A Human Rights and Health Priority
"[Violence against women] cuts across social and economic situations
and is deeply embedded in cultures around the world — so much
so that millions of women consider it a way of life."1
Bartholomew/Liaison |
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Indian prostitutes. Many women and girls are lured into prostitution by traffickers who target the poor and vulnerable. |
Gender-based
violence — in various forms including rape, domestic violence,
"honour" killings and trafficking in women — exacts a heavy
toll on mental and physical health. Increasingly, gender-based violence
is recognized as a major public health concern and a serious violation
of basic human rights.2
Around the world, at least one in every three women has been beaten,
coerced into sex, or abused in some other way — most often
by someone she knows, including by her husband or another male family
member; one woman in four has been abused during pregnancy.3
Millions of women require medical attention or otherwise suffer
the impact of gender-based violence; fear of violence inhibits discussion
and constrains the health choices and life opportunities of many
millions more.
Psychological abuse almost always accompanies physical abuse. In
addition, one third to one half of all cases involve sexual abuse.
A high proportion of women who are beaten are subjected to violence
repeatedly.4
Violence against women is a pervasive yet under-recognized human
rights violation. Accordingly, the 1993 World Conference on Human
Rights, Vienna,and the 1995 Fourth World Conference on Women, Beijing,
gave priority to this problem.
Violence against women and girls takes many forms:
- At least 60 million girls who would otherwise be expected to
be alive are "missing" from various populations, mostly in Asia,
as a result of sex-selective abortions, infanticide or neglect;
- Studies suggest domestic violence is widespread in most societies
and is a frequent cause of suicides among women;
- Rape and other forms of sexual violence are increasing. Many
rapes go unreported because of the stigma and trauma associated
with them and the lack of sympathetic treatment from legal systems.
Estimates of the proportion of rapes reported to authorities vary
— from less than 3 per cent in South Africa to about 16 per
cent in the United States;
- Two million girls between ages 5 and 15 are introduced into
the commercial sex market each year;
- At least 130 million women have been forced to undergo female
genital mutilation or cutting; another 2 million are at risk each
year from this degrading and dangerous practice;
- So-called "honour" killings take the lives of thousands of young
women every year, mainly in Western Asia, North Africa and parts
of South Asia. At least 1,000 women were murdered in Pakistan
in 1999.
Figure 5: Percentage
of Adult Women Reporting Physical Assault by Male Partner
In the United States, a woman is battered, usually by her intimate
partner, every 15 seconds.5
Physical violence is nearly always accompanied by psychological
abuse, which can be just as demeaning and degrading. Among 613 abused
women in Japan, for instance, close to 60 per cent had suffered
from physical, psychological and sexual abuse at the hands of their
partners; only 8 per cent had experienced physical abuse alone.6
Similarly, in Leon, Nicaragua, researchers found that of 188 women
abused by their partners, only 5 had not been sexually assaulted.7
Measuring acts of violence against women and girls does not, of
course, describe the atmosphere of terror that often permeates abusive
relationships. For instance, in a nationwide domestic violence survey
in Canada in 1993, researchers discovered that a full one third
of all women who had been subjected to domestic violence had feared
for their lives at some point in the relationship.8
Women often assert that prolonged psychological abuse and degradation
are more difficult to bear than physical pain.9
Many cultures condone or at least tolerate a certain amount of
violence against women. In parts of South Asia, Western Asia and
Africa, for instance, men are seen as having a right to discipline
their wives as they see fit. The right of a husband to beat or physically
intimidate his wife is a deeply held conviction in many societies.
Even women often view a certain amount of physical abuse as justified
under certain conditions. For instance, 80 per cent of women surveyed
in rural Egypt said that beatings were common and often justified,
particularly if the woman refused to have sex with her partner.10
Justification for violence stems from gender norms — distorted
views about the roles and responsibilities of men and women in relationships.
Worldwide, studies have shown a consistent pattern of events that
trigger violent responses. These include: not obeying the husband,
talking back, refusing sex, not having food ready on time, failing
to care for the children or home, questioning the man about money
or girlfriends or going somewhere without his permission.11
Impacts on Reproductive Health
Violence in all its forms causes immense damage to the reproductive
health and well-being of women and girls throughout the world, in
direct and indirect ways:
- Unwanted pregnancies and restricted access to family planning
information and contraceptives;
- Unsafe abortion or injuries sustained during a legal abortion
after an unwanted pregnancy;
- Complications from frequent, high-risk pregnancies and lack
of follow-up care;
- Sexually transmitted diseases, including HIV/AIDS;
- Persistent gynaecological problems;
- Psychological problems, including fear of sex and loss of pleasure.
Box 17: Killings in
Sweden Spark Debate about Domestic Violence
Violence as a barrier to family planning
Though most contraceptive use is accepted by both partners, researchers
have found that abused women tend not to use family planning services,
even if readily available, for fear of reprisals from husbands.
Women in Zimbabwe and Kenya, for instance, often hide their contraceptive
pills because they are terrified of the consequences should their
husbands discover that they no longer control their wives' fertility.12
Similarly, abused women who participated in focus group discussions
in Peru and Mexico said they did not discuss contraceptive use with
their husbands out of fear that the men would turn violent.13
In a study in Ghana, close to half of all women and 43 per cent
of men said a man was justified in beating his wife if she used
a family planning method without his expressed consent.14
Box 18: Women's Attackers
Seldom Punished in Pakistan
Abortion
Women who are abused or afraid to raise the issue of family planning
with their partners are at risk of repeated unwanted pregnancies.
Many abused women seek abortions.
High-risk pregnancies
Violence has been linked with increased risk of miscarriages, premature
labour, foetal distress and low birth weight.15
A study in Leon, Nicaragua, found that violence against pregnant
women was associated with a threefold increase in low birth-weight
babies.16 Blunt abdominal
trauma can lead to foetal death or low birth weight by provoking
pre-term delivery.17
Violence may also affect the outcome of pregnancies indirectly by
increasing a woman's likelihood of engaging in harmful behaviour
such as smoking and alcohol and drug abuse, all of which have been
linked to pregnancy complications and low birth weight.18
Stress and anxiety brought on by persistent violent behaviour during
pregnancy can reduce a woman's ability to obtain adequate nutrition,
rest, exercise and medical care; this may retard foetal growth.19
Violence and STDs
Forced or unprotected sex puts women at risk of acquiring STDs,
including HIV/AIDS. Many STDs and reproductive tract infections
could be prevented if men routinely wore condoms when engaging in
sex and refrained from having sex when the woman complained of soreness
or other problems. Many women are afraid to ask their partners to
wear condoms during sex for fear of violent reactions.
Rape victims are especially at risk of infection. Up to 30 per
cent of women raped in the United States every year, for instance,
develop an STD as a result.
Molestation of young girls is another profoundly disturbing aspect
of this problem. A study in Zaria, Nigeria, for example, found that
16 per cent of hospital patients with sexually transmitted infections
were under age 5.20 At
the Genito-Urinary Centre in Harare, Zimbabwe, doctors discovered
that more than 900 children under age 12 had been treated for an
STD in 1990 alone.21
Persistent gynaecological problems
Physical and sexual abuse also increases a woman's risk for a number
of common gynaecological disorders, including chronic pelvic pain.
In many countries, chronic pelvic pain accounts for up to 10 per
cent of all visits to gynaecologists and one quarter of all hysterectomies.22
Although chronic pelvic pain is normally caused by adhesions, endometriosis
or infections, about half the cases treated have no identifiable
pathology. A number of studies have found that women suffering from
pelvic pain are consistently more likely to have a history of childhood
sexual abuse, sexual assault or physical and sexual abuse by their
partners.23
Other gynaecological problems associated with sexual violence include
vaginal bleeding, vaginal discharge, painful menstruation, pelvic
inflammatory disease and sexual dysfunction.24
Sexual assault also increases the risk for premenstrual distress,
a condition that affects up to 10 per cent of menstruating women
and causes physical, mood and behavioural changes.25
Psychological problems
Violence distorts the emotional lives of women and families. In
Nicaragua, for instance, focus group studies found that many women
considered the persistent psychological effects of domestic violence
to be more severe and debilitating than the physical ones. Violence
can also lead to suicide.26
Serious episodes of depression affect about one third of battered
women in the United States.27
One study found that one fourth of all suicide attempts were preceded
by abuse. Data in the United States suggest that women who were
sexually abused as children tend to end up in abusive relationships
and have a higher than normal risk of becoming involved in prostitution
and drugs.28
Another U.S. study found that women who had been sexually molested
as children were three times more likely to be pregnant by age 18
than women who had not been abused. Women who had been abused as
children were also twice as likely to put themselves at risk of
acquiring an STD or HIV infection by having unprotected sex with
multiple partners.29
Table 1: Gender Violence throughout a Woman's
Life
|
Phase
|
Type of Violence
|
 |
| Prenatal |
Sex-selective abortions, battering during pregnancy, coerced
pregnancy (rape during war) |
|
| Infancy |
Female infanticide, emotional and physical abuse, differential
access to food and medical care |
|
| Childhood |
Genital mutilation; incest and sexual abuse; differential
access to food, medical care, and education; child prostitution |
|
| Adolescence |
Dating and courtship violence, economically coerced sex,
sexual abuse in the workplace, rape, sexual harassment, forced
prostitution |
|
| Reproductive |
Abuse of women by intimate partners, marital rape, dowry
abuse and murders, partner homicide, psychological abuse,
sexual abuse in the workplace, sexual harassment, rape, abuse
of women with disabilities |
|
| Old Age |
Abuse of widows, elder abuse (which affects mostly women) |
|
| Source: Heise, L. 1994. Violence Against Women: The Hidden Health Burden. World Bank Discussion Paper. Washington. D.C.:
The World Bank. |
|
Trafficking in Women and Girls
An estimated 4 million women and girls are bought and sold worldwide,
either into marriage, prostitution or slavery.30
Many are lured into the hands of traffickers by promises of jobs.
In some countries, traffickers target poor, vulnerable communities.
They may arrive during a drought or before the harvest, when food
is scarce, and persuade poor families to sell their daughters for
small amounts of money.
Each year, at least 10,000 girls and women enter Thailand from
poorer neighbouring countries and end up in commercial sex work,
according to UNICEF. Some 5,000 to 7,000 Nepali girls are trafficked
across the border to India each year, mostly ending up as sex workers
in Mumbai or New Delhi.31
Although the greatest volume of trafficking occurs in Asia, Eastern
European women are increasingly vulnerable.
Box 19: Trafficking
in the United States Rarely Punished, Report Says
"Honour" Killings
Throughout the world, perhaps as many as 5,000 women and girls
a year are murdered by members of their own families, many of them
for the "dishonour" of having been raped, often as not by a member
of their own extended family.
Many forms of communally sanctioned violence against women, such
as "honour" killings, are associated with the community's or the
family's demand for sexual chastity and virginity. Perpetrators
of such wanton acts often receive light sentences or are excused
by the courts entirely because defence of the family's honour is
treated as a mitigating circumstance.
"Honour" killings are on the rise worldwide, according to Asma
Jahangir, the United Nations special rapporteur on extrajudicial,
summary and arbitrary executions. Ms. Jahangir is working closely
with United Nations special investigators on violence against women
and on the independence of judges and lawyers to address the issue.
"The perpetrators of these crimes are mostly male family members
of the murdered women, who go unpunished or receive reduced sentences
on the justification of having murdered to defend their misconceived
notions of 'family honour,'" Jahangir wrote in her 2000 annual report
to the Commission on Human Rights.32
Such killings have been reported in Bangladesh, Brazil, Ecuador,
Egypt, India, Israel, Italy, Jordan, Morocco, Pakistan, Sweden,
Turkey, Uganda and the United Kingdom, according to the report.
On the order of clerics, an 18-year-old woman was flogged to death
in Batsail, Bangladesh, for "immoral" behaviour, according to the
report. In Egypt, a father paraded his daughter's severed head through
the streets shouting, "I avenged my honour."
The report says that "honour" killings tend to be more prevalent
in, but are not limited to, countries with a majority Muslim population.
It adds, however, that Islamic leaders have condemned the practice
and say it has no religious basis.
Box 20: Two 'Honour'
Killings in Jordan
NGOs Work against Gender Violence
NGOs' work worldwide on violence against women is one of the most
important contributions to ending gender-based oppression.
Through the work of African NGOs, with the support of international
organizations, FGM is being challenged and the practice outlawed,
giving millions of girls and women hopes for a life with rights,
health and security. The Inter-African Committee on Traditional
Practices Affecting the Health of Women and Children, a network
of affiliates in 26 African and 3 European countries, has led the
increasingly successful fight against FGM through public awareness
campaigns and training in schools, and communities with traditional
and trained medical staff.
NGOs are also on the front line in work with women survivors of
violence and rape in war. The Corporación Grupo de Apoyo
in Bosa, Colombia, shelters women suffering from domestic
violence and sexual violence so they can rebuild their self-esteem
and reassert their own power. In San Cristobal de las Casas, a city
in the Chiapas highlands of Mexico, the Centro de Apoyo
a la Mujer (Women's Support Centre) provides training and support
for women living in extreme poverty and uncertainty, seeking particularly
to change practices such as forcing girls as young as 10 to marry
and traditions that condone wife abuse, domestic violence and incest.
In Bosnia, where after years of conflict women suffer not
only sexual violence but also mental and physical damage and stress,
a German gynaecologist set up Medica Zenica. In its first
five years it has provided 20,000 women and children with counselling,
and reached women in isolated villages through a mobile outpatient
clinic. Isis - Women's International Cross Cultural Exchange in
Uganda supports survivors of sexual violence in Burundi,
Rwanda, the Sudan and Uganda through an exchange programme in which
women share their experiences in a supportive and healing atmosphere.
NGOs campaigning against gender-based violence are increasingly
using the Internet. For example, in Rajasthan, India, when
members of the Bal Rashmi Society — which actively opposes
sexual exploitation, rape, and dowry-related deaths and torture
— were jailed, an Internet alert led to suspension of their
trials.
B.a.B.e., a strategic lobbying group in Croatia, has used
the Internet to raise awareness of women's experience of violence
during war, and to bring about a new family law that includes restraining
orders against men in domestic rape cases. Women's International
Network-Emergency and Solidarity uses the Internet to share experiences
among women working in situations of conflict, war, ecological disaster
or extreme poverty.
Women Living Under Muslim Law has mounted a World Wide Web campaign
around the denial of women's rights in Islamic societies; it directs
support to the Association of the Women of Afghanistan, among others.
WomenNet in South Africa used the Internet for a Stop Rape
campaign supported by international signatories.
In the Philippines, women's NGOs initiated the National
Family Violence Prevention Programme; it promotes the innovative
"Voices of 2001: Breaking the Silence Campaign", which has collected
stories of 2,001 women's experiences.
Box 21: Women Foreign
Ministers Seek End To Human Trafficking
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