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There are societes in which violence against women does not exist.
Although violence against women is an integral part of virtually all cultures, there are reports of societies in which gender-based abuse does not exist. In his ethnographic review of 90 peasant and small-scale societies, Levinson (1989) identifies 16 that can be described as “essentially free off or untroubled by family violence. And Sanday (1981) has found that there are societies free of rape. Such cultures-even if few in number – offer proof that violence against women is not inevitable.
4. health consequences of gender-based violence.
A growing body of research has emerged in recent years on the mental and physical health consequences of violence against women and the burden it places on health care Although much of this research is from the industrial world, clinicians and advocates in developing countries confirm that the U.S.-based literature corresponds well to their experience with battered women and survivors of sexual assault and abuse.
When this literature is considered together with estimates of the prevalence of gender-based violence in different parts of the world, the magnitude of the violence related health burden begins to become clear. Perhaps the best estimate of this burden comes from a modeling exercise undertaken by the World Bank to inform its policy annual, the World Development Report:, which in 1993 focused on health. For this effort, Bank staff and outside experts estimated the healthy years of life lost to men and women due to different causes. The exercise counted every year lost due to premature death as one disability-adjusted life year (DALY) and every year spent sick or incapacitated as a fraction of a DALY, with the value depending on the severity of the disability.
From this analysis, broken down by region and age group, rape and domestic violence emerge as a significant cause of disability and death among women of reproductive age in both the industrial and the developing world (sees appendix C). In established market economies gender based victimization accounts for nearly one in five healthy years of life lost to women age 15 to 44. On a per capita basis the health burden of rape and domestic violence affecting reproductive-age women is roughly the same in industrial and developing countries, but because the overall burden of disease is much greater in developing countries, a smaller percentage is attributable to gender based victimization.
The World Bank estimates that rape and domestic vim fence account for 5 percent of the healthy years of life lost to women of reproductive age in demographically developing countries. In developing countries such as China, where maternal mortality and poverty-related diseases are relatively under control, the healthy years of life lost due to rape and domestic violence again account for a larger share-16 percent of the total burden. At a global level the health burden from gender-based victimization among women age 15 to 44 is comparable to that posed by other risk factors and diseases already high on the world agenda, including the human immunodeficiency virus (HIV), tuberculosis, sepsis during childbirth, cancer, and cardiovascular disease (table 5).
The following section explores the long- and short-tern health effects of different types of abuse. Box 3 presents the range of health effects recorded in the literature.
Table 5 Estimated global health burden of selected conditions for women age 15 to 44.
Disability-adjusted life years lost( millions)
STDs [excluding HIV)
Pelvic inflammatory disease.
Rape and domestic violence.
Motor vehicle accidents.
• Rape and domestic violence are included here for illustrative purposes. They are risk factors for disease conditions, such as STDs, depression, and injuries, not diseases in themselves of.
Source: World Bank 1993.
Health effects of abuse by intimate partners.
Abuse of women by intimate male partners has both physical and mental health consequences. The physical consequences include injury and a host of less-defined somatic complaints. In the United States 22 to 35 percent of women presenting to urban emergency rooms exhibit symptoms related to ongoing abuse (Council on Scientific Affairs, American Medical Association 1992). A representative survey of women in Texas found that 24 percent of women who had ever been abused required medical treatment because of the abuse (Teske and Parker 1983).
Abuse-related injuries include bruises, cuts, black eyes, concussions, and broken bones. Abuse also leads to miscarriages and to permanent injuries, such as damage to joints, partial loss of hearing or vision, and scars from burns, bites, and knife wounds. In Bangladesh and parts of Latin America acid throwing, a form of abuse increasingly perpetrated by vengeful lovers, leads to permanent disfigurement. In addition to injuries, battered women often suffer chronic headaches, abdominal pains, muscle aches, recurrent vaginal infections, and sleep and eating disorders. Two studies, one covering 390 randomly selected women in the United States and the other 2, 000 randomly selected women in New Zealand, found that abused women had significantly worse physical and mental health than non abused women (Koss, Ross, and Woodruff 1991; Mullen and others 1988). Recent research reported in the Journal of the American Medical Association suggests that abuse can also be associated with delayed physical effects, particularly arthritis, hypertension, and heart disease (Council on Scientific Affairs 1992).

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