|Violence against Women (World Bank, 1994, 84 pages)|
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.
As difficult and intractable as other health issues are, violence against women may be even more so. Deeply embedded attitudes about male-female relations, social taboos against discussing "private matters" in public, and the lack of a "technological fix" all work against a solution. Although violence against women is almost universal, its patterns and their causes can be fully understood and remedied only in specific social and cultural contexts. Each society has mechanisms that legitimize, obscure, deny-and therefore perpetuate- violence. Even where a particular act of violence might be deplored, powerful social institutions-the state, families, normative systems that regulate gender relations -collude in maintaining the status quo. Thus victims of often have 8 difficult time escaping violent relationships.
A variety of mechanisms, from oral traditions to formal educational and legal systems, define standards of acceptable behavior for men and women. These standards are learned from an early age in the family and reinforced by peer pressure, community institutions, and the mass media. In many societies children learn that males are dominant and that violence is an acceptable means of asserting powers and resolving conflict. Women, as mothers and mothers-in-law, unwittingly perpetuate violence by socializing girls and boys to accept male dominance and by acquiescing throughout life to male demands.
Mothers teach their daughters to accept the roles that society assigns them, and they punish "deviant" behavior to ensure their sexual and social acceptance.
But violence is not inevitable. Cross-cultural research shows that, although violence against women is an integral part of virtually all cultures, there are societies in which gender-based abuse does not exist (Sanday 1981; Levinson 1989). Such societies stand as proof that social relations can be organized in a way that minimizes or eliminates violence against women. Even where violence remains endemic, strategic intervention by the state, the community, and women's organizations can save lives, reduce injury, and lessen the long term effects of victimization on women and their children. Existing interventions need to be refined and systematically evaluated, and new approaches to prevention explode, but it is wrong to conclude that nothing can be done to combat violence against women.
Women organizations and, more recently, some governments have done much to assist victims and to document and publicize violence against women. Virtually everywhere these efforts have encountered strong resistance from organized religion, health professionals, the judicial system, and the police, all of whom see the home as sacrosanct and thereby tolerate-indeed condone-most of the violence against women and girls. Police in many, countries will not intervene in domestic quarrels" and do not consider wife beating a crime. In some courts men who confess to murdering their wives are acquitted in the name of "legitimate defense of honor". And women are frequently raped by the very men charged with their protection-the police, military officers, and other agents of the state.
Clearly, efforts to protect women must be strengthened and expanded at the local and national levels. But 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 undergird male violence and renegotiating the meaning of gender and sexuality and the balance of power between women and men at all levels of society.
Violence women has evolved in part from a system of gender relations which posits that men are superior to women. The idea of male dominance-even male ownership of woolen-is present in most societies and reflect in their laws and customs. Thus violence should not be considered an aberration, but an extension of a continuum of beliefs that grants men the right to control women's behavior. As Fauveau and Blanchet observed in their pathbreaking study of violent deaths among women in Bangladesh:
The underlaying causes of violent deaths among women of reproductive age, i.e. complications of an induced abortion, suicide and homicide, are clearly social. Many of them may be seen as a consequence of the strict control enforced by males over the sexual life of women and reproduction. (1989, p. 1127)
Combating violence against women requires challenging the way that gender roles and power relations are articulated in society. To marshal support for such an effort, this paper draws together existing data on violence against women worldwide and reviews the literature on the health consequences of abuse. The paper describes the scope and evolution of the problem, reviews the health consequences of gender-based abuse, and provides a primer on violence against women. It then the implications of gender violence for health and development and recommends steps toward eliminating the violence. Appendices recommend government actions to combat violence against women, discuss issues relating to defining such violence, and provide a methodology for estimating the global health burden from the abuse and rape of women. They also provide a sample "danger assessment. for screening women at risk and discuss treatment protocols for battered women.
Breaking the cycle of abuse will require concerted action across several sectors, including education, mass media, the legislative system, the judiciary, and the health sector. Appendix A provides detailed suggestions for action in each of these sectors.