Violence against women needs to come out of the shadows, researchers say

An estimated one in three women worldwide will be assaulted in their lifetime, say researchers, who have joined former U.S. president Jimmy Carter in calling for urgent global action to prevent the violence.

The medical journal The Lancet published a series of five papers on violence against women and girls Friday.

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The researchers’ estimates include:

• More than 30 per cent of women worldwide have experienced either physical or sexual partner violence.
• About seven per cent of women worldwide have experienced non-partner sexual assault.
• About 100 to 140 million girls and women worldwide have undergone female genital mutilation.
• Nearly 70 million girls worldwide have been married before the age of 18 years, many against their will.

"The more you can get people talking about it, the more it comes out of [the] shadows and we've seen that that can make a real difference  in reducing the levels of violence both in schools and in communities," Mary Ellsberg, director of the George Washington University's Global Women's Institute in Washington, and one of the co-authors of the series, said in an interview.

Age-old patriarchal structures and attitudes make it more difficult to sustain progress, Jimmy Carter said in a journal commentary accompanying the series.

"Patriarchy must be replaced by a system in which equal human rights and non-violence are promoted and accepted," Carter wrote. "Equal human dignity is a human right, as codified in many global treaties. It is my hope that political and religious leaders will step forward and use their influence to communicate clearly that violence against women and girls must stop, that we are failing our societies, and that the time for leadership is now."

Violence is often seen as a social and criminal justice problem and not as a clinical or public health issue, said Dr. Claudia Garcia-Moreno, a physician at the World Health Organization in Geneva. But health-care providers are often the first point of contact for girls and women experiencing violence and the health system can play a role both in treating the consequences of violence and in preventing it, she said.

Health workers can help women to disclose that they are victims of violence with non-judgmental, respectful and compassionate care, Garcia-Moreno suggested.  She said health professionals can also champion prevention in the wider community, such as by promoting the health benefits of delayed marriage for girls.

The series also reviewed the evidence on what type of prevention programs work. The most successful strategies are complex and use multiple approaches across many different sectors including health, the researchers concluded.

One of the successful programs highlighted by the Lancet is the Healthy Relationships program for male and female  students, now used by 5,000 schools in Canada.

"The teaching of youths about healthy relationships as part of their required health curriculum reduced physical dating violence and increased condom use 2.5 years later at a low per-student cost," psychologist Dr. David Wolfe of the Centre for Addiction and Mental Health Centre for Prevention Science in London, Ont., and his co-authors concluded in a 2009 study published in JAMA Pediatrics.

Ellsberg said the program was focused on improving communication between dating couples, which seemed to have a positive effect on reducing use of violence by both boys and girls.

"Sadly, there are not enough programs as rigorous and as intensive as Dr. Wolfe's program," she said.

Similarly, a community-based program in Uganda called SASA reduced domestic violence by nearly 50 per cent over two years, Ellsberg said. "It's getting people taking about violence and looking at non-violent ways to communicate but at every level, in schools, in hospitals, in church."

The series is published ahead of the 16 Days of Activism Against Gender Violence campaign, which begins on Nov. 25.