16 Days of Action: The burden of gender-based violence on women’s health

There are six days left in the United Nations Secretary General’s 16-day campaign, UNiTE to End Violence Against Women, and in just the last week a number of staggering statistics have gone viral on the Web, exposing the international community to facts that, activists hope, will have lasting effects on the minds of many.

By now, certain essential data provided by the World Health Organization’s mid-June report on violence against women are known well among those following the 16 Days campaign:

A third of women worldwide have been subjected to physical or sexual violence by a partner or stranger; women who have experienced abuse at the hands of a loved one are twice as likely to suffer from depression than women who do not; children who witness domestic violence are twice as likely to abuse their own partners as adults.

The WHO’s global review of violence against women has become an integral piece of UNiTE’s campaign, but it has done more than simply uncover the numbers behind a vast spectrum of human rights abuses against women that spans beyond geographical boundaries, political or religious landscapes—it has revealed a “public health problem of epidemic proportions.”

The most commonly recorded kinds of violence against women, according to Dr. Claudia Garcia-Moreno of the World Health Organization, are those acts committed by an intimate partner of a physical or sexual nature, which have proven to be associated with long-term physical, mental and reproductive health problems.

Possible “injuries” range from bruises and concussions to depression, anxiety, eating and sleeping disorders, and post-traumatic stress disorder. Data show high rates of unwanted pregnancies leading to unsafe abortions, higher exposure to sexually transmitted diseases and HIV, and low birth weight babies.

“It seems from all of the data that we have now that we can say with quite a bit of certainty that it does account for an important part of the burden associated with ill health in women,” Garcia-Moreno said.

While many may not necessarily associate violence against women and its consequences with developed nations, multi-country studies show that the impacts on women’s health are consistent across borders, even if prevalence varies. Japan, for instance, was compared as a high-income country with Serbia as middle-income, and Ethiopia as low-income, and returned similar results for health outcomes.

This, Dr. Garcia-Moreno said, is one of the most interesting elements in considering the role violence plays in the well being of women.

“It didn’t matter if we were looking at a poor woman in Ethiopia, or a poor woman in rural Bangladesh, or if we were looking at a more middle-income woman in Sao Paulo in Brazil, or in Lima, Peru, the health facts were similar,” she said. “Obviously there are regional variations and there is a low prevalence overall in high-income countries compared with other regions like Africa or Asia, but I think the main message that we want to convey is that wherever we look at it, it’s unacceptably high. Because even in high income countries there is still quite a high prevalence of intimate partner violence.”

Another risk factor that cuts across geographies is in the witnessing of violence by children. Women’s Aid, an organization working to stop domestic violence against women in Ireland, said that experiencing or witnessing abuse as a child increases your risk of being in an abusive relationship.

Asked about this connection, Garcia-Moreno said that children witnessing violence can, in fact, become problematic in later years: “It doesn’t mean to say that all people who witness or experience abuse necessarily become abusers, but we see that there is definitely a strong association there,” adding that even children who are not necessarily being maltreated themselves, but who are exposed to the violence, have long-term health and developmental consequences.

While the data makes the details of more highly reported kinds of violence clear, one thing remains a bit murkier: how exactly the world should go about solving these issues.

It seems to be a multi-sector question that demands a multi-sector response.

Violence has a tremendous human, economic and social cost, and attempts have been made by the Center for Disease Control to quantify the impacts. Health services, police and judicial systems in many places are “not responsive to women,” as panelists at the second annual London-based Trust Women conference found.

Human rights lawyer Sukti Dhital at Wednesday’s conference said women in India have been denied reproductive health care, and gave the example of a poor migrant woman who was sent to four different hospitals while holding a dead fetus. Often times, she said, women arrive at clinics to find “it’s broken. It’s either not working, not open or dirty.”

Garcia-Moreno said what we see with many services is that “they can be discriminatory” against women, and in many cases, providers do not have the skills or infrastructure to conduct services.

What needs to happen, then, is for the health sector to make sure the system has the necessary tools to provide services effectively: girls should be granted access to education and have economic equality, because both of these factors make women less likely to remain in abusive relationships.

“It is definitely not a women’s issue,” Garcia-Moreno said, recalling the focal point of UNiTE’s 16-days campaign. “It is definitely an issue that concerns everybody and affects everybody.”