Violence against women is linked to reproductive health problems

INTERNATIONAL - Unintended pregnancies, sexually transmitted infections, and miscarriages are more frequent among women who report having experienced violence at any point in their lives, studies from multiple countries around the world show.

On the International Day for the Elimination of Violence against Women, observed each year on November 25, the Pan American Health Organization/World Health Organization (PAHO/WHO) called for the health sector—especially sexual and reproductive health services—to be involved in efforts to prevent and respond to violence against women.

"This is a major problem with many health implications," said Dr. Carissa F. Etienne, PAHO’s Director. "The health sector has a role to play in both prevention and response."

Violence against women continues to be a serious public health problem in the Americas, where one in three women experiences physical or sexual violence by a partner or sexual violence by a non-partner during their lifetime, and 20% of women report being sexually abused as children. Young women aged 15-19 years are most at risk of suffering physical or sexual partner violence, with many reporting their first sexual encounter as unwanted or forced.

This violence not only results in physical injury or death but also has an under-recognized impact on women’s reproductive health, leading to more complications of pregnancy, unwanted pregnancy, miscarriage and sexually transmitted infections (STI), including HIV. In some countries in the Americas, levels of unwanted pregnancy are two to three times higher among women who report partner violence compared with women who do not. Pregnancy loss is twice as high among women who report experiencing violence, and the risk of premature labor is 1.6 times greater.

Studies have also found violence to be a significant cause of maternal mortality. Partner violence was the main cause of maternal death—responsible for 20% of such deaths— in three U.S. cities during 1993-1998. Hemorrhage was found to be three times more common in pregnant women suffering violence in one province in Canada in 2003. Between 3% and 44% of pregnant women in Latin America and Caribbean report experiencing partner violence during pregnancy.

The role of health sector should include collecting data on violence prevalence that can be used to inform policy and programming, while training personnel to provide comprehensive, non-judgmental care for survivors of domestic violence. Healthcare workers should also refer survivors to legal services and social support. Public health strategies should include efforts to change social norms and behaviors that are linked to violence.

Additionally, in the case of women who experience sexual assault, health services should asses their need for HIV or STI prophylaxis, make emergency contraception available, offer safe abortion in accordance with national law (when a woman accesses health services too late for emergency contraception or if emergency contraception fails), and provide mental health support.

In 1999, the United Nations General Assembly designated November 25 as the International Day for the Elimination of Violence against Women, which also marks the start of 16 Days of Activism that will culminate on December 10, Human Rights Day.

By the numbers

Proportion of women who report ever experiencing physical or sexual partner violence*:

• Bolivia (2003): 53.3%
• Colombia (2005): 39.7%
• Peru (2007-08): 39.5%
• Ecuador (2004): 32.4%
• Nicaragua (2006-07): 29.3%
• Guatemala (2008-09): 27.6%
• El Salvador (2008): 26.3%
• Paraguay (2008): 20.4%
• Jamaica (2008-09): 19.6%
• Haiti (2005-06): 19.3%
• Dominican Republic (2007): 17%
• Peru (2007-08): 11.3%
• Colombia (2005): 9.7%
• Dominican Republic (2007): 6.6%
• Haiti (2005-06): 5.6%
• Bolivia (2003): 3.3%
• Colombia (2005): 1.7%

Reported prevalence of partner violence during pregnancy*:

Proportion of women who reported losing a pregnancy as a result of partner violence*: