Abstract

Violence is increasing worldwide mainly among the most socially vulnerable groups such as women, elderly people, children and adolescents. In addition to the justice sector, many other areas and workers are involved and they are becoming even more important for addressing violence. One such area is the health sector. This article aims to identify the creative potential of videos that aim to tackle issues involving domestic violence against children which are categorized based on generation (age) and gender. A search was conducted between 2013 and 2014 on official sites and video channels of institutions that deal with child-related topics. We used the webQDA software to conduct our analysis and for reference purposes we used “Generation” and “Gender” as categories. We collected 40 video campaigns, of which ten were analyzed qualitatively. Upon analyzing complete scenes and parts of scenes we were able to see both inter/intra -generational and inter/intra-gender violence and its consequences for children. The videos allowed for critical reflections to be made on the educational processes and training used to combat violence against children in the context of “Generations” and “Genders”.

Violence; Domestic violence; Child abuse; Gender and health; Child sexual abuse

Introduction

The World Health Organization (WHO) notes that more than 1.6 million people die each year due to violence. For those that manage to survive violent attacks, they invariably have to live with the physical, psychological, emotional and social scares forever¹1. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. Violence: a global public health problem. In: Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Genebra: WHO; 2002. p. 3-21.,²2. Dahlberg LL, Krug EG. Violência: um problema global de saúde pública. Cien Saude Colet 2007; 11(Sup):1163-1178..

The WHO defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, developmental problems or deprivation”¹1. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. Violence: a global public health problem. In: Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Genebra: WHO; 2002. p. 3-21.. The word “power” widens the definition because apart from covering both injuries in general and physical injuries, it also covers threats and intimidations¹1. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. Violence: a global public health problem. In: Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Genebra: WHO; 2002. p. 3-21..

Aside from violence being one of the main causes of deaths in the population between the ages of 15 and 44, the WHO has recognized that it has been increasing at an accelerated pace amongst those in the most vulnerable groups such as amongst children, the elderly and women¹1. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. Violence: a global public health problem. In: Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Genebra: WHO; 2002. p. 3-21.

2. Dahlberg LL, Krug EG. Violência: um problema global de saúde pública. Cien Saude Colet 2007; 11(Sup):1163-1178.-³3. Apostólico MR, Nóbrega CR, Guedes RN, Fonseca RMGS, Egry EY. Característica da violência contra a criança em uma capital brasileira. Rev Latino-Am Enferm [periódico na internet] 2012 [acessado 2015 Out 25];20(2):[8 telas]. Disponível em: http://www.scielo.br/pdf/rlae/v20n2/pt_08
http://www.scielo.br/pdf/rlae/v20n2/pt_0... . The National Policy for the Reduction of Morbi-mortality Caused by Accidents and Violence (PNRMAV), from the Health Ministry in Brazil, also recognizes the impact of violence on the health of children, teenagers, women and the elderly because acts against such people do not necessarily result in death but they can cause serious morbidity and long lasting injuries or scars⁴4. Brasil. Ministério da Saúde (MS). Portaria GM/MS nº 737, de 16 de maio de 2001. Política Nacional de Redução da Morbimortalidade por Acidentes e Violências. Diário Oficial da União 2001; 18 maio.. It should be restated that violence against children predominantly takes place in the home and between family members with mothers and fathers being the main perpetrators⁵5. Albuquerque LM, Carvalho CMG, Apostólico MR, Sakata KN, Cubas MR, Egry EY. Terminologia da Enfermagem caracterizadora da violência doméstica contra crianças e adolescentes. Rev Brasileira Enferm 2015; 68(3):452-459..

Perpetrators of violence in homes take advantage of their hierarchical positions in families and they end up being the main abusers in their families. The family environment has become the ideal place for such violence because it favors relational inequalities of power. When one considers hierarchical relations in the family, it can be noted that gender and generational differences conform to patriarchal societal norms that advocate submission and dominance between men and women, and between adults and children. This is taught when a child is being educated and it dictates how they should behavior in society⁶6. Fonseca RMGS, Egry EY, Nóbrega CR, Apostólico MR, Oliveira RNG. Reincidência da violência contra crianças no Município de Curitiba: um olhar de gênero. Rev Acta Paulista Enferm 2012; 25(6):895-901..

Violence in the family is a complex issue. It involves relationship powers (subordinance and dominance) and bonds between family members based on emotions (involving fathers, mothers, daughters and sons). The inequality of powers in the family setting is the main determinant for the perpetuations of violence⁷7. Moreira MIC, Sousa SMG. Violência Intrafamiliar contra crianças e adolescentes: do espaço privado à cena pública. O social em Questão 2012; 15(28):13-26..

At the heart of social violence is the oppressor and the oppressed and conflicts occur through the oppressor’s dominance (aided by class position, social group, generational position or gender). The following are related to the perpetuation of violent acts: hierarchy, inequalities, the debasement of life and life’s morals, male chauvinism, and the search for immediate pleasure⁸8. Minayo MCS, Souza ER. Violência e saúde como campo interdisciplinar e de ação coletiva. Historia Cienc Saude – Manguinhos 1998; 4(3):513-531..

Upon having lived a life where violence was the norm in their daily lives, children are duly influenced by this and this violent behavior is subsequently replicated throughout their lives as they become either victims or aggressors of violence⁸8. Minayo MCS, Souza ER. Violência e saúde como campo interdisciplinar e de ação coletiva. Historia Cienc Saude – Manguinhos 1998; 4(3):513-531..

These issues are not of great importance for the health sector because it has not always been exclusively dealt with in the judicial arena. Health workers have been responsible for taking care of the physical, emotional and social needs of victims with a view to going beyond their traditional role in order to bring in preventative measures and seek to tackle these issues for the benefit of the individual and the collective⁸8. Minayo MCS, Souza ER. Violência e saúde como campo interdisciplinar e de ação coletiva. Historia Cienc Saude – Manguinhos 1998; 4(3):513-531..

It is essential that this type of violence is tackled through decisive acts taken by different social sectors in society and that issues related to gender and the different generations in households are taken into account. Taking this approach will allow for a greater understanding of this type of violence and for decisive actions to be taken and it will help in finding better solutions for more healthy family relationships⁹9. Egry EY, Apostólico MR, Albuquerque LM, Gessner R, Fonseca RMGS. Compreendendo a negligência infantil na perspectiva de gênero: um estudo em um município brasileiro. Rev Esc Enferm USP 2015; 49(4):556-563..

Given the complexity of this topic involving violence against children in the family and the need for strategies geared towards training professionals in this area, the question remains whether the institutional videos that tackle the issue of violence, taking into consideration gender and generational differences, can really provide a meaningful contribution to this debate?

The objective of this study was to identify and conduct a critical analysis of the videos that tackle domestic violence against children based on the categories of the different Generations in families and Gender roles.

Methods

This study was qualitative in nature based on the Theory of Praxic Intervention in Nursing in Public Health (TIPESC)¹⁰10. Egry EY. Saúde Coletiva: construindo um novo método em enfermagem. São Paulo: Ícone; 1996. covering methodology and it used the categories of different Generations in families and Genders for its study into violence against children.

The category of Gender presupposes a meaningful relationship formed between the sexes in society. For many, taking into account the anatomical and biological differences, it is possible to develop an interpretation of these relationships between men and women. Cultural and symbolic attributes coupled with history and social developments have played a role in shaping the roles of women and men in society and families, which have been defined by inequalities between family members. The family plays host to relational powers in which, generally speaking, women occupy submissive roles and men are the dominant figures¹¹11. Egry EY, Fonseca RMGS, Oliveira MAC. Ciência, saúde coletiva e enfermagem: destacando as categorias gênero e geração na episteme da práxis. Rev Brasileira Enferm 2013; 66(Esp):119-133.. These social and cultural constructs compel people to assume roles and standards beyond merely camouflaging and justifying attitudes and behaviors which places one group in a position to exercise dominance over another, as is the case with violence perpetuated by men over women.

With reference to the category Generation it covers the social relations established between people that are either part of the same generational age group (intra-generational) or they occupy different age groups where there is a generational gap (intergenerational) for example relations between adults and children. In this study analysis focusing on understanding the interactions between adults and children in situations involving domestic violence, was done through the category of Generational Childhood.

Children are considered immature and lacking adult abilities and as a result they receive social investment to become adults which are moments in their lives that are valued by society. Even today the perception is that they are “unfinished” beings socially speaking, rather than being considered as children in their own right having a distinct nature whilst being a part of society¹¹11. Egry EY, Fonseca RMGS, Oliveira MAC. Ciência, saúde coletiva e enfermagem: destacando as categorias gênero e geração na episteme da práxis. Rev Brasileira Enferm 2013; 66(Esp):119-133.,¹²12. Nascimento ML. Apresentação. Nove teses sobre a infância como um fenômeno social de Jens Qvortrup. Proposições – Campinas 2011; 22(1):199-211..

Understanding childhood in the context of a separate generational category and children as subjects that also make up society, is to place them in the dynamics of social relations which brings with it social and historical dimensions. They need to be looked at in the context of major transformations and changes that have taken place in societies based on hegemonic globalization and economic upheavals. They are directly or indirectly victims of poverty, a lack of food, wars and violence. Their childhood is connected to the major structures in society and societal events have direct impacts on children¹¹11. Egry EY, Fonseca RMGS, Oliveira MAC. Ciência, saúde coletiva e enfermagem: destacando as categorias gênero e geração na episteme da práxis. Rev Brasileira Enferm 2013; 66(Esp):119-133.,¹²12. Nascimento ML. Apresentação. Nove teses sobre a infância como um fenômeno social de Jens Qvortrup. Proposições – Campinas 2011; 22(1):199-211..

In order to select the videos the following steps were taken. Firstly a video bank was created on the theme of confronting violence against childhood and teenagers based on a search of official sites and channels of institutions that deal with such issues such as: protection, children’s rights and the promotion of the development of children. All of the material that was accessed was freely available on the internet between September 2013 and September 2014. 40 videos were selected, watched and evaluated. These videos covered general information on violence against children and teenagers. Of the 40 that were selected, 10 videos were subjected to qualitative research.

Intra-generational violence involving just children or teenagers was not found on the videos and therefore was not of interest for our study despite being an important and equally relevant theme with a strong social impact.

The inclusion criteria was: being official material, being available to be downloaded, having good image and sound quality and being predominantly in Portuguese except in cases where the images dispensed with the text to aid understanding. Videos that had offensive content with unnecessary messages or that were not linked to the theme of combating violence against children or that showed children in distressing situations were excluded.

A characterization tool was used for information on identifying the videos (title, the producer and director, language, country and year of edition). This was also done for the following information: duration, quality, access, type of production, themes that were touched on, target audience and the main message. We also looked at the following in reference to whether it corresponded to the theme: whether it covered gender or generational differences in families, the applicability of the message in relating to combating these issues and whether the situations presented were authentic portrayals of real live situations. After having classified the material and created the video bank the software WebQDA versão 2.0 was used to analyze 10 videos. This software aided in our qualitative analysis in an collaborative environment (available at: www.webqda.com). This proved to be a powerful tool in aiding the researchers because it allowed them to organize and analyze the extracted data from the videos.

This study did not require an evaluation by the Ethics Committee as it only used secondary data that could be freely obtained from the internet.

Results

The selected videos were produced with scenes covering everyday life, be it reenactments or animations which showed children, adults and animals. They dealt with the different types of violence against children and covered general violence to more specific forms such as domestic violence or sexual violence. The latter was predominant in the analyzed material (Table 1).

The collected videos presented strategies to combat violence against children for children and adults. Amongst them was information on what constitutes violence against children. They tried to discount the beliefs of such acts being natural and they explained the different forms of violence that exist. They noted that hotlines (Phone 100) could be used to report of abuse the use of which was encouraged providing that guarantees could be given on the service being free and confidential. Another piece of advice given was for adults to be attentive to the behavior of their children (at school, at home and in relation to their interactivity with others).

Analysis of the videos on domestic violence against children

There was group of 10 videos which were a total of 20 minutes and 52 seconds. They produced 30 parts of scenes that could be analyzed which totaled 7 minutes and 31 seconds and which constituted the corpus of the analysis.

The different parts of the scenes were described and interpreted in Notes (a tool from webQDA that allows for written notes to be taken). They were then identified by numbers and grouped in five areas. Based on this a deeper analysis centered on the categories Generational differences in families and Gender (covering inter/intra-generational and inter/intra-gender violence) was conducted. Aside from the four main areas that had been previously predetermined as being subject to analysis, a fifth area came up during the analytical phase: being the consequences of violence against children. This fifth area of analysis revealed the consequences of violent acts practiced against children, be it physical acts or emotional ones or those which are social in nature. The consequences and results include: injuries, burns, difficulties in socially interacting with others, isolation, sadness, loneliness and abandonment.

The content primarily focused on intergenerational violence (22 notes), the consequences of the violence (19 notes) and intra-gender violence (12 notes). What also appeared was inter-gender violence (10 notes) and intra-generational violence (5 notes).

Intergenerational Violence

Intergenerational violence was most prevalent in parts of the scenes as predicted based on the objectives of the study (22 notes).

A man enters a room smoking and changes the bed sheets on which there are small pictures of semi-nude children (first a girl then a boy). It is a closed, dimly lit and humid apartment that is also cold. The only sounds that can be heard comes from a scene on a television depicting violence with loud shouting and screaming. (video 7, note 1)

When the mother goes away the daughter/child/woman lowers her head and rests her hands on the table as a sign of obedience and submission. The daughter is dressed in pink pajamas (a color socially determined by women) and she looks extremely sad. The father/man looks at his daughter and gives her a command. She obeys by getting up and leaving the kitchen. Her father follows her. Her mother/woman washes the dishes in silence with a sad expression on her face (Video 9, Note 7).

The note covers intergenerational violence done by adults on children. They highlight elements that represent the authority of men and women adults over children and their submission in situations involving violence.

There is symbolism of children being treated as objects (represented by the bed sheet), without considering the condition of subjects that participate in society. The fear, lonely suffering and silence of the children that suffer violence/sexual abuse are represented by the empty scenes that do not have people, objects or furniture and through the hostile and dark environment. The younger the children are, less is the possibility of their reacting in an defensive manner and trying to seek help and this subsequently makes them very vulnerable. Violence against children is revealed both in the way that it is perpetuated directly and indirectly. This can be seen in note 7 (Video 9) where a mother does not practice direct violent acts against her daughter, but it is evident in her not offering to help her daughter who has been sexually abused by her father. This discussion shall be returned to further on, from the perspective of inter-gender and intra-generational violence in which women are also vulnerable in relationships marked by inequality of power and violence.

The household/intra-family setting is considered to be a private space and due to its nature is apt for abuse and violence acts to be conducted. Subjectively speaking, violence oppresses women who are portrayed in the silent scenes, being sad and resigned to what is going on.

Intra-generational violence

Intra-generational violence (this is violence that is caused or suffered by individuals that fall into the same generational group) was represented in the videos through references to domestic violence suffered by women caused by their close partners. The children are depicted as spectators in scenes and they become direct victims from a psychological perspective and they are equally viewed as being in positions of vulnerability.

Mother/woman holds her baby whilst seated in a public place. She has an expression of uncertainty and her sight is fixed on the horizon. It appears as though she has left her house. On the seat next to her are pieces of paper which is missing parts of a head and face as if a part has been torn from the paper(Video 18, Note 17).

The mother and her son draw together on the kitchen table when the father comes in to drink some water. He starts a row with the mother because she hasn’t washed the dishes. The boy continues drawing but he witnesses the fight between his parents with a sad face (Video 5, Note 29).

Inter-gender Violence

The inter-gender violence that is touched on in the videos was represented, principally through sexual violence perpetuated by adult men on girls.

The analyzed videos reinforce the position of girls being vulnerable to intergenerational and inter-gender violence.

A woman suffered sexual violence perpetuated by an uncle/man for years when she was a child. Gestures showing insecurity, introspectiveness and a lot of sadness can be seen. Dressed in a dress, she sits alone on a seat in a area with little light which represents coldness. Her legs remain closed and they are protected with both of her hands as if it were a sign of a fear of being touched. The scenes have no words but they have background sounds (Video 16, Note 10).

Intra-gender violence

Intra-gender violence is portrayed as being between men (between father/son and step father/son-in-law) or between women (mother/daughter and grandmother/granddaughter). Aside from this, it is perpetuated by people that have close relations with the victims through their having to rely on them as well as giving them respect and having their trust. On the one hand they are viewed as aggressors but they are also looked on as adult role models for the children.

The man was burnt with a cigar by his stepfather when he was 4 years old. There are scars showing burn marks made by cigars on his back. He is alone and seated in an area that has little light and it appears to be cold. The scenes have no words but they have background sounds (Video 16, Note 14).

The woman has a large scar that is a third degree burn mark on her upper chest which was done by her grandmother who threw burning water on her when she was 4 years old. She sits alone in a place that has little light. The scenes have no words but they are accompanied by background sounds (Video 16, Note 13).

Consequences of violence against children

Aside from the physical marks and the visible scars in some of the scenes (on children or adults) which depict violence in childhoods, the most depicted consequences of such violence shown on the videos were: shame, silence, loneliness, introspectiveness, insecurity, hurt, sadness and fear. They are strongly represented in the videos through scenes that are bereft of people and objects and are situated in places that are supposedly cold, dark, silent or are punctuated by sounds of screaming.

The sadness, the scars and the physical marks reinforce the negative experiences that were played out in childhoods and then subsequently occur in future generations

Father/man opens the door and does not see the boy/child that is disguised or ‘transformed’ into a piece of furniture (cupboard). This is a scene without background sounds except for the sound of a door being shut by his father. Background narration: ‘There are children that play pretending to be invisible. There aren’t any shouts, insults or blows. Nothing is learnt through violence. Put yourself in the position where you are on the receiving end (Video 8, Note 5).

Note 5 of Video 8 depicts fear, insecurity and a child being treated as an object where it is represented through having been transformed from a child into a cupboard. This can be interpreted as a metaphor of a child in a domestic violence situation. The cupboard is small like the child and it does not speak, which is akin to the silence that exists where there is violence in the home. The act of closure in the scene may represent the introspective behavior of the child and its feeling of shame in being a victim of violence.

Discussion

The four principal areas defined as a priori allowed for the identification of highlighted elements in the results and a correlation with the categories Gender and Generational differences in families. Nevertheless the presence of such elements did not necessarily mean the potential to combat violence. It brought about a necessity to reflect upon the issues and problems presented in the videos with the specific parts triggering off reflections.

The supposedly natural way in which violence is seen coupled with the established educational standards for children, the social roles of men and women and the abuse, can work to cover up the actual message in the videos. The fifth area deals with the consequences of violence and in turn shows the detrimental impacts for childhoods. Metaphors are also used. Therefore if one does not take a critical look at the presentation of the message we would just be reiterating what supposedly occurs in people’s daily lives which, obviously should be repudiated, but such issues are not often considered areas for intervention by health bodies.

Nevertheless in order for these videos to be used as teaching aids covering the issues of violence against children, it is necessary to highlight the historical inequalities in relationships concerning power amongst the main parties concerned. The categories Gender and Generational differences in families were fundamental for our analysis because we could take a more critical approach to violence.

An American study described the use of a video as part of a strategy to combat cases of sexual abuse through showing it to parents of children that had been recently abused. The video had a series of responses of support distributed in five behavioral approaches. It gave information on what children hoped for and how to look after them in the wake of a sexual abuse incident. It was suggested that the parents: believe in and console the abused child, tell the child that they are not to blame for the abuse, support the child emotionally and encourage the child to talk about what happened. The results showed that the strategy involving the use of the videos was effective because it was noted that the parents had positive attitudes and understood the need to support their children in order to help their family overcome such a crisis as sexual abuse¹³13. Junich S, Litrownik AJ. Coping with sexual abuse: development and evaluation of a videotape intervention for nonoffending parents. Child Abuse Negl 1999; 23(2):175-190..

In Brazil a study was done with nursing teaching staff that used videos as a strategy to talk about the social role of nurses in these areas and what type of approaches should be taken in relation to violence related cases. There was an exchange of strategies between professionals and service users which allowed for themes to be understood and used to combat these problems¹⁴14. Souza ER, Ribeiro AP, Penna LHG, Ferreira AL, Santos NC, Tavares CMM. O tema da violência intrafamiliar na concepção dos formadores dos profissionais de saúde. Cien Saude Colet 2009; 14(5):1709-1719..

The use of this approach permitted the obtaining of a more pedagogically critical perspective and the use of the educational video banks ought to include the discussion around the categories Gender and Generational differences in families, which was proposed by this study. This can be justified by the fact that interpersonal relations carry with them important natural attributes (sex and age) which have social meanings based on gender and generational differences in families which are often used to explain, justify or show as being natural, the exercise of power and dominance¹⁵15. Gessner R, Fonseca RMGS, Oliveira RNG. Violência contra adolescentes: uma análise à luz das categorias gênero e geração. Ver Esc Enferm USP 2014; 48(esp):102-108..

Upon adopting the categories Generational differences in families and Gender in the interpretation of the phenomenon of violence against children, this in turn reaffirms the prevalence of a hierarchy of perverse power that put women and children in socially submissive and inferior positions which, historically speaking, emphasizes inequality as something normal¹¹11. Egry EY, Fonseca RMGS, Oliveira MAC. Ciência, saúde coletiva e enfermagem: destacando as categorias gênero e geração na episteme da práxis. Rev Brasileira Enferm 2013; 66(Esp):119-133..

Intergenerational violence: child or pre-adult?

The Videos 7, 8, 9, 16, 18, 26, 27 and 36 allowed for more discussions on the topic of intergenerational violence, particularly with emphasis on the dominance of adults over children and the inability of children (due to their fragility) to get through such situations by themselves. The videos depicted feelings of fear, loneliness and abandonment of children.

The area of intergenerational violence shown in the videos can be analyzed from the category Generational differences in families, when childhood is historically and socially understood as a moment just before adulthood and not a specific moment in the lives of subjects that have rights and obligations. Children have historical baggage that comes from the Middle Ages where, for example, they were considered mini-adults. Processes that were historically and socially determined by the mode of production and the way people live and worked, produced the idea that children were the property of parents/adults and their being the subject of violence was just something natural where adults have the right to do as they please with their property¹¹11. Egry EY, Fonseca RMGS, Oliveira MAC. Ciência, saúde coletiva e enfermagem: destacando as categorias gênero e geração na episteme da práxis. Rev Brasileira Enferm 2013; 66(Esp):119-133.,¹²12. Nascimento ML. Apresentação. Nove teses sobre a infância como um fenômeno social de Jens Qvortrup. Proposições – Campinas 2011; 22(1):199-211.,¹⁶16. Ariès P. História social da infância e da família. Rio de Janeiro: LCT; 1978..

In spite of progress having been made both legally and socially speaking, society takes a step back when it takes the approach of preparing children for adulthood instead of allowing them to enjoy their childhood. It is commonly said that one ought to work for the citizenship of children, guaranteeing their integration into society when they become adults. Children are simply not understood when taking in account societal and economic parameters that affect them because the formulation of these parameters is not taken into consideration¹⁷17. Qvortrup J. A infância enquanto categoria estrutural. Educ e Pesq 2010; 36(2):631-644..

The Brazilian municipality of Curitiba which is the capital of the state of Paraná registered, between 2004 and 2012, 28,263 reports of domestic violence against children of which 6,924 were cases of negligence concerning children between the ages of 4 to 9 and 4,887 were cases involving babies from 3 years old⁹9. Egry EY, Apostólico MR, Albuquerque LM, Gessner R, Fonseca RMGS. Compreendendo a negligência infantil na perspectiva de gênero: um estudo em um município brasileiro. Rev Esc Enferm USP 2015; 49(4):556-563.. In all of the registered cases the abusers were adults responsible for the provision of care and ensuring the development of the children⁹9. Egry EY, Apostólico MR, Albuquerque LM, Gessner R, Fonseca RMGS. Compreendendo a negligência infantil na perspectiva de gênero: um estudo em um município brasileiro. Rev Esc Enferm USP 2015; 49(4):556-563.. Even though the families were in vulnerable situations that were not favorable for bringing up and developing children, it can be argued that they were not considered as priorities. This is in relation to the use of family resources or in society with reference to, in general, political, social and economic debates.

Intra-generational violence: relational inequalities that have become the norm

The videos 5, 9 and 18 have clearer elements for discussions on relational violence in the generational category and adulthood. Very much connected to the discussions of inter-gender violence in which women generally suffer the consequences of violence caused by men, violence by adults depicted in the analyzed videos is restricted to the household environment in families. There were women suffering violence from their close partners and it was explicit (Video 5) or implied (Video 9) that the violence was witnessed by a child or children. Given the constructed historical and social role of men in society as being the stronger party and thus the most important figure in the production process of goods, the videos reinforce the dominance of men over women and children.

The intra-generational violence observed in the videos refers to violence between adults. Although the violence occurs between adults, it is important to note that when it is witnessed by children (i.e. violence between parents) this has direct and indirect consequences on children in relation to aggression.

A study carried out in Recife, the capital of the state of Pernambuco with 245 women ranging in ages from 15 to 49 showed a high level of violence from close partners in the state population (33.3%) with the frequency being 52.7% for emotional violence, 46.1% for physical violence and 13.6% for sexual violence¹⁸18. Barros EM, Silva MA, Falbo Neto GH, Lucena SG, Ponzo L, Pimentel AP. Prevalência e fatores associados à violência por parceiro íntimo em mulheres de uma comunidade em Recife/Pernambuco. Cien Saude Colet 2015; 21(2):591-598..

A study carried out in the city of Teresina which is the capital of Piauí State in 2012 with women whose daughters were victims of domestic violence showed, that they reproduced the same concepts of natural relational inequalities in relation to their own children. They intended to marry men that would protect them and provide for their family but when they got married they blamed their frustrated relationships on themselves. Women fit in the social model of being repressed and having to be submissive while girls are required to follow rigid social standards from an early age which includes being submissive to their fathers, brothers and later their husbands. Women are seen as having to remain virgins for their ideal partners. This was highlight by them in the study¹⁹19. Serpa MG. Perspectivas sobre papéis de gênero masculino e feminino: um relato de experiência com mães de meninas vitimizadas. Psic Saude 2010; 22(1):14-22..

It is deeply rooted in Brazilian society that women should be submissive to their men. They are socially obliged to fulfill the role determined by their mothers who were dedicated wives and who projected a wholesome image of the family. This is based on the patriarchal model of the family in which men are the most important authority in the home and women end up having to sustain relationships even at the cost of suffering violence from their partners. This stereotypical view of the family made up of a man and a woman is passed on from generation to generation and it perpetuates relational violence based on gender and society defines the roles of men and women¹⁹19. Serpa MG. Perspectivas sobre papéis de gênero masculino e feminino: um relato de experiência com mães de meninas vitimizadas. Psic Saude 2010; 22(1):14-22..

For women, breaking off a relationship where a partner has been violent in the home, means to go against and deconstruct the ideal that society has determined for her. Ideologically speaking, women are perceived to be the mother and home maker and no matter how bad a relationship may become, her leaving would mean the destruction of this model and her role. This can lead to feelings of being weak where such family and social expectations are considered too much to bear. These expectations are reinforced by the media, science and the state¹⁹19. Serpa MG. Perspectivas sobre papéis de gênero masculino e feminino: um relato de experiência com mães de meninas vitimizadas. Psic Saude 2010; 22(1):14-22..

Inter-gender and intra-gender violence: reiterating expectations and inequalities

The videos that cover these areas are: 5, 7, 9, 13 and 16 (inter-gender violence) and 7, 8 and 16 (intra-gender violence).

All of the videos reinforce the view that girls are more vulnerable to intergenerational and inter-gender violence for being at the extreme end in relation to the categories of generational differences in families and gender.

As mentioned earlier, intra-gender violence depicted in the institutional videos appear in relationships between men (father/son and step father/son-in-law) and, between women (mother/daughter and grandmother/granddaughter). In this category the violence is indirect where the mother is not presence and the abuse is perpetrated by an adult man in relation to a girl. The woman’s omission is considered to be a form of negligence.

Between adults, violence against women is often continuous and takes many forms. It manifests itself through submissive relations, power, fear, isolation, intimidation, dependency and inherent conflicts between men and women that have relationships. It also exists where there are professional relationships and it is necessary to interpret/understand all contexts where the violence occurs²⁰20. Bandeira LM. Violência de gênero: a construção de um campo teórico de investigação. Soc Estado 2009; 29(2):449-469..

Gender violence does not refer to one person annihilating another. It is characterized by inequalities which support hierarchical relationships based on sex and it can also be associated with factors such as: age, race/ethnicity and social condition. Although in the last decades gender violence has become more visible and has caught the interests of the media and the authorities, the family is still capable of hiding violence and this is sustained through symbols and patriarchal norms. It is also related to control over women’s bodies²⁰20. Bandeira LM. Violência de gênero: a construção de um campo teórico de investigação. Soc Estado 2009; 29(2):449-469..

Nevertheless, when violence is perpetuated against girls or boys, only the gender category is insufficient to explain this phenomenon. Although there are characteristics of gender violence, there are also emotional links between fathers and daughters and mothers and sons based on feelings which mix with material dependencies. There is a necessity for a model of socialization and the role of the adult to be clear. Thus it can be clearly seen that there is an intersection of the areas identified in this study and there is a necessity to understand childhood as a generational category. Girls are the most vulnerable victims because they occupy subordinate positions in the two categories: Gender (for being women) and Generational differences in families (for being children)⁶6. Fonseca RMGS, Egry EY, Nóbrega CR, Apostólico MR, Oliveira RNG. Reincidência da violência contra crianças no Município de Curitiba: um olhar de gênero. Rev Acta Paulista Enferm 2012; 25(6):895-901.. These conditions may be even worse when one considers the category of social class for girls that are a part of marginalized social groups⁷7. Moreira MIC, Sousa SMG. Violência Intrafamiliar contra crianças e adolescentes: do espaço privado à cena pública. O social em Questão 2012; 15(28):13-26.,⁸8. Minayo MCS, Souza ER. Violência e saúde como campo interdisciplinar e de ação coletiva. Historia Cienc Saude – Manguinhos 1998; 4(3):513-531..

In a study that looked at violence against children in the city of Curitiba, it was shown that negligence and both physical and psychological violence were the most registered type of problems amongst boys. Sexual violence was the violence most registered by girls. Amongst all of the cases of sexual violence against children registered in 2008 in this Brazilian capital, 81.2% occurred amongst girls³3. Apostólico MR, Nóbrega CR, Guedes RN, Fonseca RMGS, Egry EY. Característica da violência contra a criança em uma capital brasileira. Rev Latino-Am Enferm [periódico na internet] 2012 [acessado 2015 Out 25];20(2):[8 telas]. Disponível em: http://www.scielo.br/pdf/rlae/v20n2/pt_08
http://www.scielo.br/pdf/rlae/v20n2/pt_0... .

Consequences of violence against children are lifelong memories

In this area all of the analyzed videos are representative in the sense that they had the potential to contribute to the wider debate on the consequences of violence against children for the children themselves and the adults that they will eventually become. The videos 16 and 18 depicted, in a clear way, the physical marks of violence and the other videos depicted in a strong manner feelings of fear, loneliness, anguish, sadness and insecurity generated by violent acts.

In this area the videos did not touch on the question of the perpetuation of violent behavior amongst various generations, in order words, the violence suffered by children in their childhood being reproduced when they moved to other generational categories.

In any case the analyzed videos were able to highlight the ethnic and social considerations in relation to the irreparable consequences of violence against children. This being the case, the videos were able to highlight the unnatural nature of the violence and the need to construct collective strategies to combat the violence.

The main consequences of violence against children, whether they suffer the violence or they are witnesses to it, are insecurity, depression symptoms, post-traumatic stress, difficulties in adjusting their lives, behavioral problems and the reproduction of the aggression with adults or other children. Other consequences include hostility, rejecting other victims of violence in the family, low self-esteem, a decrease in performance at school and bullying. In relation to the last consequence, studies have shown that both the victim and the aggressor suffer²¹21. Lourenço LM, Baptista MN, Senra LX, Almeida AA, Basílio C, Bhona FMC. Consequences of exposure to domestic violence for children: a systematic review of the literature. Paidéia Rib Preto 2013; 23(55):263-271..

Violence witnessed by children is inductive of the intergenerational transmission of violence. For this issue of combating violence, specialists state that there needs to be more partnership working between the health services, schools and social services²¹21. Lourenço LM, Baptista MN, Senra LX, Almeida AA, Basílio C, Bhona FMC. Consequences of exposure to domestic violence for children: a systematic review of the literature. Paidéia Rib Preto 2013; 23(55):263-271..

The first actions that should be taken in cases of violence against children and child abuse should be protecting the child and then punishing the abuser in the judicial and social ambits. Regrettably little or no action is taken to combat violence in the family¹³13. Junich S, Litrownik AJ. Coping with sexual abuse: development and evaluation of a videotape intervention for nonoffending parents. Child Abuse Negl 1999; 23(2):175-190..

Conclusions

The results show that the institutional educational videos contain scenes that can be analyzed under the perspective of the categories Gender and Generational differences in families which is important for training strategies and qualifications for health workers and the parents of vulnerable children open to being the subject of violence.

All of the videos touched on intergenerational violence which connected to the objective of the study. However the grouping of the scenes and /or parts of scenes allowed for a more detailed analysis to be done of the videos looking at elements more pertinent to intergenerational, intra-generational, intra-gender and inter-gender violence and the consequences of violence against children as a transversal theme in relation to the other categories.

The main message of the videos, apart from being related to recognizing and reporting violence, is to show the role that professionals in health can play in this area such as through identifying vulnerabilities and attending to the health needs of populations when violent acts have occurred. In this way educational actions can identify problems and help to find pertinent solutions in relation to health assistance and it can help to consistently have a critical look at the reality and thus go beyond merely registering and reporting suspected or confirmed cases of violence.

Based on the scope of this study, international videos were not analyzed and we only looked at those that were available during the period of the study. A wider search looking at other publication channels could widen the results and bring new possibilities for applying the material in training professionals. In this paper the analysis based on the categories Generational differences in families and Gender widened the discussion and contributed to the denaturalization of violence. It also placed limits on the vision of the two categories. Nevertheless, it is important to take into consideration the collective debate and the different visions in the world for those that use this material for educational and training purposes.

As a further challenge we identified the need to analyze the other videos in the video bank by using different methods, analyzing different categories and utilizing different support software.

Acknowledgements

To Research Foundation of São Paulo State (FAPESP) for financial support - Post-Doctoral Scholarship and Brazilian Council for Scientific and Technological Development (CNPq) for Beginner Researcher Scholarship and Fellow Productivity.

References

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