The State of World Population 2000 Chapter 3: Ending Violence against Women and Girls

United Nations Population Fund

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

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

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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


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


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.

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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

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"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

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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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