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Pregnant women in poor countries face domestic violence

BMJ 2005; 331 doi: (Published 24 November 2005) Cite this as: BMJ 2005;331:1228
  1. Paul Ress
  1. Geneva

    Pregnancy is a dangerous time for women in some parts of the world, shows a study for the World Health Organization on domestic violence. Between 4% and 12% of pregnant women in rural areas of developing countries told investigators that they had been beaten up while expecting a baby. More than 90% of them said that they had been abused by the father of the unborn child, and between a quarter and half of them had been kicked or punched in the abdomen.

    The survey, by researchers from the London School of Hygiene and Tropical Medicine and WHO, involved interviews with 24 000 women from urban and rural areas in 10 countries.

    The study, which was also sponsored by the Washington based PATH (Program for Appropriate Technology in Health), was released this week in London and Geneva.

    The 10 countries in the survey were Tanzania, Serbia and Montenegro, Namibia, Bangladesh, Ethiopia, Brazil, Thailand, Peru, Japan, and Samoa.

    All but one of them, Japan, was a developing country. Claudia Garcia-Moreno, study coordinator at WHO, said that they had chosen a predominance of developing countries because statistics already existed for domestic violence in developed countries whereas that was not true of the developing world.

    The study, said Lee Jong-wook, the director general of WHO, “shows that women are more at risk at home than in the street and this has serious repercussions for women's health and for health program costs. The study also shows how important it is to bring domestic violence out into the open and treat it as a major public health issue.”

    Another important conclusion of the study is that “intimate partner violence is the most common form of violence in women's lives—much greater than assault or rape by strangers or acquaintances.”

    At least 20% of the women who reported that they were victims of physical violence had never told anyone about it until they were interviewed. This means that “for policymakers the greatest challenge is that abuse remains hidden.”

    By contrast, abused women were twice as likely to report poor health and physical and mental problems as non-abused women, even if the violence occurred years before. “This includes suicidal thoughts and attempts, mental distress, and physical symptoms like pain, dizziness, vaginal discharge, and memory loss,” the report says.

    Charlotte Watts, from the London School of Hygiene and Tropical Medicine, and a member of the core research team, said that “partner violence appears to have a similar impact on women's health and wellbeing regardless of where she lives, the prevalence of violence in her setting, or her cultural or economic background.”

    In about half of the interview sites, between 50% and more than 90% of women thought that a man was justified in beating his wife under certain circumstances—for example, if she refused sex, disobeyed him, did not complete the housework on time, asked about other women, or was suspected of infidelity. The finding reflects similar conclusions in The Promise of Equality: Gender Equity, Reproductive Health and the Millennium Development Goals, published by the United Nations Population Fund earlier this year (BMJ 2005;331:861, 15 Oct).

    In three of the rural provincial sites as many as 44% to 51% of women did not feel entitled to refuse sex, even if their husbands mistreated them.

    “The WHO Study demonstrates that domestic violence is pervasive everywhere, although the rates vary quite significantly among settings,” said Mary Robinson, former UN high commissioner for human rights. “The report should serve as a call to action.”

    The study concludes that violence against women can be prevented and that public health has an important role to play in dealing with its causes and consequences.

    Women's Health and Domestic Violence Against Women is available at

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