Introduction to Gender Concepts and Gender-Based Violence

1.1. Basic Concepts

Let's unpack the difference between sex and gender. While this may seem basic, the
two terms are often used interchangeably although they have different meanings.

1.1.1. What is sex?

Sex refers to the biological classification of people as male or female. At its most
simplistic form, sex is what you are assigned at birth and based on a combination of
characteristics such as anatomy, chromosomes, hormones, internal reproductive
organs, and genitals.

1.1.2. What is gender?

Gender refers to the social attributes and opportunities associated with being male
and female and the relationships between women and men and girls and boys, as well
as the relations between women and those between men. These attributes,
opportunities and relationships are socially constructed and are learned through
socialization processes. They are context and time-specific and also
changeable. Gender determines what is expected, allowed and valued in a woman
or a man in a given context. In most societies there are differences and inequalities
between women and men in responsibilities assigned, activities undertaken,
access to and control over resources, as well as decision-making opportunities.
Gender is part of the broader socio-cultural context.

In addition to sex and gender, there are a few other terms that we should understand:
gender identity, gender expression and sexual orientation. These terms are best
situated across a spectrum that recognizes the diversity in sex, gender identities,
gender expressions and sexual orientations. Explore the following sex and gender
spectra to better understand each term.

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Although this figure treats biological sex, gender identity, gender expression, and
sexual orientation as separate entities, in reality, they overlap and exist on a spectrum.
For example, genderqueer (a person who does not subscribe to conventional gender
distinctions but identifies with neither, both, or a combination of male and female
genders) can be an expression and identity.

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Topic 1.2. Intersectionality

Intersectionality is an analytical framework that looks at how power and privilege

operate differently for people with different socio demographic positions. For
example, race, class, gender, ethnicity, disability, gender identity, sexual orientation,
nationality, and immigration status among others. Taking an intersectional approach
means to critically analyze the question “Where is the power?”

 If you just look at power from a binary gender equality lens, men typically
have had more power in our society compared to women. When we focus only
on gender to determine negative life outcomes, we are oversimplifying the
multiple challenges faced by most marginalized people in society.
 However, an intersectional lens would not only look at men and women, it
would look at various interlocking social positions that explain inequality. We
want to be careful not to generalize the experience of all women or all men, as
their opportunities can vary tremendously based on the combination of their
class, age, race, religion, and other factors.
 Taking an intersectional approach to research and M&E is important because
it highlights groups that we might miss if we just focused on one factor. For
example, you may conduct research on GBV experiences of refugee women,
but it's important to think about other characteristics - ethnicity, socio-
economic status, etc. - within this wider characterization.

Looking at Intersectionality

As a part of a WASH project, we are building boreholes throughout a rural

community in Maroua so that women don't have to spend more than 3 hours per day
walking to the nearest water source. The socio-demographic composition of the
community is quite diverse, and women primarily have the responsibility of fetching
water.

Do you think all women will benefit equally from this development intervention? Yes
or No.

Given the varying socio-demographic conditions of the people living in this

community, not all women will benefit equally from this development intervention.

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Topic 2.1 - Social and Gender Norms

Let's unpack the difference between social norms and gender norms. It is very
important to understand the role social norms and gender norms play in a given
conflict or humanitarian setting as harmful norms that are often exacerbated during
times of crisis which can contribute to higher rates of GBV.

Social Norms

What are social norms?

Social norms are people’s beliefs about 1) what others in the group do and 2) the
extent to which others in the group approve of something.

Even though people may want to do something, they will comply with the beliefs
common in society and the consequences for not conforming to those beliefs. You can
have an individual attitude about something but follow a different social norm.

Gender Norms
What are gender norms?

Gender norms are acceptable, appropriate, and/or obligatory unwritten rules of

behavior specifically for men and women in a given group or society.

Gender norms are a neutral construct, but there are both positive and harmful gender
norms. An example of a positive gender norm is “real men don’t beat their wives”.
This would be considered a protective gender norm. However, some gender norms
can be discriminatory or harmful or expose people to risk and danger. An example of
a negative norm is “men need to be strong and aggressive” or “women’s place is in
the house”.

People who study gender norms typically are much more aware of the power
imbalance and negative effects of discriminatory gender norms.

Discriminatory, inequitable, and harmful gender norms are at the very root of gender
inequality and are a key piece in addressing GBV.

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Topic 2.2 - Gender Inequality

Let’s explore the difference between gender equality and gender equity.

What is gender equality?

Refers to the equal rights, responsibilities and opportunities of women and men and
girls and boys. Equality does not mean that women and men will become the same but
that women’s and men’s rights, responsibilities and opportunities will not depend on
whether they are born male or female.

Gender equality implies that the interests, needs and priorities of both women and
men are taken into consideration, recognizing the diversity of different groups of
women and men. Gender equality is not a women’s issue but should concern and fully
engage men as well as women. Equality between women and men is seen both as a
human rights issue and as a precondition for, and indicator of, sustainable people-
centered development.

What is gender equity?

Refers to fairness and justice in the distribution of benefits and responsibilities

between women and men, according to their respective needs. It is considered part of
the process of achieving gender equality, and may include equal treatment (or
treatment that is different but considered equivalent) in terms of rights, benefits,
obligations, and opportunities.

Let’s further explore gender equality vs. gender equity through a case study around
latrines in a refugee camp.

Distribution of Latrines in a Refugee Camp

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This is an image of latrines that the UN built in a refugee camp. They built 3
individual latrines for men and 3 individual latrines for women. However, 75% of the
refugee camp consists of women and children. Does the distribution of latrines
illustrate gender equality or gender equity?

The distribution of latrines illustrates gender equality because men and women are
provided the same number of latrines despite the fact that 75% of the camp consists of
women and children.

You cannot achieve gender equality without first achieving gender equity.

It should be noted that

 Gender inequality exists in all societies to varying degrees. Gender inequality

is often reflected in gender roles and gender responsibilities in private and
public life. As we noted earlier, gender roles are learned behaviours.
Sometimes they are rigidly defined; meaning that women should not take on
roles that are defined for men and men should not take on roles that are
defined for women. This also means that roles can't be shared. Although, in
some cases, roles are shared, and it is socially acceptable for either men or
women to take on that role.
 When gender roles are rigidly defined though, female roles may be devalued.
In many societies, gender inequality is reflected in the greater value that is
placed on paid productive labour than on unpaid care work, also known as
reproductive labour. This means all the work done in the household to sustain
the household members. Women typically do much more care work than men.
In many societies, women and adolescent girls face a triple burden. This
means that they have to do productive work, unpaid care work and community
service work. They also typically have less leisure time than men and
adolescent boys.
 In conflict and humanitarian settings, gender roles often change. Men may be
away due to conflict, be unable to fulfil the expected role of head of the
household, or have died. We often see women taking on roles that traditionally
have been considered more “masculine” during times of conflict and
displacement.
 However, these changing gender roles can cause backlash and may result in
increases in GBV, both within their homes and communities. For example, we
often see spikes of violence in the immediate post conflict period, where men
and boys come back from war and find that women and girls have filled their
traditional positions. In order to take back this power, they may use violence
to reinforce traditional gender roles and norms.

Another key dimension of gender inequality is who has access to and control over
resources. For instance, in some societies, only men can own land. Wives and
daughters may be able to use the land if their husband or father gives them
permission, but they may not be able to own it. This affects their ability to borrow
money and make long-term investments in the land.

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Topic 2.3 - Power

Power over means the power that one person or group uses to control another person
or group. This control might come from direct violence or more indirectly, from the
community beliefs and practices that position men as superior to women. Using one’s
power over another is injustice.

Power within is the strength that arises from inside ourselves when we recognize the
equal ability within all of us to positively influence our own lives and community. By
discovering the positive power within ourselves, we are compelled to address the
negative uses of power that create injustice in our communities.

Power with means the power felt when two or more people come together to do
something that they could not do alone. Power with includes joining our power with
individuals as well as groups to respond to injustice with positive energy and support.

Power to is the belief, energy and actions that individuals and groups use to create
positive change. Power to is when individuals proactively work to ensure that all
community members enjoy the full spectrum of human rights and are able to achieve
their full potential.

Another way of thinking about power is to think about who has access to and control
over resources. Explore the following case study about who has access to and control
over resources in Dita and Mirab Abaya Districts in Ethiopia.

When we look at gender power dynamics, we find that men typically have access to
and control over more resources than women. The resources that women do have
control over may be because the resources are needed to fulfill their gender roles and
responsibilities. For example, women may have access (or more access) to firewood
because they need it to cook food.

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Rural Women's Average Control over Productive Resources in Dita and Mirab
Abaya Districts of Ethiopia

In certain contexts, men typically have control over resources if they are used for
productive purposes, and women typically have control over resources if they are
used for reproductive purposes. For example, in Dita and Mirab Abaya Distrcits of
Ethiopia, rural women may have access to and control over water if it is for home
consumption or sanitation purposes, but rural men may have access to and control
over water if it is for irrigation and livestock.

The following graph shows rural women vs. rural men's control over productive
resources in Dita and Mirab Abaya Districts in Ethiopia.

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Topic 3.1 - Introduction to GBV

Within the umbrella term gender-based violence, or GBV, there are specific forms of
violence that are commonly seen within refugee and conflict affected populations.
Explore the following prevalent forms of violence that need to be understood by
practitioners and researchers in the field.

Gender Based Violence.

GBV is an umbrella term for any harmful act that is perpetrated against a person’s
will and that is based on socially ascribed (i.e. gender) differences between males and
females. The term ‘gender-based violence’ is primarily used to underscore the fact
that structural, gender-based power differences between males and females around
the world place females at risk for multiple forms of violence. As agreed in the
Declaration on the Elimination of Violence against Women (1993), this includes acts
that inflict physical, mental, or sexual harm or suffering; threats of such acts;
coercion; and other deprivations of liberty, whether occurring in public or in private
life. The term is also used by some actors to describe some forms of sexual violence
against males and/or targeted violence against LGBTI populations, specifically when
referencing violence related to gender-inequitable norms of masculinity and/or norms
of gender identity.

Inter-Agency Standing Committee. (2015). Guidelines for Integrating Gender-Based

Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience
and aiding recovery.

Intimate Partner Violence

Intimate partner violence is one of the most common forms of violence against
women and includes physical, sexual, and emotional abuse and controlling behaviors
by an intimate partner. Intimate partner violence (IPV) occurs in all settings and
among all socioeconomic, religious and cultural groups. The overwhelming global
burden of IPV is borne by women. Although women can be violent in relationships
with men, often in self defense, and violence sometimes occurs in same-sex
partnerships, the most common perpetrators of violence against women are male
intimate partners or ex-partners. By contrast, men are far more likely to experience
violent acts by strangers or acquaintances than by someone close to them.

Inter-Agency Standing Committee. (2015). Guidelines for Integrating Gender-Based

Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience
and aiding recovery.

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Non Partner Sexual Assault

When aged 15 years or over, experience of being forced to perform any sexual act that
you did not want to by someone other than your husband/partner.

World Health Organization. (2013). Global and regional estimates of violence against
women: prevalence and health effects of intimate partner violence and non-partner
sexual violence.

Traditional Practices

Traditional cultural practices reflect values and beliefs held by members of a

community for periods often spanning generations. Every social grouping in the world
has specific traditional cultural practices and beliefs, some of which are beneficial to
all members, while others are harmful to a specific group, such as women. These
harmful traditional practices include female genital mutilation (FGM); forced feeding
of women; early marriage; the various taboos or practices which prevent women from
controlling their own fertility; nutritional taboos and traditional birth practices; son
preference and its implications for the status of the girl child; female infanticide; early
pregnancy; and dowry price. Despite their harmful nature and their violation of
international human rights laws, such practices persist because they are not questioned
and take on an aura of morality in the eyes of those practicing them.

UN General Assembly. (1979). Convention on the Elimination of All Forms of

Discrimination Against Women.

Trafficking

Article 3, paragraph (a) of the Protocol to Prevent, Suppress and Punish Trafficking in
Persons defines Trafficking in Persons as the recruitment, transportation, transfer,
harboring or receipt of persons, by means of the threat or use of force or other forms
of coercion, of abduction, of fraud, of deception, of the abuse of power or of a
position of vulnerability or the giving or receiving of payments or benefits to achieve
the consent of a person having control over another person, for the purpose of
exploitation. Exploitation shall include, at a minimum, the exploitation of the
prostitution of others or other forms of sexual exploitation, forced labor or services,
slavery or practices similar to slavery, servitude or the removal of organs.

UN Office on Drugs and Crime. (2021). Human Trafficking.

Over the last 20 years, there's been a lot of research on GBV and, although there’s
more to learn, we already know quite a bit. Explore the flashcards below to learn
about some key findings.

The World Health Organization conducted a landmark study in 2005 that documented
violence against women by their intimate partners and non-partners. The study

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interviewed over 24,000 women in 10 countries and found that 1 in 3 women
worldwide experienced either physical and/or sexual Intimate Partner Violence (IPV)
in their lifetime.

Women and girls are at the greatest risk from people in their own homes, usually a
family member or an intimate partner, not from strangers. IPV is the most common
form of violence faced by women and girls. This can include physical, sexual,
emotional, and economic abuse.

Most women and girls report that their first incident of sexual abuse took place during
their adolescence (between the ages of 10 and 19).

Gender inequality, unequal power dynamics, and harmful gender norms are the
underlying causes of violence in both conflict and non-conflict-affected settings.

GBV can take place in the home or the community, for example, in schools,
workplaces, and public spaces. It also can be either promoted or tolerated by states,
for example, in conflict settings. GBV also includes specific types of violence against
men and boys, but the term is primarily used to talk about the vulnerabilities that
women and girls have to various forms of violence in settings where they're
discriminated against specifically because they're female. For that reason, we often
use the term GBV interchangeably with the term violence against women and girls, or
VAWG, but it is important to understand the difference between the two terms.

The Interagency Gender-based Violence Information Management System

(GBVIMS) tool classifies 6 “core types” of GBV. Review these core types of GBV
below.

Rape

Non-consensual penetration (however slight) of the vagina, anus or mouth with a

penis or any other part of the body. This will also include penetration of the vagina or
anus with any object.

Sexual Assault

Any form of non- consensual sexual contact that does not result in or include
penetration. Examples include: attempted rape, as well as unwanted kissing, fondling,
or touching of genitalia and buttocks. FGM/C is an act that of violence that impacts
that sexual organs, and as such should be classified as sexual assault. This incident
type does not include rape, that is where penetration has occurred.

Physical Assualt

An act of physical violence that is not sexual in nature. This can include: hitting,
slapping, choking, cutting, burning, shooting, or use of any weapon, acid attacks or
any other act that results in pain, discomfort or injury. This incident type does not
include FGM/C

Forced Marriage

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The marriage of an individual against their will.

Denial of Resources, Opportunities or Services

Denial of rightful access to economic resources/assets or livelihood opportunities,

education, health or other social services. This does not however include general
poverty.

Psychological/Emotional Abuse

Infliction of mental or emotional pain or injury. Examples include: threats of physical

or sexual violence, intimidation, humiliation, forced isolation, stalking, harassment,
unwanted attention, remarks, gestures or written words of a sexual and/or menacing
nature, destruction of valuables, etc.

Explore the following infographic to learn more about the types of violence women
and girls experience throughout their life cycle.

Childhood

Even before birth, girls can face sex-selective abortion. At an early age, girls can face
female infanticide, neglect and malnutrition, child sexual abuse, female genital
mutilation/cutting, and/or forced early marriage.

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Adolescence

As girls grow into women, they can face physical and sexual abuse from a partner or
close family member or friend, sexual harassment and rape among many other forms
of violence.

Adult

Adult women continue to face physical and sexual abuse, sexual harassment and
abuse, and rape among many others.

Elderly

Elderly women are also exposed to different kinds of harm in different settings. For
example, widowed women are risk of being inherited by other family members to
keep the property of the family within the husband’s family, widow rites,
disinheritance, physical violence, etc.

The socio-ecological framework helps us better understand that violence occurs at all
levels. It looks at the risk factors for victimization or perpetration of GBV at various
levels: individual, interpersonal, communal, institutional, and societal. The overlap
between different levels illustrates how factors at one level drive factors at another
level, and, in order to prevent violence, it is necessary to act across multiple levels.

Explore the following infographic to learn about some of the factors that
contribute to GBV at each level in conflict and humanitarian settings.

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Societal.

- Unequal gender dynamics and patriarchal norms and practices.

- A culture of impunity and lack of rule of law.
- Emphasis on hyper masculinities as facets of warfare

Institutional

- Abuse of power by humanitarian, peacekeepers and others in power.

- Lack of female representation in decision making positions, security forces
and armies
- Suppressed civil society
- Use of rape as weapon of war
- Forced enlistment of women and girls in roles associated with armed groups.
- Not addressing GBV in peace agreements and state building mechanisms.

Community

- Normalization of violence
- Intra- and inter-communal violence and explicit targeting of women and girls
and opportunistic rape.

Interpersonal

- Household stressors including poverty

- Unequal household dynamics and increased controlling behaviours
- Changing gender roles and men’s belief that they are unable to fulfil ideals of
traditional masculine roles.
- Choice in marriage and age of marriage
- Re-integration of male combatants into the household.

Individual

- Socio-demographic characteristics
- Alcohol and drug use
- Experience of childhood GBV. For example, girls who witness violence
between parents are more likely to be victimized in adulthood and boys who
witness violence between parents are more likely to perpetrate violence in
adulthood.
- Displacement, separation from family support structures and female headed
households
- Experiences as and re-integration of combatant abductees.

When armed conflict arises, it can permeate all levels of the ecological framework,
exacerbating or intensifying many of the primary forces that increase an individual’s
risk of violence. Evidence suggests that economic and social instability, as a result of
conflict and displacement, can compound other risk factors and intensify levels of
violence experienced by women and girls. In addition to direct experiences of
violence perpetrated by armed actors, women and girls are more vulnerable to other

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forms of violence, both during and after conflict, as a result of the disruption of
institutions, displacement, and increased poverty.

IPV can have devastating effects on women’s health. Women exposed to IPV suffer
many health consequences.

Depression: IPV is a major contributor to women’s mental health problems, with

women who have experienced IPV being almost twice as likely to experience
depression compared to women who have not experienced any violence.

Alcohol use problems: Women experiencing IPV are almost twice as likely as other
women to have alcohol use problems.

Low birth-weight babies: Women who experience IPV have a 16% greater chance of
having a low birth-weight baby, and this increased risk has been shown to be as high
as 4 times in some settings.

Sexually transmitted infections: Women who experience physical and/or sexual IPV
are 1.5 times more likely to acquire syphilis, chlamydia, or gonorrhea. In some
regions (including sub-Saharan Africa), they are 1.5 times more likely to acquire HIV.

Injuries: 42% of women who have experienced physical or sexual violence at the
hands of a partner had experienced injuries as a result.

Death: Among women who have been murdered, 38% of them were killed by their
intimate partners. It's the major cause of homicide among women.

Read the results of the following study on the global homicide rate.

UNODC. (2019). Global Study on Homicide.

Another global survey found that men (80%) are more likely to be murdered globally
compared to women (20%). However, if you only look at people who are killed by

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intimate partners or family members, although men are more likely to be murdered
globally (80%), among those who are killed by intimate partners or family member,
women make up the majority (64%). If we only look at IPV, women make up 82% of
all murders by intimate partners. Basically, men are much more likely to be murdered
by somebody they don't know, in conflicts or fighting in the street, for example,
whereas women are much more likely to be murdered by somebody they know and
somebody who is close to them.

Many people believe that domestic violence is due to poverty, alcohol consumption,
or because men just can't control their anger. But we now know that violence is
actually a learned behavior. It's not innate. It's learned through opposite variation
through personal experiences, through cultures, through family and learning
communities and schools, and from peers as well.

Studies on the prevalence of violence and the characteristics of both victims and
abusers show us that boys who witnessed or experienced violence in their childhood,
or witnessed their mothers being abused by their fathers, are at least three times more
likely to abuse their own wives when they're adults.

Girls who witnessed the same, their mothers being abused by their fathers or are
abused themselves, are much more likely to be victims of abuse as adults.

Why is this? Because through these experiences in childhood, they're learning what it
means to be a woman, what it means to be a man, what is normal behavior, and this
absolutely predisposes them in adulthood to either become perpetrators of abuse or
victims of violence. So, although violence can be aggravated by alcohol use, or lack
of self-control, or economic problems, or economic stress, these are not the causes of
the violence.

Understanding the difference between root causes of violence vs. factors that
aggravate violence is very important, particularly when developing programming and
messaging around GBV as incorrect messaging or programming can do more harm
than good.

Different types of services that survivors may need.

Each incident of gender-based violence is a violation of an individual’s rights that can

have a significant impact on a survivor’s safety, health and quality of life. Survivors
of GBV can suffer significant health consequences, including unwanted pregnancies,
HIV and other sexually transmitted infections, physical trauma and even death. GBV
survivors also experience a range of psychological and social consequences, including
shame, guilt, depression, isolation, abandonment and abuse by family members.

All GBV survivors have a right to care and support. However, high-quality and
compassionate services often are not available in emergency settings, and survivors
face multiple barriers to receiving support, including a fear of perpetrators, social
stigma, and discriminatory laws and policies.

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1) Psychosocial Counselling

2) Protection/Security

3) Medical Support

Early medical interventions after incidents of rape can prevent unwanted pregnancy,
infections and HIV.

4) Shelters

5) Case Management

6) Livelihoods/Economic Support

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Understanding and addressing violence against women
Intimate partner violence
Intimate partner violence is one of the most common forms of violence against
women and includes physical, sexual, and emotional abuse and controlling behaviours
by an intimate partner. Intimate partner violence (IPV) occurs in all settings and
among all socioeconomic, religious and cultural groups. The overwhelming global
burden of IPV is borne by women.

Although women can be violent in relationships with men, often in self-defence, and
violence sometimes occurs in same-sex partnerships, the most common perpetrators
of violence against women are male intimate partners or ex-partners. By contrast, men
are far more likely to experience violent acts by strangers or acquaintances than by
someone close to them.

FORMS OF INTIMATE PARTNER VIOLENCE

IPV refers to any behaviour within an intimate relationship that causes physical,
psychological or sexual harm to those in the relationship.
Examples of types of behaviour are listed below.
 Acts of physical violence, such as slapping, hitting, kicking and beating.
 Sexual violence, including forced sexual intercourse and other forms of sexual
coercion.
 Emotional (psychological) abuse, such as insults, belittling, constant
humiliation, intimidation (e.g. destroying things), threats of harm, threats to
take away children.
 Controlling behaviours, including isolating a person from family and friends;
monitoring their movements; and restricting access to financial resources,
employment, education or medical care.

How common is intimate partner violence?

A growing number of population-based surveys have measured the prevalence of IPV,
most notably the WHO multi-country study on women’s health and domestic violence
against women, which collected data on IPV from more than 24 000 women in 10
countries, representing diverse cultural, geographical and urban/rural settings (3). The
study confirmed that IPV is widespread in all countries studied. Among women who
had ever been in an intimate partnership:
- 13–61% reported ever having experienced physical violence by a partner;
- 4–49% reported having experienced severe physical violence by a partner;
- 6–59% reported sexual violence by a partner at some point in their lives; and
- 20–75% reported experiencing one emotionally abusive act, or more, from a
partner in their lifetime.
In addition, a comparative analysis of Demographic and Health Survey (DHS) data
from nine countries found that the percentage of ever-partnered women who reported
ever experiencing any physical or sexual violence by their current or most recent
husband or cohabiting partner ranged from 18% in Cambodia to 48% in Zambia for
physical violence, and 4% to 17% for sexual violence.
In a 10-country analysis of DHS data, physical or sexual IPV ever reported by
currently married women ranged from 17% in the Dominican Republic to 75% in
Bangladesh. Similar ranges have been reported from other multi-country studies.

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Existing research suggests that different types of violence often coexist: physical IPV
is often accompanied by sexual IPV, and is usually accompanied by emotional abuse.
For example, in the WHO multi-country study, 23–56% of women who reported ever
experiencing physical or sexual IPV had experienced both. A comparative analysis of
DHS data from 12 Latin American and Caribbean countries found that the majority
(61–93%) of women who reported physical IPV in the past 12 months also reported
experiencing emotional abuse.

IPV affects adolescent girls as well as older adult women, within formal unions in
settings where girls marry young, and within informal partnerships such as ‘dating
relationships’. Estimates of the prevalence of violence against women and girls within
dating relationships vary widely, depending on how they are measured. The examples
below illustrate selected findings:
- A South African study found that 42% of females aged 13–23 years reported
ever experiencing physical dating violence;
- A survey of male college students in Ethiopia found that 16% reported
physically abusing an intimate partner or non-partner, and 16.9% reported
perpetrating acts of sexual violence.

Why don’t women leave violent partners? Evidence suggests that most abused women
are not passive victims – they often adopt strategies to maximize their safety and that
of their children. Heise and colleagues (1999) argue that what might be interpreted as
a woman’s inaction may in fact be the result of a calculated assessment about how to
protect herself and her children. They go on to cite evidence of various reasons why
women may stay in violent relationships, including:
 Fear of retaliation; n lack of alternative means of economic support;
 Concern for their children;
 Lack of support from family and friends;
 Stigma or fear of losing custody of children associated with divorce; and
 Love and the hope that the partner will change.

Despite these barriers, many abused women eventually do leave their partners, often
after multiple attempts and years of violence. In the WHO multi-country study, 19–
51% of women who had ever been physically abused by their partner had left home
for at least one night, and 8–21% had left two to five times.

Factors associated with a woman leaving an abusive partner permanently appear to

include an escalation in violence severity; a realization that her partner will not
change; and the recognition that the violence is affecting her children.

What are the causes of and risk factors for intimate partner violence?
The most widely used model for understanding violence is the ecological model,
which proposes that violence is a result of factors operating at four levels: individual,
relationship, community and societal. Researchers have begun to examine evidence at
these levels in different settings, to understand better the factors associated with
variations in prevalence; however, there is still limited research on community and
societal influences. Some risk factors are consistently identified across studies from
many different countries, while others are context specific and vary among and within
countries (e.g. between rural and urban settings). It is also important to note that, at

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the individual level, some factors are associated with perpetration, some with
victimization, and some with both.

Individual factors
Some of the most consistent factors associated with a man’s increased likelihood of
committing violence against his partner(s) are:
 Young age;
 Low level of education;
 Witnessing or experiencing violence as a child;
 Harmful use of alcohol and drugs;
 Personality disorders;
 Acceptance of violence (e.g. feeling it is acceptable for a man to beat his
partner); and
 Past history of abusing partners.

Factors consistently associated with a woman’s increased likelihood of experiencing

violence by her partner(s) across different settings include:
 Low level of education;
 Exposure to violence between parents;
 Sexual abuse during childhood;
 Acceptance of violence; and
 Exposure to other forms of prior abuse.

Relationship factors
Factors associated with the risk of both victimization of women and perpetration by
men include:
 Conflict or dissatisfaction in the relationship;
 Male dominance in the family;
 Economic stress;
 Man having multiple partners; and
 Disparity in educational attainment, i.e. where a woman has a higher level of
education than her male partner.

Community and societal factors

The following factors have been found across studies:
 Gender-inequitable social norms (especially those that link notions of
manhood to dominance and aggression);
 Poverty;
 Low social and economic status of women;
 Weak legal sanctions against IPV within marriage;
 Lack of women’s civil rights, including restrictive or inequitable divorce and
marriage laws;
 Weak community sanctions against IPV;
 Broad social acceptance of violence as a way to resolve conflict; and
 Armed conflict and high levels of general violence in society.

In many settings, widely held beliefs about gender roles and violence perpetuate
partner violence.

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EXAMPLES OF NORMS AND BELIEFS THAT SUPPORT VIOLENCE
AGAINST WOMEN
 A man has a right to assert power over a woman and is considered socially
superior
 A man has a right to physically discipline a woman for ‘incorrect’ behaviour
 Physical violence is an acceptable way to resolve conflict in a relationship
 Sexual intercourse is a man’s right in marriage
 A woman should tolerate violence in order to keep her family together
 There are times when a woman deserves to be beaten
 Sexual activity (including rape) is a marker of masculinity
 Girls are responsible for controlling a man’s sexual urges.

What are the consequences of intimate partner violence?

IPV affects women’s physical and mental health through direct pathways, such as
injury, and indirect pathways, such as chronic health problems that arise from
prolonged stress. A history of experiencing violence is therefore a risk factor for many
diseases and conditions.

Current research suggests that the influence of abuse can persist long after the
violence has stopped. The more severe the abuse, the greater its impact on a woman’s
physical and mental health, and the impact over time of different types and multiple
episodes of abuse appears to be cumulative.

Injury and physical health

The physical damage resulting from IPV can include: bruises and welts; lacerations
and abrasions; abdominal or thoracic injuries; fractures and broken bones or teeth;
sight and hearing damage; head injury; attempted strangulation; and back and neck
injury. However, in addition to injury, and possibly far more common, are ailments
that often have no identifiable medical cause, or are difficult to diagnose. These are
sometimes referred to as ‘functional disorders’ or ‘stress-related conditions’, and
include irritable bowel syndrome/gastrointestinal symptoms, fibromyalgia, various
chronic pain syndromes and exacerbation of asthma. In the WHO multi-country
study, the prevalence of injury among women who had ever been physically abused
by their partner ranged from 19% in Ethiopia to 55% in Peru. Abused women were
also twice as likely as non-abused women to report poor health and physical and
mental health problems, even if the violence occurred years before.

Mental health and suicide

Evidence suggests that women who are abused by their partners suffer higher levels
of depression, anxiety and phobias than non-abused women (2). In the WHO multi-
country study, reports of emotional distress, thoughts of suicide, and attempted
suicide were significantly higher among women who had ever experienced physical
or sexual violence than those who had not (3). In addition, IPV has also been linked
with
 Alcohol and drug abuse;
 Eating and sleep disorders;
 Physical inactivity;
 Poor self-esteem;
 Post-traumatic stress disorder;
 Smoking; n self-harm; and

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  Unsafe sexual behaviour.

Sexual and reproductive health

IPV may lead to a host of negative sexual and reproductive health consequences for
women, including unintended and unwanted pregnancy, abortion and unsafe abortion,
sexually transmitted infections including HIV, pregnancy complications, pelvic
inflammatory disease, urinary tract infections and sexual dysfunction. IPV can have a
direct effect on women’s sexual and reproductive health, such as sexually transmitted
infections through forced sexual intercourse within marriage, or through indirect
pathways, for example, by making it difficult for women to negotiate contraceptive or
condom use with their partner.

Violence during pregnancy

Studies have found substantial levels of physical IPV during pregnancy in settings
around the world. The WHO multi-country study found prevalences of physical IPV
in pregnancy ranging from 1% in urban Japan to 28% in provincial Peru, with
prevalences in most sites of 4–12%. Similarly, a review of studies from 19 countries
found prevalences ranging from 2% in settings such as Australia, Denmark and
Cambodia, to 13.5% in Uganda, with the majority ranging between 4% and 9%. A
few facility-based studies in some settings have found even higher prevalences,
including one from Egypt with an estimated prevalence of 32% and a review of
studies from Africa that found prevalence as high as 40% in some settings.

Violence during pregnancy has been associated with

 Miscarriage;
 Late entry into prenatal care;
 Stillbirth; n premature labour and birth;
 Fetal injury; and
 Low-birth-weight or small-for-gestational-age infants.

IPV may also account for a proportion of maternal mortality, although this association
is often unrecognized by policy-makers.

Homicide and other mortality

Studies from a range of countries have found that their husband or boyfriend, often in
the context of an abusive relationship, killed 40–70% of female murder victims. In
addition, evidence suggests that IPV increases the risk of a woman committing
suicide, and may also increase the risk of contracting HIV, and thus of AIDS-related
death.

Effects on children
Many studies have found an association between IPV against women and negative
social and health consequences for children, including anxiety, depression, poor
school performance and negative health outcomes. A large body of evidence indicates
that exposure to IPV against the mother is one of the most common factors associated
with male perpetration and female experience of IPV later in life. A number of studies
have found an association between IPV and child abuse within the same household. In

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addition, studies from some low-income countries, including Nicaragua and
Bangladesh have found that children whose mothers were abused
 Are less likely to be immunized;
 Have higher rates of diarrhoeal disease; and/or
 Are at greater risk of dying before the age of five.

What are the best approaches to preventing and responding to IPV?

In recent years, a number of international reviews have synthesized evidence on
effective, or at least promising, approaches to preventing and responding to violence
against women, including IPV. These reviews suggest a need for comprehensive,
multi-sectoral, long-term collaboration between governments and civil society at all
levels of the ecological framework. Unfortunately, while individual-level
interventions are relatively easy to assess, evaluation of comprehensive, multi-level,
multi-component programmes and institution-wide reforms is more challenging, and
therefore, while these approaches are almost certainly the key to long-term
prevention, they are also the most under-researched. However, these reviews have
identified a set of specific strategies that have demonstrated promise or effectiveness,
including:
 Reform civil and criminal legal frameworks;
 Organize media and advocacy campaigns to raise awareness about existing
legislation;
 Strengthen women’s civil rights related to divorce, property, child support and
custody;
 Build coalitions of government and civil society institutions;
 Build the evidence base for advocacy and awareness;
 Use behaviour change communication to achieve social change;
 Transform whole institutions in every sector, using a gender perspective; in
particular, integrate attention to violence against women into sexual and
reproductive health services;
 Promote social and economic empowerment of women and girls;
 Build comprehensive service responses to IPV survivors in communities;
 Design life-skills and school-based programmes;
 Engage men and boys to promote nonviolence and gender equality; and
 Provide early-intervention services to at-risk families.

Life-skills and school-based programmes

Many initiatives have aimed to influence knowledge, attitudes and behaviours of
young people through life-skills programmes in low-income countries or classroom-
based dating violence prevention programmes in the USA, such as Safe Dates, which
demonstrated effectiveness in reducing perpetration.

Early intervention services for at-risk families

There is growing evidence that programmes aimed at parents, including home visits
and education, can reduce or prevent child abuse and maltreatment and thus help
reduce child conduct problems and later violent behaviour, which has been associated
with IPV perpetrated by men. Efforts to include an IPV component in these
programmes are currently being tested.

Increase access to comprehensive service response to survivors and their children

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As described by Heise and colleagues (1999), women who experience IPV have
complex needs and may need services from many different sectors, including health
care, social services, legal entities and law enforcement, and therefore, multi-sectoral
collaboration is essential for ensuring survivors’ access to comprehensive services.
Evidence from many sectors indicates that the best way to improve the service
response to survivors is to implement institution wide reforms rather than narrow
policy reforms or training – a strategy sometimes referred to as a ‘systems approach’.
A systems approach may include, for example:
 Policies and infrastructure that protect the privacy and confidentiality of
women;
 On-going training and support for staff to ensure effective service provision;
 Written protocols and referral systems to help survivors access services from
other sectors;
 Efforts to strengthen the physical and human resources of the institution;
 Educational materials on violence for clients and providers;
 Data-collection systems; and
 Monitoring and evaluation to assess the quality of service provision and
benefits versus risks to women.
Organizations that provide services to survivors, including law enforcement, should
also consider the needs of children of survivors.

Build the knowledge base and raise awareness

Although there is a growing body of knowledge about the magnitude, patterns and
risk factors associated with IPV, many research gaps remain, including patterns of
women’s responses to violence and the effects of IPV on children. Expanding the
knowledge base and disseminating existing and new information will lead to better
programmes and strategies. Data on prevalence and patterns can also be important
tools to engage governments and policy-makers in addressing this issue.

Use community mobilization and behaviour change communication Mass media

‘edutainment’ strategies (e.g. programmes that use multimedia such as television,
radio and print) to change social norms and mobilize community-wide changes have
been shown to influence gender norms, community responses and individual attitudes
to IPV. Soul City, from South Africa is the most well-known and rigorously evaluated
model of edutainment, but many nongovernmental organizations have used
community mobilization, community education and mass media strategies to address
violence against women, and the evidence base about effective programming in this
area is increasing. There are also promising initiatives to engage men and boys in
violence prevention, as well as other community-based programmes that aim to
reduce IPV along with HIV transmission, such as Stepping Stones, a programme that
has been replicated in settings all over the world.

Empower women socially and economically

There is emerging evidence that interventions combining microfinance with gender-
equality training may be effective at reducing levels of IPV, as illustrated by the
IMAGE study in South Africa

Reform legal frameworks

Reforming legal frameworks may include strengthening women’s civil rights.
Improving existing laws and their implementation may curb violence by signalling

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what are socially unacceptable and strengthening sanctions against perpetrators. Some
steps in this direction include:
 Strengthening and expanding laws defining rape and sexual assault within
marriage;
 Sensitizing and training police and judges about partner violence; and
 Improving the application of existing laws.

Bibliography
https://www.unicef.org/reports/hidden-plain-sight

UNODC. (2019). Global Study on Homicide.

Inter-Agency Standing Committee. (2015). Guidelines for Integrating Gender-Based Violence

Interventions in Humanitarian Action: Reducing risk, promoting resilience and aiding recovery.

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World Health Organization. (2013). Global and regional estimates of violence against women:
prevalence and health effects of intimate partner violence and non-partner sexual violence.

UN General Assembly. (1979). Convention on the Elimination of All Forms of Discrimination Against
Women.

UN Office on Drugs and Crime. (2021). Human Trafficking.

https://learn.globalwomensinstitute.gwu.edu/login/index.php

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