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Violence against women

• Violence against women – particularly intimate partner violence and sexual violence – is a major public health problem and a violation of women's human rights.
• Estimates published by WHO indicate that globally about 1 in 3 (30%) of women worldwide have been subjected to either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime.
• Most of this violence is intimate partner violence. Worldwide, almost one third (27%) of women aged 15-49 years who have been in a relationship report that they have been subjected to some form of physical and/or sexual violence by their intimate partner.
• Violence can negatively affect women’s physical, mental, sexual, and reproductive health, and may increase the risk of acquiring HIV in some settings.
• Violence against women is preventable. The health sector has an important role to play to provide comprehensive health care to women subjected to violence, and as an entry point for referring women to other support services they may need.

The United Nations defines violence against women as "any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life"  (1).

Intimate partner violence  refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.

Sexual violence  is "any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. It includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part or object, attempted rape, unwanted sexual touching and other non-contact forms."

• World report on violence and health

Scope of the problem

Population-level surveys based on reports from survivors provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence. A 2018 analysis of prevalence data from 2000–2018 across 161 countries and areas, conducted by WHO on behalf of the UN Interagency working group on violence against women, found that worldwide, nearly 1 in 3, or 30%, of women have been subjected to physical and/or sexual violence by an intimate partner or non-partner sexual violence or both  (2) .

• Global and regional estimates of violence against women

Over a quarter of women aged 15–49 years who have been in a relationship have been subjected to physical and/or sexual violence by their intimate partner at least once in their lifetime (since age 15). The prevalence estimates of lifetime intimate partner violence range from 20% in the Western Pacific, 22% in high-income countries and Europe and 25% in the WHO Regions of  the Americas to 33% in the WHO African region, 31% in the WHO Eastern Mediterranean Region, and 33% in the WHO South-East Asia region.

Globally as many as 38% of all murders of women are committed by intimate partners. In addition to intimate partner violence, globally 6% of women report having been sexually assaulted by someone other than a partner, although data for non-partner sexual violence are more limited. Intimate partner and sexual violence are mostly perpetrated by men against women.

Lockdowns during the COVID-19 pandemic and its social and economic impacts have increased the exposure of women to abusive partners and known risk factors, while limiting their access to services. Situations of humanitarian crises and displacement may exacerbate existing violence, such as by intimate partners, as well as non-partner sexual violence, and may also lead to new forms of violence against women.

• COVID-19 and violence against women

Factors associated with intimate partner violence and sexual violence against women

Intimate partner and sexual violence is the result of factors occurring at individual, family, community and wider society levels that interact with each other to increase or reduce risk (protective). Some are associated with being a perpetrator of violence, some are associated with experiencing violence and some are associated with both.

Risk factors for both intimate partner and sexual violence include:

• lower levels of education (perpetration of sexual violence and experience of sexual violence);
• a history of exposure to child maltreatment (perpetration and experience);
• witnessing family violence (perpetration and experience);
• antisocial personality disorder (perpetration);
• harmful use of alcohol (perpetration and experience); 
• harmful masculine behaviours, including having multiple partners or attitudes that condone violence (perpetration);
• community norms that privilege or ascribe higher status to men and lower status to women; 
• low levels of women’s access to paid employment; and
• low level of gender equality (discriminatory laws, etc.).

Factors specifically associated with intimate partner violence include:

• past history of exposure to violence;
• marital discord and dissatisfaction;
• difficulties in communicating between partners; and
• male controlling behaviours towards their partners.

Factors specifically associated with sexual violence perpetration include:

• beliefs in family honour and sexual purity;
• ideologies of male sexual entitlement; and
• weak legal sanctions for sexual violence.

Gender inequality and norms on the acceptability of violence against women are a root cause of violence against women.

Health consequences

Intimate partner (physical, sexual and psychological) and sexual violence cause serious short- and long-term physical, mental, sexual and reproductive health problems for women. They also affect their children’s health and well-being. This violence leads to high social and economic costs for women, their families and societies. Such violence can:

• Have fatal outcomes like homicide or suicide.
• Lead to injuries, with 42% of women who experience intimate partner violence reporting an injury as a consequence of this violence (3) .
• Lead to unintended pregnancies, induced abortions, gynaecological problems, and sexually transmitted infections, including HIV. WHO's 2013 study on the health burden associated with violence against women found that women who had been physically or sexually abused were 1.5 times more likely to have a sexually transmitted infection and, in some regions, HIV, compared to women who had not experienced partner violence. They are also twice as likely to have an abortion (3) .
• Intimate partner violence in pregnancy also increases the likelihood of miscarriage, stillbirth, pre-term delivery and low birth weight babies. The same 2013 study showed that women who experienced intimate partner violence were 16% more likely to suffer a miscarriage and 41% more likely to have a pre-term birth (3) .
• These forms of violence can lead to depression, post-traumatic stress and other anxiety disorders, sleep difficulties, eating disorders, and suicide attempts. The 2013 analysis found that women who have experienced intimate partner violence were almost twice as likely to experience depression and problem drinking.
• Health effects can also include headaches, pain syndromes (back pain, abdominal pain, chronic pelvic pain) gastrointestinal disorders, limited mobility and poor overall health.
• Sexual violence, particularly during childhood, can lead to increased smoking, substance use, and risky sexual behaviours. It is also associated with perpetration of violence (for males) and being a victim of violence (for females).

Impact on children

• Children who grow up in families where there is violence may suffer a range of behavioural and emotional disturbances. These can also be associated with perpetrating or experiencing violence later in life.
• Intimate partner violence has also been associated with higher rates of infant and child mortality and morbidity (through, for example diarrhoeal disease or malnutrition and lower immunization rates).

Social and economic costs

The social and economic costs of intimate partner and sexual violence are enormous and have ripple effects throughout society. Women may suffer isolation, inability to work, loss of wages, lack of participation in regular activities and limited ability to care for themselves and their children.

Prevention and response

There is growing evidence on what works to prevent violence against women, based on well-designed evaluations. In 2019, WHO and UN Women with endorsement from 12 other UN and bilateral agencies published RESPECT women – a framework for preventing violence against women aimed at policy makers. 

Each letter of RESPECT stands for one of seven strategies: Relationship skills strengthening; Empowerment of women; Services ensured; Poverty reduced; Enabling environments (schools, work places, public spaces) created; Child and adolescent abuse prevented; and Transformed attitudes, beliefs and norms.

For each of these seven strategies there are a range of interventions in low and high resource settings with varying degree of evidence of effectiveness. Examples of promising interventions include psychosocial support and psychological  interventions for survivors of intimate partner violence; combined economic and social empowerment programmes; cash transfers; working with couples to improve communication and relationship skills; community mobilization interventions to change unequal gender norms; school programmes that enhance safety in schools and reduce/eliminate harsh punishment and include curricula that challenges gender stereotypes and promotes relationships based on equality and consent;  and group-based participatory education with women and men to generate critical reflections about unequal gender power relationships.

RESPECT also highlights that successful interventions are those that prioritize safety of women; whose core elements involve challenging unequal gender power relationships; that are participatory; address multiple risk factors through combined programming and that start early in the life course.

To achieve lasting change, it is important to enact and enforce legislation and develop and implement policies that promote gender equality; allocate resources to prevention and response; and invest in women’s rights organizations.

• RESPECT women: Preventing violence against women

Role of the health sector

While preventing and responding to violence against women requires a multi-sectoral approach, the health sector has an important role to play. The health sector can:

• advocate to make violence against women unacceptable and for such violence to be addressed as a public health problem;
• provide comprehensive services, sensitize and train health care providers in responding to the needs of survivors holistically and empathetically;
• prevent recurrence of violence through early identification of women and children who are experiencing violence and providing appropriate referral and support;
• promote egalitarian gender norms as part of life skills and comprehensive sexuality education curricula taught to young people; and
• generate evidence on what works and on the magnitude of the problem by carrying out population-based surveys, or including violence against women in population-based demographic and health surveys, as well as in surveillance and health information systems.

WHO response

At the World Health Assembly in May 2016, Member States endorsed a global plan of action on strengthening the role of the health systems in addressing interpersonal violence, in particular against women and girls and against children.

• Global plan of action to strengthen the role of the health system within a national multisectoral response to address interpersonal violence, in particular against women and girls, and against children

WHO, in collaboration with partners, is:

• building the evidence base on the size and nature of violence against women in different settings and supporting countries' efforts to document and measure this violence and its consequences, including improving the methods for measuring violence against women in the context of monitoring for the Sustainable Development Goals. This is central to understanding the magnitude and nature of the problem and to initiating action in countries and globally;
• strengthening research and capacity to assess interventions to prevent and respond to violence against women;
• undertaking interventions research to test and identify effective health sector interventions to address violence against women;
• developing guidelines and implementation tools for strengthening the health sector response to intimate partner and sexual violence and synthesizing evidence on what works to prevent such violence;
• supporting countries and partners to implement the global plan of action on violence and monitoring progress including through documentation of lessons learned; and
• collaborating with international agencies and organizations to reduce and eliminate violence globally through initiatives such as the Sexual Violence Research Initiative, Together for Girls, the UN Women-WHO Joint Programme on Strengthening Violence against Women measurement and data Collection and use,  the UN Joint Programme on Essential Services Package for Women Subject to Violence, and the Secretary General’s political strategy to address violence against women and COVID-19.

WHO and UN Women, along with other partners, co-lead the Action Coalition on Gender-based Violence, an innovative partnership of governments, civil society, youth leaders, private sector and philanthropies to develop a bold agenda of catalytic actions and leverage funding to eradicate violence against women.

(1) United Nations. Declaration on the elimination of violence against women. New York : UN, 1993.

(2) Violence against women Prevalence Estimates, 2018. Global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women. WHO: Geneva, 2021

(3) WHO, LSHTM, SAMRC. Global and regional estimates of violence against women: prevalence and health impacts of intimate partner violence and non-partner sexual violence. WHO: Geneva, 2013.

Related information

Gender-Based Violence (Violence Against Women and Girls)

Photo: Simone D. McCourtie / World Bank

Gender-based violence (GBV) or violence against women and girls (VAWG), is a global pandemic that affects 1 in 3 women in their lifetime.

The numbers are staggering:

• 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence.
• Globally, 7% of women have been sexually assaulted by someone other than a partner.
• Globally, as many as 38% of murders of women are committed by an intimate partner.
• 200 million women have experienced female genital mutilation/cutting.

This issue is not only devastating for survivors of violence and their families, but also entails significant social and economic costs. In some countries, violence against women is estimated to cost countries up to 3.7% of their GDP – more than double what most governments spend on education.

Failure to address this issue also entails a significant cost for the future.  Numerous studies have shown that children growing up with violence are more likely to become survivors themselves or perpetrators of violence in the future.

One characteristic of gender-based violence is that it knows no social or economic boundaries and affects women and girls of all socio-economic backgrounds: this issue needs to be addressed in both developing and developed countries.

Decreasing violence against women and girls requires a community-based, multi-pronged approach, and sustained engagement with multiple stakeholders. The most effective initiatives address underlying risk factors for violence, including social norms regarding gender roles and the acceptability of violence.

The World Bank is committed to addressing gender-based violence through investment, research and learning, and collaboration with stakeholders around the world.

Since 2003, the World Bank has engaged with countries and partners to support projects and knowledge products aimed at preventing and addressing GBV. The Bank supports over $300 million in development projects aimed at addressing GBV in World Bank Group (WBG)-financed operations, both through standalone projects and through the integration of GBV components in sector-specific projects in areas such as transport, education, social protection, and forced displacement.  Recognizing the significance of the challenge, addressing GBV in operations has been highlighted as a World Bank priority, with key commitments articulated under both IDA 17 and 18, as well as within the World Bank Group Gender Strategy .

The World Bank conducts analytical work —including rigorous impact evaluation—with partners on gender-based violence to generate lessons on effective prevention and response interventions at the community and national levels.

The World Bank regularly  convenes a wide range of development stakeholders  to share knowledge and build evidence on what works to address violence against women and girls.

Over the last few years, the World Bank has ramped up its efforts to address more effectively GBV risks in its operations , including learning from other institutions.

Addressing GBV is a significant, long-term development challenge. Recognizing the scale of the challenge, the World Bank’s operational and analytical work has expanded substantially in recent years.   The Bank’s engagement is building on global partnerships, learning, and best practices to test and advance effective approaches both to prevent GBV—including interventions to address the social norms and behaviors that underpin violence—and to scale up and improve response when violence occurs.  

World Bank-supported initiatives are important steps on a rapidly evolving journey to bring successful interventions to scale, build government and local capacity, and to contribute to the knowledge base of what works and what doesn’t through continuous monitoring and evaluation.

Addressing the complex development challenge of gender-based violence requires significant learning and knowledge sharing through partnerships and long-term programs. The World Bank is committed to working with countries and partners to prevent and address GBV in its projects. 

Knowledge sharing and learning

Violence against Women and Girls: Lessons from South Asia is the first report of its kind to gather all available data and information on GBV in the region. In partnership with research institutions and other development organizations, the World Bank has also compiled a comprehensive review of the global evidence for effective interventions to prevent or reduce violence against women and girls. These lessons are now informing our work in several sectors, and are captured in sector-specific resources in the VAWG Resource Guide: www.vawgresourceguide.org .

The World Bank’s  Global Platform on Addressing GBV in Fragile and Conflict-Affected Settings  facilitated South-South knowledge sharing through workshops and yearly learning tours, building evidence on what works to prevent GBV, and providing quality services to women, men, and child survivors.  The Platform included a $13 million cross-regional and cross-practice initiative, establishing pilot projects in the Democratic Republic of Congo (DRC), Nepal, Papua New Guinea, and Georgia, focused on GBV prevention and mitigation, as well as knowledge and learning activities.

The World Bank regularly convenes a wide range of development stakeholders to address violence against women and girls. For example, former WBG President Jim Yong Kim committed to an annual  Development Marketplace  competition, together with the Sexual Violence Research Initiative (SVRI) , to encourage researchers from around the world to build the evidence base of what works to prevent GBV. In April 2019, the World Bank awarded $1.1 million to 11 research teams from nine countries as a result of the fourth annual competition.

Addressing GBV in World Bank Group-financed operations

The World Bank supports both standalone GBV operations, as well as the integration of GBV interventions into development projects across key sectors.

Standalone GBV operations include:

• In August 2018, the World Bank committed $100 million to help prevent GBV in the DRC . The Gender-Based Violence Prevention and Response Project will reach 795,000 direct beneficiaries over the course of four years. The project will provide help to survivors of GBV, and aim to shift social norms by promoting gender equality and behavioral change through strong partnerships with civil society organizations. 
• In the  Great Lakes Emergency Sexual and Gender Based Violence & Women's Health Project , the World Bank approved $107 million in financial grants to Burundi, the DRC, and Rwanda  to provide integrated health and counseling services, legal aid, and economic opportunities to survivors of – or those affected by – sexual and gender-based violence. In DRC alone, 40,000 people, including 29,000 women, have received these services and support.
• The World Bank is also piloting innovative uses of social media to change behaviors . For example, in the South Asia region, the pilot program WEvolve  used social media  to empower young women and men to challenge and break through prevailing norms that underpin gender violence.

Learning from the Uganda Transport Sector Development Project and following the Global GBV Task Force’s recommendations , the World Bank has developed and launched a rigorous approach to addressing GBV risks in infrastructure operations:

• Guided by the GBV Good Practice Note launched in October 2018, the Bank is applying new standards in GBV risk identification, mitigation and response to all new operations in sustainable development and infrastructure sectors.
• These standards are also being integrated into active operations; GBV risk management approaches are being applied to a selection of operations identified high risk in fiscal year (FY) 2019.
• In the East Asia and Pacific region , GBV prevention and response interventions – including a code of conduct on sexual exploitation and abuse – are embedded within the Vanuatu Aviation Investment Project .
• The Liberia Southeastern Corridor Road Asset Management Project , where sexual exploitation and abuse (SEA) awareness will be raised, among other strategies, as part of a pilot project to employ women in the use of heavy machinery. 
• The Bolivia Santa Cruz Road Corridor Project uses a three-pronged approach to address potential GBV, including a Code of Conduct for their workers; a Grievance Redress Mechanism (GRM) that includes a specific mandate to address any kinds gender-based violence; and concrete measures to empower women and to bolster their economic resilience by helping them learn new skills, improve the production and commercialization of traditional arts and crafts, and access more investment opportunities.
• The Mozambique Integrated Feeder Road Development Project identified SEA as a substantial risk during project preparation and takes a preemptive approach: a Code of Conduct; support to – and guidance for – the survivors in case any instances of SEA were to occur within the context of the project – establishing a “survivor-centered approach” that creates multiple entry points for anyone experiencing SEA to seek the help they need; and these measures are taken in close coordination with local community organizations, and an international NGO Jhpiego, which has extensive experience working in Mozambique.

Strengthening institutional efforts to address GBV  

In October 2016, the World Bank launched the  Global Gender-Based Violence Task Force  to strengthen the institution’s efforts to prevent and respond to risks of GBV, and particularly sexual exploitation and abuse (SEA) that may arise in World Bank-supported projects. It builds on existing work by the World Bank and other actors to tackle violence against women and girls through strengthened approaches to identifying and assessing key risks, and developing key mitigations measures to prevent and respond to sexual exploitation and abuse and other forms of GBV. 

In line with its commitments under IDA 18 , the World Bank developed an Action Plan for Implementation of the Task Force’s recommendations , consolidating key actions across institutional priorities linked to enhancing social risk management, strengthening operational systems to enhance accountability, and building staff and client capacity to address risks of GBV through training and guidance materials.

As part of implementation of the GBV Task Force recommendations, the World Bank has developed a GBV risk assessment tool and rigorous methodology to assess contextual and project-related risks. The tool is used by any project containing civil works.

The World Bank has developed a Good Practice Note (GPN) with recommendations to assist staff in identifying risks of GBV, particularly sexual exploitation and abuse and sexual harassment that can emerge in investment projects with major civil works contracts. Building on World Bank experience and good international industry practices, the note also advises staff on how to best manage such risks. A similar toolkit and resource note for Borrowers is under development, and the Bank is in the process of adapting the GPN for key sectors in human development.

The GPN provides good practice for staff on addressing GBV risks and impacts in the context of the Environmental and Social Framework (ESF) launched on October 1, 2018, including the following ESF standards, as well as the safeguards policies that pre-date the ESF: 

• ESS 1: Assessment and Management of Environmental and Social Risks and Impacts;
• ESS 2: Labor and Working Conditions;
• ESS 4: Community Health and Safety; and
• ESS 10: Stakeholder Engagement and Information Disclosure.

In addition to the Good Practice Note and GBV Risk Assessment Screening Tool, which enable improved GBV risk identification and management, the Bank has made important changes in its operational processes, including the integration of SEA/GBV provisions into its safeguard and procurement requirements as part of evolving Environmental, Social, Health and Safety (ESHS) standards, elaboration of GBV reporting and response measures in the Environmental and Social Incident Reporting Tool, and development of guidance on addressing GBV cases in our grievance redress mechanisms.

In line with recommendations by the Task Force to disseminate lessons learned from past projects, and to sensitize staff on the importance of addressing risks of GBV and SEA, the World Bank has developed of trainings for Bank staff to raise awareness of GBV risks and to familiarize staff with new GBV measures and requirements.  These trainings are further complemented by ongoing learning events and intensive sessions of GBV risk management.

Last Updated: Sep 25, 2019

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Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action

Reducing risk, promoting resilience and aiding recovery, module 2: defining gbv.

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Gender-based Violence: Prevalence and Health Consequences

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2. Understanding Gender-based Violence

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2. Understanding Gender-based Violence. Aim of this module. To understand the concept of GBV, its causes and consequences on women ’ s health To understand the dynamics of GBV in intimate relationships and the resulting behaviour of patients showing symptoms of GBV

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• gender based
• domestic violence
• affects women
• health care providers
• men experience violence differently

Presentation Transcript

Aim of this module • To understand the concept of GBV, its causes and consequences on women’s health • To understand the dynamics of GBV in intimate relationships and the resulting behaviour of patients showing symptoms of GBV • To reflect on common myths surrounding GBV and on how they may influence the health care response to GBV

Outlook • Definitions and forms of GBV • Scope of GBV (globally and in EECA) • Causes of GBV • Dynamics of violent relationships • Myths and facts about GBV • GBV and multiple discrimination • Health consequences of GBV

Definitions and Forms of GBV 4

International definitions (1) Violence against women: “Any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”UN Declaration on the Elimination of Violence against Women (DEVAW, 1993) Gender-based violence: “Violence that is directed against a woman because she is a woman or that affects women disproportionately.”CEDAW General Recommendation no. 19 (1992)

International definitions (2) Violence against women is • a manifestation of the historically unequal power relations between men and women, which have led to domination over and discrimination against women by men • one of the crucial social mechanisms by which women are forced into a subordinate position compared with men • constitutesa violation of human rights and a form of discrimination against women (DEVAW)

International definitions (3) Violence against women includes: • Violence occurring in the family, including battering, sexual abuse of female children in the household, dowry-related violence, marital rape, female genital mutilation and other traditional practices harmful to women, non-spousal violence and violence related to exploitation; • Violence occurring within the general community, including rape, sexual abuse, sexual harassment and intimidation at work, in educational institutions and elsewhere, trafficking in women and forced prostitution; • Violence perpetrated or condoned by the State, wherever it occurs. (DEVAW)

Definition of GBV (1) 1. Violence against women is gender-based – it does not occur to women randomly. • Structural problem embedded in unequal gender power relationships • Gender dimensions of VAW: • GBV mainly affects women and girls • Women and men experience violence differently • Women are more likely to die at the hands of someone they know • Women survivors face specific barriers in accessing services • Fewer resources and options to access justice, care, and support • Laws and implementing authorities often fail to adequately respond to VAW

Definition of GBV (2) 2. GBV is a violation of women’s human rights and a form of discrimination against women. • Examples of violated rights: • Right to life • Right to be free from torture and inhuman or degrading treatment of punishment • Right to health • Right to equal protection by the law

Definition of GBV (3) 3. Women experience GBV in all areas of life – the private and the public sphere. • BUT most violence occurs in the family: • 30% of all women who ever lived in a partnership experienced physical or sexual violence by a partner (WHO 2013). • Women make up 2/3 of all persons killed by an intimate partner (but only 20% of homicide victims, UNODC 2014).

Definition of GBV (4) Domestic violence Physical, sexual, psychological or economic violence, • within the family or domestic unit or between former or current spouses or partners, • whether or not the perpetrator shares or has shared the same residence with the victim (Art. 3 Istanbul Convention) Intimate partner violence Behaviour by an intimate partner, • that causes physical, sexual or psychological harm, • including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours. • It covers violence by both current and former spouses and other intimate partners (WHO et al 2013)

Definition of GBV (5) 4. GBV encompasses a broad range of harmful acts: • Physical violence, e.g.: slapping, hitting, pushing, choking, shaking, spitting, restraining, use of weapons. May or may not cause injuries • Sexual violence, e.g. rape, other forms of sexual assault, forced marriage, forced abortion, forced sterilization, female genital mutilation (FGM) • Psychological violence, e.g. threats, emotional violence, use of children • Economic violence, e.g. withholding money, prohibiting the woman to work, excluding her from financial decisions H1 H1

Examplesof GBV in EECA H2

Examplesof GBV in EECA (2) H2

Scope of GBV

Global and regional prevalence estimates of GBV (WHO et al 2013) • For examples of country-specificprevalencedata from Eastern Europe and Central Asia, seeHandout 3. * Europe referstolow-and middle-income countries in Europe and Central Asia. H3

Causes of GBV

The ecologicalframework for undertanding GBV • GBV iscausedby a combinationoffactorsthatincreasetheriskof a man committingviolenceandtheriskof a womanexperiencingviolence. Source: Heise 1998

The ecological framework Individual-level factors Relationship-level  Relationships with partners, family, peers Men with multiple partners Partnerships with low martial satisfaction or continuous disagreements Disparities in education status between partners Family blaming the woman instead of the man for sexual violence  Biological, personal history • Low level of education • Young age (early marriage) • Past experiences of violence • Pregnancy • Use of alcohol (weak evidence for causal relationship) • Attitudes of violence as acceptable behavior Source: WHO/LSHTM 2010

The ecologicalframework Community-level Society-level factors  Cultural and social norms that shape gender roles Higher IPV when men have economic and decision-making powers in the household Ideologies of male sexual entitlement Social breakdown from conflicts or disasters  Social relationships in school, workplace, and neighbourhood • Societies with community sanctions against violence have the lowest levels of IPV and SV • Poverty – rather a “marker” than a factor increasing risk as such Source: WHO/LSHTM 2010

Domestic Violence – Understanding the Dynamics of Violent Relationships

Importanceofunderstandingthedynamics • Many health professionals share the norms, beliefs, and attitudes of broader society. • Negative attitudes towards survivors can inflict additional harm on them. • Not understanding the dynamics of violence may cause health professionals to wonder why she doesn‘t leave the abusive relationship and then think that she does not need or deserve help.  Maintain a supportive, non-judgemental and validating attitude towards survivors.

Power & Control Wheel Source: Domestic Abuse Intervention Project, Duluth. H4

The cycle of violence(Walker 1978) • Over time, phases of aggression increase in severity and duration; “honeymoon” phases become shorter. • Women develop a strategy for survival (denying abuse, refusing help offered, defending the aggressor).

Stockholm Syndrome (Grahams, Rawlings 1988) • Explains why women in violent relationships develop close bonds and identify with the abuser • For the first time observed: Stockholm, 1973 (hostage taking) • 4 conditions: • The life of the victim is threatened. • The victim cannot escape or thinks that escape is impossible. • The victim is isolated from people outside. • The captor shows some degree of kindness to the victim. .

Concept of normalization of violence (Lundgren, 1993) • Women may understand attacks as manifestation of their own failure. • Many women feel strong inner resistance to identify themselves as “battered women” and their violent partners as “abusers. • Making the violence experienced look less serious can be a coping strategy for women. • It is only when the woman has left the violent relationship that she can describe her experiences as violent (“renormalization process”).

Mythsabout GBV

Whybeawareof GBV myths? Myths and stereotypical attitudes about GBV • are harmful because they blame the survivor and not the perpetrator • shape society and the health sector‘s perceptions and responses • may prevent health care providers from identifying GBV and providing care  Health care providers need to distinguish between myths and facts and maintain a professional and impartial attitude. H5

Examples of myths about GBV • Battering is not a crime. Men have the right to control their wive‘s behaviour and to discipline them. • Some women deserve the violence they experience. • Battered women allow abuse to happen to them. They can leave if they really wanted to. • Conflicts and losing control are a normal part of any relationship. • Domestic violence is a private family matter and therefore the state or service providers have no right to intervene. H6

GBV and multiple discrimination

Women in conflictand post-conflictsituations

Women with disabilities • Stereotypes contribute to sexual violence and lack of credibility when abuse is reported, e.g. • Regarding them as recipients of charity, objects of others’ decisions • Portraying them as non-sexual beings, being compliant and timid • Other forms of violence they experience: • Withholding of medication or communication aids • Refusal of caregivers to assist with bathing, dressing or eating • Restricting access to family, friends or phone calls • Often denied control of sexual/ reproductive choices • Can lead to forced sterilization & forced termination of wanted pregnancies

Migrant women • Informal sector- domestic, agricultural, sex work • Lack of legal protection • Limited access to justice and health care • Language barriers • Lack of information on rights & options • Exclusion from national health insurance coverage • Fear of losing residency status • May prevent leaving an abusive partner or employer • Undocumented migrant women: lack of access to protection because of fear of deportation

Adolescent girls

Older women

Rural women

Consequences of GBV

Health consequences of GBV

Examples of health consequences of intimate partner violence (WHO 2013)

Impact of violence on children (1) • Directly or indirectly affected by domestic violence • Means of discipline: physical, cruel or humiliating punishment • Sexual abuse by family members • Injured (intentionally or unintentionally) during an attack against their mother • Witnessing violence against their mother • Used by the father/husband to coercively control their mother

Impact of violence on children (2) • Serious impact on their physical, psychological and sexual health and development • Witnessing intimate partner violence against their mothers – even when the child is not physically targeted • Has negative social and health consequences for children, including anxiety, depression, poor school performance and negative health outcomes • Is a risk factor for experiencing (girls) or perpetrating (boys) intimate partner violence later in life H8

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Gender-Based Violence Prevention and Response

For societies to thrive, all people must have equal rights, be able to safely exercise their own voice, and live free from intimidation, harassment, discrimination and violence. Preventing and responding to gender-based violence (GBV) around the world is a matter of human rights, justice, equity, and equality.

GBV is any harmful threat or act directed at an individual or group based on actual or perceived sex, gender, gender identity or expression, sex characteristics, or sexual orientation, and/or lack of adherence to varying socially constructed norms around masculinity and femininity. Although individuals of all gender identities may experience GBV, women, girls, and LGBTQI+ individuals face a disproportionate risk of GBV across every context due to their unequal status in society. GBV also cuts across identity categories and social statuses, including but not limited to age, disability, ethnicity, race, socioeconomic class, religion, education level, and citizenship status. Perpetrators of GBV operate in a variety of social locations, including the family, the public sphere, workplaces, schools, religious institutions, and via digital technologies, with technology-facilitated gender-based violence (TFGBV) often crossing from digital spaces to in-person experiences. GBV is rooted in structural gender inequalities, patriarchy, and power imbalances. Across its many manifestations, GBV is a human rights violation prohibited under international humanitarian law and a barrier to civic, social, political, legal, and economic participation.

Although statistics on the prevalence of GBV vary, the scale is tremendous, and the consequences for individuals, families, communities, and countries are devastating. Despite the scope of the issue, there are proven strategies to prevent, mitigate, and respond to GBV effectively. These include:

• Expand the provision of high-quality, survivorcentered GBV response services addressing health, psychosocial, shelter, economic, and legal needs in humanitarian and development settings.
• Pursue structural interventions to improve the creation, implementation, and enforcement of laws and shift harmful gender norms and beliefs.
• Reduce acceptance of GBV and promote more gender-equitable norms across individual, household, community, and institutional levels.
• Engage local, women-led, and women’s rights organizations, community influencers, and men and boys to achieve transformational change.

Eliminating GBV continues to be a long-standing goal of the U.S. government in foreign assistance. For more than two decades, USAID has worked with a wide array of partners to increase awareness of the scope of GBV and its impact; improve services for survivors; and strengthen prevention and response efforts. In December 2022, the U.S. government released an update to the U.S. Strategy to Prevent and Respond to Gender-Based Violence Globally (Global GBV Strategy) , recommitting to the critical work of preventing, mitigating, and responding to GBV globally with the vision to build a future free from GBV for all people.

With the Global GBV Strategy, we seek to:

• Advance equity and inclusivity, and address the specific identity factors that increase the risks of GBV and undermine access to services and safety, particularly for the most marginalized groups;
• Support expanded approaches for addressing GBV priorities across a range of thematic areas; and
• Strengthen the commitment and work of the U.S. government to bring to scale what works, enhance our partnerships, and improve our capacity to prevent and respond to GBV.

Related Links

• Addendum to the Toolkit for Monitoring and Evaluating Gender-Based Violence Interventions along the Relief to Development Continuum
• Toolkit for Monitoring and Evaluating Gender-Based Violence Interventions Along the Relief to Development Continuum
• Collective Action to Reduce Gender-Based Violence (CARE-GBV)
• Gender-Based Violence Environment Linkages Center
• Fact Sheet: 2022 U.S. Strategy to Prevent and Respond to Gender-Based Violence Globally
• National Strategy on Gender Equity and Equality
• USAID 2023 Gender Equality and Women’s Empowerment Policy
• Executive Order 14020 on Establishment of the White House Gender Policy Council
• LGBTQI+ Inclusive Development Policy

Foundational Elements for Gender-Based Violence Programming in Development

Striving to End Female Genital Mutilation or Cutting

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Gender-based violence is one of the world’s most pervasive human rights violations

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women and girls have experienced intimate partner violence, non-partner sexual violence or both

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Gender-based violence and harmful practices like female genital mutilation, child marriage and son preference are rooted in gender inequality.

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Gender-based violence can strip women and girls of their agency, dignity and capacity, and sometimes even their lives.

Yet amidst their trauma, survivors rise up to experience joy, personal growth and the empowerment that comes with fighting for change in their own lives and in their societies., unfpa leads programmes to prevent, respond to and mitigate gender-based violence in, over 153 countries and territories, countries and territories where unfpa works on gender-based violence, by responding to the needs of survivors, supporting their agency and investing in individuals, communities and systems, we can end gender-based violence., partnership is at the core of the movement to end gender-based violence., no single organization can do it alone..

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Make sure that sexual and reproductive health services and comprehensive sexuality education address gender-based violence.

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Support the agency of women, girls and young people in all their diversity.

Respond and act to the impacts of GLOBAL HEALTH CRISES, INCLUDING Covid-19, climate change and environmental degradation, which heighten risks of gender-based violence and make it harder for survivors to access support.

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