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The relation between domestic violence and homicide may be even more profound. Data from a wide range of countries demonstrate that domestic violence is a mayor risk factor for murder of and by women. A recent review of spousal homicide in the United States, published in the American Journal of Public Health, reports that “studies of homicides between intimates show that they are often preceded by a history of physical abuse directed at the women and several studies have documented that a high proportion of women imprisoned for killing a husband had been physically abused by their: spouses” (Mercy and Saltzman 1989, p. 597). In Canada 62 percent of women murdered in 1987 died at the hands of an intimate male partner (Canadian Centre for Justice Statistics 1988). In the first 11 months of 1992, 415 women were murdered in the Brazilian state of Pernambuco, 70 percent by a male intimate (Dimenstein 1992). Of the 100 murders in Israel (not including the territories) in 1991, 42 involved women killed by a husband or lover (Nevo 1993). And in Papua New Guinea almost 73 percent of adult women murdered between 1979 and 1982 were killed by their husbands (Bradley 1988). Studies from a variety of culture-including (Canada, Papua New Guinea, and the United States-confirm that when women kill men, it is often in self-defense and usually after years of persistent and escalating abuse (Browne 1987; Walker 1989; Canadian Centre for Justice Statistics 1988; Bradley 1988; Kellerman and Mercy 1992).
The link between intimate violence and homicide is particularly evident in India, where women’s deaths due to burns have been increasing since 1979, a development that can be tied to the commercialization of dowry demands (Pawar 1990). A young bride may be subject to severe abuse from her husband and in-laws if their continuing demands for money or goods from her family are not met. A frequent subterfuge is to set the woman on fire with kerosene and then claim that she died in a kitchen accident hence the term bride burning. In 1990 the police officially recorded 4,835 dowry deaths in India, but government sources readily acknowledge that this is a gross underestimate (Kelkar 1992). In both urban Maharashtra and greater Bombay, one of every five deaths among women age 15 to 44 is due to “accidental burns” For the younger age group 15 to 24, the proportion is one of four Karkal 1985).
Health effects of rape and sexual assault.
Sexual assaults can cause both physical injury and profound emotional trauma. A study of rape in urban and rural areas of Bangladesh reports that 84 percent of victims suffered severe injuries or unconsciousness, mental illness, or death following the rape (Shamim 1985). Rape survivors exhibit a variety of trauma-induced symptoms-nightmares, depression, inability to concentrate, sleep and eating disturbances, and feelings of anger, humiliation, and selfblame. In addition, 50 to 60 percent of victims experience severe sexual problems, including fear of sex, problems with arousal, and decreased sexual functioning (Burnam and others 1988; Becker and others 1986; Becker and others 1982).
The malignant effects of rape are not surprising given the physical, psychological, and moral violation of the person that it represents (Breslau and others 1991; Herman 1992). A study from the United States found that rape victims were nine times more likely than nonvictims to have attempted suicide, and twice as likely to experience a major depression (Kilpatrick 1990). Follow-up studies have shown that rape survivors have higher rates of persistent post-traumatic stress disorder (PTSD) than victims of other traumas (Norris 1992). Some experts consider female victims of sexual abuse and assault to be the largest single group of PI SD sufferers, and rape the single most likely event to cause PTSD (Foe, Olasov, and Steketee 1987).
Studies that follow victims over time show that the traumatic consequences of rape can persist for many years. A study to validate the Rape Aftermath Symptom Test (RAST) demonstrated that the instrument could distinguish the symptoms of rape victims from those of nonvictims at intervals up to three years after a rape (Kilpatrick 1988). According to studies in the United States, one in four women who have been raped still exhibits dysfunctional symptoms four to six years after the assault (Hanson 1990; Burgess and Holmstrom 1979). In another sample 60 percent of sexual assault victims reported sexual dysfunction three years after the assault (Becker and others 1986). Even after many years, women who have been sexually assaulted are significantly more likely to qualify for 10 different psychiatric diagnoses, including major depression, alcohol abuse, PTSD, drug abuse, obsessive compulsive disorder, generalized anxiety, eating disorders, multiple personality disorder, and borderline personality syndrome. The relative risk ratio for these diagnoses for survivors of rape and sexual assault is about two times greater risk (Koss 1990).
Beyond physical injury and emotional trauma, rape survivors face the risk of sexually transmitted diseases (STDs), including the acquired immunodeficiency syndrome (AIDS). A support center for rape victims in Bangkok, Thailand, reports that 10 percent of its clients contract a sexually transmitted disease as a result of the rape (Archavanitkui and Pramualratana 1990). In the United States almost a dozen women and twice as many children had contracted AIDS through rape and child sexual abuse by July 1992 (Dattel 1992).

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