Gender-Based Violence

Gender-based violence is the most pervasive form of human-rights abuse worldwide. One in three women around the globe endures domestic violence, is coerced into sex, or is abused psychologically during her lifetime.

Surveys from around the world show that between 10 and 50 percent of women are victims of physical abuse by their intimate partners sometime during their lifetimes. In the United States alone, an estimated 1.5 million women are battered by their partners each year. Physical aggression is usually recurrent and accompanied by sexual and psychological abuse. Gender-based violence includes female infanticide, incest, rape, child abuse and prostitution, and such harmful traditional practices as forced early marriage, and female genital mutilation. Between one and two million girls in Africa, for example, undergo female genital mutilation every year.

Gender-based violence has long-lasting adverse consequences for women’s reproductive health, including unwanted pregnancy, pregnancy complications, miscarriage, unsafe abortion, sexually transmitted infections, including HIV, and maternal death. A 1999 study in Uttar Pradesh, India, found that the wives of sexually abusive husbands were more likely to have unplanned pregnancies and to contract STIs, partly because they feared negotiating sex or condom use due to the threat of violence.

Victims of domestic violence are also more likely to suffer long-lasting psychological and health problems, including persistent fear, low self-esteem, sexual dysfunction, chronic pain, disability, substance abuse, depression, and suicide. The children of abused women are more likely to experience low birth weight, malnutrition, behavioral problems, and higher mortality. The World Bank has estimated that the health burden of gender-based violence on women aged 15-44 is as heavy as that of HIV, tuberculosis, cancer and heart disease combined.

Gender-based violence also has significant economic consequences, reducing family income and increasing health care costs, job absenteeism, and costs related to law enforcement. Gender-based violence also compounds other effects of economic exploitation.

Traditionally treated as a private family affair—and ignored by communities and government policies—gender-based violence only recently gained the status of a major public health and human rights concern. The 1993 UN Declaration on the Elimination of Violence Against Women was the first international document to include physical, sexual and psychological abuse in its definition of violence against women.

Reproductive health programs have been among the first to address gender-based violence, as they often see and deal with the consequences of such violence. Health workers can play an important role in identifying and caring for battered women because they may be the first, safest, or even only contact for injured women. With training, health workers can recognize, discuss, and provide for women experiencing violence at home. And funders could increase their commitment to relevant research, for example, on vaginal microbicides, which women can use discreetly to protect themselves from infection when they cannot negotiate sex with their partners.

The health sector alone cannot confront this silent epidemic; only fundamental social change that eliminates women’s subordinate status will bring an end to gender-based violence. The changes needed include eliminating laws that discriminate against women and children, promoting women in leadership and decision-making processes, improving access and sense of entitlement to education, and increasing women’s access to economic resources and health information.