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Introduction

Forms of Gender-based Violence and Their Consequences

Effects on Reproductive Health Decision-making

Effects on the Economics of Reproductive Health and Family Planning Service Delivery

Policy Reform Process

Gender-based violence is recognized today as a major issue on the international human rights agenda. This violence includes a wide range of violations of women’s human rights, including trafficking in women and girls, rape, wife abuse, sexual abuse of children, and harmful cultural practices and traditions that irreparably damage girls’ and women’s reproductive and sexual health.

Although reliable data on the incidence of gender-based violence are scarce, especially for developing countries, there is an increasing body of knowledge indicating that it is widespread and common. It occurs in a broad context of gender-based discrimination with regard to access to education, resources, and decision-making power in private and public life.

In 1993, the World Development Report of the World Bank estimated that "women ages 15 to 44 lose more Discounted Health Years of Life (DHYLs) to rape and domestic violence than to breast cancer, cervical cancer, obstructed labour, heart disease, AIDS, respiratory infections, motor vehicle accidents or war."

Since the Convention on the Elimination of All Forms of Discrimination Against Women was adopted by the United Nations General Assembly in 1979, important progress has been made in establishing gender-based violence as a human rights concern. But much less headway has been made in addressing violence against girls and women as a public health issue. Changes in reproductive health policy-making will be critical to recognizing and addressing the consequences of violence for women’s health.

 The ‘Culture of Silence’

Gender-based violence is universal, differing only in scope from one society to the next. Much of this violence is inflicted on girls and women by husbands, fathers, or other male relatives. The home can be one of the most dangerous places for a woman to be.

Domestic violence exists in a "culture of silence" and denial, and of denial of the seriousness of the health consequences of abuse at every level of society. The fact that domestic violence against girls and women has long been considered a "private" affair has contributed to the serious gap in public health policy-making and the lack of appropriate programmes.

"All her married life, Kanaka Thilaka used to hide the bruises on her body with her sari. Early this year, her husband made sure she could not afford even a strand of camouflage. Traumatized by years of physical abuse, Thilaka confronted her husband, saying that if he didn’t stop, she would commit suicide. But her husband mocked her by throwing kerosene on her [and burning her]. Today, she’s barely alive and the scars all over her body cannot be hidden ....‘My future is gone. All that worries me now are my children,’ she whispers."
(Menon, Subhadra, and Stephen David. 7 December 1995. "Brutal Retaliation." India Today.)

Given that gender-based violence is so widespread, the relative lack of policy debate and decision-making about it is remarkable (although there have been some encouraging recent policy statements in several Latin American countries, for instance). Moreover, the health consequences of both physical and psychological violence against women have hardly been touched by the public health sector.

Few studies have been made of gender-based violence, partly because of the lack of accurate definitions, but also because it is so seldom reported to authorities. Women have many reasons for not reporting incidents of violence. Legal authorities often do not take appropriate action. Many women do not know their legal rights. Women have good reason to fear that they will be victimized again, either by insensitive, accusatory questions or by actual assault. It is estimated that more than 60 per cent of rape victims know their attackers. And health care facilities and police seldom consistently record data on violence against women, the sex of the perpetrators, or the relationship of the abuser to the victim.

Defining Gender-based Violence

The issue must be defined before appropriate measures can be taken. The United Nations Declaration on Violence Against Women provides a basis for defining gender-based violence. According to Article 1 of the Declaration, violence against women is to be understood as:

"Any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in public or private life".

Article 2 of the Declaration presents what the international community recognizes as generic forms of violence against women. The definition encompasses (but is not limited to): physical, sexual, and psychological violence occurring in the family and in the community, including battering, sexual abuse of female children, dowry-related violence, marital rape; female genital mutilation and other traditional practices harmful to women; nonspousal violence; violence related to exploitation, sexual harassment, and intimidation at work and in educational institutions; forced pregnancy, forced abortion, and forced sterilization; trafficking in women and forced prostitution; and violence perpetrated or condoned by the state.

Girls and women face systematic discrimination from entrenched power relations that perpetuate the almost universal subordination of females. This leaves them highly vulnerable to being harmed physically, sexually or psychologically by the men in their families and communities.

In developing programmes to address this, the following definition may be helpful:

"Gender-based violence is violence involving men and women, in which the female is usually the victim; and which is derived from unequal power relationships between men and women. Violence is directed specifically against a woman because she is a woman, or affects women disproportionately. It includes, but is not limited to, physical, sexual and psychological harm (including intimidation, suffering, coercion, and/or deprivation of liberty within the family,
or within the general community).
It includes that violence which is perpetrated or condoned by the state".

- (UNFPA Gender Theme Group, 1998)

This definition clearly states the social dimensions and root causes of violence against women and girls. Without this understanding of the issue, there can be no focused and responsive policy and programming efforts to deal with that violence.


International Milestones in Addressing Violence Against Women.

A Convention on the Elimination of All Forms of Discrimination Against Women, 1979 Guarantees women equal rights with men in all spheres of life, including education, employment, health care, the vote, nationality, and marriage. The Committee on the Elimination of Discrimination Against Women was established to review reports which all countries that are signatory to the Convention must submit on women’s status.

World Conference on Human Rights, Vienna, l993

Vienna Declaration and Programme of Action: Affirmed that women’s human rights are a fundamental part of all human rights. The Declaration asserted for the first time that women’s human rights must be protected, not only in courts, prisons, and other areas of public life, but also in the home. Progress made in implementing the Vienna Declaration was reviewed at the March–April l998 session of the UN Commission on Human Rights.

The l993 UN Declaration on the Elimination of Violence Against Women for the first time provided a definition of violence, and included psychological violence in the definition.

International Conference on Population and Development (ICPD), Cairo, 1994

Affirmed that women’s rights are an integral part of all human rights. Stressed that "population and development programmes are most effective when steps have simultaneously been taken to improve the status of women". Women’s empowerment was a central theme of the conference. Recommended actions for governments included prohibiting the trafficking of women and children, promoting discussion of the need to protect women from violence through education, and establishing preventative measures and rehabilitation programmes for victims of violence. ICPD was the first international forum to acknowledge that enjoyment of sexual health is an integral part of reproductive rights. Men’s rights and responsibilities toward their partners were noted, "Human sexuality and gender relations are closely interrelated and together affect the ability of men and women to achieve and maintain sexual health and manage their sexual lives. Equal relationships between men and women in matters of sexual relationships and reproduction, including full respect for the physical integrity of the human body, require mutual respect and willingness to accept responsibility for the consequences of sexual behaviour." (ICPD Programme of Action, paragraph 7.37)

UN Fourth World Conference on Women,
Beijing, 1995

The Conference Platform for Action recognized that "all governments, irrespective of their political, economic, and cultural systems, are responsible for the promotion and protection of women’s human rights". This document also specifically declared that violence against women is one of the 12 critical areas of concern and is an obstacle to the achievement of women’s human rights. Section 106(q) states that countries should "integrate mental health services into primary health-care systems or other appropriate levels, develop supportive programmes and train primary health workers to recognize and care for girls and women of all ages who have experienced any form of violence, especially domestic violence, sexual abuse, or other abuse resulting from armed and non-armed conflict".

Source: Panos. 1998. The Intimate Enemy: Gender Violence and Reproductive Health. Panos Briefing No. 27.