2. Lecture Outline:
• Definition of health
• Definition of health determinants
• Classification of health determinants
• Special consideration regarding women health
• Definition of equity and equality
• Solutions to improve women health
• Discussion
2
3. Definition of Health
A state of complete physical , mental , social and spiritual well being and merely the
absence of disease or infirmity (WHO) .
3
physical
well being
mental
well being
social well
being
spiritual
well being
4. What decide our health status?
• You may be wondering why some people are healthy and others are not , why
some are active and functioning well and others are not?
• To understand that, there are many factors contributing to the health status of any
persons , these are called HEALTH DETERMINANTS
4
5. WHO Definition of health determinant
“the circumstances in which people are born, grow up, live, work and age, and the
systems put in place to deal with illness.”
(WHO Commission the Social Determinants of Health, 2008)
5
“The circumstances in which people are born, grow up, live,
work and age, and the systems put in place to deal with
illness.”
7. The Determinants of Health
The determinants of health are the factors that combine to affect the health of
individuals and communities.
The determinants of health include:
I. Social and economic environment
II. Physical environment
III. Individual personal characteristics and behaviors
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8. I. Social and economic environment
1. Income and social status:
• The higher the income and the social status the better the health status.
• The great the gap between the richest and poorest people , the greater the
differences in health.
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9. Social and economic environment
2. Education
• Low education levels are associated with poor health , more exposure to stress and
lower self confidence.
3. Culture
• Customs , traditions and the believes of the family and community , all affect health.
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10. Social and economic environment
4. Health services
• The quality , the availability and the access to services that prevent and treat
illnesses influences health.
5. Employment and working conditions:
• People who are employed are healthier, particularly those who have more control
over their working conditions.
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11. Social and economic environment
6. Social support networks:
• The greater the support from families, friends and community, the better the health
of the individuals.
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12. II. Physical environment
• Safe water
• Clean air
• Good sanitation system
• Heathy work places
• safe houses, roads and communities.
…. All these factors contributes to good health.
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13. III. Individual and personal characteristics and
behaviors:
• Genetic inheritance plays a role in determining lifespan, healthiness and likelihood
of developing certain diseases.
• Personal behaviors : such as balances eating , physical activity will improve health
status.
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14. Health: (as measured by premature mortality)
• 10 % health care
• 30 % genetics
• 5-20 % environment
• 15 % social circumstances
• 40 % behavior
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15. Sex:
• Sex refers to a set of biological attributes in humans and animals.
• It is primarily associated with physical and physiological features.
Female and Male
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Such as :
16. Gender
• Gender is either of the two sexes male or female, when considered with reference
to social and cultural differences rather than biological ones.
• Gender refers to the socially constructed roles, behaviors, expressions and
identities. It influences how people perceive themselves and each other, how they
act and interact, and the distribution of power and resources in society.
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Gender is usually conceptualized as (woman and man).
17. Sex- and Gender-Based Analysis (SGBA):
• Sex- and Gender-Based Analysis (SGBA) is an approach that systematically
examines sex-based (biological) and gender-based (socio-cultural) differences
between men and women.
• The purpose of SGBA is to promote science that considers sex and gender and
therefore has the potential to expand our understanding of health determinants for
all people.
• Ref: Understanding Gender and Health” in The Handbook of Medical Sociology edited by Bird, Conrad, Fremont, and Timmermans. Sixth Edition. Nashville, TN: Vanderbilt University Press.
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18. Sex- and Gender-Based Analysis (SGBA):
• Society prescribes to women and men different roles in different social contexts.
There are also differences in the opportunities and resources available to women
and men, and in their ability to make decisions and exercise their human rights,
including those related to protecting health and seeking care in case of ill health.
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19. Women Health – special considerations:
• Insufficient attention to sex differences in disease progression and treatment
across medical specialties. For example, cardiovascular disease, the leading cause
of death among women, often presents and progresses differently in women
than it does in men.
• As women age and experience natural life transitions, such as menopause, they
require special attention and care to monitor their changing needs.
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20. Women Health – special considerations:
• The burden of COPD—a lung ailment—is over 50% higher among women than
among men
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21. Women Health – special considerations:
HIV infection:
The epidemic in sub-Saharan Africa is increasingly affecting females
Of all adults living with HIV in sub-Saharan Africa, 61% are women.
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22. Women Health – special considerations:
• Women have a higher risk of becoming visually impaired than men
• Across the world and at all ages, women have a significantly higher risk of
becoming visually impaired than men.
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23. Women Health – special considerations:
• Smoking rates among men tend to be 10 times higher than among women, but
Women generally have less success in quitting the habit, have more relapses than
men, and nicotine replacement therapy may be less effective among women.
• Tobacco use among younger women in developing countries is also
rising rapidly.
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24. Women Health – special considerations:
• Even though early marriage is on the decline, an estimated 100 million girls will
marry before their 18th birthday over the next 10 years.
• Young married girls often lack knowledge about sex and the risks of sexually
transmitted infections and HIV/AIDS.
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25. Women Health – special considerations:
• Most adolescent mothers live in developing countries
• About 14 million adolescent girls become mothers every year
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26. Women Health – special considerations:
Deadly pregnancies:
• Approximately 1000 women die every day due to complications of pregnancy and
child birth
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27. Women Health – special considerations:
Violence has serious health consequences for women
• Between 15% and 71% of
women around the world
have suffered physical or
sexual violence committed
by an intimate male partner
at some point in their lives
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28. • Gaps in Training : Inadequacy of medical education and training addressing
gender.
• Most health care training programs do not equip providers to address women’s
unique needs
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Women Health – special considerations:
29. Lack of availability of regular source of primary health care.
• Nearly 20 % of adult women report not having a primary health care provider.
• 20 % of women consider their ob/gyn to be their primary health care provider, a
perception that is more common among women who are pregnant, have newborns,
and do not have a chronic condition.
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Women Health – special considerations:
30. Women Health – special considerations:
• Women are more likely than men to delay self-care as a result of their
professional and personal obligations. Caregiving, in particular, has a profound
impact on women’s ability to attend to their own health.
• For women who balance several roles at home and at work, finding time to go for
health care visits during business hours can be a challenge.
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31. “sandwich generation”
• middle-aged caregivers enter the “sandwich generation,” a period during which
they may assume simultaneous caregiving responsibilities for young children and
aging parents.
• The burden of this dual role compels the majority of working caregivers to adjust
their careers to accommodate caregiving duties and can inhibit them from
attending to their own health and well-being care.
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32. Sex- and gender-based bias:
• Frequently, women’s concerns are dismissed or perceived as being less severe than
men’s.
• Women are more likely than men to receive referrals to psychologists to address
nondescript symptoms and are less likely than men to receive pain medication or
interventions.
• Women who present with heart attack symptoms are often sent home with a
diagnosis of stress or panic disorder rather than being given the full cardiovascular
diagnostic workup that is more consistently offered to men
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Women Health – special considerations:
33. Women Health – special considerations:
Inadequate clinical guidelines: Evidence-based guidelines have historically not
accounted fully for sex differences in disease progression.
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34. Women Health – special considerations:
• Inadequate focus on addressing social determinants of health
• Social determinants of health play a particularly significant role in predicting
women’s health outcomes
For example , Factors like financial stability, housing security, nutrition, and
exposure to domestic violence during a woman’s reproductive years significantly
affect her ability to have a pregnancy free of complications.
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35. Women Health – special considerations:
There is great demand for and low supply of key women’s health specialty services :
Women’s health specialists include primary health care providers with women’s
health training, obs/gyns, and medical specialists with women’s health training,
including oncologists, cardiologists, psychiatrists, and neurologists.
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36. Women Health – special considerations:
Economic inequity:
• Income inequality and insurance coverage also have a profound impact on health.
• Women in the top 1 percent of the income distribution have a life expectancy that
is 10 years longer than that of women in the bottom 1 percent.
• The rate of screenings, such as mammograms, colon cancer screenings, and Pap
tests are lower among un-insured women
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37. Equity vs. Equality: What’s the Difference?
• Equality means each individual or group of people is given the same resources or
opportunities.
• Equity recognizes that each person has different circumstances and allocates the
exact resources and opportunities needed to reach an equal outcome.
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38. Equity vs. Equality: What’s the Difference?
“The route to achieving equity will not be accomplished through treating everyone
equally. It will be achieved by treating everyone justly according to their
circumstances.”
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41. Increase the awareness of women health
All health professionals must have knowledge and awareness of the ways in which
gender affects health, so that they may address gender issues wherever appropriate
thus rendering their work more effective.
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42. • Primary health care is associated with positive health outcomes; regions that have
more primary health care providers are associated with lower rates of
hospitalization, cancer mortality, heart disease, and stroke.
• Primary health care plays an essential role in responding to women’s unique health
needs through advanced age and in bridging care during life transitions, from
puberty and reproduction to menopause. Achieving the vision of comprehensive
primary health care for women is critical to improving health outcomes, bending
the cost curve, and promoting health equity.
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Maximize the role of primary health care:
43. Patient empowerment
I. They need to understand their role in their care
II. They need to know enough to be able to care for themselves and work with
their health care professional
III. They need skills to enable them to care for themselves
IV. Their environment must be facilitative or supportive
It is important for the patient to understand their role in their care and to have the
skills and knowledge to care for themselves. In order for the patient to feel
empowered they should ideally be in an environment (home, health care system,
community, etc.) that is facilitative or supportive.
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44. Women’s Education and Child Survival
• Increase in the education of women has been shown to decrease child deaths under
five.
• Two decades of research shows that children benefit when their mother’s status is
raised.
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48. Lectureoutline:
• Introduction
• Theories that explain sex differences in medical illnesses
• Sex bias in autoimmune disorders
• Sexual dimorphism
• Sex bias in neurodevelopmental disorders
• Sex bias in non-reproductive malignant diseases.
• CVD diseases in females.
49. Sex differences in medical illnesses:
• A varied susceptibility of males and females in developing
autoimmune diseases, cancers, and infectious diseases, as well as
different outcome of vaccination has been extensively documented.
• The need to include a sex dimension in clinical studies and practice is
increasingly felt, especially with the current growing interest in
precision medicine.
50. Role of X chromosome:
• higher incidence of several autoimmune diseases was detected in
men with two X chromosomes (e.g., Klinefelter syndrome), while an
opposite trend has been observed among females with a single X
chromosome (Turner syndrome), underlining the importance of the X
chromosome in autoimmune disorders.
51. Role of sex hormones:
• Sex hormones including estrogens, progesterone, androgens, and
prolactin, can influence immune system function and progression of
autoimmune diseases.
• They are known to act in a concentration-dependent manner, and
their functions change based on the type of target cell and receptor
subtype expression.
52. Role of sex hormones:
• Estradiol (E2) and prolactin enhance humoral immunity, while
testosterone and progesterone are known to be natural
immunosuppressant that decrease inflammatory mediators and
inhibit immune cell activation.
• Estrogens also upregulate a wide range of immunity factors,
including interferons (IFN).
• Post-menopausal women are also at increased risk of developing
cardiovascular disease, which has been explained by a reduction in
estrogen levels.
53. Role of Mitochondria
• Mitochondria is important as a regulator of the immune response, in
particular towards specific phenotypes of immune cells.
• Sex-based differences in human disease are caused in part by the
levels of endogenous sex steroid hormones which regulate
mitochondrial metabolism, particularly Estrogens which regulate
diverse cellular functions by binding to estrogen receptors.
54. Role of cytokines
• In women, an elevated induction of pro-inflammatory cytokines
correlated with higher morbidity and mortality due to influenza
infections ( cytokines storm).
55. Role of genetics:
• The expression of specific genes can be modified epigenetically by
many intracellular hormones or extracellular environmental factors.
• All these players act in the most vulnerable stages of our life, such as
pregnancy, by interfering with fetal programming and making
individuals more susceptible to develop diseases later in life.
(Epigenetics is the study of how your behaviors and environment can cause changes that affect the way your genes
work. Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they
canchange how your body reads a DNA sequence.)
56. Differences between men and women in
drug activity
• Pharmacokinetics in women is affected by lower body weight,
slower gastrointestinal motility, less intestinal enzymatic activity,
and slower glomerular filtration rate.
• Women has greater sensitivity and enhanced effectiveness of
beta blockers, opioids, selective serotonin reuptake inhibitors,
and typical antipsychotics.
• Additionally, women are 50 to 75 percent more likely than men
to experience an adverse drug reaction.
57. Gender bias in autoimmune diseases
• Sjogren’s syndrome (SS), systemic lupus erythematosus (SLE), Grave’s
disease (GD), Hashimoto’s autoimmune thyroiditis, and scleroderma
show the strongest alteration in sex ratio, with females being seven to
ten times more affected than males.
• Rheumatoid arthritis (RA), multiple sclerosis (MS), and myasthenia
gravis (MG), is two to three times more common in female.
59. Sexual Dimorphism
• Some immunological disorders display a sexual dimorphism, like
asthma and allergic disease.
• Asthma is more common in males from birth until puberty but
becomes more prevalent and more severe in females after puberty
60. Neurodegenerative diseases
• Accumulating evidence on neurodegenerative diseases indicates a
gender-dependent bias, with increased male to female ratio for the
majority of neurodegenerative diseases, as well as the severity of the
disease that differs significantly between the two sexes.
61. Neurodevelopmental diseases
• Many neurodevelopmental disorders with early onset during infancy
are characterized by a male dominance.
• Autism spectrum disorders (ASD), attention-deficit hyperactivity
disorder (ADHD), Tourette’s syndrome, and dyslexia are more
prevalent in males.
• Mood disorders, phobias, obsessive compulsive disorder, and eating
disorders, are more prevalent in females.
62. Neurodevelopmental and
Neurodegenerative diseases
Neurodevelopmental and
Neurodegenerative diseases
Female to Male Ratio
Autism Spectrum Disorders (ASD) 1:3–4
Attention Deficit Hyperactivity
Disorder (ADHD)
1:3
Tourette’s Syndrome 1:4
Depression and Anxiety disorder 2:1
Schizophrenia
Early incidence male-biased
Late incidence female-biased
Stroke 1:2
Parkinson’s disease 1:1.5
Alzheimer’s disease 1.6–3:1
63. Malignancy
• Cancer development has been observed more in men compared to
women (with few exceptions such as thyroid cancer and lung cancer
in nonsmokers).
64. Malignancy
Cancer Female to Male Ratio
Cancers developed in larynx,
esophagus, and bladder
1:4
Non-reproductive cancers 1:2
Thyroid cancers 3:1
65. Infectious diseases:
• Females have higher antibody responses to influenza, hepatitis B,
herpes virus vaccines than males.
• Increased immunity to pathogens among females corresponds to a
lower prevalence of many infections among females compared to
males, but may increase the symptoms and disease severity in
females compared to males.
67. Response to vaccinations:
• Several observational studies reported that the immune response to
some vaccines differs between men and women.
• Adult females display stronger intrinsic and adaptive immune
responses than males, which can lead to a faster clearance of
pathogens and greater vaccine efficacy in females than in males
69. Disease nature:
• Ischemic heart disease is more frequently a diffuse disease in females
and has a lower plaque burden and frequent coronary microvascular
dysfunction.
• Females are more likely to have heart failure with preserved EF.
• Females have higher prevalence of AF associated with underlying
diseases.
70. CV risk factors in females:
• Non traditional CV risk factors such as anxiety and depression are
more frequent in women.
• Traditional CV risk factors including smoking , obesity and D.M have
stronger impact on women's health.
• Females have specific risk factors such as premature menopause and
use of hormonal contraceptives.
• Pregnancy related risk factors such as gestational diabetes and
preeclampsia.
71. Disease presentations:
• Atypical presentation such as anxiety , abdominal pain , nausea ,
vomiting and S.O.B are more frequent in females.
• Emotional stress is often the trigger for ischemic heart diseases in
females.
• Women with ACS are often older and have more comorbidities
compared to men.
• Younger women with ACS have poorer overall health ( higher
prevalence of depression , HTN , diabetes and obesity) and are more
likely to be symptomatic with AF.
72. Prognosis:
• Women less than 55 years have a 2 folds higher one-year mortality
and a higher post-infarct hospitalization compared to men.
• Females have higher risk of short and long term morbidity and
mortality following CABG.
• Women with AF have an increased mortality , higher risk of stroke
and higher risk of complications during AF ablation.
76. • Definition of violence
• Prevalence and significance of the problem
• Types of violence against women
• Risk Factors and causes of Violence
• Cycle of Violence
• Impact of violence
• Interventions to lower the risks of violence
• VAW in Palestine
• What you need to know about domestic violence
2
Lecture Outline
77. 3
WHO - Violence against women: Strengthening the health
system response
• https://youtu.be/Qc_GHITvTmI
78. WHO definition of violence:
The intentional use of physical force or power, against oneself, another person, or
against a group or community, that either results in or has a high likelihood of
resulting in injury, death, psychological harm, mal-development or deprivation.
4
79. Violence against women (VAW):
• Any act of gender-based violence that results in, or is likely to result
in, physical, sexual or psychological harm or suffering to women,
including threats of such act, coercion or arbitrary deprivation of
liberty, whether occurring in public or in private life.
The United Nations Declaration on the Elimination of Violence against Women (1993) 5
80. A retrospective study was performed to compare men and women abused
by their partner, based on all the medical certificates for victims who
consulted a specialized center in assault victims.
• Consultations for domestic violence occur less frequently in men than in
women.
• Events of violence were more frequently repeated against women than
men.
• Injuries which was in most cases mild, were more frequently found in
men than women.
• A psychological impact was more frequently found in women than in
men.
https://pubmed.ncbi.nlm.nih.gov/25735783/
6
Violence against men:
81. Significance of the Problem
• Violence affects all women regardless of culture, socio-economic
status, ethnicity, age, occupation or sexual orientation.
• Violence is a significant cause of morbidity and mortality for women.
• Violence can negatively affect women’s physical, mental, sexual, and
reproductive health, and may increase the risk of acquiring HIV in
some settings.
7
83. • Estimates published by WHO indicate that
globally about 1 in 3 (30%) of women
worldwide have been subjected to either
physical and/or sexual intimate partner
violence or non-partner sexual violence in
their lifetime.
Global prevalence of VAW:
84. • Calls to helplines have increased five-fold in some countries as rates
of reported intimate partner violence increase because of the COVID-
19 pandemic. Restricted movement, social isolation, and economic
insecurity are increasing women’s vulnerability to violence in the
home around the world
• 137 women are killed by a member of their family every day
• At least 155 countries have passed laws on domestic violence, and 140
have laws on sexual harassment in the workplace.
10
Global prevalence of VAW:
85. Global prevalence of VAW
• Violence against women and girls is one of the most systematic and
widespread human rights violations:
• In 2019, one in five women, aged 20–24 years, were married before the
age of 18.
• About 70% of all human trafficking victims detected globally are
women and girls.
• At least 200 million women and girls alive today have undergone female
genital mutilation in 30 countries.
• Around 120 million girls worldwide (over 1 in 10) have experienced
forced intercourse or other forced sexual acts.
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88. • 37% of Arab women have experienced some form of violence in their
lifetime. There are indicators that the percentage might be higher.
• In Egypt, 92% of women and girls between 15 and 49 years of age have
experienced Female Genital Mutilation. Recent data shows progress with
Female Genital Mutilation reaching 61% in girls between 15 and 17
years of age down from 74% in 2008.
• 700 million women alive today have been married under the age of 18.
14% of Arab girls marry under the age of 18.
89. Types of violence
1) Physical violence
Including threats of violence, hitting, slapping, punching, kicking,
burning, cutting or otherwise harming the body. with fists or weapons,
with or without physical injury.
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90. 2) Sexual violence:
Any form of forced sexual activity or inappropriate /unwanted touching,
including rape, assault, forced prostitution, incest, female genital
mutilation, sexual harassment, etc.
Types of violence
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91. 3) Psychological or emotional abuse
Insults, humiliation, put-downs and shouting, and extreme jealousy
,verbal abuse, threats, control, constant criticism, terrorization,
humiliation, etc.
• Use of the victims emotions to control them - can be through verbal
communication (threats/insults/criticisms) or non verbal
(isolation/humiliation).
These are not crimes under the Criminal Code.
Types of violence
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92. 4) Financial abuse (economic abuse / material exploitation)
• Restricting access to family resources, inheritance or employment
opportunities, overwork, denial of ownership of property, withholding
or taking away earnings, denial of inheritance, withholding education,
unequal pay, not being allowed to work, etc
Financial abuse is not a crime under the Criminal Code, unless threat, fraud, coercion is used
Types of violence
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93. Spousal abuse = Intimate partner violence (Domestic Violence -DV)
• Physical or sexual violence or psychological or financial abuse within
current or former marital or common-law relationships.
Domestic Violence:
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95. Types of violence against women:
• The most common forms of violence are:
• Verbal abuse (50%)
• Sexual harassment (40%)
• Physical abuse (36%)
• Denial of basic needs (35%)
• Denial of means of communication (30%)
•
• Seven in 10 women surveyed believe violence against women is common in
their community.
WHO 2021
21
96. • lower levels of education (perpetration of sexual violence and
experience of sexual violence).
• a history of exposure to child maltreatment (perpetration and
experience).
• witnessing family violence (perpetration and experience).
• antisocial personality disorder (perpetration).
• harmful masculine behaviors, including having multiple partners or
attitudes that ignore violence (perpetration).
Risk factors for both intimate partner and sexual violence include:
22
97. • community norms that privilege or ascribe higher status to men
and lower status to women.
• low levels of women’s access to paid employment.
• low level of gender equality (discriminatory laws, etc.).
• harmful use of alcohol (perpetration and experience).
Risk factors for both intimate partner and sexual violence include:
23
98. Causes of violence:
• Cultural:
Notion of the family as the private sphere and under male control
Customs of marriage (bride price)
Acceptability of violence as a means to resolve conflict
Cultural definitions of appropriate sex roles
Belief in the inherent superiority of males
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99. • Economic factors
women’s economic dependence on men.
Discriminatory laws regarding inheritance, property rights, use of
communal lands and maintenance after divorce or widowhood.
Limited access to employment in formal and informal sectors.
Limited access to education and training for women.
Causes of violence:
25
100. • legal factors
-Weak position of women in front of some laws including:
laws regarding divorce.
child custody.
maintenance and inheritance.
legal definitions of rape and domestic abuse.
- low levels of legal literacy among women.
Causes of violence:
26
101. • Political factors:
Under-representation of women in politics, media, in the legal and
medical professions; make domestic violence perceived as unserious
problem.
Causes of violence:
27
102. • Although alcohol and poverty are often identified as causes, they
are triggers or contributing factors to violence
They are not the root cause of violence.
• Violence against women and girls is a complex issue that is rooted
in gender inequality and discrimination, as well as unequal power
relations between men and women which exist in varying degrees
across all communities in the world.
• Low economic and social status of women increases the risk of
violence that women face. Increasing economic independence is
important to help survivors leave abusive relationships.
28
Summary:
103. Common Characteristics of victims of abuse:
• low self-esteem
• guilt
• self-blame
• denial
• Traditional women’s roles
• history of childhood abuse
• have children
• poor financial resources
• few job skills
• Low level of education
• few friends
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104. Common Characteristics of abuser:
• low self-esteem
• dependency
• jealousy
• poor communication skills
• unemployed/underemployed
• have witnessed or experienced
abuse as children
• Victims of abuse usually abuse their
own children
• Abuse of alcohol/other drugs
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105. The cycle of Violence:
1. Tension building
• Tension is increased.
• Breakdown of communication
• Victim becomes fearful and feels the need to pacify the abuser.
2. Incident
• Verbal, physical, threats, blaming.
3. Reconciliation
• Abuser apologizes, gives excuses, blames victim, says it wasn't as bad as the victim claims , gifts…etc.
4. Calm
• Incident is forgotten (“Honeymoon” phase)
31
107. What are the consequences of violence against women and girls?
• The impact of violence ranges from immediate to long term physical,
sexual and mental health consequences for women and girls, including
death.
• It also has tremendous personal, societal and economic costs all
around the globe: from greater health care and legal expenses to
productivity losses
33
109. Effect of violence on reproductive systems of females:
• Fetal loss
• Low-birth-weight infants
• Preterm birth
• Lack of control over reproductive decision making
• STD’s & HIV/AIDS
• Vaginal bleeding or infection, genital irritation
• Unplanned pregnancies
35
110. VAW can begin or increase during pregnancy due to:
• Jealous nature of the abuser with the growing fetus that begins to
occupy more and more of woman’s time and attention
• Other family members becoming more attentive
• Abuser may feel loss of power and control
• Woman’s unavailability for sex
- On the contrary other women report that violence diminishes or stops
while pregnant therefore causing them to become pregnant more
frequently.
36
111. Psychological effect of violence:
• Posttraumatic stress disorder
• Sleep disturbance
• Eroded Self esteem
• Phobias
• Depression
• Substance Abuse
• Anxiety
• Suicide
• Long-term effects on children (increased smoking, drug and alcohol misuse,
and risky sexual behaviors in later life)
37
112. Psychological stages of battered women
• Women Denial.
The victim refuses to admit… she may call each incident an “Accident”.
• Guilt.
She now acknowledges there’s a problem, but considers herself responsible
for it.
• Enlightenment.
She no longer assumes responsibility for her husband’s abusive
behavior/treatment. She recognizes that she does not deserve to be beaten.
• Responsibility.
Accepts that her husband will not and cannot stop his violent behavior. The
battered woman decides she will no longer surrender to it and starts a new life.
38
113. Costs of VAW:
• The social and economic costs of intimate partner and sexual violence
are enormous and have great effects throughout society.
• Women may suffer isolation, inability to work, loss of earnings, lack
of participation in regular activities and limited ability to care for
themselves and their children.
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114. • Direct costs: value of goods and services used in treating or preventing
violence ( Medical - Police - Criminal justice system - Housing -
Social services)
• Non-monetary costs: pain and suffering - Increased morbidity -
Increased mortality via homicide and suicide - Abuse of alcohol and
drugs - Depressive disorders
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Costs of Violence
1.6 million people die each year through violence
Estimated economic cost of $151 billion
115. How to end violence against women?
1. We need a comprehensive approach that covers the development of
laws and policies, and focuses on prevention of violence before it
happens and access to essential services for survivors of violence.
2. It is necessary to change social norms and behaviors, targeting men
and boys, community and religious leaders, private and public sectors,
41
116. How to end violence against women?
3. Awareness-raising campaigns on the impact of violence as an
important component of prevention efforts. This need to be
complemented with educational programs to generate sustained results.
4. Increasing women's participation in political processes has shown to
result in better legislative outcomes for women and a more responsive
state.
5. The existence of a strong women's civil society movement.
42
117. Screening and referral:
• Identifying and supporting victims of violence
• Advocacy support
• Support and guidance to victims, e.g. counselling, education, legal aid.
• Psychosocial interventions
• Treat emotional & behavioral problems linked to victimization.
• Protection orders
• Prohibit perpetrators from further abusing their victims
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121. How to help someone you know?
• Support her by acknowledging the problem
• Affirm that the abusive behavior is not acceptable
• Assist her to gain access to community resources
• Help her to identify options
• Assist her to develop an escape plan
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122. What not to do:
• Blame the victim
• Question her in front of the abuser
• Minimize, deny or trivialize what she says
• Confront the abuser
• Suggest joint counselling
• Alienate her by criticizing her partner
• Criticize a woman who chooses to stay
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123. Violence against women in Palestine
37% of Palestinian women experienced some form of violence by their
husbands in 2011.
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124. Violence against women in Palestine:
• 23.3% of women who had ever been married reported that they had
been exposed to physical violence,
• 61.7% to psychological violence, and 10% to sexual violence
(PCBS,2011).
• Femicide on the pretext of “family honor”
- 11 victims in 2009
- 9 victims in 2010
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125. To achieve lasting change, it is important to
pass legislations and develop policies that:
• Address discrimination against women.
• Promote gender equality.
• Support women
• Help to move towards more peaceful cultural norms
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126. Role of Ministry of Health:
1. To adopt the concept of opposing VAW into the ministry’s vision and
mission, and to translate the concept into one of the ministry’s strategic
goals.
2. To introduce special manuals and curricula on how to deal with VAW
in medical and public health schools and colleges.
3. To set out documented mechanisms that explain how to deal with
VAW cases in health centers, including the reception, referral and
follow-up of VAW cases.
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127. Role of Ministry of Health:
4. To build a database on VAW cases received in health centers.
5. To include special sections in health centers for receiving VAW cases
in order to maintain confidentiality and safety.
6. To train staff on the mechanisms of documenting reports of VAW in
which psychological harm is included.
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129. Prevalence of domestic violence:
• 35% of women globally have experienced gender based violence.
however such violence does not include emotional violence or sexual
harassment and hence, if these are included, the prevalence may be
higher.
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130. Violence is a learned behavior:
- Men who experience abuse and neglect or have witnessed family
violence in their childhood are more likely to perpetrate intimate
partner violence.
- Studies also show that women who experience or have witnessed
family violence in their childhood are at increased risk of experiencing
intimate partner violence. The data suggest that violence is a learned
behavior.
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131. 10/7/2022
Norms must be changed:
• Norms that blame women for being raped must change and
perpetrators must be held accountable for their actions.
Norms must also make it unacceptable for men to abuse
power and dominate women
An exhibition “What she wore”
showing clothing of women and
girls who have experienced
sexual violence.
Women are never to blame.
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132. Role of health services in supporting females:
• Women who are abused are more likely to seek health services than those
who are not, even if they don’t openly reveal such violence. Therefore
health services are an important entry point for women experiencing
violence to access health care and to provide psychological support and
referrals that they need.
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133. VAW is preventable:
• Violence against women is preventable. Increasing evidence on what
works to prevent violence against women shows that we have 7
strategies which are important to end violence against women.
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134. 7 effective strategies for preventing
violence against women:
• R –relationship skills strengthened
• E –empowerment of women
• S –services ensured
• P –poverty reduced
• E –environments made safe
• C –child and adolescent abuse prevented
• T –transformed attitudes, beliefs, and norms
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