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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: Keletso.Ratsela@mrc.ac.za

Fadéla Chaib, WHO
Telephone: +41 22 791 3228
Mobile: +41 79 475 5556
E-mail: chaibf@who.int

Jenny Orton/Katie Steels
London School of Hygiene & Tropical Medicine
Telephone: +44 (0)20 7927 2802
E-mail: press@lshtm.ac.uk


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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