This Policy Forum presents new global evidence on the extent of domestic
violence against women. Data from more than 24,000 women in 10 geographically
and culturally varied countries involved in the WHO Multi-country Study on
Women’s Health and Domestic Violence against Women highlights that violence
is widespread and illustrates the degree to which levels vary between settings.
It argues that violence against women is a complex social problem with
far-reaching health consequences and one that urgently needs to be addressed.
The Millennium Development Goals commit the 191 member states of the United
Nations to sustainable human development and recognise that equal rights and
opportunities for women and men are critical for social and economic progress.
This must include addressing violence against women – a concrete manifestation
of inequality between the sexes.
There is a growing body of evidence from research that suggests that violence
against women is highly prevalent, with an estimated one in three women globally
experiencing some form of victimisation in childhood, adolescence or adulthood.
This violence has a direct economic impact along with the human and emotional
costs. A study in the USA estimated the costs of intimate partner rape, physical
assault and stalking as exceeding $5.8 billion each year, nearly $4.1 billion of
which is for direct medical and mental health care services.
Violence against women also has a substantial impact on health. In the
Australian state of Victoria, violence by intimate partners is calculated to
result in more ill health and premature death among women of reproductive age
than any other risk factor, including high blood pressure, obesity and smoking.
Intimate partner violence is also an important cause of death, accounting for 40
to 60 per cent of female homicides in many countries and an important portion of
maternal mortality in India, Bangladesh and the United States.
The evidence suggests that violence can be prevented. Policies to prevent
violence include expanding women’s access to economic and social resources and
to support services.
The results from the WHO Multi-country Study on Women’s Health and
Domestic Violence against Women released this week greatly extend the
geographic range and scope of available data. The results in this report are
based on over 24,000 interviews with 15- to 49-year-old women from 15 sites in
10 countries: Bangladesh, Brazil, Ethiopia, Japan, Peru, Namibia, Samoa, Serbia
and Montenegro, Thailand and the United Republic of Tanzania. In 13 of the 15
sites studied, between one-third and three-quarters (35 to 76 per cent) of women
had been physically or sexually assaulted by someone since the age of 15. In all
the settings but one, the majority of this violence was perpetrated by a current
or previous partner rather than by other persons.
Overall, 15 to 71 per cent of women who ever had a partner had been
physically or sexually assaulted by an intimate partner. In most settings, about
a half of these respondents reported that the violence was currently ongoing
(occurred in the past 12 months preceding the interview). In the majority of
settings, too, a greater proportion of women had experienced "severe" physical
violence than those suffering "moderate" physical violence. Much of the violence
reported was hidden: More than one-fifth (21 to 66 per cent) of women reporting
physical violence in the study had never told anyone of their partner’s violence
before the study interview.
The study findings confirm that women around the world are at significant risk
of physical and sexual violence from their partner but also highlight that there
is substantial variation both within and between countries. In the WHO study,
the lowest prevalence of lifetime and current partner violence was found in
urban Japan and Serbia and Montenegro, which suggests that rates of abuse may
reflect, in part, different levels of economic development.
However, a study in two sites in New Zealand that replicated the WHO
methodology found lifetime prevalence of partner violence as high as that found
in many WHO developing country sites. The rates of current violence were much
lower (less than 6 per cent in both sites), which suggests that women in
industrialised nations may find it easier to leave abusive relationships.
Although pregnancy is often considered a time when women are more likely to
be protected from harm, one to 28 per cent of women who had ever been pregnant
reported being beaten during pregnancy. More than 90 per cent of these women
were abused by the father of the unborn child and between a quarter and half of
them had been kicked or punched in the abdomen. In most cases, the abuse during
pregnancy was a continuation of previous violence. However, for some women the
abuse started during pregnancy. Intimate partner violence was also associated
with an increased number of induced abortions and, in some settings, with
miscarriage. In all sites except urban Thailand and Japan, women who experienced
violence were significantly more likely to have more children than other women.
Despite these health associations, over half of physically abused women (55
to 95 per cent) reported that they had never sought help from formal services or
from people in positions of authority. Only in Namibia and in both sites in Peru
had more than 20 per cent of women contacted the police and only in Namibia and
in urban Tanzania had about 20 per cent sought help from health care services.
Family, friends and neighbours, rather than more formal services, most often
provide the first point of contact for women in violent relationships.
The study also demonstrates the remarkable degree to which women in some
settings have internalised social norms that justify abuse. In about half of the
sites, 50 to >90 per cent of women agreed that it is acceptable for a man to
beat his wife under one or more of the following circumstances: if she disobeys
her husband, refuses him sex, does not complete the housework on time, asks
about other women, is unfaithful, or is suspected of infidelity. This was higher
among women who had experienced abuse than among those who had not and may
indicate either that women experiencing violence learn to "accept" or
rationalise this abuse or that women are at greater risk of violence in
communities where a substantial proportion of individuals condone abuse.
The association between the prevalence of partner violence and women’s belief
that such violence is normal or justified constitutes one of the most salient
findings of the WHO study. The data also highlights the degree to which women in
some settings feel that it is unacceptable for women to refuse sex with her
husband, even in circumstances where it could put them at risk. In three of the
rural provincial sites, as many as 44 to 51 per cent of women believe that a
woman is not justified in refusing her husband sex if he mistreats her. The fact
that the association is particularly marked in rural and more traditional
societies reinforces the hypothesis that traditional gender norms are a key
factor in the prevalence of abuse and that transforming gender relations should
be an important focus of prevention efforts.
There is nothing "natural" or inevitable about men’s violence toward women.
Attitudes can and must change; the status of women can and must be improved; men
and women can and must be convinced that violence is not an acceptable part of
human relationships.