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Africa/Global: Violence against Women is Epidemic
AfricaFocus Bulletin
July 15, 2013 (130715)
(Reposted from sources cited below)
Editor's Note
"Physical or sexual violence is a public health problem
that affects more than one third of all women globally,
according to a new report released by WHO in partnership
with the London School of Hygiene & Tropical Medicine and
the South African Medical Research Council. The report
represents the first systematic study of global data on
the prevalence of violence against women -- both by
partners and non-partners." - World Health Organization
news release, June 20, 2013
As the authors of the new report acknowledge, many of the
estimates included have wide margins of errors. The
estimates of violence against women by non-partners are
likely to be under-estimates; and the data on conflict
zones was insufficient to make systematic comparisons of
the additional violence in these areas. But the
indisputable takeaway is that, in the words of Dr.
Margaret Chan, Director-General of WHO, "violence against
women is a global health problem of epidemic
proportions."
It is also clear that the level of violence does vary.
Predictably lower-income countries and women among
populations that are already vulnerable are most
affected. The responsibility for preventing such violence
is society-wide and not limited to the health sector
alone, the report stresses. But it also emphasizes the
need to address the issue with specific health policies
and with expanded services for affected women.
For the full original report, including tables and
references, go to http://tinyurl.com/oxtug9k
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Additional Editor's Note
In sending out this Bulletin on violence against women as
a global epidemic, only days after the conclusion of the
Trayvon Martin trial, it is impossible not to note that
both gun violence and racism are also of epidemic
proportion, in the United States and in many other
places. Moving ahead must address both specific cases and
the structural issues that continue to undermine the
rights to life and to health.
A few links to add to the many that AfricaFocus readers
will already have seen and written.
Roundup of NAACP and other action on Trayvon Martin case,
including reminder that issues include gun violence laws
as well as racism.
http://tinyurl.com/oyul7ch
NAACP Petition to Department of Justice
http://www.naacp.org/ or
http://petitions.moveon.org/sign/open-a-civil-rights-case
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WHO report highlights violence against women as a global
health problem of epidemic proportions
New clinical and policy guidelines launched to guide
health sector response
http://www.who.int / direct URL:
http://tinyurl.com/oxtug9k
News release
20 June 2013 | Geneva - Physical or sexual violence is a
public health problem that affects more than one third of
all women globally, according to a new report released by
WHO in partnership with the London School of Hygiene &
Tropical Medicine and the South African Medical Research
Council.
The report,Global and regional estimates of violence
against women: Prevalence and health effects of intimate
partner violence and non-partner sexual violence,
represents the first systematic study of global data on
the prevalence of violence against women -- both by
partners and non-partners. Some 35% of all women will
experience either intimate partner or non-partner
violence. The study finds that intimate partner violence
is the most common type of violence against women,
affecting 30% of women worldwide.
The study highlights the need for all sectors to engage
in eliminating tolerance for violence against women and
better support for women who experience it. New WHO
guidelines, launched with the report, aim to help
countries improve their health sector's capacity to
respond to violence against women.
Impact on physical and mental health
The report details the impact of violence on the physical
and mental health of women and girls. This can range from
broken bones to pregnancy-related complications, mental
problems and impaired social functioning.
"These findings send a powerful message that violence
against women is a global health problem of epidemic
proportions," said Dr Margaret Chan, Director-General,
WHO. "We also see that the world's health systems can and
must do more for women who experience violence."
The report's key findings on the health impacts of
violence by an intimate partner were:
- Death and injury -- The study found that globally, 38%
of all women who were murdered were murdered by their
intimate partners, and 42% of women who have experienced
physical or sexual violence at the hands of a partner had
experienced injuries as a result.
- Depression -- Partner violence is a major contributor
to women's mental health problems, with women who have
experienced partner violence being almost twice as likely
to experience depression compared to women who have not
experienced any violence.
- Alcohol use problems -- Women experiencing intimate
partner violence are almost twice as likely as other
women to have alcohol-use problems.
- Sexually transmitted infections -- Women who experience
physical and/or sexual partner violence are 1.5 times
more likely to acquire syphilis infection, chlamydia, or
gonorrhoea. In some regions (including sub-Saharan
Africa), they are 1.5 times more likely to acquire HIV.
- Unwanted pregnancy and abortion -- Both partner
violence and non-partner sexual violence are associated
with unwanted pregnancy; the report found that women
experiencing physical and/or sexual partner violence are
twice as likely to have an abortion than women who do not
experience this violence.
- Low birth-weight babies -- Women who experience partner
violence have a 16% greater chance of having a low birthweight
baby.
"This new data shows that violence against women is
extremely common. We urgently need to invest in
prevention to address the underlying causes of this
global women's health problem." said Professor Charlotte
Watts, from the London School of Hygiene & Tropical
Medicine.
...
Regional data
The report represents data regionally according to WHO
regions.
For intimate partner violence, the type of violence
against women for which more data were available, the
worst affected regions were:
- South-East Asia - 37.7% prevalence. Based on aggregated
data from Bangladesh, Timor-Leste (East Timor), India,
Myanmar, Sri Lanka, Thailand.
- Eastern Mediterranean - 37% prevalence. Based on
aggregated data from Egypt, Iran, Iraq, Jordan,
Palestine.
- Africa -- 36.6% prevalence. Based on aggregated data
from Botswana, Cameroon, Democratic Republic of Congo,
Ethiopia, Kenya, Lesotho, Liberia, Malawi, Mozambique,
Namibia, Rwanda, South Africa, Swaziland, Uganda, United
Republic of Tanzania, Zambia, Zimbabwe.
For combined intimate partner and non-partner sexual
violence or both among all women of 15 years or older,
prevalence rates were as follows:
- Africa -- 45.6%
- Americas -- 36.1%
- Eastern Mediterranean -- 36.4%* (No data were available
for non-partner sexual violence in this region)
- Europe -- 27.2%
- South-East Asia -- 40.2%
- Western Pacific -- 27.9%
- High income countries -- 32.7%
For more information please contact:
Keletso Ratsela, South African Medical Research Council
Telephone: +27 12 339 8500, +27 82 804 8883
E-mail: [email protected]
Fadéla Chaib, WHO
Telephone: +41 22 791 3228
Mobile: +41 79 475 5556
E-mail: [email protected]
Jenny Orton/Katie Steels
London School of Hygiene & Tropical Medicine
Telephone: +44 (0)20 7927 2802
E-mail: [email protected]
Global and regional estimates of violence against women:
prevalence and health effects of intimate partner
violence and non-partner sexual violence
This report was written by Claudia García-Moreno and
Christina Pallitto of the Department of Reproductive
Health and Research (RHR) of the World Health
Organization (WHO), Karen Devries, Heidi Stëckl and
Charlotte Watts of the London School of Hygiene and
Tropical Medicine (LSHTM), and Naeemah Abrahams from the
South African Medical Research Council (SAMRC). Max
Petzold from the University of Gothenburg provided
statistical support to all of the analyses.
Preface
Violence against women is not a new phenomenon, nor are
its consequences to women's physical, mental and
reproductive health. What is new is the growing
recognition that acts of violence against women are not
isolated events but rather form a pattern of behaviour
that violates the rights of women and girls, limits their
participation in society, and damages their health and
well-being. When studied systematically, as was done with
this report, it becomes clear that violence against women
is a global public health problem that affects
approximately one third of women globally.
By compiling and analysing all available data from
studies designed to capture women's experiences of
different forms of violence, this report provides the
first such summary of the violent life events that many
women experience. It documents not only how widespread
this problem is, but also how deeply women's health is
affected when they experience violence.
...
Executive Summary
"There is one universal truth, applicable to all
countries, cultures and communities: violence against
women is never acceptable, never excusable, never
tolerable." United Nations Secretary-General, Ban Ki-Moon
(2008)
Violence against women is a significant public health
problem, as well as a fundamental violation of women's
human rights.
This report, developed by the World Health Organization,
the London School of Hygiene and Tropical Medicine and
the South African Medical Research Council presents the
first global systematic review and synthesis of the body
of scientific data on the prevalence of two forms of
violence against women — violence by an intimate partner
(intimate partner violence) and sexual violence by
someone other than a partner (non-partner sexual
violence). It shows, for the first time, aggregated
global and regional prevalence estimates of these two
forms of violence, generated using population data from
all over the world that have been compiled in a
systematic way. The report also details the effects of
violence on women's physical, sexual and reproductive,
and mental health.
The findings are striking:
- overall, 35% of women worldwide have experienced either
physical and/or sexual intimate partner violence or nonpartner
sexual violence. While there are many other forms
of violence that women may be exposed to, this already
represents a large proportion of the world's women;
- most of this violence is intimate partner violence.
Worldwide, almost one third (30%) of all women who have
been in a relationship have experienced physical and/or
sexual violence by their intimate partner. In some
regions, 38% of women have experienced intimate partner
violence;
- globally, as many as 38% of all murders of women are
committed by intimate partners;
- women who have been physically or sexually abused by
their partners report higher rates of a number of
important health problems. For example, they are 16% more
likely to have a low-birth-weight baby. They are more
than twice as likely to have an abortion, almost twice as
likely to experience depression, and, in some regions,
are 1.5 times more likely to acquire HIV, as compared to
women who have not experienced partner violence;
- globally, 7% of women have been sexually assaulted by
someone other than a partner. There are fewer data
available on the health effects of non-partner sexual
violence. However, the evidence that does exist reveals
that women who have experienced this form of violence are
2.3 times more likely to have alcohol use disorders and
2.6 times more likely to experience depression or
anxiety.
There is a clear need to scale up efforts across a range
of sectors, both to prevent violence from happening in
the first place and to provide necessary services for
women experiencing violence.
The variation in the prevalence of violence seen within
and between communities, countries and regions,
highlights that violence is not inevitable, and that it
can be prevented. Promising prevention programmes exist,
and need to be tested and scaled up. There is growing
evidence about what factors explain the global variation
documented. This evidence highlights the need to address
the economic and sociocultural factors that foster a
culture of violence against women. This also includes the
importance of challenging social norms that support male
authority and control over women and sanction or condone
violence against women; reducing levels of childhood
exposures to violence; reforming discriminatory family
law; strengthening women's economic and legal rights; and
eliminating gender inequalities in access to formal wage
employment and secondary education.
Services also need to be provided for those who have
experienced violence. The health sector must play a
greater role in responding to intimate partner violence
and sexual violence against women. WHO's new clinical and
policy guidelines on the health-sector response to
violence against women emphasize the urgent need to
integrate issues related to violence into clinical
training. It is important that all health-care providers
understand the relationship between exposure to violence
and women's ill health, and are able to respond
appropriately. One key aspect is to identify
opportunities to provide support and link women with
other services they need -- for example, when women seek
sexual and reproductive health services (e.g. antenatal
care, family planning, post-abortion care) or HIV
testing, mental health and emergency services.
Comprehensive postrape care services need to be made
available and accessible at a much larger scale than is
currently provided.
The report shows that violence against women is pervasive
globally. The findings send a powerful message that
violence against women is not a small problem that only
occurs in some pockets of society, but rather is a global
public health problem of epidemic proportions, requiring
urgent action. It is time for the world to take action: a
life free of violence is a basic human right, one that
every woman, man and child deserves.
Global and regional prevalence estimates of intimate
partner violence
This section presents the global and regional prevalence
estimates of intimate partner violence and non-partner
sexual violence. This is the first time that such a
comprehensive compilation of all available global data
has been used to obtain global and regional prevalence
estimates. Estimates are based on data extracted from 79
countries and two territories.
The global prevalence of physical and/or sexual intimate
partner violence among all ever-partnered women was 30.0%
(95% confidence interval [CI] = 27.8% to 32.2%). The
prevalence was highest in the WHO African, Eastern
Mediterranean and South-East Asia Regions, where
approximately 37% of ever-partnered women reported having
experienced physical and/or sexual intimate partner
violence at some point in their lives (see Table 2).
Respondents in the Region of the Americas reported the
next highest prevalence, with approximately 30% of women
reporting lifetime exposure. Prevalence was lower in the
high-income region (23%) and in the European and the
Western Pacific Regions, where 25% of ever-partnered
women reported lifetime intimate partner violence
experience.
Global and regional prevalence estimates of non-partner
sexual violence
The adjusted lifetime prevalence of non-partner sexual
violence by region, based on data from 56 countries and
two territories, is presented in Table 4. Globally, 7.2%
(95% CI = 5.3% to 9.1%) of women reported ever having
experienced non-partner sexual violence. There were
variations across the WHO regions. The highest lifetime
prevalence of non-partner sexual violence was reported in
the high-income region (12.6%; 95% CI = 8.9% to 16.2%)
and the African Region (11.9%; 95% CI = 8.5% to 15.3%),
while the lowest prevalence was found for the South-East
Asia Region (4.9%; 95% CI = 0.9% to 8.9%).
These differences between regions may arise for many
reasons, and need to be interpreted with caution,
especially as most of the regional estimates have wide
confidence intervals. As well as real differences in the
prevalence of non-partner sexual violence, the figures
are likely to be subject to differing degrees of underreporting
by region. Sexual violence remains highly
stigmatized in all settings, and even when studies take
great care to address the sensitivity of the topic, it is
likely that the levels of disclosure will be influenced
by respondents' perceptions about the level of stigma
associated with any disclosure, and the perceived
repercussions of others knowing about this violence.
Although we are aware that the data for non-partner
sexual violence were not as robust or extensive as for
intimate partner violence, it is likely that the
differences in prevalence of non-partner sexual violence
as compared to intimate partner violence reflect actual
differences. It appears that intimate partner violence,
which includes sexual violence, is considerably more
prevalent and more common than non-partner sexual
violence, as shown consistently in all regions.
Section 4: Summary and conclusions
The review confirms the degree to which women with
violent partners may be injured. However, despite injury
often being perceived to be one of the outcomes of
intimate partner violence, the reviews found surprisingly
limited data on this issue, with gaps in population data,
particularly on the extent and forms of injury that women
experience in different settings.
While, across regions, there are consistently higher
rates of intimate partner violence than non-partner
sexual violence, this does not indicate that non-partner
sexual violence should be given less attention or be seen
as less significant to women's health. We know that
sexual violence remains highly stigmatized, and carries
heavy social sanctions in many settings. Furthermore,
given the sensitivities of reporting sexual violence, we
know these estimates are likely to underestimate actual
prevalence. While measures of partner violence capture a
spectrum of acts of physical, sexual and psychological
violence, ranging from less severe to the most severe
forms of violence, sexual violence, by definition, is
among the most severe forms of violence.
The fact that, in spite of the constraints to reporting,
7.2% of women globally have reported non-partner sexual
violence provides important evidence of the extent of
this problem. This review found that women who have
experienced non-partner sexual violence are 2.3 times
more likely to have alcohol use disorders and 2.6 times
more likely to have depression or anxiety than women who
have not experienced non-partner sexual violence.
This is supported by clinical experience, which shows
that sexual violence can profoundly affect physical and
mental health in the short and long term, contributing to
the burden of ill health among survivors. Some studies
have shown that women who have been raped have higher
rates of use of medical care (e.g. visits to the doctor,
hospitalizations) compared to women who have not been
raped, even years after the event. These data also
highlight the need to find better ways to help the
survivors of sexual violence and prevent more women and
girls from suffering these experiences in the first
place.
Conclusions In light of these data, in which more than
one in three women (35.6%) globally report having
experienced physical and/or sexual partner violence, or
sexual violence by a non-partner, the evidence is
incontrovertible -- violence against women is a public
health problem of epidemic proportions. It pervades all
corners of the globe, puts women's health at risk, limits
their participation in society, and causes great human
suffering.
The findings underpin the need for the health sector to
take intimate partner violence and sexual violence
against women more seriously.
All health-care providers should be trained to understand
the relationship between violence and women's ill health
and to be able to respond appropriately. Multiple entry
points within the health sector exist where women may
seek health care -- without necessarily disclosing
violence -- particularly in sexual and reproductive
health services (e.g. antenatal care, post-abortion care,
family planning), mental health and emergency services.
The new WHO guidelines for the health sector response to
intimate partner violence and sexual violence emphasize
the urgent need to integrate these issues into
undergraduate curricula for all health-care provide rs,
as well as in in-service training.
In relation to sexual violence, whether by a partner or
non-partner, access to comprehensive post-rape care is
essential, and must ideally happen within 72 hours. The
new WHO guidelines describe this as including first-line
psychological support, emergency contraception,
prophylaxis for HIV, diagnosis and prophylaxis for other
STIs, and shortand long-term mental health support. This
should also include access to collection and analysis of
forensic evidence for those women who choose to follow a
judicial procedure. Similarly, for intimate partner
violence, access to first-line psychological support,
mental health and other support services needs to be
developed and strengthened.
This health sector response needs to be part of a
multisectoral response, as recently endorsed in the
Agreed Conclusions of the 57th session of the Commission
on the Status of Women. The Commission makes
recommendations for and urges governments and other
actors, at all levels, to:
- strengthen the implementation of legal and policy
frameworks and accountability;
- address structural and underlying causes and risk
factors, in order to prevent violence against women and
girls;
- strengthen multisectoral services, programmes and
responses to violence against women and girls.
The high prevalence of these forms of violence against
women globally, and in all regions, also highlights the
need to go beyond services and the importance of working
simultaneously on preventing this violence from happening
in the first place. The variation in the prevalence of
violence seen within and between communities, countries
and regions highlights that violence is not inevitable,
and that it can be prevented.
There is growing evidence about the factors that explain
much of the global variation. This evidence highlights
the need to address the economic and sociocultural
factors that foster a culture of violence against women.
Promising prevention programmes exist, particularly for
intimate partner violence, and need to be tested and
scaled up. Interventions for prevention include:
challenging social norms that support male authority and
control over women and that condone violence against
women; reducing levels of childhood exposure to violence;
reforming discriminatory family law; strengthening
women's economic rights; eliminating gender inequalities
in access to formal wage employment and secondary
education; and, at an individual level, addressing
harmful use of alcohol. Growing evidence from surveys of
men asking about perpetration of rape/ sexual assault
against non-partners, and physical and sexual violence
against partners, also points to the need to address
social and cultural norms around masculinity, gender
power relationships and violence.
This report unequivocally demonstrates that violence
against women is pervasive globally and that it is a
major contributing factor to women's ill health. In
combination, these findings send a powerful message that
violence against women is not a small problem that only
occurs in some pockets of society, but rather is a global
public health problem of epidemic proportions, requiring
urgent action. As recently endorsed by the Commission on
the Status of Women, it is time for the world to take
action: a life free of violence is a basic human right,
one that every woman, man and child deserves.
AfricaFocus Bulletin is an independent electronic
publication providing reposted commentary and analysis on
African issues, with a particular focus on U.S. and
international policies. AfricaFocus Bulletin is edited by
William Minter.
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