Press Release

For Immediate Release January 20, 2000

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Hopkins Report: Violence Against Women Widespread

Around the world at least one woman in every three has been beaten, coerced into sex, or otherwise abused in her lifetime, according to a new report from the Johns Hopkins School of Public Health and the Center for Health and Gender Equity (CHANGE). Based on the most comprehensive overview to date, the report calls on the world’s health care community to respond to physical and sexual abuse as "a major public health concern and a violation of human rights."

"What is striking is how similar the problem is around the world," says Lori Heise, Co-Director of CHANGE and lead author of the Population Reports issue, Ending Violence Against Women, published by the Johns Hopkins Population Information Program. "Without exception, women’s greatest risk of violence comes not from ‘stranger danger’ but from men they know, often male family members or husbands."

Over 50 population-based surveys indicate that 10 percent to over 50 percent of adult women have been physically assaulted by an intimate male partner. Psychological abuse almost always accompanies physical abuse. One-third to over one-half of cases also involve sexual abuse. Most women who suffer any physical aggression are abused repeatedly.

In countries as different as Bangladesh, Cambodia, Mexico, and Zimbabwe, many people see wife-beating as justified—a husband’s right to "correct" an erring wife. "Women often share this notion," note Heise and co-authors Mary Ellsberg and Megan Gottemoeller. "For example, in rural Egypt up to 81 percent of women say that wife-beating is justified under certain circumstances."

Among findings culled from over 500 studies of domestic abuse:

• Many women conceal their plight. In surveys 22% to almost 70% of abused women said that they had never told anyone about their abuse before being asked in the interview.
• Rates of abuse can vary greatly in neighboring areas. Differences among regions, towns, or villages in the same country can be greater than differences among countries.
• Beyond immediate injury, violence often leads to serious long-term health problems, including chronic pain, physical disability, drug and alcohol abuse, depression, and suicide attempts.
• The physical and psychological impact of different types of abuse and multiple episodes over time appears to be cumulative and can persist long after the violence has stopped.
• Children of battered women face a greater risk of low birth weight, malnutrition, behavioral problems, and infant death in some settings.

Gender-based violence and fear of physical and sexual abuse also has an enormous impact on women’s reproductive health. Such violence has been linked to gynecological disorders, unsafe abortion, pregnancy complications, miscarriage, low birth weight, and pelvic inflammatory disease. In addition, women living in abusive relationships often have difficulty refusing unwanted sex, negotiating condom use, or using many other types of family planning methods. Thus they risk unwanted pregnancy and sexually transmitted diseases including HIV/AIDS.

Health workers must address violence against women, say the authors. “In most countries the health care system is the only institution that interacts with almost every woman at some point in her life.” With training and institutional support, health workers can identify abuse victims, offer empathy and support, provide medical care, and refer clients to legal assistance and support services.

"Although health workers should be part of the solution, at this point they are often part of the problem," notes co-author Ellsberg. "They often violate confidentiality, trivialize the abuse, or blame the victim." Bureaucratic delays and indifference add to the problem. "Frequently, women feel re-victimized by the very system that is supposed to help them."

To make health systems more responsive, activists have begun pilot programs in Brazil, Canada, Ireland, Malaysia, Mexico, Nicaragua, and the United States to train health workers and reform institutional policy. "We are heartened by the efforts of activists and committed health care providers to make the health system sensitive and attentive to the needs of abuse victims," says Heise. "Many developing countries are taking up this challenge far quicker than Western countries did."

Training programs for health workers, regardless of their primary focus, should cover gender, sexuality, healthy relationships, and abuse. The Population Reports issue includes a 4-page pullout to help health workers in training or on the job, suggesting how to ask women about violence, how to spot symptoms of violence, and how to help women develop a personal safety plan.

While health workers can help, ending violence against women requires strategies and communication that reach across society. "An agenda for change must include: empowering women and girls; raising the cost of abusive behavior; providing for the needs of victims; coordinating institutional and individual responses; involving youth; reaching out to men; and changing community norms," the report concludes.

Ending Violence Against Women was prepared by Lori Heise, Mary Ellsberg, Lic. Med. Sci, and Megan Gottemoeller, MPH, of the Center for Health and Gender Equity (CHANGE). Population Reports is an international review journal of important issues in population, family planning, and related health matters. It is published four times a year in four languages by the Population Information Program at the Johns Hopkins Center for Communication Programs (JHU/CCP) with support from the US Agency for International Development (USAID). USAID administers the US foreign assistance program, providing economic and humanitarian assistance in more than 80 countries worldwide.

(Editors: Here is some information for a sidebar from the Population Reports issue, Ending Violence Against Women, published by the Johns Hopkins Population Information Program and the Center for Health and Gender Equity.)

Developing a Safety Plan

A safety plan can help a woman protect herself in a violent situation. Advocates against domestic violence suggest the following tips for developing a personal plan in advance:

• Identify one or more neighbors you can tell about the violence, and ask them to seek help if they hear a disturbance in your home.
• If an argument seem unavoidable, try to have it in a room or an area that you can leave easily. Stay away from any room where weapons may be available.
• Practice how to get out of your home safely. Identify which doors, windows, elevator, or stairwell would be best.
• Have a packed bag ready, containing spare keys, money, important documents, and clothes. Keep it at the home of a relative or friend in case you need to leave your own home in a hurry.
• Devise a code word to use with your children, family, friends, and neighbors when you need emergency help or want them to call the police.
• Decide where you will go if you have to leave home, and have a plan to get there (even if you do not think you will need to leave).
• Use your instincts and judgment. If the situation is dangerous, consider giving the abuser what he is demanding to calm him down. You have the right to protect yourself and your children.
• Remember: you do not deserve to be hit or threatened.

Source: Center for Health and Gender Equity (CHANGE) in Population Reports

For more information, interviews with the authors, or printed copies of the full report, contact Stephen M. Goldstein at Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA. TEL: 410 659-6300 (After hours: 301 984-1470; cell phone: 301 633-4380); Fax: 410 659-2645; E-mail: PopRepts@jhuccp.org.

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