Contrary to men, women are primarily perceived, treated, and discriminated against through their bodies. This chapter deals with the gendered nature of women’s mental health issues, with special reference to women’s bodies and human rights in contemporary social and political contexts. The interconnected nature of the women’s bodies, sexualities, and human rights is emphasized.
Any social and cultural context that devalues the bodily and emotional well-being of women needs to be analysed thoroughly. It can be argued that some of the circumstances that women experience are primordial, stemming from their biologies, such as menstruation, birth, and menopause. Women’s bodies are different than male bodies; however, most of the circumstances that women suffer are above and beyond these biological conditions. Moreover, social and cultural situations may even worsen these biological processes. The physical and emotional well-being of women suffers because of the conditions that stem from the asymmetrical gender roles in society. These gender roles prescribe women’s place, roles, and positions in society as less than that of men.
Women’s bodies and sexual rights
Women’s bodies and boundaries
‘Sexual Pleasure is a Birth Right’
Women are the symbolic representatives of the purity of their families throughout the world. Although the forms and formats are different, the girl-child’s sexuality is a matter of control and concern from the most modern to the most traditional societies. In some traditional societies women’s sexual conduct is thoroughly controlled via their bodies’ virginity. Virginity is considered the most precious asset that the unmarried woman has to bring to the marriage. This anxiety over a woman’s purity shows itself in the forms of virginity tests and virginity reconstructive surgeries (Cindog˘lu 1997). In modern societies, this control is more individualistic and medicalized in the forms of forced birth control pills, fear of sexually transmitted disease (STD), illegal abortions, etc.
How a woman conducts her body, with whom she chooses to be sexually intimate, is a matter of patriarchal concern either in traditional formats, where family enforces pre-arranged marriages and punishes with honour killings when women do not abide by the rules, or modern and romantic formats when the lover does not accept the rejection or adultery of the woman and violates her body in the form of passion crimes. It is important to note that only women, not men, experience coercions and controls of their sexualities in the most life threatening ways and to this extent.
When women do not follow the expected paths of sexual intimacy via heterosexual marriages, they are either ignored, or discriminated against and harassed for their orientations. In most parts of the world, same-sex relationships are not accepted morally, socially, and politically. The claims of gays and lesbians for ‘intimate citizenship’ entails the rights of people to be acknowledged by the state and its institutions and being eligible for all kinds of rights to which heterosexual couples are entitled. These rights are similar to rights that come with heterosexual marriage, including tax benefits, inheritance rights, social security benefits, etc. (Plummer 2003). Women, particularly, are at the most disadvantaged end of this process. Economically, on average, women globally earn 60 per cent of what men earn and have less access to social security (<http://www.weforum.org/pdf/gendergap/report2009>) Therefore, the political acknowledgement of lesbian couples in the form of social security access through marriage and inheritance will bring more benefit to lesbians than gays.
Violence against women has a negative impact on all aspects of their well-being. According to the WHO (2002), studies carried out in many countries indicate that women who have been physically and sexually assaulted and abused use health services more than those without a history of abuse. Chronic health problems such as STDs, AIDS, unplanned pregnancies, birth defects resulting from violence-related foetal injury, and premature deaths lead to a higher healthcare cost in any society (Amaro 1995).
Domestic violence and women’s human rights
The Universal Declaration of Human Rights and different conventions such as Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) suggest that men and women are equal and neither is in a position of control. But violence against women is a lingering problem that exists in almost all countries and societies. Women are often exposed to violence by their partners; therefore, the acknowledgement of IPV (Intimate Partner Violence) is essential in the elimination of domestic violence.
Victims of domestic violence suffer different psychological problems such as post-traumatic stress disorders (PTSD), depression, and somatic problems and are at higher risk for physical health problems. Psychological effects are more severe if the traumatic event is repeated by people close to the victim.
Women’s mental health and women’s human rights
Violence against women must be recognized as a human rights problem. The perception of domestic violence against women should be perceived not as a private family matter, but rather a public issue that authorities worldwide must address accordingly.
Human rights encompass civil, political, social, economic, and cultural facets of human existence. Women’s civil and political rights historically have been compromised by their social and economic status. Consequently, the social and cultural limitations placed on women’s activities, along with the ever-present threat of violence, often constitute an obstacle to women’s participation in public and political life.
We discuss the problem within the perspective of basic human rights such as the Right to Life and Survival; the Right to Nondiscrimination; and the Right to the Highest Attainable Standards of Health (Cook 1997). Physical, psychological, sexual, and economic abuses violate women’s basic human rights such as the right to live and to survive, the right to control one’s body, and the right to the highest attainable standard of health. In the 1970s, the presence and prevalence of domestic violence started to be talked about within the community and medical environment; from the 1980s we were confronted with scientific proofs of its short and long-term consequences. In the 1990s the world witnessed rape publicized and discussed as a tool of violence during wars and armed conflicts.
According to several comprehensive studies, physical and sexual violence against women by family members and mostly by their intimate partners occurs in industrialized as well as in developing countries. For example, in Egypt 35 per cent of women and in New Zealand 20 per cent of women reported being beaten by their husbands at some point in their marriage (UNICEF 2000).
The stories and situations of domestic violence victims suggest unaccomplished resistances and the possibilities of opposition. Helplessness and hopelessness may decrease the motivation for change, and recent research in Turkey suggests that over the two decades, the actual level of violence did not change. However awareness of and attitudes towards domestic violence changed in a more egalitarian direction. In 2007, women do not justify male aggression in the household to the same degree as 1994. Demand for shelter also increased (Altinay and Arat 2007).
Such traumatic experiences have a negative impact on women’s reproductive health and cause gynaecological disorders. Every year 500,000 women die during pregnancy or immediately after giving birth; 20 million women become handicapped due to reasons related with gender inequality; one third of all pregnancies in the world (80 million each year) are unwanted pregnancies. Sexual abuse of the child also presents a risk of gynaecological disorders and may cause infertility.
Mental health and gendered violence
Men are more exposed to violence than women in objectively defined events, such as wars or detentions (Criterion A1 for PTSD) which are potentially traumatic, with the exception of sexual violence. This is an important exception because sexual violence is associated with the highest conditional risk of PTSD in both men and women. Women appear to experience comparable events as more threatening (i.e. as involving more terror, or helplessness) (American Psychiatric Association 1994).
Women’s greater risk for PTSD clearly holds in general populations and disaster-stricken communities, and is even more pronounced in the context of societies that emphasize traditional sex roles. Although gender is not the only determinant for trauma-related disorders, women show more trauma-related disorders. Other factors, such as being in poverty, being a refugee, and being uneducated are almost always gender related. The World Health Organization (2002) defines poverty as the most definite risk factor on health. Poverty leads to physiological and psychological hardship, affecting self-confidence, preventing planning, and intensifying humiliation and desperation. Poverty restricts individuals’ social mobility. It is commonly accompanied by social exclusion which women suffer from the most through the ghettoization to their households as basic childcarers and elderly carers (Cockburn 1999).
Women experience traumatic stress more in the context of caregiving. Women are most of the time the only caregivers to young children, elderly, and disabled family members. Their relative lack of social and material resources to cope with trauma makes the impact of exposure more pronounced. In the United States, poor women and children tend to live together, such that 63 per cent of female-headed households are poor. Specifically, 76 per cent of women who are poor are between the ages of 18 and 44 years (Miranda and Green 1999).
In addition, there are more barriers to receiving adequate care among poor and young women. These findings are most likely pertinent for poor women throughout the world. Epidemiological studies of psychiatric disorders carried out in Africa, Asia, the Middle East, and Latin America have identified higher rates of disorders in women as opposed to men (Kimerling 2004).
The most fundamental human right is the right to live. Up to 70 per cent of the women who die due to homicide are killed by their current or former husbands or boyfriends (WHO 2002). When we consider women who are the victims of domestic violence, in different classes and different regions of the world, it is possible to see relevance between Marie Trintignant from Paris and Güldünya from Turkey, who were both killed by domestic violence (Yüksel and Sezgin 2007).
Most of the studies related to sexual abuse are conducted in Western countries and we have very limited knowledge about other parts of the world. That is why we have chosen examples from non-Western societies. The control of a woman’s life has its own dynamics with its socio-political and economic sources according to the specific region in question.
Sexually assaulted women usually internalize the ‘blaming-the-victim’ approach at different levels. Lee et al’s (2005) findings revealed that Asian and Caucasian women have different attitudes about rape. Asian students are more likely than Caucasian students to believe women should be held responsible for preventing rape, and Asians have stronger beliefs than Caucasians that victims cause the rape and most rapists are strangers.
Classical sexual abuse and rape
The classical sexual abuse or rape is the conduct of the sexual assault by a stranger (Williams 1984). Compared to intimate partner or husband rape, it is much easier for women to report and to get help in these situations.
Justified sexual abuse
‘Justified’ rapes range from individual rapes to more institutional rape forms. Individual sexual assaults include intimate partner rape, marital rape, and date rape which are all highly controversial crimes (Yüksel and Sezgin 2007). Institutional rapes and sexual assaults, on the other hand, involve using women’s bodies in wartime and in armed conflict to intimidate the group. They happen in war zones, camps, detention centres, or occupied territories.
The marital act has a basic understanding, which accepts sexual proximity and sexual intercourse to be ‘normal’ and ‘legitimate’. Partner rape, sexual activity forced upon the partner without her consent, is evaluated as a private problem of the couple. When looking at general population and community studies, it is difficult to come up with a consensus definition. The social and legal recognition of marital rape is highly problematic. Russell exposed this problem, reporting that between one in ten and one in seven married women would experience rape by their husbands (Russell 1990). Indeed, most partner rape survivors have experienced multiple rapes during a relationship.
The incidence of sexual assault among battered women is five to seven times higher than that reported by ever-married women (Russell 1990). Since these samples are composed of women who sought help or who resided in women’s shelters, they are not representative of all battered women. We argue, however, that many severely abused women don’t seek help out of fear of their abusers, and therefore the rate of rape in the case of battered women in shelters may not be overestimated when we consider the rate of sexual violence against all battered women.
Marital rape is common in contemporary Turkey. It is reported in 21 per cent of cases by Yüksel (2010) and 51 per cent by Ilkkaracan (2000). These discrepancies may be due to sampling and measurement differences. Another striking factor is that only 1.2 per cent of women go to the police for help, rather most of them leave their houses (22 per cent) or go to their families and friends (14 per cent).
Violence against women exists in all societies, modern or traditional, in different forms and shapes. During the last decades, researchers have documented the widespread problem of date rape in American society. Two decades ago, rather than blaming the offender, it was much more common for women to blame themselves. These conflictual values and norms, reflecting internalized patriarchal guilt and shame, also discouraged legal pursuits and hindered the work of therapy (Brownmiller 1975).
Date rape, like any other sexual abuse, has hazardous effects on women’s health. In social environments where the virginity of a young woman is an asset and a symbol of family honour, this phenomenon has a double binding effect. On the one hand, the woman suffers from the violation of her body; on the other hand, she suffers from humiliation and degradation of society (Cindog˘lu 1997).
In Turkey, due to the value attached to virginity, lovers pay great attention to keep the hymen intact before marriage, out of respect to the woman and her reputation in the community and with prospective suitors. Our research finds that the first characteristic of date rape is that the woman has often no physical intimacy with the person and only has a platonic affair where they talk, or might have had limited sexual intimacy. In this way, a woman who has never had intercourse, experiences first intercourse as a violation of her virginity and her body. Intimate partner rape adds to this not only the violation and loss of bodily integrity, but violation by a trusted lover, and therefore an even more traumatic entry to sexuality.
The second issue in date rape is the possibility of this intercourse influencing the woman’s reputation in the community and her chance of finding a suitor. If and when the family learn of her trauma, her status in the family and community are jeopardized. That is why these events usually go unreported. Furthermore, the lover who forced himself on the woman may pursue further abuse or blackmail her knowing that she is helpless and cannot seek help from the family or the police. In traditional parts of the non-Western world, young women usually do not disclose that they have boyfriends. Indeed the word for lover in Turkish is ‘someone I talk’. In communities where women’s contact with men is limited and closely supervised, families do not know that a woman has a man that she is ‘talking to’. This may be a justification for not letting her pursue her studies or simply go out of the house without close chaperoning. In some cases, women apply for legal protection without their family knowing. Even then, the abuser may use this against her by threatening to disclose their relationship to her family (Yüksel 2010).
Every year, thousands of women and girl-children are murdered around the world by family decision in the name of honour. Honour killings are the execution of a female family member for perceived wrongdoing vis-à-vis her body and her sexuality (Cindog˘lu et al. 2008). In certain societies, it is commonly assumed that a woman’s promiscuous behavior not only violates tradition, but affects and brings shame to the whole family. The family undertakes an honour killing as an attempt to wash away the shame, clear the family name, and re-establish family honour (Barakat 1999), as well as punishing women who are perceived as dishonouring their families. Pretexts include being involved in an extramarital affair, when women desire to remarry after divorce, or even when they are raped. Most of the time, the close family of the woman enforces the death sentence and the father’s verdict is imposed. Once the woman marries, the spouse takes the place of the father, and also the ‘powers’ of trying and sentencing (Sezgin 2006).
Honour killing is therefore a form of gendered violence that takes place within the extended family, at home, and is aimed at women. While honour killing is a psychosocial problem restricted to certain geographical areas in the world, and a variety of cultural explanations have been developed as excuses for it, the geographical boundaries of this crime have expanded with increased levels of migration. Reports submitted to the UN Commission on Human Rights show that honour killings have occurred in Bangladesh, Great Britain, Brazil, Ecuador, Egypt, India, Israel, Italy, Jordan, Pakistan, Morocco, Sweden, Turkey, and Uganda.
Honour killings often remain a private family affair so official statistical data is lacking (Cindog˘lu et al. 2008). According to statistics from KA-MER (a women’s NGO against violence in South-East Turkey), during 2003–2006 158 women asked for help when threatened by an honour killing (Sezgin 2006). The death sentence can be issued for various reasons. The top reason was disobedience (23.4 per cent). Seventeen per cent of the women stated that a decision had been taken to kill them as a result of slander (Sezgin 2006). In 2006, several Turkish women were killed by their young male family members. Some of these women lived in Turkey, and some in European countries as migrants or refugees with citizenship. Every year, 5,000 women in developing countries are killed by their relatives in the name of honour. (<http://www.who.int/mediacentre/factsheets/fs239/en>). However, the actual number of women who face or suffer honour killings is unknown.
Even though honour crimes are well-known, mental health experts tend to disregard this subject. However, with the responsible campaigns of women’s NGOs like KA-MER, these issues have become more noticeable. In recent years, murders and forced suicides in the name of virtue and honour are increasingly a focus, both in Turkey and in the world.
Human problems increase in wartime, and as Goldstein said (2001), ‘gender roles are nowhere more prominent than the war’. War disrupts social norms, releasing constraints on emotional, physical, and sexual violence. This disruption also continues to influence women’s lives in their differentiated roles and status after wars. The predicament of war widows, refugee women, women affected by mass rapes, mothers, and those giving birth in situations of starvation, homelessness, devastation, and prolonged poverty, are examples. During armed conflict all civilians are at risk of violence but sexual violence is often used as a weapon of war.
Custody, torture, and women’s bodies
Sexual torture involves a series of enforced sexual acts, regardless of whether or not there is penetration. It is a form of violence based on the difference in power between the strong and the weak, and is a direct attack on the person’s integrity. Such abuse may occur while in custody or being interrogated by state authorities or political groups, but may also occur in any situation, formal or informal, where someone is held against their will.
Testifying to sexual torture by using psychological or medical evidence is not a simple matter. People who are currently under arrest should be referred by their lawyers to a dependable trauma centre, taken regularly to their appointments, privacy should be observed during the session, and, finally, the court has to accept the medical report. During this process, specialists who have experience in evidence-based scientific clinical knowledge and who are also determined to advocate for the victim are needed.
However, the process is not merely medical. In order for the victim to be healed even partially, the medical team who has the determination to use this knowledge has to cooperate with lawyers. Despite the adverse conditions in such interviews, the psychological and social functions of victims may be improved. One of the dilemmas that it is necessary to abolish the secrecy surrounding such violence. Victims’ accusations may arise in political contexts and for political reasons. But after self-disclosure, and in undergoing the processes of testimony and therapy, victims must face the individual aspects of their problems (Sezgin et al. 2000).
Forced sex and trafficking
The trafficking of women happens all over the world yet remains hidden from public view. Human trafficking typically entails confinement, and often physical and psychological abuse. Research has demonstrated that violence and abuse are at the core of trafficking for prostitution. Sex trafficking occurs universally. Women are taken from their country and sold for sexual use. Prostitution dehumanizes, commodifies, and fetishizes woman. A nine-country assessment, concluded that 73 per cent of women used in prostitution were physically assaulted, 89 per cent wanted to escape, 63 per cent were raped, and 68 per cent met the criteria for PTSD (Farley et al. 2003)
Sexual health (STDs) and women
Sexual health and protection from sexually transmitted diseases is a critical issue for women. There is a growing literature on the increasing numbers of women with HIV/AIDS that discusses: (1) the woman’s belief that the husband is not having any relation with others and is monogamous; (2) suffering from sexual abuse, partner rape, or incest (Melendez 2003); (3) accepting forced sex from the partner or the client because of fear of further violence (Amaro 1995); and (4) the inability to force partners to use condoms for protection. All these conditions prepare a suitable environment for infection with the HIV virus (WHO 2002). Any history of sexual abuse diminishes one’s level of assertiveness for protected sex and makes one vulnerable to forced sexuality.
This chapter illuminated how gender is communicated through women’s bodies and women’s health with special reference to domestic violence, honour killings, trafficking, and STDs in contemporary social and political contexts. The interconnected nature of women’s bodies, sexualities, and the violation of their human rights are mostly due to the asymmetrical gender roles stemming from the social and cultural contexts in which they live. The extensive review of the literature suggests that women’s mental health, bodies, and sexualities are closely related and need to be studied together. Therefore, substantive legal and operational measures need to be taken through national and supra-national bodies in order to eliminate the hurdles for women’s mental health and bodily integrity.
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