UNTOLD STORIES: A NARRATIVE ANALYSIS OF IMMIGRANT WOMEN S EXPERIENCES WITH INTIMATE PARTNER ABUSE

2. UNTOLD STORIES: A NARRATIVE ANALYSIS OF IMMIGRANTWOMEN�S EXPERIENCES WITH INTIMATE PARTNER ABUSE Nadine Yammine MD MScN

3. Outline Background and Significance Statistics Role of Feminist Movement Scope of the Problem Social and Health Consequence Study Purpose Research Questions Review of the Literature Theoretical Framework Study Design Findings Discussion Recommendations Conclusion

4. Background and Significance

5. Immigrant Women in the Population 1 in 4 women victim of abuse by male partner in Canada 1/4 (22%) of women in Canada who experienced abuse never told anyone 1 in 5 women in Canada are immigrants 51% of immigrants to Canada are women 75% of immigrant women are visible minorities

6. Moved to the Forefront� In the past 20 years, violence against women moved from the behind closed doors to the forefront Inherent in their feminist origins, studies regarding woman abuse have traditionally focused on gender

7. Scope of the Problem Studies about abused immigrant women are scarce Culture-specific research 40% of South Asian immigrant women in the Greater Boston area were abused by their male partner (N = 160) (Raj & Silverman, 2003) 50% of Latina, South Asian, and Korean immigrant women abused (Dutton, Orloff, & Hass, 2000; Rodrigez, 1995; Song, 1996) Homicide data from New York City suggest: prevalence and severity of abuse among immigrant women higher than that reported for the general population (Raj & Silverman, 2002)

8. Social and Health Consequences �Drain on the economically productive workforce and generates a climate of fear and insecurity� (WHO, 2000) 30% of battered women forced to stop their regular activities because of their abuse 50% of women took sick leave from their employment because of harm inflicted by their abuser (Statistics Canada, 1998)

9. Studies aimed at identifying the role of race/ethnicity, class, gender, and other social factors in the lives of abused immigrant women are necessary

10. Attending only to one facet of abuse in the lives of immigrant women results in a failure to consider the interaction of other oppressive factors

11. Study Purpose To understand how immigrant women experience abuse To identify factors that foster their ability to leave their abusive partner, as well as impediments to leaving

12. Research Questions How do immigrant women experience intimate partner abuse? What do abused immigrant women perceive as obstacles and facilitating factors to break away from their violent realities? How can health professionals assist abused immigrant women?

13. Literature Review

14. Beyond Power of Men over Women Power and patriarchy of men over women contribute to woman abuse Also necessary to recognise: violence against women takes place in the context of: race/ethnicity Class other social constructs

15. Abuse

16. Linguistic Barriers and Isolation Women twice as more likely than men not to speak an official language (MacLeod and Shin, 1993) It impedes women from receiving services they need It exposes women to discrimination from the public services sector It �ghettoises� women who work in poor quality, low pay jobs (Agnew, 1996) The most basic tasks: banking, or talking to a family physician become impossible for these women Severely misinformed or uninformed about available resources, options, and laws to help escape their abuser

17. Distrust and Fear of the Legal System Reluctance to disclose or report the abuse to police officers Guarded stance vis � vis the Canadian legal system may stem from previous interaction with fraudulent and corrupt legal systems in their country of origin Martin and Mosher conducted interviews with immigrant women in Toronto justice system has failed to protect immigrant women from partner abuse it �depoliticized� the abuse immigrant women endure it discredited effects of power allocation due to race, class, disability, age, and gender. the legal system has assisted in sustaining, if not furthering, the oppression of abused immigrant women

18. Immigration Status & Deportation Most women sponsored by husband Exposed to threats of sponsorship withdrawal The man may threaten to take away children Some are mislead women to believe that the government will take their children away if they report the abuse Fear of deportation extended to abuser In 1984, a new immigration law stated: abused immigrant women by their partner would not be deported might be eligible for social assistance and public housing if they could confirm that their sponsorship had been terminated Several obstacles for abused immigrant women they need to know that such an option exists the cost of such a claim is about $1,475 Often do not possess official documents, passports, bankbooks

19. Fear of Ostracization Woman abuse remains a taboo subject fear of embarrassment and shame to the family and/or community fear of violating important cultural norms about maintaining the family unit and having a successful marriage Fear of destroying their reputation and the reputation of their children in the community Fear of ostracization from the community, often their only social network

20. Theoretical Framework

21. Critical Theory Aims at emancipatory actions Assumes all research is political Strives to liberate individuals from social, political, cultural, and economic restraints in society Critiques and questions may lead to the exposure of internalised oppressive ideologies

22. Critical Theory Multiple layers of oppression in immigrant women�s lives This study will look beyond gender Examine the interplay of class, culture, and immigration status on immigrant women�s experiences of abuse

23. Study Design

24. Critical Narrative Women given the opportunity to recount and make sense of their stories Avoids loss of contextual elements telling stories is a primary method of �making sense� of experiences (Mishler, 1986)

25. In-depth interviews in French or English Data analysis simultaneously with data collection Paragraphs analysed, categories identified and general themes generated Emerging themes discussed with new participants at the end of interview Demographic Data collected Data Collection and Analysis

26. Findings

27. Participants 8 women between age of 28 and 58 Countries of origin: Fiji Island (1), Philippines (1), Middle East (2), Sudan (1), Turkey (1), Ivory Cost (1), and United States (1) Resided in Canada an average of 14 years (9 months - 34 years)

28. Participants All but one sponsored by their husband 6 left their abuser, 2 still married and live with abuser 2 divorced, 3 separated, and 1 single 75% had children Various socioeconomic backgrounds Different levels of education (full illiteracy to graduate degree)

29. Findings Multiple Faces of Abuse Emotional Toll of Abuse Facilitating Factors Obstacles to Leaving the Relationship

30. Multiple Faces of Abuse Isolation & humiliation �locked alone in the house� One woman locked in the house for two years when she insisted on leaving the house, her partner beat her until she could not stand up. Four years later, this woman still lives with the partner, and does not even own a key to the house; now she occasionally �sneaks out�, as she did for this interview

31. Lack of Control over all aspects of life Daily activities, diet, finances, and country of residence If I go out for a walk, I have to ask each of them for permission. I have to say where I am going�If I�m cooking something, they come to the kitchen and say this is not the way to cook you stupid girl, what are you doing? I wasn�t allowed to eat what I want. I�m diabetic and I had to eat at certain times, he didn�t allow me to eat Multiple Faces of Abuse

32. Eroding Sense of Self�The power of words Hitting is better than the words�When you get hit, that�s it, it kind of hurts for a while and you know you won�t feel it after, but the mental abuse, it just sticks with you. The words he say to me, hurt me a lot, I feel like nothing, I am nothing�He would yell at me that I was stupid, that I was an idiot, and it was my fault...He kept on saying how ugly I am, how disgusting I am, how he hates to sleep with me or look at me�I felt I was worthless, unable to do anything on my own, everything I did was wrong Multiple Faces of Abuse

33. Beyond words Physical abuse Several women feared for their lives as the threat of death was very real to them Forms of sexual aggression He wanted things I didn�t want to do, like painful things that he wanted�Like positions or times I didn�t want, I would be forced to do it Multiple Faces of Abuse One woman described being beaten until she lost consciousness several times. One woman described being beaten until she lost consciousness several times.

34. Ambivalent allegiances Children witnessed several forms of abuse children manipulated to side against their mother He forbid the children from talking to me; he tell the kids don�t talk to your mother. Don�t even listen to her, even if she cook don�t eat. I become solitude by myself�He wants the kids to be against me, so nobody wants me. children, especially sons, were angry Multiple Faces of Abuse

35. Emotional Toll of Abuse The majority of women diagnosed by family physician with depression Several women were taking prescribed antidepressants Suicide was described as �way out� 2 referred to a psychiatrist 1 admitted to a psychiatric hospital with �battered women syndrome�

36. I used to cry in the house alone, thinking about whatever was my life before, and what it is now. I had no choice but to clean the house and cry on my own. I felt I�ve been kidnapped by a stranger�The loneliness was a big part, I didn�t feel like I had anyone here to talk to

37. I had this impending fear, no one could reassure me. The fear, the fear is so unannounced I could have had 2 million warriors around me; protecting me [�] nothing could reassure me that he wasn�t going to get me and kill me. Even in hospital, away from him, I didn�t feel safe; no one could calm me down, no one could assure me I was safe Emotional Toll of Abuse

38. Facilitating Factors Resilience I convinced myself that it was best for me to leave. I realised I deserve to be treated like a human being, no less, just because I am woman�God made me as human being, as a person�I swear god made me a woman. I am proud to be a woman�not to be a woman only, but a human being�I know me I am a woman and I can do things like men do� there is nothing wrong being a woman. I have a mind, I can think.

39. Facilitating Factors Resourcefulness The shelter and lawyer were very supportive, they gave my situation a name �woman abuse�, they told me I shouldn�t be treated like this�The shelter was very nice, actually, maybe my happiest days there�I was by myself, peacefully, nobody after 20 years to bother me�I was by myself, I was happy.

40. Facilitating Factors Faith God helped me, I talk to God since there is nobody else to talk to in the middle of the night, I can�t wake up anybody else apart from God�I feel that god prepared to deal with my misfortunes by giving me a certain way of thinking.

41. Obstacles to Leaving the Relationship Fear of being alone in a new environment Protection of abuser and self blame Honour thy family My family cut their relationship with me, they condemned me�I�m afraid of my own husband�he could say I�m not an honourable woman ...he could kill me�they call that the honourable killing. He could do that easily and nobody can do anything to him.

42. Negotiating an Unfamiliar Health and Justice System A New Life� turned their attention to their own lives and those of their children have developed plans for a better future One participant is completing a doctorate while others have held jobs for the first time

43. Negotiating an Unfamiliar Health and Justice System �New Challenges Reestablishing relationships with children and family members Custody battles Immigration status battles Striving to meet own physical and emotional needs

44. �I don�t want to look back, I have to go ahead�I have to be my own person in this world, so I have to go forward...I must rely on self and move forward...I think of my life, that�s what I�m looking forward to now.�

45. �Now, I don�t want to look at myself because it all sticks in my mind, how ugly I am, how fat�Even I�m trying to convince myself otherwise it doesn�t work, because he repeated these words so many times that I think it�s true.�

46. A Failed Health Care System Physicians, nurses, and other health care professionals not helpful Health providers not identified as a resource to assist them to recognise, name, and end the abuse One participant described her marital counsellor as an excellent resource

47. A Failed Health Care System All women have been in contact with health care system through their family physician, emergency room visits, or a psychiatrist not questioned about abuse antidepressants were prescribed and psychiatry referrals were completed During ED visits, questioned about abuse when explicit indicators were present, women were reluctant to disclose

48. A Failed Health Care System When asked why they did not disclose their abuse to health professionals, women replied they did not view health professionals as trustworthy or helpful, and appeared to be judgemental.

49. Discussion

50. Personal and Systemic Obstacles Inability to recognize and name abuse Lack of awareness about available resources compromised mental health Unaware of immigration status laws Social class factors Cultural stigma associated with a woman leaving her partner Poor health care response

51. Recommendations

52. Implications for Practice Increase awareness of health providers immigrant women are at considerable risk for abuse These women face unique obstacles affects their ability to disclose abuse affects their capacity to leave abuser Develop an approach that will foster disclosure of abuse, if women choose to disclose Provide information about available community resource Support abused immigrant women in their efforts to name and act upon the violence in their lives

53. Implications for Practice Creation of a public health nursing position specialised in dealing with abused immigrant women

54. Implications for Practice Children access to special counselling and resources to assist them to deal with their experiences need of a positive role model to look up to Involvement in organisations such as Big Brother or Big Sister might assist them in seeing other positive role models

55. Implication for Practice Offer options about a safety plan and resources to assist them in leaving their abuser Community Level awareness create environment conducive to naming of abuse helps women to learn they are not alone hold awareness campaigns in a culturally sensitive manner to community centres, cultural centres, and English as Second Language (ESL) classes Articles in academic and non academic journals Funding to professional interpreter

56. Implication for Education Education about abused immigrant women to be initiated at the undergraduate level for medical and nursing students Education regarding the rights afforded to immigrant women who have been abused Seminars may offer nurses and health care professionals specific credits and can be disseminated through professional colleges and associations Information sessions to increase awareness and suggest management plan and community resources for these women

57. Implication for Education Education beyond health providers law enforcement officers immigration officers immigration lawyers and judges

58. Implication for Research Additional research necessary to better understand unique experience of abuse among immigrant women factors that play an important role in improving the health of these women Large scale studies including qualitative and quantitative approaches long term effects of abuse on immigrant women�s mental health Short and long term effects of abuse on children of abused immigrant women

59. Conclusion

60. Although Canada is considered to be one of the leading countries in human rights policies, its current policies and programmes fall short of offering full protection to abused immigrant women Through this study, immigrant women were given the opportunity to recount their stories and recommendations were suggested according to their reports

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63. Acknowledgements Dr. Helene Berman Dr. Cheryl Forchuk The Centre For Research On Violence Against Women and Children in London The Immigrant and Visible Minority Women Against Abuse Centre in Ottawa Faculty of Medicine, University of Ottawa