Violence Against

Women
Abigail S. Polintan, MD
Resident-Lecturer

Nonie Dalisay, MD, FPOGS

Consultant-MOderator
RAPE
 RAPE
• The sexual assault of children, women
and men
 Sexual Violence
• Any sexual act performed by one person
on another without the person’s
consent
 Incidence
• 10.6% of women reported a sexual
assault at some time in their lives
• 11% of High School adolescents
reported to have been forced to have
sex
• 20-25% of College women have been
victims of actual or attempted sexual
assault during College
 Incidence
• This crime remains to be underreported
– Embarassment
– Fear of retribution
– Feeling sof guilt
– Assumptions that little will be done
– Lack of knowledge of their rights
 Who are susceptible?
• Very Young
• Very Old
• Homeless women
• Women with mental illness
Sexual assault happens to
people of all ages and races in
all socioeconomic groups
 Forms Sexual Violence
• Unwanted touching
• Rape
• Non-physical distressing acts of sexual
harassment:
– Threats
– Peeping
– Taking nude photos without consent
The perpetrator may be a
stranger, he or she is OFTEN an
individual well known to the
victim
 Marital Rape
• Involves forced coitus or related acts
without consent but within the marital
relationship
 Date Rape
• The women may voluntarily participate in
sexual play, but coitus is performed, often
forcibly, without her consent
• Often not reported
• A traumatic event that scars a woman’s self-
esteem
 Statutory Rape
• Coitus with a women under a specific
age, irrelevant of consent; because the
female is defined by statute as being
incapable of consenting
RAPE-TRAUMA
SYNDROME
Rape Trauma Syndrome
• Phase 1: Immediate or Acute Phase
– Lasts for hours to days
– May be associated with paralysis of the
individual’s coping mechanisms
• Complete loss of emotional control
• Well-controlled behavior pattern
–Reaction depends on: Relationship of the
attacker to the victim, whether force was
used, length of time the victim was held
against her will
Rape Trauma Syndrome
• Phase 1: Immediate or Acute Phase
– Generally disorganized
– Complain of both physical and emotional
symptoms
Rape Trauma Syndrome
• Phase 1: Immediate or Acute Phase
–Physical symptoms:
• Specific Injury
• Generalized soreness
• Eating problems
• Headaches
• Sleep disturbances
Rape Trauma Syndrome
• Phase 1: Immediate or Acute Phase
– Emotional symptoms:
• Fear
• Mood swings
• Irritability
• Guilt
• Anger
• Depression
• Difficulties in concentrating
• Flashbacks
Medical care is often sought
during the acute period, and at
this point it is the physician’s
responsibility to assess the
specific medical problem and
also to offer a program of
emotional support and
reassurance.
Rape Trauma Syndrome
• Phase 2: Reorganization Phase
• Flashback and nightmares may continue
• Phobias may develop:
– Towards the members of the offending sex
– The sex act itself
– Non-related circumstances: Fear of
crowded places or height
Rape Trauma Syndrome
• Phase 2: Reorganization Phase
• Victim may institute a number of important
lifestyle changes: job, residence, friends,
significant others
• If major complications (STD or Pregnancy)
occur, resolution may be more difficult
• Lasts from months to years
Rape Trauma Syndrome
• Phase 2: Reorganization Phase
• Medical care and couseling must be non-
jugdgemental, sensitive and anticipatory.
• Point out why a contemplated change is
being contemplated and the complicating
effects it may have on the patient’s overall
well being
PHYSICIAN’S
RESPONSIBILITIES IN
THE CARE OF RAPE
VICTIMS
Medical Responsibilities
• Treat injuries
• Diagnose and treat STD
• Prevent pregnancy
 Medicolegal Responsibilities
• Document history carefully
• Examine patients thoroughly and
specifically note injuries
• Collect articles of clothing
• Collect vaginal (rectal and
pharyngeal) samples for sperm
• Comb pubic hair for hair samples
 Medicolegal Responsibilities
• Collect fingernail scrapings where
appropriate
• Collect saliva for secretion
substance
• Turn specimens over to forensic
authorities and receive receipts for
chart
 Medicolegal Responsibilities
Source Motile Sperm Acid
Sperm Phosphatase
Vagina Up to 8 Up to 7- Variable (Up to
hours 9days 48 hours)
Pharynx 6 hours Unknown 100IU
Rectum Undetermin 20-24 hours 100IU
ed
Cervix Up to 5 days Up to 17 Similar to
days vagina
 Emotional Support
• Discuss degree on injury, probability of
infection, and possibility of pregnancy
• Discuss the general course that can be
predicted
• Consult with rape-trauma counselor
• Arrange a follow-up visit for a medical
and emotional evaluation in 1-4weeks
• Reassure as far as possible
INTIMATE
PARTNER
VIOLENCE
 Abuse
• Domestic violence, partner abuse,
intimate partner violence, the
battered woman, and spouse abuse
• Refer to violence occuring between
partners in an ongoing relationship
even if they are not married
 Battered Woman
• Any woman over the age of 16 with
evidence of physical abuse on at least
one occasion at the hands of an
intimate partner
Battered Wife Syndrome
• Symptom complex occurring as a
result of violence in which a woman
has at any time received deliberate,
severe, or repeated (>3x) physical
abuse from her husband or
significant male partner in which
the minimal injury is bruising.
 Intimate Partner Violence
• Actual or threatened physical, sexual, or
psychological abuse by a current or
former spouse (including common-law
spouses), dating partner, boyfriend or
girlfriend.
 Intimate Partner Violence
• Pattern of coercive behaviors that may
include repeated battering and injury,
psychological or emotional abuse,
sexual assault, progressive societal
isolation, economic deprivation,
intimidation and stalking.
(American Medical Association)
Partner abuse is often seen in
conjunction with abuse of
children and elderly persons in
the same household
 Incidence
• 14.5% reported threatened physical violence
• 20.2% reported completed physical violence
• 10.2% unwanted sex with an intimate partner
• 47% of husband who beat their wives, do so
3 or more times per year
• Rape is a major form on abuse in 54% of
violent marriages
Common sites of Injuries
• Head
• Neck
• Chest
• Abdomen
• Breast
• Upper extremities
 Common Forms of Injuries
• Scratches and • Burns
Bruises • Lacerations
• Sore muscles • Head injury
• Welts • Strangulation
• Fractures
• Broken teeth
Murder and Suicide are frequent
components of domestic
violence problems
It is important that physician’s
increase their ability to
recognize the signs of domestic
violence and spouse abuse
 Patient’s Appearance at the
ER
• Shy • Passive
• Frightened • Often cries
• Embarassed • Batterer may
• Evasive accompany the
• Anxious patient
• Drug or alcohol
abuse
 Somatic Complaints of
Abuse Women
• Headache
• Insomnia
• Choking sensation
• Hyperventilation
• Chest, back or pelvic pain
BATTERING ACT
 First Phase
• Tension building
• Manifested by discrete acts that cause
family friction
• Name calling, intimidating remarks,
meanness, mild physical abuse such as
pushing
• Victim believes at this point that she has
the power to avoid aggravating the
situation
 Second Phase
• Uncontrolled discharge of tension that
has built up through the first phase
• Attacks may take form of both verbal
and physical abuse
• Victim is often left injured
• In self-defense, victim may actually
injure or kill the batterer
 Third Phase
• Batterer apologizes, asks forgiveness, and
frequently shows kindness and remorse
• Showers the victims with gifts and
promises
• Victim begins to hope the relationship can
be saved and the violence will not recur
• The batterer learns that he can control the
victim
PHYSICIAN’S
RESPONSIBILITIES
IN INTIMATE
PARTNER ABUSE
• Acknowledge to the patient the
seriousness of the situation
• Attend to the patient’s injuries
• Assess the patient’s emotional status
from the stand point of psychiatric
condition such as suicidal ideation,
depression, anxiety, or signs of abuse of
drugs, alcohol, or other medications
• Attempt to estimate the woman’s ability
to assess her own situation and her
readiness to take appropriate action
• Determine the community resource
available for handling family violence
• Recognize the problem and either offer
counseling or get counseling for the
patient
EXIT PLAN
 EXIT PLAN
• Have a change of clothes packed for
both her and her children; including
toilet articles, necessary medications,
and an extra set of keys to the house
and car (may be left with a friend of
family member)
• Keep some cash, a checkbook, and a
savings account book with a friend or
family member
 EXIT PLAN
• Other ID papers, such a birth
certificates, social security cards, voters
registration cards, utility bills, and
driver’s license, should be kept available
• Hove something special, such as a toy or
book, for each children
• Have financial records available, such as
mortgage papers, rent receipt, and an
automobile title
 EXIT PLAN
• Determine a place on exactly where to
go regardless of the time of the day
• Ask neighbors to call police if violence
begins
• Remove weapons
• Teach children to call emergency
numbers
Intimate partner violence is a
common problem that affects
the family unit in particular and
society in general
VIOENCE AGAINST
WOMEN IN THE
PHILIPPINE
SETTING
 Republic Act No. 9262
• An act defining violence against
women and their children,
providing for protective measures
for victims, prescribing penalties
therefor and for other purposes
 Republic Act No. 9262
• Section 3. Definition of Terms
– Violence against women and their children” refers to
any act or series of acts committed by any person
against a woman who is his wife, former wife, or
against a women with whom the person has a
common child, or against her child whether legitimate
or illegitimate, within or without the family abode,
which results in or is likely to result in physical, sexual,
psychological harm or suffering, or economic abuse
including threats of such acts, battery, assault,
coercion, harassment or arbitrary deprivation of
liberty.
 Includes, but it not limited to the
following acts:
• “Physical violence”
• “Sexual violence”
• “Psychological violence”
• “Economic abuse”
 Definition of Terms:
• Battery
– Refers to an act of inflicting physical harm upon a
woman or her child resulting to physical and
psychological or emotional distress
• Battered Woman Syndrome
– Refers to a scientifically defined pattern of
psychological and behavioral symptoms found in
women living in battering relationships as result of
cumulative abuse
 Definition of Terms:
• Stalking
– Refers to an intentional act committed by a person
who, knowingly and without lawful justification
follows the woman or her child or places the
woman or her child under surveillance directly or
indirectly or a combination thereof
 Definition of Terms:
• Dating Relationship
– Refers to a situation wherein the parties live as
husband and wife without the benefit of marriage
or are romantically involved over time and on a
continuing basis during the course of the
relationship. A casual acquaintance or ordinary
socialization between two individuals in a business
or social context is not dating relationship.
 Definition of Terms:
• Sexual Relations
– Refers to a single sexual act which may or may not
result in bearing of a common child.
• Safe Place or Shelter
– Refers to any home or institution maintained or
managed by th eDepartment of Social Welfare and
Development (DSWD) or by any other agnecy or
voluntary organization accredited by the DSWD for
the purpose of this Act or any other suitable place
the resident of which is willing temporarily to
receive the victim.
 Definition of Terms:
• Children
– Refers to those beollow eighteen (18) years of age
of older but are incapable of taking care of
themselves as defined under Republic Act 7610.
As used in this Act, it includes the biological
children of the victim and other children under
her care.
 Sec. 5. Acts of Violence Against
Women
• (a) Causing physical harm to the woman
or her child
• (b) Threatening to cause the woman or
her child physicla harm
• (c) Attempting to cause the woman or
her children physical harm
• (d) Placing the women of her child in fear
of imminent physical harm
 Sec. 5Acts of Violence Against
•
Women
(e) Attempting to compel or compelling the woman or
her child to engage in conduct which the woman or her
child has the right to desist from or to desist from
conduct which the woman or her child has the right to
engage in, or attempting to restrict or restricting the
woman’s or her child’s freedom of movement or
condcut by force or threat of force, physical or other
harm or threat of physical or other harm or
intimidation directed against the woman or her child.
This shall include, but not limited to the following acts
commited with the purpose of effect of controlling or
resisting the woman’s or her child’s movement or
conduct.
 Sec. 5. Acts of Violence Against
•
Women
(1) Threatening to deprive or actually depriving
the woman or her child of custody or access to
her/his family;
• (2) Depriving or threatening to deprive the
woman or her children of financial support
legally due her or her family, or deliberately
providing the woman’s children insufficient
financial support
 Sec. 5. Acts of Violence Against
•
Women
(3) Depriving or threatening to deprive the
woman or her child of a legal right;
• (4) preventing the woman in engaging in any
legitimate profession, occupation, business or
activity, or controlling the victim’s own money
or properties, or solely controlling the conjugal
or common money, or properties;
 Sec. 5. Acts of Violence Against
•
Women
(f) Inflicting or threatening to inflict physical
harm on oneself for the purpose of controlling
her actions or decisions
• (g) Causing or attempting to cause the woman
or her child to engage in any sexual activity
which does not constitute rape, by force or
threat of force, physical harm, or through
intimidating directed against the woman or her
child or her/his immediate family
 Sec. 5. Acts of Violence Against
•
Women
(h) Engaging in purposeful, knowing, or reckless
conduct personally or through another, that
alarms or causes substantial emotional or
psychological distress to the woman or her
child, this shall include but not be limited to the
following acts;
 Sec. 5. Acts of Violence Against
•
Women
(1) Staling or followingth ewoman or her child
in public or private places;
• (2) Peering in the window or lingering outside
the residence of the woman or her child;
• (3) Entering or remaining on the dwelling or on
the property of the woman or her child against
her/his will;
 Sec. 5. Acts of Violence Against
•
Women
(4) Destroying the property and personal
belongings or inflicting harm to animals or pets
of the woman or her child; and
• (5) Engaging in any form of harassment or
violence
 Sec. 5. Acts of Violence Against
•
Women
(i) Causing mental or emotional anguish, public
ridicule or humiliation to the woman or her
child, including, but not limited to, repeated
verbal and emotional abuse, and denial of
financial support or custody of minor children
or denial of access to the woman’s
child/children
 Penalties
• Those constituting serious physical injuries shall
have the penalty of prison mayor
• Those constituting less serious physical injuries
shall be punished by prison correctional
• Those constituting slight physical injuries shall
be punished by arresto mayor
 Penalties
• In addition to imprisonment, the perpetrator
shall
• (a) pay a fine in amount of not less than one
hundred thousand pesos (P100,000.00) but not
more than Three hundred thousand pesos
(P300,000.00);
• (b) undergo mandatory psychological
counseling or psychiatric treatment and shall
report compliance to the court
 Protection Orders
• An order issued under this Act for the purpose
of preventing further acts of violence, against a
woman or her child specified in Section 5 of this
Act and granting other necessary relief.
 Protection Orders
• Who may file for a protection order?
– The offended party
– Parents, guardians of the offended party
– Ascendants, descendants or collateral
relatives within the fourth degree of
consanguinity or affinity
– Officers or social workers of the DSWD or
social workers of local government units
(LGUs)
 Protection Orders
• Who may file for a protection order?
– Punong Barangay or Barangay Kagawad
– Lawyers, counselor, therapist, or healthcare
provider of the pettioner;
– At leats (2) concerned responsible citizens of
the city or municipality where the violence
against woman and their children occurred
and who has personal knowledge of the
offense committed.
 Protection Orders
• Barangay Protection Orders (BPOs) refer to
the protection order issued by the Punong
Barangay ordering the perpetrator to desist
from committing acts under Section 5(a) and
(b) of this Act.
• 15 days, non extendible
 Protection Orders
• Temporary Protection Orders (TPOs) refer
to the protection order issued by the court on
the date of filing of the application after ex
parte determination that such order should be
issued
• 30 days + (Shall be renewed by court)
 Protection Orders
• Permanent Protection Orders (PPOs) refer
to the protection order issued by the court after
notice and hearing