London School of Hygiene & Tropical Medicine

A new study published today reveals the enormous toll domestic violence has on the health and wellbeing of women around the world, and the extent to which partner violence is still largely hidden.

Evidence has existed for some time that partner violence is an important risk factor for a range of health problems, but this has come mainly from studies in the United States and Canada. The World Health Organisation Study on Women's Health and Domestic Violence against Women, which has been conducted in collaboration with the London School of Hygiene & Tropical Medicine, the Program for Appropriate Technology in Health (PATH), and NGOs and women's organisations in each of the collaborating countries, extends these findings globally, and demonstrates that violence operates similarly in both the industrial and developing worlds.

The study consists of interviews with 24,000 women of reproductive age from 15 sites in 10 countries¹. It reveals that between 15% to 71% of ever-partnered women have been physically or sexually abused by intimate partners. In most settings, more than half of documented physical violence qualified as "severe." Likewise, about half the respondents reported ongoing violence that had occurred within the last 12 months. Significantly, partner violence was the most common form of violence in women's lives, accounting for a greater proportion of victimization than assaults or rape by strangers, acquaintances or any other perpetrators.

'The WHO Study demonstrates that domestic violence is pervasive everywhere, although the rates vary quite significantly among settings', says Mary Robinson, former United Nations High Commissioner for Human Rights, who was speaking at the report's launch. 'This clearly demonstrates that the prevalence of abuse can and does change. The report should serve as a call to action. Governments and communities need to mobilize their energies to combat this major abuse of women's rights'.

The study found clear, significant associations between lifetime experiences of partner violence and a range of health problems that include injury, emotional distress, suicidal thoughts and attempts, and physical symptoms of illness. Although pregnancy is often thought of as a protected time, between 1% and 28% of all women who had been pregnant reported being beaten during pregnancy-more than 90% by the father of the unborn child. Between a quarter and half of those abused report that they were kicked or punched in the abdomen. Victims of partner violence also experienced more miscarriages, and they had more induced abortions than their non-abused peers.

"The degree to which the health consequences of partner violence in the WHO study are consistent across sites, both within and between countries, is striking," noted Dr Charlotte Watts, from the London School of Hygiene and Tropical Medicine, and a member of the core research team for the study. 'Partner violence appears to have a similar impact on women's health and well-being regardless of where she lives, the prevalence of violence in her setting, or her cultural or economic background'. The study also shows the remarkable degree to which women in some settings internalize social norms that justify abuse. In about half the sites, between 50 and over 90% of women agreed that a man was justified in beating his wife under certain circumstances-for example, if she disobeyed him, refused sex, did not complete the housework on time, asked about other women, or was suspected of infidelity. In some settings women felt unable to refuse sex; in three of the rural provincial sites, as many as 44% to 51% of women did not feel entitled to refuse sex, even if their husbands mistreated them.

'These findings illustrate the importance of interventions that challenge the acceptability of violence around the world"', said Dr Churunrurtai Kanchanachita, one of the principal investigators from Thailand.

For policymakers trying to deal with domestic violence, the greatest challenge is that abuse remains hidden, with women finding it difficult to speak openly or seek help. In all the sites, between one-fifth to two-thirds (21% and 66%) of women reported that they had never told anyone else about the partner abuse prior to the interview. Very few had sought help from formal services or from individuals in positions of authority, preferring instead to reach out to friends, neighbours and family members. Between 55% and 95% said they had never gone to the police, health service or other agency to seek help. Those who did seek formal support tended to be the most severely abused.

Teresa Parker, Press and Publicity Officer for Women's Aid, said: 'In the UK we see similar patterns, with 1 in 4 women experiencing domestic violence at some point in her lifetime and with 30% of all domestic violence starting in pregnancy. In many instances, health care services are the first point of contact for women living with violent men and the health service has a vital role to play in responding to domestic violence'.

The report recommends a range of vital interventions aimed at challenging the inequities and social norms that perpetuate abuse, providing emotional and material support to victims, and integrating anti-violence programming into ongoing initiatives aimed at youth development, HIV/AIDS, and women's sexual and reproductive health.

'Tackling violence will require sustained coordinated action at all levels of society-the family, community, and among health, education, justice and social service sectors', concludes Dr Garcia-Moreno, the study coordinator from WHO. 'Health providers must be trained to recognize women experiencing violence and to respond appropriately to those who disclose. And those women who do reach out much be able to access services which can deal with them constructively, and in a non-judgemental way'.

To interview Dr Charlotte Watts, please contact the London School of Hygiene & Tropical Medicine Press Office on 020 7927 2073/07941 294885. To contact Dr Garcia- Moreno please contact Samantha Bolton at the World Health Organisation Press Office on 00 41 79 239 2366.

¹The WHO study interviewed 24,000 women of reproductive age from 15 sites in 10 countries: Bangladesh, Brazil, Ethiopia, Japan, Peru, Namibia, Samoa, Serbia and Montenegro, Thailand and the United Republic of Tanzania. It represents the first truly comparable dataset on violence against women, using state-of-the-art methods to enhance disclosure and ensure women's safety.