1. Gender-based Violence and Reproductive Health Herrera/Mexfam

2. Reducing Violence: What Role for Reproductive Health Agencies? Reducing Violence: What Role for Reproductive Health Agencies? Gender-based violence is a major public health problemGender-based violence is a major public health problem Violence directly affects womens reproductive healthViolence directly affects womens reproductive health

3. Violence: Facts and Figures 10 to 67% of women have been physically assaulted by an intimate male partner10 to 67% of women have been physically assaulted by an intimate male partner Rape and domestic violence account for 5 to 16% of the healthy years of life lost to womenRape and domestic violence account for 5 to 16% of the healthy years of life lost to women As many as 1 of 4 women is physically abused during pregnancyAs many as 1 of 4 women is physically abused during pregnancy 100 to 180 million women and girls globally have undergone FGM100 to 180 million women and girls globally have undergone FGM Sources: Violence Against Women:The Hidden Burden, The World Bank, 1994; Heise, Popul Rep 2000;L(11).

4. Adult Women* Ever Physically Assaulted by Intimate Male Partner, Selected Countries Papua New Guinea (1982) 67 Bangladesh (1992) 47 New Zealand (1994) 35 Egypt (1995/96) 34 Canada (1993) 29 Nicaragua (1998) 28 United States (1995/96) 22 Switzerland (1994-96) 21 South Africa (1998) 13 Philippines (1998) 10 * Ever-married/partnered except U.S. (all women) Source: Heise, Popul Rep 2000;L(11). (%)

5. Types of Violence M. Ramos/ReproSalud/Herrera Physical Psychological Sexual Psychological

6. Effect of Violence on Womens Sexual and Reproductive Health Involuntary sexual activityInvoluntary sexual activity Unintended/unwanted pregnancyUnintended/unwanted pregnancy Unsafe abortionUnsafe abortion Reduced ability to negotiate condom useReduced ability to negotiate condom use STI/HIV transmissionSTI/HIV transmission High-risk pregnancies and maternal deathsHigh-risk pregnancies and maternal deaths Covert contraceptive useCovert contraceptive use Depression and low self-esteemDepression and low self-esteem Source: Heise, Popul Rep 2000;L(11).

7. Psychosocial Risk Factors in Violence against Women Psychosocial Risk Factors in Violence against Women Witnessing marital violence as a childWitnessing marital violence as a child Being abused as a childBeing abused as a child Absent or rejecting fatherAbsent or rejecting father Alcohol/drug useAlcohol/drug use Mexfam

8. Gender Roles and Partner Abuse Many men feel entitled to be served by women and failure to meet mens expectations can lead to violenceMany men feel entitled to be served by women and failure to meet mens expectations can lead to violence Many cultures sanction physical abuse as a way to correct womens behaviorMany cultures sanction physical abuse as a way to correct womens behavior In some cultures, men use extreme violence to maintain gender honorIn some cultures, men use extreme violence to maintain gender honor

9. Gender Norms Perpetuate Acceptance of Violence Women are acculturated to accept abuse if they violate gender normsWomen are acculturated to accept abuse if they violate gender norms In Egypt and Papua New Guinea, 59% of women agree wife-beating is justified if a woman talks back/disobeys husbandIn Egypt and Papua New Guinea, 59% of women agree wife-beating is justified if a woman talks back/disobeys husband Healthcare and law enforcement workers share dominant cultural valuesHealthcare and law enforcement workers share dominant cultural values

10. Approaches to Addressing Violence against Women Approaches to Addressing Violence against Women Train family planning and reproductive health personnel to: Identify women who are victims of violenceIdentify women who are victims of violence Provide appropriate contraceptive and reproductive health counselingProvide appropriate contraceptive and reproductive health counseling Refer to appropriate servicesRefer to appropriate services

11. FP Clinics in Latin America Help Identify Abuse Three-year pilot project in IPPF affiliates in Peru, Dominican Republic and VenezuelaThree-year pilot project in IPPF affiliates in Peru, Dominican Republic and Venezuela Pan American Health Organization Screen every woman client in selected clinics for past or current abuseScreen every woman client in selected clinics for past or current abuse

12. Working with Male Perpetrators, Law Enforcement Agents and Anti-violence Advocates EngenderHealth EngenderHealth and Planned Parenthood of South Africa work to change mens attitudes towards violence and gender equityEngenderHealth and Planned Parenthood of South Africa work to change mens attitudes towards violence and gender equity 58% of men surveyed in South Africa believed that a woman could not be raped by her husband58% of men surveyed in South Africa believed that a woman could not be raped by her husband

13. Addressing Socialization, Gender Roles and Coping Mechanisms – Poster developed in mens workshop conducted by Puntos de Encuentro Puntos de Encuentro Violence Against Women: A Disaster That Men Can Prevent

14. Engage Men to Reach Other Men

15. Questions for Debate? Will reducing violence lead to better reproductive health outcomes?Will reducing violence lead to better reproductive health outcomes? Do reproductive health agencies have an obligation to help reduce violence, after helping to document the problem?Do reproductive health agencies have an obligation to help reduce violence, after helping to document the problem? J. Littlewood/World Health Organization Can reproductive health programs help reduce violence against women by working with men and boys?Can reproductive health programs help reduce violence against women by working with men and boys?