Summary Background Homicide is an important cause of premature mortality globally, but evidence for the magnitude of homicides by intimate partners is scarce and hampered by the large amount of ...missing information about the victim–offender relationship. The objective of the study was to estimate global and regional prevalence of intimate partner homicide. Methods A systematic search of five databases (Medline, Global Health, Embase, Social Policy, and Web of Science) yielded 2167 abstracts, and resulted in the inclusion of 118 full-text articles with 1122 estimates of the prevalence of intimate partner homicide after double-blind screening. All studies were included that reported the number or proportion of women or men who were murdered by an intimate partner in a country, province, or town, using an inclusive definition of an intimate partner. Additionally, a survey of official sources of 169 countries provided a further 53 estimates. We selected one estimate per country-year using a quality assessment decision algorithm. The median prevalence of intimate partner homicide was calculated by country and region overall, and for women and men separately. Findings Data were obtained for 66 countries. Overall 13·5% (IQR 9·2–18·2) of homicides were committed by an intimate partner, and this proportion was six times higher for female homicides than for male homicides (38·6%, 30·8–45·3, vs 6·3%, 3·1–6·3). Median percentages for all (male and female) and female intimate partner homicide were highest in high-income countries (all, 14·9%, 9·2–18·2; female homicide, 41·2%, 30·8–44·5) and in southeast Asia (18·8%, 11·3–18·8; 58·8%, 58·8–58·8). Adjustments to account for unknown victim–offender relationships generally increased the prevalence, suggesting that results presented are conservative. Interpretation At least one in seven homicides globally and more than a third of female homicides are perpetrated by an intimate partner. Such violence commonly represents the culmination of a long history of abuse. Strategies to reduce homicide risk include increased investment in intimate partner violence prevention, risk assessments at different points of care, support for women experiencing intimate partner violence, and control of gun ownership for people with a history of violence. Improvements in country-level data collection and monitoring systems are also essential, because data availability and quality varied strongly across regions. Funding WHO, Sigrid Rausing Trust, and the UK Economic and Social Research Council.
Intimate partner violence against women is a global public health problem with many short-term and long-term effects on the physical and mental health of women and their children. The Sustainable ...Development Goals (SDGs) call for its elimination in target 5.2. To monitor governments' progress towards SDG target 5.2, this study aimed to provide global, regional, and country baseline estimates of physical or sexual, or both, violence against women by male intimate partners.
This study developed global, regional, and country estimates, based on data from the WHO Global Database on Prevalence of Violence Against Women. These data were identified through a systematic literature review searching MEDLINE, Global Health, Embase, Social Policy, and Web of Science, and comprehensive searches of national statistics and other websites. A country consultation process identified additional studies. Included studies were conducted between 2000 and 2018, representative at the national or sub-national level, included women aged 15 years or older, and used act-based measures of physical or sexual, or both, intimate partner violence. Non-population-based data, including administrative data, studies not generalisable to the whole population, studies with outcomes that only provided the combined prevalence of physical or sexual, or both, intimate partner violence with other forms of violence, and studies with insufficient data to allow extrapolation or imputation were excluded. We developed a Bayesian multilevel model to jointly estimate lifetime and past year intimate partner violence by age, year, and country. This framework adjusted for heterogeneous age groups and differences in outcome definition, and weighted surveys depending on whether they were nationally or sub-nationally representative. This study is registered with PROSPERO (number CRD42017054100).
The database comprises 366 eligible studies, capturing the responses of 2 million women. Data were obtained from 161 countries and areas, covering 90% of the global population of women and girls (15 years or older). Globally, 27% (uncertainty interval UI 23–31%) of ever-partnered women aged 15–49 years are estimated to have experienced physical or sexual, or both, intimate partner violence in their lifetime, with 13% (10–16%) experiencing it in the past year before they were surveyed. This violence starts early, affecting adolescent girls and young women, with 24% (UI 21–28%) of women aged 15–19 years and 26% (23–30%) of women aged 19–24 years having already experienced this violence at least once since the age of 15 years. Regional variations exist, with low-income countries reporting higher lifetime and, even more pronouncedly, higher past year prevalence compared with high-income countries.
These findings show that intimate partner violence against women was already highly prevalent across the globe before the COVID-19 pandemic. Governments are not on track to meet the SDG targets on the elimination of violence against women and girls, despite robust evidence that intimate partner violence can be prevented. There is an urgent need to invest in effective multisectoral interventions, strengthen the public health response to intimate partner violence, and ensure it is addressed in post-COVID-19 reconstruction efforts.
UK Department for International Development through the UN Women–WHO Joint Programme on Strengthening Violence against Women Data, and UNDP-UN Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, a cosponsored programme executed by WHO.
Abstract Background Intimate partner violence (IPV) has a detrimental impact on the lives of women worldwide. Several studies have examined the effect IPV has on adverse birth outcomes when it occurs ...during pregnancy. Objectives To explore the association between IPV and selected adverse birth outcomes. Search strategy Multiple databases were searched to identify studies investigating the association between IPV and low birth weight (LBW), preterm birth, and/or intrauterine growth restriction (IUGR). Selection criteria Included studies defined the perpetrator of violence as an intimate partner, the type of violence as physical and/or sexual, and the study outcomes as LBW, preterm birth, or IUGR, with violence preceding delivery. Data collection and analysis Random-effects meta-analysis was used to calculate adjusted/unadjusted odds ratios (ORs). Subanalyses explored the effect of emotional/psychological violence on birth outcomes. Main results Nineteen studies met the inclusion criteria (15 LBW, 12 preterm birth, 4 IUGR). IPV was associated with LBW (OR 1.18, 95% confidence interval 1.05–1.31; I2 = 0.70, P < 0.001) and preterm birth (OR 1.42, 95% confidence interval 1.21–1.63; I2 = 0.20, P < 0.001). No statistically significant association was found for IUGR. Conclusions There are associations between IPV and LBW and preterm birth that could be causal.
Summary Health systems have a crucial role in a multisector response to violence against women. Some countries have guidelines or protocols articulating this role and health-care workers are trained ...in some settings, but generally system development and implementation have been slow to progress. Substantial system and behavioural barriers exist, especially in low-income and middle-income countries. Violence against women was identified as a health priority in 2013 guidelines published by WHO and the 67th World Health Assembly resolution on strengthening the role of the health system in addressing violence, particularly against women and girls. In this Series paper, we review the evidence for clinical interventions and discuss components of a comprehensive health-system approach that helps health-care providers to identify and support women subjected to intimate partner or sexual violence. Five country case studies show the diversity of contexts and pathways for development of a health system response to violence against women. Although additional research is needed, strengthening of health systems can enable providers to address violence against women, including protocols, capacity building, effective coordination between agencies, and referral networks.
Intimate partner violence (IPV) damages health and is costly to families and society. Individuals experience different forms and combinations of IPV; better understanding of the respective health ...effects of these can help develop differentiated responses. This study explores the associations of different categories of IPV on women's mental and physical health.
Using data from the World Health Organization (WHO) Multi-Country Study on Women's Health and Domestic Violence, multilevel mixed effects logistic regression modelling was used to analyse associations between categories of abuse (physical IPV alone, psychological IPV alone, sexual IPV alone, combined physical and psychological IPV, and combined sexual with psychological and/or physical IPV) with measures of physical and mental health, including self-reported symptoms, suicidal thoughts and attempts, and nights in hospital.
Countries varied in prevalence of different categories of IPV. All categories of IPV were associated with poorer health outcomes; the two combined abuse categories were the most damaging. The most common category was combined abuse involving sexual IPV, which was associated with the poorest health attempted suicide: odds ratio (OR): 10.78, 95% confidence interval (CI) 8.37-13.89, thoughts of suicide: 8.47, 7.03-10.02, memory loss: 2.93, 2.41-3.56. Combined psychological and physical IPV was associated with the next poorest outcomes (attempted suicide: 5.67, 4.23-7.60, thoughts of suicide: 4.41, 3.63-5.37, memory loss: 2.33, 1.88-2.87-).
Understanding the prevalence and health impact of different forms and categories of IPV is crucial to risk assessment, tailoring responses to individuals and planning services. Previous analyses that focused on singular forms of IPV likely underestimated the more harmful impacts of combined forms of abuse.
Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a ...profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors.
To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual.
We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language.
All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention.
We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach.
We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review.
Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.
Summary Background This article summarises findings from ten countries from the WHO multi-country study on women's health and domestic violence against women. Methods Standardised population-based ...surveys were done between 2000 and 2003. Women aged 15–49 years were interviewed about their experiences of physically and sexually violent acts by a current or former intimate male partner, and about selected symptoms associated with physical and mental health. The women reporting physical violence by a partner were asked about injuries that resulted from this type of violence. Findings 24 097 women completed interviews. Pooled analysis of all sites found significant associations between lifetime experiences of partner violence and self-reported poor health (odds ratio 1·6 95% CI 1·5–1·8), and with specific health problems in the previous 4 weeks: difficulty walking (1·6 1·5–1·8), difficulty with daily activities (1·6 1·5–1·8), pain (1·6 1·5–1·7), memory loss (1·8 1·6–2·0), dizziness (1·7 1·6–1·8), and vaginal discharge (1·8 1·7–2·0). For all settings combined, women who reported partner violence at least once in their life reported significantly more emotional distress, suicidal thoughts (2·9 2·7–3·2), and suicidal attempts (3·8 3·3–4·5), than non-abused women. These significant associations were maintained in almost all of the sites. Between 19% and 55% of women who had ever been physically abused by their partner were ever injured. Interpretation In addition to being a breach of human rights, intimate partner violence is associated with serious public-health consequences that should be addressed in national and global health policies and programmes. Funding WHO; Governments of the Netherlands, Norway, Sweden, Switzerland, and UK; Rockefeller Foundation; Urban Primary Health Care project of the Government of Bangladesh; Swedish Agency for Research Cooperation with Developing Countries (SAREC/Sida); United Nations Fund for Population Activities (UNFPA); and Trocaire.
To assess the prevalence of physical and sexual violence motivated by perception of sexual orientation and gender identity in sexual and gender minorities.
We searched nine databases without language ...restrictions for peer-reviewed and grey literature published from 2000 to April 2016. We included studies with more than 50 participants that measured the prevalence of physical and sexual violence perceived as being motivated by sexual orientation and gender identity or gender expression. We excluded intimate partner violence and self-harm. Due to heterogeneity and the absence of confidence intervals in most studies, we made no meta-analysis.
We included 76 articles from 50 countries. These covered 74 studies conducted between 1995 and 2014, including a total of 202 607 sexual and gender minority participants. The quality of data was relatively poor due to a lack of standardized measures and sometimes small and non-randomized samples. In studies where all sexual and gender minorities were analysed as one population, the prevalence of physical and sexual violence ranged from 6% (in a study including 240 people) to 25% (49/196 people) and 5.6% (28/504) to 11.4% (55/484), respectively. For transgender people the prevalence ranged from 11.8% (of a subsample of 34 people) to 68.2% (75/110) and 7.0% (in a study including 255 people) to 49.1% (54/110).
More data are needed on the prevalence, risk factors and consequences of physical and sexual violence motivated by sexual orientation and gender identity in different geographical and cultural settings. National violence prevention policies and interventions should include sexual and gender minorities.
PDF
