POLICY FORUM

P U B L I C H E A LT H Ethiopia, Japan, Peru, Namibia, Samoa,

Serbia and Montenegro, Thailand, and the
United Republic of Tanzania (19). In 13 of
Violence Against Women the 15 sites studied, between one-third and
three-quarters (35 to 76%) of women had
Claudia Garcia-Moreno,1* Lori Heise,2 Henrica A. F. M. Jansen,1 been physically or sexually assaulted by
Mary Ellsberg,2 Charlotte Watts3 someone since the age of 15. In all the set-
tings but one, the majority of this violence
he Millennium Development Goals change norms that condone violence was perpetrated by a current or previous

T commit the 191 member states of the against women; equipping young people partner, rather than by other persons.
United Nations to sustainable, human with skills for healthy relationships;
development and recognize that equal expanding women’s access to economic and had a partner had been physically or sexu-
Overall, 15 to 71% of women who ever

rights and opportunities for women and social resources and to support services; ally assaulted by an intimate partner (see
men are critical for social and economic providing training for health services to bet- figure, this page). In most settings, about a
progress (1). This must include addressing ter identify and support women experienc- half of these respondents reported that the
violence against women—a concrete mani- ing violence and to integrate violence pre- violence (20) was cur rently ongoing
festation of inequality between the sexes. vention into existing programs, including (occurred in the past 12 months preceding
Policies to prevent this violence should be for HIV prevention; and promotion of ado- the interview). In the majority of settings,
implemented as part of the agendas for too, a greater proportion of
equality, development, public health, and Ever women had experienced “severe”
Brazil city
human rights (2). Although statements and Current (past physical violence than those suf-
12 months)
international declarations have called for Brazil province fering “moderate” physical vio-
the eradication of violence against women lence (21). Much of the violence
(3, 4), many agencies, governments, and Ethiopia province reported was hidden: More than
policy-makers view it as a relatively minor one-fifth (21 to 66%) of women
social problem. Japan city reporting physical violence in the
There is a growing body of evidence from study had never told anyone of
research that suggests that violence against Namibia city their partner’s violence before the
women is highly prevalent, with an estimated study interview.
one in three women globally experiencing Peru city The study findings confirm that
some form of victimization in childhood, women around the world are at
Peru province significant risk of physical and
adolescence, or adulthood (5–10). This vio-
lence has a direct economic impact along sexual violence from their partner,
Samoa
with the human and emotional costs. A study but also highlight that there is sub-
in the USA estimated the costs of intimate Serbia and stantial variation both within and
partner rape, physical assault and stalking as Montenegro city between countries. In the WHO
exceeding $5.8 billion each year, nearly $4.1 Thailand city
study, the lowest prevalence of
billion of which is for direct medical and lifetime and current partner vio-
mental health care services (11). lence was found in urban Japan
Thailand province
Violence against women also has a sub- and Serbia and Montenegro,
stantial impact on health (12–15). In the United Republic of which suggests that rates of abuse
Australian state of Victoria, violence by Tanzania city may reflect, in part, different lev-
intimate partners is calculated to result in United Republic of els of economic development.
Tanzania province
more ill health and premature death among However, a study in two sites in
women of reproductive age than any other 0 10 20 30 40 50 60 70 80 90 100 New Zealand that replicated the
risk factor, including high blood pressure, Percentage WHO methodology found life-
Note: Bangladesh data not included. time prevalence of partner vio-
obesity, and smoking (16). Intimate partner
violence is also an important cause of Percentage of ever-partnered women reporting physical or lence as high as that found in
death, accounting for 40 to 60% of female sexual violence, or both, by an intimate partner, by site. many WHO developing country
homicides in many countries, and an impor- sites (22). The rates of current vio-
tant portion of maternal mortality in India, lescent health. States must take responsibil- lence were much lower (less than 6% in
Bangladesh, and the United States (17). ity for the safety and well-being of their citi- both sites), which suggests that women in
The evidence suggests that violence can zens and must tackle the problem with the industrialized nations may find it easier to
be prevented. Policies to prevent violence urgency it requires. leave abusive relationships.
include promoting social awareness to The results from the WHO Study on Assault by a partner was a direct cause
Women’s Health and Domestic Violence of injuries, with between one in five and
1Department of Gender, Women and Health, World against Women released this week (18) one-half of women reporting that they had
Health Organization, Geneva, Switzerland. 2PATH, greatly extend the geographic range and been injured as a result of physical vio-
Washington, DC; 3 London School of Hygiene and scope of available data. The results in this lence, often more than once. In addition,
CREDITS: (TOP)

Tropical Medicine, London, UK. The authors write on

behalf of the WHO Multi-Country Study on Women’s report are based on over 24,000 interviews women who experienced violence by a
Health and Domestic Violence against Women. *Author with 15- to 49-year-old women from 15 partner were more likely to report poor
for correspondence. E-mail: garciamorenoc @who.int sites in 10 countries: Bangladesh, Brazil, general health and greater problems with

1282 25 NOVEMBER 2005 VOL 310 SCIENCE www.sciencemag.org

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 POLICY FORUM
walking and carrying out daily activities, constitutes one of the most salient findings women can and must be improved; men and
pain, memory loss, dizziness, and vaginal of the WHO study. The data also highlight women can and must be convinced that vio-
discharge in the 4 weeks before the inter- the degree to which women in some set- lence is not an acceptable part of human
view. The study also found that abused tings feel that it is unacceptable for women relationships.
women were more likely to experience to refuse sex with her husband, even in cir- References and Notes
emotional distress and to have considered cumstances where it could put them at risk. 1. Resolution A/55/2, The United Nations Millennium
or attempted suicide. An association In three of the rural provincial sites, as Declaration [United Nations (UN), New York, 8
September 2000]; (www.un.org/millennium/declara-
between recent ill health and lifetime many as 44 to 51% of women believe that a tion/ares5552e.htm).
experience of violence suggests that phys- woman is not justified in refusing her hus- 2. “Addressing violence against women and achieving
ical and mental effects may last long after band sex if he mistreats her. The fact that the Millennium Development Goals” [World Health
the violence has ended. the association is particularly marked in Organization (WHO), Geneva, 2005].
3. “Declaration on the elimination of violence against
Although pregnancy is often considered rural and more traditional societies rein- women” (UN General Assembly resolution, document
a time when women are more likely to be forces the hypothesis that traditional gen- A/RES/48/104, UN, New York, 1993).
protected from harm, 1 to 28% of women der norms are a key factor in the preva- 4. The Fourth World Conference on Women, Beijing,
China, 4 to 15 September 1995 (document
who had ever been pregnant reported being lence of abuse and that transforming gen- A/CONF.177/20, UN, New York, 1995).
beaten during pregnancy. More than 90% of der relations should be an important focus 5. L. Heise, M. Ellsberg, M. Gottemoeller, Ending Violence
these women were abused by the father of of prevention efforts. Against Women (Johns Hopkins Univ. Press, Baltimore,
MD, 1999).
the unborn child, and between a quarter and Violence against women is a complex 6. L. Heise, C. Garcia-Moreno, in World Report on Violence
half of them had been kicked or punched in social problem, and our knowledge on how and Health, E. G. Krug et al., Eds. (WHO, Geneva, 2002).
the abdomen. In most cases, the abuse dur- to address it is evolving. Tackling the prob- 7. H. Johnson, Dangerous Domains: Violence Against
Women in Canada (International Thomson, Ontario,
ing pregnancy was a continuation of previ- lem requires coordinated action that 1996).
ous violence. However, for some women, engages communities and many different 8. P. Tjaden, N. Thoennes, “Extent, nature and conse-
the abuse started during pregnancy. sectors—including health, education, and quences of intimate partner violence: Findings from
the National Violence Against Women Survey”
Intimate partner violence was also associ- justice—to challenge the inequities and (National Institute of Justice,Washington, DC; Centers
ated with an increased number of induced social norms that give rise to violence and for Disease Control and Prevention,Atlanta, GA, 2000).
abortions and, in some settings, with mis- to provide emotional and physical support 9. F. Hassan et al., Inj. Control Saf. Promot. 11, 111
carriage. In all sites except urban Thailand for victims. Early intervention, particularly (2004).
10. S. Kishor, K. Johnson, “Profiling domestic violence: A
and Japan, women who experienced vio- targeting children who witness violence or multi-country study” (ORC MACRO, Calverton, MD,
lence were significantly more likely to have are abused, is a promising yet underdevel- 2004).
more children than other women. oped area for action. Developing curricula 11. National Center for Injury Prevention and Control
“Costs of intimate partner violence against women in
Despite these health associations, over for children and young people to learn emo- the United States” (Centers for Disease Control and
half of physically abused women (55 to tional and social skills, including nonvio- Prevention, Atlanta, GA, 2003).
95%) reported that they had never sought lent methods of conflict resolution, could 12. J. C. Campbell, Lancet 359, 1331 (2002).
13. S. B. Plichta, M. Falik, Womens Health Issues 11, 244
help from formal services or from people in be an important contribution to violence (2001).
positions of authority. Only in Namibia and prevention. Support services for abused 14. S. B. Plichta, C. Abraham, Am. J. Obstet. Gynecol. 174,
in both sites in Peru had more than 20% of women and programs to sensitize legal sys- 903 (1996).
15. H. S. Resnick, R. Acierno, D. G. Kilpatrick, Behav. Med.
women contacted the police, and only in tems are also needed. 23, 65 (1997).
Namibia and in urban Tanzania had about Health providers need to be trained to 16. “The health costs of violence: Measuring the burden of
20% sought help from health-care services. identify women experiencing violence and disease caused by intimate partner violence:A summary
of findings” (VicHealth, Carlton South,Australia, 2004).
Family, friends, and neighbors, rather than to respond appropriately to those who dis- 17. E. G. Krug et al., Eds., World Report on Violence and
more formal services, most often provide close abuse. Health services that women are Health (WHO, Geneva, 2002).
the first point of contact for women in vio- most likely to use, such as those for family 18. C. Garcia-Moreno, H. A. F. M. Jansen, M. Ellsberg, L.
lent relationships. planning, prenatal care, or post-abortion Heise, C . Watts, “WHO multi-country study on
women’s health and domestic violence against
The study also demonstrates the care, offer potential entry points for provid- women: Initial results on prevalence, health outcomes,
remarkable degree to which women in ing care, support, and referral to other serv- and women’s responses” (WHO, Geneva, 2005).
some settings have internalized social ices. Existing programs, particularly those 19. In Bangladesh, Brazil, Peru, Thailand, and the United
Republic of Tanzania two sites were studied: the capital
norms that justify abuse. In about half of involved in prevention of HIV, promotion of and a province with a rural-urban mix. The remaining
the sites, 50 to >90% of women agreed that adolescent health, and reduction of teenage countries had one study site only: in Ethiopia, a rural
it is acceptable for a man to beat his wife pregnancy, need to address women’s and province; in Japan and Serbia and Montenegro, an urban
site; and in Samoa, the whole country was included.
under one or more of the following circum- girl’s vulnerability to abuse. 20. The term “violence” without further qualification
stances: if she disobeys her husband, Many local and national organizations refers to physical (either moderate or severe) or sexual
refuses him sex, does not complete the exist to combat violence against women and violence, or both.
21. A woman was said to have experienced severe physical
housework on time, asks about other to promote gender equality, and these vital violence if she reported that she had been kicked,
women, is unfaithful, or is suspected of efforts deserve increased support. At the dragged or beaten up; hit with a fist or something else
infidelity. This was higher among women international level, the WHO Global that could hurt; choked or burned on purpose; or if her
partner had threatened to use or had actually used a
who had experienced abuse than among Campaign for the Prevention of Violence gun, knife, or other weapon against her. A woman is
those who had not, and may indicate either aims to increase awareness about the impact considered to have experienced moderate violence if
that women experiencing violence learn to of violence on public health and the role of she has only been slapped, pushed, shoved, or had
“accept” or rationalize this abuse, or that public health in its prevention, and seeks to something thrown at her.
22. J.Fanslow,E.Robinson, J.N.Z.Med.Assoc. 117,341 (2004).
women are at greater risk of violence in support governments in their efforts to pre- 23. “Milestones for a global campaign for violence preven-
communities where a substantial propor- vent violence and to develop policies and tion” (WHO, Geneva, 2005).
tion of individuals condone abuse. programs for this (23). Supporting Online Material
The association between the prevalence There is nothing “natural” or inevitable www.sciencemag.org/cgi/content/full/310/I5752/1282/DC1
of partner violence and women’s belief about men’s violence toward women.
CREDIT:

that such violence is normal or justified Attitudes can and must change; the status of 10.1126/science.1121400

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