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Who a public health approach to addressing violence against women copyright world health organization

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by Avni Amin on 25 July 2014

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Transcript of Who a public health approach to addressing violence against women copyright world health organization

Community level

Community level
They are the aspects of a person (or group) and environment or personal experience that make it more likely
(risk factors)
or less likely
(protective factors)
that women will experience violence.

Risk & protective factors?
Risk, protective factors and prevention principles for VAW
Risk factors can occur at multiple levels
Not all risk factors are causal
Many factors are related to multiple outcomes (IPV, SV, child maltreatment)
The more risk factors a person has, the greater the likelihood they will experience violence
The most effective prevention programmes work on
both reducing risks and enhancing protective factors

Individual
Biological and personal history factors that increase the likelihood of becoming a victim or perpetrator of violence
Relationship
Close relationships that may increase the risk of experiencing violence as a victim or perpetrator
Societal
Broad societal factors that help create a climate in which violence is encouraged or inhibited
Community
Characteristics of settings, such as neighborhoods, in which social relationships occur that are associated with becoming victims or perpetrators of violence
Individual
Risk Factor
Intervention
History of violence/abuse
in childhood
Addressing childhood abuse
Low education
Improving access to education & social skills training
Harmful use of alcohol
Personality disorders
Reducing harmful drinking
Early identification & treatment of conduct disorders

A public health approach to
addressing Violence Against Women

Overview
Snapshot

2

Relationship
Societal level
Having a solid understanding of risk & protective factors (and the people you target) gives you an excellent base from which to develop measures to prevent violence against women
By reducing risk factors & enhancing the protective factors (assets) around violence, your organization can work effectively to address violence in your community
3
4
Risk factors
Strengthening capacity for a
public health approach
to
prevention and response to violence against women
in
East Africa
Entebbe, 17–20 June 2014

Dr Avni Amin
Department of Reproductive Health and Research
VAW & health:
understanding the magnitude & consequences

Snapshot

1

Berit Kieselbach
Department of Violence and Injury Prevention and Disability


17-20 June
Entebbe, Uganda
What works to prevent violence against women:
Promising and effective strategies
Snapshot

3

Dr Avni Amin
Department of Reproductive Health and Research
Introductions to evaluations and scaling up
Snapshot
4

Risk factors for men's perpetration of intimate partner violence:
6 countries, 10,000 men in Asia-Pacific

VAW & health: understanding the magnitude and consequences
Snapshot
1

Risk, protective factors & prevention principles for VAW
Snapshot
2

Inter-generational & socio-economic consequences
Multiple health consequences
35%
Any public or private act of gender-based violence that results in, or is likely to result in physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty with the family or general community
What is a public health approach to
violence against women
Outline
women globally have experienced physical and/or sexual violence by an intimate partner
Source: UNIFEM, Investing in gender equality: Ending violence against women and girls. 2010. UN Women, New York

Gender
equality & prevalence
Risk factors f
or women's experience of partner violence:
history of abuse, gender norms, alcohol
Definitions and forms of violence
against women
Prevalence of violence against women
globally and in African Region
Health and other consequences
of violence against women
of women have experienced physical and/or sexual violence by an intimate partner and/or non-partner
1 in 3
of women globally have experienced sexual violence by a non-partner
http://apps.who.int/reproductivehealth/topics/violence/16ideas/
Key Message
Health consequences
Violence against women has multiple health (ie: physical, mental, sexual and reproductive health), social
& economic consequences for the individual, families, communities & societies
Key Message
of violence against women
Violence against women is a widespread public health & gender inequality and human rights problem worldwide
Effects on children of women who experience abuse
Effects on families
Social & economic
Higher rates of infant mortality
Behaviour problems
Anxiety, depression, attempted suicide
Poor school performance
Experiencing or perpetuating violence as adults
Physical injury or health complaints
Lost productivity in adulthood
Inability to work
Lost wages & productivity
Housing instability
Costs of services incurred by victims & families (health, social, justice)
Lost workplace productivity & cost to employers
Perpetuation of violence
Prevalence

of violence against women
Effective strategies
to prevent violence against women
Snapshot
3

Introductions to evaluations
& scaling up
Snapshot
4

Responding to VAW: WHO clinical & policy guidelines
Snapshot

5

Public health approach
Surveillance
What? Who? How much? Where?

Identify risk and protective factors
What are the causes?
Develop and evaluate interventions

Implementation
Scaling up effective policy and programmes

What works? And for whom?
Population-based
Public health approach
Interdisciplinary
Multisectoral
The characteristics
Experience of one or more acts of physical and/or sexual violence
and/or emotional/psychological abuse by a current or former partner

Intimate partner
Violence against women takes many forms
The most common form of violence experienced by women
Intimate partner
against women
VIOLENCE
VIOLENCE
Being slapped, having something thrown at you that could hurt you, being pushed or shoved, being hit with a fist or something else that could hurt, being kicked,
dragged or beaten up, being chocked or burnt on purpose, and/or being threatened with or actually having a gun, knife or other weapon used on you
Physical
VIOLENCE
Being physically forced to have sexual intercourse when you didn't want to, having sexual intercourse because you were afraid of what your partner might do and/or being forced to do something sexual that you found humiliating or degrading
Sexual
VIOLENCE
Can be measured by both
victimization
and
perpetration
.

Only a small proportion of cases are recorded in the routinely collected statistics
from victim care facilities and the police.

Both victimization and perpetration are most accurately measured through population-based surveys that count
self-reports
.

IPV & SV are often “hidden”:
There is a significant underestimation of the real level of harm caused. However, population-based surveys reveal that these forms of violence are common.
of intimate partner & sexual violence
45%
Globally
Africa region
7%
11%
Globally
Africa region
Violence starts early in the life of women
Age Group (yrs)
Prevalence %
95% CI%
15-19

29.4
26.8 - 32.1
20-24 31.6 29.2 - 33.9
25-29 32.3 30.0 - 34.6
30-34 31.1 28.9 - 33.4
35-39 36.6 30.0 - 43.2
40-44 37.8 30.7 - 44.9
45-49 29.2 26.9 - 31.5
50-54 25.5 18.6 - 32.4
55-59 15.1 6.1 - 24.1
60-64 19.6 9.6 - 29.5
65-69 22.2 12.8 - 31.6
Lifetime prevalence of intimate partner violence by
age group
among ever-partnered women
Fatal Outcomes
Non-fatal Outcomes
Femicide
Suicide
AIDS-related mortality
Maternal mortality
Physical
Sexual &
Reproductive
Psychological
& Behavioural
Fractures
Chronic pain syndromes
Fibromyalgia
Permanent disability
Gastro-intestinal disorders
Obesity (children)
Sexually-transmitted infections, including HIV
Unwanted pregnancy
Pregnancy complications/loss
Unsafe abortion
Low birth weight
Traumatic gynecologic fistula
Depression & anxiety
Eating & sleep disorders
Drug & alcohol abuse
Poor self-esteem
Post-traumatic stress disorder
Self harm
Increased sexual risk taking
Smoking
Perpetrating or being victims of violence later
He hit me in the
belly
and made me
miscarry two babies
- identical or fraternal twins, I don’t know. I went to the hospital with heavy bleeding and they cleaned me up.
VIOLENCE

Woman interviewed in Peru
Source: Garcia-Moreno C et al. 2005, WHO mult-country study on women's health and domestic violence against women: initial results on prevalence, health outcomes and women's responses
Reported statistics are under-estimates
... many incidents go unreported
Only

of women seek institutional support
Source: Adapted from Bott, Morrison & Ellsberg, 2005
Is widespread
Has serious health consequences for women
Has intergenerational consequences – affects children & families
1
2
3
VIOLENCE
Has adverse economic impact on families, communities and society
4
Take home points
of intimate partner & sexual violence on society
Healthcare costs
Annual cost to the economy in England and Wales:
Economic Impact
Information in LMICs currently not available, but consequences and costs are likely similar to high-income countries.
£22.9 billion
approximately
Canada:
1.1bn (US$)per year for direct medical costs related to intimate partner violence in 2001
Colombia:
184bn pesos (US$73.7m) spent by the government in 2003 for prevention & services related to family violence, 0.06% of naitonal budget
Uganda:
UGX 56bn (US$22m) costs of public provision
of services (health, police & judiciary) to survivors of
domestic violence in 2010-2011, 0.75% of Uganda’s
national budget in 2010-2011
UK:
£1.7bn for physical & mental health costs related to visits to general practitioners in 2008
The MDGs - Making links
MDG 4
MDG 5
MDG 6
41%
more likely to have
a preterm birth
1.7 times
more likely to experience pregnancy loss

more likely to acquire HIV; contract syphilis infection, chlamydia or gonorrhoea
as likely to have an abortion
16%
Twice
1.5 times
more likely to have low birth-weigth baby
Present research on risk and protective factors for violence against women (intimate partner and sexual violence)
Outline how risk and protective factors can be used to inform interventions to address violence against women
Public Health Approach:
Risk Factor
Intervention
Marital dissatisfaction
Promote gender equitable attitudes and behaviours / healthy relationship skills
Multiple partners
Risk Factor
Intervention
Concentrated
poverty
Urban planning
Weak community sanctions
Strengthen social norms against violence
Risk Factor
Intervention
Harmful use of alcohol
Policies to reduce harmful use of alcohol
Lack or poor enforcement of legislation on intimate
partner or sexual violence
Strengthen & enforce legislation: prohibiting intimate partner & sexual violence; promoting equality in marriage & divorce, property & inheritance laws
Key
Messages

There are several modifiable factors associated with intimate partner violence that can be targeted by prevention measures
1
Violence against women is rooted in or a manifestation of gender inequality in society: unequal gender norms held by women & men perpetuate violence against women
2
How do you identify risk and protective factors and use them to select your intervention?
Review
Gather available data (eg: on alcohol use or behaviour surveys)
Select
Does it strongly influence the issue?
Can it be easily changed?
What is the appropriate mix of risk and protective factors?
Use
who is affected by multiple risk factors to help select your target group.
the types of risk & protective factors to select strategies
Question:
information about candidate factors from existing research
Conduct qualitative research (eg: focus groups)
Implemented surveys
Develop
your own information
risk & protective factors to be addressed
information about . . .
Outcome evaluations seek to determine if a programme was effective in bringing about the intended change
WHY
Why evaluate programmes addressing violence against women?
Overview
What are principles for scaling-up effective interventions?
Ignoring violence
can do harm
1.

Abused women more likely to seek health services
2.
Violence is an underlying cause of injury and ill health
3.

Most women attend health services at some point, especially sexual and reproductive health
4.

If health workers know about a history of violence they can give
better services for women
Identify women in danger before violence escalates
Provide appropriate clinical care
Reduce negative health outcomes of VAW
Assist survivors to access help / services/ protections
Improve sexual, reproductive health and HIV outcomes
5.

Human rights obligations to the highest standard of health care
Sometimes when I ask a woman about violence, she dissolves in a sea of tears… then I think now how am I going to get rid of her?
Doctor in El Salvador
Provider behaviour
Possible consequences
Blames or disrespects women or girls

Inflicts additional emotional distress or trauma
Doesn’t recognize VAW behind chronic or reoccurring conditions

Woman receives inappropriate or inadequate medical care
Fails to provide adequate care to rape victims
Unwanted pregnancy, untreated STI, unsafe abortion

Ignoring violence
can do harm
Provider behaviour
Possible consequences
Breaches privacy or confidentiality
Partner or family member becomes violent after overhearing information
Doesn’t address VAW in family planning or STI/HIV counselling

Unwanted pregnancy; STIs/HIV/AIDS, unsafe abortion; additional violence
Ignores signs of fear or emotional distress

Woman is later injured, killed or commits suicide

Provide evidence-based guidance for clinicians on how to respond to intimate partner and sexual violence
WHO Clinical & Policy Guidelines
Guidance to policy makers on how to deliver training and on what models of health care provision may be useful

Inform educators designing medical, nursing and public health curricula regarding the integration of training on intimate partner and sexual violence
The purpose
Must ensure that:
consultation is done in private
confidentiality is maintained
Woman-centred care is . . .
being non-judgemental, supportive & validating
providing practical care that responds to her concerns, but does not intrude
asking about her history of violence, listening carefully, but not pressuring
helping her access information
about resources, including
legal and other services
assisting her to increase safety for herself and her children
Woman-centred care is . . .
Identification of women (IPV)
Minimum requirements
Certain sites may want to consider it provided certain requirements are met, including mental health, HIV testing and counselling, antenatal care
Universal screening
NOT
recommended, but…
Written information on IPV should be available in health care settings - posters, pamphlets, leaflets made available in private areas such as women’s washrooms
(with appropriate warnings about taking
them home)
Clinical enquiry is recommended – especially where can improve diagnosis and treatment
A protocol/standard operating procedure

Training on how to ask, minimum response

Private setting

Confidentiality ensured

System for referral in place
Asking about IPV
Survivors of IPV
Mental health care for pre-existing or IPV-related conditions
CARE
Survivors of sexual violence
Women-centred care
MENTAL HEALTH CARE
Primarily focused
on mental health
Cognitive behavioural therapy (CBT) or eye movement desensitization and reprocessing (EMDR) for those suffering PTSD (and are no longer in abusive relationship)
Brief to medium duration empowerment counselling* (up to 12 sessions) and advocacy/support, including a safety component, where health systems can support this intensive care.
*
The extent to which this may apply to settings outside of antenatal care or its feasibility in low- or middle-income countries is uncertain
Children are exposed to IPV: offer psychotherapeutic intervention, including sessions with and without mother
Survivors of sexual violence
Women-centred care
CARE
Take a complete history recording event, any injuries, mental health status, etc.
If within 72 hours provide:
Emergency contraception (up to 5 days)
HIV PEP as appropriate
STI prophylaxis/treatment
Safe abortion as per national law
Written information for coping strategies for dealing with anxiety/stress
Watchful waiting for up to 3 months (unless there are mental health concerns)
Treat other mental health conditions, in accordance with mhGAP WHO guidelines
For health providers
All health care providers should be trained in women-centred care & post-rape care
TRAINING
Health-care providers should receive in-service skills-based training, including:
when and how to enquire
the best way to respond to women
when and how is forensic evidence collection appropriate
Training:
should be integrated into undergraduate curricula for health care providers
must address attitudes of health care workers
should be accompanied by reinforcement & provision of continual support
There are certain behaviours that are expected of a married woman, and if you don't and your husband beats you up, then it's ok. It's like a parent disciplines a child.
Health worker interviewed in Samoa
Integrate care into existing health services, rather than as stand-alone service
HEALTH CARE
Consider different models – no one size fits all, but support provision of care at primary health care level
Ensure providers are trained
REPORTING
Mandatory reporting of intimate partner violence to the police by the health care provider is
NOT
recommended
Mandatory
But, health care providers should offer to report to appropriate authorities if the woman wants to do so
Child maltreatment and life-threatening incidents must be reported where there is a legal requirement to do so
Emphasis in many countries is on training or routine screening
System-wide changes
Training or screening alone not lead to sustained changes in health worker behavior or improved outcomes for women, unless accompanied by institutional changes
Institutional changes include:
procedures around patient flow,
documentation,
privacy and confidentiality,
feedback to health workers,
referral networks
Clinical handbook for health care providers – the "how to" for providing care (2014)
WHAT
Health systems manual for health managers – the "how to" for designing and managing services (2015)
Training curricula for health care providers – both pre-service (e.g. undergraduate) and in-service (2016)
NEXT
CONTACT
Claudia Garcia-Moreno:
garciamorenoc@who.int

Avni Amin
amina@who.int

Christina Pallitto

pallittoc@who.int
Department of Reproductive Health & Research
WHY
Have a sense that the programme is working
Have no time
Before
Outcome evaluation
Assess if a programme is ready for evaluation
Create a budget for the evaluation
Choose an evaluator
Engage stakeholders
Clearly describe the intervention
Design the evaluation
Gather credible data
Justify conclusions
Ensure lessons learnt are used & shared
The two best approaches to determine the effectiveness of a programme are:
Designing
Comparing experimental and control groups:

Creating a controlled trial in which the experimental group receives the programme & the control group does not
Time-series design:
Collecting data on outcomes at multiple times before, during, and after implementation to see at what point changes occur
Further resources
This will help to ensure that resources are not wasted on ineffective programmes
evaluate?
people are reluctant to evaluate
Are worried about getting negative results
Have no funds
HOW TO DO AN
The
process
1
2
Scaling
Scaling-up is a mechanism to achieve a broader impact during or following a project. It aims at transferring approaches and methods
Horizontal scaling up is referred to as the gradual rollout of activities to cover an ever
wider geographical area
Vertical scaling up means systematically rolling out evidence-based programmes by
institutionalising
them, so as to achieve a broader impact

Programmes addressing violence against women should be planned from the beginning with the vision of scaling them up
from the beginning
Is the intervention feasible and possible to maintain at a larger scale and a longer term?
Capacities to implement and to finance the implementation for a relevant time period should be explored from the outset
UP
Ownership
Involve key stakeholders in the planning process from the beginning to ensure relevant political back-up
Also involve them in outcome evaluations to ensure they support the process & accept and act upon the results
with results from pilot projects
Successful piloting often is the starting-point for scaling-up
Advocacy measures should be targeted to key decision-makers
Focus on visible results
Ensure
Develop standards & manuals that show implementation steps, when pilot measures are scaled-up & how to maintain quality
Institutions need to build required implementation capacities
Create
Effective programmes
do not
generally spread of their own accord
Institutions need to create incentives (not necessarily monetary) to maintain these changes or new tasks
Communication
Programmes that have effectively been scaled-up have a communication & networking strategy in place to inform, convince & involve major stakeholders
A good communication strategy can prevent misunderstandings & misconceptions
Willingness to change practices & the capacity to implement change must exist
Prevention strategies
Overview
Multi-sectoral interventions
Preventing
child maltreatment & intimate partner & sexual violence during adolescence
School-based programmes to prevent dating violence
School-based training to help children recognise & avoid potentially sexually abusive situations
SAFE DATES
Targeted at both male and female middle- and high-school students

Can be incorporated within a health education or life skills curriculum (eg: sexuality education, SRH and HIV education)

The curriculum addresses a range of topics, including:
Defining caring relationships
Defining relationship abuse
Why do people abuse
How to help friends
Equal power through communication
Sexual assault
Criteria for assessing their effectiveness
School-based strategies
Self-defence training for schools & colleges
Example
Lessons learned
Health sector interventions
Examples of what works
Effective
Promising
Effectiveness unclear or harmful
Have potential, but need testing/evaluation
Rape awareness & knowledge programmes for schools & colleges
Sexual violence prevention programmes for schools and colleges
Confrontational rape prevention programmes
Home visiting programmes (can be delivered by health sector)
Child maltreatment
Violence against women (IPV & SV)
Home-based strategies
Parenting programmes (can be delivered by health sector)
Child maltreatment
Violence against women (IPV & SV)
A dating violence prevention programme in USA
SAFE DATES
Evaluated using a randomised-controlled design in USA
Effectiveness
Programme effects were primarily due to changes in dating violence & gender norms; awareness of community services
Programme significantly reduced:
Psychological, moderate physical & sexual dating violence
perpetration
Severe physical dating abuse perpetration over time
Programme did not:
Prevent or reduce the experiencing
of psychological abuse
Affect conflict-management skills
Programme had greater impact on preventing violence before it occurred than reducing its re-occurrence among those already exposed to violence
IMAGE
Example
Intervention with microfinance for AIDS
and gender equity
Integrated economic & gender empowerment strategies
Community-based strategies
Cash Transfers – conditional and unconditional
Increasing women's ownership of property, assets and securing their inheritance rights
to empower women & girls
Goals:
Improve women’s employment opportunities
Increase women’s influence in household decisions
Improve their ability to resolve marital conflicts
Strengthen women’s social networks
Reduce intimate partner violence
Reduce HIV transmission
Encourage wider community participation to engage men and boys

Beneficiaries:
Women (>18 years) in poorest households in rural areas of South Africa
Intervention
Microfinance:
Loans to be repaid over 10-20 week cycles

Participatory gender & HIV training:
gender roles, beliefs, relationship communication, violence & HIV prevention.
10 training sessions every 2 weeks over
6 months

Community mobilisation
of youth and men to address community and male norms over 6-9 months
IMAGE
Intervention with microfinance for AIDS
and gender equity
A
55% decrease in intimate partner violence
in past 12 months
Women (< 35 years)
46% more likely to communicate
about sexual issues with partners
Decrease in
tolerance of IPV
A
64% increase
in young women & men
accessing VCT
A
24%

decrease
in young women & men
reporting unprotected sex
at last intercourse with non-spousal partner
IMAGE
Effectiveness
A randomised trial evaluation found that two years after completion:
Impact
stronger in communities that combined microfinance & gender & HIV training as compared to microfinance alone, suggesting that a larger impact was achieved mainly due to the gender & HIV training component.
Scaled up:
intervention scaled up from 855 in the trial phase to 2,598 women in two years after the trial.
Cost-effectiveness:
IMAGE cost-effective in trial phase and highly-cost effective in scale up
Being replicated in Tanzania
STEPPING STONES
Example
Changing norms & building relationship skills
Beneficiaries:
Young & old women & men in same-sex, mixed-sex & inter-generational participatory group education
Promoting gender equitable attitudes and behaviours by working with men and boys (in groups)
Community & societal level strategies
Social norms marketing/edutainment or behaviour change communication campaigns

To transform harmful gender norms
Community mobilisation
A community intervention to promote gender equitable norms and behaviours (including prevention of violence) & HIV prevention
To promote communication & relationship skills
Goals
Intervention:
Participatory training to build knowledge, risk awareness & communication skills, stimulate critical reflection about gender norms & power relationships
Implemented:
in 100 countries: Africa, Asia, Europe & Latin America
STEPPING STONES
Effectiveness
Changing norms & building relationship skills
A cluster randomised trial in South Africa with 35 intervention and 35 control villages
Intervention with single sex groups of young women and men (15-26 years)
Data collected at baseline, 12 & 24 months follow-up
Reduction in male perpetration of intimate partner violence at 24 months, but no impact in reducing women's experience of IPV
Results:
Promoting & enforcing laws and policies that ban violence against and promote gender equality (eg: girls access to education, women's employment, equality in laws on marriage, divorce, property & inheritance)
Societal & policy level
Reducing harmful use of alcohol
Advocate for a recognition of violence against women as a public health problem
Highlight relationship between violence against women and other forms of violence such as child maltreatment
Inform prevention programmes and policies using an evidence-based approach
1
Collect data about prevalence, risk factors & consequences
What can the health sector do?
Preventing violence against women
Reach out to other sectors e.g. criminal justice and stimulate multisectoral collaboration
Consider prevention programmes within the health sector
Provide comprehensive health and referral services for survivors

2
3
4
5
6
7
Heath sector strategies
Individualized care for at risk pregnant women
Home visitations to promote healthy behaviours
Screening of women at family planning followed by behaviour change coaching and referrals
Batterer interventions
Non-professional mentor support
Psycho-social support
by the Global Women's Institute, George Washington University, USA
A systematic review
28 health sector interventions
Family planning clinics in USA
Example
Of 1,278 women in five family planning clinics
53% experienced domestic violence/sexual assault
Similar rates in other clinic settings
Screening, counselling & referrals of women who experienced recent partner violence:
71% reduction
in odds for pregnancy coercion compared to control
Women receiving the intervention were
60% more likely
to end a relationship because it felt unhealthy or unsafe
Pre-natal & post-partum mental health interventions
Example
Screening & brief counseling resulted in a greater decline in IPV & significantly
lower scores for depression & suicide
ideation (Coker, 2012)
At 6 weeks post-partum, women who received a brief mental health intervention reported significantly
higher physical functioning & lower postnatal depression
scores (Tiwari, 2005)
Women pre-natal behavioural counseling for 2 to 8 sessions had fewer recurrent episodes of IPV during pregnancy & the post-partum period & had better birth outcomes
of effective health sector interventions to prevent VAW
Characteristics
There is no magic bullet
No single intervention or single
sector can prevent violence against
women
Multi-sectoral action needed
Life course approach
Underlying risk factors need to be identified and addressed
Small

changes
Salvadoran woman
The doctor helped me feel better by saying that I don’t deserve this treatment, and he helped me make a plan to leave the house the next time my husband came home drunk
make a
BIG
difference
during pregnancy
10-30%
against women
Surveillance
Who? What? How much? Where?

Identify risk and protective factors
What are the causes?
Develop and evaluate interventions

Implementation
Scaling up effective policy and programmes

What works? And for whom?
Based on
Ecological
Model
Surveillance
Who? What? How much? Where?

Identify risk and protective factors
What are the causes?
Develop and evaluate interventions

Implementation
Scaling up effective policy and programmes

What works? And for whom?
women & girls, transforming harmful gender
norms &
promoting
gender
equality in
policies
Empowering
http://iniscommunication.com/webjob/16_ideas/
Responding to VAW:
WHO clinical and policy guidelines

Snapshot

5

Surveillance
Who? What? How much? Where?

Identify risk and protective factors
What are the causes?
Develop and evaluate interventions

Implementation
Scaling up effective policy and programmes

What works? And for whom?
17-20 June
Entebbe, Uganda
17-20 June
Entebbe, Uganda
17-20 June
Entebbe, Uganda
17-20 June
Entebbe, Uganda
BIG
level
Multi
approach
Advocate
quality standards
incentives
Prior to current relationship
Education:

Completed secondary education
*Abused in childhood refers to physical beatings for men & sexual abuse for women
Demographics & relative status:
Household SES
; woman’s age; age gap with partner; relative educational status

Attitudes:
Reasons for a man to hit partner (none/any)
Alcohol:
Heavy drinking
Other relationships:
Woman has children from other;
partner has concurrent relationships
violence
of recent IPV
Surveillance
Who? What? How much? Where?

Identify risk and protective factors
What are the causes?
Develop and evaluate interventions

Implementation
Scaling up effective policy and programmes

What works? And for whom?
WHY
Men's control over women
Programmes targeting men and boys to promote gender equitable attitudes & behaviours

Relative importance of
different risk factors
Unequal gender norms that condone violence against women
Programmes promoting equitable gender norms through media, community mobilisation, schools & religious institutions

Traditional gender norms and social norms supportive of violence / ideologies of male sexual entitlement
Interventions addressing social & gender norms
Women’s lack of access to education & employment
Laws, policies & programmes that promote women’s access to employment & microcredit; girls’ access to education; and that prohibit violence against women
Berit Kieselbach
Department of Violence and Injury Prevention and Disability


Dr Avni Amin
Department of Reproductive Health and Research
CONTACT
Claudia Garcia-Moreno:
garciamorenoc@who.int

Avni Amin
amina@who.int

Christina Pallitto

pallittoc@who.int
Department of Reproductive Health & Research
Sources
Images used in all Snapshot presentations sourced from:
World Health Organization;
purchased Thinkstock creative images
History of abuse in childhood:
Mother being abused by partner; Abused in childhood
Current situation
Non-partner violence: partner violent with others; women experienced sexual violence >15yrs; women experienced physical violence >15yrs
Characteristics of union: partnership type & duration of relationship
Being insulted or made to feel bad about oneself; being belittled or humiliated in front of other people. The perpetrator has done things to scare or intimidate her, by yelling or smashing things; and/or has threatened to hurt someone she cares about
Emotional
VIOLENCE
High levels of
What is the role of the health sector in a multi-sectoral response?

Provide
Comprehensive health services for survivors
Collect data
about prevalence, risk factors and health consequences
Inform
policies to prevent violence against women
Prevent violence
by fostering and informing prevention programs
Advocate
for the recognition of violence against women as a public health issue
Question:
Gender norms & practises
Victimisation history
Psychological factors & substance abuse
Involvement in violence outside the home
Social characteristics
Results
38%
61%
33%
In USA
In Hong Kong
Local
implementation
National
policies
Key
Message

The health sector has a critical role to play in responding to violence against women
should the health sector address VAW
needed
Red
= risk factor
Green
= protective factor
Policy & provision
11 interventions effective preventing or reducing re-occurrence of violence
Results
Clear priority on violence against women and girls
Highlights critical role of health systems in providing services as part of multi-sectoral responses, collecting data and inter-facing with justice and other systems
Sexual & reproductive health services identified as important for survivors
Gender inequality acknowledged as root cause of violence against women & girls
Human rights in relation to health outcomes flagged as important
Acknowledges importance of advocating to change societal acceptance of violence against women and girls (a key element for prevention).
Resolution approved by Member States, May 2014:
Strengthening the role of the health systems in addressing violence, in particular against women and girls and against children(Resolution A67/A/CONF./1/Rev.1)
WHO requested to prepare a global plan of action on strengthening the role of the health system in addressing interpersonal violence
NEXT
STEPS:

Prevalence
the evaluation
Think
Implementation and policy advisory services should happen hand in hand
National-level policies are more convincing if they are built on concrete experience with implementation
Regularly inform central government institutions about successful programmes implemented for example at sub-national level
Political supporters can be found for scaling-up
Redirect resources from ineffective to effective programmes
Think
1
2
Key messages
from the beginning
BIG
strategies
Reduction in transactional sex & 32% reduction in problem drinking reported by men at 12 months
Reduction in HSV-2 incidence, but no impact on HIV incidence
Preventing
child maltreatment
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