Genderbased Violence: Prevalence and Health Consequences

1
Gender-based Violence Prevalence and Health
Consequences

• C. Garcia-Moreno,
• Coordinator, Gender and Women's Health
• World Health Organization
• The Development Implications of Gender-Based
  Violence, World BankWashington, D.C.

2
What this talk is about

• To provide an understanding of how common
  violence against women is, and how it affects the
  health of women and children
  
• GBV definitions, prevalence and patterns
• Health consequences

3
Definition of violence against women

• any act of gender-based violence that results
  in, or is likely to result in, physical, sexual,
  or psychological harm or suffering for women,
  including threats of such acts, coercion, or
  arbitrary deprivations of liberty, whether
  occurring in public or private life.
• -United Nations General Assembly 1993

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Types of gender-based violence

• Intimate partner violence (physical, sexual,
  psychological, economic)
  
• Forced sexual initiation
• Childhood sexual abuse
• Rape and other forms of sexual coercion
• Trafficking
• Rape/sexual abuse in conflict situations
• Acid throwing
• Female Genital Mutilation
• Killings in the name of honour
• Dowry deaths

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Prevalence of physical and/or sexual partner
violence (WHO, 2004)
6
Types of physical violence according to severity
(WHO, 2004)

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Overlap lifetime physical and sexual violence
PERU - CAP THAILAND - CAP 29 20 3 11
12 18 phys viol sex viol phys viol sex viol
NAMIBIA 19 11 5 physical viol
sexual viol
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Prevalence of non-partner sexual violence
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Sexual abuse in childhood is common
(WHO , 2003)
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Prevalence of forced first sex (WHO, 2004)
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Female adolescents forced sexual initiation, as
of those reporting having had sex.
(Population-based surveys, 1993-1999)
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Global prevalence of violence against women

• Around the world, at least one out of three women
  is beaten, coerced into sex or otherwise abused
  by a partner during her lifetime
  
• Women are most at risk at home and from men they
  know, usually a family member or spouse
  
• A growing number of studies indicate that the
  first sexual experience is often forced,
  particularly for young females
  
• Rough estimates suggest that 700,000 to 2
  million women and girls are trafficked across
  international borders every year.
  

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• Violence is a risk factor affecting womens
  health and wellbeing

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A major cause of disability and death
Source World Bank, 1993, cited in Heise et al.,
1994
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Violence increases risk for

• Fatal Outcomes
• homicide
• suicide
• maternal deaths
• AIDS related deaths
• Non-fatal outcomes
• physical
• mental
• reproductive and sexual
• injurious health behaviors

• For example
• unwanted pregnancy
• chronic pain
• injury
• depression
• alcohol/drug use
• STIs/HIV
• Irritable bowel
• gynecological disorders

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Intimate partner violence is a risk factor for
femicide
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Violence is a risk factor for health problems

• Compared to non-abused women, women who have been
  victimized have
  
• more physical symptoms,
• reduced physical functioning,
• worse subjective health,
• more life-time diagnoses,
• higher health care utilization
• Severity of abuse correlates with severity of
  symptoms
  

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Proportion of women reporting poor health and
association with reported violence
women who report their current health status as
poor or very poor
19
Violence and suicidal ideation
of women who have ever thought of suicide
20
Violence and use of health servicesin Managua,
Nicaragua (IDB, 1999)
21
Prevalence of injury among women ever physically
abused by a partner
22
Women who are physically or sexually abused by
their partner are more likely to report

• Problems with walking
• Difficulties with daily activities
• Recent pain
• Problems with memory
• Recent dizziness
• Vaginal discharge

Source WHO, 2004
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Violence contributes to adolescent pregnancy and
sexually transmitted infections
Greater likelihood of teen pregnancy, STIs
Childhood sexual abuse
Increased risk behaviors such as sex with
many partners, unprotected sex
Younger age at first intercourse
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Percentage of women whose last pregnancy was
unwanted (ever pregnant women)
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Violence increases womens vulnerability to
HIV/AIDS

• VAW, particularly sexual violence, increases
  womens risk of HIV/AIDS directly and indirectly
  
• Violence can prevent women from accessing
  HIV/AIDS information, treatment and care
  
• Fear of violence is a barrier to HIV testing and
  disclosure
  
• Violence affects womens ability to mitigate the
  impact of HIV/AIDS on themselves and their
  children
  

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Violence increases risk for other gynecological
problems

• A history of sexual violence has been
  associated with
  
• vaginal bleeding
• vaginal discharge
• painful menstruation
• sexual dysfunction
• pelvic inflammatory disease
• chronic pelvic pain

27
Many women experience physical violence in
pregnancy (ever pregnant women)
28
Physical violence during pregnancy (ever pregnant
women)
women who report violence during a pregnancy
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Violence leads to negative pregnancy outcomes

• increased smoking and substance use
• vaginal and cervical infections
• premature labor
• miscarriages/abortions
• bleeding during pregnancy
• low birth weight
• late entry into prenatal care

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Partner Violence and abortions
ever pregnant women who report 1 or more
abortions

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Conclusions

• About one in three women around the world have
  been beaten or sexually abused by an intimate
  partner
  
• Physical and sexual abuse is a major cause of
  ill-health and disability among women
  
• Most women do not receive the support they need

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I had no one...

• If I had had help I would have left my ex
  husband earlier. I would not have put up with him
  five years because I could not find anywhere to
  hold on to and I had no one who could tell me
  what I could do."
• Ana Cristina, a young woman from Nicaragua
  (in Ellsberg, 1998)

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Health sector response can

• Help change attitudes in society
• Educate providers and managers to respond
  sensitively and prevent providers from causing
  harm
  
• Improve quality of care for women and children
• Research the epidemiology of GBV
• Design and evaluate prevention and intervention
  strategies
  
• Carry out community-based education
• Educate professionals in all sectors
• Advocate to change laws and their application
• Collaborate with organizations from other sectors
  (legal, rights, social services, etc.)
  

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What can we do?
The health care setting is an opportunity for in
tervention and presently it is a lost opportu
nity (Heise, Ellsberg and Gottemuller, 1999
)