1. Prevalence of Gender-Based Violence and Its Impact on Reproductive Health [DATE][SPEAKERS NAMES]

2. Part I: Prevalence of GBV

3. Prevalence of GBV Intimate partner violence (IPV) is prevalent worldwide: A WHO study conducted in 10 countries found that between 15% and 71% of women experience some form of IPV at some point in their lives; in most countries prevalence estimates range from 30% to 60%. In most countries 20-33% of women reported IPV within the past 12 months. Source: Garcia-Moreno et al., 2005

4. Prevalence of GBV: Intimate Partner Physical and Sexual Violence 75% 52% 16% 19% 42% 27% 20% 32% 48% 33% Source: Hindin et al., 2008

5. Prevalence of GBV: Intimate Partner Physical and Sexual Violence 54% 34% 32% 29% 23% 15% Source: Garcia-Moreno et al., 2005

6. Prevalence of GBV: Intimate Partner Physical Violence The WHO study found that, of ever-partnered women, 13%-61% experience physical violence at some point in their lives. Most study sites found a prevalence of 23%- 49% of physical IPV. Source: Garcia-Moreno et al., 2005

7. Prevalence of GBV: Sexual Violence The WHO study found that 6% to 59% of women reported experience of sexual violence at some point in their lives, with most sites within the 10% to 50% range 1% to 44% of women experienced sexual violence in the 12 months prior to the study Source: Garcia-Moreno et al., 2005

8. Prevalence of GBV: Sexual Violence Source: Garcia- Moreno et al. 2005 29% 4.3% 16.6% 23.6% 5.3 % 26.6%

9. Part II: Impact of GBV on Reproductive Health

10. Health Consequences of GBV Fatal OutcomesNon-fatal Outcomes Femicide Suicide AIDS-related mortality Maternal mortality PhysicalSexual & Reproductive Psychological & Behavioral Fractures Chronic pain syndromes Fibromyalgia Permanent disability Gastro-intestinal disorders Sexually-transmitted infections, including HIV Unintended pregnancy Pregnancy complications Traumatic gynecologic fistula Abortion complications Depression and anxiety Eating and sleep disorders Drug and alcohol abuse Poor self-esteem Post-traumatic stress disorder Self-harm Source: Adapted from Bott, Morrison, and Ellsberg, 2005.

11. GBV Is a Public Health Issue Source: Heise et al.,1994.

12. Source: Dominican Republic Demographic and Health Survey, 2000, cited in Kishor and Johnson, 2004. Percentage of women who report health outcomes as a consequence of acts carried out by their husbands or partners Health Consequences of GBV

13. GBV Has Severe Reproductive Health Impacts Violence during pregnancy –Intimate partner violence prevalence of 4-15% during pregnancy –Leading cause of death among pregnant women may be homicide

14. Violence and HIV/AIDS –Low relationship power and intimate partner violence increase risk of incident HIV infection –Forced sex is correlated to HIV risk –Victims of violence tend to engage in behaviors that put their health at risk –Proposing condom use may increase womens risk of violence –Disclosing HIV status may increase risk of violence GBV Has Severe Reproductive Health Impacts (continued)

15. It is said that we were all born under a star; when I watch the stars at night I ask which of them is mine, so that I can change it for another one. --Survivor of GBV, Peru (in Velzeboer et al., 2003)

16. References Bott, S., A. Morrison, and M. Ellsberg. 2005. Preventing and Responding to Gender-based Violence in Middle and Low-income Countries: A Global Review and Analysis. World Bank Policy Research Working Paper 3618. Washington, DC: World Bank. Campbell, J.C. 2002. Health Consequences of Intimate Partner Violence. Lancet 359(9314): 1331–1336. Campbell, J.C., and K. L. Soeken. 1999. Forced Sex and Intimate Partner Violence: Effects on Womens Risk and Womens Health. Violence Against Women 5(9): 1017– 1035. Coker A., P. Smith, L. Bethea, M. King, and R. McKeown. 2000. Physical Health Consequences of Physical and Psychological Intimate Partner Violence. Archives of Family Medicines 9(5): 451–457. Garcia-Moreno, Claudia. Henrica, A.F.M. Ellsberg, M.E. Heise, L. Watts, C. 2005. WHO Multi-Country Study on Womens Health and Domestic Violence Against Women. Geneva, Switzerland: WHO.

17. References, continued Gielen, A.C., P.J. OCampo, J.C. Campbell, J. Schollenberger, A.B. Woods, A.S. Jones, J.A. Dienemann, J. Kub, and E.C. Wynee. 2000. Womens Opinions About Domestic Violence Screening and Mandatory Reporting. American Journal of Preventive Medicine 19(4): 279–285. Heise, Lori, Jacqueline Pitanguy, and Adrienne Germain. 1994. Violence against Women: The Hidden Health Burden. World Bank Discussion Paper No. 255. Washington, DC: World Bank. Heise, L., M. Ellsberg, and M. Gottemoeller. 1999. Ending Violence Against Women. Population Reports XXVII (Number 4, Series L, Number 11). Hindin, Michelle J., S. Kishor, and D.L. Ansara. 2008. Intimate Partner Violence Among Couples in 10 DHS Countries: Predictors and Health Outcomes. Calverton, MD: USAID. Horon, Isabelle. 2001. Enhanced Surveillance for Pregnancy-Related Mortality: Maryland, 1993–1998. Journal of the American Medical Association 285:1455–459.

18. References, continued Jewkes, R.J., K.Dunkle, M. Nduna, and N. Shai. 2010. Intimate Partner Violence, Relationship Power Inequity, and Incidence of HIV Infection in Young Women in South Africa: A Cohort Study. Lancet Early Online Publication, 16 June 2010. Jewkes, R., C. Vundule, F. Maforah, and E. Jordaan. 2001. Relationship Dynamics and Adolescent Pregnancy in South Africa. Social Science and Medicine 52(5):733–744. Kishor, S. and K. Johnson, 2004, Profiling Domestic Violence – A Multi-Country Study. Calverton, Maryland: ORC Macro. Letorneau, E., M. Holmes, and J. Chasedunn-Roark. 1999. Gynecologic Health Consequences to Victims of Interpersonal Violence. Womens Health Issues 9(2): 115–120. Maman, S., J. Campbell, M. Sweat, and A. Gielen. 2000. The Intersections of HIV and Violence: Directions for Future Research and Interventions. Social Science and Medicine 50: 459–478. Maman, S., J. Mbwambo, J. Campbell, M. Hogan, G. Kilonzo, E. Weiss, and M. Sweat. 2002. HIV- 1 Positive Women Report More Lifetime Experiences with Violence: Findings from a Voluntary HIV-1 Counseling and Testing Clinic in Dar es Salaam, Tanzania. American Journal of Public Health 92(8): 1331-1337.

19. References, continued Muhajarine, N., and C. DArcy. 1999. Physical Abuse During Pregnancy: Prevalence and Risk Factors.Canadian Medical Association Journal 160: 1007–1011. Murphy, C.C., B. Schei, T.L. Myhr, and J. Du Mont. 2001. Abuse: a Risk Factor for Low Birth Weight? A Systematic Review and Meta-Analysis. Canadian Medical Association Journal 164(11): 1567–72. Velzeboer, M., M. Ellsberg, C. Arcas, and C. Garcia-Moreno. 2003. Violence Against Women: The Health Sector Responds. Washington, DC: Pan-American Health Organization (PAHO).

20. Thank You!