Forms of Gender-based Violence and
Effects on Reproductive Health
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 womens 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 womens reproductive and sexual health.
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
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 womens health.
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 didnt stop, she
would commit suicide. But her husband mocked her by throwing kerosene on her [and burning
her]. Today, shes 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
(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
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
World Conference on Human Rights, Vienna, l993
Vienna Declaration and Programme of Action: Affirmed that womens human rights are
a fundamental part of all human rights. The Declaration asserted for the first time that
womens 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 MarchApril 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
International Conference on Population and Development (ICPD), Cairo, 1994
Affirmed that womens 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". Womens 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.
Mens 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,
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 womens 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 womens 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.