The West African country of Ghana is home to roughly 25.4 million people heavily concentrated along the coastal cities with various other pockets and communities throughout its rural areas. Ghana’s women face many health issues including a high maternal mortality rate, roughly 350-450 per 100,000 births, a high under five birth rate of 77 for every 1000 births, and roughly 1.4% f the country diagnosed with HIV (UNICEF 2013). Due to these high statistical deaths, it is increasingly necessary to explore and research the social and political issues surrounding women, their health and their safety so that lives can be saved and the condition improved. In this paper I will discuss the connection between intimate partner violence, or wife-beating, an issue that roughly a third of Ghanian women have experienced, and the prevalence of subsequent effects this has one women’s health, specifically how the spread and contraction of HIV is related. Finally, I will suggest that community based conversation could shift the cultural understanding of intimate partner violence and allow women greater sense of autonomy and agency over their lives and bodies.
To better understand the connection between intimate partner violence and HIV in Ghana, I have taken a critical medical anthropological perspective. Singer writes that the critical medical anthropological perspective is concerned, “with understanding and responding to pressing health issues and problems around the world as they are influenced and shaped by humans social organization, culture, and context,” (2004). In another way, this theory is concerned with the inequalities and power struggles surrounding a particular health issue, for this piece intimate partner violence and its subsequent effect on health. This perspective places value in the statistics of issues, statistic often pointing to the issues at hand, but not providing a reason for why. This perspective also makes an effort to combine interactive, face to face conversations with those suffering at the hands of a power struggle, and therefore values an immersive and intersectional knowledge. To develop of full picture of Intimate partner violence and its connection to HIV, this intersectional approach is necessary.Intimate partner violence itself is a health issue that is influenced by cultural norms and the autonomy of women. HIV remains a health issue in its own right but has a particular connection to the rate of intimate partner violence due to the marriage laws and cultural norms of marriage throughout Ghana.
In a survey conducted by UNICEF, 44% of women, compared to 22% of men, support wife-beating in Ghana (2013). This statistic caused me to stop and think, how could it be that women support a practice that places their emotional and physical health in direct sight of danger? I considered several options: perhaps men were under reporting beating their wives? perhaps women felt a threat to speak out against this violence? perhaps women felt that being beaten was a normal occurrence in the day of being a good wife? perhaps wife-beating was attached to economic or social status and therefore acceptable? After looking into the subject this semester, I have found the answer does not line up with my some of my suggestions or accusations, and to combine others. In the article Domestic Violence in Ghana: The Open Secret, Cantalupo helped connect some of the pieces. She notes in this article that “1 in 3 Ghanian women suffer from physical violence at the hands of a past or current partner” (stressing the importance that this is a severe danger to women’s health) and that intimate partner violence is an issue that should be dealt with privately within the home and family (2006). As a cultural norm, it can be difficult to understand this issue objectively – we jump to call out the men for being aggressive and accuse the women of being complacent. However, this would be ill-informed with a misunderstanding of culture. In the piece Violence Against Women in Ghana: A Look at Women’s Perceptions and Review of Policy and Social Responses, Amoakohene notes that in a survey conducted by the Women and Juvenile Unit of Ghana’s government there was shown a dramatically increase in reported incidences of intimate partner violence, increasing from 360 cases in 1999 to 3622 cases in 2002 (2004). In this way, we see that women are resisting the cultural norms of silence in the face of intimate partner violence. They are making an effort to bring the truth that women are being beating at high rates to the public sphere in order to cope with and better understand this issue. Intimate partner violence is therefore an issue that culturally women must challenge to gain autonomy within their society and reclaim their bodies.
Intimate partner violence has been shown to have a profound effect on women’s health, putting them in physical and emotional danger. Not only do women who have experience trauma live in a heightened state of stress, but women who have experienced trauma are more likely to give birth to children with a low birth weight, are more likely to contract HIV and generally the maternal and child mortality rate is higher in countries with higher rates of intimate partner violence. The issue of intimate partner violence becomes a particular risk to women’s health due to the increasing number of individuals diagnosed with HIV throughout Ghana. UNICEF reports that in 2012, roughly 240,000 people in Ghana were tested positive for the virus (2013). Of this 240,000 roughly half are women, posing a risk for pregnancy and childbirth, as the passage of the virus from mother to child is possible. HIV connects specifically to marriage and intimate partner violence because within the Ghanian government, the Criminal Code allows marital rape (a 2010). Not only does this deny women control over their sexuality, it directly affects their risk of contracting HIV. Culturally, marriage is sought after, expected, and respected, though strict monogamy is not enforced in Ghanian society. Many traditional marriages are polygynous, allowing a man more than one wife. In the article Women’s Control Over Their Sexuality and the Spread of STDs and HIV/AIDS in Ghana, Awusabo-Asare notes that within polygynous relationships, often both parties will attempt to find sexual solace outside of the relationship (1993). In this way, a women’s risk of contracting HIV is increased due to the cultural normalcy of polygamous marriages and the private nature of intimate partner violence.
Intimate partner violence and HIV place women in danger, but these issues do not exist in a vacuum, they are rather shaped by the culture at hand. Social, economic and political factors are consistently working away at these issues, changing the face of the issue. These external factors that surround a person’s life, and in this case have a dramatic effect on one’s health, are determinants of health. Ghanaian cultural pressures women to keep intimate partner violence a private matter, and this itself becomes a social determinant of health – it is a social norm. Another social determinant of health is the social standing and autonomy given to women. Takyi and Mann in their article Intimate Partner Violence in Ghana, Africa: The Perspectives of Men Regarding Wife Beating report that wife-beating is more likely to be viewed as unjustifiable to men when the women in the household are allowed to make decisions, or the relationships itself is more egalitarian (2006). In this way, when a woman is allowed a greater autonomy in her life, her husband is less likely to beat her. This trend shows that the status of women as understood by the culture of Ghana has a direct effect upon their safety and health. More interestingly, Takyi and Mann note that the socio-economic standing of men was not an important factor in determining whether intimate partner violence was an acceptable act.
In regards to women’s economy participation, this may have an effect on the agency of women in Ghanian society. In the article, Altering the Strands of the Fabric: A Preliminary Look at Domestic Violence in Ghana, Rosemary Ofeibea Ofei-Aboagye writes that many women in Ghana participate in the economy, but the jobs with the highest concentration of women such as trading, farming, domestic services, and hairdressing are often paid less and require little education. Ofei-Aboagye continues to say “The women are trained to accept ‘female’ occupations and rarely suppose that anything can be done to change their lifestyle” (1994). Because women often participate in jobs that earn them less money and do not require them to get an education, women are placed in a position in which they require assistance, financially or otherwise, from someone who is able to support themselves financially. Often time this person is a man. In this way, the economic determinant of health here is women’s inability to climb any sort of economic ladder, therefore leaving them unprepared to support themselves, socially and financially, without a man. Because women are unable to compete with men for career positions in Ghana, the issue of leaving or addressing one’s husband about intimate partner violence becomes increasingly difficult. Women therefore may feel increasingly isolated because, economically, they are the inferior.
In the piece Connecting Social Determinants of Health and Woman Abuse: A Discussion Paper, Gill and Theriault write that “people are healthier when they feel safe, supported by and connected to others – when they can trust their family members, then they can count on friends, neighbors and members of the community in general” (2005). I bring this quote in not to say that women in Ghana do not have support systems, I entirely believe that they do. But the cultural understanding of intimate partner violence as a private matter restricts the space of “community” and restricts that conversation regarding this issue that has a profound effect of women’s health. The community is not willing to acknowledge the social construction of wife-beating in their society, in a way isolating women who have fallen victim to Intimate partner violence. Gill and Theriault also note that when someone does not have “a confidant at [their] disposal it might make it much more difficult to take steps to end the abuse. Therefore, a weak network of support and a situation of relative social isolation can be considered a potential risk factor for domestic violence victimization,” (2006). Allowing someone to voice their feelings and address issues and concerns in their life with a trusted member of the community alleviates the stress placed on that person alone, allowing them to connect and open up their experience. In not allowing women an open support system regarding intimate partner violence, this lack of a social system becomes a serious determinant of health, enabling wife-beating and the slew of effects it entails. I believe that creating a social system would allow women to deal with the issue of wife-beating in their own way, and may start the ball rolling as more and more women speak out. Creating support systems would not of course put an end to the political, social and economic determinants of health and the effects these big issue have on intimate partner violence, but in beginning a dialogue about intimate partner violence, at the very least it becomes an issue that people are able to see, identify, better understand, and actively change.
The problems facing Ghanian women and their health are complex, shaped by social, political, economic and cultural factors. Because so many systems and institutions have a direct effect on how ones quality of life will be, developing solutions to the health problems at hand becomes increasingly difficult, the strands all woven together in a vast mess. The suggestion I have given in this essay, to create specific support systems in Ghanian communities for women to talk about their intimate partner violence I feel will challenge the cultural and social norm of keeping intimate partner violence a private matter. I think that in challenging the cultural norm, we can begin to chip away at the political and economic standing and treatment of women to better their health from those perspectives as well. In allowing women to talk opening about the violence they have experienced, I further think that this could influence the contraction of HIV, in that women would grow a sense of strength and autonomy by talking with members of the community and therefore may be able to gain traction in voicing issues at home. Perhaps this is all very optimistic but this solution particularly targets the social a cultural determinant of health, the determinants that I feel are most powerful and are most effective in making change. Culture is created by the people and country that surrounds it so to shift the culture seems the most effective way to solve a problem of the people.
Sources appear in the order mentioned.
UNICEF. (December 26th 2013). At a Glance: Ghana. http://www.unicef.org/infobycountry/ghana_statistics.html (H)
Singer, Merrill. (2004). Encyclopedia of Medical Anthropology: Health and Illness in the World’s Cultures. 23-30. (T)
Cantalupo, Nancy Chi. (2006). Domestic Violence in Ghana: The Open Secret. http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1432&context=facpub (H)
Amoakohene , Margaret Ivy. (2004) Violence Against Women in Ghana: A Look at Women’s Perceptions and Review of Policy and Social Responses. http://www.researchgate.net/publication/8264070_Violence_against_women_in_Ghana_a_look_at_women’s_perceptions_and_review_of_policy_and_social_responses (H)
Awusabo-Asare, Kofi. (1993). Women’s Control Over Their Sexuality and the Spread of STDs and HIV/AIDS in Ghana. http://htc.anu.edu.au/pdfs/Awusabo3_S.pdf
Takyi, Baffour. Mann, Jesse. (2006). Intimate Partner Violence in Ghana, Africa: The Perspectives of Men Regarding Wife Beating. 61-78.
Ofei-Aboagye, Rosemary Ofeibea. (1994). Altering the Strands of the Fabric: A Preliminary Look at Domestic Violence in Ghana. 924-938.
Gill, Carmen. Theriault, Luc. (2005). Connecting Social Determinants of Health and Woman Abuse: A Discussion Paper. http://www.unb.ca/fredericton/arts/centres/mmfc/_resources/pdfs/other2005.pdf