Yesterday, the Centers for Disease Control and Prevention released findings from the 2010 National Intimate Partner and Sexual Violence Survey. The numbers are sobering. In the United States:

• On average, 24 people per minute are victims of rape, physical violence, or stalking by an intimate partner, the vast majority of them women. 
• Nearly 1 in 5 women and 1 in 71 men have been raped in their lifetime.
• 1 in 4 women have been the victims of severe physical violence by an intimate partner while 1 in 7 men experienced severe violence by an intimate partner.

These new data follow close on the heels of another year’s 16 Days of Activism Against Gender Violence. The annual international campaign runs from November 25, International Day Against Violence Against Women, through December 10, International Human Rights Day, and is commemorated through global activism, blogs, stories, and special events.

One such event, "Data on Gender-Based Violence: What's New and What's Not,” was held on Tuesday, December 6, and hosted by the Pan American Health Organization (PAHO) and the Interagency Gender Working Group (IGWG). The all-day event was comprised of presentations on data on gender-based violence (GBV), data collection and use, and a training program on skills development for ethical engagement in GBV research, monitoring, and evaluation.

What is new in GBV? Well, evidence, and a lot of it.

Sixteen years ago in 1995, there were just a few published studies on the prevalence of interpersonal violence. By 2010, there were many hundreds including more than 350 in 2005 alone.¹ These studies demonstrate an astounding level of violence.

A 2004 World Health Organization (WHO) study covering ten countries found that in four of those countries—Bangladesh, Peru, Ethiopia and Tanzania—over half of the women interviewed in the study had experienced physical or sexual violence.² As noted by Dr. Jon Andrus, deputy director of PAHO, violence against women is a human rights violation as well as a social justice and public health problem.³ The impact on health is well-documented from higher rates of unintended pregnancies and abortions, a greater number of low birthweight babies, more HIV and sexually transmitted infections, less access to prenatal care, to an inability to access or stay on HIV treatment, as well as others.

It is not just women whose health is affected by violence. Men who perpetrate GBV are more likely to engage in risky HIV behaviors as well. The intergenerational effects are especially disturbing: boys who see violence in the home as children are more likely to perpetrate GBV against their partners when they grow up; girls who see violence in the home as children are more likely to grow up and partner with men who beat them, perpetuating a never-ending cycle.⁴

Over 75 surveys on violence against women have been carried out in the Latin American and Caribbean region in the last 35 years, primarily as part of the Demographic Health Surveys (DHSs) and the Reproductive Health Surveys. A comparative analysis of these data is complicated by the fact that each study is carried out under the auspices of a given country’s government, resulting in local data determinations regarding timeframes, denominators, and operational definitions which affect the comparability of the data.⁵ Despite those complications, the study data on the intergenerational effects of GBV are disheartening and clear: children in households where women report partner violence are more likely to be punished by hitting, beating, or slapping; whereas women who reported being beaten as children are more likely to report being in relationships with partners who beat them.

Ironically, survey questions related to GBV may fail to capture the subtle and contextual nature of gender leading to under-reporting and a misinterpretation of what is reported. For example, the study in Bangladesh showed that agreement or disagreement with the various “justifications” for wife beating asked about in the DHS is very much dependent on additional details not included in the survey.⁶ Female respondents were much more likely to change their responses once they had additional information on the scenarios, especially if the additional information was more in line with gender norms. The study concludes that in the absence of scenario details, respondents may provide their own contextual details confounding the study results.      

Just as there are challenges with collecting accurate GBV data from population-based surveys, challenges remain in collecting GBV data from service sites including a lack of standardization in the classification of incidents of violence and ethical issues regarding the sharing of information.

The United Nations Population Fund, the UNFPA, the Office of the United Nations High Commissioner for Refugees, and the International Rescue Committee developed a GBV information management system, which addresses these issues.⁷ The data collected through the system is vital because it can be used to not only generate reports but revenue to improve services for GBV survivors and to advocate more broadly for services, funding, resources, laws, and policies as well as increased public awareness, among other things.

The PAHO/IGWG event ended with a training on how to address ethical considerations in GBV research, monitoring, and evaluation. Using the WHO/PATH Researching Violence Against Women: A Practical Guide for Researchers and Activists as a reference⁸, the workshop focused on ethical issues in: research design and approval; the training of field workers and data collection; the analysis and interpretation of results; and the presentation and dissemination of results. The emphasis was on population-based surveys, which collect data on women’s personal experiences with violence. The group recognized the need to distinguish that which constitutes research from non-research but also the sometimes tricky nature of doing so. The examination of various types of research activities for potential ethical issues and solutions highlighted anew the contextual nature of gender emphasizing the need for gender and culturally competent staff. Ultimately, no matter the context, the safety of the researcher and the GBV survivor are paramount and must be ensured.

The evidence is piling up. Well over a thousand interpersonal violence prevalence studies have been published in the last 16 years. The links between gender-based violence and negative public health behaviors and outcomes are incontrovertible. There is still work to be done with comparability and ethical uses of the data. As we weigh the risks of research versus the benefits. we err on the side of risk as we should and ensure that all studies and data collection are ethical and safety is paramount before pressing forward to provide benefits to survivors.

Robert Clay, deputy assistant administrator of USAID’s Global Health Bureau mentioned the SGBV Initiative which gathered data through facility assessments and service statistics including from IntraHealth-supported clinics in Rwanda. What was not mentioned was that among those seeking services in Rwanda, roughly 35% were between the ages of 11 and 15, 15% were between the ages of 6 and 10, and over 5% were aged between birth and 5 years of age—a total of 55% under the age of 15.⁹ Evidence is incredibly important, but one wonders if these were statistics for any other disease or illness if there might not be more outrage, more resources directed to prevention and response—more emergency response because when 50% of women in a survey report having been physically or sexually assaulted, should that not constitute an emergency, triggering teams of doctors and emergency supplies?

Many women never tell anyone about their experience with violence, especially sexual violence. Of those that do report, going to a doctor or speaking with a health worker often ranks last or nearly last on a list of ten possible options for reporting, after “other.”¹⁰

Health workers on the other hand rarely ask women about violence even though large numbers of women experience violence, and it is a risk factor in numerous poor health outcomes. Perhaps clinic staff members do not see GBV as being within their purview, or it is not something staff feel equipped to deal with, or they already feel overwhelmed with the challenges they face.

For all of these reasons, we find ourselves with the public health version of “Don’t ask. Don’t tell.” Should health workers screen for GBV, the services for referral where the women could seek shelter, psychosocial, legal, or medical help rarely exist. And with this stalemate, women who could be protected—from unintended pregnancies, HIV infections, miscarriages, broken bones, and even death—are not. It brings to mind remarks made this week by Stephen Lewis, co-director of AIDS-Free World, at the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), in regard to scale-up of life-saving HIV/AIDs services: “Instead, during nearly a decade as the evidence piled up…evidence provided by experts in the field—we waited and waited and waited, in that self-justifying paralysis of excruciating scientific precision. As we come to this thrilling moment of progress I cannot forget the numbers of lives that might have been saved had we acted sooner.”

Evidence is important. The ethical collection of data is incredibly important especially concerning women and girls who have already been victimized. There must come a time when we can say, ”We know enough,” and the impetus and resources shift from collecting ever more evidence to providing prevention and response services to bring about an end, a cure, a vaccine to this global public health, human rights, and social justice crisis.

—Maryce Ramsey
Senior Gender Equality Advisor

References

1. Mary Ellsberg. Dec. 6, 2011 “Ethical Considerations around Data Collection on Gender-Based Violence,” presentation given at the International Center for Research on Women.

2. World Health Organization. 2005. WHO Multi-Country Study on Women’s Health and Domestic Violence.  Accessed online December 9, 2011.  

3. Remarks by Dr. Jon Andrus, Deputy Director of PAHO, on December 6, 2011.  
4. Population Reference Bureau, Interagency Gender Working Group. June 2010. Gender-Based Violence: Impediment to Reproductive Health.
5. Alessandra Guedes. Dec. 6, 2011 “Violence Against Women in Latin America and the Caribbean: A comparative analysis of population-based data from 12 countries,” presentation. 
6. Sidney Ruth Schuler. Dec. 6, 2011 “Justification of Gender-based Violence in Rural Bangladesh: What Survey Questions May Fail to Capture,” presentation.
7. Diana Arango. Dec. 6, 2011. “The Gender Based Violence Information Management System,”  presentation. 
8. World Health Organization. 2001. Putting Women First: Ethical and Safety Recommendations for Research on Domestic Violence Against Women. Accessed December 16, 2011. ,
9. Michele Maloney-Kitts. November 17, 2011. “Together for Girls We can End Sexual Violence,” presentation to the Coalition for Adolescent Girls.
10. National Bureau of Statistics, Tanzania and ICF Macro. 2011. Tanzania Demographic and Health Survey 2010. Dar es Salaam. Tanzania: NBS and ICF Macro.