World Health Organization Gender and Womens Health Gender-based Violence: Prevalence and Health...

World Health Organization Gender and Women’s Health

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 Bank

Washington, D.C.


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


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


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


27

3431

50

62

34 33

47

1014

17

23

47

30 29

23

3129

37 36

52

69

41

47

41

56

23

0

10

20

30

40

50

60

70

80

Brazil C Brazil p Namibia C Peru C Peru P Thailand C Thailand P Tanzania C Tanzania P% women who have ever experienced physical partner violence % women who have ever experienced sexual partner violence % women who have experience physical and/or sexual violence

Prevalence of physical and/or sexual partner violence (WHO, 2004)


12 14 13 11

24

12 1016 16

22

1620

35

20

27 50

13

18 17

25

0

10

20

30

40

50

60

70

Brazil C Brazil p Ethiopia P Namibia C Peru C Peru P Thailand C Thailand P Tanzania C Tanzania P% women who have ever experienced severe physical partner violence

% women who have experienced only moderate physical partner violence

Types of physical violence according to severity (WHO, 2004)

*


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


24

30

3 4

17

6 7

24

4 5

1417

8

3836

1411

18

33 33

4541

1720

4043

35

005

101520253035404550

% women whose sexual debut was reported as being forced. % force first sex < 15

Prevalence of forced first sex

(WHO, 2004)


Female adolescents forced sexual initiation, as % of those reporting having had sex. (Population-

based surveys, 1993-1999)

47.6

4037.3

29.1 28.4

2118.8

9

0

5

10

15

20

25

30

35

40

45

50

Caribbean Cameroon S AFrica Mzmbque


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.


Violence is a risk factor affecting women’s health and wellbeing


A major cause of disability and death

1993 World Bank estimates: the global health burden of selected conditions or risk factors for women aged 15-44

2926.4

10.9 10.5 10 9.5 97.8

2.3

All maternalConditions

STIsincluding

HIV

Tuberculosis Cardio-vasculardisease

(Maternal)Sepsis

Rape anddomesticviolence

All cancers Obstructedlabor

Malaria

DALYs - Disability-adjusted life years lost (millions)

Source: World Bank, 1993, cited in Heise et al., 1994


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


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

•


Proportion of women reporting poor health and association with reported violence

9

28

9

19

20

27

6

6

4

14

5

11

13

18

3

3

0 5 10 15 20 25 30

Brazil Cap

Brazil Prov

Peru Cap

Peru Prov

Thailand Cap

Thailand Prov

Namibia

Japan

ever physically orsexually abusedby partner

no abuse bypartner

% women who report their

current health status as “poor” or “very poor”


Violence and suicidal ideation

47

35

40

34

38

33

26

32

20

14

16

14

16

16

11

11

0 10 20 30 40 50

Brazil Cap

Brazil Prov

Peru Cap

Peru Prov

Thailand Cap

Thailand Prov

Namibia

Japan

physical orsexual abuseby partner

no abuse bypartner

% of women who have ever

thought of suicide


Violence and use of health servicesin Managua, Nicaragua (IDB, 1999)

0

5

10

15

20

25

30

Hospital Surgery Clinicvisits

Non-abused

Abused

3-D Column 3


Prevalence of injury among women ever physically abused by a partner

40

37

46

55

51

44

31

27

10

8

8

13

16

10

6

2

0 10 20 30 40 50 60

Brazil Cap

Brazil Prov

Peru Cap

Peru Prov

Thailand Cap

Thailand Prov

Namibia

Japan

ever injured injured > 5 times


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


Childhood sexual abuse

Younger age at first intercourse

Increased “risk” behaviors such as sex with many partners,

unprotected sex

Greater likelihood of teen pregnancy, STIs

Violence contributes to adolescent pregnancy and sexually transmitted

infections


Violence increases women’s vulnerability to HIV/AIDS

• VAW, particularly sexual violence, increases women’s 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 women’s ability to mitigate the impact of HIV/AIDS on themselves and their children


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


Many women experience physical violence in pregnancy (ever pregnant women)

8

11

15

28

4

4

6

1

0 5 10 15 20 25 30

Brazil Cap

Brazil Prov

Peru Cap

Peru Prov

Thailand Cap

Thailand Prov

Namibia

Japan


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


Partner Violence and abortions

9

3

0 0

43

5

2

6

4

19

7

21

14

8

13

8

10

7

0

2

4

6

8

10

12

14

16

18

20

no abuse bypartner

ever physicallyor sexuallyabused bypartner

% ever pregnant

women who report 1 or

more abortions

*


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


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)


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.)


What can we do?

The health care setting is an opportunity for intervention…

…and presently it is a lost opportunity

(Heise, Ellsberg and Gottemuller, 1999)

World Health Organization Gender and Womens Health Gender-based Violence: Prevalence and Health...

Documents

Transcript of World Health Organization Gender and Womens Health Gender-based Violence: Prevalence and Health...