Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 3 - Jul/Sep - 2017

Original Article Imprimir 

Páginas 63 a 70


Violence between teenage lovers in Pernambuco, Brazil

Violencia entre enamorados adolescentes en Pernambuco, Brasil

Violência entre namorados adolescentes em Pernambuco, Brasil

Autores: Lygia Maria Pereira da Silva1; Camila de Mattos Oliveira2; Marilia Gabriela Silva Santana3; Ana Virginia Rodrigues Verissimo4; Taciana Mirella Batista dos Santos5; Mirian Domingos Cardoso6

1. PhD in Sciences, São Paulo University (USP). São Paulo, São Paulo State, Brazil. Adjunct Professor, Nossa Senhora das Graças Nursing School, Lecturer, Graduate Studies Program in in Adolescent Medicine, Pernambuco University (UPE). Recife, Pernambuco State, Brazil
2. Resident in Obstetric Nursing, Pernambuco State Health Bureau (SES- PE). Recife, Pernambuco State, Brazil. Bachelor's Degree in Nursing, Pernambuco University (UPE). Recife, Pernambuco State, Brazil
3. Graduand in Nursing, Nossa Senhora das Graças Nursing School, Pernambuco University (FENSG - UPE). Recife, Pernambuco State, Brazil
4. Doctoral Student in Child and Adolescent Health, Pernambuco Federal University (UFPE). Recife, Pernambuco State, Brazil. Master`s Degree in Nursing, Post-BSc Studies Program in Nursing, Pernambuco University (UPE) and Paraíba State University (UEPB). Recife, Pernambuco State, Brazil. Assistant Professor, Nossa Senhora das Graças Nursing School, Pernambuco University (FENSG - UPE). Recife, Pernambuco State, Brazil
5. Doctoral Student in Public Health, Minas Gerais Federal University (UFMG). Belo Horizonte, Minas Gerais State, Brazil. Master's Degree in Adolescent Medicine, Pernambuco University (UPE). Recife, Pernambuco State, Brazil. Nurse, Helena Moura Pediatric Hospital. Recife, Pernambuco State, Brazil
6. PhD in Public Health, Minas Gerais Federal University (UFMG). Belo Horizonte, Minas Gerais State, Brazil; Adjunct Professor, Nossa Senhora das Graças Nursing School, Lecturer, Graduate Studies Program in Adolescent Medicine, Pernambuco University. Recife, Pernambuco State, Brazil

Lygia Maria Pereira da Silva
Universidade de Pernambuco
Rua Arnóbio Marques, 310, Santo Amaro
Recife, PE, Brasil. CEP: 50100-130
lygia.silva@upe.br

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How to cite this article

Keywords: Adolescent, violence, health information systems.
Palabra Clave: Adolescente, violencia, sistemas de información en salud.
Descritores: Adolescente, violência, sistemas de informação em saúde.

Abstract:
OBJECTIVE: Describe the profile of teen dating violence in Pernambuco state notified in the period 2009 to 2012.
METHODS: We used a quantitative epidemiological approach. The sample consisted of 604 adolescents with ages between 10 to 19 years which maintain some intimate relationship with the aggressor.
RESULTS: 98% of the victims were female, 48% of which were pregnant, 43% had between 10 to 14 years and 80% were from brown and black race/color. 37 and 26% of the cases presented sexual and physical violence, respectively 81% of those were referred to the defense and promotion of right services.
CONCLUSION: We noticed the necessity of early intervention for this population aiming to provide access of these adolescents to healthcare services where they may find a place to have an open dialog and help for deconstruction of violence.

Resumen:
OBJETIVO: Describir el perfil de violencia perpetrada entre enamorados adolescentes en el estado de Pernambuco notificados en el período de 2009 a 2012.
MÉTODOS: Estudio descriptivo en una población de 604 adolescentes con edades entre 10 y 19 años que mantenían alguna relación de intimidad (relacionamiento) con el agresor.
RESULTADOS: 98% de las víctimas eran del sexo femenino, de las cuales 48% estaban embarazadas, 43% tenían de 10 a 14 años y 80% eran de raza/color parda o negra. Un 37 y 26% de los casos presentaron violencia sexual y física, respectivamente. El 81% de los casos fueron encaminados para servicios contemplados en los ejes de defensa y promoción de derechos.
CONCLUSIÓN: se evidencia la necesidad de rápida intervención para esta población, con el objetivo de acceso de los adolescentes a los servicios de salud, en los cuales existan espacios de diálogo abierto y apoyo para a la desconstrucción de la naturalidad de violencia.

Resumo:
OBJETIVO: Descrever o perfil da violência perpetrada entre namorados adolescentes no estado de Pernambuco notificados no período de 2009 a 2012.
MÉTODOS: Estudo descritivo em uma população de 604 adolescentes com idades entre 10 e 19 anos que mantinham alguma relação de intimidade (namoro) com o agressor.
RESULTADOS: 98% das vítimas eram do sexo feminino das quais 48% estavam grávidas, 43% tinham de 10 a 14 anos e 80% eram de raça/cor parda ou negra. 37 e 26% dos casos apresentaram violência sexual e física, respectivamente. 81% dos casos foram encaminhados para os serviços contemplados nos eixos de defesa e promoção de direitos.
CONCLUSÃO: Evidencia-se a necessidade de intervenção precoce para esta população visando o acesso dos adolescentes aos serviços de saúde, nos quais existam espaços de diálogo aberto e apoio para a desconstrução da naturalização da violência.

INTRODUCTION

Violence has been acknowledged worldwide as a major public health issue. The World Health Organization (WHO) highlighted this problem as a global challenge, bringing discussions into the healthcare area, which formerly intervened only in the consequences of these episodes. Some experts have underscored the importance of intersectoral approaches to developing strategies that target more vulnerable segments of the population¹.

Due to the greater vulnerability of adolescents, violence against this age bracket is a matter of much concern², including episodes that occur in intimate relationships, which has been a matter addressed only recently in the scientific literature³. This type of relationship is permeated by control strategies that curb partner autonomy and may extend into adulthood4.

Along these lines, dating violence is a type of behavior intended to dominate the partner, and may occur in several different ways5. According to Nascimento and Cordeiro6 "dating violence is understood as any act or action, whether physical, verbal, moral or even symbolic, that cause death, harm or suffering".

Violence experienced in romantic relationships has significant adverse effects on health over the long and short terms, which may include negative emotional reactions (fear, anger, isolation, stress and suffering), physical consequences (injury, headaches, insomnia), undermining the quality of life, with the possibility that these repercussions may also weigh heavily on the healthcare system. As a result, it is necessary to disseminate studies on this topic, providing knowledge of the realities underlying violence in intimate relationships (VIR) involving adolescents, as this is a phenomenon that is barely visible and rarely identified3,7.

Research projects exploring VIR among adolescents have been on the rise during the past few decades on several continents, especially North America8. In 2005, the National Survey of Children's Exposure to Violence - a large scale school-based study conducted in the USA - suggested there were between 400,000 and 900,000 victims of severe dating violence4.

In Brazil, a study conducted in 2001 entitled Experience of Violence in Affective-Sexual Relationships among Adolescents was conducted in five Brazilian regions with pupils attending private and government schools, showing that around 80% of the 4,000 adolescents investigated in different parts of Brazil had suffered some type of dating violence. However, there is still a shortage of major studies addressing this issue, with most of those available at the State or Municipal level6.

Consequently, this study intends to describe a dating violence profile for adolescents in Pernambuco State, notified between 2009 and 2012.


METHODS

This descriptive, quantitative study is conducted through the database built up by the Violence Oversight System (VIVA) that underpins the Violent Crimes Notification Information System (SINAN -VIVA).

The project sample encompassed youngsters between 10 and 19 years of age subjected to violence by their current or former partners and notified to the oversight system; cases with marital status recorded as a civil union / marriage were not included. The selected variables for the study were categorized as: a) general data on the victim and the aggressor (gender, age, race/color, pregnant, place of occurrence, aggressor gender); b) type of violence; c) referrals for cases compliant with the strategic guidelines laid down by the National Council for Children's and Adolescents' Rights (CONANDA) set up to defend and promote human rights.

According to this Council, the protection of human rights is buttressed by the following entities/sectors: Child Protection Council, Juvenile Courts, Shelters, Sentinel Program, Women´s Aid Precinct, Children´s and Adolescent Protection Precinct, Others Police Precincts, the Prosecutor's Office and the Forensic Medicine Institute (IML). Others such as the Women´s Reference Center, the Social Welfare Reference Center (CREAS-CRAS) and similar institutions are related to the human rights promotion structure.

The data were analyzed through the Statistical Package for the Social Sciences (SPSS) software, version 20.0. This research project was approved by the Ethics Committee under CAAE Nº 20281414 0 0000 5207.


RESULTS

During the period addressed by this study, 604 cases of dating violence were registered in Pernambuco State, with 98.3% of the victims female, and 48.1% of them pregnant at the time of the aggression. In terms of age, and race/color, 56.3% were between 15 and 19 years of age, and 80.4% were mixed-race or black (Table 1).




In terms of the place of occurrence, most of these cases took place in urban zones (87.3%) and in only 3% of the cases was the aggressor the same gender of the victim. With regard to the type of violence, this was sexual in 37.3% and physical in 26.2%, with negligence accounting for 5.2% and psychological in 3.8%. Moreover, the occurrence of various types of violence was recorded in 33.7% of the cases, with four types of violence in the same case registered for 0.3% of these incidents (Figure 1).


Figure 1. Occurrence and co-occurrence of different types of violence (F = physical; P = psychological; S = sexual; N = negligence) among adolescent victims of dating violence, notified to the Official Oversight System. Pernambuco State, 2009 to 2012.



Figure 2 presents the outcomes of the referrals of the cases, shown by the approaches proposed by the Council. The prevalence of calling in two specific services (protection of human rights and promotion of human rights) reached 80.8%, while referrals to only the rights protection sector reached 9.6%, with 7.7% for rights promotion.


Figure 2. Number of referrals by the National Health System for cases of dating violence perpetrated against adolescents and notified to the Official Oversight System, according to the channels established by the National Council for Children's and Adolescents' Rights (CONANDA). Pernambuco State, 2009 to 2012.



DISCUSSION

The results of this study showed that most dating violence victims are mixed race / black girls between 15 and 19 years of age, with a large proportion of them pregnant at the time of notification. It also showed higher levels of occurrence in urban zones, where violence was largely sexual, followed by physical, in parallel to the co-occurrence of other types of violence. Two types of referrals were noteworthy to the two strategic channels established by the National Council for Children's and Adolescents' Rights.

The high proportion of female victims corroborates data found in the literature, supported by cultural aspects related to gender-based differences as motivating factors underpinning female victimization9. Historically, during colonial times, social constructs were established on the basis of gender inequalities, with male and female roles structured on female subjugation and conjugal violence. For some authors, violence against women became synonymous with conjugal violence. Although this is very similar to VIR among adolescents, the latter presents some specific characteristics as these relationships may be less firmly-rooted with "weaker" commitments and fewer or even no social demands to continue in place6,10.

Studies indicate that gender-related violence has negative effects on the sexual and reproductive health of women, and also men, stepping up situations of exposure to risks of infection with Sexually Transmitted Infections (STI) and their dissemination. Girls living in situations of gender-related violence generally find it harder to access healthcare facilities and means of preventing pregnancy, with even fewer possibilities of negotiating condom use with their partners³.

In this study, violence peaked among adolescents between 15 to 19 years of age, although a large proportion of the victims were under fifteen years old. This information is particularly noteworthy, as youngsters should be under the protection of their parents or guardians at this age, and not exposed to high-risk violent situations.

Corroborating these results, the literature indicates that large numbers of adolescents are subjected to violence before reaching 15 years of age, for which Taquete (2009) finds justification in the fact that this age bracket is extremely vulnerable, quite defenseless and endowed with limited protection mechanisms. The age bracket of 15 to 19 years of age addressed by this study does not overlap with notifications for cases involving younger adolescents.

Although most violence is imposed on women, a few cases of aggression were perpetrated by girls, thus underpinning an understanding that each violent situation has its own specific characteristics, meaning it would be careless to summarize this problem as a matter of gender-based disparity6. According to the sexual violence booklet for Recife11-12, there are social and cultural barriers hampering complaints about violence against boys, especially when sexual, highlighting the possibility of these adolescents being questioned about their virility.

The high level of pregnancy among the victims endorses the findings in the literature, which indicate that this is a good time for identifying violence, due to regular contacts with healthcare providers. This is a time of greater vulnerability to violence, with changes in physical, emotional, social and economic needs and demands. However, VIR during pregnancy may cause severe complications for the health of mothers-to-be and their babies. These consequences range from low-weight newborns through to fetal death. Other noteworthy consequences may also include pre-term birth, infection, miscarriage, placental abruption, high-risk behaviors, depression, anxiety disorders, post-traumatic stress, suicide (attempts), late starts for pre-natal care, poor maternal nutrition, smoking, drinking alcohol and using illegal drugs13.

Although violence is found at all social levels, regardless of race/color, most victims were mixed-race, corroborating the data in the 2010 Census, which shows the ethnic composition of the population of Pernambuco State to consist largely of mixed-race inhabitants. However, the absence or under-registration of social data in the National Health Oversight System hampers links between violence and social and economic conditions. In terms of the location where violence occurred, most of these areas were urban, home to much of the population14.

Out of the total number of cases, only 3% consisted of same-sex aggression, with mentions in the literature of violence in homo-affective relationships virtually invisible. Studies on violence involving couples are grounded on the assumption of heterosexuality, thus increasing the invisibility of same-sex violence within the context of an intimate relationship. This invisibility is also enhanced by fears of increasing the vulnerability of groups that are already weakened, due to a context of institutionally dominant social homophobia, where the path to achieving rights is both rocky and risky. Although homosexuality was withdrawn from the list of illnesses by the World Health Organization in 1991, discrimination still exists in the clinical universe, in form of: homophobia, biphobia and transphobia, which hampers interventions providing protection for these groups15.

The high prevalence of sexual violence followed by physical violence found in this study contrasts with the results of a study conducted in the Pernambuco State capital, Recife, which explored VIR among adolescents, finding mainly a high prevalence of physical and psychological violence16. The lower proportion of psychological violence found in this study may suggest under-notification, as this leaves no scars. However, this type of violence is just as severe as the others, as it may undermine self-esteem, causing fear, guilt and blame, with victims needing ample time to shed its nefarious effects12.

The perpetrators of sexual abuse are predominantly men, for both female and male victims, convergent with the data found in this study 17. According to Graal7, this type of violence is characterized as any type of unconsenting sexual conduct, which may range from unwanted body contacts through to rape or attempted rape, as well as mocking sexual performances and pressure to engage in sex acts against the partner´s wishes, or when not feeling prepared to do so.

As dealing with violence is a complex problem, it requires an approach that involves many different sectors. The National Council for Children's and Adolescents' Rights (CONANDA) has established parameters for the institutionalization and strengthening the Children's and Adolescents' Rights Assurance System, systematizing the care network through strategic channels. The human rights channel is characterized by guaranteed access to justice, with the attribute of material interventions that ensure breaches of rights cease. Furthermore, the perpetrators of violence are held liable through government entities and court mechanisms. The strategic channel promoting the human rights of children and adolescents is materialized through the deployment of the Children's and Adolescents' Rights Assurance Policy, which is addressed in the Children's and Adolescents' Statute (ECA)18.

Bringing both these channels into action concomitantly, as may be seen in this study, demonstrates the actions of the protection network and various players for addressing the problem, corroborating the understanding of the healthcare sector that violence is a multidimensional problem. The provisions ensuring comprehensive healthcare for this public require articulated efforts to intervene in specific high-risk situations of vulnerability, paving the way for actions and strategies focused on promotion, prevention, recovery and rehabilitation19.


CONCLUSION

This study shares some common constraints with others conducted through secondary databases, including under-notification and under-registration of information that would more clearly define the dating violence profile. However, although limited, these results offer contributions that heighten the visibility of this problem and the subsequent formulation of public policies and actions designed to prevent and deal with violence in intimate relationships among adolescents.

The healthcare sector must act more effectively for preventing violence while encouraging attitudes and actions that influence these relationships. Although it is hard for the victims of violence to report and describe their experiences, healthcare facilities are an ideal place for identifying these cases/situations, as aggression may be reflected through indirect indicators, with early detection helping avoid more severe consequences.


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