Gender-based violence: NHSScotland PIN policy

Appendix 1 An overview of Gender-Based Violence, prevalence and health impact

This information is supplemented by a package of resources on Gender-Based Violence developed by NHSScotland for staff. This includes a generic guide What health workers need to know about Gender-Based Violence: an overview, outlining the nature of Gender-Based Violence, its health impact and how to respond. It is accompanied by a series of more detailed practice guides about the following specific forms of such abuse:

• Domestic abuse;
• Childhood sexual abuse;
• Rape and sexual assault;
• Commercial sexual exploitation;
• Stalking and harassment; and
• Harmful traditional practices (for example female genital mutilation, 'honour' crimes and forced marriage).

The guides a can be accessed on www.gbv.scot.nhs.uk and hard copies should be available across health settings in all health settings.

What is Gender-Based Violence?

Gender-Based Violence is endemic in society. Defined by the United Nations as: "violence that is directed against a woman because she is a woman, or violence that affects a woman disproportionately", it encompasses a spectrum of abuse experienced mostly by women and perpetrated mainly by men i.e. domestic abuse, rape and sexual assault, childhood sexual abuse, sexual harassment, stalking, commercial sexual exploitation and harmful traditional practices such as female genital mutilation ( FGM), forced marriage and so-called 'honour' crimes.

Given the disproportionate impact on women and girls, Gender-Based Violence is one of the most sensitive indicators of gender inequality. It is important to recognise, however, that men and boys can also be subjected to abuse; most often by other men but sometimes also by women.

Definitions and Prevalence:

Domestic abuse, is a pattern of assaultive and coercive control, including emotional, sexual, psychological and physical abuse that affects between 1 in 3 and 1 in 5 women over the course of their lives ³⁴ .

• Of 53,681 domestic abuse incidents reported to Scottish police in 2008/09, 84% of victims were female. ³⁵ Although men too experience domestic abuse, women are much more likely to experience repeated incidents over time, have greater injuries, and suffer more psychological and sexual violence ³⁶.
• In around 2 in 5 domestic abuse cases, there is also childhood physical and sexual abuse by the same perpetrator.
• There is evidence that domestic abuse within same sex relationships is common and could be higher than 1 in 3 according to a 2006 study ³⁷.

Child sexual abuse is defined as exploitation of a young person by an individual for their own or others' sexual gratification. It is physically and emotionally abusive and often involves serious and degrading assault.

• 21% of girls and 11% of boys have experienced child sexual abuse ³⁸.

Rape and sexual assault is defined as unwanted or coerced sexual activity, including anal, oral or vaginal penetration, sexual touching; usually committed by a man known to the victim.

• In 54% of rape cases women are raped by a current or ex-partner ³⁹.

Commercial sexual exploitation includes prostitution, pornography, lap dancing and sex trafficking.

• One in two women in prostitution become involved at the age of 18 or younger ⁴⁰.
• There are 4,000 victims of trafficking for sexual exploitation in the UK⁴¹.

Harassment and stalking is defined as unwanted, persistent often threatening attention, e.g. following someone, constantly phoning, texting or e-mailing at home or work.

• There are clear links between stalking and domestic abuse: 37% of aggravated stalking against women was by a partner or ex-partner compared with 8% of men ⁴².

Harmful traditional practices includes: female genital mutilation, forced marriage and so-called 'honour' crimes which are culturally condoned as part of a tradition. These are likely to be a form of domestic abuse or the basis for it.

Forced marriage is a marriage which takes place against the wishes of either or both parties. This is not the same as an arranged marriage, where the individuals have a free choice as to whether to proceed.

'Honour' crimes constitute violence excused as a form of punishment for behaviour which is perceived as deviating from what the family or community believes to be the 'correct' form of behaviour, sometimes referred to as 'family honour'.

• In 2009 the UK Forced Marriage Unit dealt with 1682 cases of forced marriage. 86% of these were women and 14% men ⁴³.
• An estimated 66,000 women living in the UK have undergone female genital mutilation ⁴⁴.

Health Impact

The physical, emotional and psychological consequences of all forms of abuse can be profound and damaging, i.e.:

Physical & sexual health

• Medical attention for injuries - in around 50% of cases according to one UK study ⁴⁵;
• Greater risk of chronic health problems: Sexually Transmitted Infections, chronic pelvic pain, urinary tract infection, irritable bowel syndrome etc;
• Women experiencing abuse are 15 times more likely to misuse alcohol and nine times more likely to use drugs than non-abused women; ⁴⁶
• Higher rates of health risk behaviour such as smoking, risky sexual behaviour, unwanted teenage pregnancies and greater vulnerability to sexual exploitation; and ⁴⁷
• Abuse during pregnancy significantly increases the risk of poor maternal and infant health outcomes ⁴⁸.

Mental health

• Around 35-40% of women experiencing domestic abuse report depressive symptoms ⁴⁹; and
• Childhood sexual assault is associated with poor mental health including depression, anxiety, eating disorders, post-traumatic stress disorder, self-harm, psychosis and suicidal ideation. ⁵⁰