Incest, coerced pregnancy, mass rape, ethnic cleansing, forced prostitution (comfort women of World War Two), date rape, marital rape, rape in prison, rape as revenge, political rape, gang rape, rape in conflict situations and rape as a weapon of war - are not about violent sex (which may imply consensual sex) but power or sexual violence. That one out of every five women is a survivor of rape (whose attackers are mostly known) constitutes the prevalence of rape globally, and 40-60 per cent of known sexual assaults are committed against girls aged 15 years and younger. The reality and fear of rape affects women and girls throughout their lives: gender violence - violence perpetrated against women and girls because they are female - can occur when they are mere infant, girl, adolescent, woman of reproductive age to that of an elderly woman. Yet to what extent would the recognition of the health impacts of rape serve as a preventive, not merely curative measure in lobbying towards a zero tolerance of gender violence at state and grassroots levels?
Violence against women needs to be recognised as a public health problem not only within the Asia-Pacific region, but globally. Gender violence accounts for an estimated five to 16 per cent (depending upon region) of the healthy years of life which are lost to women of reproductive age. Data from rape crisis centres in Korea and Thailand indicate that 15-18 per cent of their clients become pregnant because of rape. According to a US study, medical care costs of women who were raped or assaulted were 2.5 times higher than the costs of non-victims. In addition, rape survivors can potentially suffer from these health (reproductive and psychological) problems:
Physically - pelvic inflammatory disease, chronic pelvic pain, asthma, irritable bowel syndrome, partial or permanent disability, even delayed physical effects such as arthritis, hypertension and heart disease, unwanted pregnancy including teenage pregnancy resulting in pregnancy complications/premature labour, miscarriage, low-birthright babies with reduced chances of survival and maternal mortality from excessive bleeding of infection, STDs (including HIV infections) and death.
Psychologically - Rape Trauma Syndrome and Post Traumatic Stress Disorder, injurious sexual/health behaviours (smoking or unprotected sex with multiple partners, prostitution and alcohol/drug abuse).
Emotionally - humiliation, guilt, shame, embarrassment, self-blame, anger and helplessness.
Thus ill-health, both of women at risk and those who are raped, is the direct fall-out of gender violence. As a holistic definition of health encompasses indicators such as educational achievement, quality of life and economic productivity, the compounded hidden costs of rape burden health care systems, drain resources and obstruct socio-economic development by lowering educational attainment, work productivity, safe reproduction and maternal and child health care.
Gender violence as a health issue should become a salient reference point in affording state, medical/therapeutic, legislative, community-based and media interventions of rape survivors, respectively through: 1) exercising political will to actualise across-the-board reforms; 2) integrating gender-sensitive and inclusive values regarding violence, racism, sexism and economic disadvantage into health education and clinical and police training (as well as ensuring the availability and accessibility of specialised health services); 3) criminalising gender violence through separate legislation/reform laws on rape, domestic violence, sexual harassment and incest; 4) gender-sensitising support groups and families of rape survivors (as well as promoting support services for the latter); and 5) raising public consciousness and unshackling prejudicial mindsets through alternative and affirmative images and treatment of women in the media.
Some of the above strategies for change are evident within Asia-Pacific. For instance, the groundbreaking Anti-Rape Law of 1997 (Act No. 8353) and the Rape Victim Assistance and Protection Act of 1998 (Act No. 8505) of the Philippines, not only broadens the definition of rape, but legislates state-funded rape crisis centres in every province and city and a women's desk in every police precinct, nationally. In addition, specialised rape crisis centres have also been established in Bangladesh, Fiji, Indonesia, Japan, Malaysia and Thailand. However, these government-NGO (non-governmental organisation) initiatives need to be galvanised, if we are to protect women and communities from quantifiable set-backs in progress which are threatened by the health costs of gender violence. A rape survivor is often doubly victimised through discrimination arising from existing social structures. Thus, the political will to effect legal reforms, rape crisis centres, gender-sensitised training programmes for legal and law enforcement officers, health providers and the community at large, recognises that women and girls rights are inalienable, integral and indivisible in themselves.
Uprooting Culture and Religion
Yet, these initiatives in themselves do not necessarily reflect nor effect a paradigm shift from the devaluation of women/girls through repressive constructions of femininity/sexuality (valued as a vessel of purity or procreation), to an affirmation of their inherent worth and spiritual integrity. Cultural tradition and religious tenets that "sanction" male domination-female subordination are equally accountable and culpable in justifying the discriminatory treatment, perception and status of women and girls and manifest gender violence.
Particularly in an Asian context where culture and religion are deeply entrenched, the empowerment and healing for women violated sexually, emotionally, psychologically, physically and spiritually, begin at the roots, through:
Reinterpreting discriminatory religious texts and teachings where biased interpretations foster gender violence (to recognize that marital rape can and does happen);
Removing cultural relativity from our understanding of rape and its impact. Violence against women is a breach of basic women's rights, regardless of cultural biases (that the loss of virginity is not shameful, that "honour killing" of rape survivors is wrong and marriage to one's rapist does not negate the violation);
Gender-sensitising religious institutions (through gender equality programmes, services, policies, practices, research, at international, regional, national and community levels to the grassroots) to effect a long-term process of reconciliation and renewal within the community so that rape survivors are no longer stigmatised, but affirmed.
Responding to the Rape of Indonesian Chinese Women and Girls
A hundred and sixty eight women and girls were gang raped and 1,200 Indonesians of mostly Chinese descent died as a result of the mid-May 1998 Jakarta riots (New Straits Times [NST], August 18, 1998, p.20). How does a nation begin to heal such broken bodies and spirits in the aftermath?
Highlighted is the 400 strong Humanity Volunteer Team, Violence Against Women Division and its notable efforts at survivors' assistance counselling (hotline, medico-legal services and shelter), investigation and case/data documentation, public education through forums and follow-up monitoring. Set up in early June, in humanitarian response to the crisis, this autonomous non-governmental organisation (NGO) aims to galvanise the tide of public empathy and international Human Rights pressure groups to condemn the objectification and brutal violation of Indonesian Chinese women and girls. Its volunteers consist of a mixed ethnic group who provide funding as well as services and expertise, and are of diverse vocational backgrounds: activists, religious workers, psychologists, lawyers, housewives, teachers, health workers and students. They are accepted as part of the team based on their commitment to the team's principles (justice based on anti-gender and anti-racial discrimination), their willingness to be trained to follow demanding work/time allocation and to work without pay. Striving for almost 24 hours a day and engender physical and psychological healing for women and girls affected (and their families), the compassionate volunteers persevere despite anonymouse threats to their lives, the non-compliance of survivors in coming forward for fear of apathy. Their courageous in-depth investigation strongly suggests that the riots and rapes were systematically organised, allegedly perpetrated by renegade military forces (The Sunday Times, August 16, 1998, p. 20). The public (and cyber) release of relevant data (including information about the kidnapping, torture and murder of activists), precipitated state accountability to the widespread and systematic rapes which in turn led to the initiation of an anti-rape task force, headed by President Habibie's wife, Hasri Ainun Habibie and Women's Affairs Minister, Tutty Alawiyah (Asiaweek July 24, 1998, p. 30).
The volunteers' holistic assistance approach which includes religious services and socio-economic support, complements existing health services that are primarily curative in alleviating the symptoms (not cause) of gender violence. Virtually all rape survivors are now in very poor psychological/physical health conditions. They suffer from or are at risk of damaged reproductive organs, Rape Trauma Syndrome, Post Traumatic Stress Disorder, psycho-neuroses, suicide mental illness and a life of fear and desperation. According to NGO sources, there are at least ten one-stop women's crisis centres with additional ones set up after the riots. These are not hospital-based, but managed by NGOs: there is one in Yogyakarta, Surabaya and Lombok and the remaining seven are in Jakarta (including at least four shelters in collaboration with churches). The Humanity Volunteer Team has the co-operation of private hospitals for the supply of medical/psychological treatment, as well as STD (including HIV) check-ups and abortions on demand.
A prevailing climate of fear impacts on the availability and accessibility of these rape crisis centres and medical treatment, for according to the Report of the Humanity Volunteer Team, speaking about and listening sympathetically to the survivors of the mass rape is still considered subversive. The survivors and their families, including the medical staff and volunteers have allegedly been intimidated via telephone threats, anonymous letters, distribution of pornographs of those raped and rumours about further riots and rapes by military renegades. As such, many rape survivors have reportedly resorted to seeking treatment and refuge from hospitals abroad, such as Singapore, Hong Kong Special Administrative Region of the Republic of China, Australia, Malaysia and the United States.
A knee-jerk reaction such as the soaring demand for modern-day chastity belts (made of stainless steel and fake leather and secured with a combination lock) (NST, August 15, 1998, p. 18), are designed to control women and girls' sexuality, rather than to protect them. In contracts, long-term preventive and reconciliatory strategies should include 1) a state apology to rape survivors and their commitment (not merely condemnation of these heinous acts); 2) an independent probe to expose the identity of the perpetrators; and 3) the protection of the civil rights of individuals and minorities (ethnic Chinese comprise just four per cent of Indonesia's population of 202 million) (NST, August 18, 1998, p. 20) in reaffirming nationalistic integrity.