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Donohoe MT. Individual and societal forms of violence against women in the United States and
the developing world: an overview. Curr Women’s Hlth Reports 2002;2(5):313-319.
Individual and Societal Forms of Violence Against Women in the United States and the
Developing World: An Overview
Abstract
This paper describes the epidemiology and management of partner abuse and sexual
assault in the United States, and discusses common forms of individual violence against women
in the developing world, such as female genital mutilation and other legal and cultural customs
which physically harm women. This paper also describes societal violence against women,
structural forms of discrimination or depravation that effect women as a class. After an overview
of the historical subjugation of women, it discusses the epidemiology of teen pregnancy and
single-motherhood in the U.S., access to abortion services in the U.S. and abroad, national and
global work and income inequalities between men and women, gender-based sexual harassment,
and human rights abuses.
Keywords: violence against women; female genital mutilation; teen pregnancy; single
motherhood; abortion; sexual harrassment
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Individual and Societal Forms of Violence Against Women in the United States and the
Developing World: An Overview
Introduction
This paper reviews individual and societal forms of violence against women that occur in
the United States and throughout the world. Its purpose is to assist readers in recognizing and
managing these phenomena, and to encourage them to advocate locally and nationally for
solutions to public health and human rights issues facing women worldwide. The incorporation
of societal and structural forms of violence against women into the medical curriculum, to
compliment current curricular offerings on domestic violence/partner abuse, would likely
enhance the willingness and abilities of health professionals to become more active in clinical
work, research, and public policy in women’s health.
Heise et al. [1] have divided violence against women into individual and societal forms
(Table 1). Individual violence against women is defined as any act of verbal or physical force,
coercion, or life-threatening depravation that causes physical or psychological harm, humiliation,
or arbitrary depravation of liberty, or that perpetuates female subordination[1]. Examples of this
include partner abuse, sexual assault (including marital rape), forced prostitution, forced noncompliance with contraception, female genital mutilation, and sex slavery. Societal violence
against women is defined as structural forms of discrimination or depravation that effect women
as a class[1]. Examples of this include excess poverty, impaired access to employment or
education, divorce restrictions, salary inequalities, political marginalization, and impaired access
to reproductive health services.
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Individual Violence Against Women
Partner abuse and Sexual Assault in the United States
The following briefly discusses the epidemiology and management of partner abuse and
sexual assault in the U.S., as a prelude to a discussion of the broader scope of the problem of
violence against women worldwide. More detailed discussions of domestic violence and rape
can be found elsewhere.
Domestic violence is seen in all age, race, and socioeconomic brackets.[2] Estimates of
the lifetime prevalence of assault and sexual abuse range from 15 to 25%.[3-5] Each year, two to
four million women are assaulted, and every fifteen seconds a woman is beaten.[4] Annual
incidence of one or more episodes of intimate partner violence is 17%.[6] The estimated
incidence of abuse in pregnancy ranges from 8 to 20%.[7-10] Fifty to 70% of mothers of abused
children have been abused themselves.[11] Over one-half of women murdered in the United
States are killed by a current or former partner, and one-half to three-quarters of the 1000 to 1500
murder-suicides per year involve domestic violence.[5, 12] Child abuse is seen in one third to
one half of families where partner abuse occurs.[13]
Rape, defined as unwanted, forced penetration, either orally, vaginally, or anally, is
reported by 33 to 46 % of women who are physically abused.[5] Annual incidence is greater
than 80 per 100,000 women and lifetime prevalence may reach as high as 25%, since rape is a
very under-reported crime. Spousal rape occurs in up to 10 to 15% of all marriages and tends to
be more violent and less frequently reported than non-spousal rape.[5] It is not illegal in many
U.S. states and other countries. Rape results in a 25% chance of pregnancy, up to a one in four
chance of acquiring a sexually transmitted disease (rates of gonorrhea are 6-12%, chlamydia 417%, and syphilis 0.5-3%), and a one to two per thousand odds of acquiring HIV (depending on
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the nature of the forced sex, infectivity of the perpetrator, and presence of erosions or sores on
the victim or rapist)[14].
Physical sequelae of partner abuse include trauma, chronic pain, eating and sleeping
disorders, sexually transmitted diseases, irritable bowel syndrome,[15] and a delayed risk of
hypertension, arthritis, and heart disease.[5] Victims of domestic violence have a five-fold
increased risk of developing a psychiatric disorder; 10% of domestic violence victims attempt
suicide.[5] Rape victims show a much higher prevalence of alcoholism and drug abuse than the
general population, with the substance abuse beginning after the rape. Early psychological
sequelae of rape include withdrawal, confusion, psychological numbing, a sense of
vulnerability/hopelessness/loss/betrayal, shock, denial, and distrust of others. Long-term
psychological outcomes include depression, anxiety disorders, phobias, anorexia/bulimia,
substance abuse, and post-traumatic stress disorder.[14]
Health care providers should make routine, repeated assessments of women for domestic
violence in all clinical settings; maintain a supportive, non-judgmental attitude; avoid victimblaming; validate the woman's experiences, building on her strengths, and transferring power and
control to her; be available, providing frequent follow-up; and involve social services. They
should discover the nature and duration of the abuse; assess for child abuse and insure children's
safety by following mandated reporting laws; keep detailed records, including photographs;
testify in court as needed; and not recommend marriage counseling.[5, 16] Practitioners should
insure the victim's safety, assist her in obtaining a restraining order, provide her with phone
numbers of shelters and hot lines, and help her develop a plan for a quick exit, including a safe
place to go. Patients should have important items (such as drivers license, birth certificate, credit
cards and documents related to their childrens’ health) handy in case a rapid exit is required.
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In caring for victims of sexual assault, providers should obtain a full medical history,
evaluate and treat physical injuries, obtain cultures, treat pre-existing infections, offer postexposure human immunodeficiency virus prophylaxis and post-coital contraception (versus in
utero paternity testing followed by selective abortion for those who might already be pregnant),
[17] arrange medical follow up, and provide counseling.[14]
Screening practices of primary care providers vary, but on the whole physicians
frequently fail to recognize violence against women.[18] This results from fears of offending,
feelings of powerlessness, time constraints, a low confidence in their ability to affect change, a
sense of their own vulnerability, and deficits in education and training. Doctors frequently
underestimate the prevalence of domestic violence in their patients and communities.
Compassionate asking and trust building are useful in getting patients to discuss abuse.[19]
Regrettably, the availability of domestic violence shelters in the United States is poor,
with up to 70% to 80% of women and 80% of children turned away on any given night in major
cities.[13] Shelters are woefully under-funded. Average length of stay at a US shelter is fourteen
days; most allow a thirty day maximum stay. Over 50% of all homeless women and children
become homeless as a direct result of fleeing domestic violence.
Individual Violence Against Women in the Developing World
As in the U.S., women in the developing world suffer verbal, emotional, physical and
sexual abuse. Worldwide at least one woman in three has been beaten, forced into sex, or
otherwise abused in her lifetime.[1] In countries such as Bangladesh, Cambodia, Mexico and
Zimbabwe, many see wife-beating as justified. In rural Egypt, up to 81% of women say that
wife-beating is justified under certain circumstances.[1] In the developing world, resources for
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victims are often extremely limited. For example, Mexico City, the most heavily populated city
in the world, has only one shelter for battered women.[20]
Other types of individual violence against women noted more frequently in the
developing world than in the U.S., include dowry-related murder, bride-burning, forced abortion
and sterilization, divorce restrictions, forced prostitution, and child prostitution. Even so, an
estimated 300,000 children under age 18 work in the sex trade in North American; their
exploitation fuels a $7 billion-a-year industry.[21] One to two million women and girls are being
trafficked annually around the world for the purposes of forced labor, forced prostitution, servile
domestic labor, or involuntary marriage.[21] Selective abortion, malnutrition, and killing of
female children is not uncommon, and may account for the ratio of male to female births in
China being 1.1:1.0, and for higher infant mortality rates among girls in numerous poorer
nations.[22] Some women use suicide as “vengeance” against an abusive spouse. Others commit
post-rape suicide or are killed by friends or relatives to “cleanse the family honor” after a rape.
These types of killings constitute 47% of homicides in Alexandria, Egypt.[1]
South Africa has recently suffered a “rape epidemic”.[23] Their official rape rate is 104
per 100,000 people (versus 34 per 100,000 in the U.S.), the highest rate in the world. An
estimated 50,000 rapes occur annually, but only 1 in 35 are reported. Victims are at high risk of
acquiring HIV infection, due to rates of infection of up to 40% in young adult males and because
of the poor availability of post-rape antiretroviral drugs in government hospitals.[23]
Other disturbing phenomena include sex slavery at animist shrines in Ghana, Benin and
Togo;[24] the widespread belief in some parts of sub-Saharan Africa that having sex with a
virgin cures HIV infection; and physicians’ performance of virginity exams to certify women as
pure and “marry-able,” which occurs in Turkey and elsewhere.[25]
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Female Genital Mutilation
Female genital mutilation ranges from simple clitoridectomy to infibulation (removal of
the clitoris and labia minora, stitching the labia majora together, and leaving a small opening
posteriorly for urine and menstrual blood); the most extreme forms constitute a surgical “chastity
belt”.[26] This practice should not be called “female circumcision”, as the male equivalent of
clitoridectomy would be penectomy. Female genital mutilation represents the cultural control of
women’s sexual pleasure and reproductive capabilities. Mutilation procedures were formerly
used in the U.S. and the United Kingdom as treatments for hysteria (“floating womb”), epilepsy,
melancholy, lesbianism, and excessive masturbation.
Worldwide, one hundred million women, most in sub-Saharan Africa, have been affected
by female genital mutilation.[26] These women are found across all socioeconomic strata and in
all major religions. Two million girls are mutilated per year. Operations are most commonly
carried out on young girls between ages four and ten; physicians perform about 12% of
procedures.[27] Cutting is often done under non-sterile conditions and without anesthesia.
Complications and sequelae include bleeding, infection, dyspareunia, painful neuromas, keloids,
dysmenorrhea, infertility, decreased sexual responsiveness, shame, fear, and depression.[27]
Physicians managing those who have suffered genital mutilation need to be sensitive to cultural
identity issues and aware of the availability of deinfibulation procedures.[26]
The United Nations, World Health Organization, and Federation International
Gynecology and Obstetrics (FIGO) have all condemned female genital mutilation.[26] It is
illegal to perform it in the U.S. under child abuse statutes. Some have called this prohibition
“cultural imperialism”; others note that we have outlawed other coercive and abusive “cultural
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practices”, including slavery, polygamy, child labor, and the denial of appropriate, life-saving
medical care to sick children.[28] Immigrant women who fear that they are likely to face a
forced operation upon return to their countries of origin have successfully petitioned for political
asylum.
Societal/Structural Violence Against Women
Societal violence against women involves economic, legal, political, and educational
structures; repressive, entrenched belief systems; and social phenomena that deny women basic
human rights and/or impede women’s abilities to achieve their full potentials.[1] After a brief
review of the historical subjugation of women and ideals of beauty, I will focus on teen
pregnancy and single motherhood, impaired access to abortion services, economic
marginalization, and gender-based harassment.
The Historical Subjugation of Women and Ideals of Beauty
Most of human history has been marked by the subjugation and marginalization of
women. Examples include witch trials and burnings at the stake in the Middle Ages (and later in
Salem, Massachusetts); the Chamberlin family’s hoarding of its invention of the obstetrical
forceps, motivated by profit and the desire for fame; and J. Marion Sims’ early operative
gynecologic surgeries on slaves, performed without anesthesia.[29] These examples can be
contrasted with the relatively rapid acceptance of chloroform for obstetrical anesthesia, after its
introduction for other surgical procedures, mostly due to its use by Queen Victoria and its
promotion by Charles Darwin and Charles Dickens.[30]
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Many historical ideals of beauty have been dangerous and/or have involved the
subjugation of women [31]. These include the ancient Greek practice of wrapping newborn baby
girls’ heads; Roman and Persian women’s applying antimony to make their conjunctivae sparkle;
the use of belladonna eyedrops by sixteenth and seventeenth century women to dilate their pupils
and make their eyes appear doe-like; the Elizabethan era practice of hair plucking and the use of
lead-based ceruce makeup; Chinese foot binding, which causes pain and puts women at high risk
of osteoporosis, falls, and balance problems;[32] and the longstanding practice of corseting.
More recent examples include breast implants, available since 1903; tapeworms to cause
malabsorption and promote weight loss, employed by opera singer Maria Callas; 11th and 12th rib
removals; botulinum toxin injections; and liposuction.[31, 33] Today plastic surgeons perform
more than one million cosmetic procedures annually, a 153% increase over last decade’s
rates.[34]
Certainly today most women freely opt for these appearance-altering interventions, yet
they are motivated by societal norms promoted by a media which values appearance over
character, style over substance.[34] Women who have been sexually abused report more body
dissatisfaction and self-consciousness, and may opt for cosmetic procedures more often than
those without a sexual abuse history.[35] Regrettably, today only 29% of teens state that they are
“happy with the way I am.”[36] Sixty percent of girls in grades 9 through 12 are trying to lose
weight (compared to 24% of boys), and 5% to 10% of females over age 18 have an eating
disorder.[37] Girls who diet are at increased risk of smoking initiation;[38] many see smoking as
a helpful weight loss aid.
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Teen Pregnancy
Greater than 50% of high school-age adolescents are sexually active; average age at first
intercourse is 17 for girls and 16 for boys [39, 40]. Current birth rates to girls age 15 to 19 are 55
per 1,000 per year; these have gradually decreased since 1960.[39, 40] Up to two-thirds of
adolescents use condoms, three times as many as did so in the 1970s. Nevertheless, the U.S. has
rates of teen pregnancy which are three to ten times higher than those among the industrialized
nations of Western Europe.[41] U.S. teen poverty rates are higher by a similar magnitude.[42]
Six out of seven U.S. teen births are to the 40% of girls living at or below the poverty level.
Two-thirds of teen mothers were raped or abused as children.[42]
The role of adult males in teen pregnancy is under-recognized. In California in 1993,
71% of teen pregnancies (for whom a father was reported) were fathered by adult men with an
average age of 22.6 years, or five years older than the mothers.[42] More births were fathered by
men over 25 than by boys under 18. Sexually transmitted disease and acquired
immunodeficiency syndrome rates among teenage girls were two to four times higher than
among age-matched teenage boys; instead, teenage girls’ rates were closer to adult male
rates.[42] Statutory rape, in which adult perpetrators or boyfriends have sexual intercourse with
underage girls, is infrequently reported by providers, who cite as reasons the appearance of
consensual “adult relationships”, a lack of confidence in the criminal justice system,
confidentiality, fear of deterring patients from seeking health care and social services follow-up,
and the risk of physical retaliation.[11] States are evenly split on whether or not mandated
reporting is required.[43]
Only 8 % of U.S. high schools provide condoms, despite the fact that promotion and
distribution of condoms does not increase teen sexual activity.[44, 45] Many health plans fail to
10
cover all contraceptive methods, even though all methods are more effective and less costly than
no method.[46] Many fewer plans cover abortion than cover sterilization, leaving poor women in
the unenviable position of having to choose sterilization if they lack the resources for adequate
contraception or for an abortion (which may become necessary even when accepted
contraceptive methods are used as directed).[47] On a positive note, the U.S. House of
Representatives recently voted to reinstate the contraceptive coverage for federal employees that
President Bush has omitted in his 2002 budget proposal.[48]
The availability of emergency contraception should help further decrease teen
pregnancy rates. However, some Catholic hospitals prohibit discussion of emergency
contraception, even with rape victims.[49] Unfortunately, recent so-called “Welfare Reform”
legislation allocated to states fifty million dollars over five years to teach abstinence, rather than
to provide contraceptives.[50]
The vast majority of sex education programs in the U.S. do not affect teenage
behavior in any substantial way.[51] They neither promote more sexual activity, nor do they
significantly reduce unprotected sex. The few programs that do work give teenagers a clear and
narrow message – delay having sex, but if you have sex, always use a condom. Good programs
also teach teens how to resist peer pressure.[51]
Single-Motherhood
Twenty-one percent of U.S. children currently live in solo-mother families. Of white
children born since 1980, 50% will spend some part of their childhood in a single parent family,
compared with 80% of African-American children. The current U.S. divorce rate is just under
50% [52]. Over 50% of children in solo-mother families live below the poverty line.[53] On
11
average, children from single parent families show poorer school performance, a higher risk of
teen pregnancy, increased rates of delinquency, and decreased overall mental health.[53]
Fifty percent of mothers of preschoolers and 70% of mothers of school age children work
outside the home. One-half of working mothers’ children are cared for by relatives, threeeighths are in family day care, and one-eighth are in day care centers, many of which are poorly
regulated and experience high worker turnover. The U.S. is one of the only industrialized
countries without paid maternity leave and health benefits guaranteed by law. The Family and
Medical Leave Act of 1993 guarantees only unpaid leave, and only to individuals from
establishments employing at least fifty workers.[54] Forty-four percent of working women are
ineligible, and low-wage workers are disproportionately excluded.
Access to Pregnancy Care
Many women each access to comprehensive prenatal and obstetrical care. Almost
600,000 women die each year from complications related to pregnancy and childbirth, nearly
99% of them in developing nations.[55] About one-quarter of pregnant women experience a
serious complication during labor or at delivery, including excessive bleeding, infection, and preeclampsia.[55] The U.S. lags behind most of the industrial world in infant mortality, due in large
part to lack of universal access to health insurance.[56]
Access to Abortion Services
Since abortion was legalized in 1973, more than 30 million U.S. women have had this
procedure.[57] Between 1.2 and 1.4 million abortions are performed in the U.S., a rate of 20
abortions per 1000 fertile women per year.[57] There are 314 induced abortions for every 1000
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recognized pregnancies.[58] Forty-eight percent of those obtaining abortions are over age 25,
59% white, 20% married, and 56% have children. By age 45, the average female will have had
1.4 unintended pregnancies; 43% will have had an induced abortion.[59] Fifty-eight percent of
women with unintended pregnancies get pregnant while using birth control.[57] This is not
surprising, given one year contraceptive failure rates ranging from 2 to 3% for IUDs, to 7% for
contraceptive pills, to 21% for periodic abstinence.[57]
Since the 1973 Roe vs. Wade decision legalizing abortion, various barriers have been
erected in the path of those seeking to obtain one. The Hyde Amendment of 1977 cut off
Medicaid funding for nearly all abortions. Before former President William Clinton took office,
discussion of abortion in federally funded health clinics was prohibited. Upon taking office,
current President George W. Bush reinstated the Mexico City Policy, a Reagan-era rule that bans
U.S. family planning aid to overseas groups[60] that provide abortions or abortion referrals, even
if they do so with private, non-U.S. funds.[59] Thirty-nine states have parental notification
laws,[61] which have led to a rise in late trimester abortions and to increased numbers of
abortions in neighboring states without such laws. Recently, the Bush Administration drafted a
policy that would let states define unborn children as persons eligible for medical coverage.[62]
In 1994, only 12% of Ob/Gyn residency programs required training in abortion methods,
down from 25% in 1985, even though only 10-15% of Ob/Gyn residents are morally opposed to
abortion.[63-65]. Today approximately one-third of medical schools teach something about
abortion, through mandatory coursework, elective classes, lectures, or Planned Parenthood
rotations, although no hard data exist on the percentage of students exposed and exactly what
they learn.[66] In the U.S., 86% of counties and 30% of metropolitan areas have no abortion
provider.[59] Abortions cost approximately $350; most patients pay out of pocket.[57] Only one
13
out of three patients has insurance coverage, and only one out of three insurance companies
cover the procedure after the deductible is met.[57] Often patients are reluctant to file claims due
to confidentiality concerns.
Other obstacles to abortion include bans on specific methods, mandated waiting periods,
spousal notification laws, regulation of abortion facility locations, and zoning ordinances
designed to keep abortion clinics from being built in certain areas.[67] Both patients and
providers face harassment by individuals and organized groups. Between 55% and 86% of
providers report harassment.[57] There were 166 violent incidents reported in 1997, including
seven arsons, eleven death threats, six assaults, 62 stalkings, 65 cases of vandalism, and one
attempted murder.[68] The availability of mifepristone (RU-486) for medical pregnancy
termination has the potential to improve women’s access to safe abortion.[69]
Worldwide there are 36 to 53 million abortions performed per year. Abortion on request
is permitted in only 22% of countries (6% of developing countries).[70] Although international
abortion laws are being slowly liberalized, one-third of the developing world lives where
abortion is prohibited, or allowed only in cases of rape or incest or to save the mother’s life.
Many procedures are performed illegally, outside the traditional health care system, which
explains in part why 70,000 women (8 per hour) die annually from abortions; these fatalities
constitute 13% of all maternal deaths.[57] One-quarter to one-half of maternal deaths in Latin
America are due to unsafe abortions. For every one abortion death, there are 30 infections or
injuries. In some countries, lack of access to contraception has been a bigger issue than lack of
access to abortion services.[57] The average number of lifetime abortions for a woman in Russia
is nine; it was 18 in Romania, prior to the fall of Communism.
14
Despite abortion foes’ arguments that having an abortion leads to irrevocable
psychological harm, most data suggest only a self-limited sense of loss and guilt and minimal to
no long-term emotional or psychological sequelae [71]. Indeed, women denied abortions often
experience resentment and distrust, and their children may face social and occupational
deficiencies.[72]
Education, Work and Income Inequalities
In the developing world, there exists a large gender gap in access to primary and
secondary education.[73] Fertility rates vary in inverse proportion to literacy rates. Women do
two-thirds of the world’s work, receive 10% of global income, and own only 1% of global
property.[74] Each year, an estimated 50,000 women are brought to the U.S. to work under
conditions of forced servitude; even so, the Justice Department has prosecuted only 250 cases in
the last 2 years involving such victims.[75] Women working full-time in the U.S. make $0.75 for
each $1.00 made by males; this ratio has remained essentially stagnant over the last 2
decades.[76] Today 53% of mothers return to work within one year of giving birth, two-thirds of
these full-time, up from 17% returning to work in 1976.[77] While women make up 46% of the
U.S. work force, they hold less than 2% of senior-level management positions in Fortune 500
companies.[76]
Nevertheless, from 1987 to 1999, the number of female-owned firms doubled to 9.1
million; the number of workers employed by these firms quadrupled, to 27.5 million, and sales of
these firms quadrupled, to 3.6 trillion dollars. The fastest growing fields of employment for
women are construction, wholesale trade, transportation, communications, agriculture and
manufacturing.[78]
15
Gender-Based Sexual Harassment
Sexual harassment occurs when there exists a quid pro quo, i.e. the threat or expectation
of inappropriate behavior in response to a woman’s actions, or if their exists a hostile work
environment.[79] Gender discrimination, psychological abuse, and sexual harassment are
reported by high percentages of medical students and residents.[80] In a recent study of U.S.
women physicians,[81] 48% of respondents had experienced gender-based harassment, and 37%
sexual harassment. Harassment was more common in medical school, than in internship and
residency, and more common in training than in practice. Higher rates were reported by
physician who were younger, divorced, or in historically male specialties. Lower rates were
reported by Asians, those satisfied with their careers, those in government jobs, and the
politically very conservative. Perceived gender bias by female academic physicians is associated
with lower career satisfaction.[82] After adjustment for work hours, practice type, and specialty,
female internists in one study still made 14% less than their male colleagues.[83] On the other
hand, Baker[84] found no difference in earnings among young male and female physicians with
similar practice characteristics, although older men and certain specialists did earn more than
their female colleagues. The Physician Work Life Study [85], however, found lower rates of pay
and higher burnout rates among female physicians.
It should be noted that while the Civil Rights Act of 1964 prohibits discrimination based
on race and sex, it does not prohibit discrimination based on sexual orientation, and hence this
still occurs, often overtly, in many settings.
16
Other International Forms of Structural Violence Against Women
Outside the United States, widespread violations of women’s rights occur through social,
legal, and political marginalization.[1] In Afghanistan, after the Taliban militia took over in
1996, human rights abuses were perpetrated primarily against women.[86] These included
gender-based violence, denial of access to education and health care, and limited opportunities
for employment. Female employment rates decreased from 62 % to 12%. Afghanistan’s
maternal mortality rate is among the world’s highest, and is likely to increase, at least in the short
term, as a consequence of the current war. Afghanistan ranks lowest on the United Nation’s
(U.N.’s) Development and Gender-Disparity Indices. The current interim government plans to
continue many Islamic law statutes which make it difficult for female victims of violence to
achieve justice and safety. In Pakistan, four witnesses are required for a rape conviction.[87]
Worldwide, including recently in the former Yugoslavia and in Chechnya, rape continues to be
used in war, for domination, humiliation, control, “soldierly bonding”, and ethnic cleansing; it is
often carried out in front of family members. It has been recognized as a War Crime since the
Nuremberg Trials.
Conclusions
Individual and societal violence against women remains common, both in the U.S. and
internationally. Societal violence often begets, or at least facilitates, individual violence.
Societal forms of violence are being increasingly seen as violations of basic human rights.[88]
Even so, the U.S. has still not signed the U.N.’s Convention on the Elimination of all Forms of
17
Discrimination Against Women,[89] nor the U.N.’s Convention on the Political Rights of
Women.[90]
Hopefully this brief overview will encourage educators to broaden the scope of health
professions education beyond domestic violence to include other national and international forms
of individual and structural violence against women. Curricular offerings should include a
historical perspective and cover the medical profession’s obligations and roles in combating
violence against women with their patients, in their institutions and communities, and in the
world-at-large. Ideally this essay will prompt practitioners and policy makers to become more
aware of inequities and injustices, to discuss these issues with their patients, colleagues and
students, and to lobby at the local, national and even global level for changes in law and policy to
protect victims and to improve the status of women.
18
Acknowledgements: The author gratefully acknowledges the excellent technical assistance of
Linda Ward, Betty Ward, Peggy Miner, Cari Gandrud, and Lynn San Juan.
19
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