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Violence against women: the hidden health burden / Lori L. Heise with Jacqueline Pitanguy and Adrienne Germain. p cm. – (World Bank discussion papers; 255)
Includes bibliographical references.
1. Wife abuse-Health aspects.
2 Women-Crimes against-Health aspects.
3 Sex crimes Health aspects.
I. Pitanguy, Jacqueline.
II. Germain. Adrienne.
III. International Bank for Reconstruction and Development.
V. Series. HV6626 H38 1994 362.1968582200973-dc20 94-27745 CIP.
Violence against women has recently been acknowledged as a human rights concern with a profound impact on the physical and mental well-being of those affected by it, but it has received little attention as a public health issue. The World Bank recognizes that much more needs to be known about the health consequences of gender violence. as well as their broader socioeconomic effects on development. This paper pulls together all the information available on the score of the problem and the lessons to be learned from developing countries regarding how violence can be addressed through programmatic interventions.
This paper was prepared to raise awareness of the extent and consequences of violence against women. It also examines the implications of gender violence for health and development and suggests practical steps that can be taken toward eliminating violence against women Although paper is directed toward the health sector, strategies that can be taken in other sectors are also discussed. The primary audience of the paper is the staff of the World Bank, but we hope the paper will also benefit the design and implementation of health programs of other international agencies, governments, and non governmental organizations. This paper is one in a series of papers related to the broaders issues affecting women’s health.
The authors would like to thank the following people for their help in preparing and reviewing this document: Jacquelyn Campbell, Elizabeth Shrader Cox, Lea Guido, Simone Grilo Dinez, Kirrin Gill, Rita Raj Hashim, Emmanuel Jimenez, Mary Koss, Jo Anne Leslie, Lisa Morris, Helen Saxenien, and Anne Tinker.
Gender-based violence-including rape domestic violence, mutilation, murder, and sexual abuse-is a profound health problem for women across the globe. Although gender violence is a significant cause of female morbidity and mortality, it is almost never seen as a public health issue. Recent World Bank estimates of the global burden of disease indicate that in established market economies gender-based victimization is responsible for one out of every five healthy days of life lost to women of reproductive age. On a per capita basis, the health burden imposed by rape and domestic violence in the industrial and developing world is roughly equivalent, but because the total disease burden is so much greater in the developing world, the percentage attributable to gender-based victimization is smaller. Nonetheless, on a global basis, the health burden from gender based victimization is comparable to that from other conditions already high on the world agenda.
Female-focused violence also represents a hidden obstacle to economic and social development. By sapping women’s energy, undermining their confidence, and compromising their health, gender violence deprives society of women’s full participation As the United Nations Fund for Women UNIFEM recently observed, “Women cannot lend their labor or creative ideas fully if they are burdened with the physical and psychological scars of abuse. (Carillo 1992, p.ll).
This paper draws together existing data on the dimension of violence against women world wide and reviews available literature on the health consequences of abuse. It also explores the relationship between violence and other pressing issues, such as maternal mortality, health care utilization, child survival, AIDS prevention, and socioeconomic development.
To assist policymakers in addressing this issue, the paper explores insertions in primary prevention, justice system reform, health care response, programs to assist victims, and treatment and reeducation programs for perpetrators. It argues that any strategy to combat violence must attack the root causes of the problem in addition to treating its symptoms. This means challenging the social attitudes and beliefs that undergrid men’s violence, and renegotiating the meaning of gender and sexuality and the balance of power between women and men at all levels of society.
For decades women’s organizations around world have worked against gender-based violence through advocacy, victim services, and consciousness-raising. Largely because of their efforts, violence against women has recently been recognized as a legitimate human rights issue by the United Nations and by some governments. Yet almost no policy attention has been given to addressing violence against women as 8 public health issue, and even less to tackling its underlying causes. Efforts to gain recognition of violence as an issue warranting international concern have been hampered by lack of population-based data on abuse and its health consequences. But the data that exist are nonetheless sufficient to justify increased attention to this neglected-yet important-women’s health issue.

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