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Violence against women.

It may be the biggest human rights issue in the world - and it is certainly one of the least discussed. Yet increasingly, women are finding ways to fight the mutilation, rape, beating, and murder that have been their lot.


It is not a ritual that many people would expect much less want - to witness. Yet in the fall of 1994, the television network CNN brought the practice of female genital mutilation (FGM) into living rooms around the world, by broadcasting the amputation of a young Egyptian girl's clitoris. Coinciding with the United Nations International Conference on Population and Development in Cairo, the broadcast was one of several recent events that have galvanized efforts to combat the various forms of violence that threaten women and girls throughout the world. The experience suffered by 10-year-old Nagla Hamza focused international attention on the plight of the more than 100 million women and girls in Africa victimized by FGM. In doing so, it helped spur conference delegates into formulating an official "Programme of Action" that condemned FGM and outlined measures to eliminate the practice.

Euphemistically referred to as female circumcision, FGM encompasses a variety of practices ranging from excision, the partial or total removal of the clitoris and labia minora, to infibulation, in which all the external genitals are cut away and the area is restitched, leaving only a small opening for the passage of urine and menstrual blood. Nagla's mutilation, performed by a local barber without anesthesia or sanitary precautions, was typical. Although the physical and psychological consequences of FGM are severe and often life-threatening, the practice persists due to beliefs that emerged from ancient tribal customs but which have now come to be associated with certain major religions. In Israel, for instance, FGM is practiced by Jewish migrants from the Ethiopian Falasha community; elsewhere in Africa, it is found among Christian and Islamic populations. But FGM has no inherent association with any of these religions. Although some Islamic scholars consider it an important part of that religion, FGM actually predates Islam, and neither the Qur'an, the primary source for Islamic law, nor the Hadith, collections of the Prophet Mohammed's lessons, explicitly require the practice.

Justifications for FGM vary among the societies where it occurs (FGM is practiced in 28 African nations, as well as in scattered tribal communities in the Arabian Peninsula and various parts of South Asia). But most explanations relate in some way to male interest in controlling women's emotions and sexual behavior. One of the most common explanations is the need to lessen desire so women will preserve their virginity until marriage. The late Gad-Alhaq All Gad-Alhaq, Sheik of Cairo's al-Azhar Islamic University at the time of the CNN broadcast, explained it this way: the purpose of FGM is "to moderate sexual desire while saving womanly pleasures in order that women may enjoy their husbands." For Mimi Ramsey, an anti-FGM activist in the United States who was mutilated in her native Ethiopia at age six, FGM is meant to reinforce the power men have over women: "the reason for my mutilation is for a man to be able to control me, to make me a good wife." Today, migrants are bringing FGM out of its traditional societies and into Europe, North America, and Australia. Approximately 2 million girls are at risk each year.

As in other countries where the practice is commonplace, Egypt's official policy on FGM has been ambiguous. Although a Ministry of Health decree in 1959 prohibited health professionals and public hospitals from performing the procedure, and national law makes it a crime to permanently mutilate anyone, clitoridectomies and other forms of FGM are not explicitly prohibited. An estimated 80 percent of Egyptian women and girls, or more than 18 million people, have undergone some form of FGM, which is often carried out by barbers in street booths on the main squares of both small towns and large cities.

Before the CNN broadcast, Egyptian public opinion seemed to be turning against the practice. In early 1994, activists founded the Egyptian Task Force Against Female Genital Mutilation. Later that year, during the population conference, Population and Family Welfare Minister Maher Mahran vowed to delegates that "Egypt is going to work on the elimination of female genital mutilation." Plans were even laid for legislation that would outlaw FGM. But some members of Egypt's religious community saw the broadcast as a form of Western imperialism and used it to challenge both the secular government of Hosni Mubarak and the conference itself.

In October 1994, Sheik Gad-Alhaq ruled that FGM is a religious obligation for Muslims. The same month, Minister of Health Dr. Ali Abdel Fattah issued a decree permitting the practice in selected government hospitals. The Minister's directive came just 10 days after a committee of experts convened by him condemned FGM and denied that it had any religious justification. Fattah affirmed his personal opposition, but insisted that the decree was necessary to "save those victimized girls from being 'slaughtered' by unprofessionals."

In the wake of the Minister's decision, plans for the bill outlawing FGM were postponed. Contending that Fattah had effectively legalized the procedure, national and international nongovernmental organizations sought to reverse the decision through petition drives, public education initiatives, and lawsuits. And on October 17, 1995, Fattah reversed his decision, and the Ministry of Health once again banned FGM in public hospitals. The anti-FGM legislation, however, remains on hold.


Egypt's confused and ambivalent response to FGM mirrors in many ways the intensifying international debate on all forms of violence against women. And even though FGM itself may seem just a grotesque anomaly to people brought up in cultures where it isn't practiced, FGM is grounded m attitudes and assumptions that are, unfortunately, all too common. Throughout the world, women's inferior social status makes them vulnerable to abuse and denies them the financial and legal means necessary to improve their situations. Over the past decade, women's groups around the world have succeeded in showing how prevalent this problem is and how much violence it is causing - a major accomplishment, given the fact that the issue was not even mentioned during the first UN Women's Conference in 1975 or in the 1979 UN Convention on All Forms of Discrimination Against Women. But as the situation in Egypt demonstrates, effective policy responses remain elusive.

Violence stalks women throughout their lives, "from cradle to grave" - in the judgment of the Human Development Report 1995, the UN's annual assessment of social and economic progress around the world. Gender-specific violence is almost a cultural constant, both emerging from and reinforcing the social relationships that give men power over women. This is most obvious in the implicit acceptance, across cultures, of domestic violence - of a man's prerogative to beat his wife. Large-scale surveys in 10 countries, including Colombia, Canada, and the United States, estimate that as many as one-third of women have been physically assaulted by an intimate male partner. More limited studies report that rates of physical abuse among some groups in Latin America, Asia, and Africa may reach 60 percent or more.

Belying the oft-cited cliches about "family values," studies have shown that the biggest threat to women is domestic violence. In 1992, the Journal of the American Medical Association published a study that found that women in the United States are more likely to be assaulted, injured, raped, or murdered by a current or former male partner than by all other types of attackers combined. In Canada, a 1987 study showed that 62 percent of the women murdered in that year were killed by an intimate male partner. And in India, the husband or in-laws of a newly married woman may think it justified to murder her if they consider her dowry inadequate, so that a more lucrative match can be made. One popular method is to pour kerosene on the woman and set her on fire - hence the term "bride burning." One in four deaths among women aged 16 to 24 in the urban areas of Maharashtra state (including Bombay) is attributed to "accidental burns." About 5,000 "dowry deaths" occur in India every year, according to government estimates, and some observers think the number is actually much higher. Subhadra Chaturvedi, one of India's leading attorneys, puts the death toll at a minimum of 12,000 a year.

The preference for sons, common in many cultures, can lead to violence against female infants and even against female fetuses. In India, for example, a 1990 study of amniocentesis in a large Bombay hospital found that 95.5 percent of fetuses identified as female were aborted, compared with only a small percentage of male fetuses. (Amniocentesis involves the removal of a sample of amniotic fluid from the womb; this can be used to determine the baby's sex and the presence of certain inherited diseases.) Female infanticide is still practiced in rural areas of India; a 1992 study by Cornell University demographer Sabu George found that 58 percent of female infant deaths (19 of 33) within a 12-village region of Tamil Nadu state were due to infanticide. The problem is especially pronounced in China, where the imposition of the one-child-per-family rule has led to a precipitous decline in the number of girls: studies in 1987 and 1994 found a half-million fewer female infants in each of those years than would be expected, given the typical biological ratio of male to female births.

Women are also the primary victims of sexual crimes, which include sexual abuse, rape, and forced prostitution. Girls are the overwhelming target of child sexual assaults; in the United States, 78 percent of substantiated child sexual abuse cases involve girls. According to a 1994 World Bank study, Violence Against Women: The Hidden Health Burden, national surveys suggest that up to one-third of women in Norway, the United States, Canada, New Zealand, Barbados, and the Netherlands are sexually abused during childhood. Often very young children are the victims: a national study in the United States and studies in several Latin American cities indicate that 13 to 32 percent of abused girls are age 10 and under.

Rape haunts women throughout their lives, exposing them to unwanted pregnancy, disease, social stigma, and psychological trauma. In the United States, which has some of the best data on the problem, a 1993 review of rape studies suggests that between 14 and 20 percent of women will be victims of completed rapes during their lifetimes. In some cultures, a woman who has been raped is perceived as having violated the family honor, and she may be forced to marry her attacker or even killed. One study of female homicide in Alexandria, Egypt, for example, found that 47 percent of women murdered were killed by a family member following a rape.

In war, rape is often used as both a physical and psychological weapon. An investigation of recent conflicts in the former Yugoslavia, Peru, Kashmir, and Somalia by the international human rights group, Human Rights Watch, found that "rape of women civilians has been deployed as a tactical weapon to terrorize civilian communities or to achieve 'ethnic cleansing'." Studies suggest that tens of thousands of Muslim and Serbian women in Bosnia have been raped during the conflict there.

A growing number of women and girls, particularly in developing countries, are being forced into prostitution. Typically, girls from poor, remote villages are purchased outright from their families or lured away with promises of jobs or false marriage proposals. They are then taken to brothels, often in other countries, and forced to work there until they pay off their "debts" - a task that becomes almost impossible as the brothel owner charges them for clothes, food, medicine, and often even their own purchase price. According to Human Rights Watch, an estimated 20,000 to 30,000 Burmese girls and women currently work in brothels in Thailand; their ranks are now expanding by as many as 10,000 new recruits each year. Some 20,000 to 50,000 Nepalese girls are working in Indian brothels. As the fear of AIDS intensifies, customers are demanding ever younger prostitutes, and the age at which girls are being forced into prostitution is dropping; the average age of the Nepalese recruits, for example, declined from 14-16 years in the 1980s, to 10-14 years by 1994.


Whether it takes the form of enforced prostitution, rape, genital mutilation, or domestic abuse, gender-based violence is doing enormous damage both to the women who experience it, and to societies as a whole. Yet activists, health officials, and development agencies have only recently begun to quantify the problem's full costs. Currently, they are focusing on two particularly burdensome aspects of the violence: the health care costs, and the effects on economic productivity.

The most visible effects of violence are those associated with physical injuries that require medical care. FGM, for example, often causes severe health problems. Typically performed in unsterile environments by untrained midwives or barbers working without anesthesia, the procedure causes intense pain and can result in infection or death. Long-term effects include chronic pain, urine retention, abscesses, lack of sexual sensitivity, and depression. For the approximately 15 percent of mutilated women who have been infibulated, the health-related consequences are even worse. Not only must these women be cut and stitched repeatedly, on their wedding night and again with each childbirth, but sexual dysfunction and pain during intercourse are common. Infibulated women are also much more likely to have difficulties giving birth. Their labor often results, for instance, in vesico-vaginal fistulas - holes in the vaginal and rectal areas that cause continuous leakage of urine and feces. An estimated 1.5 to 2 million African women have fistulas, with some 50,000 to 100,000 new cases occurring annually. Infibulation also greatly increases the danger to the child during labor. A study of 33 infibulated women in delivery at Somalia's Benadir Hospital found that five of their babies died and 21 suffered oxygen deprivation.

Other forms of violence are taking a heavy toll as well. A 1994 national survey in Canada, for example, found that broken bones occurred in 12 percent of spousal assaults, and internal injuries and miscarriages in 10 percent. Long-term effects may be less obvious but they are often just as serious. In the United States, battered women are four to five times more likely than non-battered women to require psychiatric treatment and five times more likely to attempt suicide. And even these effects are just one part of a much broader legacy of misery. A large body of psychological literature has documented the erosion of self esteem, of social abilities, and of mental health in general, that often follows in the wake of violence. And the problem is compounded because violence tends to be cyclical: people who are abused tend to become abusers themselves. Whether it's through such direct abuse or indirectly, through the destruction of family life, violence against women tends to spill over into the next generation as violence against children.

Only a few studies have attempted to assign an actual dollar value to gender-based violence, but their findings suggest that the problem constitutes a substantial health care burden. In the United States, a 1991 study at a major health maintenance organization (a type of group medical practice) found that women who had been raped or beaten at any point in their lifetimes had medical costs two-and-a-half times higher during that year than women who had not been victimized. In the state of Pennsylvania, a health insurer study estimated that violence against women cost the health care system approximately $326.6 million in 1992. And in Canada, a 1995 study of violence against women, which examined not only medical costs, but also the value of community support services and lost work, put the annual cost to the country at Cdn $1.5 billion (US $1.1 billion).

One important consequence of violence is its effect on women's productivity. In its World Development Report 1993, the World Bank estimated that in advanced market economics, 19 percent of the total disease burden of women aged 15 to 44 - nearly one out of every five healthy days of life lost - can be linked to domestic violence or rape. (Violence against women is just as pervasive in developing countries, but because the incidence of disease is higher in those regions, it represents only 5 percent of their total disease burden.) Similarly, a 1993 study in the United States showed a correlation between violence and lower earnings. After controlling for other factors that affect income, the study found that women who have been abused earn 3 to 20 percent less each year than women who have not been abused, with the discrepancy depending on the type of sexual abuse experienced and the number of perpetrators.

Violence can also prevent women from participating in public life - a form of oppression that can cripple Third World development projects. Fear may keep women at home; for example, health workers in India have identified fear of rape as an impediment to their outreach efforts in rural sites. The general problem was acknowledged plainly in a UN report published in 1992, Battered Dreams: Violence Against Women as an Obstacle to Development. "Where violence keeps a woman from participating in a development project, force is used to deprive her of earnings, or fear of sexual assault prevents her from taking a job or attending a public function, development does not occur." Development efforts aimed at reducing fertility levels may also be affected, since gender-based violence, or the threat of it, may limit women's use of contraception. According to the 1994 World Bank study, a woman's contraceptive use often depends in large part on her partner's approval.

A recurrent motive in much of this violence is an interest in preventing women from gaining autonomy outside the home. Husbands may physically prevent their wives from attending development meetings, or they may intimidate them into not seeking employment or accepting promotions at work. The World Bank study relates a chilling example of the way in which violence can be used to control women's behavior: "In a particularly gruesome example of male backlash, a female leader of the highly successful government sponsored Women's Development Programme in Rajasthan, India, was recently gang raped [in her home in front of her husband] by male community members because they disapproved of her organizing efforts against child marriage." The men succeeded in disrupting the project by instilling fear in the local organizers.


"These women are holding back a silent scream so strong it could shake the earth." That is how Dr. Nahid Toubia, Executive Director of the U.S.-based anti-FGM organization RAINBO, described FGM victims when she testified at the 1993 Global Tribunal on Violations of Women's Human Rights. Yet her statement would apply just as well to the millions of women all over the world who have been victims of other forms of violence. Until recently, the problem of gender-based violence has remained largely invisible. Because the stigma attached to many forms of violence makes them difficult to discuss openly, and because violence typically occurs inside the home, accurate information on the magnitude of the problem has been extremely scarce. Governments, by claiming jurisdiction only over human rights abuses perpetrated in the public sphere by agents of the state, have reinforced this invisibility. Even human rights work has traditionally confined itself to the public sphere and largely ignored many of the abuses to which women are most vulnerable.

But today, the victims of violence are beginning to find their voices. Women's groups have won a place for "private sphere" violence on human rights agendas, and they are achieving important changes in both national laws and international conventions. The first major reform came in June 1993, at the UN Second World Conference on Human Rights in Vienna. In a drive leading up to the conference, activists collected almost half a million signatures from 124 countries on a petition insisting that the conference address gender violence. The result: for the first time, violence against women was recognized as an abuse of women's human rights, and nine paragraphs on "The equal status and human rights of women" were incorporated into the Vienna Declaration and Programme of Action.

More recently, 18 members of the Organization of American States have ratified the Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women. Many activists consider this convention, which went into effect on March 5, 1995, the strongest existing piece of international legislation in the field. And the Pan American Health Organization (PAHO) has become the first development agency to make a significant financial commitment to the issue. PAHO has received $4 million from Sweden, Norway, and the Netherlands, with the possibility of an additional $2.5 million from the Inter-American Development Bank, to conduct research on violence and establish support services for women in Latin America.

National governments are also drawing up legislation to combat various forms of gender violence. A growing number of countries, including South Africa, Israel, Argentina, the Bahamas, Australia, and the United States have all passed special domestic violence laws. Typically, these clarify the definition of domestic violence and strengthen protections available to the victims. In September 1994, India passed its "Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act," which outlaws the use of prenatal testing for sex-selection. India is also developing a program to eradicate female infanticide. FGM is being banned in a growing number of countries, too. At least nine European countries now prohibit the practice, as does Australia. In the United States, a bill criminalizing FGM was passed by the Senate in May, but had yet to become law. More significant, perhaps, is the African legislation: FGM is now illegal in both Ghana and Kenya.

It is true, of course, that laws don't necessarily translate into real-life changes. But it is possible that the movement to stop FGM will yield the first solid success in the struggle to make human rights a reality for women. Over the past decade, the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, an NGO dedicated to abolishing FGM, has set up committees in 25 African countries. And in March 1995, Ghana used its anti-FGM statute to arrest the parents and circumciser of an eight-year-old girl who was rushed to the hospital with excessive bleeding. In Burkina Faso, some circumcising midwives have been convicted under more general legislation. These are modest steps, perhaps, but legal precedent can be a powerful tool for reform.

In the United States, an important precedent is currently being set by a 19-year-old woman from the nation of Togo, in west Africa. Fleeing an arranged marriage and the ritual FGM that would accompany it, Fauziya Kasinga arrived in the United States seeking asylum in December 1994. She has spent much of the time since then in prison, and her request for asylum, denied by a lower court, is at the time of writing under appeal. People are eligible for asylum in the United States if they arc judged to have a reasonable fear of persecution due to their race, religion, nationality, political opinions, or membership in a social group. However, U.S. asylum law makes no explicit provision for gender-based violence. In 1993, Canada became the world's first country to make the threat of FGM grounds for granting refugee status.

Whichever way the decision on Kasinga's case goes, it will be adopted as a binding general precedent in U.S. immigration cases (barring the passage of federal legislation that reverses it). But even while her fate remains in doubt, Kasinga has already won an important moral victory. Her insistence on her right not to be mutilated - and on the moral obligation of others to shield her from violence if they can - has made the threat she faces a matter of conscience, of politics, and of policy. Given the accumulating evidence of how deeply gender-based violence infects our societies, in both the developing and the industrialized countries, we have little choice but to recognize it as the fundamental moral and economic challenge that it is.

Toni Nelson is a staff researcher at the Worldwatch Institute.
COPYRIGHT 1996 Worldwatch Institute
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Author:Nelson, Toni
Publication:World Watch
Date:Jul 1, 1996
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