Woman sitting next to a window, holding her child on her lap.

Women may internalize social norms that justify abuse. Photo: David and Lucile Packard Foundation.

Research sheds light on global trends

Editor’s note: PATH’s work to improve the health and status of women and girls, particularly in the poorest settings, includes a focus on finding, addressing, and ending the causes of gender-based violence. We are joined in this effort by local and international partners. When we began our work, little was known about the extent of violence or its effects on the health of women and children. The Lancet (April 5–11, 2008) featured the work described in this story—an important milestone for the global health community and women around the world.

Violence against women reaches beyond the immediate threat of bruises and broken bones. The violence women in many parts of the world routinely endure is linked to severe health problems—chronic pain, disability, disease, and mental problems—that affect not only the health of individuals, but the social health of communities and the economic health of nations.

In the United States and other countries, the unfinished journey away from gender-based violence started with information—the information leaders and activists need to justify laws that protect women and the information women and men need to reconsider long-standing ideas about what is acceptable. In the developing world, reliable information about violence against women has been less readily available, and traditional cultural values are a greater barrier to change.

That’s why the World Health Organization, PATH, and the London School of Hygiene and Tropical Medicine embarked on a landmark study that crossed countries and cultures to shed light on gender-based violence.

Understanding gender-based violence

How many women endure violence? Who are they? Where do they live?
How does violence affect them?
Which factors may protect against violence—and which put women at risk?
Are there any strategies or services that women use to deal with violence?

These are the questions researchers set out to answer with the most ambitious study ever conducted on gender-based violence. The WHO Multi-country Study on Women’s Health and Domestic Violence against Women involved more than 24,000 women in ten countries: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Tanzania, and Thailand. Specially trained interviewers surveyed random samples (by household) of women aged 15 to 49 years.

As a member of the core research team, PATH is proud to have helped design the study, the questionnaire, and training manuals; train interviewers; and supervise field work. We also analyzed data and helped prepare national reports and the international findings.

What 24,000 women told us

The research findings confirmed that violence seriously affects women’s health. Women who reported violence were more likely to report poor general health and reported more physical symptoms of ill health, emotional distress, miscarriages, and abortions. They were also more likely to have considered or attempted suicide.

But there were also new insights—such as the existence of more violence overall, especially in the home. In 13 of the 15 study sites, one-third to three-quarters of women had been physically or sexually assaulted by an intimate partner. At some sites, as many as 28 percent of women who had been pregnant had been assaulted during pregnancy.

Much of this violence had been hidden and previously unreported—more than one-fifth of women reporting violence during the study had never told anyone about it before.

Levels of violence varied greatly, both within and between countries. This finding raises questions for future research: which factors at individual, community, and national levels increase women’s risk of violence? Which provide a measure of protection?

One factor may be women’s internalization of social norms that justify abuse. In at least half the study sites, women reported that it is acceptable for a man to beat his wife under certain circumstances, including if she disobeys him, refuses sex, does not complete the housework on time, or is unfaithful. Although legal and institutional reforms are needed, they alone will not be enough to eliminate violence against women.

The power of women’s voices

Simply by creating a safe space to ask for help, the project affected women’s lives and efforts to stop violence. Furthermore, local organizations that assisted with the research learned new skills and connected with each other and with researchers. We also coauthored a guide that will help others conduct further research on violence.