Harvard Public Health Alumni Forum Addresses Domestic Violence
by Irma S. JarchoThis year's Spring Forum of the Harvard School of Public Health Alumni -- held on Wednesday, 5 June 1996, at the Harvard Club in New York City -- was devoted to "Domestic Violence: A Public Health Issue." A threat to women's physical and mental as well as reproductive health, domestic violence has now become recognized as a global problem. The spate of highly-publicized incidents concerning attacks on women by their husbands or boy friends -- in some cases, ending in the death of the woman -- gave a strong sense of immediacy to the discussion. The discussants were Suzanna Stout Banwell, J.D., M.P.H., a well-known University lecturer and consultant, and Francesca Gany, M.D., M.S., Director of the New York Task Force on Immigrant Health. They offered a very depressing glance at a most depressing topic.
Dr. Banwell emphasized that domestic violence cuts across social and cultural lines and is a naked exertion of power and control. The percentage of women victimized may be as high as 30%, she said, but it is often difficult to ascertain what has happened. She observed that the best results are usually obtained if the questions are part of an overall health survey. In an Emergency Room situation, the batterer will often accompany the battered woman, and it is important to isolate her to be able to get accurate information.
Dr. Banwell reported that when a campaign to help battered women was started in Nairobi, Kenya, the proponents were overwhelmed by the number of women asking for help. They could not handle these numbers and had to pull the posters and stop the campaign. In Mexico City a program that was starting interviewed 30 women who applied for jobs in the unit, but 22 had to drop out because they were battered themselves.
"Why should we care?" asked Dr. Banwell. Because domestic violence impacts not only on the woman's health and her opportunities but also affects the children who witness such episodes and often become batterers as adults. In the United States domestic violence has become the leading predictor for suicide in women.
Dr. Gany spoke of special problems faced by an immigrant woman who is a victim of domestic violence. To start with, migrating itself changes family dynamics and imposes economic constraints. Very often the woman cannot speak English and the batterer acts as interpreter. Interviewers sometimes ask the children to interpret; this is the worst possible situation and should be avoided, Dr. Gany said, adding that clinics dealing with immigrants must have adequate interpreting services.
Another factor in the reluctance of the woman to complain noted by Dr. Gany is her fear that her husband -- and the whole family -- might be deported. There is also a shamed reluctance to complain about what is happening and often a total ignorance of the remedies available to the victimized woman. No money, a language barrier, fear of deportation, shame, all are factors, Dr. Gany said.
Unfortunately, domestic violence seems to be accepted in almost all countries. There may be changes in the offing as a result of the work of the UN Conference on Women, but it is doubtful that any real changes will be achieved soon.
Last year's Spring Forum of the Harvard School of Public Health Alumni focused on the problem of AIDS testing in the newborn and the controversy about releasing the information to the mother, which gave rise to Infusion Tip #5 on page 22 of our Fall 1995 issue, followed by updates in our Winter 1996 and present issues.
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