Gender-based 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. 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 What this talk is about

3. “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 Definition of violence against women

4. 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 Types of gender-based violence

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

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

7. 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

8. Prevalence of forced first sex (WHO, 2004)

9. Female adolescents forced sexual initiation, as % of those reporting having had sex. (Population-based surveys, 1993-1999)

10. 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. Global prevalence of violence against women

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

12. A major cause of disability and death Source: World Bank, 1993, cited in Heise et al., 1994

13. 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 increases risk for …

14. 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 Violence is a risk factor for health problems

15. Proportion of women reporting poor health and association with reported violence %women who report their current health status as “poor” or “very poor”

16. Violence and suicidal ideation % of women who have ever thought of suicide

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

18. Prevalence of injury among women ever physically abused by a partner

19. Problems with walking Difficulties with daily activities Recent pain Problems with memory Recent dizziness Vaginal discharge Women who are physically or sexually abused by their partner are more likely to report: Source: WHO, 2004

20. 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

21. 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 women’s vulnerability to HIV/AIDS

22. A history of sexual violence has been associated with: vaginal bleeding vaginal discharge painful menstruation sexual dysfunction pelvic inflammatory disease chronic pelvic pain Violence increases risk for other gynecological problems

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

24. 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

25. Partner Violence and abortions % ever pregnant women who report 1 or more abortions *

26. 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 Conclusions

27. “…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) I had no one...

28. 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.) Health sector response can:

29. 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)