New research sheds light on global trends

Editor’s note: Only a decade ago, violence against women was a marginal issue on the international health and development agenda. Little was known about the extent of violence or its effects on the health of women and children. The Lancet (April 5–11, 2008, vol. 371[9619]) featured the work described below—an important milestone for the global health community and women around the world.

Violence against women reaches beyond the immediate threat of bruises and broken bones. The violence women in many parts of the world routinely endure is linked to severe health problems—chronic pain, disability, disease, and mental problems—that affect not only the health of individuals, but the social health of communities and the economic health of nations.

In the United States and other countries, the slow (and still unfinished) journey away from gender-based violence has started with information—the information leaders and activists need to justify laws and shelters that protect women and the information women and men need to reconsider long-standing ideas about what is acceptable. In the developing world, though, reliable information about violence against women is less readily available, and traditional cultural values are an even greater barrier to change.

That’s why the World Health Organization, PATH, and the London School of Hygiene and Tropical Medicine embarked on a landmark study that crossed countries and cultures to shed light on gender-based violence. The findings were released to coincide with the “16 Days of Activism Against Gender Violence” (Nov. 25 to Dec. 10, 2005), an international campaign designed to highlight issues of gender violence and human rights.

Understanding gender-based violence

How many women endure violence? Who are they? Where do they live?
How does violence affect them?
What factors may protect against violence—and which put women at risk?
Are there any strategies or services that women use to deal with violence?

These are the questions researchers set out to answer with the most ambitious study ever conducted on gender-based violence. The WHO Multi-country Study on Women’s Health and Domestic Violence against Women involved more than 24,000 women in ten countries: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Tanzania, and Thailand. Specially trained interviewers surveyed random samples (by household) of women aged 15 to 49 years.

As a member of the core research team, PATH is proud to have helped design the study, the questionnaire, and training manuals; train interviewers; and supervise field work. We also analyzed data and helped prepare national reports and the international findings.

What 24,000 women told us

The research findings confirmed that violence seriously affects women’s health. Women who reported violence were more likely to report poor general health and reported more physical symptoms of ill health, emotional distress, miscarriages, and abortions. They were also more likely to have considered or attempted suicide.

But there were also new insights—such as more violence overall, especially in the home. In 13 of the 15 study sites, one-third to three-quarters of women had been physically or sexually assaulted by an intimate partner. At some sites, as many as 28 percent of women who had been pregnant had been assaulted during pregnancy.

Much of this violence had been hidden and previously unreported—more than one-fifth of women reporting violence during the study had never told anyone about it before. Said one study participant from Brazil, “it made me feel good, because it was something that I had never told anyone before. Now I’ve told someone.”

Levels of violence varied greatly, both within and between countries. This finding raises questions for future research: which factors at individual, community, and national levels increase women’s risk of violence? Which provide a measure of protection?

One factor may be women’s internalization of social norms that justify abuse. In at least half the study sites, women reported believing that it is acceptable for a man to beat his wife under certain circumstances, including if she disobeys him, refuses sex, does not complete the housework on time, or is unfaithful. It goes to show how complex an issue gender-based violence is: although legal and institutional reforms are needed, they alone will not be enough to eliminate violence against women.

The power of women’s voices

Simply by creating a safe space in which women could ask for help, this project has affected women’s lives and efforts to stop violence. As a participant from Japan explained, “I did not know where I could go for help. Now I know where I can go. I was looking for such places.”

Furthermore, the local organizations in the study countries that assisted with the research learned new skills and connected with each other and with researchers. PATH is now building on these established networks by disseminating information and supporting regional initiatives to address violence, such as the Alianza Intercambios (see the Intercambios website) and the Gender-based Violence Prevention Network in eastern and southern Africa. We’ve also coauthored a guide that will help others conduct further research on violence.

As part of our broader efforts to reduce gender-based violence and advocate for scientifically sound, locally relevant solutions, PATH continues to serve as an advisor to United Nations agencies and others. Together with partners across the world, we are helping expose the violence women endure.

Photo: David and Lucile Packard Foundation.