GENDER-BASED VIOLENCE AND ITS IMPACT ON MENTAL HEALTH IN SOUTH AFRICA

Sabelo Gumede (PhD Candidate) - 10/08/2021

1. Understanding Gender-Based Violence

Gender-based violence is violence that is directed at an individual based on his or her biological sex or gender identity.

 

Gender-based violence includes physical, sexual, verbal, emotional, and psychological abuse, threats, coercion, and economic or educational deprivation, whether occurring in public or private life, and that is a result of gendered power inequalities.

 

As such, the term includes, but is not limited to, intimate partner violence.

 

2. Gender-Based Violence: Global Perspective

Gender-based violence is an issue faced by people all over the world.

 

Women are disproportionately harmed by gender-based violence. That is why several organisations focus on ending violence against women. One (1) in 3 women have experienced physical or sexualised violence in their lifetime (WHO, 2019). That is not including emotional, financial, or verbal abuse.

 

Frighteningly, most of this violence is intimate partner violence (WHO, 2019).

 

Women who have experienced intimate partner violence are 55% more likely to contract sexually transmitted infections than women who have not been exposed to such treatment by their spouses (UNAIDS, 2014).

 

Despite being so prevalent, gender-based violence is largely under reported because of stigma and lack of access to resources and support systems.

 

Gender-based violence can impact anyone regardless of their geographical location, socio-economic background, race, religion, sexuality, or gender identity.

 

While women and girls are the most at risk and the most affected by gender-based violence, boys, men, and sexual and gender minorities also experience gender-based violence.

 

3. Gender-Based Violence: South African Perspective

Rates of gender-based violence in South Africa are among the highest in the world and a significant problem.

 

As a result, South Africa is regarded as the rape capital of the world.

 

The South African Police Services publish crime statistics on an annual basis. For these purposes, crimes “against the person” are classified as “contact crimes.” One of the subcategories is “sexual offenses” -an umbrella term for rape, intimate partner violence, and domestic violence, or gender-based violence.

 

The total of reported sexual offenses in 2020 was 60,617. These numbers paint a gloomy picture of gender-based violence in South Africa, especially when compared with the figures for murder and attempted murder, which are between 16,000 and 17,000 per year (Crime Statistics South Africa, 2020).

 

Whilst people of all genders perpetrate and experience intimate partner and or sexual violence, men are most often the perpetrators and women and children the victims (Crime Statistics South Africa, 2020).

 

More than half of all the women murdered (56%) in 2020 were killed by an intimate male partner.

 

Between 25% and 40% of South African women have experienced sexual and/or physical intimate partner violence in their lifetime (Crime Statistics South Africa, 2020).

 

Just under 50% of women report having ever experienced emotional or economic abuse at the hands of their intimate partners in their lifetime (Crime Statistics South Africa, 2020).

 

Prevalence estimates of rape in South Africa range between 12% and 28% of women ever reporting being raped in their lifetime.

 

Between 28% and 37% of adult men report having raped a women.

 

South Africa also faces a high prevalence of gang rape.

 

Most men who rape do so for the first time as teenagers and almost all men who ever rape do so by their mid-20s.

 

It is well-nigh impossible to specify the exact extent of gender-based violence in South Africa with any accuracy because of the problem of underreporting and a lack of current research into the problem.

 

For example, in South Africa only seven percent of rapists are likely to face incarceration and perpetrators of murders are rarely persecuted. This allows violent groups and individuals to continue abusing their power without fear of repercussions.

 

4. Drivers of Gender-Based Violence

Gender-based violence is a multidimensional problem, and that isolating the root causes is well-nigh impossible, making prevention equally difficult to achieve.

 

Drivers of gender-based violence are the factors which lead to and perpetuate gender-based violence. Ultimately, gendered power inequality rooted in patriarchy is the primary driver of gender-based violence.

 

Gender-based violence is more prevalent in societies where there is a culture of violence, and where male superiority is treated as the norm. A belief in male superiority can manifest in men feeling entitled to sex with women, strict reinforcement of gender roles and hierarchy (and punishment of transgressions), women having low social value and power, and associating masculinity with control of women.

 

These factors interact with a number of drivers, such as social norms (which may be cultural or religious), low levels of women’s empowerment, lack of social support, socio-economic inequality, and substance abuse.

 

In many cultures, men’s violence against women is considered acceptable within certain settings or situations - this social acceptability of violence makes it particularly challenging to address gender-based violence effectively.

 

In South Africa in particular, gender-based violence pervades the political, economic and social structures of society and is driven by strongly patriarchal social norms and complex and intersectional power inequalities, including those of gender, race, class and sexuality.

 

5. Impact of Gender-Based Violence on mental health

What is equally worrying is that gender-based violence is an important risk factor for mental health problems among adult women in South Africa.

 

But the question is, what is mental health?

 

A major obstacle for integrating mental health gender based violence prevention initiatives into South African health programmes and primary healthcare services is lack of consensus on a definition of mental health. There is little agreement on a general definition of ‘mental health’ and currently there is widespread use of the term ‘mental health’ as a euphemism for ‘mental illness’. 

The proposed definition is that mental health is a dynamic state of internal equilibrium which enables individuals to use their abilities in harmony with universal values of society. Basic cognitive and social skills; ability to recognize, express and modulate one's own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind represent important components of mental health which contribute, to varying degrees, to the state of internal equilibrium.

The 2019 South Africa Human Rights Commission’s report on the status of mental health services should cause all of us to pause and reflect on what needs to be done to provide quality, rights-based mental health services for the people of South Africa.

·         One in six South Africans suffer from anxiety, depression, or substance-use disorders.

·         40% of South Africans with HIV suffer from a mental disorder.

·         41% of pregnant women are depressed.

·         Only 27% of South Africans with severe mental disorders receive treatment.

·         Gender based violence cost the South African economy a minimum of between R28.4 billion and R42.4 billion, or between 0.9% and 1.3% of gross domestic product (GDP) in the year 2012/2013.

The situation of mental health in South Africa is troubling and urgent action is needed. This means that a national movement is urgently needed.

It is clear that mental health has been neglected nationally in South Africa (The Lancet Commission Report on Mental Health and Sustainable Development, 2018).

The national burden of disease attributable to mental disorders has been rising (Patel et al., 2018). Human rights violations and abuses persist, with large numbers of people locked away in mental institutions, or living on the streets, often without legal protection.

The quality of mental health services is routinely worse than the quality of those for physical health even when the two are dependent on each other.

Government investment and development assistance for mental health remain pitifully small. Collective failure to respond to this national health crisis results in monumental loss of human capabilities and avoidable suffering.

In addition, there is neglect, mismanagement, as well as under-funding of mental health services (The South African Human Rights Commission, 2018).

About 50 per cent of mental health problems in South Africa are caused by gender based violence (Bantjes, Swartz and Niewoudt, 2017).

People who live in rural areas, the poorly educated, and the unemployed had poorer psychological well-being caused by gender based violence (Khumalo, Temane and Wissing, 2012).

 

Adult women in the general population who have experienced intimate partner violence and rape have a much higher prevalence of depression, post-traumatic stress disorder, binge drinking and suicidal thoughts and attempts.

 

Adolescent women without mental health morbidity exposed to physical or sexual intimate partner violence were significantly more likely to develop depression, to develop stress, alcohol use disorders, low self-esteem, feelings of hopelessness or suicidal thoughts (The Stepping Stones Study cohort, 2018).

 

Emotional abuse increased the risk of depression among all women and in those with physical or sexual intimate partner violence exposure.

 

Wider range of forms of gender based violence is associated with mental health problems, including a cumulative effect of non-partner rape and emotional abuse as well as sexual or physical intimate partner violence. Mostly mental health impact of gender based violence occurs relatively contemporaneously and if this does not happen women will be resilient.

 

 

 

6. Prevention and Response

Broadly speaking, approaches to addressing the impact of gender-based violence on mental health should be divided into response and prevention. Response services should aim to support and help survivors of gender-based violence in a variety of ways.

 

Prevention initiatives should look at how the impact of on gender-based violence on mental health can be prevented from happening.

 

Response services can in turn contribute towards preventing the impact of gender-based violence on mental health from occurring or reoccurring.

 

6.1 Response

 

6.1.1 Mobile counselling stations: there is a need for mobile counselling stations for residents in need of mental health services to help them access services at their doorstep.

 

Mobile counselling stations should have social work agents, social work supervisors, quality assurers and station managers, to operate and offer services to victims of gender based violence. Services should include psychosocial services following incidents of trauma and destigmatising mental illness in population with high rates of gender based violence.

 

6.1.2 Enhancing the capacity of intervention facilitators and service providers to deliver gender-based violence interventions: intervention facilitators must guide participants through a process of change. To do this successfully, they need rapport-building skills, behavioural observation skills, and group processing skills. These interpersonal skills are core competencies of mental health service providers indicating another key point of integration between the gender-based violence primary prevention and mental health fields. Facilitators must have the skills to model the types of relationships and interaction patterns the gender-based violence primary prevention intervention promotes. Gender-based violence primary prevention programmes address very personal and sensitive beliefs, attitudes, and behaviours. Given the sensitive nature of programme content, the intervention sessions may elicit mental health distress or resistance that the facilitators need to deal with and resolve in order to continue with the intervention. Thus, management of these mental health issues within the group and group processes are essential skills for the successful delivery of gender-based violence interventions. It is essential that training and on-going support and supervision of facilitators assess and build these skills.

 

The mental health of staff working on gender-based violence primary prevention interventions is also hugely important. As noted, these interventions often confront very sensitive and very difficult concepts and skills which may precipitate emotional distress, cognitive dissonance, defensiveness or disclosure of past traumas and managing these reactions and disclosures can take a heavy toll on facilitators’ mental health and well-being. Indeed, vicarious trauma has been recognised as a significant risk to people working in the gender-based violence field; mental health issues that may arise in the wake of vicarious trauma include compassion fatigue, depression, anxiety or PTSD-type symptoms, and burnout. Staff safety and strategies for the prevention and responses to vicarious trauma should be considered when working on gender-based violence primary prevention projects.

 

6.1.3 Research tools and methods: Integration of mental health in gender-based violence primary prevention is hampered by a paucity of validated, simplified mental health tools. Tools developed in the global north are not necessarily valid in other settings, nor can the methods used to measure various psychological outcomes be easily applied in community settings. Researchers in gender-based violence and mental health fields need to work together to develop mental health measures and valid tools to measure them. This measurement would facilitate the integration of mental health skills and concepts into the theoretical models of gender-based violence primary prevention that drive the field.

 

7.2 Prevention

7.2.1 Individual level prevention strategies: programmes on the impact of gender-based violence on mental health should address the biological and personal history factors that increase the likelihood of becoming a victim or perpetrator of gender based violence. Some of these factors are age, education, income, substance use, or history of abuse. Prevention strategies on the impact of gender-based violence on mental health at this level should promote attitudes, beliefs, and behaviours that prevent gender based violence. Specific approaches may include conflict resolution and life skills training.

7.2.2 Relational level prevention strategies: there is need for programmes on the impact of gender-based violence on mental health to examine close relationships that may increase the risk of experiencing gender based violence as a victim or perpetrator. A person’s closest social circle-peers, partners and family members-influences their behaviour and contribute to their experience. Prevention strategies on the impact of gender-based violence on mental health at this level may include parenting or family-focused prevention programmes and mentoring and peer programmes designed to strengthen problem-solving skills and promote healthy relationships.

7.5.2.3 Community level prevention strategies: programmes on the impact of gender-based violence on mental health should address the settings, such as schools, workplaces, and neighbourhoods, in which social relationships occur and seeks to identify the characteristics of these settings that are associated with becoming victims or perpetrators of gender based violence impacting on mental health. Prevention strategies on the impact of gender-based violence on mental health at this level impact the social and physical environment. For example, by reducing social isolation, improving economic and housing opportunities in neighbourhoods, as well as the processes, policies, and social environment within school and workplace settings.

7.2.4 Societal level prevention strategies: there is need for programmes on the impact of gender-based violence on mental health to examine the broad societal factors that help create a climate in which gender based violence is encouraged or inhibited. Factors to be addressed should include social and cultural norms that support violence as an acceptable way to resolve conflicts. Other large societal factors should include the health, economic, educational and social policies that help to maintain economic or social inequalities between groups in society.

 

 

8. Conclusions

In summary, mental health interventions can and should be incorporated into gender-based violence primary prevention efforts at every level including creating change at the individual, relational/interpersonal, community, and societal levels that are overlapping. There is need to support people in conducting and implementing mental health interventions.

 

At the same time, it is important to develop the evidence base further by exploring a range of other interventions that have the potential to be effective in a South African context. Many actors, including government, civil society and funders, as well as community members, should working in creative and innovative ways every day to address the impact of gender-based violence on mental health.

 

I recommend the development of a joint research agenda on the role of mental health in primary prevention of gender-based violence and the creation of a joint learning initiative for mental health and gender-based violence prevention practitioners, advocates, and researchers.

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