Although violence towards women has become increasingly regarded as a major public health issue, available data about the global magnitude and nature of the problem, particularly in poorer countries, has previously been scarce.

In a first for the World Health Organisation (WHO), a Multi-Country Study on Women's Health and Domestic Violence Against Women identifies the scope and effects of violence against women worldwide.

Around 500 female interviewers were trained to interview more than 24,000 women, aged 15 to 49 years in 15 sites throughout Bangladesh, Brazil, Ethiopia, Japan, Peru, Namibia, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania.

Major findings from the research show that intimate partner violence is the most common form of violence in women's lives - much more so than assault or rape by strangers or acquaintances.

The study also revealed how much intimate partner violence remains a hidden problem, through documenting the prevalence of intimate partner violence and its association with women's physical, mental, sexual and reproductive health.

"Women are at more risk from their intimate partners than from strangers or men in the street," says Dr Henrica Jansen, from the WHO, the epidemiologist for the study who worked with the researchers.

"Four out of five women who report violence report abuse by a partner. It is said that the streets are not safe - but it is the homes that are not safe for most women. This is still very much a hidden problem."

Data on non-partner violence, sexual abuse during childhood and forced first sexual experiences is also included in the study, along with women's responses to violence: Whom do women turn to and whom do they tell about the violence in their lives? Do they leave or fight back? Which services do they use and what response do they get?

At least 20% of the women who were interviewed for the study reported that they had never talked about their experience of violence before.

"We found, in countries where domestic violence is a part of daily life, that the interview for the first time made women realize that what they were undergoing was not normal," Dr Jansen said. "A woman in Bangladesh said she thought it was normal for a husband to beat his wife and have sex against her will."

Despite the health consequences, very few women reported seeking help from formal services like health and police, or from individuals in positions of authority, preferring instead to reach out to friends, neighbours and family members. Those who did seek formal support tended to be the most severely abused.

The study also found that one quarter to one half of all women who had been physically assaulted by their partners had suffered physical injuries as a direct result.

The abused women were also twice as likely as non-abused women to have poor health and physical and mental problems, even if the violence occurred years before. This includes suicidal thoughts and attempts, mental distress and physical symptoms like pain and dizziness.

Key findings

  • Between 15% and 71% of women who ever had a partner report they have at least once suffered physical or sexual violence, or both, by a partner.
  • In some places home is not safe for one in two women - partner violence is more common than rape and assaults by acquaintances and strangers.
  • In most sites four in five women who have ever been abused by anybody report being abused by a partner.
  • Domestic violence is hidden and women find it difficult to talk. More than 20% (up to 60%) reporting physical violence had never told anyone before they were being interviewed.
  • Less than one in five women seek help and if help is sought it is done more when violence is severe.

Measurement of physical and sexual violence

For physical violence, women were asked whether a current or former partner had ever:

  • Slapped her, or thrown something at her that could hurt her.
  • Pushed or shoved her.
  • Hit her with a fist or something else that could hurt.
  • Kicked, dragged or beaten her up.
  • Choked or burnt her on purpose.
  • Threatened her with, or actually used a gun, knife or other weapon against her.

Sexual violence was defined by the following three behaviours:

  • Being physically forced to have sexual intercourse against her will.
  • Having sexual intercourse because she was afraid of what her partner might do.
  • Being forced to do something sexual she found degrading or humiliating.

Recommendations

Among the report's 15 recommendations, a range of vital interventions to change attitudes and challenge the inequities and social norms that perpetuate abuse were recommended.

These include the integration of violence prevention programming into ongoing initiatives aimed at children, youth, HIV/AIDS, sexual and reproductive health.

The study was completed in collaboration with the London School of Hygiene and Tropical Medicine, PATH and national research institutions and women's organisations in the participating countries.

Findings from the study have recently been published in the medical journal, The Lancet.

For more information about the study please visit the World Health Organisation's website.