Title: Intimate partner ('domestic') violence
Course: Non-Communicable Diseases, Emergency Care and Mental Health Part 2 - Ethiopia (Full)

Intimate partner (‘domestic’) violence

Figure 16.4 A woman being beaten in her home.

Violence against women, usually carried out by their husband or another family member (intimate partner violence, Figure 16.4), is sadly common in all cultures and societies around the world. Studies show that Ethiopia is no exception: nearly 3 out of 4 women experience violence at some point in their life. Of course, men can also be the victims of violence carried out by women, but this is much rarer and so we won't focus on that problem here. Violence against women can be physical (e.g. beating), sexual (e.g. rape) and/or psychological (e.g. saying things that make the woman feel bad about herself). Violence tends to be worse when a woman is pregnant. Women who have just given birth may also be at increased risk because the tradition means that they should stay inside their home after giving birth and so they may not be able to escape from a bad situation.

Women who experience violence are at increased risk of developing mental illnesses. These women are more likely to develop depression or anxiety disorders, somatisation (see Section 16.1) and/or become so desperate that they consider ending their lives (suicide).

Read about the case of Mrs Alemtsehay, a postnatal woman living in a rural area (Case Study 16.2). This shows you the effect of violence on one woman's mental health (this is a real case but the woman's name has been changed). As you read about Mrs Alemtsehay's experience, can you identify possible symptoms of mental illness?

Case Study 16.2 Mrs Alemtsehay's story

'First, we quarrelled and then he [her husband] started to beat me. I cried. I became angry about having a baby at that time. I was irritated. After that day, I couldn't sleep. All I did was cry. … At that time, had I been God or had I been the person who can do anything, I thought of killing her [her baby] and killing myself. … Since I didn't have the guts to kill the baby or kill myself, I just thought about it.'

Mrs Alemtsehay is showing possible symptoms of depression: sleep problems, crying, hopelessness and suicidal thoughts. It may not be abnormal for a woman to feel like this if she is being beaten by her husband, but it is important to check that she hasn't also developed a depression. The thoughts of wanting to harm her child suggest that severe depression is present. If she does have depression, this might make her situation even worse. She may even try to end her life. If her depression is treated, she might be able to think more clearly and be more motivated to try to find ways to solve the problem.

As well as mental health effects, violence can lead to physical injury (see Study Session 7). If a pregnant woman is the victim of violence can lead to pain or bleeding and even cause her to lose her baby. If the baby survives, violence can cause the baby to be born early, have a lower birth weight or develop other health problems.

A woman who is the victim of violence may not know how to get help. Often women blame themselves even when it is not their fault. For example, they might say 'I deserved to be beaten because I forgot to fetch the water', or 'He is my husband so it is his right to have sex with me even when I don't want to have sex'. They may also be frightened that the violence will get worse if they tell an outsider (and this could be true). If they have also developed depression, this may be another obstacle that stops them looking for help.

See Box 16.4 for some ways in which you can help with the mental health effects of intimate partner violence.

Box 16.4 Intimate partner violence: what can you do to help?

- Educating the community to prevent violence happening in the first place. (We will discuss this further in Study Session 18.)
- Be ready to detect violence, particularly among pregnant and postnatal women.
- When asking a woman about violence, make sure the discussion is private.
- If you find out that a woman is the victim of violence:
  - Be supportive by listening to her difficulties
  - Screen for mental illness and suicidal thoughts or plans
  - Encourage her to speak with another family member or community elder
  - Advise her of any local organisations or charities that offer help to vulnerable women
  - Offer to speak with a community elder who could then help to sort out the problem.