Chapter 3: Research on engaging men and boys and preventing violence against women
3.4 Theorising prevention through the lens of public health
3.4.1 Applying the social ecological model to violence against women
The social ecological approach to health promotion, which forms the basis for the spectrum of prevention discussed in section 3.3, has become a particularly influential theoretical framework within the field of preventing men's violence against women (Flood, 2011; Casey et al., 2013). This approach is built upon Bronfenbrenner’s (1979) ecological model, which theorised how nested levels of the human environment have reciprocally influential impacts on both human behaviour and social problems (Casey et al., 2013). It is based on the
50 recognition that there are multiple, complex, interacting levels of influence on how people choose to behave, and that the practices of individuals both shape, and are shaped by, the environment around them (Fertman et al., 2010). The approach helps to locate intervention points within these different levels of influence. The model was first applied to the analysis of violence against women by Heise (1998), who conceptualised it as a multifaceted
phenomenon rooted in the interplay between individual, relationship, community, institutional, and societal factors.
Ottoson and Green (2005) argue that successful community-based health interventions demonstrate that these activities have to be coordinated and mutually supportive across the different levels and spheres of influence, ranging from individuals, to peers, to institutions, to entire communities. Cohen and Chehimi (2010) contend that efforts at the broadest levels of the spectrum of prevention, in terms of changing organisational practices and policies, provide the tipping point for changing social norms. This is because they transform the environment of the community as a whole, and alter what is considered to be acceptable and desirable behaviour. This encourages people to actively contemplate their own practices, and provides relevant awareness and a supportive environment for helping to promote change. New social norms then emerge when enough individuals have made the choice to transform their current behaviour (Cohen and Chehimi, 2010).
The social ecological approach has been adopted by a number of bodies and organisations working in the fields of preventing violence against women and engaging men and boys (for example, see: UNFPA and Promundo, 2010; Our Watch et al., 2015). However, there have also been some critiques about its utilisation, for example by Pease (2011; 2014; 2015a; 2015b), who has articulated some of the limitations of applying public health models to men’s violence against women. Pease (2015b) points out that these approaches, from which the language of ‘primary’ prevention originates, risk conceptualising violence against women as an epidemiological or medical problem, as if it were a disease. This is also a danger when using language which describes violence and abuse as an ‘epidemic’, for example. Such constructions of men’s violence against women risk implying that it is in some way an inevitable, uncontrollable, or natural phenomenon, rather than a pattern of practices and choices made by human beings. There are considerable differences between diseases and men’s use of violence towards women - and treating them in the same way can diminish men’s agency and responsibility for the perpetration of violence, as if it were an unstoppable and unavoidable problem.
51 Pease (2014) also notes that the ecological approach suggests that there are multiple causal factors at different levels of society which all play a part in explaining men’s violence against women. This relegates patriarchal inequalities to only one among many factors underpinning violence against women, rather than what Pease (2015b: 79) describes as its ‘central
organising framework’. What’s more, explanations drawn from these different levels can actually sometimes contradict one another. For example, whilst psychological explanations at the individual level and feminist approaches at the structural level may make sense on their own, they may conflict with each other if we attempt to bring them together into a coherent, holistic account of the problem. Pease (2015b) refers to the criticism made by Stanger (2011), that the ‘ecosystem’ concept employed by ecological theorists - which originates from the principles of biological ecology - is not sufficiently complex to be applied to social, political, and economic contexts.
For Pease (2014), it is not a coincidence that the ecological model is increasingly taking on primacy in work to prevent men’s violence against women. He notes that it coincides with the growing professionalisation of prevention work, where there is a risk of it being co-opted to fit into neoliberal and managerialist policy agendas which are contributing to the
depoliticisation of efforts to end violence against women. Of course, violence and abuse is a public health problem. But if we limit our focus to this lens only, then do we fail to see how it is also a political, economic, and societal problem? By seeking to change specific parts of the social ecology, do we lose our focus on transforming the social system as a whole? Within public health, the social ecological approach is diametrically opposed to medical models of disease prevention. Yet by applying it to men’s violence against women, we may risk reproducing a medicalised and depoliticised conception of the phenomenon.
The social ecological model has arguably been useful in relation to the prevention of violence against women because it does advocate for holistic social change, in a way which is
relatively accessible and politically palatable for policymakers to embrace. Yet Pease (2014) points out that despite the aim to take into account all levels of the ‘social ecology’, these approaches to prevention often end up focusing primarily on individual attitudes and
behaviours, with less attention placed on changing the structural levels of patriarchy. Another important criticism that Pease (2015b) makes is that whilst public health distinctions between ‘primary’, ‘secondary’, and ‘tertiary’ prevention may be relevant in relation to disease, they may be overly simplistic and obfuscating of reality when applied to men’s violence against women. For example, a workshop in a university is likely to include a mixture of young men;
52 some of whom may have already perpetrated some form of violence towards women, whilst many others will have engaged in sexist and misogynistic behaviours. It is therefore unlikely that even young men can be divided so neatly into categories of ‘primary’, ‘secondary’, or ‘tertiary’ preventative interventions within patriarchy.
There is also a risk that such distinctions can diminish the role of women’s movements in the prevention of men’s violence against women. Pease (2015b) argues that by placing primacy upon ‘primary’ prevention, and associating women’s organisations with ‘secondary’ and ‘tertiary’ prevention, there may be an implication that this work is in some way less important, in dealing ‘only’ with the consequences of men’s violence, rather than trying to stop it from happening in the first place. Such a construction obscures the ways in which ‘secondary’ and ‘tertiary’ efforts contribute in multiple ways to ‘primary’ prevention, and cannot always easily be separated out from one another. Furthermore, it conceals how women’s organisations have for many decades led the way in developing prevention efforts, whilst at the same time supporting the victim-survivors of men’s violence. Pease (2015a) contends that the notion that work with men addresses the problem ‘upstream’, whilst women’s organisations deal with the consequences ‘downstream’ (described by Messner, Greenberg, and Peretz, 2015) is similarly problematic, and suggests a hierarchy between ‘men’s’ and ‘women’s’ anti-violence work. Meanwhile, Storer et al. (2016) found in interviews with representatives from different organisations engaging men across the globe that rigid distinctions between ‘primary’ and other levels of prevention do not fully
encapsulate the reality of these efforts. They argue that more expansive understandings of prevention are needed, which recognise that there is significant overlap between different levels of intervention, in order to more accurately reflect the unique and contextualised approaches that different organisations adopt.
As a result of the criticisms made by Pease and others, I decided against basing this project around the social ecological model, and have sought to avoid using some of the
epidemiology-influenced frameworks and language surrounding public health approaches when discussing men’s violence against women. Whilst recognising the potential uses of a public health lens and the insights that it can provide, there is a risk that feminist analyses can become absorbed within such approaches, when they should be front and centre of efforts to understand and tackle men’s violence. Pease (2014) advocates the integrative feminist model (IFM) developed by McPhail et al. (2007) as one such approach to conceptualising violence against women and its prevention. McPhail et al. (2007: 834) argue that “rather than being
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one component of an ecological model, the feminist perspective can be the glue holding together these puzzle pieces, multiple theories, and interventions”. The IFM therefore
represents a synthesis of academic debates, research findings, victim-survivors’ voices, and critiques of existing theories. Multiple theoretical perspectives and models of causation can thus be incorporated where relevant, whilst feminist accounts (such as a continued emphasis on the political nature of personal relations) remain at the centre of its explanation of men’s violence against women.
McPhail et al. (2007) argue that such an approach would also allow for more comprehensive understandings of the totality of violence and abuse, including those forms experienced by men or LGBT people. This would also enable new assessments and intervention practices to be introduced within feminist work to tackle men’s violence against women, whilst nurturing the coexistence of both professionalism and activism in such practice. McPhail et al. note that the IFM supports an increase in choices and an amplification of the voices of victim-
survivors, in which personalised solutions can be developed and where the criminal justice system is not seen as the only option available. The IFM also therefore advocates further changes in policy and institutional responses to violence against women, including
recognising where such responses have failed to date, for example by investing in developing alternative models and programmes to the criminal justice system where appropriate.
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Figure 1 The Integrative Feminist Model for Intimate Partner Violence
McPhail et al. (2007) describe the IFM’s structure as forming that of a puzzle (see Figure 1), in which interlocking theoretical pieces fit together in order for a more complete picture of the problem to become clear. However, it is important to note that not all theoretical frameworks can fit into this puzzle, and that a gendered, feminist approach to violence against women forms its central piece, whilst other parts provide further detail and context to help make sense of the range of forms of violence and abuse. Whilst different aspects of the IFM can be debated, it demonstrates that it is possible to take into account the societal complexities of violence and abuse and its prevention, and retain an analysis which holds feminist theory at its core. Such an approach would be based around creating systemic change across the different levels of society, but potentially in a more far-reaching, nuanced, and elemental way than the ecological model allows, and without necessarily leaving itself vulnerable to the same internal contradictions.