'The public health turn on violence against women': analysing Swedish healthcare law, public health and gender-equality policies.

This article focuses on policy and law concerning violence against women as a public health issue. In Sweden, violence against women is recently recognized as a public health problem; we label this shift "The public health turn on violence against women". The new framing implies increased demands on the Swedish healthcare sector and its' ability to recognise violence and deal with it in terms of prevention and interventions. The aim was to describe and discuss the main content and characteristics of Swedish healthcare law, and national public health and gender-equality policies representing the public health turn on violence against women. Through discursive policy analysis, we investigate how the violence is described, what is regarded to be the problem and what solutions and interventions that are suggested in order to solve the problem. Healthcare law articulates violence against women as an ordinary healthcare issue and the problem as shortcomings to provide good healthcare for victims, but without specifying what the problem or the legal obligation for the sector is. The public health problem is rather loosely defined, and suggested interventions are scarce and somewhat vague. The main recommendations for healthcare are to routinely ask patients about violence exposure. Violence against women is usually labelled "violence within close relationships" in the policies, and it is not necessarily described as a gender equality problem. While violence against women in some policy documents is clearly framed as a public health problem, such a framing is absent in others, or is transformed into a gender-neutral problem of violence within close relationships. It is not clearly articulated what the framing should lead to in terms of the healthcare sector's obligations, interventions and health promotions, apart from an ambivalent discourse on daring to ask about violence.

Critical discourse analysis of policies impacting the intersection of health and experiences of intimate partner violence for rural women in Ontario, Canada.

INTRODUCTION: Intimate partner violence (IPV) impacts approximately one quarter of Canadian women, and services provided to support women are heavily influenced by policy. Policy sets the stage and tone for action in all sectors. To date, there have been no critical discourse analyses examining how provincial, hospital, and women's shelter policies intersect and impact women in rural communities. METHODS: A critical discourse analysis using a case study of one rural community in south-western Ontario was undertaken by a multisectoral team of researchers using a critical, feminist, intersectional lens. The selected policies were (1) Domestic Violence Action Plan for Ontario (ODVAP), (2) the rural women's shelter policy, and (3) the hospital policy. RESULTS: The internal analysis of the policies revealed that ODVAP focused on societal solutions to violence requiring cross-sectoral cooperation with a focus on marginalized populations, whereas the rural shelter policy focused on creating a philosophical orientation to underpin their work with clients. There was no formal hospital policy related to the provision of services for women who have experienced violence. The policies revealed a disconnect between the stated goals and the specifics concerning how the policies would come together to achieve these goals. Obstacles such as having no clear link for how ODVAP and the shelter policy would work together, idealization of training but a lack of specificity on what training would be useful, and the requirement of affirmative action on the part of women to engage with services functioned as a means to maintain the status quo, that is, working in a siloed approach to care. CONCLUSIONS: Integrative systems are important for women who have experienced IPV given the wide range of health, social, and economic consequences of violence. Policy alignment is important for women who have experienced or are experiencing IPV, particularly in rural contexts where services are fraught with additional barriers.

Ghanaian Women's Knowledge and Perceptions of Services Available to Victims of Intimate Partner Violence.

This article presents qualitative findings on women's knowledge and perceptions of services available to victims of domestic violence in Ghana. In addition, the challenges to access of service and service delivery are explored. Semistructured interviews were conducted with 10 female residents of Sowutuom, a periurban community in Accra, Ghana. An additional three semistructured interviews were also conducted with local service providers in Accra. Results showed that awareness among respondents of available services was low. The majority of women had heard of the Domestic Violence and Victim Support Unit of the Ghana Police Service, though they had limited knowledge of the kind of support provided by this service provider. In addition, most women expressed doubt in the ability of these services to adequately handle cases of intimate partner violence. This study demonstrates that more educational campaigns need to be carried out to raise awareness among Ghanaians on domestic violence and the formal interventions available in the country.

Factors Related to Rape Reporting Behavior in Brazil: Examining the Role of Spatio-Temporal Factors.

The reporting of rape to police is an important component of this crime to have the criminal justice system involved and, potentially, punish offenders. However, for a number of reasons (fear of retribution, self-blame, etc.), most rapes are not reported to police. Most often, the research investigating this phenomenon considers incident and victim factors with little attention to the spatio-temporal factors of the rape. In this study, we consider incident, victim, and spatio-temporal factors relating to rape reporting in Campinas, Brazil. Our primary research question is whether or not the spatio-temporal factors play a significant role in the reporting of rape, over and above incident and victim factors. The subjects under study are women who were admitted to the Women's Integrated Healthcare Center at the State University of Campinas, Brazil, and surveyed by a psychologist or a social worker. Rape reporting to police was measured using a dichotomous variable. Logistic regression was used to predict the probability of rape reporting based on incident, victim, and spatio-temporal factors. Although we find that incident and victim factors matter for rape reporting, spatio-temporal factors (rape/home location and whether the rape was in a private or public place) play an important role in rape reporting, similar to the literature that considers these factors. This result has significant implications for sexual violence education. Only when we know why women decide not to report a rape may we begin to work on strategies to overcome these hurdles.

Risk Factors in Arrest of Rural and Urban Female Victims of Intimate Partner Violence.

This study used a sample of women who obtained protective orders (N = 709) from urban and rural communities and identified risk factors in arrest for victims of intimate partner violence 12 months after the protective order was obtained. Lower social support, higher loneliness, living in a rural community, substance abuse/dependency, a history of prior arrest, engaging in illegal behavior, and younger age were all identified as significant predictors of arrest at follow-up. The findings highlight the need for support and resources in vulnerable populations to reduce the risk of offending and recidivism. Implications for reentry programs and services for victimized women at risk are discussed.

Sexual assault and other types of intimate partner violence in women with protection orders in Vhembe District, South Africa.

The aim of this study was to assess the prevalence and correlates of sexual assault in the context of intimate partner violence in a sample of women receiving a protection order in South Africa. In all, 268 women (18 years of age and older) consecutively receiving a protection order in the Vhembe District in South Africa were assessed by an external interviewer. Results indicate that from the total sample, 40.7% reported sexual assault, one or more times, during the relationship in the past 3 months; 58.2% reported stalking by the intimate partner; and almost all reported some form of psychological abuse (94.0%), physical violence (93.7%), and danger (99.3%). In all, 37% reported psychological, physical, and sexual violence. In multivariate regression psychological abuse, physical violence and stalking were found to be associated with sexual assault.

Rural Australian women's legal help seeking for intimate partner violence: women intimate partner violence victim survivors' perceptions of criminal justice support services.

Intimate partner violence (IPV) is a widespread, ongoing, and complex global social problem, whose victims continue to be largely women. Women often prefer to rely on friends and family for IPV help, yet when informal support is unavailable they remain hesitant to contact formal services, particularly legal support for many reasons. This study applies a sociological lens by framing the IPV and legal help-seeking experiences of rural Australian women gained from 36 in-depth face-to-face interviews as socially contextualized interactions. Findings reveal police and court responses reflect broader social inequalities and rurality exacerbates concerns such as anonymity and lack of service. Cultural differences and power imbalances between survivors and formal support providers are manifested to inform future research seeking to improve survivors' willingness to engage and satisfaction with formal services. Finally, the important role police and the criminal justice system play in de-stigmatizing IPV and legitimating its unacceptability is argued a crucial, yet unrecognized, key to social change.

The impact of victim-focused outreach on criminal legal system outcomes following police-reported intimate partner abuse.

Randomized control designs have been used in the public health and psychological literatures to examine the relationship between victim outreach following intimate partner abuse (IPA) and various outcomes. These studies have largely relied on samples drawn from health providers and shelters to examine outcomes outside the criminal legal system. Based on the positive findings from this body of research, we expected that a victim-focused, community-coordinated outreach intervention would improve criminal legal system outcomes. The current study used a randomized, longitudinal design to recruit 236 ethnically diverse women with police-reported IPA to compare treatment-as-usual with an innovative community-coordinated, victim-focused outreach program. Findings indicated that the outreach program was effective in increasing women's engagement with prosecution tasks as well as likelihood of taking part in prosecution of their abusers. Results were particularly robust among women marginalized by ethnicity and class, and those still living with their abusers after the target incident.

Patterns of violence against women in three communities in Alexandria, Egypt.

PURPOSE: To identify patterns of violence against women (VAW) in three communities in Alexandria, Egypt, and develop recommendations to address the issue. DESIGN AND METHODS: One hundred fifty women were randomly selected and interviewed from each of the three settings representing an urban, squatter, and rural community in Alexandria, for a total sample of 450 women. RESULTS: More than half (60% and 59.3%) of the squatter and rural women, as compared to less than half of urban women (41.3%), reported they were exposed to domestic violence (DV) at least once in their marriages. Rural and squatter women believed that husbands have a right to beat their wives and have sex with their wives whenever they desire. About half of urban, squatter, and rural women (48.4%, 56.7%, and 61%, respectively) did not seek help when they were beaten despite incurring injuries. Exposure to DV was associated with many factors including the woman's education, occupation, number of children, and socioeconomic status. CLINICAL IMPLICATIONS: The following recommendations are made: empowering women and girls to lead change by increasing their access to education and information; meeting the needs of abused women; mobilizing advocacy initiative by enlisting social, political, and other leaders to speak about VAW; changing policies and legislation to address gender-based violence; conducting education, awareness, and sensitization programs highlighting the problem; screening for violence in healthcare facilities and developing culture sensitive protocols for prevention and interventions for DV; and promoting nurses' participation and involving men in movements to end VAW.

[Violence against women: the role of the health sector in international legislation]. / Violencia contra las mujeres: el papel del sector salud en la legislación internacional.

OBJECTIVES: To identify and describe the responsibilities attributed to health administrations in preventing and addressing violence against women in the international legislation on this issue. METHODS: We carried out a content analysis of the laws on violence against women collected in the following legal databases: the Annual Review of Law of Harvard University, the United Nations' Secretary-General's database on Violence against Women, the International Digest of Health Legislation and Stop Violence against Women. All legal documents explicitly mentioning the participation of the health sector in interventions against violence against women were identified. Subsequently, the interventions selected were classified into primary, secondary and tertiary prevention, as defined by the World Health Organization in its first World Report on Violence and Health (2002). RESULTS: Of the 115 countries analyzed, 55 have laws on violence against women that include the participation of the health sector in interventions concerning this phenomenon. In most of these countries, this participation focusses on reporting detected cases and on providing healthcare and assistance to women referred from police services. We identified 24 laws that explicitly mention the interventions developed by the health sector, mainly consisting of tertiary prevention. The laws of Mexico, Colombia, Argentina, El Salvador, Spain and the Philippines include interventions involving the three levels of prevention. CONCLUSIONS: One-fourth of the laws concerning violence against women studied incorporate specific interventions in the health sector, suggesting that a comprehensive approach to the problem is still required. Greater utilization of the potential of this sector is required in interventions to prevent violence against women.

An ecological synthesis of research on older women's experiences of intimate partner violence.

In this systematic literature review, we synthesized the current knowledge of intimate partner violence experienced by older women. We identified 32 studies that included data collected from older women and synthesized the findings using the ecological model as an organizing framework. Themes in the microsystem included the immediate context in which the abuse takes place and impacts on older women. The mesosystem included themes on the older woman's relationships with her social network. Themes in the exosystem encompassed community-based services. Finally, themes in the macrosystem encompassed broad ideologies, mores, and influences of the geographic location. We used the ecological model to frame a discussion of implications for future research, policy, and practice.

Worldwide violence against women legislation: an equity approach.

OBJECTIVES: To describe the recommendations and interventions addressing violence against women (VAW) in vulnerable women (disabled, pregnant, ethnic minority, immigrant and older women) in key documents and laws enacted in different countries. METHODS: Content analysis of key documents for the development of VAW policies and laws: The United Nations Handbook for Legislation on Violence Against Women Advance Version, the Model of Laws and Policies on Intrafamiliar Violence Against Women of the Pan-American Health Organization and Recommendation No. R(2002)5 of the Committee of Ministers of the European Council. The content of the 62 VAW laws was also analyzed. RESULTS: Key documents demonstrate the importance of eliminating any obstacle facing disabled, pregnant, immigrant, ethnic minority or older women when accessing VAW services. Only 12 laws mention one or more of these groups of vulnerable women. Pregnant, disabled and ethnic minority women are the groups most often mentioned. In these laws, references to punitive measures, action plans and specific strategies to guarantee access to VAW resources are the most common interventions. CONCLUSION: Decisive interventions addressing the specific needs of disabled, pregnant, immigrant, ethnic minority and older women are needed in order to achieve a broader equity approach in VAW legislation.

Battered women's perceptions of civil and criminal court helpfulness: the role of court outcome and process.

Although most battered women seeking formal help have some contact with court, limited research exists on what they find helpful and harmful about these experiences. Using qualitative data from low-income, largely Black battered women, this study finds that issues related to court outcomes, such as case disposition and enforcement, are important to evaluations of helpfulness. More frequently mentioned, however, are court processes, including treatment by staff, process length, and public disclosure. Results highlight the importance of research and practice attending to issues beyond court outcomes, as well as the potential impact supportive treatment at court may have for victims' recovery.

Protection order petitioners' health care utilization.

Little work has explored the extent to which female victims of intimate partner violence use medical and legal services. In this cross-sectional study of a sample of women seeking orders of protection at family court (N = 95), we report descriptive, self-report data on health care utilization and insurance coverage. Although 85% of the petitioners had private or public health insurance, 39% reported delayed medical care, and 14% had not obtained medical care of any kind. The response to address interpersonal violence victimization should attempt to connect women using the courts with needed health care services.

The ability of criminal law to produce gender equality: judicial discourses in the Swedish criminal legal system.

The main aim of the Swedish Women's Peace reform in 1998 was to enhance criminal legal protection for women exposed to violence in heterosexual relationships and to promote gender equality. However, these ambitions risk being contravened in a masculinist criminal legal system. One problem concerns how the victim is constructed in criminal legal cases. The author argues that moral balancing and discourses of responsibility and guilt in Swedish cases constrain the agency possible for women and suggest that a more comprehensive policy in Sweden must be developed to include violent men, their agency, and their responsibility for the violence.

Reframing violence against women as a human rights violation: Evan Stark's Coercive Control.

Evan Stark claims that partner-perpetrated physical abuse and other forms of violence against women ought to be understood as a human rights violation. The authors engage Stark's rhetorically powerful political and analytical innovation by outlining one theoretical and one practical challenge to shifting the paradigm that researchers, advocates, and policy makers use to describe, explain, and remedy the harms of coercive control from misdemeanor assault to human rights violation. The theoretical challenge involves overcoming the public/ private dichotomy that underpins liberal conceptions of human rights.The practical challenge involves using the human rights framework in the United States, given public indifference to human rights rhetoric or law, reluctance of U.S. policy makers to submit to scrutiny or justice-oriented processes under international law on issues of human rights and especially war crimes, and the consequent U.S. legacy of refusal to participate meaningfully in the international human rights process. The authors conclude that employing a human rights framework holds potential in the United States, but the paradigm shift Stark advocates will not materialize without widespread mobilization of interest in and understanding of human rights among domestic violence advocates and the society in general.

[Description of registration of episodes of gender violence in medical records in the Principality of Asturias, Spain]. / Descripción del registro de los casos de violencia de género en las fuentes de información sanitarias del Principado de Asturias.

OBJECTIVE: To describe how episodes of gender violence notified to the Registro de Atención Sanitaria en Violencia contra las Mujeres del Principado de Asturias (VIMPA) are registered in the clinical records of a health area of this geographical region. METHODS: We performed a cross-sectional, descriptive study in a sample of cases collected in the VIMPA Registry in 2005 and 2006. The variables analyzed were the way in which the episode of gender violence was coded and registered, the presence of antecedents, and the diagnostic agreement among documents. RESULTS: A total of 51.7% of primary care patients were attended in a center with access to their medical records. A specific International Classification of Primary Care-2 (World Organisation of National Colleges and Academics) code of abuse was used in only 15.1%, while a written diagnosis was used in all cases in specialized care. CONCLUSION: Episodes of gender violences were identified differently in distinct clinical documents. Our results point to the need for specific registries that would aid the combined use of distinct information sources.

When a man hits a woman: moral evaluations and reporting violence to the police.

We use experimental data from a nationally representative sample to examine whether gender and the victim's relationship to the offender affect attitudes about the seriousness of the offense and whether the offense should be reported to the police. We find that respondents are particularly likely to condemn men's assaults on women, and to favor reporting them. The pattern appears to reflect both greater moral condemnation of men's assaults on women and the belief that the victims of these assaults are in greater danger. In general, moral judgments and attitudes toward reporting do not depend on the gender, age, level of education, or political ideology of the respondent. Condemnation of men's violence against women, and support for police intervention when it occurs, are apparently widespread across different segments of the population.

Partner stalking: psychological dominance or "business as usual"?

Partner stalking may remain one of the least clearly understood forms of intimate violence. This review examines the literature guided by two main goals: (a) to examine how partner stalking is distinct from nonpartner forms of stalking and (b) to describe areas of research on partner stalking that need to be systematically addressed to deepen the understanding of partner stalking and to craft more effective mental health and criminal justice responses. These areas of research include three overarching questions: (a) Is partner stalking a unique form of psychological dominance or is it just "business as usual"? (b) What components characterize stalking differently from business as usual for women? and (c) How is psychological distress within the context of partner stalking best characterized?