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Violence against women

Intimate partner and sexual violence against women

Fact sheet N°239
Updated January 2016

Key facts:

Violence against women - particularly intimate partner violence and sexual violence - are major public health problems and violations of women's human rights.
Recent global prevalence figures indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime.
Most of this violence is intimate partner violence. Worldwide, almost one third (30%) of women who have been in a relationship report that they have experienced some form of physical and/or sexual violence by their intimate partner.
Globally, as many as 38% of murders of women are committed by an intimate partner.
Violence can negatively affect women’s physical, mental, sexual and reproductive health, and may increase vulnerability to HIV.
Factors associated with increased risk of perpetration of violence include low education, child maltreatment or exposure to violence in the family, harmful use of alcohol, attitudes accepting of violence and gender inequality.
Factors associated with increased risk of experiencing intimate partner and sexual violence include low education, exposure to violence between parents, abuse during childhood, attitudes accepting violence and gender inequality.
There is evidence from high-income settings that school-based programmes may be effective in preventing relationship violence (or dating violence) among young people.
In low-income settings, primary prevention strategies, such as microfinance combined with gender equality training and community-based initiatives that address gender inequality and relationship skills, hold promise.
Situations of conflict, post conflict and displacement may exacerbate existing violence, such as by intimate partners, and present additional forms of violence against women.
Introduction

The United Nations defines violence against women as "any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life."

Intimate partner violence refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.

Sexual violence is "any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. It includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part or object."

Scope of the problem

Population-level surveys based on reports from victims provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence in non-conflict settings. The first report of the "WHO Multi-country study on women’s health and domestic violence against women" (2005) in 10 mainly low- and middle-income countries found that, among women aged 15-49:

between 15% of women in Japan and 71% of women in Ethiopia reported physical and/or sexual violence by an intimate partner in their lifetime;
between 0.3–11.5% of women reported sexual violence by someone other than a partner since the age of 15 years;
the first sexual experience for many women was reported as forced – 17% of women in rural Tanzania, 24% in rural Peru, and 30% in rural Bangladesh reported that their first sexual experience was forced.
A more recent analysis of WHO with the London School of Hygiene and Tropical Medicine and the Medical Research Council, based on existing data from over 80 countries, found that globally 35% of women have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence. Most of this violence is intimate partner violence. Worldwide, almost one-third (30%) of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner, in some regions this is much higher. Furthermore, globally as many as 38% of all murders of women are committed by intimate partners.

Intimate partner and sexual violence are mostly perpetrated by men against women. Child sexual abuse affects both boys and girls. International studies reveal that approximately 20% of women and 5–10% of men report being victims of sexual violence as children. Violence among young people, including dating violence, is also a major problem.

Risk factors

Factors associated with intimate partner and sexual violence occur at individual, family, community and wider society levels. Some factors are associated with being a perpetrator of violence, some are associated with experiencing violence and some are associated with both.

Risk factors for both intimate partner and sexual violence include:

lower levels of education (perpetration of sexual violence and experience of sexual violence);
exposure to child maltreatment (perpetration and experience);
witnessing family violence (perpetration and experience);
antisocial personality disorder (perpetration);
harmful use of alcohol (perpetration and experience);
having multiple partners or suspected by their partners of infidelity (perpetration); and
attitudes that are accepting of violence and gender inequality (perpetration and experience).
Factors specifically associated with intimate partner violence include:

past history of violence;
marital discord and dissatisfaction;
difficulties in communicating between partners.
Factors specifically associated with sexual violence perpetration include:

beliefs in family honour and sexual purity
ideologies of male sexual entitlement and
weak legal sanctions for sexual violence.
The unequal position of women relative to men and the normative use of violence to resolve conflict are strongly associated with both intimate partner violence and non-partner sexual violence.

Health consequences

Intimate partner and sexual violence have serious short- and long-term physical, mental, sexual and reproductive health problems for survivors and for their children, and lead to high social and economic costs.

Violence against women can have fatal results like homicide or suicide.
It can lead to injuries, with 42% of women who experience intimate partner violence reporting an injury as a consequence of this violence.
Intimate partner violence and sexual violence can lead to unintended pregnancies, induced abortions, gynaecological problems, and sexually transmitted infections, including HIV. The 2013 analysis found that women who had been physically or sexually abused were 1.5 times more likely to have a sexually transmitted infection and, in some regions, HIV, compared to women who had not experienced partner violence. They are also twice as likely to have an abortion.
Intimate partner violence in pregnancy also increases the likelihood of miscarriage, stillbirth, pre-term delivery and low birth weight babies.
These forms of violence can lead to depression, post-traumatic stress disorder, sleep difficulties, eating disorders, emotional distress and suicide attempts. The same study found that women who have experienced intimate partner violence were almost twice as likely to experience depression and problem drinking. The rate was even higher for women who had experienced non partner sexual violence.
Health effects can also include headaches, back pain, abdominal pain, fibromyalgia, gastrointestinal disorders, limited mobility and poor overall health.
Sexual violence, particularly during childhood, can lead to increased smoking, drug and alcohol misuse, and risky sexual behaviours in later life. It is also associated with perpetration of violence (for males) and being a victim of violence (for females).
Impact on children
Children who grow up in families where there is violence may suffer a range of behavioural and emotional disturbances. These can also be associated with perpetrating or experiencing violence later in life.
Intimate partner violence has also been associated with higher rates of infant and child mortality and morbidity (e.g. diarrhoeal disease, malnutrition).
Social and economic costs
The social and economic costs of intimate partner and sexual violence are enormous and have ripple effects throughout society. Women may suffer isolation, inability to work, loss of wages, lack of participation in regular activities and limited ability to care for themselves and their children.

Prevention and response

Currently, there are few interventions whose effectiveness has been proven through well designed studies. More resources are needed to strengthen the prevention of intimate partner and sexual violence, including primary prevention, i.e. stopping it from happening in the first place.

Regarding primary prevention, there is some evidence from high-income countries that school-based programmes to prevent violence within dating relationships have shown effectiveness. However, these have yet to be assessed for use in resource-poor settings. Several other primary prevention strategies: those that combine microfinance with gender equality training; that promote communication and relationship skills within couples and communities; that reduce access to, and harmful use of alcohol; and that change cultural gender norms, have shown some promise but need to be evaluated further.

To achieve lasting change, it is important to enact legislation and develop policies that:

address discrimination against women;
promote gender equality;
support women; and
help to move towards more peaceful cultural norms.
An appropriate response from the health sector can play an important role in the prevention of violence. Sensitization and education of health and other service providers is therefore another important strategy. To address fully the consequences of violence and the needs of victims/survivors requires a multi-sectoral response.

WHO actions

WHO, in collaboration with partners, is:

building the evidence base on the size and nature of violence against women in different settings and supporting countries' efforts to document and measure this violence and its consequences. This is central to understanding the magnitude and nature of the problem at a global level and to initiating action in countries;
strengthening research and research capacity to assess interventions to address partner violence
developing technical guidance for evidence-based intimate partner and sexual violence prevention and for strengthening the health sector responses to such violence;
disseminating information and supporting national efforts to advance women's health and rights and the prevention of and response to violence against women;
supporting countries’ to strengthen the health sector response to violence against women, including the implementation of WHO tools and guidelines; and
collaborating with international agencies and organizations to reduce/eliminate violence globally.
1. Physical Violence

Physical violence occurs when someone uses a part of their body or an object to control a person’s actions.

Physical violence includes, but is not limited to:

Using physical force which results in pain, discomfort or injury;
Hitting, pinching, hair-pulling, arm-twisting, strangling, burning, stabbing, punching, pushing, slapping, beating, shoving, kicking, choking, biting, force-feeding, or any other rough treatment;
Assault with a weapon or other object;
Threats with a weapon or object;
Deliberate exposure to severe weather or inappropriate room temperatures; and,
Murder.


Medication abuse
Inappropriate use of medication, including:
withholding medication;
Not complying with prescription instructions; and,
Over- or under-medication.

Restraints abuse
Forcible confinement;
Excessive, unwarranted or unnecessary use of physical restraints;
Forcing a person to remain in bed;
Unwarranted use of medication to control a person (also called “chemical restraint”); and,
Tying the person to a bed or chair.
2. Sexual Violence

Sexual violence occurs when a person is forced to unwillingly take part in sexual activity.

Sexual violence includes, but is not limited to:

Touching in a sexual manner without consent (i.e., kissing, grabbing, fondling);
Forced sexual intercourse;
Forcing a person to perform sexual acts that may be degrading or painful;
Beating sexual parts of the body;
Forcing a person to view pornographic material; forcing participation in pornographic filming;
Using a weapon to force compliance;
Exhibitionism;
Making unwelcome sexual comments or jokes; leering behaviour;
Withholding sexual affection;
Denial of a person’s sexuality or privacy (watching);
Denial of sexual information and education;
Humiliating, criticizing or trying to control a person’s sexuality;
Forced prostitution;
Unfounded allegations of promiscuity and/or infidelity; and,
Purposefully exposing the person to HIV-AIDS or other sexually transmitted infections.
3. Emotional Violence

Emotional violence occurs when someone says or does something to make a person feel stupid or worthless.

Emotional violence includes, but is not limited to:

Name calling;
Blaming all relationship problems on the person;
Using silent treatment;
Not allowing the person to have contact with family and friends;
Destroying possessions;
Jealousy;
Humiliating or making fun of the person;
Intimidating the person; causing fear to gain control;
Threatening to hurt oneself if the person does not cooperate;
Threatening to abandon the person; and,
Threatening to have the person deported (if they are an immigrant).
4. Psychological Violence

Psychological violence occurs when someone uses threats and causes fear in a person to gain control.

Psychological violence includes, but is not limited to:

Threatening to harm the person or her or his family if she or he leaves;
Threatening to harm oneself;
Threats of violence;
Threats of abandonment;
Stalking / criminal harassment;
Destruction of personal property;
Verbal aggression;
Socially isolating the person;
Not allowing access to a telephone;
Not allowing a competent person to make decisions;
Inappropriately controlling the person’s activities;
Treating a person like a child or a servant;
Withholding companionship or affection;
Use of undue pressure to:
Sign legal documents;
Not seek legal assistance or advice;
Move out of the home;
Make or change a legal will or beneficiary;
Make or change an advance health care directive;
Give money or other possessions to relatives or other caregivers; and,
Do things the person doesn’t want to do.
5. Spiritual Violence

Spiritual (or religious) violence occurs when someone uses a person’s spiritual beliefs to manipulate, dominate or control the person.

Spiritual violence includes, but is not limited to:

Not allowing the person to follow her or his preferred spiritual or religious tradition;
Forcing a spiritual or religious path or practice on another person;
Belittling or making fun of a person’s spiritual or religious tradition, beliefs or practices; and,
Using one’s spiritual or religious position, rituals or practices to manipulate, dominate or control a person.
6. Cultural Violence

Cultural violence occurs when a person is harmed as a result of practices that are part of her or his culture, religion or tradition.

Cultural violence includes, but is not limited to:

Committing “honour” or other crimes against women in some parts of the world, where women especially may be physically harmed, shunned, maimed or killed for:
Falling in love with the “wrong” person;
Seeking divorce;
Infidelity; committing adultery;
Being raped;
Practicing witchcraft; and,
Being older.
Cultural violence may take place in some of the following ways:
Lynching or stoning;
Banishment;
Abandonment of an older person at hospital by family;
Female circumcision;
Rape-marriage;
Sexual slavery; and,
Murder
7. Verbal Abuse

Verbal abuse occurs when someone uses language, whether spoken or written, to cause harm to a person.

Verbal abuse includes, but is not limited to:

Recalling a person’s past mistakes;
Expressing negative expectations;
Expressing distrust;
Threatening violence against a person or her or his family members;
Yelling;
Lying;
Name-calling;
Insulting, swearing;
Withholding important information;
Unreasonably ordering around;
Talking unkindly about death to a person; and,
Telling a person she or he is worthless or nothing but trouble.
8. Financial Abuse

Financial abuse occurs when someone controls a person’s financial resources without the person’s consent or misuses those resources.

Financial abuse includes, but is not limited to:

Not allowing the person to participate in educational programs;
Forcing the person to work outside the home;
Refusing to let the person work outside the home or attend school;
Controlling the person’s choice of occupation;
Illegally or improperly using a person’s money, assets or property;
Acts of fraud; pulling off a scam against a person;
Taking funds from the person without permission for one’s own use;
Misusing funds through lies, trickery, controlling or withholding money;
Not allowing access to bank accounts, savings, or other income;
Giving an allowance and then requiring justification for all money spent;
Persuading the person to buy a product or give away money;
Selling the house, furnishings or other possessions without permission;
Forging a signature on pension cheques or legal documents;
Misusing a power of attorney, an enduring power of attorney or legal guardianship;
Not paying bills;
Opening mail without permission;
Living in a person’s home without paying fairly for expenses; and,
Destroying personal property.
9. Neglect

Neglect occurs when someone has the responsibility to provide care or assistance for you but does not.

Neglect includes, but is not limited to, the following:

Failing to meet the needs of a person who is unable to meet those needs alone;
Abandonment in a public setting; and,
Not remaining with a person who needs help.


Physical neglect
Disregarding necessities of daily living, including failing to provide adequate or necessary:
Nutrition or fluids;
Shelter;
Clean clothes and linens;
Social companionship; and,
Failing to turn a bed-ridden person frequently to prevent stiffness and bed-sores.

Medical neglect
Ignoring special dietary requirements;
Not providing needed medications;
Not calling a physician; not reporting or taking action on a medical condition, injury or problem; and,
Not being aware of the possible negative effects of medications.