Avni Amin, Department of Reproductive Health

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Avni Amin, Department of Reproductive Health
ResearchHuman Reproduction ProgrammeWorld
Health OrganizationDublin, March 8, 2012
Violence against women children health other
consequences
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Acknowledgements

• Global Burden of Disease - team on VAW in WHO
  London School of Hygiene Tropical Medicine
  (LSHTM)
• WHO
• Claudia Garcia-Moreno - Chair
• Christina Pallitto
• LSHTM
• Charlotte Watts - Co-chair
• Karen Devries - coordinator

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Outline

1. Prevalence of violence against women girls
2. Health consequences socio-economic consequences
3. Risk factors
4. Prevention response
5. WHO's priorities

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Main data sources

• Forthcoming analyses of the Global Burden of
  disease estimates of violence against women
  prevalence
• WHO multi-country study on women's health and
  domestic violence - surveys from 10 countries
• Analyses of Demographic and Health Surveys (DHS)
  data from the violence against women module
• Forthcoming "VAW in 12 countries from LAC
  Comparative data from reproductive, Demographic
  and Health Surveys (PAHO/CDC)

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Key Message 1
Violence against women children is a widespread
public health human rights problem worldwide.
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Definitions gender-based violence (GBV)
violence against women (VAW)

• GBV violence involving men women derived from
  unequal power relationships between men and
  women includes
• acts of physical aggression and harm
• emotional, psychological abuse controlling
  behaviours
• coerced sex, sexual harassment, rape  
• VAW public or private act of gender-based
  violence that results, or likely to result in
  physical, sexual or psychological harm to women.

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Different forms of GBV

• Sexual, physical, or emotional violence by an
  intimate partner (intimate partner violence or
  IPV) non partners
• Child sexual abuse child maltreatment
• Sexual violence in conflict situations
• Sexual harassment abuse by authority figures
  (e.g teachers, police officers or employers etc),
  
• Forced prostitution and sexual trafficking
• Child marriage
• Violence perpetrated or condoned by the state.
• Homophobic violence

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Source Preventing HIV by preventing violence
the global prevalence of intimate partner
violence against women and its links with HIV
infection. Devries K et al 2010. Paper presented
at the Vienna AIDS Conference. Forthcoming
publication on the Global Burden of Disease.
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Prevalence intimate partner physical or sexual
violence or both, life time recent WHO
multi-country study
Source Garcia-Moreno C et al. 2005, WHO
mult-country study on women's health and domestic
violence against women initial results on
prevalence, health outcomes and women's
responses.
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Violence against women in Ireland

• Data from 2 surveys in 1995 and 2003
• Prevalence of sexual violence from intimate
  partner life-time is 4 and 8
• Prevalence of any physical violence life time
  10
• Severe sexual violence 1.5 and 8
• Severe physical violence prevalence is 2 and 13

Source Devries K et al Forthcoming Global Burden
of Diseases Estimate on violence against women.
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Violence against children

• Child maltreatment abuse and neglect of children
  lt 18 years of age.
• All types of physical and/or emotional
  ill-treatment,
• Sexual abuse,
• Neglect, negligence and commercial or other
  exploitation
• 2. Approximately 20 of women 510 of men
  report being sexually abused as children, while
  2550 of all children report being physically
  abused.
• Non contact sexual abuse (3 boys 7 girls)
• Contact sexual abuse (4 boys 13 girls)
• Penetrative sexual abuse (2 boys 5 girls)
• Any sexual abuse (9 boys 25 girls)

Source Garcia-Moreno C et al. 2005, WHO
mult-country study on women's health and domestic
violence against women initial results on
prevalence, health outcomes and women's
responses.
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Prevalence of childhood sexual abuse lt 15 years-
WHO multi-country study
Source Garcia-Moreno C et al. 2005, WHO
mult-country study on women's health and domestic
violence against women initial results on
prevalence, health outcomes and women's
responses.
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Violence against children in Tanzania 2009
Source Violence against children in Tanzania
Findings from a national survey 2009. UNICEF,
CDC, Muhimbili University of Health and Allied
Sciences. United Republic of Tanzania, 2011.
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Violence against girls in Swaziland 2007
Source A Reza et al., 2009. Sexual violence
and its health consequences for female children
in Swaziland a cluster survey study. Lancet
2009 373 196672.
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Key Message 2
Violence against women children has multiple
health, social economic consequences for the
individual, families, communities societies.
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VAW Children has multiple health consequences
Fatal Outcomes Non-fatal Outcomes Non-fatal Outcomes Non-fatal Outcomes
Femicide Suicide AIDS-related mortality Maternal mortality Physical Sexual Reproductive Psychological Behavioral
Femicide Suicide AIDS-related mortality Maternal mortality Fractures Chronic pain syndromes Fibromyalgia Permanent disability Gastro-intestinal disorders Obesity (children) Sexually-transmitted infections, including HIV Unwanted pregnancy Pregnancy complications Traumatic gynecologic fistula Unsafe abortion   Depression and anxiety Eating and sleep disorders Drug and alcohol abuse Poor self-esteem Post-traumatic stress disorder Self harm Increased sexual risk taking Smoking Perpetrating or being victims of violence later (children adolescents)
Source Adapted from Bott, Morrison and Ellsberg,
2005
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Attempted suicide among women who experience VAW
Source Source Garcia-Moreno C et al. 2005, WHO
mult-country study on women's health and domestic
violence against women initial results on
prevalence, health outcomes and women's
responses.
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VAW unintended pregnancies pregnancy loss

• Unintended pregnancy 2- fold increased
  likelihood among women who experienced VAW
• Abortion 3 fold increase
• Stillbirth or miscarriage 1.5 -fold increase
• pregnancy loss in general 2 fold increase

Source Garcia-moreno C and Pallitto C. Results
of the WHO multi-country study on women's health
and domestic violence, presented at the
international RH conference in Mumbai February
15-18 2009.
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VAW STI HIV
Across all settings women who have experienced
VAW are 2-fold more likely to be at risk of
HIV/STI infection compared to those with no VAW
Source Is intimate partner violence a risk
factor for HIV and STI infection? A systematic
review and meta-analysis . Devries K et al 2012
Forthcoming publication on the Global Burden of
Disease.
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Violence against children health outcomes
Tanzania 2009
Source Violence against children in Tanzania
Findings from a national survey 2009. UNICEF,
CDC, Muhimbili University of Health and Allied
Sciences. United Republic of Tanzania, 2011.
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Violence against children health outcomes
Tanzania 2009
Source Violence against children in Tanzania
Findings from a national survey 2009. UNICEF,
CDC, Muhimbili University of Health and Allied
Sciences. United Republic of Tanzania, 2011.
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Inter-generational socio-economic consequences
Effects on children of women who experience abuse Higher rates of infant mortality Behavior problems Anxiety, depression, attempted suicide Poor school performance Experiencing or perpetrating violence as adults Physical injury or health complaints Lost productivity in adulthood
Effects on families Inability to work Lost wages and productivity Housing instability
Social and economic effects Costs of services incurred by victims and families (health, social, justice) Lost workplace productivity and costs to employers Perpetuation of violence
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Key Message 3
Violence against women is rooted in or a
manifestation of gender inequality in society
Traditional gender norms held by women men
perpetuate violence against women.
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Risk factors for VAW WHO multi-country study
Abramsky T et al 2011, What factors are
associated with recent intimate partner violence?
Findings from WHO multi-country study on
womens health domestic violence. BMC Public
Health
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Gender norms womens agreement that wife-beating
justified for at least 1 reason
Source Preliminary results, PAHO/CDC
(forthcoming) Violence against women in 12
countries from LAC
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Key Message 4

• Violence against women children can be
  prevented.
• Prevention programmes should increase focus on
• transforming harmful gender norms and attitudes,
• addressing childhood abuse,
• reducing harmful drinking.
• improving access to education for girls and boys

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Preventing VAW promising or effective
interventions

• 1. Empowering women
• Microfinance, gender relationship training
• School-based programmes to prevent dating
  violence

• 2. Transforming harmful gender norms
• Media awareness
• Community mobilization
• Gender equality education in schools

Socio-economic conditions
Individual behaviours characteristics
Cultural Social Gender Norms
Laws Policies
Couples families

• 3. Engaging men boys
• Peer participatory education to change male
  norms behaviours
• Reducing access to and use of alcohol

• 4. GE laws policy change
• Anti-violence laws
• Training law-enforcement
• Legal aid services
• Forensic evidence collection
• National standards on post-rape care

Communities
Countries
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Preventing violence against children promising
interventions

• School-based training to help children
  adolescents recognize avoid potentially
  sexually abusive situations
• Home-visitation parent-education programmes
• School based social emotional skills
  development bullying prevention programmes

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Improving health sector response

• Developing policies protocols for treatment of
  survivors
• Training health staff
• Ensuring privacy confidentiality for womens
  adolescent health services
• Strengthening referral networks with other VAW
  services
• Providing emergency supplies
• Providing educational materials on VAW
• Monitoring evaluating VAW services

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Multi-sectoral response

• Coordinate health justice systems to improve
  medico-legal services
• Gender equality violence prevention education
  in schools
• Mass media community campaigns against VAW
• Set up or strengthen socio-economic support
  services
• Coordinate a referral network for victims of VAW.

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WHO priorities on VAW Children 1. Research
Evidence

• Global Burden of Disease (GBD) Study
• Estimates of deaths, illness disability-adjusted
  life years due to VAW child maltreatment
•  Estimates of health effects low birth
  weight/prematurity, HIV STI, injuries, mental
  health outcomes
• Intervention study on addressing VAW in ANC
  South Africa Mozambique
• Study on adverse childhood experiences
  life-long effects Philippines
• WHO multi-country study on going analyses
  dissemination
• Emotional abuse prevalence health impacts
• Risk and protective factors for VAW in adolescents

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2. Norms guidelines

• WHO clinical policy guidelines on health sector
  response to violence against women
• Guidance on primary prevention of intimate
  partner sexual violence child maltreatment
• Violence against women HIV
• Violence against sex workers
• Programming guide on addressing VAW HIV

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3. Policy, capacity programme development in
countries

• Course on how to research VAW with university in
  Thailand
• Primary prevention of VAW workshops for East
  African Western-Pacific countries
• Developing policy capacity for preventing child
  maltreatment in Malawi South Africa
• 3-day course focusing on child maltreatment and
  VAW

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Take home points

• Violence against women children
• is widespread
• has serious health consequences for women and
  girls
• has intergenerational consequences affects
  children families
• poses considerable economic costs
• Violence against women can and must be prevented
• We must promote gender equality
• Preventing VAW requires multidisciplinary action

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• For more information about WHO's work on VAW
  Children
• Contact
• Department of Reproductive Health Research
• Claudia Garcia-Moreno garciamorenoc_at_who.int
• Avni Amin amina_at_who.int
• Department of Violence and Injuries Prevention
• Berit Kieselbach kieselbachb_at_who.int