June 26, 2013
by anupamasrinivasan
Earlier this week, WHO published new data on global and regional estimates of violence against women. This is based on a study assessing the ‘prevalence and health effects of intimate partner violence and non-partner sexual violence’ and was carried out by WHO in partnership with the London School of Hygiene & Tropical Medicine and the South African Medical Research Council.
While acknowledging that women experience many forms of violence, the study focuses specifically on intimate partner violence which is defined as a ‘self-reported experience of one or more acts of physical and/or sexual violence by a current or former partner since the age of 15 years’. The report also acknowledges that the term ‘intimate partner’ is understood differently in different settings, both legally and culturally. So this includes married couples as well as those in live-in relationships, those dating and those engaged in sexual relationships (not necessarily married). There’s no explicit reference but my assumption is the study has focused only on heterosexual relationships.
Incidentally, there’s no specific legal category in Indian law for intimate partner violence. However the Protection of Women from Domestic Violence Act of 2005 extends to those who are in live-in relationships and not just married couples.
What’s also interesting is the inclusion of ‘self-reported experiences’ of violence in arriving at the global prevalence rates. We always talk about how official data and statistics, i.e cases reported to the police, are merely the tip of the iceberg and we have to assume there are many many more that don’t get reported. By including self-reported experiences (often considered the gold standard in violence research), the research team has circumvented the tricky challenge of under-reporting to a certain extent.
A word on the research methodology: this report is not based on new data specifically collected by the research team but on rigorous analysis of existing data from 155 studies in 81 countries. See Section 1 of the report for a detailed discussion on the methodology, challenges and limitations of the study.
So what are the key findings?
Excerpts from the Executive Summary on page 2 of the report:
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Overall, 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence;
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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;
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Globally, as many as 38% of all murders of women are committed by intimate partners;
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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;
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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.
So what does this new data tell us?
1. That globally, 1 in 3 women experience intimate partner or non-partner violence at some point in their lives.
2. Countries in South-East Asia (WHO-defined region that includes India and other South Asian countries) have the highest prevalence, at a staggering 37.7%. The Eastern Mediterranean and African regions aren’t far behind, with prevalence rates of 37% and 36.6% respectively.
3.There is a real and urgent case to view violence against women as a public health issue, and not merely a criminal or law and order problem. This has serious long-term implications for how we train our health care professionals on how to respond to violence.In the words of the study authors, this is ‘a global health problem of epidemic proportions’.
4. When a woman experiences violence, whether once or repeatedly, it has a definitive impact on her physical and mental health. Of course, we already know this but the report draws our attention to evidence that highlights the association between violence and a long (but select) list of health outcomes including HIV infection, incident sexually transmitted infections (STIs), induced abortion, low birth weight, premature birth, growth restriction in utero and/or small for gestational age, alcohol use, depression and suicide, injuries, and death from homicide.
The health sector in particular has been slow to engage with violence against women. Yet, this report presents clear evidence that exposure to violence is an important determinant of poor health for women.
…..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 (110 ) emphasize the urgent need to integrate these issues into undergraduate curricula for all health-care providers, as well as in in-service training.
So? What now?
In many ways of course, this is nothing we didn’t already know. However for those of us who knock on doors in the health sector and meet apathy or disinterest, the findings of this study are a potentially valuable tool. At Prajnya, we’ve done some nascent work in training health care professionals, primarily nurses, to recognise and respond to violence. Across the board, we’ve found that existing curricula rarely contains anything about dealing with violence, barring cursory mentions in the context of either HIV/STI or reproductive health. Trainee nurses were often unsure of what constitutes violence, when to intervene, whether its any of their business at all, what they should say, what they shouldn’t say, how they could help…
After all, asking anyone about her/his experience of violence isn’t easy. How then can we expect a young 22-year-old nurse who has received no training whatsoever to offer someone she suspects has experienced physical or sexual violence, the right kind of support? The study report stresses on the importance of training health care workers at all levels – this includes doctors, nurses, hospital administrators, community workers, NGO staff – the list is long.
Bottom line: there’s lots of work to be done, we really should get going sooner than later.
PS – Incidentally, according to WHO, at the Sixty-sixth World Health Assembly held recently in May 2013, seven governments – Belgium, India, Mexico, Netherlands, Norway, United States of America, and Zambia – declared violence against women and girls “a major global public health, gender equality and human rights challenge, touching every country and every part of society” and proposed the issue should appear on the agenda of the Sixty-seventh World Health Assembly.
Some useful links:
A quick overview of the report is available here.
The full report: Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence (WHO 2013)
Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines (WHO 2013)
In India, CEHAT has done pioneering work on health sector responses to sexual violence and assault. Their publications are accessible here.
The GRIT@Prajnya Blog 