Gender-based violence (GBV) is violence involving men and women in which the female is usually the victim. GBV often stems from unequal power relationships and includes physical, sexual, and psychological harm. Various forms of GBV include intimate partner violence (including marital rape, sexual violence, and dowry-related violence), female infanticide, femicide, sexual abuse of female children in the household, early marriage, forced marriage, female genital cutting (FGC) and other harmful traditional practices, sexual harassment in schools and workplaces, commercial sexual exploitation, trafficking of girls and women, and violence against domestic workers. GBV also encompasses violence which is perpetuated or condoned by the state.
Although the global community has focused greater attention on GBV in recent years, levels of violence against women remain high. Eliminating GBV is a political challenge because it necessitates challenging the social, political, and economic inequalities between men and women.
Gender-Based Violence Threatens Youth Reproductive Health
A 2008 analytical study conducted by the Demographic Health Survey (DHS) in 10 DHS countries found that women from nine of the 10 countries reported having forced sexual experiences. The data also show that a major factor related to sexual violence is age at first marriage. In countries such as Bangladesh, Bolivia, Dominican Republic, Kenya, Rwanda, and Zimbabwe, women who were younger than 20 years old when they married or started living with their husband or partner were more likely to report physical or sexual violence than those who were 20 years or older when they married.
GBV results in reproductive health problems-- often with lasting physical, social, emotional, psychological, and economic consequences. Research has uncovered numerous links between exposure to GBV and subsequent health outcomes among youth.
- Fatal outcomes include femicide, suicide, AIDS-related mortality, and maternal mortality.
- Non-fatal outcomes encompass the following:
- Physical: fractures, chronic pain syndromes, fibromyalgia, permanent disability, gastrointestinal disorders
- Sexual and reproductive: STIs including HIV, unintended pregnancy, pregnancy complications, traumatic gynecologic fistula, abortion complications
- Psychological and behavioral: depression and anxiety, eating and sleep disorders, drug and alcohol abuse, poor self-esteem, post-traumatic stress disorder, self-harm
Key Areas for Policy Action
Effective action involves addressing both the complex root causes of GBV, as well as its immediate and long-term effects on victims. Aside from the health sector, the education sector can play an important role in preventing and addressing GBV, particularly through health programs and policies in schools. The judicial sector and police can also play important roles by enforcing laws and policies aimed at GBV prevention and treatment. A comprehensive approach to addressing GBV as a youth reproductive health issue should include the following integrated and multi-sectoral policy actions:
- Enact policies to empower women and girls. To reduce gender imbalances at the root of GBV, key legal and policy actions should advocate for delayed marriage, promote equitable divorce and property laws that allow women the chance to leave abusive relationships, and establish constitutional frameworks that guarantee equality for women.
- Pass laws against sexual coercion and domestic violence. It is just as important to have a legal and justice system that enforces these laws effectively.
- Demonstrate clear political commitment to ending GBV. High-level government officials should consistently and publicly denounce GBV and support necessary changes in community norms that influence GBV-related behaviors of boys and young men.
- Establish operational policies and guidelines to support program efforts. Public and private health facilities should institute policies and procedures to help providers recognize the signs of GBV and respond appropriately to meet the needs of GBV victims.
- Ensure that national reproductive health, HIV, adolescent health, and maternal health policies and legislation specifically address the negative reproductive health consequences of GBV. Such policies should give clear guidance to health workers on their obligations in reporting and treating GBV. Policies should also address the provision of emergency contraception and post-exposure antiretroviral prophylaxis to rape victims to protect against pregnancy and HIV infection.
- Ensure that school policies and guidelines directly address GBV. Schools may be a particularly unsafe place for young women. Policies should strengthen the ability of teachers and administrators to address GBV and also require them to report sexual violence against students.
The State of Policymaking
Although many governments have adopted policies related to GBV, few of them specifically relate to young people. Furthermore, many supportive laws and policies are not enforced. Several international agreements and policies address GBV and can be useful for formulating national laws and policies and conducting advocacy:
From Rhetoric to Reality: Policy Implementation Tips
Watch out for well-intentioned GBV-related policies that could negatively affect provision of reproductive health services. Laws requiring health workers to report GBV cases can run counter to principles of confidentiality. Without clear guidelines and careful training of health workers, such policies may inadvertently diminish the willingness of both victims and health workers to discuss violence. Health workers must be trained to recognize the symptoms of GBV and assist victims of GBV in a knowledgeable manner. Victims should feel secure that health workers will not blame them or divulge confidential information to relatives, thus putting the victims at additional risk of violence. Furthermore, HIV prevention services, sexual and reproductive health services, antenatal care, maternal and child health services, and voluntary counseling and testing services need to address GBV in an integrated manner.