1. GENDER BASED
VIOLENCE:
THE HIDDEN CAUSE OF
POOR HEALTH
OUTCOMES
Phyllis W. Sharps, PhD, RN, FAAN
Professor and Associate Dean
Community and Global Programs
Johns Hopkins University School of Nursing

2. Gender Based Violence
 Violence that results in harm to men
and women:
Physical
Sexual
Psychological
 Any form of violence or abuse that
targets men or women based on their
sex

3. Types of GBV
 Battering
 Intimate partner
Violence (IPV)- marital
rape
 Sexual violence
 Dowry Related
violence
 Female infanticide
 Sexual abuse of
children in homes
 Honor Crimes/killings
 Early and/or Forced
marriage
 Female Genital
Cutting & other
traditional practice
harmful to women
 Sexual harassment in
the workplace &
educational settings
 Commercial sexual
exploitation
 Trafficking of girls
and women (and
boys)
 Violence perpetrated
against domestic

4. Victims of GBV
 Victims – men and
boys –
 Trafficking
 Conflict
 Educational setting
 Victims - MOST
ARE WOMEN

5. Globally 1 in 3 women (30%) will experience
physical and/or sexual violence by a partner in
lifetime (WHO)

6. Globally
Girls and Women Most
Vulnerable
 Across the lifespan
women are more
vulnerable
 1 in 5 women are victim
of rape in her lifetime
 1 in 5 women are
sexually abused by age
15
 >130 M girls subjected to
female genital cutting
 800,000 people are
trafficked
 80% are girls and women
 50% are minors

7. GBV Across A Women‟s Life
Developmental Phase Violence Specific to Developmental Phase
Prenatal Prenatal sex selection (female feticide)
Infancy Female infanticide, differential access to food &
medical care
Childhood Female genital cutting; differential access to food,
medical care & education; incest, sexual
molestation, commercial sex; violence & abuse in &
around school; early marriage
Adolescence Harmful initiation rites, incest, commercial sex,
school & workplace violence, early marriage,
coerced sex, teen dating violence, honor crimes
Adulthood IPV, marital rape, dowry abuse & murder, femicide,
psychological abuse, violence& sexual abuse &
harassment in workplace, honor crimes, abuse of
widows, coerced sex& pregnancy, traumatic fistula,
perinatal abuse, elder abuse, abuse of women with
disabilities

8. Femicide
 Femicide - the killing of females
by males because they are female
(Russell ‟76, „92)
 Includes other forms of GBV killings
 With the notion that not naming as
obscures nature of crime -
male hatred of women
 More pragmatic to describe
femicide as murder of women –but
globally many do not
8

9. Global and Societal Cost
 Violation of Human Rights
 In Bangladesh GBV is equivalent to 2% of
GDP
 Medical Cost
 Legal and Law Enforcement costs
 Lost of productive citizens – men and
women – lower income
 Lack of access to education
 Individual psychological despair, anxiety,
depression

10. Cost Of Violence Against
Women
Cost of non-fatal
injuries
 1995 = $5.8 M
 2012 = > $5.8 B
Costs are
 Direct medical/mental
health care
 Lost productivity from
paid work & household
duties – 13.6 M days of
lost productivity
10

11. The health effects of intimate partner violence
and non-partner sexual violence

12. Perinatal IPV
Statistical Overview
 Recent studies estimate that 3% to 19% of pregnant women report
being abused during the childbearing year – before, during or
after the pregnancy (Campbell, Garcia-Moreno & Sharps, 2000).
Health Consequences
 Poor Maternal Outcomes
◦ Physical health consequences -late entry into/no prenatal care, poor weight
gain, preterm delivery , pregnancy loss
◦ Mental health consequences - depression, low self esteem, PTSD, substance
use
 Poor Fetal and Neonatal Outcomes
◦ Pre-term delivery; Pre-term birth, low birth weight, fetal injuries (Bullock et all, 2001;
Marin et al, 1998; Murphy et al, 2001;).
Women are at risk for intimate partner homicide, before, during and after of
the pregnancy (McFarlane , Campbell, Sharps & Watson, 2002) & IPH is the major cause of
maternal mortality
12

13. Comparison Of Infant Mortality
Rates By Women's Experience Of
IPV
105
29
35
81
90
86
51
43
95
91
20
35
72
109
69
42 43
92
Experienced DV Not experienced DV
13

14.  Each year 3-10 million children are affected by
IPV (Campbell & Lewandoski, 1997)
 Up to 60% of children of abused women are also
abused (record review DeVos, Newberger et. al. „89; Stark & Flitcraft „88)
 Step-child in home associated with intimate
partner femicide & child murder (Daly & Wilson ‟95; Campbell et al
2003)
 20 years of research have reported
consequences of IPV for children's physical
and socio-emotional health such as:
 Depression, poor self-esteem, anxiety, aggression, poor
peer relations, poor academic performance,
 Physical health symptoms, under immunization
 Adolescent risky behavior (Bair-Merritt, et all, 2006; Baldry, 2003;
Holden, 2003; Fantuzzo, et al, 1991; Fredland et al, 2008; Kernic et al, 2002; Polillo, 2003).
Intimate Partner Violence and
Child Abuse Overlap

15. GBV and Associated Factors
 Socio-cultural factors
 Legal Factors
 Policy and Practice Factors
 Economic Factors
 Institutional Factors
 War and Conflict Factors

16.  GBV is a core health issue which
requires a health care response
 “Whether there is room for neutrality
is debatable. Doing nothing may
often function as de facto support of
the perpetrator” (R Klein)
Take-Home Message