Preventing intimate partner and sexual violence against women

102 Pages·2010·0.98 MB·English

by  World Health Organization and London School of Hygiene and Tropical Medicine

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Preventing
intimate partner
and sexual violence
against women
Taking action and
generating evidence
WHO Library Cataloguing-in-Publication Data:
Preventing intimate partner and sexual violence against women: taking action
and generating evidence / World Health Organization and London School of Hygiene
and Tropical Medicine.
1.Spouse abuse – prevention and control. 2.Violence – prevention and control.
3.Sexual partners. 4.Risk assessment. 5.Battered women. 6.Sex offenses – prevention
and control. I.World Health Organization.
ISBN 978 92 4 156400 7 (NLM classification: HV 6625)
Suggested citation: World Health Organization/London School of Hygiene and Tropical
Medicine. Preventing intimate partner and sexual violence against women: taking action
and generating evidence. Geneva, World Health Organization, 2010.
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iii
Contents
Acknowledgements v
Executive summary 1
Foreword 3
Introduction 5
The hidden costs of intimate partner and sexual violence 5
A public health approach to prevention 6
A life-course perspective 8
What is the purpose of this document? 8
Who should use this document? 9
Key messages 10
Chapter 1 The nature, magnitude and consequences of intimate partner
and sexual violence 11
1.1 What are intimate partner and sexual violence? 11
1.2 How prevalent are intimate partner and sexual violence? 12
1.3 What are the consequences of intimate partner and sexual violence? 15
1.4 Key messages 17
Chapter 2 Risk and protective factors for intimate partner and sexual violence 18
2.1 The ecological model of violence 18
2.2 Identifying risk factors 19
2.3 Risk factors associated with both intimate partner violence
and sexual violence 20
2.4 Risk factors associated with intimate partner violence 26
2.5 Risk factors associated with sexual violence 29
2.6 Protective factors for intimate partner violence and sexual violence 31
2.7 Gender norms and inequality 31
2.8 Key messages 32
iv Preventing intimate Partner and sexual violence against women
Chapter 3 Primary prevention strategies – the evidence base 34
3.1 Introduction 34
3.2 Assessing the evidence for different prevention approaches 36
3.3 Summary tables of primary prevention strategies and programmes 38
3.4 During infancy, childhood and early adolescence 41
3.5 During adolescence and early adulthood 44
3.6 During adulthood 47
3.7 All life stages 51
3.8 Key messages 57
Chapter 4 Improving programme planning and evaluation 58
4.1 Step 1: Getting started 58
4.2 Step 2: Define and describe the nature of the problem 62
4.3 Step 3: Identify potentially effective programmes 66
4.4 Step 4: Develop policies and strategies 67
4.5 Step 5: Create an action plan to ensure delivery 68
4.6 Step 6: Evaluate and share learning 70
4.7 Key messages 75
Future research priorities and conclusions 76
Future research priorities 76
Conclusions 77
References 79
Annexes
Annex A: Operational definitions 91
Annex B: Prevention activities that can be used for process
evaluation and potential sources of information on such activities 94
v
Acknowledgements
This document was written by Alexander Butchart, Claudia Garcia-Moreno, and Chris-
topher Mikton of the World Health Organization, and builds on an early draft produced
by Joanna Nurse of the London School of Hygiene and Tropical Medicine and the
United Kingdom Department of Health, and Damian Basher of the United Kingdom
Department of Health. Natalia Diaz-Granados of McMaster University drafted Chap-
ter 2: Risk and protective factors for intimate partner and sexual violence, while Joanne
Klevens and Linda Anne Valle of the United States Centers for Disease Control and
Prevention contributed to Chapter 4: Improving programme planning and evaluation. The
document was edited by Tony Waddell.
The document has also benefited greatly from comments and suggestions provided by
the following peer reviewers: Linda Dahlberg, Kathryn Graham, Rachel Jewkes, Holly
Johnson, Julia Kim, Karen Lang, Charlotte Watts and Alys Willman.
The conceptual foundations for this document were outlined in a May 2007 expert
consultation on the primary prevention of intimate partner and sexual violence and the
background paper for the meeting prepared by Alison Harvey, Claudia Garcia-Moreno
and Alexander Butchart. Consultation participants included: Mark Bellis, Pimpawun
Boonmongkon, David Brown, Carme Clavel-Arcas, Jane Cottingham, Pamela Cox,
Isabelle De Zoysa, Jane Ferguson, Vangie Foshee, Kathryn Graham, Henrica Jansen,
Holly Johnson, Faith Kasiva, Jackson Katz, Karen Lang, Lori Michau, Adepeju Ader-
emi Olukoya, Judith Ann Polsky, Jamela Saleh Al-Raiby, Susan Blair Timberlake, Ber-
nice Van Bronkhorst and Charlotte Watts.
The development and publication of this document has been made possible by the gen-
erous financial support of the Government of Belgium and the United States Centers
for Disease Control and Prevention.

1
Executive summary
Intimate partner and sexual violence affect a large proportion of the population – with
the majority of those directly experiencing such violence being women and the majority
perpetrating it being men. The harm they cause can last a lifetime and span genera-
tions, with serious adverse affects on health, education and employment. The primary
prevention of these types of violence will therefore save lives and money – investments
made now to stop intimate partner and sexual violence before they occur will protect
the physical, mental and economic well-being and development of individuals, families,
communities and whole societies.
This document aims to provide sufficient information for policy-makers and planners
to develop data-driven and evidence-based programmes for preventing intimate part-
ner and sexual violence against women and is divided into the following chapters:
l Chapter 1 outlines the nature, magnitude and consequences of intimate partner and
sexual violence within the broader typology of violence.
l Chapter 2 identifies the risk and protective factors for such violence and the impor-
tance of addressing both risk and protective factors in prevention efforts.
l Chapter 3 summarizes the scientific evidence base for primary prevention strate-
gies, and describes programmes of known effectiveness, those supported by emerging
evidence and those that could potentially be effective but have yet to be sufficiently
evaluated for their impact.
l Chapter 4 presents a six-step framework for taking action, generating evidence and
sharing results.
In the closing section, several future research priorities are outlined and a number
of key conclusions drawn.
The evidence-based prevention of intimate partner and sexual violence is still in its early
days and much remains to be accomplished. At present, only one strategy has evidence
supporting its effectiveness – and this only relates to intimate partner violence. The
strategy in question is the use of school-based programmes to prevent violence within
dating relationships. Evidence is, however, emerging of the effectiveness of a number of
other strategies for preventing intimate partner and sexual violence, including micro-
finance programmes for women combined with gender-equality education; efforts to
reduce access to and harmful use of alcohol; and changing social and cultural gender
norms. Many more strategies appear to have potential, either on theoretical grounds or
because they target known risk factors, but most of these have never been systematically
implemented – let alone evaluated.
2 Preventing intimate Partner and sexual violence against women
The public health approach to prevention taken in this document is intended to comple-
ment criminal justice-based approaches. The approach relies upon the use of popula-
tion-based data to describe the problem, its impact and associated risk and protective
factors, while drawing upon the scientific evidence for effective, promising and theo-
retically indicated prevention strategies. Part of the approach is also to ensure that all
policies and programmes include in-built monitoring and evaluation mechanisms. At
the same time, taking a life-course perspective will help to identify early risk factors and
the best times to disrupt the developmental trajectories towards violent behaviour using
a primary prevention approach. For successful primary prevention, early intervention is
required that focuses on younger age groups.
Although pressing, the need for evidence and further research in all these areas in no
way precludes taking action now to prevent both intimate partner violence and sexual
violence. Those programmes that have evidence supporting their effectiveness should
be implemented and, where necessary, adapted. Those that have shown promise or
appear to have potential can also play an immediate role – provided strenuous efforts
are made to incorporate at the outset rigorous outcome evaluations. It is only by tak-
ing action and generating evidence that intimate partner and sexual violence will be
prevented and the field of evidence-based primary prevention of such violence will suc-
cessfully mature.
3
Foreword
Intimate partner violence and sexual violence are serious and widespread problems
worldwide. Apart from being violations of human rights, they profoundly damage the
physical, sexual, reproductive, emotional, mental and social well-being of individuals
and families. The immediate and long-term health outcomes that have been linked to
these types of violence include physical injury, unwanted pregnancy, abortion, gynae-
cological complications, sexually transmitted infections (including HIV/AIDS), post-
traumatic stress disorder and depression, among others. There are also a number of
pregnancy-related complications such as miscarriage, premature labour and low birth
weight associated with violence during pregnancy. In addition, high-risk behaviours
such as smoking, harmful use of alcohol and drugs and unsafe sex are significantly
more frequent among victims of intimate partner and sexual violence.
The overwhelming burden of intimate partner violence (physical, sexual and emotion-
al) and of sexual violence is borne by women at the hands of men. In acknowledging
the large scale and extensive consequences of the problem, scores of countries have
passed laws to criminalize intimate partner and sexual violence, and many countries
are increasingly providing legal, health and social services to abused women. At the
same time, there have been remarkably few efforts to prevent intimate partner or sexual
violence from occurring in the first place. Well-designed and properly implemented
services for victims will continue to be vitally important. However the sheer magnitude
of the problem means that preventing intimate partner and sexual violence before it
occurs will be crucial not only in reducing the burden of suffering but also in reducing
the long-term human, economic and public health costs of such violence. Both primary
prevention efforts and responding services need to be well documented and evaluated
for their effectiveness.
The current paucity of evidence-based prevention approaches is partly due to the sepa-
rate development and implementation of research and advocacy activities in this area.
It is also due in part to the complex array of factors that increase the likelihood of such
violence occurring in the first place. These factors include gender inequality and social
norms around masculinity, and other social determinants such as economic inequality;
other problem behaviours (such as harmful use of alcohol); and other types of vio-
lence (such as child maltreatment). There is little coordination between programmes or
research agendas on child maltreatment, alcohol and substance misuse, social determi-
nants, and intimate partner and sexual violence. And yet all of these problems regularly
affect families, predictably with greater frequency in economically disadvantaged com-
munities where there is often also greater inequality between women and men.