Mental Health of Survivors of Domestic Violence in Rural Northern ...
Transcript of Mental Health of Survivors of Domestic Violence in Rural Northern ...
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Österreichische Forschungsstiftungfür Internationale Entwicklung
Die 1967 gegründete ÖFSE bietet seit Oktober 2009 ihre Dienstleistungen im C3 – Centrum für Internationale Entwicklung an. Sie steht für: Bibliothek, Information & Dokumentation Wissenschaft & Forschung (Politik-)Beratung Wissenschaftliche Publikationen Veranstaltungen zu aktuellen Themen Veranstaltungsräume im C3
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616161
Mental Health of Survivors of Domestic Violence in Rural Northern India.A Qualitative, Intersectional Approach
Edith Gahleitner
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61
Dezember 2015
Mental Health of Survivors of Domestic Violence in Rural Northern India.A Qualitative, Intersectional Approach
Edith Gahleitner
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1. Auflage 2015© Österreichische Forschungsstiftung für Internationale Entwicklung (ÖFSE)im C3 – Centrum für Internationale EntwicklungA-1090 Wien, Sensengasse 3, Telefon: (+43 1) 317 40 10, Fax: (+43 1) 317 40 10 – 150e-mail: [email protected], Internet: http://www.oefse.at, http://www.centrum3.atFür den Inhalt verantwortlich: Edith GahleitnerDruck: druck.at Südwind-Verlag ISBN: 978-3-902906-17-5
Bibliografische Information Der Deutschen NationalbibliothekDie Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie;detaillierte bibliografische Daten sind im Internet über http://dnb.ddb.de abrufbar.
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Vorwort
Die Arbeit von Edith Gahleitner ist auf den ersten Blick weder eine klassische Diplomarbeit zum Abschluss eines Medizinstudiums noch eine Arbeit, die ihre entwicklungspolitische Relevanz sofort erkennen lässt. Die Verknüpfung von psychischer Gesundheit und häusli-cher Gewalt sowie die Berücksichtigung der Lebensumstände der marginalisierten Frauen sowie der Bezug zu Strategien zur Implementierung der Förderung psychischer Gesund-heit bieten aber konkrete Perspektiven für den Gesundheitssektor in Nordindien. Gerade dieser interdisziplinäre Ansatz sowie die qualitativ sehr gute empirische Analyse machen die Arbeit nicht nur spannend, sondern untermauern deutlich, dass die Autorin die Situati-on der Frauen im Distrikt Kangra nicht nur sehr gut kennt, sondern dass sie mit ihrer Arbeit einen Beitrag zur Verbesserung der Situation leisten möchte.
Die Arbeit hat auch im Kontext mit dem Ziel drei der Sustainable Development Goals (SDGs) – nämlich „Ensure healthy lives and promote well-being for all at all ages” – beson-dere Relevanz. Folgt man dem Grundprinzip der SDGs „Leave no one behind”, dann sind Fragen nach den Folgen von häuslicher Gewalt und nach Marginalisierung aufgrund von psychischen Problemen relevante gesellschaftliche Fragen. Edith Gahleitners Analyse ist somit ein wichtiger Beitrag, der eine Brücke zwischen Medizin und Sozialwissenschaften herstellt und eine Grundlage für die Präventionsarbeit zur Vermeidung häuslicher Gewalt darstellt. Die Arbeit ist ebenso ein hervorragendes Beispiel für einen ganzheitlichen Ansatz im Bereich der kurativen Medizin und der Gesundheitsvorsorge.
Der Ausbildungsweg sowie die Forschungsaufenthalte der Autorin in Indien zeigen ein starkes persönliches Engagement, das mit dieser Diplomarbeit eine hervorragende wis-senschaftliche Basis erhalten hat.
Dr. Michael ObrovskyLeitung des Bereichs Wissenschaft & Forschung der ÖFSE
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Mental Health of Survivors of Domestic Violence in Rural Northern India.
A Qualitative, Intersectional Approach
Doktorin der gesamten Heilkunde
(Drin.med.univ.)
Medizinischen Universität Wien
Edith Gahleitner
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voiceless
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Acknowledgments
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Preface
Nishtha
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Abstract
Background
Objectives
Method
Results
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Zusammenfassung
Hintergrund:
Ziel
Methode
Ergebnisse
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Aims of the Study
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1 Introduction
1.1 Violence Against Women in India
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'Scheduled Castes'dalits
Scheduled Tribes
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1.1.1 Women's Life in the Context of Violence
prenatal sex determination tests
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son preference
Female infanticide
girls neglect
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pativrata4
sexual
harassment
Pativrata pati = , vrta =
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child marriages Dalit
kanyaadaan,
dowry harassment
dowry killings
Dalits harijans
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Domestic violence
Marital rape
Rape
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Nirbhaya's6
Nirbhaya
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Badaun8
devadasis9
Human trafficking
femicide
Badaun
Devadasidevadasi
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Honour killing
female genital mutilation
Khatna
haraam ki boti
Acid throwing
Violence against widows or elderly women
sati
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Sati
sati
1.1.2 Legal Aspects
against
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The Protection of Women
from Domestic Violence Act , 2005.
The Criminal Law
(Amendment) Act, 2013
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The Sexual Harassment of Women at Workplace (Prevention, Prohibition and
Redressal) Act , 2013,
The
Scheduled Castes and The Scheduled Tribes (Prevention of Antrocities) Amendment
Ordinance, 2014
Underreporting of violence
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1.1.3 Medical Aspects
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1.2 Community Mental Health in India
The Lancet
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1.2.1 Gender and Women's Mental Health
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'the'
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2 Material and Methods
2.1 Qualitative Research
‐
2.2 Study Site
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Gaddi
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Nishtha Rural Health, Education and Environment
Centre13 Jagori Grameen14
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Nishtha Rural Health, Education and Environment Centre
gram
panchayats15
'Panchayat'
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Jagori Grameen's
2.3 Sampling Methods
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anganwaadi
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2.4 Interviews
World Health Organization Multi-
Country Study on Women's Health and Domestic Violence
Gaddi
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2.5 Participant Observation
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Nishtha Rural Health, Education and
Environment Centre
2.6 Data Analysis
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2.7 Ethical Considerations
"The safety of respondents and the research team is paramount, and should infuse all
project decisions.
Prevalence studies need to be methodologically sound and to build upon current
research experience about how to minimize the under-reporting of abuse.
Protecting confidentiality is essential to ensure both women’s safety and data quality.
All research team members should be carefully selected and receive specialized
training and on-going support
The study design must include a number of actions aimed at reducing any possible
distress caused to the participants by the research
Fieldworkers should be trained to refer women requesting assistance to available
sources of support. Where few resources exist, it may be necessary for the study to
create short-term support mechanisms.
Researchers and donors have an ethical obligation to help ensure that their findings
are properly interpreted and used to advance policy and intervention development.
Violence questions should be incorporated into surveys designed for other purposes
only when ethical and methodological requirements can be met."
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3 Results
3.1 Socioeconomic Background
Below Poverty Line (BPL
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Code
Date
Age
EducationL
evel(grade)
Em
ployment
statusE
mploym
ent 19M
arital status
No. of
childrenPersons
perhousehold
Household
monthly
income
in Rp.
Household
monthly
income
in Euro
Below
Poverty
Line
(BPL
) 20
BPL
-C
ardFinancialSupportSource
s1s2s3s4s5s6s7s8s9s10
s11
s12
s13
s14
s15
s16Com
ission based work
Manual w
orkLabor w
orkThe M
ahatma G
andhi N
ational Rural Employm
ent Guarantee Act (M
GN
REA)
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s17
s18
s19
s20
s21
s22
s23
Code
Date
Em
ployment
e1e2e3e4e5e6e7e8
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3.2 Multiple Forms of Violence
Wife-battering
Dowry disputes
alcohol consumption
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Economical violence
roti
roti chai roti
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3.3 Mechanisms of Violence
3.3.1 Subordination
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3.3.2 Humiliation
panchayat21
)
Extreme verbal assault and emotional violence
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Depraved sexual violence
forced to prostitution
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sexual harassment
Discrimination,
kutcha
3.3.3 Stigmatization
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Abuse in public
Negative emotions were not considered socially
acceptable
suppression of emotions
aggressive behaviour against oneself or others who were powerless,
3.3.4 Exploitation
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3.4 Mental Health
depression
tension hogayee'
mental distress
'tension hogayee'
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duppatta
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roti
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roti
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mahila mandal
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post traumatic stress disorder
concentration problems
sleeping disorders
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Emotional hyperarousal
Suicidal thoughts and suicidal attempts
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3.5 Physical Health
Bruises, injuries and fractures
Medically unexplained symptoms
chronic headaches
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Dizziness
fatigue
anaemia
Functional disorders
Gynecological problems
Violence during
pregnancy
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3.6 Women's Strategies in the Context of Domestic Violence
3.6.1 Coping Strategies
Resilience
strong survival struggle
distraction
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Anxious avoidance
substance abuse
Denial
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self-blame
Spirit possession
mata aya is ke pas",
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Religion and spirituality
3.6.2 Silencing
domestic
violence was seen a private matter
naivety and subordination
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fear of not being believed
mata
Fear of social pity and stigmatization
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3.6.3 Finding Courage
protect their children
danger to their
own life
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fight back
3.6.4 Support Sources
Medical institutions
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legal support Nari Adalat
Nishtha
panchayat
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3.6.5 The Empowerment Process
Social participation and social support
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Wenlido23 self-defence workshops
Wenlido
Wenlido
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3.6.6 Where to go?
optionless
returning to one's maternal home
panchayat
panchayat
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4 Discussion
4.1.1 Structural and Economic Violence
structural violence
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Economic violence
4.1.2 Strategies of Oppression in the Context of Social Interdependence
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Humiliation
subordination
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Exploitation
Stigmatization
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Discrimination
4.1.3 Mental Health
Common
mental disorders
pagal,
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Pagalpan
stigmatization of
mental health
Manasik svastha
Depression
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mental distress
'tension hogayee'
post traumatic stress disorder
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suicidal tendency
4.1.4 Physical Health
Physical injuries
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gynecological complaints
Medically unexplained somatic symptoms
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4.1.5 Coping Mechanisms
Maladaptive coping strategies
Spirituality
social support and social participation
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women’s shelters
4.1.6 Policy Recommendations and Implementation Strategies
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First Level: Prevention - Education and Awareness Building
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Second Level: Early-intervention - Training of Professionals
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Third Level: Rehabilitation - Establish a Women's Shelter
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Fourth Level: Advocacy Work on a Structural Level
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5 Strengths and Limitations
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6 Annex
6.1 Acronyms
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6.2 List of Figures
.
Crime in India 2012
.
.
.
6.3 List of Tables
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6.4 List of Nonprofit Organizations
Jagori Rural Charitable Trust
Nishtha Rural Health, Education and Environment Centre
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7 References
BMC Public Health 11
Singapore Medical Journal
Violence Against Women 10
Woman-Nation-State.
Engendering international health: the challenge of equity
BMC Public Health 9
Public Health
Trauma, Violence, & Abuse 15
Training Manual on Empowering Youth for Reflection and Action.
Demography
Evolutionary Psychology, 10
Do Arrests and Restraining Orders Work?
The Lancet
Constructing grounded theory: A practical guide through qualitative analysis
Economic and Political Weekly
Meridians: feminism, race, transnationalism 6
Am J Public Health,
The University of Chicago Legal Forum
Stanford Law Review
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Qualitative methodology for international public health.
Asia-Pacific Journal of Public Health 24
Life and Words: Violence and the Descent into the Ordinary
Our Lives Our Health
Mental health of Indian women: A feminist agenda.
Meeting the mental health needs of developing countries: NGO innovations in India
Indian Journal of Gender Studies
Social Science & Medicine
The Times of India.
Amnesty International.
Researching Violence against Women: A Practical Guide for Researchers and Advocates.
International Journal of Gynecology & Obstetrics
The Lancet, (9619), 1165-1172.
Infections and inequalities: The modern plagues
Journal of Interpersonal Violence 12
International Journal of Gynecology & Obstetrics 65
Social Science & Medicine 45
Designing qualitative research
Managing quality in qualitative research.
An introduction to qualitative research
Introducing Research Methodology. A Beginner's Guide to Doing a Research Project.
Mental health, resilience and inequalities.
Der Bürger im Staat
The issues at stake: Theory and practice in the contemporary women's movement in India
WHO multi-country study on women's health and domestic violence against women.
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Why the Prevention of Atrocities Act doesn't work.
The interpretation of cultures: Selected essays
When Technology and Tradition Collide: From Gender Bias to Sex Selection
The discovery of grounded theory: strategies for qualitative research.
The discovery of grounded theory: strategies for qualitative research.
The Times of India
Common mental disorders: a bio-social model.
A Pinch of Skin
Human Trafficking in India: Dynamics, Current Efforts, and Intervention Opportunities for the Asia Foundation
Violence Against Women
International Journal of Gynecology & Obstetrics 78
World Bank Discussion Paper 255
Rape in Kashmir. A Crime of War
Broken People: Caste Violence Against India's" untouchables"
World Report 2014. Events of 2013
National Family Health Survey (NFHS-3), 2005-06: India: Key Findings
International Journal of Health Services 38
Women's rights, human rights: International feminist perspectives
Violence Against Women 10
Asian Journal of Psychiatry 4
Studies in Family Planning
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Journal of Advanced Nursing 23
BMC Public Health
Public health 123
International Review of Psychiatry
Social Science & Medicine 44
Archives of Disease in Childhood 99
Indian Journal of Medical Sciences 59
Journal Interpersonal Violence,
Beyond trauma: Cultural and societal dynamics. Plenum series on stress and coping.
American Journal of Public Health 96
Violence Perpetrated Against Women in India.
Violence Against Women, Women Against Violence
Freedom from the Known
Violence Against Women, Women Against Violence
Mental Health & Prevention
BMC Proceedings
Manokamna: A Woman Centric Project in Mental Health and Emotional Health Care for Himachal Pradesh
Social psychiatry and psychiatric epidemiology
The British Journal of Psychiatry
Interviews: Learning the craft of qualitative research interviewing
The Lancet
The Lancet
Foundations for research: Methods of inquiry in education and the social sciences
Tehelka
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Naturalistic inquiry
Violence Against Women, Women Against Violence
The Lancet 378
JAMA: The Journal of the American Medical Association 282
American Journal of Epidemiology
Child survival. Culture, Illness and Healing. Vol. 11,
To have and to hit: cultural perspectives on wife beating
Domestic violence as a public issue: A review of responses
Social Science & Medicine 54
Qualitative health psychology: Theories and methods
NCMH Background Papers—Burden of Disease in India. National Commission on Macroeconomics and Health.
The British Journal of Psychiatry
The Times of India
Reader in Comparative Religion
Human Rights from the Dalit Perspective
Violence Against Women11
Social Science & Medicine
Reproductive Health Matters
Meeting the mental health needs of developing countries: NGO innovations in India.
. The Lancet
BJOG: An International Journal of Obstetrics & Gynaecology 111
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Neuroscience & Biobehavioral Reviews 29
International Journal of Epidemiology
The Lancet
The Times of India.
Social Science & Medicine 72
BMJ 325
Social Science & Medicine
Peace & The New Corporate Liberation Theology. 2004 City of Sydney Peace Prize Lecture. CPACS Occasional Paper No. 04/2.
The Lancet 373
Journal of Obstetrics & Gynecology
Journal of Obstetrics & Gynaecology 33
Industrial Psychiatry Journal
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International Journal of Social Psychiatry
International Journal of Epidemiology.
Indian Journal of Public Health 56
Violence Expressed: An Anthropological Approach.
Women's economic dependency and men's support obligations: Economic relations within households. CDE Working Paper #89-26
Economic and Political Weekly
International Family Planning Perspectives
Social organization and social process: Essays in honor of Anselm Strauss. (Starkoff Institute Studies in Ethics and Contemporary Moral).
Journal of the Indian Academy of Applied Psychology 35
World Psychiatry,
‐ Worldviews on
Evidence‐Based Nursing 1
Journal of Affective Disorders 102
Qualitative methods in public health: a field guide for applied research.
Say NO to Gender Based Violence - Respones from South Asia.
Reproductive Health Matters,
Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children, Supplementing the United Nations Convention against Transnational Organized Crime.
Qualitative Health Psychology: Theories and Methods
Indian Journal of Community Medicine: official publication of Indian Association of Preventive & Social Medicine
African Journal of Reproductive Health
Journal of Affective Disorders 102
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Putting women’s safety first: ethical and safety recommendations for research on domestic violence against women.
The Lancet359
Protocol for WHO multi-country study on women’s health and domestic violence.
The World health report: 2001: Mental health: new understanding, new hope.
WHO multi-country study on women's health and domestic violence: Study protocol.
Addressing violence against women and achieving the Millennium Development Goals.
WHO multi-country study on women’s health and domestic violence against women: summary report of initial results on prevalence, health outcomes and women’s responses.
Understanding and addressing violence against women: femicide.
Global and regional estimates of violence against women. Prevalence and health effects of intimate partner violence and non-partner sexual violence.
Violence against women: Global picture health response.
Violence against women: The health sector responds.
7.1 Legal References