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.
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.