Presentation on theme: "Gender-based Violence: Prevalence and Health Consequences"— Presentation transcript:
1Gender-based Violence: Prevalence and Health Consequences C. Garcia-Moreno,Coordinator, Gender and Women's HealthWorld Health OrganizationThe Development Implications of Gender-Based Violence, World Bank Washington, D.C.
2What this talk is aboutTo provide an understanding of how common violence against women is, and how it affects the health of women and children:GBV: definitions, prevalence and patternsHealth consequences
3Definition 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
4Types of gender-based violence Intimate partner violence (physical, sexual, psychological, economic)Forced sexual initiationChildhood sexual abuseRape and other forms of sexual coercionTraffickingRape/sexual abuse in conflict situationsAcid throwingFemale Genital MutilationKillings in the name of honourDowry deaths
5Prevalence of physical and/or sexual partner violence (WHO, 2004)
6Types of physical violence according to severity (WHO, 2004) *In all countries but Japan, more severe violence than “moderate”. Ethiopia and Peru, particularly serious.
7Overlap lifetime physical and sexual violence PERU - CAP THAILAND - CAP29% 20% 3% 11% 12% 18%phys viol sex viol phys viol sex violNAMIBIA19% 11% 5%physical viol sexual viol
11Female adolescents forced sexual initiation, as % of those reporting having had sex. (Population-based surveys, )
12Global 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 lifetimeWomen are most at risk at home and from men they know, usually a family member or spouseA growing number of studies indicate that the first sexual experience is often forced, particularly for young femalesRough estimates suggest that 700,000 to 2 million women and girls are trafficked across international borders every year.
13Violence is a risk factor affecting women’s health and wellbeing
14A major cause of disability and death One reason the health sector should address GBV is that it is a major cause of morbidity and mortality among women. The data in this slide are estimates of the disability and death worldwide caused by GBV (specifically, rape and domestic violence), relative to other common conditions.These estimates were developed by the World Bank in 1993, in an attempt to quantify the global burden of ill health due to different causes. The World Bank counted every year lost due to premature death as a “disability-adjusted life year” (DALY), and every year spent sick or incapacitated as a fraction of a DALY, depending on the severity of the disability. (World Bank, 1993, cited in Heise et al )The World Bank estimated that among women of reproductive age, the burden of disability and death due to rape and domestic violence is higher than that due to malaria and cancer, and only slightly lower than tuberculosis and cardiovascular disease.These estimates probably underestimate the burden caused by gender-based violence, given that in 1993, the current extent of the HIV/AIDS pandemic had not been fully recognized. More recent estimates of the burden due to AIDS is approximately 3 times as high as the 1993 estimate and, both rape and domestic violence play a role in the spread of HIV.Moreover, DALYs give less weight to years of lost health and life among women older than 25, discounting health in most of the reproductive years, and they use a fairly narrow definition of disability.Source: World Bank, 1993, cited in Heise et al., 1994
15Violence increases risk for … Fatal Outcomeshomicidesuicidematernal deathsAIDS related deathsNon-fatal outcomesphysicalmentalreproductive and sexualinjurious health behaviorsFor example:unwanted pregnancychronic paininjurydepressionalcohol/drug useSTIs/HIVIrritable bowelgynecological disorders
16Intimate partner violence is a risk factor for femicide
17Violence 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 utilizationSeverity of abuse correlates with severity of symptoms
18Proportion of women reporting poor health and association with reported violence % women who report their current health status as “poor” or “very poor”All women were asked early on in the questionnaire (before we asked about the partner and about violence) questions on general and reproductive health. The respondents had to indicate on a scale of 5 how they generally describe their health: Excellent, good, fair, poor, very poor.In all countries and sites we see that abused women report worse perceived health and this is statistically significant.
19Violence and suicidal ideation % of women who have ever thought of suicideWith regards to the association between violence and suicide ideation we found that in every site women who have experienced physical or sexual abuse by a partner were more likely to have ever thought of suicide.
20Violence and use of health services in Managua, Nicaragua (IDB, 1999)
21Prevalence of injury among women ever physically abused by a partner
22Women who are physically or sexually abused by their partner are more likely to report: Problems with walkingDifficulties with daily activitiesRecent painProblems with memoryRecent dizzinessVaginal dischargeSource: WHO, 2004
23Violence contributes to adolescent pregnancy and sexually transmitted infections Greater likelihood of teen pregnancy, STIsChildhood sexual abuseIncreased “risk” behaviors such as sex with many partners, unprotected sexYounger age at first intercourse
24Percentage of women whose last pregnancy was unwanted (ever pregnant women)
25Violence increases women’s vulnerability to HIV/AIDS VAW, particularly sexual violence, increases women’s risk of HIV/AIDS directly and indirectlyViolence can prevent women from accessing HIV/AIDS information, treatment and careFear of violence is a barrier to HIV testing and disclosureViolence affects women’s ability to mitigate the impact of HIV/AIDS on themselves and their children
26Violence increases risk for other gynecological problems A history of sexual violence has been associated with:vaginal bleedingvaginal dischargepainful menstruationsexual dysfunctionpelvic inflammatory diseasechronic pelvic pain
27Many women experience physical violence in pregnancy (ever pregnant women) The results on physical violence in pregnancy show that between 4 and 28 percent of women report having been beaten or kicked in pregnancy.One third to one half of these women reported to have been punched or kicked in the stomach
28Physical violence during pregnancy (ever pregnant women) % women who report violence during a pregnancy
29Violence leads to negative pregnancy outcomes increased smoking and substance usevaginal and cervical infectionspremature labormiscarriages/abortionsbleeding during pregnancylow birth weightlate entry into prenatal care
30Partner Violence and abortions % ever pregnant women who report 1 or more abortions*
31ConclusionsAbout one in three women around the world have been beaten or sexually abused by an intimate partnerPhysical and sexual abuse is a major cause of ill-health and disability among womenMost women do not receive the support they need
32I 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)Por ejemplo, Ana Cristina cuenta que...“…Si yo hubiera tenido una ayuda, creo que me hubiera apartado antes de mi ex-marido. No le hubiera aguantado cinco años porque yo no hallaba por donde agarrar, y no tenía a nadie quien me dijera que podía hacer. “
33Health sector response can: Help change attitudes in societyEducate providers and managers to respond sensitively and prevent providers from causing harmImprove quality of care for women and childrenResearch the epidemiology of GBVDesign and evaluate prevention and intervention strategiesCarry out community-based educationEducate professionals in all sectorsAdvocate to change laws and their applicationCollaborate with organizations from other sectors (legal, rights, social services, etc.)
34What can we do?The health care setting is an opportunity for intervention……and presently it is a lost opportunity(Heise, Ellsberg and Gottemuller, 1999)