Our Bodies, Ourselves (147 page)

As consumers of health care services, we should be able to determine for ourselves if the treatments we are receiving are safe and effective, what our care will cost, whether our care providers are competent, and whether the settings in which we receive care adhere to best practices and reliably protect patient safety. Transparency exists when the information we need to make these determinations is easy to access and understand.

Hospitals and insurers collect and report extraordinary amounts of data about the costs, processes, and outcomes of care. For instance, hospitals track their cesarean section rates, rates
of various complications of hysterectomy and other gynecological surgeries, incidence of infections, and costs of services. Unfortunately, few hospitals report these data to the public. Recent health care reform legislation has mandated even more data collection, and future widespread adoption of electronic health records will enable collection and analysis.

Increasingly, the federal government is reporting hospital quality and cost data in ways that are useful and meaningful to consumers. Medicare's online “Hospital Compare” tool (hospital compare.hhs.gov), for example, allows patients to compare some quality of care and patient satisfaction measures for nearby hospitals, but most of the data reported come from Medicare payments, so data pertaining to many reproductive and sexual health issues such as family planning, cancers that affect younger women, and pregnancy and birth remain inaccessible, since Medicare plays a minor role in funding these services. Until federal or state governments prioritize the public reporting of costs and outcomes of all types of health care, consumer advocates are filling in the gap by tracking down data themselves or using Freedom of Information Act requests to obtain the data, then making them available to other consumers.

Major Forces Affecting Women's Sexuality and Reproductive Health

CHAPTER 24
Violence Against Women

V
iolence against women is pervasive in the United States and around the world. Often the violence comes from those closest to us. Almost one in every four women in the United States has been raped and/or physically assaulted by a current or former spouse, live-in partner, boyfriend, or date; young women, low-income women, women of color, immigrant and elderly women, and women with disabilities are disproportionately affected.
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On average, more than three women are murdered by husbands or boyfriends every day in the United States.
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Even greater numbers of women experience verbal and emotional abuse–from partners, family members, or caregivers, for example–that may inflict less immediate physical harm but nonetheless leaves lasting scars.

The World Health Organization recognizes sexual violence, intimate-partner violence, and other abuse of women and children as public health problems of epidemic proportions.
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The United Nations has repeatedly called for the “elimination of all forms of violence against women.” The International Criminal Court in The Hague has recognized rape used in war as a war crime. And in the United States and many other countries, law enforcement agencies increasingly provide specialized training for officers dealing with abuse situations. Yet violence against women is so woven into the fabric of acceptable behavior that many of us who experience violence feel that we are at fault or have no right to complain about violent treatment.

The vast majority of violence against both men and women is inflicted by men.
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They may feel justified by strong societal messages that say rape, battering, sexual harassment, child abuse, and other forms of violence are acceptable, or at least understandable. Every day we see images of male violence against women in the news and in advertising, and in all forms of entertainment media. The prevalence of these images makes it appear that violence against women is simply an accepted fact of life.

There were eight of us girls pre-partying at a friend's house in our early twenties. I'm not sure how we got to this point in the discussion, but someone asked, “How many of us here have been a part of sexual abuse or violence?” To my surprise, seven of the eight girls raised their hands. I don't know why I was surprised, since I was one of the seven, but this moment is forever burned in my mind.

In the broadest sense, violence against women is any assault on a woman's body, physical integrity, or freedom of movement inflicted by an individual or through societal oppression. It includes physical, verbal, and emotional and also abuse, rape, sexual assault, murder by a partner or spouse, “honor” killings by a family member (for sexual activity or identity that “dishonors” the family), forced sterilization, female genital cutting, stalking, sexual coercion in the workplace, preparing women and girls for prostitution through rape and psychological manipulation, and trafficking of women and girls.

Every form of violence limits our ability to make choices about our lives. Sexual violence is particularly insidious because sexual acts are ordinarily and rightly a source of pleasure and loving human contact. Persistent cultural images linking sex with violence have caused violence itself sometimes to be seen as sexual or erotic.

Historically, violence against women and children has been hidden under a cloak of silence and tolerance. Four decades of feminist activism and the rise of a movement against domestic violence have resulted in greater awareness. The health care and justice professions are more likely to acknowledge the problem and to respond more effectively but they still have a long way to go. We must continue to be outspoken about the ongoing need to address the violence in women's lives.

One man's act of violence against a woman may seem to result from individual psychological problems, or from sexual frustration, childhood abuse, unbearable life pressures, or drug or alcohol abuse. All these factors may contribute to the dynamic of violence. But these reasons, often given to explain or even justify violent actions, oversimplify a complex reality.

Violence against women is about power and coercive control exerted over another person in the context of a relationship, culture, or social and institutional system (for example, intimate
partner, parent/child, employer/employee, teacher/student). The power to exert such coercive control is rooted in the power imbalances that exist between men and women. The U.S. culture—like most other cultures in the world—assigns a superior position to men and an inferior or dependent position to women. Most people have been taught to relate to the world in terms of dominance and control, and men in particular have been taught that violence is an acceptable method of maintaining control, resolving conflicts, and expressing anger.

Reprinted with permission of Peace At Home (peaceathome.com)

The Power and Control Wheel, developed by the Domestic Abuse Intervention Project of Duluth, Minnesota, is one model for understanding the dynamics of violence and abuse.

When rapists select their victims or bosses sexually harass employees, they act out of a wish to control or punish. When images in the media present women only in terms of bodies and sexuality, this hypersexualizing can be understood as a means of limiting and controlling women through presenting and valuing them only as sexual objects. When a batterer uses beatings or the threat of harm to coerce a partner, confine her to the home, prevent her from seeing friends and family, and/or keep her from pursuing outside work, the abuser is exerting dominance and coercive control.

Little by little, he isolated me from my friends, he convinced me to quit working, he complained about how I kept the house, he kept track of the mileage on the car to make sure that I wasn't going anywhere. Eventually, when the beatings were regular and severe, I had no one to turn to.

A young woman who was tackled by a boy at her high school describes her experience:

He pinned me down, and then sat on me in such a way that his genitalia were rubbing against my face and called me a bitch while the people watching laughed. I reported the incident about a month ago, and the school has yet to do anything about it, probably due to the fact that he is very well liked amongst staff and other students.

On the surface, it may seem that men benefit from male dominance, control, and violence. On a deeper level, men's violence against women harms men, too, not only because it harms the women and girls in their lives but also because it keeps men from having positive and loving relationships with their partners, daughters, mothers, and sisters. Growing numbers of men are recognizing this and working with women to stop the violence.

While violence is often targeted toward us simply because we are women, some factors put particular women at greater risk. Women of color; older women; young women; women without legal immigration status; refugees; lesbians;
poor women; women who are transsexual, are transgender, or otherwise identify as gender nonconforming; and women with disabilities are especially likely to encounter violence. Violence against women may occur alongside other hate-based violence aimed at a particular race, nationality, or religion.