2 Determinants of Receiving Services for Women with Disabilities Who Have Been

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Determinants of Receiving Services for Women with Disabilities Who Have Been Sexually Assaulted in Saudi Arabia
The Importance of Problem for Society
Disability is a problem that affects millions of people globally and the Kingdom of Saudi Arabia (KSA) is not immune to this issue. Within KSA, it is estimated that anywhere from 750,000-850,000 of the citizens are disabled in some manner (Statista Research Department, 2021). This high population of individuals with a disability however do not all have the same access to treatment and services that they badly need (Peter et al., 2018). Of the nearly 1 million estimated individuals who are disabled in the country, a little over 400,000 are believed to be women (Statista Research Department, 2021). Additionally, women in KSA, despite some recent improvements in rights, are still lagging men in many areas of society. This often means that because of both formal laws/ policies and informal cultural norms, women with disabilities in KSA have double the burdens that women with disabilities in many other nations have. A woman with a disability can expect hardships, higher rates of abuse, rape, assault and less access to services and support globally (Alem, 2020). In KSA, the added gender imbalance in rights only leads to higher instances of difficulty in getting help when a woman has a disability.
One issue that women with disabilities face in KSA and worldwide is the risk of sexual assault (Martin et al., 2006). Women with disabilities who are victims of sexual assault in KSA need services, but are often not able to get them, are discouraged from voicing any openness of the experiences they have faced (abuses) or are fearful of even attempting to get services (Wali et al., 2020). This is an important issue for society because at the current time, there are many gaps in understanding, knowledge, and access to services. The determinants of receiving services for sexual assault when an individual is disabled are therefore not as well-known as possible and therefore services are not given or being developed as well as they should be. Society in KSA is lacking in this area but there are women who need the services. This gap is a problem to Saudi society and for the many women who are not being afforded the treatment that they want and need.
Population Affected by the Problem
Women in KSA are the major target in this problem as they are the ones who lack the needed services and the needed support in KSA when they have a disability and have been sexually assaulted. KSA has a population total that is a little over 32 million individuals (World Meter, 2021). Of this population, about five and a half million of them are women and within this population of the women a little over 400,000 of them are women with a disability (Yousef, 2019). This problem of services, lack of them, and what even helps to determine who is eligible, who can get them and more, is a major problem in the country for women (Yousef, 2019). The target therefore really affects women, specifically women with disabilities. However, this does not mean that they are the only ones affected because at the smaller level, their families are also affected, their children are affected as well. Moving up the societal level, communities are also affected because of this lack of services within the country. This problem/ issue therefore affects women, women with disabilities, families, and the community as well (Yousef, 2019).
Target of Intervention
While women are the main population who will be affected by this issue, to have an intervention that is realistic, there needs to be a response in the form of an intervention aimed at the societal level. The main reason for this is that in KSA, the community and collectivism are all important (Cassell & Blake, 2012). Family is also paramount and to ensure that any level of success can be had with regards to change in the current situation with receiving services for women with disabilities who have been sexually assaulted, there must be a strong societal campaign that allows women to get treatment in a way that lets them feel safe and comfortable to get such treatment. At first, it may seem that offering women a set of solutions to empower them directly or give them platforms directly would be the best solution. However, no matter how empowered and supported the women are in the country to stand up and attempt to get the help that they need, they will not be able to realistically get far with it, unless there is change in family attitude and community attitude towards these problems. Focusing on services and intervention that only looks at the variable of the women themselves will not be able to translate past an abstract concept into a realistic one that can be applied in the real world because as a family-oriented culture and a collectivist culture, the inclusion of family and community is needed in addition to empowering women alone. A societal intervention will ensure that women not only individually feel safe to get help, but also feel that they can have support within their society to get this help so that it is not a taboo and not something that they avoid.
The Special Significance of Problem for the Practice of Social Work
Service, dignity, social justice, and more are all the reasons that this issue is of so much importance to the world of social work. Firstly, social work and social workers aim to offer support for issues related to social justice. This issue is directly related to social justice because as it stands now, women and men are in an inequitable position where women are not able to get services they need and are also subjected in many situations to sexual assault at the hands of those who they are close to. This inequality is a form of clear discrimination which is directly listed in the National Association of Social Workers NASW’s own list of ethical principles. In addition to this, there is also the issue of service which is another value that is clearly listed within the NASW and is a direct issue in this problem as well. Social workers are supposed to be there for their communities to address social problems and help create the needed change that can offer relief for those who are marginalized and in need of help. What we can see in this issue within the population of women in KSA is that social work and social workers are the perfect support system for them as these social workers are able to draw on the very core ethics and principles of the field which the issue is directly related to.
Prevalence & Incidence
Prevalence of Problem
Research on the extent of abuse in the Kingdom of Saudi Arabia (KSA) is not at the fullest capacity that I can be which can be mostly attributed to the fact that there are socio-political and religious reasons that reporting, and data collection are not at their most optimal. However, this does not mean that no information is available. Over the last few years more reports have come out to address specifically what the problem of both general abuse against women is in KSA as well as the more specific realities or sexual abuse prevalence. A study conducted by Wali et al (2020) and published in the British BioMed Central repository went into details on the prevalence of sexual abuse in KSA. This study found that the age in which the abuse was first seen was in the teens and that there was a rate of almost 17% (16.75%) in women in KSA for sexual abuse (Wali et al., 2020).
Other kinds of abuse had higher rates of prevalence such as psychological abuse which was found in 50% of participants and overall abuse against women which reports suggested accounted for 1/3 of the entire population of KSA (Wali et al., 2020).
What can be seen is that in KSA, there is a large problem with abuse and a high prevalence of both psychological as well as sexual abuse. The research that has been conducted to date has verified that there is a problem and while much more research is needed, over the last 2 years there has been an increase in the breadth and extent of available research available (Wali et al., 2020).
Existing Research Types
The kinds of research that has been undertaken has been diverse and has been conducted from various angles as well. Most of the available recent research has been quantitative in nature and has relied on the collection of primary data. The Wali et al (2020) research for example used a sample of 1845 participants who filled out a self-report Arabic version of the Norvold Domestic Abuse Questionnaire (NORAQ) (Wali et al., 2020). Other research like the Alharbi et al (2021) used 2254 participants who filled in questionnaires online using the WHO’s multi country instrument for assessment and collection of data (Alharbi et al., 2021). This is a common trend in the literature where there appears to mostly be the use of quantitative methods and the use of comparative and cross-sectional methods.
This is not to say that qualitative and mixed method are not also normal in this area of research. Previously there was less available data on the specific conditions of women in KSA when it comes to how they were dealing with, and to what extent they were dealing with abuse of any form. As more data has become available it seems that more focus is being placed on quantitative. A part of this is perhaps tied into the opening of the country more with more access being available to women with both Saudi groups and international NGOs who are attempting to fill the gaps of access and equity for women in healthcare and legal issues and concerns. The literature in the past was limited and this can explain why more reliance on qualitative methods was normal previously and why now there is a larger body of quantitative data that is giving firsthand data from women in KSA specifically looking at their rates of violence and abuse in multiple formats. The best option moving forward would be to use a mixed method approach which can make use of the existing literature and data and focus in on one specific area to also acquire primary data that can be assessed (Timans et al., 2019).
Limitations &Strengths
The research that does exist currently is still potentially limited. Yes, KSA has opened more now than it had been in the past, but this does not mean that the level of openness now is able to allow for women to have the full range of access to help and information as they can have. This is a limitation, and it must be remembered that the specific government makeup and norms in politics coupled with the socio-religious makeup and cultural norms of the communities within the country all ensure that the research is going to be limited to a large extent. These limitations can and do come from both the formal and official state level controls as well as the more informal cultural and family level of controls that women face in the country overall.
These limitations are also followed with the possibility that in KSA there are specific urban/ metropolitan areas that have more representation, and the women have more access to help, information and even healthcare. This means that many women in communities within the country who are in more rural areas or cities that are more conservative, will not even have the access to participate and report their conditions to the same extent as women who are from more urbanized and liberal (relative) cities/ locations within the country.
This brings up another limitation which is that access to those women who come from more conservative communities and families will mean that many women are again being left out of the potential research because they simply have no way to access a platform to make their voices heard. Many groups within the country are therefore potentially being left out of the research and the reporting which can mean that the existing research is only giving a snapshot of a segment of the women in KSA at this time who may be dealing with abuse in any format at all. This is a major limitation and specific ways to counter it are needed to ensure that the data are representative of the actual conditions being faced by women in KSA at this specific point and time.
While the limitations stood out in the existing research, there were also some clear positives in the research as well. One strength was that in comparison to information that was available before 2020, there is far more research that is focusing on the condition of abuse within the population of women in KSA. It would be beneficial to have some of the research focus more narrowly on disability status, but despite this, there are strengths in that the research is doing more to give information about types of abuse against women and breaking it down with more information on the issue of sexual abuse amongst women in KSA. Also, the newer research is stronger because there are larger sample sizes that they are using. Major areas of the population are being covered with this information which is highly helpful and is allowing there to be more insight into what future research is still needed at this point and time.
Diversity in Research
Another potential problem within KSA with regards to the collection of data is that there are subgroups in the country that are not always given the level of representation that they need. The government of KSA does not conduct census reports that consider the specific religious and ethnic breakdowns of people. This makes it even harder to assess the issue of diversity in the populations in the country because so much of the information on diversity is simply not known at all. With this unknown, we can only be left to guess to an extent as to what the specific problems are with regards to religious and ethnic groups and what they are dealing with in KSA. What they are dealing with of course will refer to not only the issue of abuse, or sexual abuse, but life overall and what this means in all possible aspects within the nation in general.
The issue of abuse and the research around it has failed to really see what the subgroups in the country are dealing with. Two main issues stand out. The first is that there is a religious minority in the country, and they are very often not accounted for or represented. This is the Shia subgroup within the nation. They are believed to be anywhere from 10%-15% of the nation’s population, but this is not known specifically because census checks that ask about religion are simply not known that well within KSA (Council Foreign Relations, 2021). Another issue with diversity being considered is that there are many people from nations such as India, Bangladesh and the Philippines who live and work in KSA who the victims of abuse are potentially as well. However, because of political reasons, religious reasons, and fear of immigration, are not participating in research and are not being included in the research as well.
Generalizability of Findings
One problem with the information that has to date been found within this research is that it is not very generalizable at all. Firstly, it is possible that it cannot even be generalizable within KSA itself. The reason for this is that within KSA there are many groups of women who are potentially being left out of the conversations regarding abuse in women who have disabilities or really any group of women. Some of these have been discussed above, but this will include potentially lacking information from the following groups of women:
Women from religious minorities who are not being accessed or included in the research.
Women from religiously conservative communities/ cities/ families who are not being included in the research.
Women who live and work in KSA and have done so for a long time, but are ethnically different, i.e., Indian, Yemeni, Bangladeshi, etc. women.
In addition to this, there is also the potential for women to not be generalizable in this research that exists because it cannot cover the differences that are seen in neighboring nations. The Middle East and North Africa (MENA) region itself may not be able to relate to these findings because while there are some similarities in other Gulf Cooperation Council (GCC) states, like Qatar, UAE, etc., each one also has its own political, social, and religious norms that are affecting their conditions. This level of difference is even higher in other Arab nations, like Maghrebi and Levantine, all of which are only at best loosely connected through language and religion but have their own unique realities in culture and circumstance that can affect their conditions. Generalizing can therefore be difficult as there are many potential differences between the makeup and political realities in KSA compared to other nations facing similar problems with abuse.
Relevant State Policies
Women’s Empowerment Policy In KSA
The KSA has a specific set of laws and policies that are meant to help ensure that women are treated equitably and fairly within the Islamic system of governance that is in place in the country. One specific policy is the women’s empowerment policy which can be found on the KSA government portal and is broken down into several segments including education, employment, and healthcare. For this report, the most relevant of the considerations will be the healthcare access as we are concerned with women being able to receive and have access to the support that they need in terms of abuse assistance (United National Platform, 2021).
The Council of Health Insurance is required to aid all women in the country, regardless of status, ethnicity, and citizenship status (Council of Health Insurance, 2017).The laws in the country and the related policies state that “The state cares for public health and provides health care for every citizen and his family in cases of emergency, sickness, disability and old age”. The policy has several considerations to ensure that this is all made possible including health education programs, awareness programs, nutrition programs, disease prevention, health education, pregnancy, and childcare support and more. Related to this is the labor and women’s law intersection which states that:
The Women Empowerment Agency seeks to create initiatives and projects that support the empowerment of women and people with disabilities in the Saudi workplace and work to implement them to achieve the goal of increasing women’s participation in the labor market to achieve justice in equal opportunities in the labor market (Council of Health Insurance, 2017).
This overall concept however is tempered with the fact that each policy that is meant to help ensure that women are able to have support and access, are also somewhat limited with the fact that verbiage is used that talks about women in even the workforce being qualified with rules such as women only being in environments and positions that are “compatible with their nature” which shows that while policies like the women’s empowerment one have been crafted to ensure women have access to jobs and support, they are also still limited in some regards (United National Platform, 2021).
Relation to Women in KSA
This policy is directly related to women and the very title of the government page, and the majority focus of it as well is all on women and the desire to bring about levels of equity for them in their community. Women are the ones who are abused, and many variables ensure that conditions exist where women are not able to get help or even get away from the conditions that make abuse so possible for them. An example of this is that women in the community are often not able to have independence and therefore are forced to rely on family members or spouses for basic survival.
This policy is meant to help start building the foundations that can allow women to have the needed agency required to break out on their own. The policy also additionally assists women in better having the tools of formal government support so that should they need help, they can rely on more than just their families or charity to get help but know that they have actual legal avenues in which they are being protected from abuse and the conditions that give rise to abuse.
Social Justice, Ethical Considerations & Diversity
This policy is attempting I believe its best given the clear limitations that are in place within the society overall. For social justice it is helping to ensure that women are being given the building blocks to have their rights considered in a way that allows them agency and allows them some voice in society to have equity. The policy specifically has areas of consideration for healthcare, for housing, for employment and for many additional issues that affect women in society. The policy also has clear language to make it clear that there is to be no differentiation based on issues such as race or even nationality or citizenship so that any woman who is in the country, has access, or should have access, to the same rights and support services and protections that men have in the country as well. The issue is that often the language is qualified with some verbiage that suggests that there are limitations here when the policies are potentially putting women into positions that are not appropriate, not safe, or not ideal according to the cultural and maybe also religious norms that the nation is accustomed to. There can be many issues here because these qualifications can mean that women are going to be infantilized in some of their own decisions, which strips them of the fairness and equitability that the policy on women’s empowerment was likely hoping to counter in the first place.
Diversity does not seem to be the issue here, but what is an issue is the ethical considerations of on the one hand stating a desire for women to have full rights, and on the other hand qualifying their rights and equity based on a patriarchal system in which norms according to men are used as a marker or measure of what should or should not be allowed to take place in the country overall. Women in that sense are being given rights but also having them controlled which may eliminate some of the sincerity and meaning behind policies such as the women’s empowerment policy that KSA has in place currently.
The diversity perspective is most useful in terms of social justice viewpoints as it is the one that can help to ensure that what is lacking in KSA for women can be filled. The lacking area is their participation and inclusion in many policies and rules that affect them. Furthermore, women from marginalized or poorer backgrounds in the country are left out of the discourse even more and are not included in policy making. The lack of agency that women have in this regard leads to a setting that is not ethical as it does not meet the needs of women in KSA and strips them of agency along the way because they are later subject to the rules that had no part in creating. People from all backgrounds in the country are needed to create inclusive and ethical norms, programs, and policies and therefore, the social justice perspective is the one that most can address the needs of the women in KSA and help work towards the equity that they need.
Potential Policy Alterations
The policy alteration that I would make if there was ability to control this would be to add more voices of women into the policy. Yes, it means well, and it is an improvement and move into the right direction but by having qualifying language it in a way strips its entire meaning and purpose. This is because it goes in a circle and brings the women back into the control and influence of men who will dictate what is considered appropriate, safe, and acceptable. When this happens, it means that men have a sort of veto over the women in issues that are related to them. How can a policy mean to ensure proper and equitable healthcare and access to support for women who have been victims of sexual abuse who have disabilities be potent when the women must rely on men to gatekeep for them what is ok and not ok and what is acceptable or reasonable or not acceptable and reasonable?
The change here that I believe is needed perhaps is not yet possible as the conditions in the nation have not moved onto ensure that women are given agency in their own conditions, and not simply seen as individuals who need more representation, but with supervision. While laws have been passed that have extended the rights of women, and this women’s empowerment is a good example of the move towards protecting women more realistically and helpfully, there is a long way to go to ensure that women have the support they need and feel the safety they need to voice concerns and complaints when they are facing abuse. While nothing in the current women’s empowerment explicitly states any limitations for women to get medical support and help if they are being abused, there is also no explicit support for how a woman would go about getting this help if she is being blocked or intimidated in any way by her family or community. These need to be addressed for there to be more efficacy in the policy to help women.
Ethical Theories
Consequentialist and Non- Consequentialist Approaches
The consequentialist approach to ethical considerations approaches the decisions based on what the end or the consequences of actions are. This grouping of ethical considerations looks at classical teleology, proportionalism, egoism, and utilitarianism. All of these do share a major variable with each other, and that is that each one is looking at the ends to perhaps justify the actions taken to get to these ends. On the other hand, the non- consequentialist approach which includes deontology, and egalitarianism as well as natural rights theory is based more on an action being taken despite what the consequences may be, and more on the moral or ethical consideration of decisions (Cooper, 2004).
When a person for example wants to make the decision on the train path of killing 2 people or killing 10 people, would choose to kill the 2 to save the 10 because your actions are based ok, ethical, or good based on the sum of the end consequence. In this case, it would be saving more than killing. On the other hand, the non- consequentialist will say that no matter the outcome, it was wrong to kill anyone. This would mean that even if you chose to not kill one person to save 10, 100, or 1000 people, your decision was right because the rightness of your decision is not based on the end results, or the final consequences of the decision, but instead the specific decision that you are making in that moment .The deontological model, or Kantian model with its categorical imperatives (CI) encompasses this best because it says that an act cannot be considered ethical unless that act could be universal and used by all people in the same situation. If this cannot be met as a condition, then it is not likely that this is a decision that can be ethical in nature.
Theoretical Examples
The best-known approach in the consequentialist camp is the utilitarian or greatest good for the most people approach. In this approach many common examples can come up and one that was already addressed above is the classic one with the train. However, there are many possible ways to see this specific problem. The consequentialist camp overall is focused heavily on the “overall amount of well-being” that the state can offer through its actions, and within this specific problem we see this exact situation as the community needs actions that will be justified through the creation of more well-being (Eggleston, 2020). If the goal is to balance the good against the bad, then there needs of course to be definitions of what constitutes good and bad, and while this can to an extent be subjective, some common areas are agreed on, such as ensuring safety for people within the country. In KSA the subjective nature of definitions comes into play with the consequentialist approach as some limitations are placed because it is believed this is the best balance for good and bad (like limitations in the kinds of fields women can go in) (McNaughton & Rawling, 1998).
Some policies are created with the belief that they will help protect the larger population, but they tend to hurt smaller groups. In this kind of scenario, many will justify the utilitarian approach because they believe that this will help them ensure that more people are helped than not helped with the alternative being seen as causing too many problems and gaps. Some policies, like NCLB (no child left behind) have been viewed like this because they help many children, but they also leave behind smaller pockets of children who do not fit as well into the policy.
Another example of this can be seen with KSA and how the women’s empowerment is making a blanket attempt to help women within the confines of current political and religious realities. This has caused there to be many women who have support and help now, but as noted before, they also have language that can harm some women, i.e., the concept of women needing to be protected and somewhat infantilized. The belief here is that for the greater good of society, some limitations on women are justified which creates a situation in which the result is being used to justify the marginalization of some women along the way.
Another approach for ethics, this one the non- consequentialist method is the Kantian or deontological method of assessing if a decision is right or not. In this approach the goal is to decide based on whether the decision is right on its own merits. The tool used for this can be seen in the categorical imperatives in which rules are given for how a decision is made and what is the right choice (Pogge, 1998). In essence, an individual cannot be used as an end to a mean. If the consequentialist approach in KSA allows women to be limited in some fields because it increases the greater good but at the expense of women who are having their existence and worth measured against society, therefore making them a means to an end. Therefore, if we look at the same examples from above, we can see that there would be different results in what would be considered acceptable or not.
If there was a policy that helped 80% of children but caused problems for or marginalized the other 20% of the children, then the decision itself would not be ok. Yes, 80% of children are not left behind or harmed, but any children being sacrificed or not considered for the sake of the other ones is not going to be the acceptable choice at all. In this case, the right thing to do would be to ensure that you are making a choice based on whether it was right on its own merit and if it could be made universal in all cases and if these conditions or CIs are not able to be met, then they are not going to be the ethical choices to make in the situation.
In the case of the women in KSA and the women’s empowerment, the decision to try and improve the condition of women, but at the same time qualify the situation needs to be looked at within the CI again. Firstly, based on its own merit, then it is not ethical and even if the result or the consequence would mean that more women would be able to enjoy freedoms and equity, does not excuse that many women will not because they will be limited in how they can get any assistance at all. Also, can this be made to be universal? Will all laws and policies be made with an “out” in which each right is qualified with a condition that is supposedly being crafted to ensure that society is safeguarded? Can we sacrifice the freedom and rights of the individual to safeguard the society as a whole? In the case of the women ‘s empowerment, this is how it is being seen. Women are qualified in their rights and limited (their actions must appropriate) so that the greater good of society overall and its morality is protected. Therefore, in this case, what is being done is not morally right in itself but is instead being validated or justified with a reference to another end, i.e., the morality of society.
Kantian Deontology
My paper relies on the issue of women being given rights and allowing these rights to healthcare, access and consideration all be equitable to what men would receive. To work towards this, the government has started over the last few years to work on a women’s empowerment policy in which women are having the gap between them and men closed more and more. However, as noted, this is being qualified with specific language that continues to limit women. The deontological approach is needed in this case and applies best to it because women need their condition and their cases to be looked at specifically through the lens of their own morality not in terms of how they need to be a cog within society and therefore put their own needs aside to protect society and its moral fiber (Barrow & Khandhar, 2017).
The deontological approach therefore makes the most sense because too often women are used as a direct means to an end and their rights and freedoms are conditioned on the end they are seen as serving, or needing to serve for their families, their children, and their spouses. This strips them of being able to be considered on their own merit and what they need for themselves. Instead, too often, women are used to generate happiness for society, for families, etc. While this may sound like a moral, or righteous reason to limit women, it is unethical when we apply the deontological model to the actions of society and the government. This model is the best one to apply to this situation as women will need to be seen within a context of their own considerations, wants and needs, and not within the consideration of any other variables.
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