COMMENTARY

December 2004: The Year in Review -- Ob/Gyn & Women's Health

Ursula Snyder, PhD

Disclosures

January 24, 2005

Violence Against Women

This is not something that just happens over there, it happens here. It is not something that only happens to other people, it happens to you, your friends and your family. Until all of us, men as well as women, say 'no, I will not let this happen,' it will not stop.

Irene Khan, Secretary General, Amnesty International

In 2004, we learned that at least 40,000 women and girls in the past 6 years have been raped during the war in Congo, that in the 1994 genocide in Rwanda, 250,000 to 500,000 women were raped, that today in Darfur, sexual violence is being used as a weapon of war to humiliate, punish, control, inflict fear and displace women and their communities, that an estimated 100,000 Iraqi civilians -- mostly women and children -- have been killed since the beginning of the invasion, mostly as a result of airstrikes by coalition forces.[228,229,230,231] In early December, Amnesty International released its report, "Lives Blown Apart." Crimes against women in times of conflict," which, as the introduction notes, "lays out the global picture revealing a systematic pattern of abuse repeating itself in conflicts all over the world from Colombia, Iraq, Sudan, Chechnya, Nepal to Afghanistan and in 30 other ongoing conflicts. Despite promises, treaties and legal mechanisms, governments have failed to protect women and girls from violence." In addition, according to a report in the Guardian, "as of September this year, the Miles Foundation had received credible reports of rape or sexual assault (in the period August 2002 to August 2003) from 243 women serving in the US military in Iraq, Kuwait, Bahrain, and Afghanistan. An additional 431 instances of assault were reported elsewhere."[232]

Of course, violence against women does not only occur in regions of conflict. In the United States, while the murder rate has declined, the incidence of rape has increased. According to an FBI report, in the first half of 2004, the only crime that was on the rise was rape -- up 1.4% nationwide and up 6.5% in cities, with populations ≥ 1 million.[233] A report by Crandall and colleagues[234] published in 2004 found that 44% of women murdered by their intimate partner had visited an emergency department within 2 years of the homicide, 93% of whom had at least 1 injury visit. The study also found 2 factors independently associated with increased risk of injury: the victim's lack of full-time employment and physical abuse on the index incident date. The authors conclude: "By questioning our patients about these issues, we can begin to identify the complex risk factors that predispose women in abusive relationships to future injury." Yet, this year, the USPSTF found insufficient evidence to recommend for or against routine screening of parents or guardians for domestic violence. (See Medscape Medical New story.) How does one respond to this? Dr. Lachs' response seems appropriate:

For some conditions that clinicians regularly encounter, robotic devotion to evidence-based medicine risks dehumanizing certain aspects of doctoring... Any clinician who has extricated a family violence victim from an abusive situation understands this.... Our patients and their families are suffering, and the relief of suffering is among our mandates.

Clinicians clearly need help, and a focus group study published this year noted the need for more awareness about intimate partner violence.[235] In this regard, it is worth noting that the CDC recently published an update on their strategic approach and research agenda aimed at prevention of violence against women.[236]

The year 2004 came to a dreadful and violent close with the continued violence wrought by human beings on one another and the sudden catastrophic violence wrought on human beings by the earth itself. It is a profoundly sad time. It has been difficult to focus in on the year in ob/gyn and women's health, because here, too, there is much room for sadness as well as for feelings of anger, shame, and helplessness. Certainly, there have been advances and causes for excitement -- the successful live birth after orthotopic autotransplantation of cryopreserved ovarian tissue, discoveries at the molecular level that are beginning to shed light on the great mystery of preeclampsia, improvements in breast cancer therapies, to name a few examples. But 2004 has again exposed the role of poverty, racism, lack of education, lack of access to healthcare, and violent conflict in women's (lack of) health. The overwhelming response to the tsunami followed with action by the world's citizens is extraordinarily inspiring. Can we feed off that inspiration to work hard in 2005 for women's health on any and every level? I hope so. Here's to 2005.

If you have comments or questions about the site, please contact me at usnyder@webmd.net.

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