Violence Against Women
	Global Challenges in Ending Gender-Based Violence
	The Impact of Violence Against Women on Reproductive Health
	Violence Against Women: The Problems Facing South Africa
	The Population Information Program
	Global Video-Conference on Violence Against Women

Violence Against Women and its Impact on Reproductive Health was the topic of a daylong meeting organized by Face to Face Campaign Partners IPPF and Population Concern during the Commonwealth Heads of Government Meeting in Durban, South Africa, on November 11, 1999. The meeting was co-chaired by Dr. Abe Nkomo, Member of Parliament in South Africa and winner of the 1999 Nelson Mandela Award for Health and Human Rights, and Chris McCafferty, Member of Parliament in the United Kingdom and Chair of the United Kingdom All-Party Group on Population, Development and Reproductive Health.

This issue of Face to Face Update summarizes the outstanding presentations of three women who have worked in this field for many years. The conference also produced A Call for Action on Violence Against Women to the Commonwealth Heads of Government. It contains recommendations from IPPF, Population Concern, Marie Stopes International and the United Kingdom All-Party Group on Population, Development and Reproductive Health for actions against gender-based violence. This document was an official submission to all the Commonwealth Government delegations attending the South African meeting.

Dr. Pramilla Senanayake, Assistant Director General of IPPF, has been involved in women's health issues for more than 20 years. In her position at IPPF, Dr. Senanayake oversees global advocacy and scientific expertise in many areas, including gender and HIV/AIDS.

Dr. Senanayake uses the 1993 UN General Assembly definition of gender- based violence as: "Any act of gender violence that results in or is likely to result in physical, sexual or psychological harm and suffering to women, including threats of such acts, coercion, or arbitrary deprivations of liberty, whether occurring in public or private life."

Gender-based violence occurs in different forms in different parts of the world: domestic violence; sexual abuse; forced prostitution; female genital mutilation; rape; honour killings; and the selective malnourishing of female children. While the form varies, the nature of the gender-based violence has certain common characteristics. For example, most gender-based violence is perpetrated by men. Women and girls are most at risk from men they know. Physical abuse in intimate relationships is almost always accompanied by severe psychological and verbal abuse, and often sexual abuse. Gender-based violence has long- term mental and physical health consequences. Although given this information, it is almost universally true that professionals and social institutions blame the victim, not the perpetrator.

Dr. Senanayake described the magnitude of this problem by referring to several population-based quantitative studies. One analysis covered 24 countries on four continents and found that 25 to 50 percent of women were physically assaulted by male partners. Another study confirmed that gender-based violence causes more death and disability in women, ages 15 to 44, than cancer, malaria, traffic accidents or war. In Alexandria, Egypt, domestic violence accounts for 25 percent of all trauma center visits by women. A study in Colombia shows that one of every five Colombian women was beaten by a partner and one of three women was emotionally or verbally abused.

Dr. Senanayake believes that health care providers, especially those in reproductive health clinics, are in unique positions to offer support, counseling, information and advice as they treat women suffering from gender-based violence. The survivors of violence need to break their silence. They must be assessed correctly by sensitized providers and receive appropriate care. They must be educated about gender-based violence and obtain adequate case referrals into a network for their safety and well-being. Governments must assume an active role in funding the improvement and expansion of sexual and reproductive health care, advocates Dr. Senanayke. "While $1.4 billion will buy 10 vertical take-off combat aircraft, $1.3 billion will provide community health posts for all. While $5.3 billion will buy 10 B2 Stealth aircraft, $5 billion would provide for health-related research globally. While $7.9 billion will buy 243 Trident 11 submarine-launched missiles, $6 billion would provide maternal health care and education for all."

Dr. Rachel Jewkes is a Senior Specialist with the South African Medical Research Council based in Pretoria. She is also an advisor and Steering Group member of the World Health Organizations' Multi-Country Study on Domestic Violence Against Women.

Dr. Jewkes maintains that the United Nations' recognition of violence against women as a human rights issue is one of the most significant achievements of the last decade. However, in most countries, little attention has been given to addressing violence against women as a public health policy issue and even less to tackling its underlying causes.

She says, "Violence against women impacts on sexual and reproductive health in multiple ways and the eradication of this violence must become an integral part of efforts to promote the sexual and reproductive health of women worldwide."

The impact of gender-based violence is evident in many areas. Research studies show that forced sexual initiation as a child increases the likelihood of teenage pregnancy by a factor of three in the United States and a factor of fourteen in South Africa. High-risk sexual practices often bring about unwanted pregnancy, STDs and HIV infections.

The most important determinant of high-risk sexual activity is childhood sexual abuse. In the United States, for example, a woman raped as a child is four times more likely to engage in prostitution. HIV transmission is facilitated by gender-based violence, especially rape. There are cultural biases about condom use and the ability of women to negotiate is often severely restricted. In the Eastern Cape of South Africa, 57% of women believe they absolutely cannot refuse sex with their partners.

Pregnancy outcomes are also affected by gender-based violence. Partner battering has been identified in several countries as an appreciable cause of maternal mortality. Pregnant women abused in the past are twice as likely to experience pregnancy loss. These same women are sometimes prevented from receiving antenatal care for their unborn child by abusive spouses.

Lesley Ann Foster is the founder of the Masimanyane Women's Support Centre, the first gender-specific centre in East London, South Africa. She is involved with the Women's Caucus of the United Nations Human Rights Commission and is coordinating a report on women's rights in South Africa. Lesley Ann Foster received the 1999 Katlego Spirit of Hope Award for her dedication to women survivors of violence and advocacy work for women's rights.

South Africa is said to have the highest statistics of gender-based violence in the world for a country not at war. This appears true in spite of the genuine and active commitment to gender equality of President Nelson Mandela and his successor, President Mbeki. Government must hire women for 30% of the jobs in the three tiers of government. National agencies have been established to address this problem, including the Commission on Gender Equality, the Office on the Status of Women, the Human Rights Commission, and the Public Protector. Gender equality programs have been implemented, especially the National Crime Prevention Strategy, the Sexual Offenses Guidelines, the Justice Department's Gender Policy, and a National Plan of Action for Children, to name but a few.

The Government is also attacking gender-based violence through legislative reform and changes in the criminal justice system. The Masimanyane Women's Support Centre has studied the judicial reforms and found them limited and ineffective.

Some 624 cases of violence against women in the Mdantsane magistrate's court were examined. Of this number, 368 cases had been postponed, 100 struck off the roll, 30 arrest warrants were issued, 60 cases were withdrawn, 20 entered in error, 40 went to trial and 6 were finalized. In those six cases, the sentences ranged from two to nine years imprisonment.

In the East London courts, the situation was found to be much the same. There were 793 reported cases of violence against women. Only 32 were tried and convicted with sentences ranging from US$33 to 20 years imprisonment. Ms. Foster describes the economic situation of South African women as "a dismal picture of deprivation." The Development Bank of South Africa estimates that 56.4% of women are without income of any sort and, as such, constitute the most deprived sector of the South African population. At least 24% of the South African population live on less than US$1 per day. Women head more than 35% of single parent households and these households are poorer than male-headed households. International studies show that this extreme poverty has a negative impact on women's health, both physically and psychologically.

Constitutional and governmental progress in South Africa in recent years has not changed the level of violence South African women experience. Ms. Foster believes there must develop a "strong recognition that responsibility for eradicating violence against women lies not with government alone but with communities and the entire South African society."

This social movement must acknowledge the pain of apartheid and its role in generating violence against women. Apartheid is part of the everyday mindset in South Africa and it must be healed if violence against women is to abate. Comprehensive and integrated public education programs, in all the languages of South Africa, that focus on the teaching of human rights and the principles of democracy are essential ingredients in the transformation that must take place. Ms. Foster says, "We need strong accessible public education programmes which have great depth and which aim to create awareness, but which instill the values necessary to build and sustain a human rights culture and democracy." Greater cooperation between governments and NGOs is necessary with government taking the responsibility for encouraging coalition building between NGOs, community-based organizations and government structures at the local, provincial and national level. According to Ms. Foster, the active involvement of men in the work to eradicate violence is also a necessity. Men and men's groups have their own agendas, but they can form partnerships with women's groups to address issues jointly.

Finally, Ms. Foster asserts that interventions into gender-based violence will "make justice where there has been profound injustice. The injustice of [violence] is brokenness to the body, the spirit and human relationships. Justice-making involves breaking the silence and allowing the truth to be told ... confronting the abuser and holding him accountable." Pregnancy outcomes are also affected by gender-based violence. Partner battering has been identified in several countries as an appreciable cause of maternal mortality. Pregnant women abused in the past are twice as likely to experience pregnancy loss. These same women are sometimes prevented from receiving antenatal care for their unborn child by abusive spouses.

The Population Information Program of the Center for Communications Programs of The John Hopkins University School of Public Health regularly publishes Population Reports. In cooperation with the Center for Health and Gender Equality, the December 1999 issue of Population Reports focused on Ending Violence Against men.

This 42-page report is a must for anyone with a personal or professional interest in the subject. In clear language, supported by numerous illustrations and authoritative charts and graphs, the report looks at intimate partner abuse, sexual coercion, impact on women's reproductive health, threats to overall health and development, the role of health care providers, and what can be done to end the violence, including reaching out to men to change their behavior.

On March 8, 1999, The United Nations Development Fund for Women (UNIFEM) sponsored a United Nations Inter-agency Global Videoconference - A World Free of Violence Against Women. The program explored four types of violence against women: 1) domestic violence, including dowry violence and rape; 2) threats to women's bodily integrity, such as female genital mutilation; 3) violence against women in war and conflict situations; and 4) economic violence, including the situation of women and girls who are victims of sex trafficking.