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Mental Health of Survivors of Domestic Violence in Rural Northern India.A Qualitative, Intersectional Approach

Edith Gahleitner

61

Dezember 2015

Mental Health of Survivors of Domestic Violence in Rural Northern India.A Qualitative, Intersectional Approach

Edith Gahleitner

1. Auflage 2015© Österreichische Forschungsstiftung für Internationale Entwicklung (ÖFSE)im C3 – Centrum für Internationale EntwicklungA-1090 Wien, Sensengasse 3, Telefon: (+43 1) 317 40 10, Fax: (+43 1) 317 40 10 – 150e-mail: office@oefse.at, Internet: http://www.oefse.at, http://www.centrum3.atFür den Inhalt verantwortlich: Edith GahleitnerDruck: druck.at Südwind-Verlag ISBN: 978-3-902906-17-5

Bibliografische Information Der Deutschen NationalbibliothekDie Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie;detaillierte bibliografische Daten sind im Internet über http://dnb.ddb.de abrufbar.

Vorwort

Die Arbeit von Edith Gahleitner ist auf den ersten Blick weder eine klassische Diplomarbeit zum Abschluss eines Medizinstudiums noch eine Arbeit, die ihre entwicklungspolitische Relevanz sofort erkennen lässt. Die Verknüpfung von psychischer Gesundheit und häusli-cher Gewalt sowie die Berücksichtigung der Lebensumstände der marginalisierten Frauen sowie der Bezug zu Strategien zur Implementierung der Förderung psychischer Gesund-heit bieten aber konkrete Perspektiven für den Gesundheitssektor in Nordindien. Gerade dieser interdisziplinäre Ansatz sowie die qualitativ sehr gute empirische Analyse machen die Arbeit nicht nur spannend, sondern untermauern deutlich, dass die Autorin die Situati-on der Frauen im Distrikt Kangra nicht nur sehr gut kennt, sondern dass sie mit ihrer Arbeit einen Beitrag zur Verbesserung der Situation leisten möchte.

Die Arbeit hat auch im Kontext mit dem Ziel drei der Sustainable Development Goals (SDGs) – nämlich „Ensure healthy lives and promote well-being for all at all ages” – beson-dere Relevanz. Folgt man dem Grundprinzip der SDGs „Leave no one behind”, dann sind Fragen nach den Folgen von häuslicher Gewalt und nach Marginalisierung aufgrund von psychischen Problemen relevante gesellschaftliche Fragen. Edith Gahleitners Analyse ist somit ein wichtiger Beitrag, der eine Brücke zwischen Medizin und Sozialwissenschaften herstellt und eine Grundlage für die Präventionsarbeit zur Vermeidung häuslicher Gewalt darstellt. Die Arbeit ist ebenso ein hervorragendes Beispiel für einen ganzheitlichen Ansatz im Bereich der kurativen Medizin und der Gesundheitsvorsorge.

Der Ausbildungsweg sowie die Forschungsaufenthalte der Autorin in Indien zeigen ein starkes persönliches Engagement, das mit dieser Diplomarbeit eine hervorragende wis-senschaftliche Basis erhalten hat.

Dr. Michael ObrovskyLeitung des Bereichs Wissenschaft & Forschung der ÖFSE

Mental Health of Survivors of Domestic Violence in Rural Northern India.

A Qualitative, Intersectional Approach

Doktorin der gesamten Heilkunde

(Drin.med.univ.)

Medizinischen Universität Wien

Edith Gahleitner

voiceless

Acknowledgments

Preface

Nishtha

Abstract

Background

Objectives

Method

Results

Zusammenfassung

Hintergrund:

Ziel

Methode

Ergebnisse

Aims of the Study

1 Introduction

1.1 Violence Against Women in India

'Scheduled Castes'dalits

Scheduled Tribes

1.1.1 Women's Life in the Context of Violence

prenatal sex determination tests

son preference

Female infanticide

girls neglect

pativrata4

sexual

harassment

Pativrata pati = , vrta =

child marriages Dalit

kanyaadaan,

dowry harassment

dowry killings

Dalits harijans

Domestic violence

Marital rape

Rape

Nirbhaya's6

Nirbhaya

Badaun8

devadasis9

Human trafficking

femicide

Badaun

Devadasidevadasi

Honour killing

female genital mutilation

Khatna

haraam ki boti

Acid throwing

Violence against widows or elderly women

sati

Sati

sati

1.1.2 Legal Aspects

against

The Protection of Women

from Domestic Violence Act , 2005.

The Criminal Law

(Amendment) Act, 2013

The Sexual Harassment of Women at Workplace (Prevention, Prohibition and

Redressal) Act , 2013,

The

Scheduled Castes and The Scheduled Tribes (Prevention of Antrocities) Amendment

Ordinance, 2014

Underreporting of violence

1.1.3 Medical Aspects

1.2 Community Mental Health in India

The Lancet

1.2.1 Gender and Women's Mental Health

'the'

2 Material and Methods

2.1 Qualitative Research

‐

2.2 Study Site

Gaddi

Nishtha Rural Health, Education and Environment

Centre13 Jagori Grameen14

Nishtha Rural Health, Education and Environment Centre

gram

panchayats15

'Panchayat'

Jagori Grameen's

2.3 Sampling Methods

anganwaadi

2.4 Interviews

World Health Organization Multi-

Country Study on Women's Health and Domestic Violence

Gaddi

2.5 Participant Observation

Nishtha Rural Health, Education and

Environment Centre

2.6 Data Analysis

2.7 Ethical Considerations

"The safety of respondents and the research team is paramount, and should infuse all

project decisions.

Prevalence studies need to be methodologically sound and to build upon current

research experience about how to minimize the under-reporting of abuse.

Protecting confidentiality is essential to ensure both women’s safety and data quality.

All research team members should be carefully selected and receive specialized

training and on-going support

The study design must include a number of actions aimed at reducing any possible

distress caused to the participants by the research

Fieldworkers should be trained to refer women requesting assistance to available

sources of support. Where few resources exist, it may be necessary for the study to

create short-term support mechanisms.

Researchers and donors have an ethical obligation to help ensure that their findings

are properly interpreted and used to advance policy and intervention development.

Violence questions should be incorporated into surveys designed for other purposes

only when ethical and methodological requirements can be met."

3 Results

3.1 Socioeconomic Background

Below Poverty Line (BPL

Code

Date

Age

EducationL

evel(grade)

Em

ployment

statusE

mploym

ent 19M

arital status

No. of

childrenPersons

perhousehold

Household

monthly

income

in Rp.

Household

monthly

income

in Euro

Below

Poverty

Line

(BPL

) 20

BPL

-C

ardFinancialSupportSource

s1s2s3s4s5s6s7s8s9s10

s11

s12

s13

s14

s15

s16Com

ission based work

Manual w

orkLabor w

orkThe M

ahatma G

andhi N

ational Rural Employm

ent Guarantee Act (M

GN

REA)

s17

s18

s19

s20

s21

s22

s23

Code

Date

Em

ployment

e1e2e3e4e5e6e7e8

3.2 Multiple Forms of Violence

Wife-battering

Dowry disputes

alcohol consumption

Economical violence

roti

roti chai roti

3.3 Mechanisms of Violence

3.3.1 Subordination

3.3.2 Humiliation

panchayat21

)

Extreme verbal assault and emotional violence

Depraved sexual violence

forced to prostitution

sexual harassment

Discrimination,

kutcha

3.3.3 Stigmatization

Abuse in public

Negative emotions were not considered socially

acceptable

suppression of emotions

aggressive behaviour against oneself or others who were powerless,

3.3.4 Exploitation

3.4 Mental Health

depression

tension hogayee'

mental distress

'tension hogayee'

duppatta

roti

roti

mahila mandal

post traumatic stress disorder

concentration problems

sleeping disorders

Emotional hyperarousal

Suicidal thoughts and suicidal attempts

3.5 Physical Health

Bruises, injuries and fractures

Medically unexplained symptoms

chronic headaches

Dizziness

fatigue

anaemia

Functional disorders

Gynecological problems

Violence during

pregnancy

3.6 Women's Strategies in the Context of Domestic Violence

3.6.1 Coping Strategies

Resilience

strong survival struggle

distraction

Anxious avoidance

substance abuse

Denial

self-blame

Spirit possession

mata aya is ke pas",

Religion and spirituality

3.6.2 Silencing

domestic

violence was seen a private matter

naivety and subordination

fear of not being believed

mata

Fear of social pity and stigmatization

3.6.3 Finding Courage

protect their children

danger to their

own life

fight back

3.6.4 Support Sources

Medical institutions

legal support Nari Adalat

Nishtha

panchayat

3.6.5 The Empowerment Process

Social participation and social support

Wenlido23 self-defence workshops

Wenlido

Wenlido

3.6.6 Where to go?

optionless

returning to one's maternal home

panchayat

panchayat

4 Discussion

4.1.1 Structural and Economic Violence

structural violence

Economic violence

4.1.2 Strategies of Oppression in the Context of Social Interdependence

Humiliation

subordination

Exploitation

Stigmatization

Discrimination

4.1.3 Mental Health

Common

mental disorders

pagal,

Pagalpan

stigmatization of

mental health

Manasik svastha

Depression

mental distress

'tension hogayee'

post traumatic stress disorder

suicidal tendency

4.1.4 Physical Health

Physical injuries

gynecological complaints

Medically unexplained somatic symptoms

4.1.5 Coping Mechanisms

Maladaptive coping strategies

Spirituality

social support and social participation

women’s shelters

4.1.6 Policy Recommendations and Implementation Strategies

First Level: Prevention - Education and Awareness Building

Second Level: Early-intervention - Training of Professionals

Third Level: Rehabilitation - Establish a Women's Shelter

Fourth Level: Advocacy Work on a Structural Level

5 Strengths and Limitations

6 Annex

6.1 Acronyms

6.2 List of Figures

.

Crime in India 2012

.

.

.

6.3 List of Tables

6.4 List of Nonprofit Organizations

Jagori Rural Charitable Trust

Nishtha Rural Health, Education and Environment Centre

7 References

BMC Public Health 11

Singapore Medical Journal

Violence Against Women 10

Woman-Nation-State.

Engendering international health: the challenge of equity

BMC Public Health 9

Public Health

Trauma, Violence, & Abuse 15

Training Manual on Empowering Youth for Reflection and Action.

Demography

Evolutionary Psychology, 10

Do Arrests and Restraining Orders Work?

The Lancet

Constructing grounded theory: A practical guide through qualitative analysis

Economic and Political Weekly

Meridians: feminism, race, transnationalism 6

Am J Public Health,

The University of Chicago Legal Forum

Stanford Law Review

Qualitative methodology for international public health.

Asia-Pacific Journal of Public Health 24

Life and Words: Violence and the Descent into the Ordinary

Our Lives Our Health

Mental health of Indian women: A feminist agenda.

Meeting the mental health needs of developing countries: NGO innovations in India

Indian Journal of Gender Studies

Social Science & Medicine

The Times of India.

Amnesty International.

Researching Violence against Women: A Practical Guide for Researchers and Advocates.

International Journal of Gynecology & Obstetrics

The Lancet, (9619), 1165-1172.

Infections and inequalities: The modern plagues

Journal of Interpersonal Violence 12

International Journal of Gynecology & Obstetrics 65

Social Science & Medicine 45

Designing qualitative research

Managing quality in qualitative research.

An introduction to qualitative research

Introducing Research Methodology. A Beginner's Guide to Doing a Research Project.

Mental health, resilience and inequalities.

Der Bürger im Staat

The issues at stake: Theory and practice in the contemporary women's movement in India

WHO multi-country study on women's health and domestic violence against women.

Why the Prevention of Atrocities Act doesn't work.

The interpretation of cultures: Selected essays

When Technology and Tradition Collide: From Gender Bias to Sex Selection

The discovery of grounded theory: strategies for qualitative research.

The discovery of grounded theory: strategies for qualitative research.

The Times of India

Common mental disorders: a bio-social model.

A Pinch of Skin

Human Trafficking in India: Dynamics, Current Efforts, and Intervention Opportunities for the Asia Foundation

Violence Against Women

International Journal of Gynecology & Obstetrics 78

World Bank Discussion Paper 255

Rape in Kashmir. A Crime of War

Broken People: Caste Violence Against India's" untouchables"

World Report 2014. Events of 2013

National Family Health Survey (NFHS-3), 2005-06: India: Key Findings

International Journal of Health Services 38

Women's rights, human rights: International feminist perspectives

Violence Against Women 10

Asian Journal of Psychiatry 4

Studies in Family Planning

Journal of Advanced Nursing 23

BMC Public Health

Public health 123

International Review of Psychiatry

Social Science & Medicine 44

Archives of Disease in Childhood 99

Indian Journal of Medical Sciences 59

Journal Interpersonal Violence,

Beyond trauma: Cultural and societal dynamics. Plenum series on stress and coping.

American Journal of Public Health 96

Violence Perpetrated Against Women in India.

Violence Against Women, Women Against Violence

Freedom from the Known

Violence Against Women, Women Against Violence

Mental Health & Prevention

BMC Proceedings

Manokamna: A Woman Centric Project in Mental Health and Emotional Health Care for Himachal Pradesh

Social psychiatry and psychiatric epidemiology

The British Journal of Psychiatry

Interviews: Learning the craft of qualitative research interviewing

The Lancet

The Lancet

Foundations for research: Methods of inquiry in education and the social sciences

Tehelka

Naturalistic inquiry

Violence Against Women, Women Against Violence

The Lancet 378

JAMA: The Journal of the American Medical Association 282

American Journal of Epidemiology

Child survival. Culture, Illness and Healing. Vol. 11,

To have and to hit: cultural perspectives on wife beating

Domestic violence as a public issue: A review of responses

Social Science & Medicine 54

Qualitative health psychology: Theories and methods

NCMH Background Papers—Burden of Disease in India. National Commission on Macroeconomics and Health.

The British Journal of Psychiatry

The Times of India

Reader in Comparative Religion

Human Rights from the Dalit Perspective

Violence Against Women11

Social Science & Medicine

Reproductive Health Matters

Meeting the mental health needs of developing countries: NGO innovations in India.

. The Lancet

BJOG: An International Journal of Obstetrics & Gynaecology 111

Neuroscience & Biobehavioral Reviews 29

International Journal of Epidemiology

The Lancet

The Times of India.

Social Science & Medicine 72

BMJ 325

Social Science & Medicine

Peace & The New Corporate Liberation Theology. 2004 City of Sydney Peace Prize Lecture. CPACS Occasional Paper No. 04/2.

The Lancet 373

Journal of Obstetrics & Gynecology

Journal of Obstetrics & Gynaecology 33

Industrial Psychiatry Journal

International Journal of Social Psychiatry

International Journal of Epidemiology.

Indian Journal of Public Health 56

Violence Expressed: An Anthropological Approach.

Women's economic dependency and men's support obligations: Economic relations within households. CDE Working Paper #89-26

Economic and Political Weekly

International Family Planning Perspectives

Social organization and social process: Essays in honor of Anselm Strauss. (Starkoff Institute Studies in Ethics and Contemporary Moral).

Journal of the Indian Academy of Applied Psychology 35

World Psychiatry,

‐ Worldviews on

Evidence‐Based Nursing 1

Journal of Affective Disorders 102

Qualitative methods in public health: a field guide for applied research.

Say NO to Gender Based Violence - Respones from South Asia.

Reproductive Health Matters,

Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children, Supplementing the United Nations Convention against Transnational Organized Crime.

Qualitative Health Psychology: Theories and Methods

Indian Journal of Community Medicine: official publication of Indian Association of Preventive & Social Medicine

African Journal of Reproductive Health

Journal of Affective Disorders 102

Putting women’s safety first: ethical and safety recommendations for research on domestic violence against women.

The Lancet359

Protocol for WHO multi-country study on women’s health and domestic violence.

The World health report: 2001: Mental health: new understanding, new hope.

WHO multi-country study on women's health and domestic violence: Study protocol.

Addressing violence against women and achieving the Millennium Development Goals.

WHO multi-country study on women’s health and domestic violence against women: summary report of initial results on prevalence, health outcomes and women’s responses.

Understanding and addressing violence against women: femicide.

Global and regional estimates of violence against women. Prevalence and health effects of intimate partner violence and non-partner sexual violence.

Violence against women: Global picture health response.

Violence against women: The health sector responds.

7.1 Legal References