Younger women among those most at risk: WHO

9 March 2021 GENEVA | NEW YORK

Violence against women remains devastatingly pervasive and starts alarmingly young, shows new data from WHO and partners. Across their lifetime, 1 in 3 women, around 736 million, are subjected to physical or sexual violence by an intimate partner or sexual violence from a non-partner – a number that has remained largely unchanged over the past decade.

This violence starts early: 1 in 4 young women (aged 15-24 years) who have been in a relationship will have already experienced violence by an intimate partner by the time they reach their mid-twenties.

“Violence against women is endemic in every country and culture, causing harm to millions of women and their families, and has been exacerbated by the COVID-19 pandemic,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But unlike COVID-19, violence against women cannot be stopped with a vaccine. We can only fight it with deep-rooted and sustained efforts – by governments, communities and individuals – to change harmful attitudes, improve access to opportunities and services for women and girls, and foster healthy and mutually respectful relationships.”

Intimate partner violence is by far the most prevalent form of violence against women globally (affecting around 641 million). However, 6% of women globally report being sexually assaulted by someone other than their husband or partner. Given the high levels of stigma and under-reporting of sexual abuse, the true figure is likely to be significantly higher.

Emergencies exacerbate violence, increasing vulnerability and risks

This report presents data from the largest ever study of the prevalence of violence against women, conducted by WHO on behalf of a special working group of the United Nations. Based on data from 2000 to 2018, it updates previous estimates released in 2013.

While the numbers reveal already alarmingly high rates of violence against women and girls, they do not reflect the ongoing impact of the COVID-19 pandemic.

WHO and partners warn that the COVID-19 pandemic has further increased women’s exposure to violence, as a result of measures such as lockdowns and disruptions to vital support services.

“It’s deeply disturbing that this pervasive violence by men against women not only persists unchanged, but is at its worst for young women aged 15-24 who may also be young mothers. And that was the situation before the pandemic stay-at home orders. We know that the multiple impacts of COVID-19 have triggered a “shadow pandemic” of increased reported violence of all kinds against women and girls,” said UN Women Executive Director Phumzile Mlambo-Ngcuka. “Every government should be taking strong, proactive steps to address this, and involving women in doing so”, she added.

Though many countries have seen increased reporting of intimate partner violence to helplines, police, health workers, teachers, and other service providers during lockdowns, the full impact of the pandemic on prevalence will only be established as surveys are resumed, the report notes.

Inequities are a leading risk factor for violence against women

Violence disproportionately affects women living in low- and lower-middle-income countries. An estimated 37% of women living in the poorest countries have experienced physical and/or sexual intimate partner violence in their life, with some of these countries having a prevalence as high as 1 in 2.

The regions of Oceania, Southern Asia and Sub-Saharan Africa have the highest prevalence rates of intimate partner violence among women aged 15-49, ranging from 33% – 51%. The lowest rates are found in Europe (16–23%), Central Asia (18%), Eastern Asia (20%) and South-Eastern Asia (21%).

Younger women are at highest risk for recent violence. Among those who have been in a relationship, the highest rates (16%) of intimate partner violence in the past 12 months occurred among young women aged between 15 and 24.

Violence against women must be prevented

Violence – in all its forms – can have an impact on a woman’s health and well-being throughout the rest of her life – even long after the violence may have ended. It is associated with increased risk of injuries, depression, anxiety disorders, unplanned pregnancies, sexually-transmitted infections including HIV and many other health problems. It has impacts on society as a whole and comes with tremendous costs, impacting national budgets and overall development.

Preventing violence requires addressing systemic economic and social inequalities, ensuring access to education and safe work, and changing discriminatory gender norms and institutions. Successful interventions also include strategies that ensure essential services are available and accessible to survivors, that support women’s organisations, challenge inequitable social norms, reform discriminatory laws and strengthen legal responses, among others.

“To address violence against women, there’s an urgent need to reduce stigma around this issue, train health professionals to interview survivors with compassion, and dismantle the foundations of gender inequality,” said Dr Claudia Garcia-Moreno of WHO. “Interventions with adolescents and young people to foster gender equality and gender-equitable attitudes are also vital.”

Countries should honour their commitments to increased and strong political will and leadership to tackle violence against women in all its forms, through:

Sound gender transformative policies, from policies around childcare to equal pay, and laws that support gender equality,
A strengthened health system response that ensures access to survivor-centred care and referral to other services as needed,
School and educational interventions to challenge discriminatory attitudes and beliefs, including comprehensive sexuality education,
Targeted investment in sustainable and effective evidence-based prevention strategies at local, national, regional and global levels, and
Strengthening data collection and investing in high quality surveys on violence against women and improving measurement of the different forms of violence experienced by women, including those who are most marginalized.

Violence against women

9 March 2021

Key facts

Violence against women – particularly intimate partner violence and sexual violence – is a major public health problem and a violation of women’s human rights.
Estimates published by WHO indicate that globally about 1 in 3 (30%) of women worldwide have been subjected to 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 (27%) of women aged 15-49 years who have been in a relationship report that they have been subjected to some form of physical and/or sexual violence by their intimate partner.
Violence can negatively affect women’s physical, mental, sexual, and reproductive health, and may increase the risk of acquiring HIV in some settings.
Violence against women is preventable. The health sector has an important role to play to provide comprehensive health care to women subjected to violence, and as an entry point for referring women to other support services they may need.

Factors associated with intimate partner violence and sexual violence against women

Intimate partner and sexual violence is the result of factors occurring at individual, family, community and wider society levels that interact with each other to increase or reduce risk (protective). Some 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);
a history of exposure to child maltreatment (perpetration and experience);
witnessing family violence (perpetration and experience);
antisocial personality disorder (perpetration);
harmful use of alcohol (perpetration and experience);
harmful masculine behaviours, including having multiple partners or attitudes that condone violence (perpetration);
community norms that privilege or ascribe higher status to men and lower status to women;
low levels of women’s access to paid employment; and
low level of gender equlity (discriminatory laws, etc.).

Factors specifically associated with intimate partner violence include:

past history of exposure to violence;
marital discord and dissatisfaction;
difficulties in communicating between partners; and
male controlling behaviours towards their 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.

Gender inequality and norms on the acceptability of violence against women are a root cause of violence against women.

Health consequences

Intimate partner (physical, sexual and psychological) and sexual violence cause serious short- and long-term physical, mental, sexual and reproductive health problems for women. They also affect their children’s health and wellbeing. This violence leads to high social and economic costs for women, their families and societies. Such violence can:

Have fatal outcomes like homicide or suicide.
Lead to injuries, with 42% of women who experience intimate partner violence reporting an injury as a consequence of this violence (3).
Lead to unintended pregnancies, induced abortions, gynaecological problems, and sexually transmitted infections, including HIV. WHO’s 2013 study on the health burden associated with violence against women 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 (3).
Intimate partner violence in pregnancy also increases the likelihood of miscarriage, stillbirth, pre-term delivery and low birth weight babies. The same 2013 study showed that women who experienced intimate partner violence were 16% more likely to suffer a miscarriage and 41% more likely to have a pre-term birth (3).
These forms of violence can lead to depression, post-traumatic stress and other anxiety disorders, sleep difficulties, eating disorders, and suicide attempts. The 2013 analysis found that women who have experienced intimate partner violence were almost twice as likely to experience depression and problem drinking.
Health effects can also include headaches, pain syndromes (back pain, abdominal pain, chronic pelvic pain) gastrointestinal disorders, limited mobility and poor overall health.
Sexual violence, particularly during childhood, can lead to increased smoking,substance use, and risky sexual behaviours. 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 (through, for example diarrhoeal disease or malnutrition and lower immunization rates).

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

There is growing evidence on what works to prevent violence against women, based on well-designed evaluations. In 2019, WHO and UN Women with endorsement from 12 other UN and bilateral agencies published RESPECT women – a framework for preventing violence against women aimed at policy makers.

Each letter of RESPECT stands for one of seven strategies: Relationship skills strengthening; Empowerment of women; Services ensured; Poverty reduced; Enabling environments (schools, work places, public spaces) created; Child and adolescent abuse prevented; and Transformed attitudes, beliefs and norms.

For each of these seven strategies there are a range of interventions in low and high resource settings with varying degree of evidence of effectiveness. Examples of promising interventions include psychosocial support and psychological interventions for survivors of intimate partner violence; combined economic and social empowerment programmes; cash transfers; working with couples to improve communication and relationship skills; community mobilization interventions to change unequal gender norms; school programmes that enhance safety in schools and reduce/eliminate harsh punishment and include curricula that challenges gender stereotypes and promotes relationships based on equality and consent; and group-based participatory education with women and men to generate critical reflections about unequal gender power relationships.

RESPECT also highlights that successful interventions are those that prioritize safety of women; whose core elements involve challenging unequal gender power relationships; that are participatory; address multiple risk factors through combined programming and that start early in the life course.

To achieve lasting change, it is important to enact and enforce legislation and develop and implement policies that promote gender equality; allocate resources to prevention and response; and invest in women’s rights organizations.

Role of the health sector

While preventing and responding to violence against women requires a multi-sectoral approach, the health sector has an important role to play. The health sector can:

Advocate to make violence against women unacceptable and for such violence to be addressed as a public health problem.
Provide comprehensive services, sensitize and train health care providers in responding to the needs of survivors holistically and empathetically.
Prevent recurrence of violence through early identification of women and children who are experiencing violence and providing appropriate referral and support
Promote egalitarian gender norms as part of life skills and comprehensive sexuality education curricula taught to young people.
Generate evidence on what works and on the magnitude of the problem by carrying out population-based surveys, or including violence against women in population-based demographic and health surveys, as well as in surveillance and health information systems.

Devastatingly pervasive: 1 in 3 women globally experience violence