A central theme of the Beijing +5 conference

CMAJ 2000;163(3):253

This incident drives home a central theme to emerge from the 23rd Special Session of the General Assembly of the United Nations on "Gender Equality, Development and Peace for the 21st Century," known as the Beijing +5 conference, held June 5–9 in New York City and attended by delegates and activists from over 180 countries.² Gender equality will not be achieved until violence against women is eliminated. This violence takes many forms, ranging from the culturally strange to the intimately familiar: genital mutilation in Somalia, honour killings in India, public floggings in Afghanistan, marital rape in Kosovo, unprotected intercourse in Burundi and domestic violence in Canada.

In a 1993 survey of 12 300 Canadian women, 29% of women who were or had been married reported having been assaulted by their partner at least once.³ This proportion seems high, but it is remarkably consistent with estimates for Australia (23%), England and Wales (23%) and the United States (25%).⁴ Most of these women do not report the assault to police or seek medical attention. Only 6% of the Canadian women who had been assaulted reported the first assault.³ According to the 1997 records of 179 police forces in 6 provinces, most domestic assaults involved either no injuries (26%) or minor injuries (70%) requiring no medical attention.⁴ This means that physicians who rely on patterns of physical injury to detect cases of domestic violence are only seeing the tip of the iceberg.

Demographic profiles can be helpful. Couples aged 18 to 24 in common-law relationships in which the male partner is chronically unemployed have rates of spousal abuse 6 times greater than the national average.³ But the strongest predictor of wife assault is a pattern of emotional abuse practised by her spouse: typically, a man who insists on knowing where his wife is at all times, puts her down, calls her names, limits her contact with family and other men, and prevents her from having access to the family income.³ Men such as these do not often reveal themselves in a doctor's office. But their wives reveal themselves, when the right questions are asked.⁵

Case detection is not enough, however. It did not help Gillian Hadley. As observed by Ngamau Munokoa, delegate at the Beijing +5 conference for the Cook Islands, domestic violence is a community problem requiring collaboration between governments, nongovernment organizations, judiciary bodies, police, probation officers and health care professionals. Canada needs to move on this, for restraining orders are obviously not working. Pierre Trudeau was wrong when he adamantly asserted that the State has no place in the bedrooms of the nation. The State does, when the alternative is the coroner. — CMAJ

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1. Gallam M, Brown D. Court order did not put end to beatings before murder. National Post [Toronto edition] 2000 June 23;Sect A:18.
2. www.un.org/womenwatch/followup/beijing5/index.html
3. Family violence in Canada: a statistical profile 1998. Ottawa: Statistics Canada. Cat no 85-224-XIE.
4. Family violence in Canada: a statistical profile 1999. Ottawa: Statistics Canada. Cat no 85-224-XIE.
5. Eisenstat SA, Bancroft L. Primary care: domestic violence. N Engl J Med 1999;341:886-92. [MEDLINE]

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