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State of World Population 2005

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CHAPTER 7

© Marie Dorigny/UNFPA
Villager covers face in the town of Tigray, Ethiopia.

Gender-Based Violence:
A Price Too High

-The Magnitude and Many Forms of Gender-Based
Violence


-Violence Against Women and the MDGs

-Mobilizing for 'Zero Tolerance'

-Men Take a Stand

Violence Against Women and the MDGs


The UN Millennium Project affirms that "freedom from violence, especially for girls and women" is a core right and essential to the ability to lead a productive life.(38) Gender-based violence directly jeopardizes the achievement of the MDGs related to gender equality and the empowerment of women, infant and maternal health and mortality, and combating HIV/AIDS. It can also affect educational attainment. A study in Nicaragua found that 63 per cent of the children of abused women had to repeat a school year and left school on average four years earlier than others.(39) Gender-based violence imposes obstacles to the full participation of women in social, economic and political life. Illustrating the importance of this issue is the call of the UN Millennium Project Task Force on Education and Gender Equality for a global campaign on violence against women under the leadership of the UN Secretary-General.(40)

CONSEQUENCES FOR REPRODUCTIVE HEALTH. Violence against women compromises reproductive health and pregnancy outcomes. Consequences include: unwanted pregnancy, unsafe abortion and maternal mortality; miscarriage and stillbirth; delayed antenatal care; premature labour and childbirth;(41) foetal injury and low birth weight.(42) Abused women also face higher risks of contracting HIV and other sexually transmitted infections. Exposure increases directly with rape and indirectly through fear of negotiating condom use. The fact that violent men tend to have more partners outside of marriage adds to the risks.(43) Sexual coercion is now considered a significant factor in the continuing rise of HIV among young women (see Chapter 5).(44) Brutal rape, such as reported in situations of armed conflict, can result in fistula, perforated sexual organs and other related injuries.(45) The physical consequences of female genital mutilation/cutting include great pain, excessive bleeding, shock, painful sexual intercourse, risks of HIV or other infections from the use of unsanitary tools, chronic pelvic inflammation and even death. Psychological effects include anxiety and depression.(46)


"I hate early marriage. I was married at an early age and my in-laws forced me to sleep with my husband and he made me suffer all night. After that, whenever day becomes night, I get worried thinking that it will be like that. This is what I hate most."

- Ethiopian girl, age 11, married at age 5


About one in four women is abused during pregnancy, which endangers both mother and child.(47) In some districts of India, 16 per cent of deaths during pregnancy were attributed to domestic violence.(48) Violence during pregnancy quadruples the risk of low birth-weight and doubles the risk of miscarriage.(49) In Nicaragua, abuse of expectant mothers accounts for 16 per cent of low-birth-weight infants.(50) Clinical studies, for example, in Hong Kong SAR, China,(51) and Uganda,(52) found that about 30 per cent of women who had abortions reported abuse as the main reason for terminating their pregnancies.

ADDRESSING ABUSE THROUGH REPRODUCTIVE HEALTH PROGRAMMES. Reproductive health services offer a strategic venue for offering support to women who have suffered violence. A visit to a reproductive health centre may be a woman's only chance to obtain help. Even in sub-Saharan Africa, where public health infrastructures are very limited, the overwhelming majority of women receive some antenatal care or family planning information.(53) Addressing violence against women in reproductive health settings may also be cost-effective. Violence is a cause of recurring health problems and prevents a woman from protecting herself against unwanted pregnancies and sexually transmitted infections. Routine screening of women in reproductive health settings can help reduce the risks for both women and infants.

At the 1995 Beijing Conference, governments promised to "integrate mental health services into primary health care systems.and train primary health workers to recognize and care for girls and women of all ages who have experienced any form of violence".(54) During the 1990s, more countries began providing integrated services to address genderbased violence. Malaysia was among the first to establish "one-stop crisis centres" that offered both medical and legal services.(55) Affiliates of the International Planned Parenthood Federation (IPPF) in Brazil, Colombia, the Dominican Republic and Peru expanded their reproductive health services to include a gender-based violence component. An assessment of an IPPF multi-country project found that detection and referral rates of abused women rose dramatically within the first year.(56) UNFPA has tested similar pilot interventions in reproductive health settings in 10 countries. In some, the interventions led to an increase in the availability of health facilities offering on-site screening and care for abused women. It also expanded the network of services available to women beyond the health sector.(57) Governments are also increasingly making emergency contraception available as a component of post-rape care.

EDUCATION, SAFETY AND ECONOMIC ASSETS. Although gender-based violence affects women of all classes, poverty and lack of education are additional risk factors. (58) Increasing educational levels can help prevent violence by empowering young women. Quality educational programmes can also serve as a vehicle for sensitizing young men to respect women's rights.

Making schools safe for girls is an essential step for achieving the MDG education targets. In some countries, parents keep their daughters out of school for fear of sexual abuse or rape. Some countries are taking action. For example, the Government of Panama with UNFPA support developed a national programme to prevent sexual abuse of girls in schools.(59) Women and girls living in poverty are often more vulnerable to rape, possibly because their neighbourhoods and commutes to work or school are more dangerous. Successful public responses include Montreal's "Between Two Stops", which allows women to get off a bus as close to their destination as possible at night, and Bangkok's "Lady Bus" service.(60)

Economic assets also seem to have a protective effect. In Kerala, India, a survey found that 49 per cent of women without property reported physical violence, compared to only 7 per cent of women who owned assets.(61) In some cases, anti-violence efforts are focusing on women's economic empowerment. In Algeria and Morocco, UNFPA is supporting efforts to include such initiatives in existing services for survivors. (62) In Venezuela, UNFPA has supported the efforts of the National Women's Bank, Banmujer, to integrate violence prevention into its credit services. The National Women's Institute, a member of the network of government and non-governmental organizations established to provide relevant services for victims of abuse, operates a hotline to report violence. Bank officers regularly receive refresher training on gender-based violence and reproductive health to better meet the non-financial needs of female clients. Promoting women's economic rights, including their rights to property and inheritance, as recommended by the UN Millennium Project, can help women avoid and end abusive relationships.(63)

31    |    A LIFE FREE OF VIOLENCE-IT'S OUR RIGHT

An initiative launched in 1998 by eight UN agencies, including UNFPA, shows how campaigns can help sustain long-term collaboration among governments, civil society, women's groups and the UN system. The UN Inter-Agency Campaign on Women's Human Rights in Latin America and the Caribbean, "A Life Free of Violence-It's Our Right", was endorsed by 22 governments and kept the issue on the agenda of policymakers and in the public eye.

The campaign used mass media, including a magazine called "Maria Maria," a touring photo competition and public service announcements, to spur national and regional action on violence against women. In 2001, a symposium on gender violence, health and rights in the Americas brought together representatives of health ministries, women's organizations and civil society from 30 countries to identify strategies to meet the public health challenge of violence against women. The symposium's Call to Action placed women's rights to personal security squarely on the agenda of health systems, and urged governments and civil society to take comprehensive legislative, financial and social action. Regional entities and UN agencies continue their collaboration, supporting and monitoring progress at regional and country levels. See Sources


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