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10 th Anniversary Seminar of the Nordic Forum Turku, August 11-12 2004 Equal opportunities - for WoMen Violence Women subjected to sexual violence - ten.

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Presentation on theme: "10 th Anniversary Seminar of the Nordic Forum Turku, August 11-12 2004 Equal opportunities - for WoMen Violence Women subjected to sexual violence - ten."— Presentation transcript:

1 10 th Anniversary Seminar of the Nordic Forum Turku, August Equal opportunities - for WoMen Violence Women subjected to sexual violence - ten years´experience from the National Center for Battered and Raped Women Annika Björck, Deputy Head of Clinic National Center for Battered and Raped Women, Uppsala, Sweden

2 ” Rape is to violate another persons innermost integrity. Rape is to say to a woman: You are not a human being. Rape is the worst violation you can be subjected to as a human being. Rape is a mixture of torture, castration and mutilation - which does not show on the outside.” (Maria-Pia Boethius) openly translated

3 1948 ”Everyone has the right to life, liberty and security of person” Article 3, UN Universal Declaration of Human Rights 1993 UN Declaration on the Elimination of Violence against Women 1996 Prevention of violence – a public health priority, WHO Statement 1995 EU Annual review of Beijing Platform - Daphne program - Seven indicators

4 Important steps in Swedish legislation sexual crimes and domestic violence 1993 The Commission on Violence against Women 1994 National Center for Battered and Raped Women established 1998 Violence against Women – Government Bill 1997/98:55 Gross Violation of a Woman’s Integrity Widened definition of Rape 2000 National Council for the Protection of Women against Violence

5 Cases of Rape reported to the Police in Sweden

6 Statistics cases of rape were reported to the police in Sweden in (Nat center for Crime Prevention) The statistics give no information about the sex of the victim or the perpetrator Only 15 per cent of the women reported the most recent violent incident to the police (Swedish prevalence study, Captured Queen, 2001)

7 Men´s violence against women- a serious health hazard Violence against women causes injuries and death to the same extent as cancer (WHO 1997) Violated women have poorer health and comsume more medicine than non- violated women (Captured Queen 2001) Suicide thoughts and attempts are more common among violated women (Captured Queen 2001)

8 A National Center for Battered and Raped Women A Center of Knowledge and Resources, established in 1994 Patient services with accessability round the clock. The Woman should always be in focus. Collaboration between various clinical departments, public institutions and volunteer organizations is crucial Education and Information Research and Development

9 National Center for Battered and Raped Women - patient services Emergency visits round the clock Appointment to doctors and medical social workers Doctors and midwives standing by during after- hours Emergency telephone 24 hours Cooperation with other medical units, social services, police, forensic dpt., NGO:s

10 Mecial treatment - rape victims medical examination - anamnesis, status, documentation medico-legal certificates test-taking - pregnancy, HIV, VD, drugs securing evidence - Rape-Kit next appointment

11 Psychosocial treatment - rape victims Acute medical attendance and co- ordination of resources to solve basic practical problems therapeutic talks group therapy support through legal proceedings

12 is part of the national commission of the National Center Regional National - university courses, textbook International l Education and Information

13 Research and development National Prevalence Study (Captured Queen) Violence during Pregnancy National Survey of Resources in Sweden Patient Data at National Center: Statistics, Rape Verdicts, Documentation of Injuries, Forensic Certificates Questionnaires

14 Uppsala University 2001 Lifetime sexual abuse: 24 % Swedish Prevalence Study, Captured Queen 2002 Lifetime sexual abuse: 8.1% Stenson K: Men´s violence against women - a challenge in antenatal care

15 Violence during Pregnancy Lifetime sexual abuse: 8.1% Emotional or physical abuse at some time in life: 15.4% Fear of partner or other perpetrator: 3.3% Stenson K: Men´s violence against women - a challenge in antenatal care, Dept of Women´s and Children´s Health, Uppsala University Hospital

16 Violence during Pregnancy Uppsala university % reported physical abuse during pregnancy or before latest visit to the antenatal clinic 2.8% reported physical abuse the year preceeding pregnancy Stenson K: Men´s violence against women - a challenge in antenatal care, Dept of Women´s and Children´s Health, Uppsala University Hospital

17 Attitudes to being questioned about violence Stenson K: Men´s Violence against Women - A Challenge in Antenatal Care,

18 Research and development Men´s violence against women in ”equal” Sweden - a prevalence study % had been subjected to sexual violence since turning fifteen

19 Prevalence of Violence in intimate relation and psychiatric illness - a pilote study on women in a psychiatric emergency ward 48% had experienced physical violence 37% had experienced sexual abuse 39% had experienced sexual abuse in childhood, 37% as grown ups, and 25% both in childhood and as grown ups 66% of the violated women did not get adequate help Unpublished data, Rikskvinnocentrum Uppsala, 2004

20 Few Rape Cases lead to prosecution and sentence Studies: Stridsberg, Uppsala university 1998: Of 27 women who were medically examined due to rape at Uppsala University Hospital, 15 were reported to the police. One lead to a verdict of guilty Cederholm, Uppsala University 2002: Of 38 cases of rape, 18 were reported to the police and 1 lead to prosecution.

21 …… Few Rape Cases Diesen/Swärd-Liedholm, Stockholm University 2004: Of 67 reported cases of rape, only 3 suspects were prosecuted. del Sante, Uppsala University 2004: Of 125 reported cases of rape, 7 lead to prosecution

22 Reasons why few cases go all the way through the judicial system Imperfect medico-legal certificates Inadequate police and prosecutor investigation Stale attitudes Focus on the victim - dress, state of intoxication, previous sexual experiences Lack of knowledge

23 Retrospective study of records Women subjected to sexual violence (165 cases) Age distribution Del Castillo, Uppsala university 2004

24 Retrospective study of records Women subjected to sexual violence (165 cases) Occupation Del Castillo, Uppsala university 2004

25 Retrospective study of records Women subjected to sexual violence (165 cases) Del Castillo, Uppsala university 2004 Location

26 Retrospective study of records Women subjected to sexual violence (165 cases) 84% visited a doctor - most of them only once 49% visited a medcial social worker, on average 2-5 times Del Castillo, Uppsala university 2004

27 Rape cases 2002 (32) The majority of the women were between years old The general crime scene - her or his home Many women were under the influence of alcohol The perpetrator was mostly an aquaintance Two thirds of the women never came to next appoinment Cerderholm M, Uppsala university,2002

28 Acute effects Injuries bruises, wounds, burn marks, fractures, etc Mental reactions acute stress reaction

29 Injuries - rape In 60% of the rape cases there are no injuries Danielsson, E, Uppsala university 1998

30 Long-term effects Chronic pains headache, muscular pain, chest pain, gynaecological pain Psychosomatic pains dizziness, numbness, fatigue Mental disorders depression, sleeping and eating disorder, suicidal thoughts, anxiety, panic attacks, addiction to drugs, PTSD

31 Patterns of reaction traceable to abuse Difficulties to put up with a common gynaecological examination difficulties to undergo rectal palpation strong reaction to examination of mouth and throut inability to stay in narrow spaces, e.g. CT scanner

32 Women subjected to rape During the rape - the dominating feeling is often fear do what you want - just don´t kill me let it soon be over this is not happening - this body is not mine And afterwards - frequent feelings of shame and guilt couldn´t stand my reflected image feelings of disgust, sadness, indifference and apathy

33 Conclusion Adequate legislation is of great importance, but it must be properly implemented by the whole chain of actors. The health care system must collect evidence and produce adequate medico- legal certificates. Police investigations must be performed in a thorough and unbiased way. Strict routines are absolutely necessary. The understanding of the effects of rape and a professional approach to the victims is crucial.

34 ….. Conclusion Violence constitutes a threat against women’s health and wellbeing. The medical services is an important actor in society to deal with men´s violence against women.

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