In addition to informing policies and health interventions, the WHO Multi-country Study on Women’s Health and Domestic Violence against Women presents a model for research that is methodologically rigorous and yields information that can be directly applied to violence-prevention activities. To help others undertake similar research, PATH and WHO have produced an additional resource, Researching Violence Against Women: A Practical Guide for Researchers and Activists.
The guide draws on the experience of researchers from more than 40 countries and presents methods for performing surveys and qualitative research on gender-based violence in low-resource settings. It covers all aspects of the research process, from study design to training field workers. It also describes ways to use findings to influence decision-makers. Most important, it presents clear guidelines for protecting the safety of women participating in the research.
Women may internalize social norms that justify abuse.
Violence against women reaches beyond the immediate threat of bruises and broken bones. The violence women in many parts of the world routinely endure is linked to severe health problems—chronic pain, disability, disease, and mental problems—that affect not only the health of individuals, but the social health of communities and the economic health of nations.
In the United States and other countries, the slow (and still unfinished) journey away from gender-based violence has started with information—the information leaders and activists need to justify laws and shelters that protect women and the information women and men need to reconsider long-standing ideas about what is acceptable. In the developing world, though, reliable information about violence against women is rare, and traditional cultural values are an even greater barrier to change.
That’s why the World Health Organization, PATH, and the London School of Hygiene and Tropical Medicine embarked on a landmark study that crossed countries and cultures to shed light on gender-based violence. The findings have been released to coincide with the “16 Days of Activism Against Gender Violence” (Nov. 25 to Dec. 10), an international campaign designed to highlight issues of gender violence and human rights.
How many women endure violence? Who are they? Where do they live?
How does violence affect them?
What factors may protect against violence—and which put women at risk?
Are there any strategies or services that women use to deal with violence?
These are the questions researchers set out to answer with the most ambitious study ever conducted on gender-based violence. The WHO Multi-country Study on Women’s Health and Domestic Violence against Women involved more than 24,000 women in ten countries: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Tanzania, and Thailand. Specially trained interviewers surveyed random samples (by household) of women aged 15 to 49 years.
As a member of the core research team, PATH is proud to have helped design the study, the questionnaire, and training manuals; train interviewers; and supervise field work. We also analyzed data and helped prepare national reports, as well as the international findings just released.
The research findings confirmed that violence seriously affects women’s health. Women who reported violence were more likely to report poor general health and reported more physical symptoms of ill health, emotional distress, miscarriages, and abortions. They were also more likely to have considered or attempted suicide.
But there were also new insights—such as more violence overall, especially in the home. In 13 of the 15 study sites, one-third to three-quarters of women had been physically or sexually assaulted by an intimate partner. At some sites, as many as 28 percent of women who had been pregnant had been assaulted during pregnancy.
Much of this violence had been hidden and previously unreported—more than one-fifth of women reporting violence during the study had never told anyone about it before. Said one study participant from Brazil, “it made me feel good, because it was something that I had never told anyone before. Now I’ve told someone.”
Levels of violence varied greatly, both within and between countries. This finding raises questions for future research: which factors at individual, community, and national levels increase women’s risk of violence? Which provide a measure of protection?
One factor may be women’s internalization of social norms that justify abuse. In at least half the study sites, women reported believing that it is acceptable for a man to beat his wife under certain circumstances, including if she disobeys him, refuses sex, does not complete the housework on time, or is unfaithful. It goes to show how complex an issue gender-based violence is: although legal and institutional reforms are needed, they alone will not be enough to eliminate violence against women.
Simply by creating a safe space in which women could ask for help, this project has affected women’s lives and efforts to stop violence. As a participant from Japan explained, “I did not know where I could go for help. Now I know where I can go. I was looking for such places.”
Furthermore, the local organizations in the study countries that assisted with the research learned new skills and connected with each other and with researchers. PATH is now building on these established networks by disseminating information and supporting regional initiatives—they’ve already been started in Latin America and South Africa—to address violence. We’ve also coauthored a guide that will help others conduct further research on violence.
As part of our broader efforts to reduce gender-based violence and advocate for scientifically sound, locally relevant solutions, PATH continues to serve as an advisor to the World Bank, the United Nations Division for the Advancement of Women, and UNIFEM. Together with partners across the world, we are helping expose the violence women endure.
Notes: Copies of the WHO Multi-country study are available online. An article in Science also describes this work. Read the announcement.