Viewing Gendered Violence in Guatemala Through Photovoice

Abstract

This research examined rural and urban women’s experiences of gender-based violence in Chimaltenango, Guatemala. Photovoice methodology was used to describe and analyze local realities and vulnerabilities, and ethnographic techniques added cultural and contextual factors. While the initial focus was on intimate partner violence, results showed that violence for women exists from childhood to senior years. Participants noted gaps in services and participated in a public strategy workshop to address these. Challenges and opportunities are presented around the enduring and complex global crisis of gendered violence. Photovoice is a powerful method for organizations to better understand and respond to local issues.

Keywords

violence against women photovoice IPV Guatemala community-based research university–community partnerships lifespan violence

Violence against women (VAW) is a widespread social, public health, and human rights issue that occurs regardless of age, race, or social class. The World Health Organization (WHO; 2014) estimated that globally 35% of women experience intimate partner violence (IPV) and/or sexual violence. IPV can be more difficult to establish than other crimes and in some countries is not considered an offense (Schweizer, 2011). Even where laws exist, underreporting is common, often due to cultural and religious beliefs along with lack of trust in police and justice systems. These factors contribute to its invisibility (Orpinas, 1999; Schweizer, 2011). Cases labeled homicide could also be the result of IPV that may not be fully investigated and can skew statistics.

IPV affects the health of both women and their children. Women experiencing violence are at higher risk for unplanned and complicated pregnancies, unsafe abortions, and other gynecological disorders such as sexually transmitted infections including HIV. Yet, family planning and other social support programs often fail to address this important determinant of women’s health (Guedes, Helzner, & Tabac, 2002). The physical and emotional effects of violence may not be visible, but can be severe and long lasting, including disabling injuries and a variety of chronic physical and psychological health challenges that last long after the abuse may have stopped (Campbell, 2002; Leslie, 2001; Vives-Cases, Ruiz-Cantero, Escribà-Agüir, & Miralles, 2011). A report by the Pan American Health Organization (PAHO) showed that in 12 Latin American and Caribbean countries, between 41% and 82% of women experiencing IPV had serious physical outcomes, yet between 28% and 64% did not seek help or communicate their experience (Bott, Guedes, Goodwin, & Mendoza, 2012). The social and economic costs to individuals, families, and communities are high (Modi, Palmer, & Armstrong, 2014).

There are multiple notions around IPV risk. McNaughton Reyes, Billings, Paredes-Gaitan, and Zuniga (2012) discussed macro-level risk factors of sexual violence in Central America that include “high rates of crime and weak social controls, which contribute to an atmosphere of high tolerance of violent behavior” (p. 84). These authors also implicated the elevated levels of poverty that may increase women’s economic and social vulnerability, along with normalization of VAW and the secrecy around childhood sexual abuse. The 1999 Guatemala Archdiocese Recovery of Historic Memory Project (REMHI; as cited in Hastings, 2002) noted that the high level of unreported cases of sexual violence during the civil war was likely related to stigma and cultural and religious values around purity and sexual intimacy, possibly resulting in shame and self-blame.

In Latin America, machismo is often considered an important cultural variable. It used to refer to “a family provider who has a strong work ethic and lives up to his responsibilities. However, machismo also fosters an exaggerated importance of maleness, sexual prowess, and expectation of deference to men by women” (Weidel, Provencio-Vasquez, Watson, & Gonzalez-Guarda, 2008, p. 249). Heaton and Forste (2008) noted the strict gender roles in Latin America that result in “negative patterns of couple interactions such as male dominance and domestic violence” fueled by machismo (p. 183). Sagot (2005) viewed violence as “a product of social organization structured on the basis of gender and age” (p. 1292). Reimann (2009) identified the interrelatedness of femicide, sexual violence, and domestic abuse in Guatemala, with these having “similar root causes” (p. 1200) namely, cultural devaluation of women and the pervasive impunity that continues from the civil war.

Context of the Research

Guatemala is the largest and most industrialized country in Central America (Anderson, 2003), but high levels of disparity and oppression experienced by members of the 21 indigenous Mayan groups result in four out of five living in extreme poverty. The remaining citizens are mostly of European descent, called Ladino (Ladina for women). Mayans have experienced over 500 years of oppression, exploitation, and death at the hands of Spanish invaders beginning in the 1500s and continuing under a variety of dictators. In spite of past and current economic and political oppression by the Ladino population, the Maya have preserved a strong ethnic identity including traditional values and practices (Bertrand, Ward, & Pauc, 1992).

The country is still recovering from the brutal 36-year civil war that officially ended in 1996 with the signing of the Peace Accords. More than 200,000 were killed or disappeared a million displaced; thousands tortured, massacred, and raped; and over 400 villages burnt to the ground in a scorched earth policy (Hastings, 2002). Over 100,000 children lost parents (Anderson, 2003) and sexual violence was used as a weapon of war, mainly state-sponsored and sanctioned acts against indigenous women (Crosby, 2009; Hastings, 2002). With little government effort to operationalize clauses of the Peace Accords that would reduce social and ethnic inequality, new forms of violence by former members of the police, military, and paramilitary have emerged (Ogrodnik & Borzutzky, 2011).

High levels of insecurity for Mayan women in Guatemala are the result of ongoing racism, economic and social disparity, trauma from a protracted and violent civil war, and increases in drug trafficking and gangs, and can be seen in increasing rates of femicide in both urban and rural areas. Femicide is used to describe the murder of women because of their sex, frequently in areas where they are oppressed, vulnerable to violence, and where it is state sanctioned (Carey & Torres, 2010; Vásquez, 2009). Often it is committed by intimate partners (Garcia-Moreno, Guedes, & Knerr, 2012). Guatemala has one of the highest rates of femicide in the world with a corresponding high level of impunity for perpetrators (Suarez & Jordan, 2007). In 2011, more than 20,000 cases of VAW reached the courts, yet “less than 3 percent resulted in a judgment” (Musalo & Bookey, 2014, p. 106). Carey and Torres (2010) wrote that femicide exists due to “culturally accepted practices that promote gendered violence, including the socially tolerated forms of sexual abuse, physical and emotional battery, and sexual harassment” making the lives of women and girls (quoting Russell, 2001) “chronically and profoundly unsafe” (p. 143).

Many women in Guatemala live with both historical and present-day trauma. Following the arrival of the Spaniards in the early 1500s, women experienced sexual abuse from colonizers attempting to “create a metizo race,” while during the most recent civil war known as La Violencia (1960-1996), women were targeted as the “reproductive source of guerillas” (Bellino, 2010, p. 7). A Spanish court hearing cases of Guatemalan genocide noted that over 100,000 women had been raped by military and paramilitary forces during the civil war (Patterson-Markowitz, Oglesby, & Marston, 2012), and this sexual violence continues. Chan, Lam, and Cheng (2009) noted the large body of literature showing a strong correlation between community and family violence, while Menjívar (2008) stressed that for women in Guatemala, these “multiple forms of violence coalesce . . . and become normalized” (p. 109).

The Department of Chimaltenango (similar to a province or state) includes its capital city of the same name, 15 towns, and many smaller communities with a total population of around 450,000 (Statoids, 2015). Historically, it is the land of the Kaqchikel people and was the site of the first Spanish conquest. Chimal, as its capital is called, is a large sprawling industrial area an hour west of the country’s capital.

The Community Partner

The Kaqchikel Presbyterio, situated in Chimal, was formed in 1976 by Pastors Vincente and Margerita Similox in response to a humanitarian crisis from an earthquake (K. Anderson, personal communication, August 2005). With Chimaltenango also experiencing some of the worst violence from the armed conflict, their work focused on safety for fleeing widows and children, and more recently health and development. Their Tabita Levántate program began in January 2009 in response to the levels of abuse, discrimination, and rape experienced by women, including sex workers. Physical and psychological health care and legal support were available, and health promoters and midwives received training on abuse prevention and intervention.

The Kaqchikel Presbyterio was the first partner of a solidarity network (Maritimes-Guatemala Breaking the Silence Network) that emerged out of the civil war. I first visited the area with other members of the network in 2005 as part of a human rights delegation and returned several more times to study Spanish. With a sabbatical year approaching, I contacted the Presbyterio administrator to see if there was an interest in a joint research project. The response was very positive and I later made a site visit with him and the director of the Tabita program to discuss possibilities and confirm their commitment. While several ideas for a study were mentioned, they expressed a strong interest in better understanding women’s context of violence and whether the Tabita program was meeting women’s needs.

Direction of the Research

Further discussion with the Presbyterio team clarified the purposes of the study that were established as follows: (a) to enhance understanding of rural and urban women’s experiences of gender-based violence, (b) to describe the women’s experiences with available interventions around violence, and (c) to provide a means for the participants to discuss gaps in service and areas for change. The first purpose is presented in the “Findings” section, while some interventions and gaps in services are found in a subsequent section as they relate to ways of moving forward.

Researchers have noted how the silence surrounding women’s experiences of violence only perpetuates its continuation and is reflected in low levels of reporting (Crosby, 2009; Hastings, 2002; Sagot, 2005). Goodman, Smyth, Borges, and Singer (2009) stressed the need to understand IPV in various contexts including women in poverty and those from minority ethnic groups, and to better understand ways they can be supported, as well as the “effectiveness and limits of different interventions” (p. 322). They suggested that methodologies such as participatory action research are needed and what is critical is “ongoing engagement with people who have experienced or worked directly with the phenomenon of interest to insure the research questions are significant” (Goodman et al., 2009, p. 322). Thus, through a collaborative process with the Presbyterio leaders and with midwives and health promotors included as participants as they meet women in their homes and communities on a daily basis, the participatory action research method of photovoice was deemed to be appropriate.

Method

Photovoice is an innovative community-based research method used to uncover a variety of health and social realities with diverse populations. Photovoice can be an effective method for helping community-based organizations deepen their understanding of the populations they are serving. As it works from the grass roots, there is a greater chance that the most relevant and pressing needs will receive the most appropriate response or intervention.

Photovoice was first used by its founders with Chinese peasant women (Wang & Burris, 1994) and is a dynamic process that continues to evolve as use increases. Foundational principles include health promotion, community-based approach to documentary photography, Paulo Freire’s work on developing critical consciousness, and feminist theory (Wang, 1999; Wang & Burris, 1994; Wang & Pies, 2004; Wang, Wu, Zhan, & Carovano, 1998). Participants are provided with cameras to take pictures of the topic under study, meet to discuss their photos and meanings, and move from the described situations in the photos to analyzing root causes and possibilities for social change. Participants choose what they will photograph within the topic of study, what they will reveal about the meaning of their photos, and which photos and stories will be made public. Generally, photovoice discussions are held in a group format, although some researchers carry out individual interviews, at times in combination with other qualitative methodologies and group discussion (Capous-Desyllas & Forro, 2014; Galvaan, 2015; White, Kuper, Itimu-Phiri, Holm, & Biran, 2016).

The oral-based and interactive design of photovoice has been used effectively with marginalized and indigenous populations in various countries (Adekeye, Kimbrough, Obafemi, & Strack, 2014). A few examples include sex workers in the United States (Capous-Desyllas & Forro, 2014), Rwandan women farmers (Gervais & Rivard, 2013), women and violence in Northern Ireland (McIntyre, 2003), youth (Ohmer & Owens, 2013; Strack, Magill, & McDonagh, 2004; Streng et al., 2004), women and homelessness (Fortin, Jackson, Maher, & Moravac, 2015), people living with HIV/AIDS (Teti, Conserve, Zhang, & Gerkovich, 2016), Mexican and Asian immigrant women and violence (Frohmann, 2005), and mental illness (Mizock, Russinova, & DeCastro, 2015).

In Guatemala, several photovoice studies have taken place. Williams (2001) used photovoice in her doctoral research with women in rural Guatemala and she and Lykes have applied this method over several years working with rural Guatemalan Mayan women around their experiences of healing from the civil war violence (Lykes, 2001; Williams & Lykes, 2003). Cooper and Yarbrough (2010) combined photovoice and focus groups in a health study in rural Guatemala. Carey and Little (2010) described how the Kaqchikel Maya painted memorials to recount their 500-year history of violence as a critique of invasion, oppression, and war. The importance of visual representation for meaning-making is highlighted in their work and through other visual memorials I have seen throughout the country.

Implementation

I returned to Chimaltenango 10 months after our original planning meetings with study approval from my university’s Research Ethics Board and the nursing faculty Ethics Review Committee. Regular meetings were begun with the Presbyterio’s administrator, lawyer, doctor, and psychologist that included training on photovoice, developing roles and responsibilities of a project monitoring team (PMT), and planning for recruitment. Meanwhile, translated Spanish documents were checked and edited by staff to ensure local and cultural relevance. A local woman, Brenda Rimola, was hired and trained to assist in group facilitation, transcription, and translation. As well, a Canadian volunteer from the Breaking the Silence Network, Meghan Langille, who was spending 7 months with women’s groups in nearby rural communities, assisted in recruitment and meetings. The study lasted for 6½ months, from October to the following April.

Recruitment and Sample

Participants were recruited through purposeful sampling using various strategies and with a letter of invitation that explained the study. Following a recruitment flow chart and a script, the medical doctor invited midwives and health promoters assigned to the department at their regular meetings; the lawyer and psychologist recruited women, including sex workers, who came for services and programing around violence; and Meghan and I worked through a women’s microcredit group in a rural area. Inclusion criteria were the following: (a) 18 years or older (age of consent in Guatemala), (b) experienced violence or had clients with this experience, and (c) speaks Spanish. The resulting sample of 21 was diverse in age (from 18 to over 40 years) and ethnicity (Kaqchikel, other Mayan groups, and Ladina). According to the administrator, this was the first time that both Mayan and non-indigenous women (n = 7) had worked together on a project and the first time any had been involved in research. Based on the response, we developed four photovoice groups: (a) health promoters (five females, one male), (b) midwives (six females), (c) service users group (five females), and (d) a rural women’s group (four females). As well, two ethnographic interviews were held with a male community leader and a female social worker/traditional spiritual guide. Other ethnographic techniques were employed such as participant observation (e.g., attending various cultural events, meetings, and a training on women’s rights) and document review (e.g., government laws and policies, nongovernmental organization [NGO] materials related to women’s rights and violence).

Consent forms attached to the letter of invitation were signed before starting and information included the study purpose, description, rights, safety, risks, responsibilities, and benefits. Participants could keep their camera at the end of the study, they received copies of their photos with an album, and they were paid a small honorarium for each meeting to show respect for their time and to cover transport costs. Children were cared for by family or neighbors while babies were brought to the meetings.

Study Process

Approximately 6 weeks after arrival, we held a training session where all participants were introduced to the photovoice process, practiced using the supplied digital cameras, and learned about safety and ethical guidelines around community photography and violence. Each participant received a pen and note book with a summary of the main training topics.

Participant safety was paramount. Meetings were held where they felt the safest, they were encouraged to not participate or to leave the study at any time if they felt unsafe, and any forms to keep were labeled as “A Women’s Health Study” so as not to highlight the focus on violence. They could also leave these at the Presbyterio office. A one-page handout was provided that outlined possible stress responses in emotional, physical, behavioral, and cognitive domains, including practical ways to manage stress appropriate for the context. If anyone became upset during a meeting, or had any symptoms such as anxiety afterward, they were provided a free consultation with the psychologist. The meetings could become very emotional, but it seemed to be a cathartic experience for them and no one dropped out. Each participant was asked to choose a pseudonym if they did not wish their names made public and many other measures were taken to ensure security and privacy of participants and their data. A community consent form had to be signed before photos of any person or their property could be used publically.

At the end of the training session, participants received the first photo assignment. Table 1 shows the schedule of meetings, their focus, and activities undertaken.

Table 1.

Meeting Schedule, Photo Assignments, Activities.

Month	Meetings	Assignments/activities
November	Photovoice training (3 urban groups together) and 1 in the rural village	Assignment 1: Take pictures of places and things that represent (a) health or a healthy life (b) your experiences with violence (c) the effects of violence on health and quality of life of women and families (personally or others).
December	Group Analysis of first assignment photos (4 groups separately)	Assignment 2: Take pictures of places and things that represent (a) how women can protect themselves against violence or prevent it from happening (b) what women can do when they are hurt (physically and/or emotionally) (c) what help is available when women are victims of violence.
January	Group analysis of Assignment 2 photos (4 groups separately)	Assignment 3: Take pictures of things that you think are missing from previous sessions
February	Addition of Assignment 3 photos. Joint meeting and first viewing of all photos from each group.	Participants decide which photos were most representative of their issues and on photo organization.
February to April	Subsequent meetings with the participants and members of the Project Monitoring Team to plan for local dissemination through a public strategy workshop.	Preparing invitations for government departments and NGOs, notices for the general public, creating two large laminated posters summarizing the study and findings, developing smaller posters with individual photos and stories (25), and locating a suitable venue.
Mid-April	Public Strategy workshop in collaboration with NGO CICAM. Appreciation Dinner for participants and Project Monitoring Team	Participation in workshop; i.e., help in preparing the venue and displays, talking to attendees, answering questions about photos and stories, media interviews.

Note. NGO = nongovernmental organization; CICAM = Centro de Investigación, Capacitación y Apoyo a la Mujer.

The photo assignments were reviewed at each meeting, with copies in Spanish provided in their notebook, and participants were encouraged to take notes about their photos if they wished (e.g., why the photo was chosen, what they were thinking and feeling at the time). Each group met separately during each of the next 3 months where they shared their photos that were downloaded onto a computer as they arrived and displayed through a media projector. Individual group meetings ended with a new assignment, except for the final one. All discussions were audio taped, transcribed, and translated into English as soon as possible after each meeting.

We followed the usual photovoice process that includes these three stages:

1. Selecting—Participants choose two or more of their photographs that had the most personal significance.

2. Contextualizing—Participants analyze the photos by describing the meaning of their images to other group members. Typically photovoice studies follow the acronym SHOWeD, although variations have been used (Freedman, Pitner, Powers, & Anderson, 2014; Nash, 2014). I also adapted this slightly as from earlier Canadian experiences participants often found this difficult to follow. This adaption is similar to the SHOWeD model and respects Freire’s process of social analysis. Table 2 displays the steps in both models for comparison.

Describe your picture (initial description of issue/concern),

How is this important to your life? (context, deeper personal meaning),

Why does this happen? (examining root causes),

What needs to change? (desired outcomes/needed actions),

Who should be involved in this change? (responsibility for specific actions alone or collectively [e.g., a person/group/committee/agency/department]).

Table 2.

Comparison of Analysis Processes (Contextualizing).

SHOWeD	This study’s process
S: What do you See here? H: What is really Happening?	1. Describe your picture.
O: How does this relate to Our lives?	2. How is this important to your life?
W: Why does this situation/concern/strength exist?	3. Why does this happen?
e	4. What needs to change?
D: What can we Do about it?	5. Who needs to be involved in the change?

During the contextualizing stage, the person who took the picture began with steps (a) and (b) and the rest of the group was invited to participate in (c), (d), and (e). These statements/questions were posted in the room as a reminder, but once the women began describing their pictures, they told the story in their own way. For most, Spanish was a second language and this was one of the few times they were asked to speak about the topic of violence and health. I thought it was important to allow them to speak with limited interruption and return to the questions when appropriate.

3. Codifying—Participants identify issues, themes, or theories that emerge (Wang et al., 1998). To formalize this and to check agreement and differences between groups, everyone came together in the fifth month to view their chosen photos and discuss integration and dissemination. Over several joint meetings, we began choosing and arranging the photos that best represented their experiences, along with planning for a public strategy workshop to display findings and facilitate a wider community discussion of violence.

Findings

When participants saw the photos loosely displayed on poster boards, they were surprised and shocked to see the evidence of lifespan violence for themselves and others and stressed that this was what they wanted to make public. Therefore, examples of the photos from each major life stage are presented below, recognizing that there is some overlap between them. For example, what a mother might experience so might her children.

Childhood and Adolescence

Young girls especially have little decision-making power and are often exposed to violence from an early age. One participant spoke of being sexually abused around the age of 5 years; others were raped as adolescents, followed by frequent experiences of violence in their marriages, which often take place in the teen years. One stated, “It is sad to think that those who are supposed to care for us are the ones that hurt us the most.” (Photo 1)

Photo 1.

Why are those who are supposed to love us the ones that hurt us?

The photo of the doll with no mouth represented their reality that girls have little voice and, when they do speak, few listen or believe them. (Photo 2)

Photo 2.

I have no voice.

Mothers carry much responsibility for home, gardens, animal/child care, and income generation; all with limited time, energy, and resources. This can lead to emotional neglect, lack of protection, and failure to meet the basic physical needs of their children. (Photo 3)

Photo 3.

Neglect.

Alcohol plays a critical role in violence across the lifespan. While it is not necessary for violence to happen, it can be an antecedent if men become angry and aggressive while drinking. (Photo 4) Women and children may be beaten and/or sexually abused and deprived of basic livelihood when money is spent on drink. Women talked about their husbands arriving home late and demanding meals or sex, or driving them out of the house where they would have to sleep on the ground.

Photo 4.

Alcohol is no friend of the family.

The machete and axe are symbols of men’s hard work and are often used to earn a living. (Photo 5) Unfortunately, many women described them as tools of intimidation and attack against them and children, with one taking a photo of a tree dying from too many machete cuts.

Photo 5.

Machete and axe: Tools of intimidation.

So much is expected of youth, especially the girl child, and they are often forced to grow up quickly. “At the age of 12 I worked in a factory from Monday to Saturday, and on Sunday I had to wash clothes in a river . . . it was washing all day.” While brothers play outside, girls help mothers with their many responsibilities. (Photo 6)

Photo 6.

Girls work while boys play.

They talked about having to do everything for their brothers who had little, if any, responsibility and would beat them if the work wasn’t done as expected. Females are usually last to be considered for school and when resources are limited, they stay home or are sent to work for other families or in factories, often at a very young age and where they are most vulnerable to abuse. This lack of access to education, that includes learning Spanish, results in further exclusion of indigenous women, compounded by their limited ability to travel outside their communities (Ertürk, 2005).

Participants talked about the lack of sex education and the strict social and religious guides for behavior. One at 14 years was beaten by her mother when she assumed her daughter had had “sinful” contact with a man; she was later forced to marry him. He was 22 years old and she ended up in the emergency room on the wedding night from being raped. Many marry at a young age, not because they are in love, but to escape an unhappy home life. One reported, “You think that going to a different place will make things better, but it isn’t like that.” At some point, the emotional and physical abuse begins, often with having no one to confide in or provide support. One woman talked about how her in-laws said she was only good for “food for the ravens” as she had only conceived two girls. Having a son improved her relationship with her husband (until she found out he was living with another woman): then she found her in-laws maltreating her daughters.

Participants stressed the need for a peaceful home instead of a place where children learn violence. When one mother noticed her children watching their arguments, she told her husband that they should not do this in front of the children. Participants also discussed the level of violence seen by children through television and video games. Parents “need to be vigilant of what comes in our home,” because, “if we let violence be a part of our day-to-day life this will impact our children and they will learn it. We have to educate ourselves so that we can educate our children.”

Adulthood

Abuse of women and their children is often seen and accepted as a man’s right to keep order in the family. Besides male aggression from alcohol use, family stress and the burden of poverty increase when limited income is spent on drink. The emotional effects of violence can be as serious as or worse than the physical effects and can last a lifetime; these include depression, anxiety, post-traumatic stress disorder, and panic attacks. (Photo 7)

Photo 7.

Effects of violence are serious and long lasting.

The women often used photos of the natural world to help describe the effects of violence, such as a damaged plant. “This is how we feel when we are victims of abuse and rape. We are broken, but we are still alive.” (Photo 8)

Photo 8.

We’re bent and broken, but still alive.

They talked about feeling “damaged,” “hopeless,” “mixed up in a lot of dirty things,” and “having lost [their] dreams.” One had a picture of a broken window reminding us that this could be repaired, “not like the wounds we have that don’t disappear.”

Through a bleak picture of a board used to cross a ditch, a young, single mother depicted her life after a rape and giving birth as a result of the attack. (Photo 9) “This is similar to what happened to me. I feel like this bridge, people walking all over me, stepping on me.” Another photo of a dead flower represents how she feels “like that plant that will never bloom again.” Since the rape, she has received no follow-up intervention, she is ostracized by the community, and the perpetrator still lives nearby. Participants recognized that women who experience abuse frequently have worse health and need more medications. However, they may misuse drugs and alcohol to reduce their emotional and physical pain, and several participants talked about their suicide attempts. (Photo 10)

Photo 9.

People walk all over me.

Photo 10.

Looking for relief from physical and emotional pain.

Entrapment was a common theme representing their many social limitations that are kept in place through violence. (Photo 11) Being trapped can be both emotional and physical. Some women are not allowed to leave home without their husband’s permission; they described feeling “cornered, “alone,” and “fearful.” (Photo 12)

Photo 11.

Trapped.

Photo 12.

Doors aren’t open to us and if we try to get out, the abuse can get worse.

The expression “It’s a Dog’s Life” takes on a new meaning in Guatemala as this participant reported, “I was treated like a dog all my life . . . first by my family when I was a little girl and later by my husband.” (Photo 13) One woman who went to work for another family at a very young age said, “So like a dog I would get fed if they wanted me to or starve if they didn’t.” Another lamented, “I tried to please my husband in a thousand ways, to please my mother and his family, but I couldn’t; I was always tied up—we don’t need to have a visible chain to be tied up.”

Photo 13.

It’s a dog’s life.

One participant reported that in her community “violence is seen as something normal . . . where only men have rights and when a woman tries to succeed, she cannot do it.” They said that men shouldn’t feel threatened because a woman is educated or successful. Within their culture of violence, they hear messages that “marriage is for life” or “you just have to live with it.”

The Third Age

Photos and discussions on this phase of life were more limited as many women could only speak from observation of or work with older women. Still, their stories were full of despair as they expressed sadness that their value as a woman decreases after bearing children, with menopause, or when appearances change.

After working so hard all their lives, they expect some comfort in their older years, but instead, they may be further neglected and abused resulting in greater poverty. (Photo 14) While married, they rarely hold formal positions, and employment in the informal sector can be limited by age, cultural norms, and illness. Some widows are also treated badly by other family members and can be forced out of the family home that they and their husbands spent a lifetime building. One woman explained,

When we experience abuse at any time we can feel like garbage. When we can no longer reproduce we can be thrown away like this old, rusty desk. As we get older and should be enjoying life we are often treated worse; even abused by our children. (Photo 15)

Photo 14.

We’re unwanted like these dried up plants.

Photo 15.

Treated like rubbish.

Through the photos and stories, the following general concepts emerged:

Violence is prevalent in the lives of many women and children in their respective communities and is very often life long.

Violence against women and children is normalized and rarely challenged.

Girls and women often have little voice in personal, family, and community decision-making.

When resources are limited (e.g., living in poverty, living in a rural area), interventions and justice can be especially elusive.

These are further examined in the following section that also highlights their interrelatedness, along with opportunities and challenges for addressing needed changes.

Opportunities and Challenges for Change

This small study in a specific area of Guatemala has shown the extent of gendered violence from childhood to old age. While findings cannot be generalized to other populations, the literature is replete with similar stories from other areas. The PAHO report on VAW showed a strong correlation between abuse in childhood and later abuse in an intimate partner relationship (Bott et al., 2012). Sagot’s (2005) case study of family violence in 10 Latin American countries noted that in spite of differences in socioeconomic status and ethnicity, “their experiences were tragically similar” and the women spoke about “long histories of violence that often began in childhood” (p. 1299). The two male voices (health promoter group and ethnographic interview) confirmed women’s experiences and the strongly entrenched beliefs and practices around women’s low status and gendered violence.

If there is a word to describe the lives of many girls and women throughout the lifespan, it might be difficult, although there is really no one term that can possibly depict their habitual lifelong oppression and pain. Each experience is different and there are both variations and similarities between rural and urban and indigenous and Ladina women. Very often, the differences are related to poverty that severely limits opportunities and increases vulnerability beyond the variable of gender. Traditional values can be more strongly entrenched in rural areas where contact with the outside world is reduced. Examining culture historically may reveal that many traditional practices were gradually introduced in response to outside forces such as colonialism, to maintain or reinstate male dominance (Duffy, 2005). Weidel et al. (2008) wrote that IPV is “a complex, multifactorial phenomenon [and that] alcohol abuse and socioeconomic pressures combined with a perceived violation of traditional gender roles have been identified as antecedents of IPV” (p. 248).

Resources

Women face tremendous challenges in help-seeking and finding justice. Having strong family systems is important as family members are often the mediators in conflict situations. However, if the woman’s or partner’s family members are unsupportive, she may not perceive other options. Some participants eventually brought charges against their husbands in spite of threats and lack of support. The closed family system means that uncles and neighbors are often not charged for rape either, due to threats or shame, placing the welfare of the male perpetrator over that of the girl or woman. Sagot (2005) found that in rural Guatemala, girls can be forced to marry their rapists to preserve their own and the family’s honor. Even if a man tries to support women, others will challenge his manhood, and the participants felt that this ignorance has to end.

There is a serious lack of safe houses for women. These are not situated in areas with the highest rates of violence; they are underfunded, and are restricted to women with children under 12 years of age (Musalo & Bookey, 2014). One participant spoke of a positive experience of support and guidance from a shelter in the capital, which empowered her to stand up to her husband. There are several NGOs working on issues of VAW who provide training and some legal and psychological support, but they are often inaccessible (physically, culturally, linguistically) to many women, or their existence is not well known. The work of the NGO Centro de Investigación, Capacitación y Apoyo a la Mujer (CICAM) and the Presbyterio clinic in Chimaltenango are especially effective as they integrate legal, social, and psychological assistance in one site. CICAM also provides valuable training for women and education for police to improve interventions in cases of IPV and sexual violence. The latter is critical as many officers do not consider domestic violence worthy of investigation and they and other officials may push for reconciliation without protection of the woman (Musalo & Bookey, 2014).

Help seeking is often a complex and protracted process for most women experiencing abuse, but one that is often central to the journey for a better life. Selecting a source of support is an important step in this process (Liang, Goodman, Tummala-Narra, & Weintraub, 2005). When there is no family support and when public resources are not easily accessible, or not seen as trustworthy, women remain trapped in oppressive and dangerous situations. Sagot (2005) noted that the most critical inhibitor for women seeking help is “inadequate institutional responses” that can lead to further discrimination and victimization (p. 1314). This is especially imperative for women in countries such as Guatemala, where the police and justice systems have been the enemy through repressive and violent acts of terror.

Government supports are available, such as the Attorney General’s Office and Family Court, where some women found helpful processes with good lawyers who assisted them in overcoming fears and understanding their rights. Others felt deceived by officials, or their husbands bribed the lawyers so they were not listened to and did not find help. One public institution providing legal and psycho-social-physical support, the Office for the Defense of Indigenous Women (DEMI), has seven offices in the country and the women found the Chimaltenango branch beneficial, especially in learning about their legal rights and obtaining alimony-support payments. Two challenges faced are pervasive gender discrimination and the lack of a coherent and cohesive system for registering cases of violence (Musalo & Bookey, 2014; United Nations Women, 2013).

Other sources of both help and harm include doctors, hospitals, and churches with outcomes seeming to depend on who is available, as well as their training, experience, and beliefs about women’s rights and gender violence. With the lack of violence-related services in most rural areas, an increased use and improved training of health promoters and midwives who visit in women’s homes could fill some of this gap.

The lack, or poor quality, of sex education in schools is a reproductive health challenge for girls and women. Parents may not want to provide information, but neither do they want the schools to do this. Teachers are not well trained in these topics and some do not want children to have knowledge, as participants noted that educators have been implicated in sexual abuse of students. Many girls never attend school or are forced to leave early so, along with illiteracy, they also miss the opportunity to learn about human and reproductive rights when available.

Midwives and health promoters in the study received training on sexual and reproductive health, but with the strong Roman Catholic presence, many of their colleagues refused to take part in teaching about regular and emergency contraceptives, even in situations of rape. Abortion is only legal if the life of the mother is at risk, yet some health professionals are against performing abortions under any circumstances (Kestler, 2012). Due to the religious context and negative thinking around abortions, they are often carried out secretly and illegally; unsafe abortions were the fourth leading cause of maternal mortality from 2002-2012 (Kestler, 2012). Participants noted that many clients are reluctant to disclose abuse thinking that nothing would change or that confidentiality could be compromised.

Many citizens are unaware of the laws around VAW. In 2008, the Guatemalan government enacted the Ley Contra el Femicidio y otras Formas de Violencia contra la Mujer [Law Against Femicide and Other Forms of Violence Against Women]. Previous legislation did not provide for punishment, while the new law names femicide, and physical, sexual, psychological, and economic abuses as crimes and includes maximum sentences (Immigration and Refugee Board of Canada, 2012). Still, enforcement is extremely limited (Davis & Bannan, 2010) and there is considerable corruption at various levels of the justice system. Those with money (husbands more than their wives) are often exempt from sentencing and may even prevent a case from being heard in court. As noted earlier, male perpetrators of gender violence are protected by the unwritten laws of impunity in Guatemala.

The challenges to bringing about improvements are great, yet many individuals, groups, and organizations are working toward a better life for women and families and toward changing the structures that inhibit women’s progress. An evaluation of all violence-related policies from Guatemala and other countries showed large gaps between policy, funding, and implementation, and researchers have recommended intersectoral collaboration in evaluation (Stewart, Aviles, Guedes, Riazantseva, & MacMillan, 2015). Programs need to ensure quality and effectiveness not easily measured with commonly accepted statistical tools. Noteworthy is Raab and Rocha’s (2013) work in Guatemala, Mozambique, and Nicaragua to develop and test a flexible and participatory monitoring and evaluation framework with five dimensions that, if present, could assure quality; importantly, the model is specific to programs working with women and violence.

Economic Disparity

With the close relationship between violence and poverty, it is critical that economic disparity be addressed. It has been shown that women’s coping skills and mental health are more negatively affected when both IPV and poverty are present (Goodman et al., 2009). These authors stress the importance of having a “greater understanding of what it means to live at the highly vulnerable intersection of poverty and partner violence and the profound costs this location has for women’s mental health” (Goodman et al., 2009, p. 307). Addressing family violence without tackling poverty will not be as effective for women facing these compounding factors.

Coope and Theobald (2006) examined neglect in the capital, Guatemala City, and found a myriad of risk factors with probably the greatest risk and challenge being poverty and with children’s low status placing them at high risk for various forms of abuse. They noted lack of legal recourse, alcoholism, and family violence as contributors; female children are at higher risk as males may receive food before females.

As divisions between rich and poor widen, it appears that change and support are needed for immediate and long-term sustainable outcomes, including changes to the world economic order. Guatemala has many development organizations working at the grass roots, yet rates of poverty continue to rise. Of course, these agencies are unable to control the occurrence of natural disasters such as extreme flooding in the rainy season, and they have little political influence. It is not easy to change long-standing beliefs and practices around women’s and men’s societal roles and the use of violence to maintain these. Very often, local solutions are short-term and do not address the root causes of poverty, discrimination, or violence. Closer collaboration between agencies could prevent gaps and streamline services.

Mayan men as well face terrible discrimination and oppression that need rectifying to reduce their stress and frustration. The effects of colonization, the most recent civil war, and ongoing oppressive government polices around land access have affected men’s ability to provide for their families, and this has led to higher rates of abandonment, alcoholism, and violence. While men still earn more than women, many have a low level of financial responsibility (Ertürk, 2005) that increases the family’s vulnerability.

Healing

Many questions need to be addressed around possibilities for change that involve healing. How to mitigate and heal the effects of years of trauma experienced by women (and men) in postconflict Guatemala? How can the men who brutalized women during the war change the way they view women now? What can be done to elevate women’s status so they are seen as equal to men, not as possessions or threats to male status, and without men feeling like they have lost something?

Chan et al. (2009), taking an ecological perspective, assert that community can be either a risk factor or a protective factor in situations of family violence and that population health approaches can be effective by focusing on community practices and government policy. They discuss community capacity building as having the potential to solve local problems and to build social capital. This is especially important as capacity building has been extremely limited in Guatemala as “the purpose of violence as a structural feature of political culture is to remove from communities and popular organizations their capacity for joint action and to terrorize their constituencies into political passivity” (Rapone & Simpson, 1996, p. 117).

There are programs that recognize the intergenerational effects of historical trauma, although it can be difficult to separate historical and present-day trauma outcomes. Treating one without recognizing the other may not be as effective as integrating both. Art forms are seen as one way to address issues of human rights violations and oppression. Indigenous researchers Johnson and Santos (2012) stressed that art can address social issues and provides a forum for questioning oppression, inequalities, and injustice. They describe various examples of activist art forms that bring oppressive practices into the public forum and prevent further silencing of women.

Crosby (2009) described an international workshop for women recovering from sexual abuse in conflict situations (in Peru, Guatemala, and Columbia) based on her model of transformative participation. Besides their horrific history, the women were also experiencing intimidation and threats for attempting to promote social change. In the workshop, various artistic modes were used to break their silence, including journal writing, popular theater, mask making, and network mapping. One assumption of this work is that it needs to be done in relationship with others, especially others with similar experiences. For too long, many women have not spoken of the horrors they experienced and this is understandable when they often suffer further trauma from family and community responses. For example, husbands have left their wives after a rape and a child born of a rape can be rejected by both family and community members.

Murals painted by Mayan people are seen throughout Guatemala. Carey and Little (2010) analyzed a series of these by the Kaqchikel that depict their history, the armed conflict, and the peace process. They noted that while there are problems with these depictions, including the perpetuation of gender inequality, it is one way people are reclaiming their nation and preserving historical memory in the hope that La Violencia does not ever reoccur. These are important as in most countries it is the colonizers who have written history.

Our participants and the people attending the strategy workshop stressed that public education is critical for long-term change. Art forms can be both healing to the survivor and a powerful educational tool for others. Photovoice, as one example, is offered as a potential process of empowerment where participants and facilitators work together for social change (Shah, 2015). Lykes (2001) used photovoice in Guatemala to assist female Mayan survivors in talking about their experiences and the effects of the war, resulting in a widely distributed photobook (Women of PhotoVoice/ADMI & Lykes, 2000). Lykes (2010) noted that, “through taking and storying pictures, we re-membered broken bodies, re-storied culture and initiated performances of truth, justice and equality” (p. 251). The photos and stories at our strategy workshop aroused powerful community responses and stimulated conversations in the search for actions. Bell (2008) stressed that the benefits of photovoice include a possible change in self-perception of the participants, moving from objects with little influence to a role as a public actor that others are listening to.

Talking about the abuse through testimonies, even without the use of art, is still effective for many women. Provided there is a safe space, women have been able to “challenge entrenched power structures and to rebuild the moral and social order for themselves and their communities” (Leslie, 2001, p. 55). Guatemala’s truth-telling commissions have provided spaces for women to talk about gendered violence from the civil war and have been important in de-normalizing the brutality, but many women did not come forward. Newer and less intimidating forms of testimonial practices provide critical arenas for women to speak of sexual violence and to come together in solidarity (Patterson-Markowitz et al., 2012). Crosby and Lykes (2011) underlined that historical and structural causes of gendered violence are obscured within the truth-telling process, while Wilding (2010) reminded us that silencing women “limits our understanding of patterns of violence and how it is reproduced” (p. 720).

Strengths and Limitations

There are both strengths and limitations of this study. While we aimed for a broad cross section of the population of interest through purposeful sampling, the voluntary nature of participation and working through one agency limited the reach of recruitment. Women with different experiences and those not having any access to services were not included, and some women were not permitted by their husbands to take part. Moreover, those who could not speak Spanish and possibly face greater marginalization because of this were not eligible.

A strength is that with the general silence around violence, the photovoice method and meeting over time helped to develop trust and enabled participants to speak more openly about this difficult topic than if they had been invited to take part in an interview. The long-term relationship with the agency and the high level of collaboration in developing the research proposal also meant it was very relevant to the local context. The participants enjoyed taking photos (some had never done this before) and as I was leaving, they said they hoped another photovoice project would happen. They expressed feelings of empowerment and appreciation for how much they had learned.

Photovoice itself is a time-intensive process and scheduling four group meetings each month that met participant needs was challenging. The participants themselves faced challenges attending that included distance, time to travel by local bus, and their work and home responsibilities; yet, few missed any meetings. My personal limitation in speaking advanced Spanish meant that the facilitation that I am familiar with had to be handed over to a local person to ensure two-way understanding. It is difficult to say if the process would have been different if that had not been required. From past experience with photovoice, I have found that following the process (from participant training to public dissemination) has always led to powerful photos and narratives that are meaningful and relevant to others beyond the research group. This certainly happened here and having trained the facilitator/translator in the process was likely critical to that happening.

Catalani and Minkler (2010) in their review of 37 photovoice studies list the three original goals (established by Wang and Burris in their 1997 publication) and conclude that it is only the most participatory projects that are able to meet these goals. These are as follows:

“Recording and reflecting on community strengths and concerns” (Catalani & Minkler, p. 448). This occurred during the photo assignments and group analysis that included issues of violence and lack of resources (the concerns) and positive supports and women’s strategies to prevent or protect (the strengths). This was enhanced by the high level of attendance and participation by all who were recruited and the freedom they had to choose what they would photograph to represent the issues.

“Promoting critical dialogue and knowledge” (Catalani & Minkler, p. 448). Giving voice to the experiences of the participants was unique in this city and surrounding rural areas, especially as women’s and girl’s silence was revealed. The photovoice questioning about personal meaning, root causes, and possible actions for change aids in meeting this goal. The participants learned much about their own lives and their community and were able to critique public and private responses to violence. Presenting findings to the agency and to the public at the strategy workshop, along with facilitated table groups, allowed the conversations to be shared with and discussed by the wider community.

“Reaching policy makers” (Catalani & Minkler, p. 448). This would be the weakest link in our achieving the three photovoice goals, in spite of the level of participation. Not everyone who attended the strategy workshop identified where they were from, but local government officials and representatives from various NGOs were invited and several took part. There was also one person from the media taking pictures and interviewing participants and attendees. While I was not able to remain in the country following the workshop to facilitate further actions, the smaller posters and stories were displayed at the Presbyterio offices; one of the large conference style vinyl posters is also being used by a local NGO working with families around violence, while the other is with a woman activist in the country’s capital. They are especially used at events such as International Women’s Day to continue educating and bringing awareness to the issue of gender-based violence.

While there are challenges to carrying out a photovoice study, the strengths and benefits of photovoice, as one method of community-based participatory research, outweigh any of these. Bell (2015) supports photovoice as a tool for community organizing, empowerment, and increasing social capital. Empowerment as an outcome is frequently reported with photovoice studies (Duffy, 2011; Fortin et al., 2015; Gervais & Rivard, 2013; Shah, 2015), especially when participation is high (Catalani & Minkler, 2010). Community participation has great potential to tap into “rich sources of knowledge, often overlooked by traditional researchers” (Yoshihama & Carr, 2002, p. 85) and can lead to sustainable and culturally relevant change (Walker & Early, 2010).

Conclusion

Women and girls in Guatemala, especially those in indigenous communities, face serious threats to their safety and security, both inside and outside the home. Every day is a struggle for women to maintain the family, often with untreated chronic health challenges and little support or appreciation for all they do. Still, they continue with perseverance and hope for a better future–if not for themselves, then for their children. Gendered violence is complex and interwoven within all structures of society. Multilevel and multipronged actions are needed that work on elimination of VAW, that normalize nonviolence in all our societies, and that provide adequate resources to support a variety of quality and effective gender-sensitive and trauma-informed programs of prevention, mitigation, and care. Using methods such as photovoice can increase program effectiveness by identifying authentic issues in partnership with the people most affected, thus ensuring that organizations are using their often scarce resources to work toward meaningful social change.

Footnotes

Acknowledgements

Sincere appreciation to all participants who took photos and shared these and their stories, and to all others who assisted in making this research possible with special thanks to Brenda, Meghan, and staff of the Kachiquel Presbyterio. Your commitment to violence-free families and communities lends hope that change will happen.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was partially funded through a University of New Brunswick Faculty Research Fund.

Author Biography

Lynne Duffy holds an honorary research professorship from the University of New Brunswick since retirement in 2014 as a full professor, and after teaching nursing and carrying out nine funded studies. Prior to this, she spent 3 years in Lesotho in community health, 2 years at the Aga Khan University in Karachi, Pakistan, teaching nursing, and 3 years in Zimbabwe opening a nursing school and completing doctoral research on HIV prevention. These experiences have been interspersed with various hospital positions in eastern Canada. Her teaching and research interests include community, international, and women’s health; family violence; social justice; and health promotion.

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