Preventing violence against women: An evidence-informed perspective

Claudia García-Moreno

World Health Organization

57th Commission on the Status of Women

What do we know? What do we know?

• More data than ever before, particularly on intimate partner violence

• The causes of partner violence are multiple and intertwined – factors interact at multiple levels to place women at risk of abuse

• More knowledge of risk and protective factors and of promising approaches to prevention─ Interventions can reduce acceptability & levels of violence over

programmatic timeframes

• At country level, multiple entry points for intervention

Many risk factors for intimate partner violence

Many risk factors for intimate partner violence

Individual & relationship

Experiences of childhood abuse, growing up in violent household

Problematic alcohol use by male partner

Acceptance of violence as means to resolve conflict

Low education level

Community level

Acceptability of wife beating

Norms supporting male authority / control over women

Norms of family privacy/acceptability of divorce

Lack of social sanction for violence

Societal level

Lack of economic rights & entitlements for women, including access to formal wage employment

Discriminatory family law & limited acceptability of divorce for women

Inequality in access to higher education

Level of economic development

Intervening at different levelsIntervening at different levels

Individual characteristics and behaviour

Choice in partner(s)

Couples & families

Socio-economic conditions

Laws & Policies

Communities

Countries

Cultural & Social Gender

Norms

Transforming harmful gender norms:1. Mass Media2. Community mobilization3. Peer and participatory education

with men and boys.4. Gender equitable attitudes in

schools

Empowering women: 1. Integrated gender,

microfinance & HIV training 2. Securing property rights 3. Conditional Cash transfers

Promoting GE laws & policies:1. Laws against violence2. Training law enforcement3. National standards on post-

rape care4. Reducing access to alcohol

What works to prevent partner violence?What works to prevent partner violence?

Review evidence of association and promising interventions to address:

•Social norms around gender and violence

•Women's economic and social empowerment

•Childhood exposure to violence

•Harmful alcohol use

• Legal and justice system interventions

1. Changing Social Norms1. Changing Social Norms

Evidence of link

•acceptability of violence

•male authority/dominance over women

Promising interventions

• Awareness campaigns – e.g. “We Can” , "It's Not Ok"• Small group transformational change efforts, often supplemented with

community-based activities – eg Stepping Stones; Programme H; IMAGE programme

• Social norms marketing and “edutainment programmes” e.g. Soul City, Sexto Sentido; Breakthrough’s “Bell Bijao” Campaign

• Population level social change programming e.g. SASA!

Examples of prevention interventions

Community focused• Soul City • SASA! Uganda

Both sexes:• Stepping Stones, S. Africa• Sexto sentido, Nicaragua

Men• Program H (Brazil) • Yari Dhoshi (India)• We Can Women• IMAGE • SisterAct• Program M

2.Women’s social & economic empowerment2.Women’s social & economic empowerment

Evidence of link

•Secondary education protective•Employment, ownership or cash or assets may decrease risk •Some effects context specific, depending on factors related to partner and/or broader social norms

Promising interventions • Evidence that combined livelihood & empowerment programmes achieve impact (e.g. IMAGE, South Africa)•Some evidence that economic empowerment interventions reduce violence, although context specific •Evaluation of impact of cash transfer programmes on partner violence are just beginning

In South Africa combined micro-credit & gender training intervention (IMAGE) cut levels of intimate partner violence

by a half over 2 years

In South Africa combined micro-credit & gender training intervention (IMAGE) cut levels of intimate partner violence

by a half over 2 years

Among participants:

• Past year experience of IPV reduced by 55%

• Households less poor

• Improved HIV communication

Among younger women:

• 64% higher uptake HIV testing

• 25% less unprotected sex

Pronyk et al. The Lancet Dec. 2006, Pronyk et al AIDS 2008

3. Childhood exposure to violence3. Childhood exposure to violence

Evidence of link • Strong evidence that child abuse (physical and/or sexual) and witnessing

marital violence increase risk of perpetration

• Poor parenting and gender socialization help reproduce negative child outcomes (including partner violence) across generations

Promising interventions • Parenting programmes shown to reduce negative child outcomes,

including precursors to partner violence, in randomized studies

• Current programmes target harsh parenting, child maltreatment and exposure to parental violence (home visitation)

4. Harmful use of alcohol4. Harmful use of alcohol

Evidence of link

•Not sufficient or necessary, but where present it increases frequency and severity

Promising interventions

•Early identification and brief counselling by health workers has been shown to reduce harmful drinking

•Reduce alcohol availability– Recent studies from the US and Australia have found clear link between outlet density and

domestic violence– Meta-analysis of 122 studies confirms that increasing alcohol taxes decreases harmful drinking

•Community based interventions

•Alcohol misuse treatment has been shown to reduce frequency and severity of partner violence

5. Legal and justice system interventions5. Legal and justice system interventions

• Women’s police stations– Mixed evidence

• Informal justice and rights-based initiatives– Novel strategies being applied in southern countries: mobile courts; working with village

dispute resolution systems need to be evaluated

• Protection Orders– Research from the United States suggests that protective orders do reduce repeat

violence for some victims some of the time; no studies have evaluated protective orders in southern countries

• Pro-arrest policies– Arrest may have a modest effect on recidivism for some men, especially first-time

domestic violence offenders with no other history of criminal conduct

– No evidence outside of high-income countries

RecommendationsRecommendations

We need: – national strategies that are tailored around a local understanding

of the problem – to implement what works and theoretically-informed best

practice, using all entry points possible (building on strategic opportunities of all agencies to achieve impact)

– to escalate intervention research – to develop services for victims in tandem with rolling out

prevention interventions – to ensure coordination across strategies for maximum impact

High level political support globally, nationally and within communities is essential

Violence against women

is preventable.

Let's do it together!!

Sources and acknowledgementsSources and acknowledgements

WHO/LSHTM, 2010 Preventing intimate partner and sexual violence against women. Geneva: WHO

http://www.who.int/reproductivehealth/publications/violence/en/index.html

Heise L, 2012 What works to prevent partner violence

http://strive.lshtm.ac.uk/resources/what-works-prevent-partner-violence-evidence-overview

Acknowledgements

Lori Heise and Charlotte Watts, Centre for Gender Violence and Health, LSHTM