Preventing intimate partner and sexual violence against women: taking action and generating evidence
- Correspondence to Dr Christopher Mikton, WHO Department of Violence and Injury Prevention and Disability, 20 Avenue Appia, 1211 Geneva 27, Switzerland;
Intimate partner and sexual violence affect a large proportion of the population. The majority of those directly experiencing such violence are women, and the majority perpetrating it are men. The WHO Multi-Country Study on Women's Health and Domestic Violence against Women,1 for instance, indicated that 15-71% of women experience physical and/or sexual violence by an intimate partner at some point in their lives. The majority of those directly experiencing such violence are women, and the majority perpetrating it are men.
The harm these forms of violence cause can last a lifetime and span generations. They have serious adverse effects on health, education, employment and the wider economy. The health outcomes due to intimate partner and sexual violence are comparable to (and in some cases exceed) those associated with many other better-known health risk factors. For example, a study in Victoria, Australia, estimated that among women 18–44 years of age, intimate partner violence was associated with 7% of the overall burden of disease and was a larger risk factor than raised blood pressure, tobacco use and increased body weight.2 Intimate partner violence also very often has severe negative impacts on the emotional and social well-being of entire families, affecting parenting skills and educational and employment outcomes. Children exposed to intimate partner violence exhibit increased rates of behavioural and emotional problems that can result in dropping out of school, being unemployed, and becoming pregnant at an early age.3 4 In addition, intimate partner violence has a significant adverse economic impact. One analysis estimated that its annual cost to the economy in England and Wales was approximately £22.9 billion.5
To help address intimate partner and sexual violence, WHO, in partnership with the London School of Hygiene and Tropical Medicine and with input from a globally representative panel of experts, has published Preventing Intimate Partner And Sexual Violence against Women: Taking Action and Generating Evidence. This document aims to provide sufficient information for policy-makers, programme planners, and funding bodies in public health and related sectors to develop evidence-based programmes and policies. The document emphasises the importance of integrating rigorous effectiveness evaluations into prevention programmes to strengthen the global evidence base in this area.
This manual is based on public health principles—but also draws on the human rights, criminal justice, and especially, gender equality approaches—and adopts a life-course perspective. This document emphasises the primary prevention of intimate partner and sexual violence because of their serious and far-reaching consequences and because—given the high prevalence of these forms of violence—even the best-resourced countries can only provide quality secondary and tertiary services to a fraction of victims.
The first of the four chapters of the manual outlines the nature, magnitude and consequences of intimate partner and sexual violence. It focuses in particular on the prevalence of, and health risk behaviours and outcomes associated with, intimate partner and sexual violence in adulthood and adolescence.
Chapter 2 summarises what is known about risk and protective factors. The review is organised according to the four levels of the ecological model—individual, relationship, community and society—and stresses the need to address both risk and protective factors in prevention efforts.
Chapter 3 reviews the scientific evidence base for primary prevention strategies, organised according to the main life stages. It 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. For instance, school-based programmes for preventing violence occurring in ‘dating relationships’ have been shown to be effective in randomised trials in the USA and Canada. Evidence is emerging for the effectiveness of empowerment approaches which use microfinance combined with gender-equality training or are based on communications and relationship skills training such as the Stepping Stones training package, which has been widely used in low- and middle-income countries. Strategies that aim to prevent intimate partner and sexual violence by reducing access to, and harmful use of, alcohol also show promise.
Chapter 4 presents a six-step framework for implementing prevention policies and programmes, which includes defining and describing the nature of the problem, identifying potentially effective programmes, developing policies and strategies, and planning and implementing appropriate evaluations.
At present, evidence for the effectiveness of primary prevention strategies for intimate partner and sexual violence is limited. There are sound reasons to believe, however, that the field is poised to expand rapidly in coming years. A few programmes have been demonstrated to be effective in rigorous outcome evaluations, and evidence is beginning to emerge to support the effectiveness of many more.
However, most of the current evidence base on the effectiveness of programmes in preventing intimate partner and sexual violence—as well as on prevalence, consequences, and risk and protective factors—comes from high-income countries, especially the USA. If future research is to inform practice and policy in any meaningful way, more now needs to be known about prevention effectiveness in low- and middle-income countries.
Although pressing, the need for evidence and further research in no way precludes taking action now in all countries. 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 be put into practice immediately—with strenuous efforts made to incorporate rigorous outcome evaluations from the outset. It is only by taking 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 successfully mature.
Investments made to stop intimate partner and sexual violence before they occur will protect the physical, mental and economic well-being and development of individuals, families, and the communities in which they live. We therefore urge policy-makers, programme developers, and practitioners to consult this document, which is freely downloadable from the WHO Prevention of Violence web site (http://whqlibdoc.who.int/publications/2010/9789241564007_eng.pdf) or can be obtained in hard copy from WHO. For further information, please contact Christopher Mikton ( ), Alexander Butchart ( ) or Claudia Garcia Moreno ( ).
Competing interests None.
Provenance and peer review Not commissioned; not externally peer reviewed.