcement that her government will seek to transform the way in which domestic violence cases are dealt with represents a positive move forward, but thinking of the broader issue of VAW, there is much more still to be done, and we each have a responsibility to do our part in ensuring that efforts to tackle the many forms of VAW are high on the political agenda.

[1] ‘Sexual harassment and sexual violence in schools’, The Women and Equalities Committee (2016)

 

Iman Azzi reports on ‘Violence Against Women: A Determinant of Health’

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Iman Azzi, Cumberland Lodge Scholar 2016 – 2018

Cumberland Lodge: How much do we want to know about the connections between violence against women (VAW), being well, and being at ease in the world? This question was posed early to participants at Cumberland Lodge’s annual health conference, which focused on Violence Against Women: A Determinant of Health. The question lingered throughout the two-day conference, as participants sought to deepen their awareness of the structural limitations and cultural realities facing those who are being abused.

Using the 2014 Annual Report of the Chief Medical Officer, Professor Dame Sally Davies, which focused on women’s health, as a starting point for discussions, this conference brought together public health directors, NHS representatives, policy makers, and professionals from law enforcement and academia.

Almost a third of 16-18 year old girls say they have experienced unwanted sexual touching at school; a rape occurs in a school every day of term.[1] Sexual harassment is the most prevalent form of abuse reported by British women.[2] Statistics are shocking, but those at the conference were well aware of the extent to which violence against women occurs at all levels of British society.

The focus of the conference was not on the numbers, although they are useful to underscore the cross-sector challenges, but on the policy changes needed to reduce and prevent violence against women to lower such statistics, and to hold perpetrators accountable for their actions. While most of the conference was consumed by navigating the interplay between the legal and the health sectors, the most moving sessions were led by women who shared their own experiences as victims and survivors, urging others not to ascribe labels to women experiencing trauma and offering ways to best support those who are at their most vulnerable.

Of course, intimate partner violence, rape by strangers or family members, and other forms of sexually-motivated violence happen to men as well as women, but it is women who are disproportionately affected by such crimes. Thus, it is women who are disproportionately neglected, or failed, by health services and law enforcement when the systems in place do not offer as comprehensive policies as needed.

Ultimately, the conference supported participants to better situate their role in the extensive network designed to help survivors and victims of abuse, and to clarify how their role interacts with other layers of the system. Throughout the conference, participants either shared observations they took for granted that shocked others, or expressed amazement at a different sector’s approach having never had the chance to explore the issue from outside their field.

As is often the case when a group of researchers, policy makers and health advocates against violence against women convenes, the conversation eventually turned to the pernicious role patriarchy plays within British, European, and international cultures and societies, and how subconscious gender attitudes continually stymie efforts to reduce violence against women.

Several speakers pointed out the progress the UK has made in terms of these challenges, but several also criticized current attempts aimed at preventing violence against women: ‘[w]e are almost nowhere in terms of prevention,’ one speaker said. ‘We are obsessed with risk management’.

More than once, the conversation returned to the same point: regardless of policies, strategies and funding allotted to preventing abuse, protecting societies’ most vulnerable members, or prosecuting offenders, and without acknowledging that the coercion of women by men remains embedded across all levels of societies, prevention cannot occur. Participants debated how to challenge societies’ foundational assumptions about relationships between men, women, and intimate partners of all genders, especially in regards to the health sector.

One specific health example was provided by a GP, who mapped the thoughts a doctor goes through during the average eight-minute consultation with a patient.  A woman comes in with eczema and adds that she’s suffering from depression. Which would you treat first? If you’re already running ten minutes behind schedule, how much attention can you give to exploring the roots of this woman’s depression? How much trust can you build up with a patient? These are just some of the challenges facing GPs, who acknowledge the gaps in their training and the need to raise awareness for all medical professionals. But, if this conference showed anything, it is that violence against women cannot be neatly defined by professional fields.

From song lyrics and ads that seem to condone, or even promote, sexual harassment and abuse of women, to medical professionals who see intimate partner violence as beyond their remit of care, coercion of women by men is embedded across professional fields and communities.

As host, Cumberland Lodge provided not only a safe space for difficult conversations, but offered opportunities for the participants to see challenges they face on a daily basis from other perspectives. Alliances were formed: law enforcement professionals met medical professionals, academics spoke to council representatives, charity workers shared knowledge with doctoral students, and, in the final debrief, more than one person said they would be contacting someone they met at the conference to continue the cross-sector conversation.

Last week, Prime Minister Theresa May unveiled a proposal for a new law to increase prosecutions for domestic violence. May said she believes the new reforms ‘have the potential to completely transform the way we think about and tackle domestic violence and abuse’.[3] These reforms and greater public attention on this issue are welcome but, as I’m sure many at the conference agree, legal reforms will never be enough.

The answer to ‘Do we really want to know?’ must be yes. A society is only as healthy as its most vulnerable individual. This conference welcomed debate and highlighted challenges to measures of prevention, protection and prosecution. However, violence against women is not only an issue to be debated at the crossroads of law and health. The next step is for participants to continue this cross-sector work and to continue challenging the cultural and social realities behind the statistics.

[1] ‘Sexual harassment and sexual violence in schools’, The Women and Equalities Committee (2016)

[2] ‘Violence against women: an EU-wide survey’, Fundamental Rights Agency of the European Union (2014)

http://fra.europa.eu/en/publication/2014/violence-against-women-eu-wide-survey-main-results-report

[3] Rowena Mason, ‘Theresa May: I want to transform how we think about domestic violence’, Guardian, 17 February 2017

https://www.theguardian.com/society/2017/feb/17/theresa-may-domestic-violence-abuse-act-laws-consultation.