EXPRESSIONS OF CONJUGAL VIOLENCE AND SERVICES ATTENDED IN THE NETWORK

Objective: to unveil the expressions of conjugal violence experienced by women and the services attended due to it. Method: qualitative, descriptive study, anchored in the gender category. Nineteen women experiencing conjugal violence were interviewed. Data were analyzed from the technique of the Collective Subject Discourse. Results: women experienced patrimonial, moral, psychological, physical and sexual violence. Regarding the suffering caused by the phenomenon, women attended hospital service, police, violence court and shelter home, in addition to having the support from women’s association, created in the community for this purpose. Conclusion: the knowledge of expressions of gender asymmetry in the lives of women and the services sought may subsidize the preparation of health professionals to recognize the phenomenon and referral in the network. Descriptors: Violence Against Women; Psychosocial Support Systems; Coping Strategies; Gender-Based Violence; Community Health Nursing; Domestic Violence. RESUMO Objetivo: desvelar as expressões da violência conjugal vivenciada por mulheres e os serviços percorridos por conta do agravo. Método: estudo qualitativo, descritivo, ancorado na categoria de gênero. Entrevistaram-se 19 mulheres em vivência de violência conjugal. Analisaram-se os dados a partir da técnica do Discurso do Sujeito Coletivo. Resultados: as mulheres experienciaram violência, expressa nas formas patrimonial, moral, psicológica, sexual e física. Diante o sofrimento desencadeado pelo fenômeno, as mulheres percorreram serviço hospitalar, delegacia, vara de violência e a casa abrigo, além de contar com o apoio da associação de mulheres, criada na comunidade para tal fim. Conclusão: o conhecimento acerca das expressões da assimetria de gênero na vida das mulheres e os serviços buscados poderá subsidiar o preparo dos profissionais da saúde para o reconhecimento do agravo e encaminhamento na rede. Descritores: Violência Contra a Mulher; Redes de Apoio Social; Estratégias de Enfrentamento; Violência Baseada em Gênero; Enfermagem em Saúde Comunitária; Violência Doméstica. RESUMEN Objetivo: develar las expresiones de violencia conyugal vivida por las mujeres y los servicios recorridos por el agravio. Método: estudio cualitativo, descriptivo, anclado en la categoría de género. Se entrevistó a 19 mujeres en la experiencia de la violencia conyugal. Los datos fueron analizados a partir de la técnica del Discurso del Sujeto Colectivo. Resultados: las mujeres han sufrido violencia, expresada en las formas patrimonial, moral, psicológica, física y sexual. Ante el sufrimiento causado por el fenómeno, la mujer recorrió el servicio del hospital, la policía, el juzgado de la violencia y de la casa abrigo, además de contar con el apoyo de la asociación de mujeres, creada en la comunidad para este fin. Conclusión: el conocimiento de las expresiones de la asimetría de género en la vida de las mujeres y los servicios solicitados podrá subvencionar la preparación de los profesionales de la salud en el reconocimiento de la responsabilidad extracontractual y el enrutamiento en la red. Descriptores: Violencia Contra la Mujer; Sistemas de Apoyo Psicosocial; Estrategias de Enfrentamiento; Violencia de Género; Enfermería en Salud Comunitaria; Violencia Doméstica. PhD, State University of Bahia/UNEB. Salvador (BA), Brazil E-mail: gilvania.paixao@gmail.com ORCID iD: https://orcid.org/0000-00016539-482X; PhD, Federal University of Bahia/UFBA Salvador (BA), Brazil. E-mail: nadirlenegomes@hotmail.com ORCID iD: https://orcid.org/0000-0002-6043-3997; MSc (Doctorate Students), Federal University of Bahia/UFBA Salvador (BA), Brazil. E-mail: nanmatheus@yahoo.com.br ORCID iD: https://orcid.org/0000-0001-7501-6187; E-mail: silva.andrey1991@hotmail.com ORCID iD: https://orcid.org/0000-0002-1038-7443; Graduate, Federal University of Bahia/UFBA Salvador (BA), Brazil. Email: jemima.raquel03@outlook.com ORCID iD: https://orcid.org/0000-0002-9466-0936; Graduate, Federal University of Bahia/UFBA Salvador (BA), Brazil. E-mail: monikyac@hotmail.com ORCID iD: https://orcid.org/0000-0003-2955-5408; MSc, Federal University of Bahia/UFBA Salvador (BA), Brazil. E-mail: josilirio@hotmail.com ORCID iD: https://orcid.org/0000-0001-7610-3186; PhD, Federal University of Bahia/UFBA Salvador (BA), Brazil. E-mail: alvaro_pereira_ba@yahoo.com.br ORCID iD: https://orcid.org/0000-0003-1899-7374 ORIGINAL ARTICLE Paixão GPN, Gomes NP, Estrela FM et al. Expressions of conjugal violence and... English/Portuguese J Nurs UFPE online., Recife, 12(9):2368-75, Sept., 2018 2369 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i9a234997p2368-2375-2018 Violence against women is a public health problem, and it often occurs in domestic space, mainly perpetrated by their spouses. Due to the difficult identification of conjugal violence, anchored in the uneven construction of gender, health professionals need to pay attention to investigate the grievance and refer women, considering their demands. The high rates of violence against women can be evidenced in international and national surveys, such as the United States and Brazil, whose prevalence of intimate partner’s aggression was 4.7 and 7 for every 100 women, respectively. In Canada, in 2011, conjugal violence was responsible for approximately 25% of all violent crimes reported to the police. These data indicate the magnitude of conjugal violence throughout the world. In addition to the prevalence data related to violence, it generates an expenditure of more than R$ 5 million (Real – Brazilian currency) per year. However, it does not represent the actual expenditures in the health sector, since it is only the expenses with hospitalizations, when the physical ailment demand hospital care. Studies in Brazil and Spain show that the repercussions, such as death threats, social isolation, difficulty to break this cycle, reduced self-esteem, sadness, fear, and depression, cannot be ignored, as well as the non-qualification for the job market, since they have abandoned their studies to take care of the house, the children and the husband. Despite these implications for the woman’s life, the violence perpetuates due to the social construction of gender present throughout the world. The naturalization of violence is anchored in a historical and sociocultural process that reproduces the social construction of a submissive and passive woman and admits aggressiveness as justifiable and belonging to male characteristics. Corroborating, a Brazilian study with women victims of violence, when investigating the factors that trigger the conflicts in the conjugal relationship, identified the male idealization of sole owner of knowledge, which must not be questioned and the female as a person without the right of expression and dissent in relation to the partner. A research in Nigeria also defends the male control and female subservience as factors associated to conjugal violence. Due to the complexity of the phenomenon, its relevance and magnitude, in 2006, the Law 11.340 was created. Known as Maria da Penha Law, this device allowed greater rigor in the prosecution of crimes of violence against women based on gender, in the granting of protective measures, in prison in flagrante and in preventive detention in cases of risk for women and children. It also determined the creation of special courts to judge the cases, in order to urge the situation. Other policies of assistance to women were created for promoting an integral care. In this sense, services were organized in order to build up the “Rede de Atenção à Mulher em Situação de Violência” (Network for Attention to Women in Situation of Violence). This aims to integrate and coordinate various institutions considered important to protect the woman and/or empower her to cope with the gender violence, such as women’s police station, shelter homes, reference centers, Legal Medical Institute (IML – Instituto Médico Legal) and health services. However, a study in Santa Catarina warns to the fragility in the articulation of the support network and points to the difficulty of health professionals to recognize the violence, as well as to perform referrals of women who suffer from the phenomenon. It also highlighted the need for a management that prioritizes coping with violence, which includes academic and in-service training, focused on the topic from the gender perspective. ● To unveil the expressions of conjugal violence experienced by women and the services attended due to it. This is a qualitative, descriptive study, supported by the theoretical framework of gender and linked to the research-action entitled “Coping with conjugal violence: strategies for ensuring safety and health of families”, funded by the Fundação de Amparo à Pesquisa da Bahia (FAPESB – Foudation for Research Support of Bahia). The collaborators were 19 women from a community with low socioeconomic indicators and high rates of conjugal violence, in the city of Salvador. The inclusion criteria were: being older than 18 years and having a history of conjugal violence. The rapprochement between community and collaborators occurred with the aid of a neighborhood association, which, with the support of a OBJECTIVE

English/Portuguese J Nurs UFPE online., Recife, 12 (9):2368-75, Sept., 2018  2369 Violence against women is a public health problem, and it often occurs in domestic space, mainly perpetrated by their spouses.Due to the difficult identification of conjugal violence, anchored in the uneven construction of gender, health professionals need to pay attention to investigate the grievance and refer women, considering their demands.
The high rates of violence against women can be evidenced in international and national surveys, such as the United States and Brazil, whose prevalence of intimate partner's aggression was 4.7 and 7 for every 100 women, respectively. 1In Canada, in 2011, conjugal violence was responsible for approximately 25% of all violent crimes reported to the police. 2These data indicate the magnitude of conjugal violence throughout the world.
In addition to the prevalence data related to violence, it generates an expenditure of more than R$ 5 million (Real -Brazilian currency) per year. 3However, it does not represent the actual expenditures in the health sector, since it is only the expenses with hospitalizations, when the physical ailment demand hospital care.
Despite these implications for the woman's life, the violence perpetuates due to the social construction of gender present throughout the world.The naturalization of violence is anchored in a historical and sociocultural process that reproduces the social construction of a submissive and passive woman and admits aggressiveness as justifiable and belonging to male characteristics. 6Corroborating, a Brazilian study with women victims of violence, when investigating the factors that trigger the conflicts in the conjugal relationship, identified the male idealization of sole owner of knowledge, which must not be questioned and the female as a person without the right of expression and dissent in relation to the partner. 7A research in Nigeria also defends the male control and female subservience as factors associated to conjugal violence. 8e to the complexity of the phenomenon, its relevance and magnitude, in 2006, the Law 11.340 was created.Known as Maria da Penha Law, this device allowed greater rigor in the prosecution of crimes of violence against women based on gender, in the granting of protective measures, in prison in flagrante and in preventive detention in cases of risk for women and children.It also determined the creation of special courts to judge the cases, in order to urge the situation. 9her policies of assistance to women were created for promoting an integral care.In this sense, services were organized in order to build up the "Rede de Atenção à Mulher em Situação de Violência" (Network for Attention to Women in Situation of Violence).This aims to integrate and coordinate various institutions considered important to protect the woman and/or empower her to cope with the gender violence, such as women's police station, shelter homes, reference centers, Legal Medical Institute (IML -Instituto Médico Legal) and health services. 7wever, a study in Santa Catarina warns to the fragility in the articulation of the support network and points to the difficulty of health professionals to recognize the violence, as well as to perform referrals of women who suffer from the phenomenon.It also highlighted the need for a management that prioritizes coping with violence, which includes academic and in-service training, focused on the topic from the gender perspective. 10To unveil the expressions of conjugal violence experienced by women and the services attended due to it.This is a qualitative, descriptive study, supported by the theoretical framework of gender and linked to the research-action entitled "Coping with conjugal violence: strategies for ensuring safety and health of families", funded by the Fundação de Amparo à Pesquisa da Bahia (FAPESB -Foudation for Research Support of Bahia).
The collaborators were 19 women from a community with low socioeconomic indicators and high rates of conjugal violence, in the city of Salvador.The inclusion criteria were: being older than 18  To organize the data, the Speech of Collective Subject (SCS) and the interpretation of the data based on the gender perspective, theoretical reference that allows understanding the relationship of power of the male over the female sex. 6e collaborators of the research were between 19 and 58 years old, self-reported, in their majority, black, low schooling, living in a stable and economically dependent on parents and/or companions, with whom they reside with their children.
The synthesis core ideas represent the expressions of violence experienced by women and the services they attended resulting from disrespectful conjugal relationships:

• Synthesis core idea A: Expressions of conjugal violence
Women reported experiencing disrespectful conjugal relationships, marked by abuse, expressed in the forms: patrimonial, moral, psychological, physical and sexual.Such expressions can be best illustrated from the speech below:

• Synthesis core idea B: Services attended for coping with conjugal violence
Because of the suffering that permeates the daily lives of women experiencing conjugal violence, these go through governmental and non-governmental services aiming at a life free from violence.The following speech displays the services sought by the collaborators The discourse of women alert to the experience of the forms of gender violence typified by Maria da Penha Law: property, moral, psychological, physical and sexual.These were expressed by the destruction of home furniture, threats, insults, slander, forced sex and physical assault. Among the forms of manifestation, the patrimonial violence stood out, through the partial or total destruction of goods, relating to breaking of the home furniture, behavior that can relate to the social education of boys.In this sense, the culture legitimizes that they must be strong, face the situations also with violence. 13A study in Minas Gerais, Brazil, indicates that this type of expression is still little perceived by women, because they are unaware that the retention, subtraction, partial or total destruction of their personal objects by the aggressor is a crime and is laid down in the law. 14This non-understanding of the acts characterized as patrimonial violence, as well as the moral violence, is also reality of underdeveloped countries, such as Uganda, 15 and developed countries, such as the USA, 16 which until today do not have a law that classify such expressions.

RESULTS
English/Portuguese J Nurs UFPE online., Recife, 12(9):2368-75, Sept., 2018 2371 Regarding moral violence, the participants' speech allowed unveiling that it is marked by slander and libel, from male statements that refer to the companion's betrayal, as well as her devaluation in front of neighbors, situations that expose women and denigrates their image.A study in Spain reveals that men commit moral violence with the aim to affect their companions, causing them to lose the good reputation and to be in disbelief in society. 9The violence is justified as a manifestation of masculinity, being founded in the construction of the patriarchate and expresses itself through the conduct of domination and submission of women. 6In a study in Sweden, authors emphasize that gender-based violence should be eradicated, mainly those related to honor, in what refers to man's reaction regarding cases of betrayal. 17e to the cause-and-effect relationship, moral violence is usually associated to psychological violence, 18 considered, in some countries, such as Norway, as a single type, expressed through threats, humiliation and insults. 19However, Maria da Penha Law separates moral violence from psychological, which includes, in addition to public insults, aggression in the domestic sphere, including threats of taking children away.Whether in the psychological or moral forms, this experience triggers fear, helplessness, guilt and low self-esteem. 19he gender perspective, continuity in the relationship, even with these feelings and sensations, sustains the social belief that a woman should ensure the maintenance of the home and is responsible for satisfying her husband's wills.
Female submission is often found in studies on conjugal violence, considering that it permeates through an unequal relationship of gender, which imputes to men power over women. 6This whole scenario relates to the patriarchal model of society in which both were educated. 20In this perspective, sexual violence perpetrated by their own companion appears in this study, without understanding the context as abuse.2] Thus, sexual violence is often difficult to identify, hindering the perception of women (and men) of spousal rape.This is ratified in a study conducted in the USA that alerts to the experience of spousal rape in the marital relationship. 16 addition to sexual abuse, this study shows physical violence, manifested by damage to the entire body, maximum expression of power that men believe they have on women.In some cases, physical violence against women has serious repercussions, as evidenced by a study conducted in Australia, which highlights the aggressions which lead the woman to surgical centers, such as burns throughout the body caused by intimate partner. 23This study draws attention to the physical aggression directed to the face, dialoguing with a study conducted in Brazil which showed aggression directed to the companion's face, suggesting this act aims at decreasing her self-esteem. 24A research in Italy discussing gender violence between spouses discusses women's guilt when experiencing and remaining in the conjugal relationship from the critical reflection about the their shame to be experiencing the phenomenon.
;17 This context makes women even more vulnerable to remain in a disrespectful marital relationship and ends up feeding the belief of male power in the relationship. 6spite the various repercussions of violence to women's physical and mental health, the female discourse points only the hospital emergency as the place sought in the health system.Since this is a high-complexity service, their search is possibly due to the severity of the case, which suggests the perpetration of a more pronounced physical abuse. 26Importantly, not only physical violence require health services, but all and any form of abuse, because there is the somatization of the experience through physical and mental illness.;10 In this perspective, scholars highlight the importance of considering the subtle expressions of violence, silenced within the conjugal relationships, and that cause as many or more damage to women than their most visible forms, such as anxiety, insomnia and depression, symptoms which may lead to suicide attempts. 27mands of women in situations of violence go beyond health sector; they imply social, legal, security, and other actions.Thus, due to the experience of conjugal violence, some women who are willing to stop the abuses experienced in their homes go through English/Portuguese J Nurs UFPE online., Recife, 12(9):2368-75, Sept., 2018 2372 services, governmental and/or nongovernmental organizations, aiming at solving their causes.Regarding demands within legalpolice context, the speeches refer to the search for civilian police stations, preferably the one specialized in serving women as a gender approach, in order to record the occurrence of violence, and, thus, establish the investigation.However, the study is limited, since it does not make clear the motivation for representing the fact, which may consist of a strategy to cease the violence and not necessarily to break up with their companions. 7Thus, professionals, considering gender perspective, need to respect the woman's choice and create spaces of understanding about the social construction, responsible for gender inequality. 6om the representation of the fact through the judge's sentence, there is a path to travel.Studies show the critical path that women sometimes go through when they decide to end the violence, 28 despite the importance of networks as a strategy of empowering women in situations of violence and, therefore, coping with this phenomenon.By involving different instances and, many times, being a long journey, it is not uncommon when women give up, which may be related to the unfamiliarity of the whole process in the legal-police context.For recording an occurrence, routinely, the first step is to go to the police station, which may be common, but, primarily, women's police station (DEAM -Delegacia Especializada de Apoio à Mulher).From there, the police inquiry is sent to the Public Ministry, which will decide whether or not to offer the complaint.If so, the case is assembled and forwarded to the violence court, where the trial occurs, as well as the execution of the causes arising from domestic and family violence against women, which may be of a civil nature, such as protective measure, or criminal.When they do not have lawyers, women are forwarded to the Women's Rights Defense Core (NUDEM -Núcleo de Defesa dos Direitos da Mulher), which binds to the public defenders for providence of legal representation. 7ciety needs to understand that the record of occurrence in the police station is just the kickoff; there is a long and arduous path, sometimes leading the woman to give up the process.When talking about the slowness of the process, this situation was also pointed out by the female discourse.A research corroborates the delay for problem solving, emphasizing the accumulation of processes resulting form disability that some Courts of Domestic and Family Violence against women have in their structure, such as the lack of magistrates and servers in the specialised courts.Added to the inadequacy of the physical installations and material deficiencies, such situations hinder the implementation of Law 11,340/2006 and contribute to the accumulation of processes and their consequent delays throughout Brazil. 27nsidering that the representation of the fact in the legal-police context can make women even more vulnerable to situations of abuse, some resources are used to ensure their protection, such as distancing measures of the aggressor and the referral of women to shelter homes. 18 Considering the services pointed out by collaborators, sometimes, these were indicated by women also with a history of gender violence, members of an association located in the studied community that has as purpose to welcome the female population who experiences the phenomenon.As the female discourse, this NGO has made referrals to the institutional services, signaling for its relevance in the empowerment of women in the search for a life free from violence.Therefore, one can see women's recognition that this association is part of the network of protection for people in situations of violence, reaffirming that the process of coping with this grievance is not limited to seeking government institutions.

Scholars
emphasize the beneficial contributions of neighborhood associations in the commitment with the community, through the provision of spaces for discussing domestic violence based on gender, in addition to supporting and guiding women to find outlets for the conjugal relationships full of violence. 26Configuring as a relevant service to support women, professionals who work in the framework of the PHC need to know the territory where they act and to articulate with these spaces in order to prevent and face the problem, in addition to strengthening the network of care to women in situations of violence.A research with PHC nursing professionals shows that they recognize the importance of identifying the violence, as well as they feel prepared to suspect and English/Portuguese J Nurs UFPE online., Recife, 12(9):2368-75, Sept., 2018 2373 investigate domestic violence and refer women to network sites, including psychological care. 10This knowledge must involve not only the support network, but also the social process of asymmetry between genders, considered essential for professionals of health services and for all who are part of the network.Thus, they will be better prepared to welcome and guide women, favoring their empowerment so that they can cope with the grievance.
The study showed that women with a history of conjugal violence experience abuses in the patrimonial, psychological, moral, physical and sexual forms.Due to the abuses in the conjugality, women reported having gone through the community women's association, health services, police station, court and shelter home.
Although women mention the services they went through due to the conjugal violence, the study is limited by not revealing the motivations for such searches, especially regarding the separation from their husbands or control strategy of new aggressions.In this sense, future researches should be developed involving such object, also under the gaze of the gender category, in order to consider the social construction that defines male power over women.
The knowledge about the expressions of conjugal violence and services that are parto f the support network women suffering this abuse can assist in directing strategies that qualify professionals to identify this grievance and refer in several scenarios, including in the health areas.Thus, it is important to discuss this topic in health spaces, with an emphasis on the family health units, especially regarding nurses' role who, by their bond established with the users, is located in a strategic position for suspicion of the phenomenon and referrals in the network.