Domestic Violence: A Global Health Priority

Women’s rights activists have long fought to place violence against women on the global agenda, and they’ve made considerable progress over the last decade. And now, new scientific research verifies what these advocates have been saying for years: The violence against women that is endemic in every country around the world erodes women’s physical and mental wellbeing, interferes with their productive engagement in society, destroys families, and unravels the very fabric of communities.

Recent data from a World Health Organization study on domestic violence and women’s health reveals that as many as 70 percent of women surveyed reported having experienced physical and/or sexual violence by an intimate partner during their lifetime. Rates of current partner violence (within the last 12 months) varied from less than 4 percent of women in Yokohama, Japan, and Belgrade, Serbia & Montenegro, to more than 53 percent of women in rural Ethiopia and 34 percent of women in provincial Peru.

Intimate partner violence and sexual coercion are the most common types of violence affecting women and girls. International research conducted over the last ten years shows that sexual abuse of women and girls by non-partners is also much more common than previously thought. Between 10 and 27 percent of women and girls reported having been sexually abused by a non-partner, either as children or adults. In many parts of the world, violence reflects cultural and historical conditions, and is manifest in, for example, honor killings, trafficking of women and girls, female genital mutilation, and the rape of women in situations of armed conflict.

There is growing evidence that abuse has severe consequences for women’s long-term health. For years, clinicians and policymakers focused on injury as the primary health outcome of violence, if and when they considered health-related outcomes at all. What research now shows, however, is that injury is actually one of the lesser consequences of abuse. Far more significant is the role that abuse and stress play in chronic and more distal health conditions.

Like smoking or a poor diet, victimization increases women’s risk of other physical and mental health problems. Women who have experienced violence tend to report poorer health overall, more physical symptoms of illness and decreased productivity. They are as much as three times more likely to consider and/or attempt suicide. Abused women are also more likely than non-abused women to report digestive problems, eating disorders and other problems such as chronic irritable bowel syndrome. Not surprisingly, women who have experienced violence use health services more frequently than their non-abused peers.

The devastating impact of violence on women’s sexual and reproductive health is also well documented. Abused women are at increased risk of unwanted pregnancies, miscarriages, sexually transmitted diseases and gynecological problems. And sexual coercion is a defining factor in women’s vulnerability to HIV. Many women are simply unable to make free decisions about the timing and circumstances of sex, much less about protecting themselves against sexually transmitted infections, like HIV.

Not surprisingly, violence against women is rooted in women’s lack of power in relationships – and in society – relative to men. In many cultures, women are expected to be submissive and sexually available to their husbands at all times, and it is considered both a right and an obligation for men to use violence in order to “correct” or chastise women for perceived transgressions. Violence within the family has been traditionally considered a private matter in which outsiders, including government authorities, should not intervene. For unmarried women, sexual violence is so stigmatizing that most women prefer to suffer in silence than to risk the shame and discrimination that comes from disclosure.

Although violence is increasingly being factored in to national health policies and programs, progress is slow in coming. A myriad of successful and innovative pilot programs have been launched, but are not yet being translated successfully into national programs. Moreover, international donors often overlook gender or violence in bilateral aid programs supporting HIV prevention, reproductive health, or health sector reform. As a result, we miss opportunities to respond to violence and undermine our ability to achieve other programmatic goals.

For example, U.S. support to HIV prevention programs for developing countries is based on the assumption that most sexual activity among youth is consensual, notwithstanding an increasing body of evidence to the contrary. Similarly, many international family planning programs do not take into account whether women are actually able to use birth control, or whether to do so would expose them to greater levels of violence.

October is Domestic Violence Awareness Month. Policymakers and public health professionals would do well to make a commitment to address the problem globally. How to do so? Let us make three recommendations:

  • Increase support for women’s groups and other organizations working to assist victims and to change the social norms that perpetuate abuse.
  • Ensure that health and development programs sponsored by the U.S. government explicitly address violence.
  • Focus on youth so that future generations of children come of age with better skills than their parents for managing relationships and more equitable visions for male/female relationships.

Domestic violence “awareness” is essential, and worth far more than one month per year. Indeed, what we really need is policy advocacy and action to advance women’s rights and health year-round.

Mary Ellsberg is a senior advisor on gender, violence and human rights at PATH, and Lori Heise is the director of the Global Campaign for Microbicides and a senior program officer at PATH. Both have more than 15 years of experience in international research and policy analysis on gender-based violence.

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