Medical and Social Research on Violence Against Women (Based on Materials from the City of Naberezhnye Chelny)

The dissertation is devoted to a comprehensive medico-social study of domestic violence against women based on materials from the city of Naberezhnye Chelny of the Republic of Tatarstan. The work examines socio-hygienic, legal, clinical, and psychological aspects of the problem of violence, analyzes the reproductive health of women who have experienced domestic violence and their aggressors. The study is oriented toward developing recommendations for the prevention of family violence and improving the interdepartmental system of medico-social assistance to affected women with the participation of health care workers, crisis centers, and public organizations.

Relevance of the Problem.

Since the 1990s, the issue of violence against women has been at the center of international attention. Many international organizations have documented this in their publications. According to a study conducted by the American Medical Association, as a result of violence by a husband or partner, women sustain more physical injuries than victims of automobile accidents, street assaults, and rape combined (A. Felder, P. Victor, 1997). According to data from the Research Institute of the Ministry of Internal Affairs of Russia (2000), violence in one form or another is observed in every fourth family. Annually, 12 to 14 thousand women are killed by their partners. In 81.6% of domestic crimes, the perpetrators are husbands. The primary motives for these offenses are, as a rule, that 46% of offenders sought to assert their authority in this manner, while 65.7% took out on their wives grievances stemming from various setbacks. As legal scholars note, we are dealing with "shadow crime". The law is extremely reluctant to intrude into intimate relationships: «they, supposedly, will sort it out themselves» (I. Myskina, 2004).

In May 1996, the 49th World Health Assembly adopted a resolution identifying violence as a priority in the field of public health. In May 2000, the Ministry of Health of the Russian Federation, together with the Ministry of Labor and Social Development and the Ministry of Education of the Russian Federation, adopted the Concept for the Protection of Reproductive Health of the Population for 2000-2004 and a Plan of Measures for its Implementation. The Concept pays special attention to the problem of violence against women.

Domestic violence affects all socioeconomic and cultural strata. Studies conducted in the United States indicate that 14 to 28% of all women visiting outpatient clinics are victims of domestic violence, 16% of pregnant women are regularly subjected to violence, and 23% of pregnant women have ever been subjected to violence (V. Feiteraft, 1993; D. Abbot, 1995). At the same time, violence during pregnancy is one of the most tragic and least known aspects of tender violence, with serious consequences for the mental and physical health of affected women. In addition to these consequences, it should be noted that there is an increased risk of contracting sexually transmitted infections, a significant number of cases of pregnancy termination, and ruptures of the uterus, spleen, and liver (N. Klein, V. Chao, 1995; M. Ellsberg, et al, 1996; E. Nelson, E. Zimmerman, 1996).

Research results indicate that violence during pregnancy is a serious problem requiring study and intervention, as both the mother and the unborn child are at risk. In this context, health care workers play a decisive role in assisting women who have experienced violence (JL Kostina, 2001; M. Pisklava, A. A. Sinelnikov, 2001; T. Day, 1995; F. Burns, et al, 1997).

At the same time, many medico-social aspects of the problem of violence against women have been little or not studied at all. In fact, comprehensive socio-hygienic studies on this topic have not been conducted in the country.

Objective of the Study.

Based on a comprehensive medico-social study, to develop recommendations for the prevention of domestic violence and the implementation of an interdepartmental approach to improving medico-social assistance to women who have experienced domestic violence.

Tasks of the study:

1. To analyze the medico-demographic situation in the city of Naberezhnye Chelny of the Republic of Tatarstan according to key indicators of reproductive health and population behavior.

2. To provide medico-social characteristics of women who have experienced violence and their offenders; to determine the main risk factors of domestic violence.

3. To establish the role of the health care sector in assisting women who have experienced violence.

4. To evaluate the activities of crisis centers for women who have experienced violence.

5. To develop proposals for improving assistance to women who have experienced domestic violence.

Scientific Novelty of the Study.

A medico-social study has been conducted in which, for the first time, an assessment is given of the medico-social aspects of domestic (family) violence against women. As a result of the study:

- the relevance of domestic violence against women as a socio-hygienic problem has been demonstrated and substantiated;

- a comprehensive characterization of the reproductive health of women living in a major industrial center has been provided;

- socio-hygienic characteristics of women who are victims of domestic violence and their offenders have been presented;

- risk factors of domestic violence have been identified;

- the place and role of physicians and nursing staff in the prevention and rehabilitation of women who have experienced violence have been determined;

- data on the activities of crisis centers and public organizations for women who have applied to these institutions have been presented;

- the unity of the system of interdepartmental interaction among medical workers, lawyers, psychologists, social workers, and others has been scientifically substantiated with the aim of forming an integrated approach to each case of violence and awareness of the needs of the victim.

Practical Significance of the Study.

The proposals developed on the basis of the study materials can be used:

- in the work of practical health care for the prevention and rehabilitation of women suffering from family aggression;

- for the preparation of national programs and legal documents of various levels on the protection of reproductive health in the aspect of the medico-social significance of this problem;

- in the activities of health care bodies and institutions and other state and public organizations.

Thesis to be defended:

1. Domestic violence against women as a serious problem of violation of their rights and a risk factor for disorders of mental, physical, and reproductive health.

2. Characteristics of women against whom violence is committed by their family partners, and analysis of their reproductive health.

3. Results of the study of the experience of crisis centers and other public organizations whose activities are aimed at assisting women suffering from domestic violence.

4. Basic principles of organizing a system of assistance to women who have experienced violence and its prevention; the role of medical workers in this sphere of activity.

Testing of the Study. The main provisions and results of the dissertation were reported at the IX Congress of Pediatricians of Russia (Moscow, 2004) and at plenary meetings of the Health Administration of the City of Naberezhnye Chelny (2003-2004).

Implementation in Practice. The results of the conducted study have been implemented and are successfully used in the work of women's clinics, maternity hospitals, city outpatient clinics, in the work of social institutions and rehabilitation centers of the Social Protection Administration of the City of Naberezhnye Chelny, in the pedagogical and scientific activities of the departments of public health and health care of KGMU and KGMA, biomedical ethics and medical law with a course on the history of medicine of KGMU. The main provisions of the dissertation are reflected in the informational letter "Domestic Violence Against Women," approved by the Ministry of Health of the Republic of Tatarstan.

CHAPTER 1.

VIOLENCE AGAINST WOMEN AS A SOCIO-HYGIENIC PROBLEM (ANALYTICAL REVIEW OF DOMESTIC AND FOREIGN LITERATURE AND OFFICIAL SOURCES)