1. Addressing Gender-Based Violence: A Critical Review of Interventions Andrew Morrison Gender and Development Group (PRMGE) World Bank September 30, 2008

2. Risk factors Sectoral good practices  Health  Education prevention control  Justice  Urban development Beyond sectoral approaches Conclusions…policy recommendations Outline

3. Risk factors for violence occur at many levels: Individual Relationship Community Society Source:Heise 1998

4. Correlates of violence against women Societal-level Factors that create an acceptable climate for violence, reduce inhibitions against violence and foster inequality Community- level Context in which social relationships are embedded: neighborhood workplace, school Relationship- level Relationships with spouse, family, friends and peers Individual- level Biological and personal history of victims and perpetrators Norms that accept violence as a means to resolve conflict Norms that support male dominance and require women’s obedience Policies and laws that discriminate against women High crime rates Lack of economic opportunity for men Poor situational control of violence Male control of household decision making and wealth Controlling behavior Multiple partners of male spouse Association with gangs, delinquent or patriarchal peers Differences in age or education level between spouses Witnessing abuse Suffering abuse Absent or rejecting father Alcohol or drug use Educational level Women engaged in income- generating activities

5. Health sector

6. A graduated response to violence First, do no harm Decide on how to screen for violence Undertake explicit efforts to address abuse  Inside health institutions  Via referrals

7. Identifying abused women: what is the best strategy? Ask all women about abuse at all visits Ask only when there are signs of violence Screen routinely in strategic programs (emergency, reproductive health, mental health, etc.)

8. Health sector plans and protocols should: Avoid secondary victimization (do no harm) Specify policy/instruments for screening Offer free consultations/treatment for victims Expedite referrals among health institutions Enhance coordination between clinics/hospitals and social services/criminal justice Increase focus on prevention using public health approaches

9. Education sector

10. Alarming statistics from Africa Six country study: Between 16% and 47% of girls in primary and secondary schools report sexual abuse or harassment Botswana: 20% of students pressured by teachers for sex Cameroon: 8% of all sexual abuse of girls was accounted for by teachers South Africa: 37.7% of rape victims identified teacher or principal as the rapist South Africa: Girls more likely to be assaulted by male classmates than teachers Sources: Leach (2003) and Medical Research Council, 2000

11. …but little information from LAC To our knowledge, only two studies:  Brazil: 8% of students (5th to 8th grade) had witnessed sexual violence within school  Ecuador: 22% of adolescent girls reported being sexually abused in school (one-school survey) No national policies or regulations on harassment or sexual abuse in schools Sources: Abramovay and Franco, 2004; Leon, 1994

12. Why does VAW in schools matter? Impact on girls’ school attendance Impact on girls’ performance in school Sexual and reproductive health issues  Boys’ behavior may set lifelong pattern of abuse and predation  STDs and AIDS

13. Elements of a policy response in education Measure and document levels of violence against girls in schools Reform laws and policies of the education sector Reform institutions of the education sectors

14. Justice sector

15. Strengthening access to justice Ratification of international conventions Improving institutional response of police, judiciary, forensic medicine and legal aid Women’s police stations Protective/restraining orders – civil remedies Batterer’s treatment programs

16. Multi-sectoral approaches

17. Beyond sectoral approaches…. One-stop shops National plans for prevention of violence against women Integration into national crime prevention strategies

18. Conclusions & Recommendations Dearth of high-quality evaluations No single intervention can address all important risk factors: need to intervene at different levels— individual, community, institutional, etc. Some risk factors can be addressed quickly and at relatively low cost There is systematic underinvestment in prevention programs that confront underlying attitudes and beliefs that promote violence

19. Conclusions & Recommendations One-stop shops are desirable, but costly and most appropriate for urban areas of middle- income countries Some interventions from developed countries are of questionable efficacy and inappropriate for developing countries: mandatory reporting by health sector, batterer treatment programs, shelters…