Gender-Based Violence

© 2003 Henrica A.F.M. Jansen, Courtesy of PhotoshareGender-based violence (GBV) is violence involving men and women, in which the female is usually the victim. GBV often stems from unequal power relationships between men and women 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.

Common forms of GBV particular to youth. The nature and extent of GBV can vary across cultures, countries, and regions. Data on the following three forms of GBV show clear links with reproductive health outcomes for youth:

  • Female genital cutting. Over 100 million girls and women worldwide have undergone FGC. Immediate health consequences of FGC at any age can include severe pain, shock, hemorrhage, tetanus or sepsis, urine retention, open sores in the genital region, and injury to nearby genital tissue. A 2006 WHO study found an association between FGC and increased complications in childbirth including severe pain, hemorrhage, tetanus, infection, and urinary incontinence.
  • Early marriage. Early marriage often results in vulnerability to reproductive health problems and psychosocial harm. Societal norms, isolation, and gender dynamics related to early marriage inhibit girls from having control over their own bodies and sexual and reproductive decisions. This can result in severe reproductive health problems, such as sexually transmitted infections (STIs); HIV; early childbearing and increased risk of maternal and infant mortality; unintended pregnancies; obstetric fistula; and other physical, psychological, and emotional harm.
  • Cross-generational sex. Cross-generational sex occurs when a young woman has a sexual relationship with a partner at least  5 to 10 years older in exchange for money or goods. Consequences of an unequal balance in age, gender, economic status, self-esteem, and power can hinder adolescent girls’ ability to negotiate safe sexual practices. Studies from several countries in sub-Saharan Africa found that girls’ motivations for engaging in sexual relationships with older partners range from the need to find love, a spouse, or economic security; pay for school fees and supplies; or elevate their status among peers through material goods. These girls might not realize the risks and severe health consequences associated with these relationships.

GBV-related health consequences for youth. 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: femicide, suicide, AIDS-related mortality, maternal mortality
  • Non-fatal outcomes:
    • 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. National policies that refer to GBV and youth include Kenya’s 2003 Adolescent Health and Development Policy, which addresses the reporting of adolescent rape and punishment of offenders. The 2003 National AIDS Policy in Malawi deals with sexual abuse of girls and women. Panama’s 1998 Framework for Formulation of Youth Policy and Action Plans has a section on sexual abuse of youth and intra-family physical violence against adolescents.

Education policies. South Africa is one of the few countries with a concerted policy effort to address GBV in schools. Its 2007 National Policy for the Prevention and Management of Learner Pregnancy acknowledges the role and importance of teachers in educating students about sexual abuse, rape, and GBV and also directs school administrators to report cases of rape to the police.

Health service policies. Some organizations have adopted specific operational policies and procedures to address GBV among youth in clinical settings. Health nongovernmental organizations in the Dominican Republic, Peru, and Venezuela trained staff and instituted new clinical history forms, policies and procedures, and in-house services and referrals. The very first national policy for youth and sexual reproductive health was developed by Nicaragua. Developed by the government in 1996, The National Integrated Child and Adolescent Policy integrates reproductive health into a broader framework of citizenship, peer education, and political participation. Following a nationwide consultation with adolescents, the government integrated adolescent reproductive health needs into its poverty reduction strategy. In 2002, Nicaragua also developed a National Policy against the Sexual Exploitation of Children and Adolescents.

Several international agreements and policies address GBV and can be useful for formulating national laws and policies and conducting advocacy:

Convention on the Elimination of All Forms of Discrimination against Women (1979)

Convention on the Rights of the Child (1990)

Vienna Declaration and Programme of Action (1993)

The UN Declaration on the Elimination of Violence against Women (1993)

International Conference on Population and Development Programme of Action (1994)

Inter-American Convention on the Prevention, Punishment, and Eradication of Violence against Women (1994)

Beijing Declaration and Platform for Action (1995)

For more on international policies, see Prevent GBV Africa and UN Division for the Advancement of Women.

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.