Comment
Prevention of violence against women and girls: a new chapter
Published Online: 20 November 2014
Article Info
In Margaret Atwood's novel, The Handmaid's Tale,
set in the near future, a totalitarian state has come to power in the
USA having cracked down on women's rights, forbidding them to own
property or hold jobs.1
In this futuristic dystopia, women have strict roles in society. Those
of healthy reproductive age, Handmaids, are enslaved to elite couples
unable to conceive to bear them children. Although Atwood's book is a
fictional work, the underlying themes will be familiar to many women and
girls around the world, and certainly to those working to eliminate
violence against this population.
Every day, millions of
women and girls experience violence. This abuse takes many forms,
including intimate physical and sexual partner violence, female genital
mutilation, child and forced marriage, sex trafficking, and rape. The
burden is substantial. One in three women will experience physical
and/or sexual violence by a partner or sexual violence from someone
other than a partner in their lifetime, constituting a “global public
health problem of epidemic proportions”, according to WHO.2
Women's health and wellbeing can be affected by this violence in many
ways, including physical and mental trauma, increased vulnerability to
HIV/AIDS, and sexual and reproductive health problems. Childhood
experience of violence, directly or witnessing violence in the home, is a
risk factor for a range of high-risk health behaviours, such as smoking
and unsafe sexual practices, and, for boys, for violence perpetration
in adolescence and adulthood.3
Men
are victims of unacceptable violence too. However, different strategies
are likely to be needed to address this health problem, since the
largest burden among men is likely to be from street or gang violence
perpetrated by other men.4
Such violence is common in many inner-cities around the world, with a
particularly high burden in regions such as Latin America.4
Violence against women and girls, meanwhile, is widespread but often
hidden, and has a common root cause—gender inequality—perpetuated by
entrenched social norms and structures that exist in every economic
setting.
Although a developing field, primary and secondary prevention is possible, and this is the central theme of the Lancet Series on violence against women and girls.4, 5, 6, 7, 8
We thank Charlotte Watts, Claudia García-Moreno, and Cathy Zimmerman,
who conceived the idea for this Series, and steered the expert teams of
authors to cover crucial aspects of this issue. The five papers assess
the evidence base for prevention interventions,5 discuss the vital role of the health sector in care and prevention,6 show the need for men and women to be involved in effective programmes,4 provide practical lessons from experience in countries,7 and present a call for action with five key recommendations and indicators to track progress during the next 5 years.8
What
do the papers tell us? The most successful strategies are complex,
using multiple approaches, across many different sectors, with an
essential role for the health sector.5, 6
Success requires the involvement of men and women, in single-sex and
mixed group discussions, over a substantial period of time.4
Interventions that not only discuss the implications of violence, but
also explicitly address the underlying issue of inequality and seek to
transform gender norms by promoting more equitable relationships between
men and women, are essential to achieve lasting change.4
Programming requires action at the individual, community, and societal
levels and sufficient investment with specifically allocated budgets.7, 8
The Series also highlights the substantial limitations in data quality
and quantity in this field, and an accompanying Comment by Marleen
Temmerman9
discusses these concerns. The gaps in knowledge should act as a
rallying call for funders and researchers to strengthen the evidence
base.
Community members and leaders in Mwanza, Tanzania, talk about their role in preventing violence against women
Heidi Brady/Raising Voices/Kivulini
There
is one sector that lags behind in its vital role in addressing violence
against women and girls: the health sector. Health workers have a
crucial part to play not only in treating the consequences of violence,
but also helping women to disclose that they are victims of violence and
to understand that what they are experiencing is abuse. This type of
supportive—potentially life-saving—response requires non-judgmental,
respectful, and compassionate care. As noted by García-Moreno and
colleagues,6
systems-wide changes are needed to enable health workers to address
violence against women and girls, such as regular training, protocols,
and referral networks. Health professionals also have a role in
championing primary prevention and being agents of change not only in
clinical settings but also in the wider community, for example by
promoting the health benefits of delayed marriage for girls.
The
women's movement has been, and will continue to be, instrumental in
advocacy and government action on violence against women and girls, but
it is time for the campaign to be broadened. We hope this Series will
initiate a new health and sustainable development movement for 2015 and
beyond, one that involves women and girls, men and boys, health-care
workers, researchers, teachers, religious leaders, the judiciary,
police, and politicians, and one that can eventually eliminate violence
against women and girls.
We thank Alison Morris-Gehring for her help coordinating this Series.
References
2WHO. Global
and regional estimates of violence against women: prevalence and health
effects of intimate partner violence and non-partner sexual violence. World Health Organization,
Geneva; 2013http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/. ((accessed Oct 28, 2014).)
3Krug, RG, Mercy, JA, Dahlberg, LL, and Zwi, AB. World report on violence and health. Lancet. 2002;
360: 1083–1088
4Jewkes, R, Flood, M, and Lang, J. From
work with men and boys to changes of social norms and reduction of
inequities in gender relations: a conceptual shift in prevention of
violence against women and girls. Lancet. 2014;
(published online Nov 21.)http://dx.doi.org/10.1016/S0140-6736(14)61683-4.
5Ellsberg, M, Arango, DJ, Morton, M et al. Prevention of violence against women and girls: what does the evidence say?. Lancet. 2014;
(published online Nov 21.)http://dx.doi.org/10.1016/S0140-6736(14)61703-7.
6García-Moreno, C, Hegarty, K, Lucas d'Oliveira, AF, Koziol-Maclain, J, Colombini, M, and Feder, G. The health-systems response to violence against women. Lancet. 2014;
(published online Nov 21.)http://dx.doi.org/10.1016/S0140-6736(14)61837-7.
7Michau, L, Horn, J, Bank, A, Dutt, M, and Zimmerman, C. Prevention of violence against women and girls: lessons from practice. Lancet. 2014;
(published online Nov 21.)http://dx.doi.org/10.1016/S0140-6736(14)61797-9.
8García-Moreno, C, Zimmerman, C, Morris-Gehring, A et al. Addressing violence against women: a call to action. Lancet. 2014;
(published online Nov 21.)http://dx.doi.org/10.1016/S0140-6736(14)61830-4.
9Temmerman, M. Research priorities to address violence against women and girls. Lancet. 2014;
(published online Nov 21.)http://dx.doi.org/10.1016/S0140-6736(14)61840-7.
