The nature of women abuse and the effect of abuse on their quality of life

Authors Avatar

The nature of women abuse and the effect of abuse on their quality of life

CHAPTER 1

Introduction

1. Statement of the problem

Intimate partner abuse is a public worldwide health problem resulting in

negative mental and physical health outcomes for abused women. It occurs in all

countries and transcends social, economic, religious, and cultural groups

(Campbell & Humphreys, 1993; Campbell & Lewandowski, 1999, Carolyn,

2002; Center for Health and Gender Equity, 2002). World Health Organization

(1997) reported on domestic violence, highlighting its prevalence in 24 countries

with 20-50% of women being the victims in intimate partner abuse sometime in

their lives.

Intimate partner abuse during pregnancy is common. Studies have

shown that the prevalence of physical and sexual abuse during pregnancy ranges

from 3% to 8%, depending on the population surveyed and the number of

questions asked (Hedin, Grimstad, Moller, Schei & Janson, 1999; Muhajarine &

D’Arcy, 1999; Stewart & Cecutti, 1993). Pregnancy may indeed increase the risk

of abuse (Wester, Sweett & Stolz, 1994) while the pattern of abuse may alter

2

during pregnancy (Bohn, 1990). In a study by Gielen, O’Campo, Faden, Kass

and Xue (1994), moderate to severe violence was reported during the postpartum

period.

Intimate partner abuse during pregnancy and postnatal period threatens

maternal and child health because it directly and indirectly affects the mortality

and morbidity of both baby and mother. The adverse effects of violence against

women are well documented, including acute and chronic injuries (Brokaw,

Fullerton-Gleason, Olson, Crandall, McLaughlin & Sklar, 2002; Campbell, 1997;

Campbell, 1999; Campbell, Kub, Williams & Raphael, 1998; Campbell &

Soeken, 1999; Ellsberg, Pena, Herrera, Liljestrand & Winkvist, 1999;

Levendosky & Graham-Bermann, 2001; Plichta, 1996); and mental health

consequence such as low self-esteem, social isolation, depression, and increased

incidence of alcohol and drug abuse (Campbell, Kub, Belknap & Templin, 1997;

Golding, 1999; McCauley et al., 1995; Stark & Flitcraft, 1995). For pregnant

women, the adverse effects of intimate partner abuse is even more dire not only

affecting their health but also inducing low birth weight in infants and

compromising the woman’s ability to care for herself and her baby (McFarlane,

Parker, Soeken, 1996; Parker, McFarlane, & Soeken, 1994; Tang, 1997). In

economic terms, health care costs for abused women are likely to be higher due

3

to the need for emergency treatment, hospitalizations, general clinic and mental

health services as a result of the abuse (Wisner, Gilmer, Saltzman & Zink, 1999).

Thus, intimate partner abuse in pregnancy is an important health and social

concern that has implications for the woman, her baby and family, and the

society.

2. Background

Although intimate partner abuse is widespread worldwide, there has been

a lack of public awareness about this problem in Hong Kong until 1981, when

the Hong Kong Family Welfare Society, a non-governmental organization

(NGO), identified 60 cases of abused wives from their marital problem couples

(Yeung, 1991). In 1982, the Hong Kong Council of Women, another NGO, also

reported that about half of the 300 battered wives involved in a mini-study had

been repeatedly physically and emotionally abused by their intimate partners

(Yeung, 1991).

The total numbers of reported cases of abused women according to the

official statistics of the Social Welfare Department were 970, 1558, 2150 and

2433 in the year 1998 to 2001 respectively, showing an upward trend of abuse.

The most common type of abuse was physical and the least common was sexual

abuse (C. Sin, personal communication, April 16, 2002). With the increased rate

4

of intimate partner abuse in recent years, the number of shelters for battered

women has increased to meet the demand and a new one has just commenced

operation on March 25 2002.

The problem of intimate partner abuse has also received increased

attention from local researchers, as evidenced by a gradual proliferation of

research studies on the prevalence of women abuse (Leung, Leung, Lam & Ho,

1999; Tang, 1994, 1997); types of abuse (Tang, 1999b); pregnancy outcome

following domestic violence (Leung, Wong, Leung & Ho, 2000), validation of

instruments for spousal abuse (Tang, 1998); women’s responses to intimate

partner abuse (Tiwari, Wong & Ip, 2001); social construction of women as

legitimate victims of violence (Tang, Wong & Cheung, 2002) and study on the

definition of violence against women (Tang, Cheung, Chen & Sun, 2002).

The official statistics on domestic violence is likely to be under-reported,

when compared with research findings (Tang, 1999b). A number of factors may

have accounted for the under-reporting. One of the factors may be the cultural

values and beliefs of Chinese people. Traditionally, Chinese culture is patriarchal,

patrilineal, with a patrilocal family system (Tang, 1999b). Chinese people have a

high commitment to their family (filial piety) and strongly discourage disclosing

family problems to outsiders to avoid bringing shame on the family (Tsang,

5

1992). Thus, the patriarchal family structures oppress Chinese women and

sustain the violence against women. In addition, Chinese women are

traditionally socialized to be subservient, obedient and passive, and are

encouraged to endure the harsh hardship for the sake of their family and the

upbringing of the children. In a place such as Hong Kong, where Chinese values

are mixed with Western norms, the remnants of traditional values and beliefs

have been shown to persist in many Chinese societies despite Western influences

or socioeconomic changes (Cheung, 1996). Thus, it should not be assumed that

Chinese women in Hong Kong are free from the oppression of the traditional

cultural values against women.

3. Rationale for the study

In a recent study on the prevalence of intimate partner abuse in a group of

pregnant women attending antenatal clinics in a local hospital (Leung, Leung,

Lam & Ho, 1999), it was revealed that 113 out of 631 pregnant women had a

history of abuse by their intimate partners. While the study highlighted the

existence of intimate partner abuse among pregnant women, it did not further

explore the magnitude of the problem or the quality of life of abused women, the

latter was significant given its impact on the woman’s well-being and her ability

to care for herself and her newborn baby. In this study, the incidence and

nature of intimate partner abuse will be explored and the effects of abuse on the

6

women’s quality of life will be examined. It is intended that the findings of this

study will provide further understanding of intimate partner abuse in a Chinese

community.

4. The significance of the study

Although intimate partner abuse is not a new problem, there is a dearth of

such studies in H.K; and no existing study can be found on the quality of life of

abused women in the local context. In view of the paucity of local data and in

order to effectively address the problem, the present study is justified. It is

hoped that this exploratory study would provide empirical evidence to

professionals caring for abused women, so that a better understanding of the

problem may be achieved. In addition, better planning and service provision may

be given to pregnant abused women for their protection and the betterment of

their health.

5. Purpose of the study

5.1 To investigate the incidence and nature of intimate partner abuse in a

group of Chinese women in Hong Kong.

5.2 To identify the risk factors associated with intimate partner abuse.

5.3 To explore the effect of intimate partner abuse on the quality of life of

abused women.

7

6. Research questions

6.1 What are the incidence and nature of intimate partner abuse among

Chinese women?

6.2 What are the effects of intimate partner abuse on the women’s quality of

life?

7. Definition

In this study, intimate partner abuse is defined as a physical or sexual

assault or both by a spouse or sexual intimate with or without psychological

coercion (Campbell, 2002).

8

CHAPTER 2

Literature review

1. Definition of intimate partner abuse

The definition of intimate partner abuse is difficult to clearly define. Gelles

and Straus (1988) stated that there would never be an accepted or acceptable

definition of abuse because abuse is not a scientific or clinical term. Rather it is a

political concept. Gelles and Straus indicated that abuse is essentially any act that

is considered deviant or harmful by a group large enough or with sufficient

political power to enforce the definition. Murphy and Cascardi (1993) suggest that

abuse generally implies harmful intention and harmful or potentially harmful

effects of behaviour with connotation of excessive or exploitative expressions of

power or dominance within interpersonal and social contexts.

Intimate partner abuse hence comprises a wide range of behaviour and

diverse adult intimate relationships. It may be predominantly a harmful physical,

psychological, or sexual behaviour. Actually, intimate partner abuse not only

includes physical battery, verbal denigration, forced sexual activity, social

isolation and economic deprivation but also rape in the context of marriage

9

(Walker, 2000). It is also different from wife beating because beating may be a

single incident. It is often interchangeable with other terms like spouse abuse,

marital assault, and wife battering (Campbell & Fishwisk, 1993).

2. The prevalence of intimate partner abuse

2.1. The United States:

The prevalence of intimate partner abuse has been studied

extensively in Western countries. In The United States, a recent

population-based survey indicated that 30% of women have experienced

violence from an intimate partner during their lives, and that 53% to 63%

of these women had physical injury related to their abuse (Centers for

Disease Control, 1998). In another women health’s telephone survey study

on the prevalence of intimate partner abuse conducted from January to

July, 1995 (Centers for Disease and Control, 1998), 30% of the 3130

women interviewed reported that they had experienced partner abuse

during their lifetime, 6% reported they had experienced partner abuse in

the last year. The National Violence Against Women Survey in 1998

conducted by United States Justice Department estimated that 1.5 million

women were raped and/or physically assaulted by an intimate partner

annually in United States (United States Justice Department, 2000). Many

10

of the victims were usually victimized more than once, so the number of

intimate partner victimizations exceeded the number of intimate partner

victims annually, with 4.8 million intimate partner rapes and physical

assaults reported annually. These findings concluded that intimate partner

abuse is a serious criminal justice and public health concern (United States

Justice Department, 2000).

2.2 The United Kingdom

In The United Kingdom, the most comprehensive survey of intimate

partner abuse was done in 1996 (The British Crime Survey, 1996).

Mirrlees-Blank & Byron (2002) analyzed the above survey and concluded

that among a sample of 10,844 female respondents aged 16 to 59, 4.2% of

women had been physically assaulted by a current or former intimate

partner in the last year; 5.9% of women had experienced physical assault

and /or frightening threats; 23% of women had been physically assaulted

by a current or former intimate partner at some time in their lives. From

the result, it was estimated there were 6.6 million incidents of domestic

assault in 1995. On average, female victims were more likely to

experience repeated assault.

11

2.3 In Hong Kong

In Hong Kong, despite the increased attention given to intimate

partner abuse, there is a dearth of research on prevalence of intimate

partner abuse. As far as this investigator can deduce, there are only three

local studies on the prevalence of intimate partner abuse (Leung, Leung,

Lam & Ho, 1999; Tang, 1994, 1999). In a community survey of intimate

partner abuse in Hong Kong (Tang, 1999), 67.2% of the 1132 female

respondents reported experiencing at least one incident of verbal abuse

and 10% experienced at least one incident of physical abuse by their

intimate partners during the surveyed year. Minor physical violence was

reported to be seven times more common than severe physical violence

(9.8% against 1.4%).

The findings of the afore-mentioned studies suggest that the local

official statistics on intimate partner abuse are likely to be under-reported.

The recent reported cases of battered spouses according to the Central

Information System of Social Welfare Department are shown as follows

(Table 1 and Table 2):

12

Table 1.

Distribution of Battered Persons by Types of Battering

Type of Battering 1998 1999 2000 2001

Physical abuse

709 1358 1880 2067

Sexual abuse

5 1 10 10

Psychological abuse

59 67 61 51

Multiple abuse

236 253 370 305

Total

1009 1679 2321 2433

Note: From Central Information System on Battered Spouse Cases of Social Welfare

Department (C. Sin, personal communication, April 16, 2002).

Table 2.

Distribution of Battered Persons by Sex

Sex 1998 1999 2000 2001

Male 39 121 171 179

Female 970 1558 2150 2254

Total 1009 1679 2321 2433

Note: From Central Information System on Battered Spouse Cases of Social Welfare

Department (C. Sin, personal communication, April 16, 2002).

13

According to the Central Information System of Social Welfare

Department statistics on battered spouse cases, the trend of battered

spouses has been increasing throughout the year and has dramatically

increased to 2321 (2150 females and 171 males) in 2000 and was still

rising in 2001. The majority of the abuse is physical abuse and this has

remained unchanged from 1988 to 2001.

The occupancy rate in the local shelters for abused women also

supports the suggestion that there is under-reporting in the official

statistics, for example, the total numbers of women admitted into

Harmony house, a shelter for abused women, from 1/4/00 to 31/3/01 was

208. Within the same period, the total numbers of abused women referred

to the Social Welfare Department was only 70.

The difference between the shelter and official statistics is obvious.

The underreporting may be due to society, police, or judges ignoring acts

of violence between couples, or treating violence as a private matter not

deserving jurisdiction in the public sphere of law (Wong, 1986). The

under-reporting may also be due to cultural factors in that the Chinese

culture places women in a subservient position while condoning wife

14

abuse (Rimonte, 1991; Tang, 1998). Further, the stigma associated with

separation, divorce, and breaking up the family in a Chinese society

presents further social obstacles faced by women. Hence, fear of financial

dependence, having to testify against their spouse in court, and being held

responsible for having a spouse incarcerated encourages the women to

tolerate their abuser and not to report their circumstances to protective

services (Fong & Mulvey, 1991), thus accounting partly for the

under-reporting of intimate partner abuse.

2.4 Prevalence of intimate partner abuse in pregnant women

Intimate partner abuse in pregnancy is not uncommon. A review of

thirteen research studies has shown that the prevalence of violence during

pregnancy range from 0.9% to 20.1% (Gazmararian et al, 1996). In a

survey conducted in the antenatal clinic of a local teaching hospital from

11th August to 3rd November 1998 (Leung, Leung, Lam & Ho, 1999),

15.7% of the 631 pregnant women participating in the research reported

that they had been abused during their current pregnancy and 9.4% had

been sexually abused during the past year. The nature of violence was

limited to threats of abuse and no physical injury was reported. The few

available local studies suggest that intimate partner abuse in Hong Kong is

15

predominantly verbal. Compared with Western studies, the nature of the

abuse may appear to be less serious. However, as a recent study (Leung,

Kung, Lam, Leung & Ho, in press) reveals, women abused during

pregnancy were significantly more likely to develop postnatal depression.

Therefore, the effect of verbal abuse should not be under estimated.

3. Types of intimate partner abuse

According to McCue (1995), intimate partner abuse is classified into

emotional, physical, and sexual abuse. In many cases all three occur relationship;

however, in some cases however there may be only one kind of abuse and not

the others.

Emotional abuse has been described as psychological abuse,

non-physical abuse and verbal abuse. Emotional abuse is supposed to be always

accompanied by or occurs before physical abuse (Campbell, 2002). While it has

been recognized in recent years, emotional abuse is difficult to define as

compared to physical or sexual abuse, and what constitutes emotional abuse is

not easily determined (Gelles & Straus, 1988). To complicate matters further,

researchers have used different definitions for emotional abuse. For example,

Carden (1994) identifies emotional abuse as consisting of verbal or nonverbal

behaviour which is intended to isolate, humiliate, demean, or control a female

16

intimate partner. Gelles & Straus (1988) suggest that belittling, scorning,

ignoring, tearing down, harping, criticizing are all possible forms of emotional

abuse. Gelles & Strass (1988) suggest that emotional abuse is the same as the

brainwashing inflicted on prisoners of war. Tolman (1992) describes emotional

abuse as a graded sequence of behaviour, which includes withdrawing

momentarily, listening empathetically, speaking angrily and perversely, and

causing severe psychological torment.

Psychological abuse among intimate partner abuse women has been

relatively understudied (Street & Arias, 2001). Gelles and Straus (1988)

suggest that it is perhaps the most hidden, insidious and damaging form of

Join now!

abuse. Walker (1979) also found that most of the abused women in her study

described the incidents of psychological abuse as their worst abuse experiences.

McCue (1995) stresses that targeted or repeated emotional abuse can severely

affect the victim’s sense of self and reality and result in psychological distress.

Sexual abuse involves forcing an intimate partner, through the use of

verbal or physical threats, to participate in sexual activities against the person’s

will (Carden, 1994; McCue, 1995). Forms of sexual abuse are commonly a part

of violence in the home and may happen with other forms of abuse (Campbell,

2002). ...

This is a preview of the whole essay