Violence Against Women With Disabilities – An Overview of the Literature
A paper written by Keran Howe. Copyright 2000.
This overview explores the literature in relation to women with disabilities and violence within the period 1990 to 1999. Specifically this article explores: the meaning of disability from an individualised medical perspective and as a social construct; the extent and nature of violence against women with disabilities and barriers to service response; and feminist explanations of violence against women with disabilities.
It is of concern that women with disabilities are traditionally conceptualised as child-like and frequently spoken of in combination with children. For this reason, questions of sterilisation, child sexual abuse and other forms of violence particular to girls with disabilities will not be addressed although clearly they are of major concern.
To locate my own perspective, my feminist philosophy derives from my experience as a woman, as a person with a disability and as a practitioner in women’s health and the field of disability over some 20 years. My own view is that Western society is diverse, peopled with groups who spring from different histories, beliefs and experiences. Despite this richness of difference, prevailing values and cultural norms derive from and predominantly benefit a particular, dominant male group. These values are universalised and upheld as shared societal values; to the extent that one is different from the dominant group, be it on the basis of gender, ethnicity, race, age, sexual preference or biological ability, one is devalued and marginalised. This devaluation serves to maintain the social order. To define an individual other than from this dominant position requires acknowledgment of the existence of particular disadvantaged groups and hearing the voices of these groups.
This position is theorised and articulated by feminist writers such as Iris Marion Young (Young, 1990). Young identifies the dominant mode of political discourse in the United States as ‘liberal individualism’ and notes that for groups who seek social emancipation such as ‘socialists, radical feminists, American Indian activists, Black activists, gay and lesbian activists’ oppression is a central category of political discourse.’ (Young, 1990, 39). Similarly, Briennes and Gordan identify violence as a power struggle for maintenance of a certain kind of social order (cited in Weeks, 1998,6).
Conceptions of disability
Definitions of disability are contested and controversial. The World Health Organisation has developed an International Classification of Impairments, Disabilities and Handicaps: ‘Impairment’ refers to ‘any loss or abnormality of psychological, physiological or anatomical structure or function'; ‘disability’ refers to ‘any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being'; ‘handicap’ refers to ‘a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual. (United Nations Division for Economic and Social Information cited in Crow, 1996)
This definition is both widely accepted around the world and strongly criticised by disability activists as a definition imposed by ‘professional’ (non-disabled) individuals. Disability activists note its emphasis on normality and on the individual’s deficits or deviation from normality as the cause of disability. Paul Hunt in 1966 challenged this notion of disability and asserted ‘ the problem of disability lies not in the impairment of function and its effects on us individually, but also, more importantly, in the area of our relationship with normal people” (Crawshaw, 1994, 27) Finkelstein and French suggest disability should be seen as “the loss or limitation of opportunities that prevents people who have impairments from taking part in the normal life of a community on an equal level with others due to physical and social barriers” (Chadwick, 1994, 37) This definition shifts focus to the social construction of disability as a dynamic and culturally determined interaction between a person’s individual function and the social meaning and response imposed upon that function. Disability, then, is the result of disabling social, environmental and attitudinal barriers. Social change, in this context, is about the eradication of oppression experienced by people with impairments. This contrasts strongly with the dominant ‘medical’ construction of disability, which emphasises overcoming or conquering disability through medical treatment or individual fortitude (Crowe, 1996, 208). The social construction of disability is critical to understanding the nature and extent of violence against people with disabilities and in particular women with disabilities.
The extent of disability
Current disability data is based on variations of the traditional individual WHO definition described above. In a detailed overview of data available on women with disabilities, Anderson summarises the current status of information on disability: In Australia, data on disability is difficult to obtain and the current census does not include disability as a demographic field. There are few large-scale random sample surveys done in Australia, which include items on disability. The most significant ones are the Australian Bureau of Statistics Disability surveys: Survey of Handicapped Persons, 1981, Disability and Handicap Survey 1988, and Disability, Aging and Caring, 1993. Specific service areas do not disaggregate data according to gender and disability, for example, SAAP does not collect data on crisis housing for women with disabilities (Anderson, 1996). Based on the 1993 survey, there are 1,557,400 Australian women (17.6% of women) who have a disability.
In examining gender differences within the findings of the 1993 survey, there were more men (18.4%) than women (17.6%) with disability overall but more women reported having a severe handicap. Age was a significant factor in gender differences in rate of disability as well as differences in type of disability. Anderson noted “there is a consistent pattern found throughout the range of areas which were examined here, and that is that there are fewer women accessing services, and that women have a greater level of unmet need. This is an issue which needs to be addressed, and the underlying causes of these gender differences needs to be brought into the open”. This is consistent with Yeatman’s finding (1996) that groups who are already disadvantaged by gender, race or ethnicity in Australian society experienced additional barriers in accessing disability services.
Extent of violence against women with disabilities
In exploring the literature on the extent of violence against women with disabilities, the most striking feature is the dearth of research on this issue. Research into the incidence of violence is extremely limited and fragmented, often it does not distinguish either the nature of the disability, gender differences and differences between children and adults. Much of the literature on violence appears to focus particularly on sexual abuse and mainly in relation to people with intellectual disabilities (McCarthy, 1996; Sobsey and Doe, 1991; Muccigrosso, 1991). Research into the extent of violence is also limited by the lack of data collected on disability by law enforcement agencies and violence support services (Cattalini, 1993; Sobsey and Doe, 1991).
What we do know from research suggests that women with disabilities experience violence in situations similar to all women: that is, they will be assaulted by someone who is known to them, will most likely be assaulted by a man and it will most likely be in private, in their place of residence, the home of a friend or relative or in their workplace (Catallini, 1993). Catallini describes how these factors mitigate against women with disabilities: firstly, women with disabilities are more likely to be in institutions which are “closed” and will often be under the management of men; residents of institutions are more likely to be women; women with disabilities are more likely to work in closed environments where the supervisors are male (Catallini, 1993, 11).
Overseas studies indicate that women with disabilities are raped and abused at a rate at least twice that of the general population of women. (Sobsey, 1994; Sobsey and Doe, 1991;) Sobsey (1988) suggests that 83% of women with disabilities will be sexually assaulted in their lifetime. Muccigrosso (1991) estimates the incidence of sexual assault of people with developmental disabilities is at least four times higher than within the non-disabled population. “The emerging consensus is that women with developmental disabilities are at particularly high risk of sexual abuse as both children and adults” (Carlson, 1997,79). However, a qualitative study by Nosek, found approximately one third of women with physical disability had experienced sexual abuse at some stage in their life (Nosek, 1996). Similarly, in Doucette’s study of Canadian women with disabilities, 40% experienced abuse and 12% had been raped (Nosek, 1996).
There are relatively few studies into the incidence of physical violence and rates vary widely. A study for the Canadian Ministry of Community and Social Services in Toronto found 33% of women with disabilities were assaulted mostly by their husbands compared with 22% of non-disabled women (Nosek, 1996). Feuestein estimates that upward of 85% of women with disabilities are victims of domestic violence in comparison with 25% to 50 % of the general population (cited in Waxman, 1991).
Australian Research on the extent of violence
In Australia, Chenoweth (1997), Sceriha (1996) and Cattalini (1993) all highlight the lack of Australian research on the incidence of violence against women with disabilities to date. Available information is usually limited to violence against women with intellectual disability. “The data confirm that these women are more likely to be abused than women in general” (Cattalini, 1993,11).
What we know of the nature and extent of violence against women with disabilities is mainly derived from qualitative research which has tended to explore violence in relation to barriers to accessing services or with people with intellectual disabilities in institutional care.
The National Council on Intellectual Disability commissioned a study into abuse of adults with intellectual disabilities in residential services (Conway and Bergin, 1996). The gender analysis is brief and argues there was little difference between abuse of men and women with intellectual disability. Women (15%) were more likely to experience sexual abuse than men (5%) while men (22%) were more likely to experience emotional, psychological and verbal abuse than women (8%). These rates of abuse are significantly lower than the rates estimated in the studies cited above and must be challenged in the light of the emerging consensus that “women with developmental disabilities are at particularly high risk of sexual abuse both as children and adults” (Carlson, 1997). This study relied on carers of people with intellectual disability and residential managers for data collection. It could be argued that all people contributing to the study are in a position of power over the people who were the focus of the study and should not therefore be the source of data on for the experience of people with disabilities, particularly in relation to sexual abuse.
Davidson conducted a qualitative study of women who were sexually abused in psychiatric institutions interviewing 9 women and 11 staff members. Participants identified 25 single incidents of sexual abuse and 9 ongoing incidents of sexual abuse. More than a third of these incidents were perpetrated by staff and the remainder by other patients and visitors (Frohmader, 1998).
Chenoweth (1997) reports on the Queensland Commission of Inquiry into Townsville General Hospital Psychiatric Ward which found patients were sexually and physically assaulted, verbally abused and medically maltreated. Two people died as a result of unsafe treatment, there were six suicides and 65 died in circumstances that required further investigation.
A study by the National Police Research Unit and Flinders University of 174 people with intellectual disability indicated a prevalence rate of assault as three times more likely to be physically assaulted and ten times more likely to be sexually assaulted than non-disabled people (Cattalini, 1993, 12).
An overview of the literature on the extent of violence against women with disabilities indicates the fragmentation and limited understanding of the issue – clearly more research is required for more comprehensive analysis.
The nature of violence against women with disabilities
Violence against women with disabilities has been identified as not only more extensive than amongst the general population but also more diverse in nature than for women in general. A concise definition of violence in this area is made difficult by the pervasive nature of abuse against women with disabilities. Cattalini argues the nature of violence against women with disabilities incorporates an “almost endless list of injustices and maltreatment” including unnecessary institutionalisation, denial of control over their bodies, lack of financial control, denial of social contact, employment and community participation as well as physical, mental and sexual abuse (Cattalini, 1993, 10). Feminist writers on disability believe people with disabilities in general and women with disabilities in particular, are at greater risk of physical, sexual, and emotional abuse as well as to other forms of violence, such as institutional violence, chemical restraint, drug use, unwanted sterilisation, medical exploitation, humiliation, and harassment” (Waxman, 1991; Crossmaker, 1991; Morris, 1993; Chenoweth, 1997, 23).
An extensive study into violence across a range of disabilities was carried out by Sobsey and Doe (1991) who explored 166 reports of sexual abuse through requests sent to a sample of sexual assault treatment centres and disability advocacy groups. This study sheds considerable light on the nature of violence, the gender and relationship of victims and perpetrators and the conditions under which sexual abuse occurs. Participants ranged from 18 months to 57 years of age; almost all adults were women (95.6% of those over 21years). 91% of perpetrators were male and in 99% of cases the perpetrator was known to the victim. 70% of participants were people with intellectual impairment and 20.4% had some form of mobility impairment. Significantly, in 44% of instances, the location of the abuse was disability-related, that is, a hospital, group home or institution.
Womendez and Shneiderman (1991) identify the nature of domestic violence against women with disabilities which may include abuse common to all women such as incest, rape, beating and shooting and in addition be particular to a woman’s disability such as withholding of medicine, removing a wheelchair, a ramp or a white cane.
Crossmaker (1991) explores the nature of institutional abuse against women with mental illness and intellectual disability. She notes that power and abuse are pivotal to the nature of institutions and create the same effects of passivity, withdrawal and a loss of sense of self. In this way institutions can create or exacerbate mental illness. Crossmaker cites instances where sexual abuse has resulted in effects that are diagnosed as mental illness whilst the abuse goes undetected and unexplored. Crossmaker and other researchers (Waxman, 1991; Sobsey and Doe, 1991) have also identified the rewarding of compliance to medication and compliant behavior as a predisposing factor in the vulnerability of women with disabilities to abuse in institutions.
Of particular concern is the seeming tolerance of abuse toward women with disabilities that is widespread in our communities. Almost all literature examining this issue identified the failure of those responsible for providing protection and care to notice violence, believe the victim, protect against future violence or take legal action against the perpetrator (Carlson, 1997, McCarthy,1993; Waxman, 1991; Crossmaker, 1991; McPherson, 1991; Sobsey and Doe, 1991). Sobsey and Doe found that even though in 95.6% of cases the perpetrator was identified, the perpetrator was charged in only 22.2% of cases. Reasons for no response or tolerance include the victim not reporting, staff member’s fear of retaliation if they report abuse of a resident, administration ignoring abuse, refusal by police or court to prosecute. Victims refusing to report was related to a fear of reprisal, of not being believed, of removal of privileges or because victims “may be so insensitized to daily indignities that they may not recognise abuse.” (Crossmaker, 1991,212)
Work in America and Canada also indicates the serious failure of treatment and abuse response services to respond adequately to women with disabilities experiencing violence. Sobsey and Doe (1991) note that in only 22% of instances did victims of sexual abuse in their study receive an adequate service response. People with developmental disabilities are often not able to make use of sexual abuse prevention and response services (Muccigrosso, 1991). Feminist writers point out that it is frequently more difficult for a woman with a disability to leave an abusive situation because of dependency on her partner/carer for physical care and yet if she manages to leave may not be able to locate a refuge or support service that is accessible and responsive to her needs. (Womendez and Schniederman, 1991; McPherson, 1991; Gill, 1996)
Australian studies on the nature of violence
In Australia, extensive research from a feminist perspective has been carried out by Chenoweth. In analysing the nature of violence against women with disabilities, Chenoweth identifies herself as a non-disabled woman who is concerned with documenting violence as a result of working “alongside people with disabilities and their families for more than 10 years”. (Chenoweth, 1997, 23). She bases her analysis on literature in two separate areas of discourse: firstly, the field of sexual and physical abuse of people with disabilities and a number of published government reports on institutional violence and secondly, the feminist critique of disability. Chenoweth cites a study conducted in Victoria which found people with intellectual disability living in community settings were more likely to experience violence, the most common of which were sexual offences, but does not distinguish the extent of sexual assault on the basis of gender (Chenoweth, 1997 28). Chenoweth’s interest in explanations of violence against women with disabilities are explored further below.
National consultations with women with disabilities and relevant service providers have highlighted the enormous service response gaps that both women’s support services and disability services contain (Mulder, 1995; Catallini, 1993; Strahan, 1997). Barriers to accessing services include lack of knowledge of the issues and of services available by women with disabilities; physical barriers to services; inappropriateness of services to the need of women with disabilities; philosophy of management and community attitudes reflected in attitudes and skills of service providers.
Perhaps the most significant barrier to women in institutions accessing services and support following abuse, is the cultural acceptance of abuse noted by researchers in overseas studies. Australian research notes the same concern with tolerance of abuse and failure to take seriously the abuse of women with disabilities that overseas research has reported (Chenoweth, 1997, Davidson cited in Frohmader, 1998; Catallini, 1993).
Factors associated with violence against women with disabilities
In seeking explanations of why women with disabilities are at increased of violence, much of the research focuses on the notion of vulnerability. It is disappointing to note that even the feminist literature devotes more space to a consideration of the individual characteristics of the victim rather than a speculation on the motivations for abuse. Further, the distinction between the personal characteristics of the victims and the perpetrators perception of increased vulnerability are at times blurred. The Roeher Institute lists factors which account for the higher level of vulnerability related to disability; emotional deprivation, social isolation, more open to incentives, feelings of helplessness and powerlessness, repressed sexuality and susceptibility to coercion and bribery. (Cattlini, 1993). Cattalini’s consultations validated this list and further noted vulnerability related to: additional dependence on carers; greater difficulties in self protection; lack of understanding of violence. Catallini also noted structural relationships such as poverty; women’s place within disability organisations and causal effects of disability, for example, women’s place in society could cause disability such as mental health problems.
Even where there is acknowledgement of the broader social structures that predispose women with disabilities to violence, there appears to be a pathologising of the victim, as for example, where Carlson writes: ” a number of personality characteristics that are reported to be typical of those with developmental disabilities and that might predispose one to being abused include high levels of dependency on others, lack of assertiveness, overcompliance and low self-esteem or poor self-concept”(Carlson, 1997, 80). Carlson goes on to note that these “dysfunctional characteristics” may be internalised as a result of negative societal stereotyping. Similarly, Womendez and Schneiderman describe dissociation learned from medical abuse as a defense mechanism that allows women to tolerate abuse (Womendez and Schneiderman, 1991). Such theorising does not explain the existence of the violence in the first instance. One may more accurately construe such personality characteristics as survival mechanisms for avoiding abuse in a violent environment when there is no escape.
Any consideration of the factors associated with violence from a feminist perspective must begin with a consideration of power. Crossmaker has concisely analysed some of the cultural characteristics of institutions that encourage a repressive and violent environment: she notes how institutions are generally structured hierarchically with clear delineation’s of power and authority and that in institutional culture “behavior is shaped by the social structure of the ward, not by individual personality traits” (Crossmaker, 1991, 207). In this environment violence serves as a means of social control where the “basic aim of the treater is the imposition and possibly the forcing of one set of beliefs upon another person who may hold a different set of beliefs” (Magaro, Gripp and McDowell cited in Crossmaker, 1991, 207).
Chenoweth argues women with disabilities are so devalued they are perceived as asexual and “being denied even a sexual identity…enter a state of extreme marginalisation” (Chenoweth, 1997,26). This marginalisation both within the disability and women’s movement, exposes women to grave risk of emotional, physical and sexual abuse and when this occurs they are likely to be ignored by both the disability and violence-related support systems.
The voice of women with disabilities
Women with disabilities have argued long and cogently that both the women’s movement and the disability movement have marginalised and silenced women with disabilities (Meekosha, 1998; Wendell, 1996; Crawshaw, 1994; Morris, 1993; Begum, 1992;). It is argued that this marginalisation has left women excluded from community life, powerless, poor, denied a real education or opportunity for political decision-making, silenced and vulnerable to violence. Fine and Asch succinctly describe the nub of the matter: “Perceiving disabled women as childlike, helpless and victimized, non-disabled feminists have severed them from the sisterhood in an effort to advance more powerful, competent and appealing female icons” (Fine and Asch cited in Begum, 1992, 73).
The failure of the feminist discourse to integrate the experience of women with disabilities leaves both women with disabilities marginalised and feminist analysis of social reality incomplete. Meekosha argues that gendered and disabled bodies must be central to feminist analysis because they offer a site for the study of the major contradictions of the social, psychological and political (Meekosha, 1998).
Waxman argues that people with disabilities experience hatred in the same way that other minority groups experience hatred but in the case of people with disabilities, analysis of the issue is fragmented focussing on different types of violence as “discrete problems” (Waxman, 1991, 187). To address this violence systematically requires policy makers to understand the nature of this systematic violence in the same way that legislation in the USA has specifically addressed hate crime against on the basis of race, ethnicity, religion and sexual preference.
Young (1990) also identifies the various ways that oppression is expressed toward marginalised groups. She identifies violence as a specific type of oppression and describes the following elements of this type of violence: oppressed groups experience greater violence, violence is systematic against particular groups – women, blacks, gay and lesbian; violence is a social practice, that is, it is rule-bound, social (may happen in groups) and pre-meditated; group violence is tolerated by the wider community. Young fails to acknowledged the violence that people with disabilities experience but her analysis of the interrelated nature of violence is useful in understanding the experiences of people with disabilities and women with disabilities in particular. The nature and extent of violence described in the literature lends credence to the view that people with disabilities experience violence as an oppressed group who have been negatively stereotyped and disenfranchised by cultural beliefs.
This overview highlights the bleak and pervasive nature of violence against women with disabilities. Further research is required to understand both the incidence of abuse and the nature of abuse in relation to gender and particular disabilities. The literature also suggests a failure of service providers in both the disability field and in support services for victims of violence to take account of the needs of women with disabilities experiencing violence. The literature indicates the failure of theorists in the field of violence against women and in particular the feminist discourse to address what appears to be the systematic and protracted abuse of people, and in particular women, with disabilities. From a feminist perspective it is critical that any response to violence recognises the correlation between violence and disadvantage. An understanding of individual needs and difference is important for a respectful and considered response. However, socially constructed difference reinforces negative stereotypes and devalues individuals within the groups so categorised. Challenging the factors that contribute to violence requires an inclusive and collective response spearheaded by members of the most disadvantaged groups and supported by enlightened policy makers and activists for social justice alike.
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