Di Cesare, M

Genus

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MARIACHIARA DI CESARE*Women, marginalization, and vulnerability:introduction“We must unite. Violence against women cannot be tolerated, in anyform, in any context, in any circumstance, by any political leader or by anygovernment” (Ban Ki-moon, International Women’s Day, 5 March 2009). TheUN Secretary-General Ban Ki-moon opened the International Women’s Dayin 2009 with this statement. Yet a lot needs to be done to stop women’s dis-crimination, violence, and marginalization. Towards the end of 2012, a seriesof events have increased the attention and the awareness of the public opin-ion on gender discrimination and violence. On October 9th, 2012, MalalaYousafzai, a 15 year old human rights activist for women and girls’ education,was shot on her way to school as a consequence of her activism. Malala sur-vived the attempted murder, and went on to become the youngest person everto receive the Nobel-Prize, and is leading one of the most impressive interna-tional movements for girls’ and women’s human rights. However, many oth-ers girls and women in the world cannot say the same. While writing thisintroduction, Reyhaneh Jabbari was executed in Iran for having killed theman who tried to rape her.Every year, millions of women and girls around the world experiencesome form of physical or psychological violence and discrimination, withdramatic consequences for their health and human capital.Gender discrimination starts inside the mother's womb. The biologicalsex ratio at birth averages 106 boys for every 100 girls. In Eastern, South, andCentral Asia, the sex-ratio has reached values up to 130 (WHO, 2011). Suchlevels can happen only under specific circumstances such as selective abor-tion or infanticide. Despite the efforts of the countries with such unbalancedsex ratios at birth to put in place policies aimed at avoiding gender selectionduring pregnancy (e.g. restricting the use of technology to identify the genderof the foetus), the complexity of the problem requires breaking cultural gen-der attitudes within societies.Immediately after birth, gender biases against girls show up in a varietyof dimensions related to their health. Discriminatory allocation is present infood allocation, vaccinations, access to healthcare, and household healthcareexpenditure (Khera et al. 2014), with boys more likely to receive better carethan girls. Despite the worldwide effort to reach gender parity in school atten-1GENUS, LXX (No. 2-3), 1-6* Department of Epidemiology and Biostatistics, School of Public Health, Imperial College,London, UK. E-mail: m.di-cesare@imperial.ac.uk.DI CESARE2dance, the  gap is still wide in many low-income countries, especially in ruralareas (UNESCO, 2003). The gap is again the product of cultural norms,where families, primarily those with limited resources, tend to perceive boys’education as more economically beneficial than girls’. The limited access toeducation can be considered the first step against girls’ human capital devel-opment. Restriction to education has life-long and intergenerational effects,and is the pillar on which girls’ and women’s vulnerability and marginaliza-tion rests and women’s empowerment is dismantled. Lack of economic auton-omy, fair pay, an imbalance in the number of working (paid and unpaid) hoursare all dimensions which affect women’s health and wellbeing (UNFPA,2007) and increase their risk of poverty.Inequalities in the power distribution between men and women result ina condition of subordination and danger throughout a woman's life. Nowa-days almost 700 million women have been married before the age of 18 (30%of which before reaching 15 years of age), with South Asia and Sub-SaharanAfrica being the regions with the highest rates of child marriage (UNICEF,2014). The impact on girls’ physical and psychological wellbeing is enor-mous. Girls are usually married to older men, isolated from their family oforigin, forced to skip school, unable to negotiate with their partners about anyaspect of their life, including decisions about contraception and their ownhealth. Within their new households, women face pressure from their partnerand, often, extended family, to contribute to household production and repro-duction. It is in fact within the household that one of the most common formsof violence occurs: physical and psychological violence inflicted by an inti-mate partner (IPV). Up to 70% of women worldwide have experienced someform of violence from an intimate partner (WHO, 2013). For high-, middle-and low-income countries, it has been widely demonstrated that IPV is asso-ciated with poor health in women (Campbell, 2002; Bonomi et al. 2006; Dil-lon et al. 2013).  This includes both physical health problems (such as chron-ic disorders, chronic pain, gynaecological problems, and increased risk ofSTIs) and mental health issues (e.g. depression, self-harm, anxiety). IPV canoften result in the woman’s death: 38% of the all women's murders reportedhaving been committed by an intimate partner (WHO, 2013).Women’s subordination within society is also reflected in cultural prac-tices such as genital mutilation (FGM), which affects between 100 and 140million women worldwide. Based on the most recent estimates, in Africa 91.5million girls and women 9 years of age and over are living with the conse-quences of FGM (UNICEF, 2013). Moreover, girls and women around theworld have to face the daily risk of being raped (WHO, 2007), abused (WHO,2005) or trafficked (WHO, 2012). Finally, although women in low-income countries are at a higher risk ofvictimization than women in high-income countries, it is also true that basedWOMEN, MARGINALIZATION, AND VULNERABILITY: INTRODUCTION3on the last Global Gender Gap report (World Economic Forum, 2014) there isno country in the world in which the gender gap has been closed.The nine papers included in this Thematic Issue - two of which havebeen published in Genus, Volume LXX(1) 2014 -, tackle the problem ofwomen’s vulnerability from different perspectives, providing valuableinsights into the problem, its determinants and possible actions. Four papers are centered on intimate partner and domestic violence.Raushan and Raushan use a nationally representative survey to investigate theprevalence of forced sex and its associated factors in India. In West Bengal,Bihar, Uttar Pradesh and Rajasthan (almost 30% of the total Indian popula-tion), more than 10% of  married women have experienced forced sex by theirintimate partner. Results suggest that the human capital of the members of thehousehold and the economic wellbeing of the household itself play a protec-tive role. Similarly, the work by Pomper and colleagues in Burkina Fasofocuses on two different dimensions of women’s sexual autonomy: the legit-imacy to refuse sex with the intimate partner, and the degree of agreementwith being beaten if the refusal occurs. Again, improving women’s educationand economic wellbeing are seen as necessary steps to improving women’sautonomy and reducing IPV. The paper by Rajan  provides an interestinganalysis of the association between household arrangements and domesticviolence. From the analysis of 52 in-depth interviews, the author provides aclear description of the effects of matri-local (when the couple resides withthe wife’s family) versus patri-local (when the couple resides with the hus-band’s family) household arrangements on women’s vulnerability to intimatepartner violence and abuse by inlaws. The results suggest that matri-local res-idency offers the best protection to women against domestic violence. Patri-local residency is, on the other hand, the most vulnerable situation for thewife; she is not only at risk of IPV but also abuse by inlaws. The unbalancedeconomic distribution and decision-making process within the couple in patri-local arrangements as well as the social isolation experienced by the wife, areall factors that dramatically increase her vulnerability. These contributions area clear call for economic and educational programmes that address genderinequalities within the household. However, Rajan’s paper suggests that thephenomenon is much more complex, and that women's vulnerability is linkedto social norms and cultural dimensions in society, which are harder tochange. On this aspect, the paper by Utomo and colleagues, based on under-standing domestic violence in Indonesia, reminds us that domestic violenceaffects all the members of the household and contributes to the intergenera-tional transmission of social and cultural norms. Children in primary schoolare less aware of domestic violence than children in secondary school, withonly 70% of Grade 6 students being able to describe a father hitting a moth-er as domestic violence (versus 95% among Grade 12 students). Students withmore traditional gender role attitudes are less likely to identify domestic vio-lence when this occurs. As the author suggests, “the earlier students under-stand the unacceptability of violent behaviour and abusive language, thegreater is the chance that they will not become perpetrators later in life andthat they will report domestic violence when it is observed”. Similarly, Pom-per and colleagues observed young women being more tolerant of wife beat-ing than older women. The transmission of gender roles occurs as soon aschildren are embedded in the household environment. Changing gender rolesrequires discussion in school as well as a general effort to have egalitariangender role attitudes within the school, and a drastic change in the social par-adigm. The fact that cultural norms are extremely hard to change is alsoshown by Dodoo and colleagues (Dodoo et al., 2014). Wife subordination isoften the consequence of economic dependence on the husband. The authorsanalyse women’s reproductive obligations caused by bridewealth payment, adiffuse habit in some African countries, through which the husband acquiresfull authority over the timing and number of children. Results suggest thateducation, in this case, has limited effects. Bridewealth is an extremely strongcultural norm which requires policies to tackle the normative obligations cre-ated by these types of marital contracts.Female genital mutilation is another example of women’s vulnerabilitylinked to cultural, religious and social factors within households and commu-nities. Looking at the practice of FGM in Nigeria, Oyefara provides a pictureof the cultural beliefs underlying the practice there. Reducing promiscuity isconsidered the main justification for performing FGM; however, this workhighlights how this perception doesn’t correspond to reality. Circumcisedwomen in the study had higher levels of promiscuity than uncircumcisedones. On the other hand, the former experience long lasting negative sexualand mental health consequences, including being deprived of the human rightof leading a fulfilling sexual life. Education is a protective factor in thesesocio-cultural practices, with more educated mothers less likely to circumcisetheir daughters in the future than uneducated mothers. Even if FGM is a practice linked to specific subpopulations in specificcountries, it is a reality that needs to be addressed in and by Western coun-tries, as migration makes the practice a global phenomenon. Many EU countries have put in place severe laws to restrict the practiceof FGM. The EU Community issued the Communication to the European Par-liament and the Council “Towards the elimination of female genital mutila-tion”. Alone in the UK there are around 66,000 women with FGM and 30,000at risk of the practice (European Community, 2013).The papers by Farina and Ortensi and Leye and colleagues (Leye et al.,2014) highlight the need for gathering information about FGM in Europe. The former, using data from a survey about the sexual and reproductivehealth of migrant women, looks at the practice of FGM among second gener-ation migrants. Lower levels of cutting have been observed among secondDI CESARE4WOMEN, MARGINALIZATION, AND VULNERABILITY: INTRODUCTION5generation migrants as a consequence of the characteristics of their migrantmothers, who in turn also had lower levels of FGM and a higher propensityto abandon the practice.Leye and colleagues, through a systematic review of the available statis-tics on FGM, raise the need for monitoring the prevalence of FGM within theEuropean Union. The widespread lack of ad-hoc studies, funding aimed toimprove the monitoring process, and networking across countries, result inpoor and partial information which is not helpful for policymaking.Finally, the paper by Acharya and Clark addresses the problem ofwomen’s trafficking and vulnerability to sexually transmitted infections.Based on their results, trafficked women in the two Mexican cities analysedare forced into unsafe sex and unable to negotiate condom use, which meansthat they are at high risk of STIs and HIV. The trafficked women in the studyalso experienced other health problems, including sleep disorders and pain,which affected their daily lives.Through these selected papers and diverse viewpoints, we hope to enrichand further motivate the discussion of women’s exposure to violence.AcknowledgementsWe thank all the reviewers for their assistance, without which this thematicissue would not have been possible.ReferencesBONOMI A.E., THOMPSON R.S., ANDERSON M., REID R.J., CARRELL D., DIMER J.A.,RIVARA F.P. (2006), Intimate partner violence and women’s physical,mental, and social functioning, American Journal of Preventive Medi-cine, 30(6): 459-466.CAMPBELL J.C. (2002). Health consequences of intimate partner violence,Lancet, 359(9314):,1331–36.DILLON G., HUSSAIN R., LOXTON D., RAHMAN S. (2013), Mental and PhysicalHealth and Intimate Partner Violence against Women: A Review of theLiterature, International Journal of Family Medicine, 15 p. DODOO F.N, HORNE C., BINEY A. (2014), Does education mitigate the adverseimpact of bridewealth on women’s reproductive autonomy?, Genus,LXX(1): 77-97.DI CESARE6EUROPEAN COMMUNITY (2013). Communication from the commission to theEuropean Parliament and the council. Towards the elimination of femalegenital mutilation, Brussels, 25.11.2013, COM(2013) 833 final.KHERA R., JAIN S., LODHA R., RAMAKRISHNAN S. (2014), Gender bias in childcare and child health: global patterns. Archives of Diseases in Childhood,99, 369-374.KI-MOON B. (2009), International Women’s Day, 5 March 2009,http://www.un.org/press/en/2009/sgsm12127.doc.htm. LEYE E., O’BRIEN GREEN S., ARNAUT C., MERGAERT L. (2013), Towards a bet-ter estimation of prevalence of female genital mutilation in the EuropeanUnion: interpreting existing evidence in all EU Member States, Genus,LXX(1): 99-121.UNITED NATIONS, EDUCATIONAL, SCIENTIFIC AND CULTURAL ORGANIZATION(2003), Gender and Education for All: the leap to equality, UNESCO,France, 416 p.UNITED NATION POPULATION FUND (2007), Women’s Economic Empower-ment: Meeting the Needs of Impoverished Women, UNFPA, New York,38 p.UNITED NATIONS CHILDREN’S FUND (2014), Ending Child Marriage: Progressand prospects, UNICEF, New York, 7 p.UNITED NATIONS CHILDREN’S FUND (2013), Female Genital Mutilation/Cut-ting: A statistical overview and exploration of the dynamics of change,UNICEF, New York, 184 p.WORLD HEALTH ORGANIZATION (2005), Addressing violence against womenand achieving the Millennium Development Goals, WHO Geneva, 45 p.WORLD HEALTH ORGANIZATION (2007), Rape: how women, the communityand the health sector respond, WHO Geneva, 127 p. WORLD HEALTH ORGANIZATION (2008), Eliminating Female genital mutila-tion: An interagency statement, UNAIDS, UNDP, UNECA, UNESCO,UNFPA, UNHCHR, UNHCR, UNICEF, UNIFEM, WHO. WHO Gene-va, 40 p.WORLD HEALTH ORGANIZATION (2011), Preventing gender-biased sex selec-tion: an interagency statement OHCHR, UNFPA, UNICEF, UN Womenand WHO, WHO Geneva, 18 p.WORLD HEALTH ORGANIZATION (2012), Human trafficking. Understandingand addressing violence against women, WHO Geneva, 9 p.WORLD HEALTH ORGANIZATION (2013), Global and regional estimates of vio-lence against women: prevalence and health effects of intimate partnerviolence and non-partner sexual violence, WHO Geneva, 47 p.WORLD ECONOMIC FORUM (2014), The Gender Gap Report 2014,http://reports.weforum.org/global-gender-gap-report-2014/. 

Women, marginalization, and vulnerability

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Women, marginalization, and vulnerability

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