children

Case 21

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Case study from Kenya on FGM and cultural practices which violate girls’ rights

Objective:

To show how cultural practices violate the rights of girls.

Narrative Case:

The UN convention on the rights of children define this group as those aged under 18 years. One ethnic grouping in Kenya honours the rites of passage for adolescent boys by unfortunately violating the rights of girls.

Mwandi is fifteen years old. She has known since she started her menses at the age of 12 years that she was destined for something special. Her mother kept a close eye on her and did not allow her to spend nights away from home at her friend’s houses like other girls. Early one morning her mother woke her up and after she had bathed, dressed her up nicely and took her to a strange hut in the nearby village where she was told to lie on a bed and keep her legs open[1].  Before she could scream, she felt a sharp excruciating pain down below after which she felt the sting of some herbal preparations [2]. She was told to keep her legs together. That was the beginning of the end of her childhood. Two weeks later when it had all healed up her mother gave her some special fragrant herbs to bathe with and told her she had to be good as she was going to bring honour to their family.

Later she learnt that ‘warrior’ boys are confined in a camp for various rites. Tradition and culture means girl children are circumcised and given to ‘warriors’ as sexual companions.There was no protection offered against sexually transmitted infections when she developed sores and was later told at the clinic that she was HIV positive [3]. Treatment consisted of herbs that her mother procured from a medicine man [4].

If girls get pregnant, because these relationships are outside marriage, the mother of the girl has to find a way of aborting the foetus. This is done by crushing the head of the foetus against the girl’s pelvis.  Mwandi was brought to the clinic by an aunt who visited the village and noticed the severe pain and extreme bleeding (menorrhagia) she was having [5,6].

 

Learning Points:

[1] Perpetrators are primary caregivers, parents, teachers and close relatives in Kenya and many other countries where culture and tradition are the predominant reason for a large number of practices that are harmful and violent, especially to girls.

[2] Female genital mutilation is believed to help control sexual urge in young girls and keep them chaste. The same tradition and culture is however throwing these virgin girls at young men to whom they are not married.

[3] There is no sex education of either young men or the young women to protect them against sexually transmitted infections (STIs) or pregnancies.

[4] There is a lack of healthcare available for those who get STIs.

[5] Women doctors must be aware of these practices and use every available opportunity to educate their patients on the dangers of these practices and the continued violations of the rights of children especially girls.

[6] Women doctors need to work with community opinion leaders to offer education on the effects and outcomes of these harmful practices.

 

Bibliography

  1. Mohamed  FJ. Does Kenya have the courage to lead on women’s rights in Africa? The Guardian April 21 2014. Available at : http://www.theguardian.com/global-development/poverty-matters/2014/apr/21/kenya-courage-lead-africa-womens-rights [Accessed 28th August 2015]
  2. Munyao WL.  Gender Issues Affecting the Girl Child in Kenya International Journal of Humanities and Social Science 2013; 3(4): 125-9. Available at: http://www.ijhssnet.com/journals/Vol_3_No_4_Special_Issue_February_2013/13.pdf [Accessed 28th August 2015]
  1. Queens University Belfast. Children’ rights resources. Available at http://www.qub.ac.uk/research-centres/CentreforChildrensRights/ChildrensRights-BasedResearch/ChildrensRightsResources [Accessed 28th August 2015]
  1.  Armstrong S. In Kenya, a Victory for Girls and Rights. The New York Times June 4 2013. Available at: http://www.nytimes.com/2013/06/05/opinion/global/in-kenya-a-victory-for-girls-and-rights.html?_r=0  [Accessed 28th August 2015]

 

 

Case 20

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Effectiveness of a Domestic Violence Perpetrator Programme (DVPP)

Note:  

Respect is a national Domestic Violence charity working with the perpetrators
DVPP: Domestic Violence Perpetrator Programme
ISS: Independent Support Service associated with the DVPP

Objectives

  1.  To show the effectiveness of a DVPP in stopping domestic violence at its source, by changing behaviour and managing the risk of perpetrators.
  2. To show the impact on children of domestic violence.

 

Narrative

A family safely together

Jason rang the Respect helpline following an incident of violence where he had grabbed his partner Elly by the hair and thrown her to the floor, causing bruising to her face and a sprained wrist. This was not the first time Jason had been violent but it was the first time Elly had been visibly injured.

The Phoneline workers spent some time talking with him about what had happened and then referred him to a local DVPP. Elly was initially reluctant for Jason to involve outside agencies. She felt that she and Jason had a good family and a good way of life. They both had successful jobs and two children together. She felt ashamed at admitting that she was a victim of domestic violence as she always imagined this was something that happened to other people. Nonetheless, when ISS contacted her, she agreed to regular updates about Jason’s progress.

On the programme, Jason quickly learned to be non-violent, but he struggled to be non-controlling.

Jason was asked to conduct a re-enactment exercise in the group. With the guidance of DVPP workers, he re-enacted the worst incident of violence he had committed, step by step, stopping just before he used violence. Until this exercise he had always maintained that the children had never been aware of the abuse. However, during the re-enactment he had to account for the children’s whereabouts and it quickly became obvious to him and the group that the two children were aware and very distressed by him hurting their mother.

This was an important contributory factor in getting Jason to end his verbal and emotional abuse. He had already developed an increased awareness of his own stresses. Further awareness of the effects of his behaviour upon the children as witnesses to violence helped positively motivate Jason to remain non-abusive. This was confirmed by the ISS contact with Elly and by the end of the programme Jason had achieved a sustained period of non-violent and non-abusive behaviour. Elly felt that she and the children were safe to continue living with him, knowing that the ISS was there, should things change.

Learning points

  1. Women are often reluctant to disclose abuse, because they are ashamed. Having children and not wishing to ‘rock the boat’ is another reason to remain silent.
  2. Domestic violence and abuse is more commonly associated with poverty or hardship , but    can occur in any social class.
  3. Knowing that children are aware of their father’s abuse of their mother is a very important factor in changing the perpetrator’s behaviour. Many men are not aware of the distress they are causing their children.
  4. Children from families where domestic violence has occurred are more likely to become perpetrators themselves
  5. Without the DVPP/ISS it is  more likely that domestic violence will continue, perhaps leading to more serious violence, greater impact on the children, police call-outs, and involvement of the criminal justice system and health services.  Recurrence of domestic violence with a new partner is a real risk.

 

Acknowledgments: This case has been adapted from cases from the UK charity
Respect, with their kind permission.

 

Case 15

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Domestic violence and impact on children

Objective

  1.  Safeguarding children, and considering the impact on them, is a very important component of dealing with domestic violence

Abbreviations

DVPP       Domestic Violence Perpetrator Programme
ISS            independent Support Service

Narrative case

Tom and Sarah separated a year ago because of Tom’s violence and abuse, which culminated in an incident where he was violent in front of their children Jack (9) and Sam (7). Tom had not seen the children since. He was desperate to resume contact and applied for an order to do so through the family court. The court instructed him to attend a Domestic Violence Perpetrator Programme (DVPP) for risk assessment and to complete the group work programme. The programme was required to provide an initial assessment and then report on Tom’s progress half way through and at the end of the programme.

During the programme, Tom started a new relationship with Julie. He gave her contact details to the DVPP workers as required. The ISS then contacted Julie, who said she did not need any support and that Tom had not been violent to her. She said that Tom had admitted his past violence towards Sarah and she was pleased to know he was attending the DVPP. If Tom was ever violent or abusive, she knew she could call the ISS. Just knowing this – and knowing that Tom knew it – made her feel safer.

The DVPP’s half way report was largely positive. Tom had remained non-violent and had not attempted to contact Sarah or the children, despite desperately wanting to. However, he needed to work more on his empathy for Sarah and workers thought that he still underestimated the likely effect upon the children of witnessing violence. In the court proceedings Tom admitted he had been violent and abusive to Sarah and took responsibility for it. Sarah had also been in regular contact with the ISS and was pleased with how Tom appeared to be changing. However, she was still worried about the impacts of contact on the children and wasn’t sure she could trust him. Tom was granted supervised contact at this point.

Tom continued to engage with the programme and appeared profoundly affected by the sessions relating to children and the impact of his behaviour towards Sarah. In the week before his first supervised session he discussed with the group how he would handle the situation – particularly how he might deal with his children’s anger towards him or answer difficult questions about his past violence. The next week he reported how useful this had been as Jack had directly challenged him, asking ‘Why did you hit Mum?’. If he had not been prepared he would not have known what to do. He said he would probably have tried to avoid the question or would have played down how serious it was. Instead, he was able to fully admit what he did, explain it was wrong, say how much he regretted it and give the children a heartfelt apology.

By the time of the final court hearing Tom and Sarah had not seen each other for almost 2 years. Sarah approached Tom through her lawyer and asked to speak with him. He was able to tell her what he had learned on the programme, saying that he was totally responsible for the violence, that she was not to blame and that he deeply regretted the harm he had caused to her and the children. Sarah felt safe enough to tell him how angry, afraid and hurt she had been. She felt more confident that Tom was in the right place to be a decent father – and also knew who to contact with any future concerns. At the final hearing Tom was granted unsupervised contact which has been reliable, safe and positive to date.

Learning points

  1. Perpetrators are often not aware of the impact of domestic violence on their children. Children who have witnessed violence are more likely to become perpetrators themselves in their future relationships.
  2. Providing new partners  and ex- partners of perpetrators with support gives them reassurance and confidence that they and their children will be safe.
  3. The relationship between fathers and their children is often underestimated when couples separate. Wherever possible this relationship must be maintained as long as suitable safeguards are in place.

 

Acknowledgments: This case has been adapted from cases from the UK charity Respect, with their kind permission.

Case 12

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Children are at serious risk in households where there is domestic violence

Objectives

  1. To show how children who live in households where there is domestic violence are seriously at risk and need child protection.
  2. To illustrate how parents can manipulate health care professionals and deliberately set out to deceive them
  3. To demonstrate the need for all agencies involved with children to share information and to ensure it is formally documented.

Narrative Case

This case is about Daniel a 4 year old boy and his 27-year-old-mother Ms. Luscak, who has had four different partners and did not seem able to detect abusive relationships or learn from past experiences [1]. This was made worse by her alcohol misuse [2] and occasional violence towards her partners. Originally from Poland she spoke little English [3].

Daniel had 2 siblings, a 7 year old sister Anna by her first partner, and a 1 year old brother Adam by her fourth partner, Mr. A.  On 27 different occasions, the police were called to domestic violence incidents often complicated by both parents being drunk [4]. On 2 occasions Daniel’s mum took overdoses with the intention of committing suicide [5]. She suffered a number of serious incidents with partners including attempted strangulation, being threatened with a knife, suffering a hand fracture and rape allegations. When asked to press charges she withdrew her statements [6]. On numerous occasions the children were judged not to be at risk and left with the parents with sometimes children’s social care not being informed [7]. The family moved house on a number of occasions due to inability to pay the rent [8].

When pregnant with Adam, Mr. A urged Ms. Luscak to have a termination. She missed 4 antenatal appointments. At one stage she was hospitalised and Mr. A took the drip out of her arm and she self discharged. Ms. L phoned the midwife and told her there was  domestic violence, despite previously denying this fact to healthcare professionals [9].

In January 2011 Daniel had a spiral fracture to the left arm [10] reported as due to jumping off the settee with his sister the previous day. Bruises on his shoulder and lower tummy were said by his mother to be due to falling off his bike regularly. Meetings of health care professionals took place but the long history of domestic violence was not considered.[8] In September 2011, Daniel started school. There were frequent absences as for his sister Anna. On a number of occasions different members of staff noticed injuries including black bruises around the eyes, blood spots on the face, severe marks on the nose, spot bruises on the neck and forehead bruising.  They also became concerned as Daniel was getting markedly thinner and always seemed hungry, taking food from lunchboxes and rubbish bins. [11 ]His sister Anna was told by Ms L to say that Daniel had this pattern of behaviour at home, ate more food than she did and was constantly falling over. Daniel had poor English and although a cooperative boy was shy and reserved and did not talk to the teachers.

Daniel saw a Paediatrician in February 2012 who was unaware of the school’s concerns.  His mother was very convincing that Daniel had an eating disorder and fell over a lot. Tests for medical conditions were initiated.  Three weeks later Daniel died. At post-mortem he was found to have high sodium levels and over 40 injuries including an acute subdural haematoma and an older smaller one.  His mother and stepfather have been convicted of Daniel’s murder and his 2 siblings are in foster care. Daniel had been subject to the most appalling abuse including being starved at home, fed salt to make him sick if school said he had taken food, put in cold baths nearly drowning on one occasion, locked in a box room with the handle taken off the door, had a soiled mattress and urine soaked carpet. He had physical punishments given by his stepfather of situps for 1 hour, standing in the corner, squats and running on the spot which were planned in advance. He had no toys.[12] His sister Anna had tried to protect him as much as possible including physically. She confirmed that Daniel had been hit “many,many times” by the stepfather.

 

Learning Points

[1] Children in households with domestic violence are at serious risk and must be thought about carefully. There is a strong association between witnessing DV and severe PTSD symptoms: withdrawal, clinging, regressive behaviour, hyperactivity, aggression, difficulties in concentration (Kilpatrick et al, 1997).  Child witnesses are much more likely to grow up to be either victims (females) or perpetrators (males).

[2] This is a typical pattern in DV: alcohol and/or drug abuse leads to fighting and then reconciliation.  Often the man feels overcome with remorse after beating the woman and there are pleas for forgiveness, promises to reform, lovemaking and then further cycles. The perpetrator is often very loving and repentant following a violent outburst and this intensifies the partner’s attachment to him.

[3] Abuse of children is more prevalent in socially isolated or disadvantaged families, with alcohol and drug abuse and with domestic violence. This case has all these risk factors including the mother speaking little English.

[4] Every minute in the UK, the police receive a call from the public for assistance for domestic violence. This leads to police receiving an estimated 1,300 calls each day or over 570,000 each year.  However, only 23-35% of incidents of domestic violence are reported to the police.

[5]  Domestic violence commonly results in self-harm and attempted suicide.  Abused women are five times more likely to attempt suicide and one third of all female suicide attempts can be attributed to current or past experience of domestic violence.

[6] The low rate of conviction in cases of domestic violence can be attributed to the victim’s inability or unwillingness to give evidence (Cretney and Davis 1995).

[7] Interagency communication is vital and children’s social care should always be informed. In all the landmark cases in recent years in the UK, there has been lack of communication between agencies (Lord Laming 2003).

[8] Moving house several times is a typical pattern seen and the mother may lose all her possessions

[9] Domestic violence increases during a pregnancy and is the commonest cause of injury in pregnant women. Men often feel threatened by the prospect of having a child – economically they have little to offer and emotionally it means one more person to be cared for. This intensifies the man’s feelings of worthlessness and he defends against this by being more angry and violent. Bacchus (2004) reported 23% of women receiving care on antenatal and postnatal wards had a lifetime experience of domestic violence, and 3% had experienced violence in the current pregnancy.

[10] The possibility of abuse needs to be considered with spiral fractures and a judgment made as to whether the suggested mechanism of injury is plausible. In this case the issue was not considering other red flags i.e. the bruises on the abdomen which are unusual and for which there needs to be a clear explanation and the history of domestic violence.

[11] This eating behaviour is grossly abnormal and needed communicating to health care professional eg school nurse or general practitioner. Again there is lack of communication between different professionals.

[12] Health care professionals need to be able to “think the unthinkable” – this is a catalogue of abuse which if this was not a real case many would think was not possible

Background information

Background information on domestic violence

This is defined as abuse between persons in an intimate relationship, independent of gender, sexuality or marital status.  The term usually excludes abuse of children and the elderly.

Prevalence:

  • One incident of domestic violence is reported to the police every minute in the UK
  • On average, 2 women a week are killed by a current or former male partner.
  • 23% of women experience DV in their relationships at some time.
  • 45% female homicide victims are murdered by their partners. (Australian Bureau of Statistics: Women’s safety survey, 1996.) Women presenting to ER (Australian study)
  • 49% had experienced DV, 40% in the last 12/12.
  • 25% had a history of childhood abuse plus adult DV (Roberts et al, 1998).

 

Background of risks to children of domestic violence

Unicef figures estimate that globally the number of children exposed to domestic violence is 133-275 million. This varies by country: Developed countries 4.6-11.3million,

SubSaharan Africa 34.9-38.2 million and South Asia 40.7 – 88 million. At least 750,000 children a year witness domestic violence (Department of Health UK). Estimates vary from 30%-66% children are abused either physically or sexually by the same perpetrator. Children are completely dependent on adults and all children witnessing domestic violence are being emotionally abused

Children react in various ways to living with a violent person. Age, race, sex, culture, stage of development, and individual personality affect response. Children can be affected by tension, witnessing arguments, distressing behaviour or assaults. They may get caught in the middle of an incident, sometimes trying to make the violence stop; they may be in another room but be able to hear the abuse or see their mother’s physical injuries following an incident of violence; or they may be forced to take part in verbally abusing the victim. They experience a range of emotions including that they are to blame, anger, guilt, being alone, frightened, powerless, or confused. They may have ambivalent feelings, both towards the abuser, and towards the non-abusing parent.

Effects of domestic violence on children include:

    • Anxiety and depression
    • Difficulty sleeping.
    • Nightmares or flashbacks.
    • Physical symptoms such as headaches and abdominal pain
    • Enuresis
    • Temper tantrums
    • Behave as though they are much younger
    • School problems including truanting, sometimes staying at home to protect their mother
    • Aggression
    • Withdrawal from other people due to internalizing the distress
    • Lowered sense of self-worth
    • Start to use alcohol or drugs.
    • Self-harm eg overdoses or cutting themselves.
    • Develop an eating disorder.
    • Affecting social relationships – they may feel unable to or are prevented in bringing friends to the house

 

References

  1. Bacchus L, Mezey G, Bewley S, Hawort A, (2004) Prevalence of domestic violence when midwives routinely enquire in pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology 111; 441-5.
  2. Cretney A, Davis G. (1995) Punishing violence. Routledge, London  
  3. Family Rights Group: www.frg.org.uk
  4. Lord Laming (2003). The Victoria Climbié Inquiry https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/273183/5730.pdf
  5. Mind ‘How to parent when you’re in crisis’. http://www.mind.org.uk
  6. Mullender, A. and Morley, R. ‘Children living with domestic violence’ (London: Whiting and Birch).
  7. Royal College of Psychiatrists (2004) ‘Mental health and growing up, 3rd edition: Domestic violence: Its effects on children’ Available from http://www.rcpsych.ac.uk/info/young.htm).
  8. NSPCC Children living with domestic abuse
  9. http://www.nspcc.org.uk/help-and-advice/worried-about-a-child/online-advice/domestic-violence/domestic-violence_wda86312.html
  10. Parentline Plus.  Support for parents under stress www.parentlineplus.org.uk
  11. Radford L, Aitken R,  Miller P, Ellis J, Roberts J, Firkic A. Meeting the needs of children living with domestic violence in London Research report. 2011 http://www.nspcc.org.uk/Inform/research/findings/domestic_violence_london_pdf_wdf85830.pdf
  12. Royal College of Psychiatrists (2004) ‘Mental health and growing up, 3rd edition: Domestic violence: Its effects on children’ Available from http://www.rcpsych.ac.uk/info/young.htm
  13. Save the Children and  Women’s Aid services.  Safe Learning – an insight into children’s experiences of domestic violence and how these may affect their learning, 2006
  14. Serious case review: Daniel Pelka http://www.coventrylscb.org.uk/dpelka.html
  15. The Hideout website
  16. http://www.thehideout.org.uk/under10/adults/effectonchildren/default.aspa
  17. UNICEF: behind Closed Doors the impact of domestic violence on children
  18. http://www.unicef.org/protection/files/BehindClosedDoors.pdf
  19. Women’s aid organization  – Statistics on Domestic Violence http://www.womensaid.org.uk/domestic_violence_topic.asp?section=0001000100220036sionTitle=statistics
  20. Women’s aid organization – Children and domestic violence http://www.womensaid.org.uk/domestic-violence-survivors-handbook.asp?section=000100010008000100380001.  

Case 5

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Domestic violence leading to death by so-­called accident

Objectives

  1.   To show how detected but denied physical violence can lead to fatality.
  2.   To  show  how  law-­‐enforcement  and  hospital  staff  can  be  better  trained  to  pick  up on these cases and have better (legal) tools to intervene on time.

Narrative Case

A divorced woman of approximately 39 years (Sonia) with a daughter from her marriage goes to live with her new boyfriend. She was a clerk in a hospital and regularly came to work with cuts and bruises. Clearly they were from physical abuse but she insisted that they were the product of accidents and slip-­‐ups by her. In addition, she began to be drawn into the alcohol abuse perpetuated by her boyfriend. Possibly she did the latter to make the physical abuse less dreadful for her to undergo. In any case she never had the courage to get away from him. One day, upon not arriving at work, the police were dispatched to her home where she was found dead at the bottom of the stairs. The boyfriend said she fell while drunk and he didn’t find her until he himself was woken by police, as he was sleeping off his drunken stupor. The case was concurrently dismissed by prosecutors because of lack of evidence, although many believe it was at least manslaughter by the boyfriend.

Learning Points

[1]  Sometimes  the  obvious  should  lead  to  investigation,  even  if  the  party  involved denies wrongdoing, or covers up wrongdoing by their partner

[2] More  specific  training  could  be  given  to  law enforcement  and  or  hospital staff  to detect abuse sooner and be able to intervene more quickly.

 

Case 1

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Professional and ethics related violence 

Objectives

  1.    To show how professional women (for example doctors and teachers) in Afghanistan and their families can be targeted because they work with victims of abuse.

 

Narrative

Dr. C. works as a gynaecologist in Afghanistan, providing healthcare to women suffering from abuse, including rape and domestic violence.

Her problems began when she was working in a clinic carrying out abortions on girls who had become pregnant after being raped by a male relative. These girls had to have an abortion or they would have been killed by their relatives or members of their community (an “honour” killing). Dr C. received threatening letters and phone calls from the Taliban, warning that she and her family would be killed because of her work.

Two years later, one evening she heard an explosion and rushed outside. Her children had been playing in the front yard. Her 11-year-old son was lying on the ground, very badly wounded.

He required medical treatment for almost a year, moving from hospital to hospital. Fortunately he was admitted to an army hospital at an American airbase. After surgery, he was left disabled with one leg shorter than the other. The incident affected him badly. He became mentally ill. He is now bullied at school and can no longer fulfil his lifelong dream of becoming a footballer. He is always tired and depressed. But sometimes he says with a smile: ‘Mum, it is good that I became the victim of a Taliban attack, otherwise I would have been without my mum now and you would have been the victim.‟

 

Six months later, her 22-year old brother was killed in a grenade attack in front of her house. The threats to her family were reported to the government, but nobody listened. Dr C. realised that further incidents were inevitable. She decided that her family had to move. She has now stopped doing abortions and keeps a low profile at work. Nobody knows her address. She is doing her best to make victims of violence aware of their human rights.

 

‘When they listen to my story of how I have lost my brother and how my son became disabled as a result of my struggle for womens human rights they get more courage to stand up and defend their rights’.

 

‘The situation here is very bad for women. Women have problems going out to work and girls are prevented from going to school. There are too many cases of violence against women. I have witnessed 30 to 50 cases in a month. When I tell [the women] to report their case to the police they refuse because their family would be ashamed of them and would treat them very badly. They don‟t go to the police and they tolerate the violence and harassment.

We have to help our people, particularly women, they need us and we have to serve the country and the people. I can‟t sit at home and do nothing, this is not in my nature.

Though I understand and have witnessed that there is great danger to my life in every step as a woman human rights advocate, I also understand that we cannot reach our goals and make a difference without accepting this risk to our own lives. Therefore my final goal is that all Afghan women become united to defend their human rights and know that a woman must be treated by men or her husband as a wife, as a mother and as a human’.

Learning points

  1. In some countries such as Afghanistan, violence against women and girls is accepted as part of the culture. Honour killings are not uncommon, and women can be stoned to death because of ‘adultery’ (the women are actually victims of sexual violence and are then blamed).
  2. Education and empowerment of women, and education of men and boys that violence against women is wrong, are important first steps.
  3. There must be a change in the culture towards gender equality – the government must take responsibility, and police must take action to protect women when violence is uncovered.
  4. Professionals who deal with victims of violence must be listened to and protected.