Endemic violence against women and girls

Abstract

An outpouring of anger marked March, 2021, as thousands took to the streets to protest violence and discrimination against women. The contexts varied hugely across settings such as Turkey, Australia, Mexico, the UK, and the USA, but the frustration was universal. Many women related the fear they live with, and a sense of despair and powerlessness at the situation. And yet the force of these conversations provides grounds for measured optimism for the future. That wouldn't be the obvious conclusion to draw from the new report on violence against women by WHO and partner organisations, published on March 9, 2021. This comprehensive report includes 2000–18 data for 161 countries on intimate partner violence and 137 countries for non-partner sexual violence. Overall, an estimated 31% of women aged 15–49 years have been subjected to physical or sexual violence from a current or former husband or male intimate partner, or to sexual violence from someone who isn't a current or former husband or partner, at least once since age 15 years. Although there is national and regional variation in the prevalence of intimate-partner and non-partner violence, it is clearly a globally pervasive problem of pandemic proportions. These horrific numbers make it imperative that more action is urgently taken by governments and societies. An alarming level of violence is already present early in women's lives. The report estimates 16% of young women aged 15–24 years were subjected to physical or sexual violence from an intimate partner within the past 12 months. Adolescence is a time when relationship patterns are being solidified, closely tied to developing self-esteem and the empowerment to say no in sexual or romantic contexts. The amount of intimate partner violence is therefore deeply concerning, indicating early entrenchment of abusive relationship dynamics. Furthermore, the aftermath of non-partner or intimate-partner violence changes the life course, whether through unwanted pregnancy and its repercussions on education and career, or sexual and reproductive health problems, chronic conditions, or depression, anxiety, post-traumatic stress disorder, and devoting energy to healing. Provision of quality care after abuse is therefore crucial. Many women do not report sexual abuse because of the stigma, emotional difficulty, and likelihood of being blamed. For adolescents who have been sexually abused, studies advocate providing care that respects their autonomy and wishes, ensures confidentiality, and makes services welcoming. As the WHO report emphasises, women should be able to access survivor-centred health care. Believing women is key to this. Within this bleak picture, however, is the potential for optimism. Exactly because of its foundational character, adolescence is a window of opportunity for establishing healthier gender dynamics. The report highlights that violence against women is not inevitable, urging for prevention programmes to be more widely tested and scaled up. Deep societal changes are needed, beginning with creating gender equality that encompasses economic empowerment and access to education. Real change also requires fundamentally challenging social norms around gender roles and behaviour, which adolescent health professionals are well positioned to do. Given that men are primarily responsible for violence against women, adolescent boys must be included in these interventions; it is essential that such initiatives challenge sexist ideas and norms that support masculinities based on control over women and condoning violence. Schools and communities are key for programmes that aim to develop a joint understanding of gender dynamics, sexuality, and relationships. For example, many programmes for preventing adolescent dating violence include coaching for healthy relationships, promoting gender equitable attitudes, or modifying school environments or policies. Efforts to reduce violence must vary according to context; in humanitarian settings, for instance, providing safe places for girls and women is of paramount importance. The WHO report is a valuable addition to the increasingly open discussions in the past years around gender-based violence, as women disclose what they have been through. Discourse is a step to creating a new reality, and the extent of discussions today should make us hopeful that change is possible in the future. To end violence against women, these discussions must span the genders—with far greater reflection by men and boys on their role in this problem—and they should include adolescents, whose involvement offers the promise of changing cultural norms, creating more gender equitable societies, and developing healthy relationships. Preparing a global trauma-informed workforceA recent editorial in The Lancet Child & Adolescent Health calls attention to the alarming prevalence of violence against women and girls, beginning in the important developmental period of adolescence, and the crucial need for accelerated governmental intervention for violence prevention.1 We wish to emphasise that progress in surveillance and improving care after abuse will be impeded if health professionals are not properly equipped with the competencies and experience to deal with gender-based violence. Full-Text PDF