Around the world at least one woman in every three has been beaten, coerced into sex, or otherwise abused in her lifetime. Most often the abuser is a member of her own family. Increasingly, gender-based violence is recognized as a major public health concern and a violation of human rights.
The effects of violence can be devastating to a woman's reproductive health as well as to other aspects of her physical and mental well-being. In addition to causing injury, violence increases women's long-term risk of a number of other health problems, including chronic pain, physical disability, drug and alcohol abuse, and depression. Women with a history of physical or sexual abuse are also at increased risk for unintended pregnancy, sexually transmitted infections, and adverse pregnancy outcomes. Yet victims of violence who seek care from health professionals often have needs that providers do not recognize, do not ask about, and do not know how to address.


What Is Gender-Based Violence?
Violence against women and girls includes physical, sexual, psychological, and economic abuse. It is often known as "gender-based" violence because it evolves in part from women's subordinate status in society. Many cultures have beliefs, norms, and social institutions that legitimize and therefore perpetuate violence against women. The same acts that would be punished if directed at an employer, a neighbor, or an acquaintance often go unchallenged when men direct them at women, especially within the family.
Two of the most common forms of violence against women are abuse by intimate male partners and coerced sex, whether it takes place in childhood, adolescence, or adulthood. Intimate partner abuse—also known as domestic violence, wife-beating, and battering—is almost always accompanied by psychological abuse and in one-quarter to one-half of cases by forced sex as well. The majority of women who are abused by their partners are abused many times. In fact, an atmosphere of terror often permeates abusive relationships.


How Health Care Providers Can Help
Health care providers can do much to help their clients who are victims of gender-based violence. Yet providers often miss opportunities to help by being unaware, indifferent, or judgmental. With training and support from health care systems, providers can do more to respond to the physical, emotional, and security needs of abused women and girls.
First, health care providers can learn how to ask women about violence in ways that their clients find helpful. They can give women empathy and support. They can provide medical treatment, offer counseling, document injuries, and refer their clients to legal assistance and support services.

Family planning and other reproductive health care providers have a particular responsibility to help because:


Abuse has a major—although little recognized—impact on women's reproductive health and sexual well-being;
Providers cannot do their jobs well unless they understand how violence and powerlessness affect women's reproductive health and decision-making ability;
Reproductive health care providers are strategically placed to help identify victims of violence and connect them with other community support services.
Providers can reassure women that violence is unacceptable and that no woman deserves to be beaten, sexually abused, or made to suffer emotionally. As one client said (379), "Compassion is going to open up the door. And when we feel safe and are able to trust, that makes a lot of difference."

Societal Responses
Health workers alone cannot transform the cultural, social, and legal environment that gives rise to and condones widespread violence against women. Ending physical and sexual violence requires long-term commitment and strategies involving all parts of society. Many governments have committed themselves to overcoming violence against women by passing and enforcing laws that ensure women's legal rights and punish abusers. In addition, community-based strategies can focus on empowering women, reaching out to men, and changing the beliefs and attitudes that permit abusive behavior. Only when women gain their place as equal members of society will violence against women no longer be an invisible norm but, instead, a shocking aberration.

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