Although reliable data on the incidence of gender-based violence are scarce, especially for developing countries, there is an increasing body of knowledge indicating that it is widespread and common. It occurs in a broad context of gender-based discrimination with regard to access to education, resources, and decision-making power in private and public life.

In 1993, the World Development Report of the World Bank estimated that "women ages 15 to 44 lose more Discounted Health Years of Life (DHYLs) to rape and domestic violence than to breast cancer, cervical cancer, obstructed labour, heart disease, AIDS, respiratory infections, motor vehicle accidents or war."

Since the Convention on the Elimination of All Forms of Discrimination Against Women was adopted by the United Nations General Assembly in 1979, important progress has been made in establishing gender-based violence as a human rights concern. But much less headway has been made in addressing violence against girls and women as a public health issue. Changes in reproductive health policy-making will be critical to recognizing and addressing the consequences of violence for women’s health.

Gender-based violence is universal, differing only in scope from one society to the next. Much of this violence is inflicted on girls and women by husbands, fathers, or other male relatives. The home can be one of the most dangerous places for a woman to be.

Domestic violence exists in a "culture of silence" and denial, and of denial of the seriousness of the health consequences of abuse at every level of society. The fact that domestic violence against girls and women has long been considered a "private" affair has contributed to the serious gap in public health policy-making and the lack of appropriate programmes.

Given that gender-based violence is so widespread, the relative lack of policy debate and decision-making about it is remarkable (although there have been some encouraging recent policy statements in several Latin American countries, for instance). Moreover, the health consequences of both physical and psychological violence against women have hardly been touched by the public health sector.

Few studies have been made of gender-based violence, partly because of the lack of accurate definitions, but also because it is so seldom reported to authorities. Women have many reasons for not reporting incidents of violence. Legal authorities often do not take appropriate action. Many women do not know their legal rights. Women have good reason to fear that they will be victimized again, either by insensitive, accusatory questions or by actual assault. It is estimated that more than 60 per cent of rape victims know their attackers. And health care facilities and police seldom consistently record data on violence against women, the sex of the perpetrators, or the relationship of the abuser to the victim.

The issue must be defined before appropriate measures can be taken. The United Nations Declaration on Violence Against Women provides a basis for defining gender-based violence. According to Article 1 of the Declaration, violence against women is to be understood as:

Article 2 of the Declaration presents what the international community recognizes as generic forms of violence against women. The definition encompasses (but is not limited to): physical, sexual, and psychological violence occurring in the family and in the community, including battering, sexual abuse of female children, dowry-related violence, marital rape; female genital mutilation and other traditional practices harmful to women; nonspousal violence; violence related to exploitation, sexual harassment, and intimidation at work and in educational institutions; forced pregnancy, forced abortion, and forced sterilization; trafficking in women and forced prostitution; and violence perpetrated or condoned by the state.

Girls and women face systematic discrimination from entrenched power relations that perpetuate the almost universal subordination of females. This leaves them highly vulnerable to being harmed physically, sexually or psychologically by the men in their families and communities.

In developing programmes to address this, the following definition may be helpful: