Elsevier

The Lancet

Volume 385, Issue 9978, 25 April–1 May 2015, Pages 1685-1695
The Lancet

Series
Addressing violence against women: a call to action

https://doi.org/10.1016/S0140-6736(14)61830-4Get rights and content

Summary

Violence against women and girls is prevalent worldwide but historically has been overlooked and condoned. Growing international recognition of these violations creates opportunities for elimination, although solutions will not be quick or easy. Governments need to address the political, social, and economic structures that subordinate women, and implement national plans and make budget commitments to invest in actions by multiple sectors to prevent and respond to abuse. Emphasis on prevention is crucial. Community and group interventions involving women and men can shift discriminatory social norms to reduce the risk of violence. Education and empowerment of women are fundamental. Health workers should be trained to identify and support survivors and strategies to address violence should be integrated into services for child health, maternal, sexual, and reproductive health, mental health, HIV, and alcohol or substance abuse. Research to learn how to respond to violence must be strengthened. The elimination of violence against women and girls is central to equitable and sustainable social and economic development and must be prioritised in the agenda for development after 2015.

Introduction

Violence against women and girls is a global phenomenon that historically has been hidden, ignored, and accepted. Child sexual abuse has remained a silent shame. Rape has often been a matter of stigma for the victim rather than the perpetrator. Violence in the home has been considered a private affair. Turning of the head and closing of the eyes have occurred despite global estimates that one in every three women will experience physical violence, sexual violence, or both, from an intimate partner, or sexual violence from someone other than a partner in her lifetime.1 The full extent of abuse is even greater, with multiple different forms of violence around the world often remaining uncounted and under-researched (table 1).

Section snippets

International and global agendas

As Michau and colleagues13 stress in the fourth paper in this Series, the tide of silence has been slowly turning thanks largely to the sustained advocacy and organising of women's movements locally and worldwide. The high prevalence of violence against women and girls and damage to the victims and society are being recognised. Indeed, empirical analysis of policy changes over time in 70 countries suggests that, of all factors, the presence of autonomous women's movements was the main driver of

Violence as a risk factor for poor health in women

The physical and mental effects of violence against women are many and profound and short and long term. Consequences of exposure to violence, such as women's lack of control over sexual and reproductive choices, have other long-term effects that result from increased risk of unwanted pregnancies and unsafe abortions, HIV, and low-birthweight babies.1 Additionally, emerging biomedical evidence suggests that these long-term effects result from the combined effects of chronic stress,

Social and economic burdens

Violence against women and girls is a barrier to their equal participation in society and affects overall social and economic development.25 For example, estimates of lost productivity from domestic violence against women range from 1·2% of the gross domestic product in Brazil and Tanzania to 2·0% in Chile.26, 27 The annual cost of intimate partner violence was estimated to be $5·8 billion in the USA in 2003, £22·9 billion in England and Wales in 2004, and UK£4·5 billion in Australia,28, 29, 30

A call to action

Eliminating violence against women and girls is achievable, but it requires sustained action to ensure that political commitments translate into meaningful change, and support for coordinated, well funded, evidence-informed strategies implemented by governments, communities, and civil society partners. On the basis of the evidence presented in this Series, we call on national and local leaders and policy makers to commit to the five actions described here (panel).

Key indicators to monitor progress

Violence against women and girls is not just another women's issue, but is a public health and development problem of concern to all. Its elimination should be part of the post-2015 Sustainable Development Goals (SDGs), just as the elimination of apartheid was an important goal of the 1970s and 1980s for the worldwide community. Addressing violence against women is also important for other SDGs, particularly those related to maternal and infant mortality and HIV. Progress towards each of the

Conclusions

In many regions in the past 50 years women's status has improved markedly. In too many settings, however, women remain second-class citizens, are discriminated against, and made subservient to men. Even where women enjoy many freedoms, the fear and reality of male violence persists.

With increased recognition on how many women's, men's and children's lives are affected by violence, and growing evidence on how to respond to and prevent violence against women and girls, there is no excuse for

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