Injury is one inevitable and commonly recognised consequence of violence by a male partner, but this is not the only outcome—gynaecological and gastrointestinal disorders, and mental-health problems, including suicidal thoughts and attempts, are also frequent. Some of these issues are discussed in an Article in this week’s edition of The Lancet.
Studies into the health effects of partner violence have been limited by being clinic-based rather than population-wide, being mainly in north America and Europe, and having a small sample size. Nor has violence been defined or measured consistently—making comparisons difficult.
WHO, and partners from around the world, led by Dr Claudia Garcia-Moreno, undertook the WHO multi-country study between 2000 and 2003, interviewing nearly 25 000 women. The countries included were Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania. Women aged 15–49 years were asked about experiences of physical or sexually violent acts by a current or former intimate male partner, and about subsequent symptoms linked to physical and mental health.
Ever having experienced physical or sexual partner violence was linked with poor health overall, and with specific health problems in the 4 weeks before being interviewed: difficulty walking or daily activities, pain, memory loss, dizziness, and vaginal discharge. Not only that, women who had experienced partner violence at least once in their lives reported much more emotional distress, or suicidal thoughts or attempts, than women who had never been abused in this way. These associations do not seem to be explained by differences in age, education, or marital status.
Notably, the association found was between self-reported ill-health in the previous 4 weeks and lifetime experiences of partner violence. This finding suggests that the effect of violence might last long after the actual violence has ended.
Because of the cross-sectional design of the study, the authors could not establish causality—ie, whether violence caused poor health or whether women with poor health (mental-health problems or alcohol misuse, for example) were more likely to have violent partners. Nevertheless, previous studies suggest that health problems are outcomes of abuse rather than precursors of it.
The authors conclude: “In addition to being a breach of human rights, the high prevalence of partner violence and its associations with poor health—including implied costs in terms of health expenditures and human suffering—highlight the urgent need to address partner violence in national and global health-sector policies and programmes.”
In a Comment, Riyadh K Lafta (Mustansiriya Medical School, Baghdad, Iraq) states: “Accurate and comparable data on violence against women are needed to strengthen advocacy efforts, help policy makers understand the problem, and guide the design of preventive interventions. Unfortunately, data-collection efforts that measure the scope and magnitude of the situation of violence against women are hampered by several factors. These include the influence of social and cultural norms in determining what constitutes violence, changes in reported rates of abuse according to the definition of violence used, the way questions are asked, the type of target population, and the setting of the interview. Under-reporting of violence is a common problem for several reasons: minor injuries might pass without being reported; violence is viewed as normal in certain communities; victims are too frightened of their partners to report the incident; sexual abuse and violence are rarely discussed in certain cultures; and verbal assault, an important type of gender violence, is often overlooked or under-researched. Future studies with a longitudinal cohort design should go further to measure the mortality and life expectancy among women who are victims of intimate-partner violence”.
Dr Claudia Garcia-Moreno, Department of Reproductive Health and Research, WHO, 20 Avenue Appia, 1211 Geneva 27-CH, Switzerland. T) +41 22 791 4353 /
Dr Mary Ellsberg, PATH, Washington D.C., USA /
Dr Charlotte Watts, LSHTM, UK /
Dr Henriette Jansen /
Dr Lori Heise
Comment Dr Riyadh K Lafta, Mustansiriya Medical School, Baghdad, Iraq riyadhlafta@yahoo.com
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Issued by Tony Kirby, Press Officer, The Lancet Press
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