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The Prevalence and Psychological Costs of Household Violence by Family Members Against Women With Disabilities in Cambodia
Abstract
Women with disabilities (WWDs) are at triple jeopardy due to the combined risks associated with gender, disability, and violence. Not only are WWDs marginalized socially but the violence against them in their own homes is largely neglected in domestic violence research. Evidence from developing countries is particularly sparse. A cross-sectional survey conducted in Cambodia found rates of violence by household members besides intimate partners were significantly higher among WWDs than non-disabled women. This violence engendered increased levels of psychological distress and higher rates of physical injury but low rates of disclosure to health workers and other formal sources of potential support. Community-based strategies are recommended to radically change social and cultural attitudes, beliefs, and responses to WWDs who are victims of household violence to reduce negative social reactions toward them and to make it safer for them to disclose and receive psychosocial, legal, and other necessary support for this underreported type of violence.
... In nine studies, it was not specified how the authors defined the problem. Eight studies applied the WHO Women's Health and Life Experiences Questionnaire or variations of this instrument (Astbury & Walji, 2014;Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006;Hayati, Hogberg, Hakimi, Ellsberg, & Emmelin, 2011;Kiss et al., 2015;Nguyen et al., 2012;Shuib et al., 2013;Tran et al., 2013;Vung, Ostergren, & Krantz, 2008). Only three studies discriminated rates of severe from less severe forms of sexual victimization (Choo, Dunne, Marret, Fleming, & Wong, 2011;Falb et al., 2013;Ruangkanchanasetr, Plitponkarnpim, Hetrakul, & Kongsakon, 2005 Full-text articles excluded, with reasons (N = 33): -n = 13 studies provided sexual aggression or victimization rates combined with other forms of aggression n = 12 studies addressed other forms of aggression rather than sexual aggression n = 5 studies were based on the same database, providing overlapping findings n = 2 studies had an updated version of their findings n = 1 study provided rape rates for both respondents and family members in a single Decker, and Silverman (2010) Forced to perform sex acts against her will Moret et al. (2016) "Have you been physically forced to have sex or had sex when you did not want to?" East Timor Hynes, Robertson, Ward, and Crouse (2004) By nonfamily members: included "unwanted kissing," "touched on sexual parts of body," and "forced give/receive oral/vaginal/anal sex"; by partner: included "threats of physical harm or force to obtain sex" Indonesia Hayati, Hogberg, Hakimi, Ellsberg, and Emmelin (2011) WHO Women's Health and Life Experiences Questionnaire a Morineau et al. (2011) Ever forced into sex Sheridan, Scott, and Roberts (2016) Forced sexual contact Malaysia Choo, Dunne, Marret, Fleming, and Wong (2011) "Touched or fondled your private parts or forced you to touch or fondle their private parts"; "forced you to have sexual intercourse" Marret and Choo (2016) "Forced me to have sexual intercourse" Saim, Dufaker, and Ghazinour (2014) Not specified Shuib et al. (2013) WHO Women's Health and Life Experiences Questionnaire a Tan et al. (2012) Not specified Wickersham et al. (2016) Ever had any unwanted sexual experience since the age of 18 Philippines Ansara and Hindin (2009) Ever had sex with the husband when she did not want to because she was afraid of what he might do Antai and Anthony (2014) Forced sexual intercourse; other sexual acts when undesired Kuning, McNeil, and Chongsuvivatwong (2003) "Have you ever been physically forced to have sex with someone?" Lucea, Hindin, Kub, and Campbell (2012) "First sexual experience was unwanted or pressured," "ever had sex against your will," and "ever had sex out of fear of what your partner would do" Sano, Sedziafa, and Tenkorang (2016) The first time you had sexual intercourse, would you say you had it because you wanted or because you were forced to have it against your will? ...
... In terms of gender composition, 32 studies included women only, 5 studies addressed men only (4 included only men who have sex with other men), and 12 studies included both women and men. Among women, the lifetime prevalence of sexual victimization was 4.2% in Cambodia (Astbury & Walji, 2014), 22% in Indonesia (Hayati et al., 2011), 4.2% in Singapore (Bouhours et al., 2013), and ranged from 14% to 33.7% in Thailand (Allen et al., 2003;Garcia-Moreno et al., 2006;Tangmunkongvorakul et al., 2011;van Griensven et al., 2004;van Griensven et al., 2013), from 5% to 64.6% in the Philippines (Antai & Anthony, 2014;Lucea, Hindin, Kub, & Campbell, 2012;Serquina-Ramiro, 2005;Urada et al., 2016;Urada et al., 2014), from 3.2% to 10.4% in Vietnam (Le et al., 2014;Nguyen et al., 2012;Tran et al., 2013;Vung et al., 2008), and from 1.7% to 13.8% in Malaysia (Choo et al., 2011;Shuib et al., 2013). Among men, figures ranged from 3% to 14.8% in Malaysia (Choo et al., 2011) and from 3.2% to 29.6% in Thailand (Chemnasiri et al., 2010;Guadamuz et al., 2011;Tangmunkongvorakul et al., 2011;van Griensven et al., 2004;van Griensven et al., 2013); 42.3% of men in the Philippines (Serquina-Ramiro, 2005) and 1% in Vietnam (Le et al., 2014) reported some form of sexual victimization in their lifetime. ...
... Other groups. Astbury and Walji (2014) found that disabled women (6.8%) were significantly more likely to report lifetime sexual victimization committed by household members than nondisabled women (1.7%) in Cambodia. However, the comparison must be taken with caution due to the small number of victims in the sample. ...
Southeast Asia is one of the most dynamic regions in the world. It is experiencing rapid socioeconomic change that may influence the level of sexual aggression, but data on the scale of sexual aggression in the region remain sparse. The aim of the present article was to systematically review the findings of studies available in English on the prevalence of self-reported sexual aggression and victimization among women and men above the age of 12 years in the 11 countries of Southeast Asia (Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam). Based on four scientific databases, the search engine Google, Opengrey database, and reference checking, 49 studies were found on sexual victimization. Of those, 32 included only women. Self-reported perpetration was assessed by only three studies and included all-male samples. Prevalence rates varied widely across studies but showed that sexual victimization was widespread among different social groups, irrespective of sex and sexual orientation. Methodological heterogeneity, lack of representativeness of samples, imbalance of information available by country, missing information within studies, and cultural differences hampered the comparability between and within countries. There is a need for operationalizations that specifically address sexual aggression occurring after the age of consent, based on detailed behavioral descriptions of unwanted sexual experiences and allied to a qualitative approach with cultural sensitivity. Data on sexual aggression in conflict settings and in human trafficking are also limited. Recommendations for future research are presented in the discussion.
... Current research suggests that the experience of living with a disability is dominated by stigma and discrimination 18,19 , social exclusion 20,21 , and physical barriers to accessing services 3,22 including the provision of public transport and physical access to buildings. The majority of studies on the experience of disability have, however, excluded participants who are uneducated and illiterate 19,22 and those with cognitive-communicative impairments 19,[22][23][24] , with few studies being conducted with those living in rural areas 25 . ...
... Current research suggests that the experience of living with a disability is dominated by stigma and discrimination 18,19 , social exclusion 20,21 , and physical barriers to accessing services 3,22 including the provision of public transport and physical access to buildings. The majority of studies on the experience of disability have, however, excluded participants who are uneducated and illiterate 19,22 and those with cognitive-communicative impairments 19,[22][23][24] , with few studies being conducted with those living in rural areas 25 . This implies that research into the impact of sociocultural contexts on the implementation of policies and practices has been superficial. ...
... Current research suggests that the experience of living with a disability is dominated by stigma and discrimination 18,19 , social exclusion 20,21 , and physical barriers to accessing services 3,22 including the provision of public transport and physical access to buildings. The majority of studies on the experience of disability have, however, excluded participants who are uneducated and illiterate 19,22 and those with cognitive-communicative impairments 19,[22][23][24] , with few studies being conducted with those living in rural areas 25 . This implies that research into the impact of sociocultural contexts on the implementation of policies and practices has been superficial. ...
Introduction:
Persons with disabilities make up approximately 15% of the world's population, with vulnerable communities disproportionately affected by the incidence of disability. Research reflects that persons with disabilities are vulnerable to stigma and discrimination, social isolation, and have physical barriers to accessing support services, all of which serve to perpetuate a sense of uncertainty and vulnerability within their lives. Recently a number of policies and models of intervention have been introduced intended to protect the rights of those affected by disability, yet limited research has been conducted into the lived experiences of persons with disabilities, particularly in rural contexts. This implies that little is known about the impact of the rural context on the lived experience of disability and the ways in which context impacts on the implementation of policies and practices.
Methods:
The current study employed a qualitative design underpinned by the principles of narrative inquiry and participant observation. Thirty adults with a variety of congenital and acquired disabilities (15 men and 15 women, ranging in age from 19 to 83 years) living in 12 rural communities in the Mpumalanga Province of South Africa were recruited through snowball sampling. Data collection comprised a combination of narrative inquiry and participant observation. Narratives were collected in SiSwati with the assistance of a SiSwati-speaking research mediator and were transcribed and translated into English. Data were analysed inductively according to the principles of thematic analysis.
Results:
Findings confirmed that the experience of living with a disability in a rural area is associated with discrimination, social exclusion, and isolation and barriers to accessing services, underpinned by numerous context-specific experiences, including mortality rates, exposure to numerous and repeated forms of violence across the lifespan, and corruption and lack of transparency in the implementation of government policies and practices. These experiences are not currently reflected in the literature or in guidelines on the implementations of policies and service provision, and thus have the potential to offer novel insights into the barriers faced by persons with disabilities living in rural areas.
Conclusions:
The results of this study suggest that barriers to service provision extend beyond physical obstacles, and include a variety of sociocultural and sociopolitical barriers. By failing to take these into account, policies and current models of service provision are only able to provide limited support to persons with disabilities living in rural areas. The findings reveal narrative inquiry to be a powerful and culturally safe tool for exploring lived experience among vulnerable populations and hold significant implications for both practitioners and policy developers. Furthermore, it emerges that one-size-fits-all policies are unable to meet the needs of persons with disabilities living in rural areas. However, the implementation of site-specific needs analyses with the use of flexible and culturally appropriate tools has the potential to redress the discrepancies in policy implementation and can be used to strengthen institutional ties and referral pathways.
... To apply for a disability grant, individuals are requested to provide proof of identity and citizenship, undergo a means test, and are then assessed in terms of their levels of functioning by a medical doctor who decides whether a disability grant is warranted. The initiatives described above highlight the theoretical commitment to protecting the rights of persons with disabilities, yet despite this, reports continue to abound of violence directed toward people with disabilities (Astbury & Walji, 2014;Mikton et al., 2014). ...
... This has led to a fragmented understanding of the nature and persistence of violence in society. Furthermore, the literature reveals that the most common methods used to study violence directed toward people with disabilities are surveys (e.g., Emerson & Roulstone, 2014;Mitra & Mouradian, 2014), structured questionnaires (e.g., Astbury & Walji, 2014;Hasan, Muhaddes, Camellia, Selim, & Rashid, 2014), retrospective file reviews (e.g., Ballan et al., 2014;Hughes et al., 2012), and secondary analysis of data collected in large-scale projects (e.g., Mikton et al., 2014;Plummer & Findley, 2012). While a number of these studies have included large samples of people with a variety of disabilities, they have frequently excluded participants who are poor, marginalized, uneducated, or those with cognitive-linguistic or psychiatric impairments (e.g., Astbury & Walji, 2014;Mueller-Johnson, Eisner, & Obsuth, 2014), or have relied on proxies to speak on behalf of people with disabilities (Emerson & Roulstone, 2014). ...
... Furthermore, the literature reveals that the most common methods used to study violence directed toward people with disabilities are surveys (e.g., Emerson & Roulstone, 2014;Mitra & Mouradian, 2014), structured questionnaires (e.g., Astbury & Walji, 2014;Hasan, Muhaddes, Camellia, Selim, & Rashid, 2014), retrospective file reviews (e.g., Ballan et al., 2014;Hughes et al., 2012), and secondary analysis of data collected in large-scale projects (e.g., Mikton et al., 2014;Plummer & Findley, 2012). While a number of these studies have included large samples of people with a variety of disabilities, they have frequently excluded participants who are poor, marginalized, uneducated, or those with cognitive-linguistic or psychiatric impairments (e.g., Astbury & Walji, 2014;Mueller-Johnson, Eisner, & Obsuth, 2014), or have relied on proxies to speak on behalf of people with disabilities (Emerson & Roulstone, 2014). Furthermore, data are frequently collected in languages that are not the participants' home languages, and thus, the data collection methods may be considered to be culturally inappropriate or unsafe (Bessareb & Ng'andu, 2010) as they have the potential to diminish, demean, or disempower the individual's cultural identity (Coffin, 2007). ...
People with disabilities are vulnerable to multiple forms of violence in their everyday lives, including structural violence, deprivation, and physical, emotional, and sexual exploitation. Despite increasing reports of violence against people with disabilities, little is known about this phenomenon, especially in the context of poverty. Furthermore, the various types of violence have traditionally been studied in isolation, which has led to a limited understanding of the nature and persistence of violence in society, and has affected our understanding of the relationship between different forms of violence. In this article, we explore the relationship between violence, disability, and poverty among people living in a rural area of South Africa. Thirty adults with a variety of disabilities living in 12 rural villages in the Mpumalanga Province of South Africa participated in the study. Each of the participants was provided with an opportunity to tell their life story. Narrative inquiry and participant observation were used to explore the ways in which violence pervades the participants' everyday experiences. Results were analyzed using thematic analysis and suggest that in the context of poverty, it is impossible to separate the experience of disability from the experience of violence. Structural violence was shown to underpin all other forms of interpersonal violence, making persons with disabilities vulnerable to additional forms of exploitation, and serve to further isolate people with disabilities from society, compromising both health and human rights. The findings suggest that an understanding of contextual factors is fundamental to understanding the relationship between violence and disability.
© The Author(s) 2015.
... The study characteristics, including country and region of focus, research question, study sample, data collection methods and type of comparison(s) included, are shown in Table 2 [38][39][40][41][42][43][44][45] and some studies employed a case-control study design [46][47][48][49][50][51][52][53][54][55][56][57][58][59]. ...
... exposure [46][47][48][49][50][51][52][53][54][55][56][57][58]. These studies explicitly focused on questions of comparison of violence exposure between women, or men and women, with and without disabilities. ...
Introduction
Existing evidence indicates that prevalence of violence against women with disability is elevated compared to women without disability. We conducted a scoping review with a focus on measurement to assess the forms of measurement and study design utilized to explore the intersection of violence against women with disabilities, and to identify strengths and limitations in current approaches to measuring violence against women with disabilities. This scoping review is designed to inform current debates and discussions regarding how to generate evidence concerning violence against women with disabilities.
Methods and results
We conducted systematic searches of the following databases: PubMed, PsycINFO, Embase, CINAHL, PILOTS, ERIC, Social Work Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, ProQuest Criminal Justice, and Dissertations & Theses Global, and conducted structured searches of national statistics and surveys and grey literature available on-line. We identified 174 manuscripts or reports for inclusion. n = 113 manuscripts or reports utilized acts-specific measurement of violence. In terms of measurement of disability, we found that amongst the included manuscripts and reports, n = 75 utilized measures of functioning limitations (n = 20 of these were Washington Group questions), n = 15 utilized a single question approach and n = 67 defined participants in the research as having a disability based on a diagnosis or self-report of a health condition or impairment.
Discussion
This scoping review provides a comprehensive overview of measurement of violence against women with disabilities and measurement of violence within disability-focused research. We identified several important gaps in the evidence, including lack of sex and disability disaggregation, limited evidence concerning adaptation of data collection methods to ensure accessibility of research activities for women with disabilities, and limited evidence concerning differential relationships between types of disability and violence exposure. This scoping review provides directions for sub-analyses of the included studies and further research to address gaps in evidence.
... Most research on disability and IPV in the Global South has been small-scale, with limited ability to compare to women without disabilities or compare across settings. [22][23][24][25][26][27] In addition to the geographical limitations of detailed examinations of the link between disability and IPV, few studies disaggregate severity of disabilities included in their samples. Across the board, there remain challenges in estimating IPV prevalence among disabled women due to inconsistent strategies for measuring both disability and experiences of violence, which further undermines any ability to compare and synthesise findings on IPV against women with disabilities across settings. ...
... 11 These findings from diverse settings in the Global South echo a similar demonstration of increased risk of IPV among women with disability in the Global North [11][12][13][14][15][16][17][18] and build on the limited research on this topic to date in the Global South. [22][23][24][25][26][27] Our findings affirm that the increased occurrence of IPV among women with disability is a consistent global phenomenon, and strongly indicate that interventions seeking to assist women experiencing IPV in in low and middle income countries, or to identify groups at increased risk of IPV for prevention programming, need to accommodate the likelihood that an appreciable proportion of the target population will have a disability. ...
Introduction
Intimate partner violence (IPV) is a serious public health and human rights violation which impacts approximately one in three women worldwide. Some existing evidence suggests that women with disabilities are at higher risk of IPV, but is largely limited in geographical scope to the Global North, and comparison across settings has been hampered by inconsistent measurement of both IPV and disability.
Methods
Pooled analysis of baseline data from 8549 adult women participating in seven IPV prevention studies in five countries across Africa and Asia that used collaborative, comparative measurement strategies to assess both disability and IPV.
Results
After adjusting for age, women with disabilities were more likely to experience past 12-month physical IPV (adjusted OR (aOR)=1.79; 95% CI 1.49 to 2.17), sexual IPV (aOR=1.98; 95% CI 1.36 to 2.89), emotional IPV (aOR=1.84; 95% CI 1.49 to 2.27) and economic IPV (aOR=1.66; 95% CI 1.45 to 1.89), with an overall association between disability and past 12-month physical/sexual IPV of aOR=1.93 (95% CI 1.52 to 2.46). Compared to women without disability, women with moderate and severe disability showed a trend of increasing risk of IPV in the past 12 months for each of physical, sexual, emotional and economic IPV. Overall, both women with moderate disability (aOR=1.86, 95% CI 1.57 to 2.21) and women with severe disability (aOR=2.63; 95% CI 1.95 to 3.55) were significantly more likely to experience any form of IPV when compared with women without disability.
Conclusion
Women with disabilities are at increased risk of past-year IPV compared to women without disabilities across a range of settings in the Global South, and the risk of IPV increases with increasing severity of disability. IPV prevention and response efforts in these settings must find ways to include and address the needs of women with disabilities, including increased outreach and improved accessibility of programmes.
... Increased dependency on others for care, physical vulnerability, social isolation, and lack of economic independence are posited to make women with disabilities more vulnerable [27,[31][32][33][34]; however, the devaluation of all persons with disabilities and the particular marginalization of sexuality in women with disabilities are important drivers of vulnerability as well. Consequently, some researchers maintain that violence against women with disabilities encompasses both disability-based and gender-based violence [35][36][37]. ...
... This study contributes to an emerging body of research examining associations between IPV and disability among women in low-income countries using nationally representative data and robust, rigorous methods [37,58]. To date, this type of research has not been feasible. ...
Violence against women with disabilities is pervasive, yet a paucity of research examines intimate partner violence (IPV) experienced by women with disabilities in low- and middle-income countries. The purpose of this study is to document the prevalence and consequences of IPV exposure among Ugandan women with disabilities. Cross sectional data from the 2011 and 2016 Uganda Demographic and Health Surveys (UDHS) were used to study married and/or partnered women aged 15–49 who answered specific questions about lifetime intimate partner violence (N = 8592). Univariate and multivariate logistic regression models were used to investigate the relationship between disability, IPV, and indicators of maternal and child health. Compared to women without disabilities, women with disabilities were more likely to experience lifetime physical violence (odds ratio (OR) 1.4, p < 0.01), sexual violence (OR = 1.7, p < 0.01), and emotional abuse (1.4, p < 0.01) after controlling for sociodemographic and household characteristics. Study findings suggest that women with disabilities in Uganda may experience increased risk for IPV compared to women without disabilities, with concomitant risks to their health and the survival of their infants. Further research examining the prevalence and correlates of IPV in low- and middle-income countries is needed to address the needs and rights of women with disabilities.
... As one participant suggests, there is an assumption by others that disabled women are not at risk of being victims of sexual inappropriateness. Yet, other research shows that they are (Astbury & Walji, 2014;Chirawu, Hanass-Hancock, Aderemi, de Reus, & Henken, 2014). As such, and as suggested in other research, disabled women are more likely to be victims precisely because they are not educated to be aware of the dangers of sexual assault, and their claims of violation are not taken seriously when they do report them (Astbury & Walji, 2014). ...
... Yet, other research shows that they are (Astbury & Walji, 2014;Chirawu, Hanass-Hancock, Aderemi, de Reus, & Henken, 2014). As such, and as suggested in other research, disabled women are more likely to be victims precisely because they are not educated to be aware of the dangers of sexual assault, and their claims of violation are not taken seriously when they do report them (Astbury & Walji, 2014). ...
The sexuality of people with disabilities has historically been a site of oppression and discrimination. The sexuality of people with disabilities remains relatively under-researched and poorly understood. As a result, many myths and misconceptions about the sexuality of people with disabilities may prevail. This paper reports on findings from a qualitative study exploring the experiences of 13 people with physical disabilities in South Africa. A thematic analysis was conducted to explore how the sexuality of participants are constructed by others, as revealed by reported interactions with non-disabled people. Results show that often the sexuality of people with disabilities is erased by others, or they are questioned, often in prejudiced ways, and less frequently they are explored in intimate relationships.
... 9,15 Previous international research has suggested that there are also gender differences in the experience of violence for those with disabilities, with women with disabilities at a higher risk of sexual and intimate partner violence. 11,[16][17][18] while men with disabilities have a higher risk of physical and non-domestic violence. 12 There is also evidence to suggest that men with disabilities are more likely to experience intimate partner violence than men without disabilities. ...
... 12 Our findings regarding women with disabilities being at the greatest risk of sexual and intimate partner violence are also consistent with previous results. 11,16,17,24 Similar to Khalief 12 and Goodman, 25 we found that the pattern of gender difference in the experience of violence was similar to that found among men and women without disabilities, with men more likely than women with disabilities to experience physical violence, while women are more likely to experience sexual violence, partner violence and stalking and harassment. ...
Objectives:
There are no population-based estimates of the prevalence of interpersonal violence among people with disabilities in Australia. The project aimed to: 1) estimate the prevalence of violence for men and women according to disability status; 2) compare the risk of violence among women and men with disabilities to their same-sex non-disabled counterparts and; 3) compare the risk of violence between women and men with disabilities.
Methods:
We analysed the 2012 Australian Bureau of Statistics Survey on Personal Safety of more than 17,000 adults and estimated the population-weighted prevalence of violence (physical, sexual and intimate partner violence and stalking/harassment) in the past 12 months and since the age of 15. Population-weighted, age-adjusted, logistic regression was used to estimate the odds of violence by disability status and gender.
Results:
People with disabilities were significantly more likely to experience all types of violence, both in the past 12 months and since the age of 15. Women with disabilities were more likely to experience sexual and partner violence and men were more likely to experience physical violence.
Conclusions:
These results underscore the need to understand risk factors for violence, raise awareness about violence and to target policies and services to reduce violence against people with disabilities in Australia.
... People with disability face all forms of discrimination and exclusion from the social, cultural, political and economic life of their communities. Women with disability are acknowledged as experiencing unique and additional disadvantage because of intersectional discrimination associated with their gender and disability, resulting in a higher likelihood of experiencing exclusion compared with men with disability or women without disability [3][4][5]. This exclusion compromises a number of life outcomes for women with disability including education, employment, and attainment of health, including sexual and reproductive health (SRH). ...
... Evidence suggests women with disability are two to four times more likely to experience physical and sexual violence (including intimate partner violence, abuse by other family members, rape, forced sterilisation, and/or abortion) than women without disability [4,5,16,17]. Women with cognitive, communicative or psycho-social impairments are thought to be at particular risk [18]. ...
The Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers’ efforts to respond. This study aims to contribute to the available evidence by examining service providers’ perceptions of disability and their experiences providing sexual and reproductive health services to women with disability.
The study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants’ discussion of service provision to women with disability.
Analysis of service providers’ accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse.
Recent legislative change in the Philippines opens a window of opportunity to strengthen sexual and reproductive health service provision across the country. However the development of services that are disability-inclusive will require substantial efforts to address supply-side barriers such as prejudiced service provider attitudes and limited capacity. Disability inclusion must be prioritised for the national goal of responsible parenthood and reproductive health to be realised for all.
... 33,34 Additionally, as suggested in other research, disabled women are more likely to be victims of sexual assault precisely because they are not educated to be aware of these dangers, and when they are, their rape reports are not taken seriously. 35 Some of the issues identified by marginalized voices point to intersections with sexual identity, where people with disabilities must challenge heterosexist assumptions and "come out of the closet" twice, not only as part of the LGBTQIA+ community, but also as disabled individuals. 1 Individuals must recognize and confront multiple layers of discrimination. ...
Is the population of people with physical functional diversity the most invisible among invisible populations? This question persists when examining the state of sexual rights exercise among acquaintances, colleagues, family members, friends, and strangers living with physical functional diversity. This paper forms part of the theoretical framework of an ongoing research project on the sexuality of individuals with physical functional diversity conducted at the University of Puerto Rico, Cayey Campus. Collaborating with students from various academic disciplines, the primary investigator aims to shed light on this crucial issue within a social, human rights, and intersectional framework. This effort seeks to raise awareness and actively include individuals from this population in the everyday processes of life in Puerto Rico.
... They are subject to many types of prejudice and exclusion from community social, cultural, political, and economic life. Compared to males with disabilities or women without impairments, women with disabilities experience losses as a result of discrimination based on their gender and disability, increasing their chance of being excluded (Astbury & Walji, 2014). However, women with impairments require the same reproductive care as those without disabilities (Taouk et al., 2018;Obasi et al., 2019). ...
Secara global, penyandang disabilitas merupakan salah satu dari kelompok yang paling terpinggirkan dan tersisih secara social. Kebutuhan kesehatan reproduksi perempuan penyandang disabilitas tidak mendapat banyak perhatian, kemungkinan besar karena anggapan yang salah bahwa perempuan penyandang cacat tidak aktif secara seksual dan tidak ingin melahirkan anak-anak. Penelitian ini bertujuan untuk secara sistematis meninjau kesetaraan gender dan inklusi sosial pada perempuan penyandang disabilitas dalam layanan kesehatan reproduksi. Artikel-artikel yang digunakan dipilih dari database jurnal Google Scholar, World Cat, PROQUEST, dan PubMed yang diterbitkan pada bulan Januari 2010 hingga bulan September 2020. Kata kunci untuk penelitian ini meliputi “gender” atau "kesetaraan gender" atau "inklusi sosial" atau "disabilitas" dan “kesehatan reproduksi” atau "kesehatan reproduksi perempuan". Sebanyak 476 artikel dihasilkan dari pencarian awal, penulis mengidentifikasi 10 artikel mengenai kesetaraan gender dan inklusi sosial untuk perempuan penyandang disabilitas dalam layanan kesehatan reproduksi. Kurangnya informasi dan pendidikan tentang masalah kesehatan reproduksi, aksesibilitas fisik dan/ infrastruktur, sikap tenaga kesehatan yang menghakimi, pengetahuan tenaga kesehatan yang terbatas tentang masalah disabilitas dan faktor individu, termasuk hambatan dalam mencari perawatan kesehatan dan hambatan keuangan, diidentifikasi sebagai faktor penghambat layanan kesehatan reproduksi pada perempuan dengan disabilitas
... Similar to the research findings, Mac-Seing et al. stated that WPD are seen as a burden by their families, stigmatized, exposed to social isolation, and experienced violence [36]. Astbury and Walji stated that women with disabilities are subjected to violence by their family members as well as their partners compared to women without disabilities [37]. In this study, it can be said that this complex structure experienced by women with visual and orthopedic disabilities about their sexuality and sexual life by their families, which is one of the important support elements that will help them in their lives, negatively affects the sexuality and sexual life of women with visual and orthopedic disabilities (such as do not want to experience sexuality, do not get married, cannot become mothers and helplessness). ...
The study aims to determine the life experiences of married women with visual and orthopedicdisabilities concerning sexuality and sexual health with the grounded theory method and develop a theory revealing the concepts and processes that affect these experiences with an explanatory framework. The study was implemented with a constructivist grounded theory design and method. The data were collected and analyzed by performing profound interviews with 12 visually disabled women and 13 orthopedically disabled women and recording the data, taking notes with observation, taking analytic notes (mnemonic notes), using secondary data sources and continuous comparison method until attaining satisfaction and using analysis stages (open, axial and selective coding) of the grounded theory synchronously with analysis stage of the data. Focus categories defining the life experiences of married women with visual and orthopedic disabilities concerning sexuality and sexual health were determined as; “Social Perception”, “Immediate Environmental Perception”, “Familial Perception”, “Partner Perception” and “Disabled Individual’s Perception”, “Coping Mechanisms” and “Solution Offers”. Focus categories were under the influence of the categories of; disability, sexuality, disabled sexuality, marriage and starting a family, the intention of having a child and were explained accordingly. Every stage of the grounded theory is affected by the characteristics of married women with visual and orthopedic disabilities, the relationship of their life experiences concerning sexuality and sexual health with each other, contextual and comparative factors, as well as a complex structure that varies according to time and experience.
... The identified need for more research to be conducted on the needs of children and adults with mental health and/or disability issues supports the works of a number of authors [17,41,49,50]. The need for research examining the impact of living with a mental health and/or disability issue would have in the Cambodian context, again is well supported in the literature [51][52][53][54]. The workshop participants also identified that people with mental health issues and disorders suffer from high levels of stigma and discrimination due to their issue or impairment [6]. ...
Background
The limited health and social care infrastructure that existed in the 1970s in Cambodia was destroyed due to the Khmer Rouge. Mental Health service infrastructures have developed in Cambodia in the last twenty five years, however, they have been shaped significantly by very limited funding being made available for human resources, support services and research. The lack of research on Cambodia’s mental health systems and services is a significant barrier to the development of evidence-based mental health policies and practice. In order to address this barrier, effective research and development strategies are needed in Cambodia, which are based on locally well-informed research priorities. There are many possibilities for mental health research in LMIC countries such as Cambodia, therefore focused research priorities in these areas are needed to guide future research investment. This paper is the result of the development of international collaborative workshops, which focused on service mapping and research priority setting in the field of mental health in Cambodia.
Methods
A nominal group technique was used to gather ideas and insights from a range of key mental health service stakeholders in Cambodia. Results: The key issues in service provisions for people with mental health issues and disorders, the interventions and programmes of support available, and currently needed, were identified. This paper also identifies five key mental health research priority areas which could form the basis for effective mental health research and development strategies in Cambodia.
Conclusion
There is a clear need for the Cambodian government to devise a clear policy framework for health research. This framework could focus on the five research domains identified in this paper and could be incorporated within its National Health Strategic plans. The implementation of this approach would likely lead to the development of an evidence base which would allow the development of effective and sustainable strategies for mental health problem prevention and intervention. This would also contribute to promote the Cambodian government’s capacity to take the deliberate, concrete, and targeted steps necessary to address the complex mental health needs of its population.
... Quite a lot of people in the society, especially in developing countries, continually show their lack of confidence in women with disabilities' capability to engage maximally in entrepreneurial ventures; presupposing that running one requires some extraordinary strength beyond the reach of these women (Astbury & Walji, 2014;Dawn, 2014). Entrepreneurship is a leveraging of opportunities for self-economic empowerment that makes for self-reliance. ...
The challenge before both the general and special education teacher in the 21st century is that of enhancing the engagement and full participation of all learners, irrespective of their disabilities, in societal functionalities, thereby building inclusive communities for global citizenship. This attainable ideal will be possible as people, especially women with disabilities, are accorded the opportunities to thrive, compete, and achieve their dreams in a world where the odds are stacked against persons with disabilities , especially in developing countries. This chapter explores the idea of equalizing opportunities for women with disabilities through the vehicle of entrepreneurship education. It delves into discourse on the intersectionality of gender, entrepreneurship, and disabilities, including the challenges, possibilities, new thinking, and the imperatives for gender-inclusiveness in entrepreneurial education in a globalized society. It emphasizes this training dimension to guarantee women this population's independence, empowerment, survival, and profitable and engaged living.
... This matters because, as notes, intimate, equitable relationships play a dominant role in securing the social support and capital which support activity in numerous other facets of existence, including safety and security, and accessing important resources (Ignagni et al., 2016). Equitable intimate relationships and partnerships are also a source of support against violence and discrimination, experiences to which people with physical disabilities in South Africa are all too vulnerable (Astbury & Walji, 2014;. As such, the attitudinal barriers described by the participants in this study, and revealed in the survey, may have very real social and economic costs for people with physical disabilities . ...
This open access edited volume explores physical disability and sexuality in South Africa, drawing on past studies, new research conducted by the editors, and first-person narratives from people with physical disabilities in the country. Sexuality has long been a site of oppression and discrimination for people with disabilities based on myths and misconceptions, and this book explores how these play out for people with physical disabilities in the South African setting. One myth with which the book is centrally concerned, is that people with disabilities are unable to have sex, or are seen as lacking sexuality by society at large. Societal understandings of masculinity, femininity, bodies and attractiveness, often lead people with physical disabilities to be seen as being undesirable romantic or sexual partners. The contributions in this volume explore how these prevailing social conditions impact on the access to sexual and reproductive healthcare, involvement in romantic relationships, childbearing, and sexual citizenship as a whole, of people with physical disabilities in the Western Cape of the country. The authors' research, and first person contributions by people with physical disabilities themselves, suggest that education and public health policy must change, if the sexual and reproductive health rights and full inclusion of people with disabilities are to be achieved.
Xanthe Hunt is Senior Researcher at Stellenbosch University, South Africa.
Stine Hellum Braathen is Research Manager at SINTEF, Norway.
Mussa Chiwaula is Director of the Southern African Federation of the Disabled, Botswana.
Mark T. Carew is Honorary Research Associate at the UCL International Disability Research Centre, UK.
Poul Rohleder is Senior Lecturer at the University of Essex, UK.
Leslie Swartz is Distinguished Professor of Psychology at Stellenbosch University, South Africa.
... This matters because, as Hunt (2018) notes, intimate, equitable relationships play a dominant role in securing the social support and capital which support activity in numerous other facets of existence, including safety and security, and accessing important resources (Ignagni et al., 2016). Equitable intimate relationships and partnerships are also a source of support against violence and discrimination, experiences to which people with physical disabilities in South Africa are all too vulnerable (Astbury & Walji, 2014;Hunt, 2018). As such, the attitudinal barriers described by the participants in this study, and revealed in the survey, may have very real social and economic costs for people with physical disabilities (Hunt, 2018). ...
In Chapter 10.1007/978-3-030-55567-2_1 we provided a discussion of participatory research as a method for doing research, and provided an outline of what we did in the research project upon which this book is based. In this final chapter, we reflect back on our experiences of doing a participatory research project of this kind.
... This matters because, as notes, intimate, equitable relationships play a dominant role in securing the social support and capital which support activity in numerous other facets of existence, including safety and security, and accessing important resources (Ignagni et al., 2016). Equitable intimate relationships and partnerships are also a source of support against violence and discrimination, experiences to which people with physical disabilities in South Africa are all too vulnerable (Astbury & Walji, 2014;. As such, the attitudinal barriers described by the participants in this study, and revealed in the survey, may have very real social and economic costs for people with physical disabilities . ...
In this chapter, we will explore the intersections of physical disability and femininity. We look at how societies’ ideas about disability influence the way women with physical disabilities are viewed and view themselves as sexual beings. Using a combination of background literature and qualitative data from our photovoice study, we explore how social representations of femininity and expectations for women may negatively affect women with physical disabilities’ sense of themselves. We include pictures, written texts, and stories produced by some of the female participants from the project.
... Intimate partner violence (IPV) is a major threat to women's health and human rights, with around one in three women worldwide reporting experience of physical and/or sexual IPV during their lifetime. 1 A notable body of evidence from the Global North, [2][3][4][5][6] and increasing evidence from the Global South [7][8][9][10][11] shows that women with disabilities are at higher risk of IPV than women without disabilities, including risk for greater duration and severity of IPV. [11][12][13] A recent analysis of pooled baseline data from 8156 women participating in seven IPV prevention trials across the Global South found that women with disabilities were more likely to report experiencing physical and/or sexual IPV ...
Introduction Women with disabilities experience higher
rates of intimate partner violence (IPV) than women without
disabilities. There remains limited evidence about whether
IPV prevention interventions for the general population
have benefits for women with disabilities that compare to
those for women without disabilities. Using data from IPV
prevention randomised controlled trials in diverse locations
(Rwanda, South Africa and Afghanistan), we assess
whether outcomes differed by disability status.
Methods We assessed disability at baseline in three
IPV prevention trials. We performed post-hoc
analysis of
intervention impacts at endline (22 or 24 months post-baseline)
stratified by disability status at study baseline
and tested an interaction term for disability at baseline
by intervention arm for three sets of outcomes: (1) past
year experiences of physical, sexual and severe IPV; (2)
economic and livelihood outcomes; and (3) health, mental
health and substance use outcomes.
Results At baseline between 17.7% and 26.2% of women
reported being disabled. For IPV prevention, in seven out of
eight tests across three studies, women with and without
disabilities had similar outcomes. For economic, health and
substance use outcomes, there was more variation, with
women with disabilities reporting both better and worse
outcomes than women without disabilities; however there
was no clear pattern in these differential results.
Conclusion IPV prevention programmes targeting
general populations can prevent IPV among women with
disabilities participants with benefits that mirror those
for women without disabilities. Benefits for participants
with and without disabilities on secondary programme
outcomes related to economic empowerment and health
may be more varied and should be explicitly monitored.
... This matters because, as notes, intimate, equitable relationships play a dominant role in securing the social support and capital which support activity in numerous other facets of existence, including safety and security, and accessing important resources (Ignagni et al., 2016). Equitable intimate relationships and partnerships are also a source of support against violence and discrimination, experiences to which people with physical disabilities in South Africa are all too vulnerable (Astbury & Walji, 2014;. As such, the attitudinal barriers described by the participants in this study, and revealed in the survey, may have very real social and economic costs for people with physical disabilities . ...
... ¶ (Astbury & Walji, 2014;Dembo, Mitra, & McKee, 2018;Joseph, Soletti, & Basumatary, 2017). This study focused on sensitive topics relating to stigma, discrimination and violence, which had the potential to invoke embarrassment, fear, sadness, or anxiety for participants. ...
Globally, women with disabilities experience heightened and unique forms of violence compared to men with disabilities and women without disabilities. Yet formalised guidelines for their inclusion in gender-based violence (GBV) research is lacking. This paper draws on ethical guidelines for researching violence against women, and studies on the ethicality of including people with disabilities in research, to advocate for women with disabilities’ inclusion and safety in GBV research. Reflecting on lessons from a qualitative study on violence against women living with disabilities in South Africa, the paper considers what could be of value for GBV researchers and ethics review committees in low-middle income countries (LMICs). It aims to stimulate debate around the integration of reasonable accommodation, accessibility, and equal participation of women with disabilities in planning and conducting ethical GBV research. The paper recommends that considerations are practically applied and tested in other LMICs, and thereafter critiqued in consultation with a range of stakeholders and women with disabilities, to enhance best practice and form a basis for developing guidelines for undertaking ethical and inclusive GBV research in LMICs.
... This particular comment highlights the lack of security and its concomitant evocation of severe stress, anxiety and fear experienced by many PWDs who become imprisoned in their homes, unable to participate safely and equally in daily community activities. These experiences concur with literature (Astbury & Walji 2014;Naidu et al. 2005) PWDs reported abuse from family members and this was confirmed by the CHWs. This included mainly verbal abuse, neglect such as being locked-up and confined to a room, or being denied food. ...
... Discriminatory beliefs and attitudes held by non-disabled persons have consequences for the lives and experience of people with physical disabilities (O' Dea et al., 2012;Sakellariou, 2006;Sakellariou and Algado, 2006;Siebers, 2012). The latter are excluded from SRH education ( Cheausuwantavee, 2002;Seidel et al., 2014), and SRH services ( Rohleder and Swartz, 2012) experience barriers in their sexual development ( Howland and Rintala, 2001;Stohl, 1996) and are at increased risk to be victims of sexual violence ( Astbury and Walji, 2014). In sub-Saharan Africa in general, and South Africa in particular, negative attitudes towards the sexuality of this group of persons-largely negating that any such sexuality exists-have been suggested to put people with physical disabilities at increased risk for HIV, hinder their accessing SRH services, hamper their sexual expression and diminish their sexual selfesteem ( Groce et al., 2013). ...
There is a growing recognition of the sexual and reproductive rights of people with disabilities, and since the World Health Organisation’s World Report on Disability, increased international attention has been given to these issues. Past research, however, suggests that this group encounter barriers to sexual and reproductive rights, which are both physical and attitudinal. Against this backdrop, this article employs a sequential mixed qualitative methodology to explore the practical and subjective experiences of 13 people with physical disabilities in South Africa, with regard to their sexual lives and experiences of sexuality. These experiences were marked by concerns about their ‘fitness’ as sexual beings and indicated that social forces were key in shaping their expectations for their own sexual life.
... [35][36][37][38] These include reticence to date people with physical disabilities, and so negative romantic appraisals of people with physical disabilities by non-disabled people, [5,32,34,[39][40][41] the exclusion of people with physical disabilities from family planning clinics, [7] and possibly even increased risk for sexual violence against people with physical disabilities. [42] Indeed, there is much evidence of an elevated rate of sexual violence perpetrated against women with physical disabilities when compared to non-disabled women. [43] One of the reasons put forward for this sorry fact, is that -again, due in no small measure to societal attitudeswomen with physical disabilities lack social experience and sexual education. ...
There is a body of theoretical work, and some empirical research, which suggests that non-disabled people assume people with physical disabilities are not suitable romantic partners, do not have sexual drives or desires, or are not sexually active. It has also been proposed that people with physical disabilities face barriers to sexual healthcare access which are structural as well as social. The present paper explores nondisabled South Africans’ beliefs concerning the degree to which non-disabled respondents enjoy sexual and reproductive rights, and benefit from sexual and reproductive healthcare, compared to people without disability. Using a survey, we asked 1989 South Africans to estimate the degree to which people with physical disabilities and people without disability have sexual rights, and benefit from sexual and reproductive healthcare services, respectively. Respondents were more likely to support the idea that the population without disability were deserving of sexual rights compared to people with physical disabilities. Respondents were more likely to rate the degree to which people with physical disability benefit from sexual and reproductive healthcare as less than that for people without physical disabilities. These findings provide some of the first empirical support that non-disabled people perceive people with physical disabilities as having fewer sexual and reproductive rights, and deriving less benefit from sexual and reproductive health services, than the population without disability. To have diminished sexual rights, and benefit less from sexual and reproductive healthcare, we suggest, evinces a negation of the sexual and reproductive needs and capacity of people with physical disabilities.
... This particular comment highlights the lack of security and its concomitant evocation of severe stress, anxiety and fear experienced by many PWDs who become imprisoned in their homes, unable to participate safely and equally in daily community activities. These experiences concur with literature (Astbury & Walji 2014;Naidu et al. 2005) PWDs reported abuse from family members and this was confirmed by the CHWs. This included mainly verbal abuse, neglect such as being locked-up and confined to a room, or being denied food. ...
Background
Primary healthcare (PHC) is central to increased access and transformation in South African healthcare. There is limited literature about services required by occupational therapists in PHC. Despite policy being in place, the implementation of services at grassroots level does not always occur adequately.
Objectives
This study aimed at gaining an understanding of the challenges of being disabled and the services required by occupational therapists (OTs) in rural communities in order to better inform the occupational therapy (OT) training curriculum.
Method
An exploratory, descriptive qualitative design was implemented using purposive sampling to recruit 23 community healthcare workers from the uGu district. Snowball sampling was used to recruit 37 members of the uGu community, which included people with disability (PWD) and caregivers of PWDs. Audio-recorded focus groups and semi-structured interviews were used to collect data, which were thematically analysed. Ethical approval was obtained from the Biomedical and Research Ethics Committee of the University of KwaZulu-Natal (BE248/14).
Results
Two main themes emerged namely: firstly, the challenges faced by the disabled community and secondly appropriate opportunities for intervention in PHC. A snapshot of the social and physical inaccessibility challenges experienced by the community was created. Challenges included physical and sexual abuse, discrimination and marginalisation. Community-based rehabilitation and ideas for health promotion and prevention were identified as possible strategies for OT intervention.
Conclusion
The understanding of the intervention required by OT in PHC was enhanced through obtaining the views of various stakeholders’ on the role. This study highlighted the gaps in community-based services that OTs should offer in this context.
... While this criterion likely restricts the study from including the most vulnerable women, it is meant to protect women in high-risk situations from exacerbated abuse and protect the research team and other participants from potentially dangerous situations. Another important limitation regarding external validity is that the trial excludes participants with easily detectable physical or cognitive impairments, and growing research has underscored how women with disabilities may be particular to VAWG [45][46][47][48]. Thus, the research team is fully aware that those who are restricted from participating may have different profiles than those who are able to join. ...
Background
Intimate partner violence (IPV) is a significant public health issue that affects 1 in 3 women globally and a similarly large number of women in Nepal. Over the past decade, important policy and programmatic steps have been taken to address violence against women in Nepal. There remains a dearth of evidence on the effectiveness of primary violence prevention strategies. The Change Starts at Home study begins to fill this gap by utilizing a multi-component social behaviour change communication (SBCC) strategy involving a radio drama and community mobilization to shift attitudes, norms and behaviours that underpin IPV perpetration in Nepal.
Methods/Design
The study uses a concurrent mixed-methods design. The quantitative aspect of the evaluation is a pair-matched, repeated cross-sectional 2-armed, single-blinded cluster trial (RCT: N = 36 clusters, 1440 individuals), comparing a social behaviour change communication (SBCC) strategy to radio programming alone for its impact on physical and / or sexual IPV at the end of programming (12 months’ post-baseline) and 6-months post the cessation of project activities (18-months post baseline). The qualitative aspects of the design include several longitudinal approaches to understand the impact of the intervention and to examine mechanisms of change including in-depth interviews with participants (N = 18 couples), and focus group discussions with community leaders (N = 3 groups), and family members of participants (N = 12 groups). Treatment effects will be estimated with generalized logistic mixed models specified to compare differences in primary outcome from baseline to 12-month follow-up, and baseline to 18-months follow-up in accordance with intention-to-treat principles.
Discussion
The study rigorously evaluates the effectiveness of a promising strategy to prevent IPV. The results of the trial will be immediately useful for governmental, nongovernmental, and donor funded programs targeting partner violence or social norms that underpin it. Findings of the study will also contribute to global knowledge on the effectiveness of media and community engagement as a primary prevention strategy for IPV.
Trial registration
Trial was registered in clinicaltrials.gov, NCT02942433, 10/13/2016, retrospectively registered.
... Participants' names and exact job titles for provincial authorities who could be identified have also been changed. 2. Since this point, a range of academic research has been published on domestic violence (DV) in Cambodia relating to the "triple burden" of disability (Astbury & Walji, 2014), nongovernmental organization (NGO) programming (Lilja, 2011), refuge in Buddhism (Kent, 2011), experiences of marriage (Surtees, 2003;Yount & Carrera, 2006), and alcohol as an external explanation for DV (Brickell, 2008). ...
This article examines victims' purported complicity in the judicial failures of domestic violence law to protect them in Cambodia. It is based on 3 years (2012-2014) of research in Siem Reap and Pursat Provinces on the everyday politics of the 2005 "Law on the Prevention of Domestic Violence and the Protection of the Victims" (DV Law). The project questioned why investments in DV Law are faltering and took a multi-stakeholder approach to do so. In addition to 40 interviews with female domestic violence victims, the research included 50 interviews with legal and health professionals, NGO workers, low- and high-ranking police officers, religious figures, and local government authority leaders who each have an occupational investment in the implementation and enforcement of DV Law. Forming the backbone of the article, the findings from this latter sample reveal how women are construed not only as barriers "clouding the judgment of law" but also as actors denying the agency of institutional stakeholders (and law itself) to bring perpetrators to account. The findings suggest that DV Law has the potential to entrench, rather than diminish, an environment of victim blaming. In turn, the article signals the importance of research on, and better professional support of, intermediaries who (discursively) administrate the relationship between DV Law and the victims/citizens it seeks to protect.
© The Author(s) 2015.
In this chapter, the literature on the prevalence, nature, and offending dynamics of sexual offending in Southeast Asia is synthesized, and cultural values and norms related to sexual offending are discussed, followed by penal codes of different Southeast Asian countries. Two Southeast Asian violent sexual offenses in Indonesia and Malaysia are summarized—i.e., the Indonesian serial child murderer and the Malaysian serial sexual offender in Singapore—to provide greater clinical context to the diverse nature and offending patterns of sexual offenders in Southeast Asia.
This chapter addresses the developing field of disability in public health. Disability is traditionally associated with morbidity and mortality as negative public health outcomes. Primary prevention activities addressing birth defects, developmental disabilities, injuries, and chronic illnesses associated with disabling conditions are the foundation of public health. Public health is developing rapidly in promoting the health and well-being of the population of people living with disabling conditions. This chapter outlines the essential public health functions of assessment, policy development, and assurance for this population across countries and age groups. The WHO’s International Classification of Functioning, Disability and Health (ICF) provides the framework for the conceptual and scientific issues. Finally, the chapter discusses directions for public health and disability to develop more closely. Recommendations are made for improving communication, cooperation, and coordination of activities between the public health and disability communities. The fundamental tenet of the chapter is that people with disabilities should be included in planning, development, and implementation of all public health activities.
Purpose
Although some research has been done with entertainment workers in KTV bars, little has been done to gain a qualitative understanding of the vulnerabilities of masseuse women. This is due to a prevalent focus on girls under 18 years, thereby excluding most masseuses. The paper aims to discuss these issues.
Design/methodology/approach
In total, 98 female participants completed an interview answering both open and closed questions concerning relationships, stigma and discrimination and personal sexual abuse among other topics.
Findings
This study finds that many women working in the massage parlor industry are vulnerable to various threats, including sexual exploitation and abuse. Dependency structures within the massage parlor as well as with their families seem to play a key role in the life situations that can be positive as well as negative, and in some cases both.
Social implications
The findings provide a baseline evaluation of the vulnerable conditions of the massage industry for women in Cambodia. Specifically, that stigma, discrimination, physical and sexual abuse, as well as a lack of access to education are all vulnerabilities not commonly covered, especially with adult women working in the entertainment industry. This research has been adapted from the original transcript “Strive, No Matter What” (Miles et al. , 2014).
Originality/value
The paper seeks to understand the reality of life and vulnerabilities as perceived by Phnom Penh’s female masseuses in the lower-priced massage parlors which is largely unknown.
The Convention on the Rights of Persons with Disabilities (CRPD) enshrines the freedom from exploitation, violence and abuse, a provision, which has hitherto received little attention. Exploring the contents of Article 16, this paper seeks to unpack both the potential for violence prevention as well as the implementation challenges. It situates violence protection within related treaty provisions and touches on specific challenges in institutional care as well as the private realm.
There is good reason to believe that the attitudes of persons without disability towards dating a person with a physical disability might be unfavourable. However, in general, and in the Global South in particular, there is a dearth of research in this area. This study sought to take the first step in addressing this lack of enquiry, by surveying the attitudes of a general population sample in South Africa towards dating people with physical disabilities, using a vignette. Data from 1723 survey respondents were analysed thematically. Findings reveal largely negative attitudes towards people with physical disabilities. Respondents without disability perceived numerous barriers to dating a person with a physical disability, including social stigma, anxiety and concerns about the burden of care they believed such a relationship would place upon them. However, there was some evidence to suggest that some positive attitudes do exist, and a few respondents were open to dating a person with physical disabilities. Findings contribute to a nuancing and expanding of the ‘myth of asexuality’ among physically disabled people by showing that people with physical disabilities are actively desexualised by persons without disability. Future research is needed to explore how the inclusive attitudes, of which we did find evidence here, can be further cultivated.
The Philippines has developed a range of national laws, policies, and programmes in response to violence against women and girls (VAWG). However, as elsewhere, the needs and experiences of women with disabilities are rarely considered in government policies or development activities. Yet women with disabilities are more likely to experience violence than their peers without disability, and they experience a range of barriers that prevent them accessing violence prevention and response services. This article describes initiatives supported by the W-DARE programme to respond to this. These initiatives have involved disabled people’s organisations, local researchers, and activists in the women’s movement, and officials from multiple levels of government. They aspire to build the ability of national policymakers, programme staff, and local service providers to respond to the interests of women and girls with disabilities who face violence.
The importance of a sound research strategy for measuring and understanding violence against women cross-culturally is well recognized. However, the value of specialized interviewer training to attain these data is not always fully appreciated. This article describes interviewer selection and training in the World Health Organization (WHO) Multi-Country Study on Women’s Health and Domestic Violence and highlights their importance. Such training ensures high-quality data and cross-country comparability, protects the safety of respondents and interviewers, and increases the impact of the study. Moreover, women are not only willing to share experiences with trained and empathetic interviewers but also find the interview a positive experience.
The WHO Multi-country Study on Women’s Health and Domestic Violence against Women is a landmark research project, both in its scope and in how it was carried out. For the results presented in this report, specially trained teams collected data from over 24 000 women from 15 sites in 10 countries representing diverse cultural settings: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania.
Intimate partner violence (IPV) is a serious, devastating, and prevalent problem. IPV places women at risk for negative health consequences, including increased mental health disorders. The majority of research to date has focused on mental health disorders among women in domestic violence shelters, and research is needed that examines mental health disorders among a broader range of women experiencing IPV. Therefore, the present study examined the prevalence of posttraumatic stress disorder (PTSD), depression, and substance abuse disorders in a community sample of IPV victims (N = 94) using diagnostic interviews. Results showed that the majority of women met diagnostic criteria for a mental health disorder, with PTSD being the most common mental health disorder. Furthermore, psychological abuse was a significant predictor of both PTSD and depression, whereas physical aggression did not predict these outcomes. Implications of these findings for treatment and intervention work with battered women are discussed.
Research findings reveal that women with disabilities experience rates of emotional, physical, and sexual abuse that are comparable to, if not greater than, women without disabilities. Disability specialists propose that women with disabilities experience specific vulnerabilities to abuse. The question in the present study was, What types of abuse experienced by women with physical disabilities are directly related to their disability? Of the 504 women with disabilities who responded to a questionnaire assessing sexuality and relationships, 181 of the women completed open-ended questions about abuse. Using qualitative techniques, we analyzed their responses and identified disability-specific types of emotional, physical, and sexual abuse. Certain disability-related settings increased vulnerability for abuse. The need for personal assistance with daily living created additional vulnerability. We conclude that disability is not a protective factor against abuse; indeed, it often serves to reduce a woman's emotional and physical defenses. These findings indicate a need for the development of disability-sensitive abuse screening instruments, and development and testing of interventions to assist women with disabilities in recognizing abuse, protecting themselves in abusive situations, and removing themselves from potentially abusive relationships and situations.
To review the empirical literature on the prevalence of interpersonal violence (IPV) against people with disabilities.
The authors searched for, obtained, and reviewed 6,000 abstracts published between January, 2000 and August, 2010 via searches in PsycINFO and PubMed. Subsequently, 177 potentially applicable full-text articles were independently assessed for inclusion; 22 articles describing 21 individual studies were included in this review.
The prevalence of IPV varied depending on the time frame, the definition and type of violence, perpetrator, and disability. Prevalence of any type of IPV among women with disabilities ranged from 26.0%-90.0% for lifetime; 4.9%-29.1% for the past 5 years; and 2.0%-70.0% for the past year. In some studies, when compared to women without disabilities, women with disabilities experienced more lifetime, 5 year, and past year physical and sexual IPV. Prevalence of any IPV in men with disabilities ranged from 28.7%-86.7% for lifetime; 24.9% for the past 5 years; and 36.7% for the past year.
IPV occurs at elevated and disproportionate rates among women and men with disabilities, especially when assessed over the course of their lives. Future research that relies on standard definitions of disability and violence, uses accessible measurement, and examines IPV in diverse populations of people with disabilities will strengthen future reviews and better inform research and policy priorities on disability and violence.
This study took place to enable the measurement of the effects on mental health of a psychosocial intervention in Rwanda. It aimed to establish the capacities of the Self-Reporting Questionnaire (SRQ-20) to screen for mental disorder and to assess symptom change over time in a Rwandan community setting.
The SRQ-20 was translated into Kinyarwanda in a process of forward and back-translation. SRQ-20 data were collected in a Rwandan setting on 418 respondents; a random subsample of 230 respondents was assessed a second time with a three month time interval. Internal reliability was tested using Cronbach's alpha. The optimal cut-off point was determined by calculating Receiver Operating Curves, using semi-structured clinical interviews as standard in a random subsample of 99 respondents. Subsequently, predictive value, likelihood ratio, and interrater agreement were calculated. The factor structure of the SRQ-20 was determined through exploratory factor analysis. Factorial invariance over time was tested in a multigroup confirmatory factor analysis.
The reliability of the SRQ-20 in women (α = 0.85) and men (α = 0.81) could be considered good. The instrument performed moderately well in detecting common mental disorders, with an area under the curve (AUC) of 0.76 for women and 0.74 for men. Cut-off scores were different for women (10) and men (8). Factor analysis yielded five factors, explaining 38% of the total variance. The factor structure proved to be time invariant.
The SRQ-20 can be used as a screener to detect mental disorder in a Rwandan community setting, but cut-off scores need to be adjusted for women and men separately. The instrument also shows longitudinal factorial invariance, which is an important prerequisite for assessing changes in symptom severity. This is a significant finding as in non-western post-conflict settings the relevance of diagnostic categories is questionable. The use of the SRQ-20 can be considered an alternative option for measuring the effect of a psychosocial intervention on mental health.
Nederlands Trial Register NTR1120.
There is extensive evidence of the adverse effects of domestic violence across all age groups and cultural backgrounds. The impact of domestic violence may be long-term, affecting emotional adjustment, physical health and subsequent relationships. Health professionals should be aware of the confounding effect of youth, age and cultural diversity on presentation. Shame and isolation militate against disclosure. Specific, sensitive questioning that incorporates awareness of cultural and social issues is essential to detect domestic violence and initiate appropriate assistance. ©MJA 2000
Intimate partner violence is a serious and pervasive social problem with deleterious consequences for survivors' well-being. The current study involved interviewing 160 survivors 6 times over 2 years to examine the role of social support in explaining or buffering these negative psychological consequences. The authors examined both between- and within-persons variability to explore women's trajectories regarding their experiences of abuse, social support, depression, and quality of life (QOL). Findings revealed the complex role of social support on women's well-being. Evidence was found for main, mediating, and moderating effects of social support on women's well-being. First, social support was positively related to QOL and negatively related to depression. Social support also partially explained the effect of baseline level and subsequent change in physical abuse on QOL and depression over time, partially mediated the effects of change in psychological abuse, and moderated the impact of abuse on QOL. The buffering effects of social support were strongest at lower levels of abuse. Implications for future research and intervention are discussed.
Miranda and Patel argue that mental disorders are among the most important causes of disability and premature mortality in developing countries.
The high prevalence of adverse health outcomes related to intimate partner violence (IPV) is well documented. Yet we know little about the pathways that lead to adverse health outcomes. Research concerning the psychological, biological, neurological, behavioral, and physiological alterations following exposure to IPV--many of which are associated with posttraumatic stress disorder (PTSD)--represents a promising area of empirical discovery. New technologies and interdisciplinary collaborative efforts are required to integrate diverse methodologies and to apply new findings to improving the health and well being of those affected by IPV. This article focuses on victimization by IPV and addresses the most important research findings in the last 20 years (health and mental health burden of IPV), the most important research issue for the next decade (pathways between IPV and adverse health outcomes), and the most promising methodological innovation for the study of IPV (integrated, interdisciplinary, biobehavioral methodology).
Using burden of disease methodology, estimate the health risks of intimate partner violence (IPV) among women in Victoria, Australia.
We calculated population attributable fractions (from survey data on the prevalence of IPV and the relative risks of associated health problems in Australia) and determined health outcomes by applying them to disability-adjusted life year estimates for the relevant disease and injury categories for Victoria, Australia for 2001.
For women of all ages IPV accounted for 2.9% (95% uncertainty interval 2.4-3.4%) of the total disease and injury burden. Among women 18-44 years of age, IPV was associated with 7.9% (95% uncertainty interval 6.4-9.5%) of the overall disease burden and was a larger risk to health than risk factors traditionally included in burden of disease studies, such as raised blood pressure, tobacco use and increased body weight. Poor mental health contributed 73% and substance abuse 22% to the disease burden attributed to IPV.
Our findings suggest that IPV constitutes a significant risk to women's health. Mental health policy-makers and health workers treating common mental health problems need to be aware that IPV is an important risk factor. Future research should concentrate on evaluating effective interventions to prevent women being exposed to violence, and identifying the most appropriate mental health care for victims to reduce short- and long-term disability.
This article summarises findings from ten countries from the WHO multi-country study on women's health and domestic violence against women.
Standardised population-based surveys were done between 2000 and 2003. Women aged 15-49 years were interviewed about their experiences of physically and sexually violent acts by a current or former intimate male partner, and about selected symptoms associated with physical and mental health. The women reporting physical violence by a partner were asked about injuries that resulted from this type of violence.
24,097 women completed interviews. Pooled analysis of all sites found significant associations between lifetime experiences of partner violence and self-reported poor health (odds ratio 1.6 [95% CI 1.5-1.8]), and with specific health problems in the previous 4 weeks: difficulty walking (1.6 [1.5-1.8]), difficulty with daily activities (1.6 [1.5-1.8]), pain (1.6 [1.5-1.7]), memory loss (1.8 [1.6-2.0]), dizziness (1.7 [1.6-1.8]), and vaginal discharge (1.8 [1.7-2.0]). For all settings combined, women who reported partner violence at least once in their life reported significantly more emotional distress, suicidal thoughts (2.9 [2.7-3.2]), and suicidal attempts (3.8 [3.3-4.5]), than non-abused women. These significant associations were maintained in almost all of the sites. Between 19% and 55% of women who had ever been physically abused by their partner were ever injured.
In addition to being a breach of human rights, intimate partner violence is associated with serious public-health consequences that should be addressed in national and global health policies and programmes.
Demographics, assault variables, and postassault responses were analyzed as correlates of PTSD symptom severity in a sample of 323 sexual assault victims. Regression analyses indicated that less education, greater perceived life threat, and receipt of more negative social reactions upon disclosing assault were each related to greater PTSD symptom severity. Ethnic minority victims reported more negative social reactions from others. Victims of more severe sexual victimization reported fewer positive, but more negative reactions from others. Greater extent of disclosure of the assault was related to more positive and fewer negative social reactions. Telling more persons about the assault was related to more negative and positive reactions. Implications of these results for developing contextual theoretical models of rape‐related PTSD are discussed.
This chapter explores the relationships between women's depression and various human rights violations that cross cultures. The author contends that a human rights framework should be applied in analyzing factors that precipitate women's depression and that such a framework can expose the social realities that put women's psychological health at risk. Although some social factors have been explored in previous research on women's depression, there has been a lack of research specifically focused on human rights violations as social determinants of depression and related conditions. This chapter describes various types of violations including war-related acts, sexual violence, unjust work practices, and injuries to human dignity to demonstrate the social factors that can assist in explaining women's significantly higher rates of depression as compared with men's. It also provides a framework for examining how self-silencing relates to women's social inequality and human rights violations.
This study investigated the perceptions and experiences of women with physical and cognitive disabilities related to abuse by formal and informal personal assistance providers. Focus groups and individual interviews were conducted with 72 women to explore how women define personal assistance abuse, the barriers they face in handling abuse, and strategies they recommend to prevent and/or stop abuse. Key themes that emerged included (a) the role of social and personal boundary confusion and power dynamics within the personal assistance services relationship; (b) expanded forms of abuse experienced by women with disabilities; (c) the complexity of using family and friends as providers; (d) personal, social, and systemic barriers that impede women's response to abuse; and (e) the benefits of supports that validate women's experiences and bolster their capacities to prevent and manage abuse. Findings suggested that, with experience, support, and appropriate resources, women with disabilities can effectively manage this challenge.
About 15% of adults worldwide have a disability. These individuals are frequently reported to be at increased risk of violence, yet quantitative syntheses of studies of this issue are scarce. We aimed to quantify violence against adults with disabilities.
In this systematic review and meta-analysis, we searched 12 electronic databases to identify primary research studies published between Jan 1, 1990, and Aug 17, 2010, reporting prevalence estimates of violence against adults (aged mainly ≥18 years) with disabilities, or their risk of violence compared with non-disabled adults. We included only studies reporting violence occurring within the 12 months before the study. We assessed studies with six core quality criteria, and pooled data for analysis.
Of 10,663 references initially identified, 26 were eligible for inclusion, with data for 21,557 individuals with disabilities. 21 studies provided data suitable for meta-analysis of prevalence of violence, and ten for meta-analysis of risks of violence. Pooled prevalence of any (physical, sexual, or intimate partner) recent violence was 24·3% (95% CI 18·3-31·0) in people with mental illnesses, 6·1% (2·5-11·1) in those with intellectual impairments, and 3·2% (2·5-4·1) in those with non-specific impairments. We identified substantial heterogeneity in most prevalence estimates (I(2) >75%). We noted large uncertainty around pooled risk estimates. Pooled crude odds ratios for the risk of violence in disabled compared with non-disabled individuals were 1·50 (95% CI 1·09-2·05) for all studies combined, 1·31 (0·93-1·84) for people with non-specific impairments, 1·60 (1·05-2·45) for people with intellectual impairments, and 3·86 (0·91-16·43) for those with mental illnesses.
Adults with disabilities are at a higher risk of violence than are non-disabled adults, and those with mental illnesses could be particularly vulnerable. However, available studies have methodological weaknesses and gaps exist in the types of disability and violence they address. Robust studies are absent for most regions of the world, particularly low-income and middle-income countries.
WHO Department of Violence and Injury Prevention and Disability.
Demographics, assault variables, and postassault responses were analyzed as correlates of PTSD symptom severity in a sample of 323 sexual assault victims. Regression analyses indicated that less education, greater perceived life threat, and receipt of more negative social reactions upon disclosing assault were each related to greater PTSD symptom severity. Ethnic minority victims reported more negative social reactions from others. Victims of more severe sexual victimization reported fewer positive, but more negative reactions from others. Greater extent of disclosure of the assault was related to more positive and fewer negative social reactions. Telling more persons about the assault was related to more negative and positive reactions. Implications of these results for developing contextual theoretical models of rape-related PTSD are discussed.
Intimate partner violence, which describes physical or sexual assault, or both, of a spouse or sexual intimate, is a common health-care issue. In this article, I have reviewed research on the mental and physical health sequelae of such violence. Increased health problems such as injury, chronic pain, gastrointestinal, and gynaecological signs including sexually-transmitted diseases, depression, and post-traumatic stress disorder are well documented by controlled research in abused women in various settings. Intimate partner violence has been noted in 3-13% of pregnancies in many studies from around the world, and is associated with detrimental outcomes to mothers and infants. I recommend increased assessment and interventions for intimate partner violence in health-care settings.