Violence against women

World Health • 46th Year, No. l, January-february 1993 21 Violence against women Lori L. Heise Seldom seen as a public health issue, violence against women is a significant cause of female morbidity and mortality around the globe. In the USA, for example, wife abuse is the leading cause of injury among women of reproductive age. Between 22% and 35% of women who visit United States emergency clinics are there for symptoms related to on-going abuse. But women in the USA share the reality of violence with women in virtually every other culture in the world. Data from developing countries reveal that one-third to over half of women surveyed report being beaten by their partner. Not uncommonly, beatings are part of a pattern of emotional and physical abuse that escalates over time. In Papua New Guinea, 18% of all urban wives surveyed had sought hospital treatment for injuries inflicted by their husbands. A survey of one Caribbean island revealed that one in three women had been sexually abused as a child. Wife abuse also provides the primary context for many other health problems. Again, research from the USA indicates that battered women are four to five times more likely to require psychiatric treatment and five times more likely to attempt suicide than non-battered women. And they are at increased risk of alcohol abuse, drug dependence, chronic pain, and depression. In one US study of the use made of health care, a history of rape and/or assault was a stronger predictor of physician visits and outpatient costs than were a woman's age or other health risks such as smoking. Along with physical injury and emotional trauma, rape survivors run the risk of becoming pregnant or contracting sexually transmitted diseases, including AIDS. An image of despair. Battered women are often prey to depression and despa ir. Violence poses a powerful obstacle to achieving other goals that are high on the development agenda. During pregnancy, for example, it threatens the goal of "Safe motherhood" for all women. Battered women run twice the risk of miscarriage and four times the risk of having a low-birth-weight infant. Despite such statistics, violence against women has only recently begun to be recognized as a health problem by the medical and public health establishment. The American Medical Association launched a major campaign in 1991 to educate the public and physicians about family violence. Hitherto, health professionals seldom identified battered women, and often failed to refer them to useful (and potentially live-saving) services. On the international front, the Pan American Health Organization sponsored a conference in Managua, Nicaragua, in 1991 entitled "Violence against women: a problem of public health". The Ministry of Health in Colombia issued an action plan on women's health which included a programme on the "Prevention of abuse and attention to victims of violence". And the United Nations Development Fund for Women published Battered dreams: violence against women as an obstacle to development. These international initiatives are the fruits of almost two decades of campaigning by women's groups around the world to combat gender- based abuse. In country after country, women have started crisis centres, passed laws, and worked to challenge the cultural beliefs and attitudes that underpin male violence. A recent directory lists 379 separate organizations working against gender violence in Latin America alone. These grassroots efforts need to be supported and amplified by a commitment on the part of governments to prevent violence and assist the survivors of abuse. Important steps include: reforming laws that discriminate against women; expanding services to help victims; enacting and enforcing laws against battering, rape and sexual abuse; training professionals in the dynamics of abuse; eliminating gratuitous violence in the media; incorporating gender training, parenting skills, and non-violent conflict resolution into school curricula; and working to create social norms that define violence against women as unacceptable. • This anicle was prepared for the World Bank 's World Development Report, 1992. Ms Lori L. Heise directs the Violence, Health and Development Program at the Center for Women 's Global Leadership, Rutgers University, 27 Clifton Avenue, New Brunswick, N) 08903, USA