Mapping the role of structural and interpersonal violence in the lives of women: implications for public health interventions and policy

Abstract

Background: Research on interpersonal violence towards women has commonly focused on individual or proximate-level determinants associated with violent acts ignores the roles of larger structural systems that shape interpersonal violence. Though this research has contributed to an understanding of the prevalence and consequences of violence towards women, it ignores how patterns of violence are connected to social systems and social institutions.

Methods: In this paper, we discuss the findings from a scoping review that examined: 1) how structural and symbolic violence contributes to interpersonal violence against women; and 2) the relationships between the social determinants of health and interpersonal violence against women. We used concept mapping to identify what was reported on the relationships among individual-level characteristics and population-level influence on gender-based violence against women and the consequences for women's health. Institutional ethics review was not required for this scoping review since there was no involvement or contact with human subjects.

Results: The different forms of violence-symbolic, structural and interpersonal-are not mutually exclusive, rather they relate to one another as they manifest in the lives of women. Structural violence is marked by deeply unequal access to the determinants of health (e.g., housing, good quality health care, and unemployment), which then create conditions where interpersonal violence can happen and which shape gendered forms of violence for women in vulnerable social positions. Our web of causation illustrates how structural factors can have negative impacts on the social determinants of health and increases the risk for interpersonal violence among women.

Conclusion: Public health policy responses to violence against women should move beyond individual-level approaches to violence, to consider how structural and interpersonal level violence and power relations shape the 'lived experiences' of violence for women.

Fig. 1

Thurston and Visandjée [12] Ecological Framework to Study Women’s Health. The framework illustrates the interplay of personal, situational, and sociocultural factors that shape women’s health. It offers a holistic approach to analyze multilevel and interactive influences of violence against women. In Canada, 12 determinants of health have been adopted in official policy: social support networks; biology and genetic endowment; personal health practices and coping skills; healthy child development; education; income and social status; employment and working conditions; social environments; physical environments; health services; gender; and culture [23]. These determinants are shaded in boxes. Gender and culture are listed in Symbolic Institutions. The micro-level is that of the individual woman who embodies the meso- and the macro-systems or institutions. Gender is shaped by micro-level politics: gender expectations, gender norms, a socially constructed body, symbolic representation and symbolic language. Gender also orders and is ordered by other social institutions at the meso- and macro-levels: the economy; ideologies; family; politics; religion; and the media [20]

Fig. 2

The Relationship between Gender-Based Structural Violence to Interpersonal Violence Experienced by Women. The framework illustrates how structural violence can lead to interpersonal violence against women. Gender as a symbolic institution (GSI)—e.g., gender role performance—may have a causal role in creating interpersonal violence

Fig. 3

Concept Map: Relationship Among Individual-level characteristics and Population-level Influences on Gender-based Violence Against Women and Consequences on Women’s Health. Using the Cmaps^TM software we created a web of causation for gender-based violence against women that illustrates the interrelationship between structural and interpersonal violence for women