Violence against women and girls
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q1791 (Published 16 August 2024) Cite this as: BMJ 2024;386:q1791Linked Opinion
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- 1Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
- 2Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Correspondence to: R B Lawn rlawn{at}hsph.harvard.edu
Violence against women and girls is a national emergency in England and Wales according to a recent disturbing analysis by the National Police Chiefs’ Council (NPCC), which described an estimated 3000 violent offences against women and girls daily.1 Every three days, at least one of these offences is likely to be homicide.2 Considering that many crimes go unreported, the NPCC’s findings probably underestimate the full scale of the problem.
Intimate partner violence is the most prevalent form of violence for women worldwide, with 27% of ever partnered women reporting lifetime experiences of physical, sexual, or psychological abuse by intimate partners.3 The prevalence of intimate partner homicide in England and Wales seems to be higher than in other high income countries such as Sweden, France, and Germany.4 Country comparisons must be treated with caution, however, because of missing data and varying definitions of violence45; even when a woman is killed, her death may not count towards estimates of femicide.6 Less well studied forms of violence can be especially heterogeneous across countries.5 However, stalking and harassment seem pervasive internationally as well as being key threats in England and Wales, representing 40% of offences in the NPCC report.178
Recent evidence links intimate partner violence and sexual harassment with later adverse mental and physical health.910 The prevalence and severity of stalking remains under-recognised, and it is often dangerously misunderstood as an innocent act of romance rather than a potentially health damaging experience.711 Most online or technology facilitated offences pertain to stalking and harassment.1 Online violence predominantly targets girls and adolescents and is likely to expand in an increasingly digital world.1 Critically, the age of first exposure to violence is decreasing,1 while overall exposure to online abuse is increasing for women and girls.1
Available evidence suggests that women and girls who experience violence often experience multiple victimisations over their lifetime, such as experiencing childhood abuse and later experiencing intimate partner violence in adulthood, which may collectively increase long term health risks.12 However, there is still little research on lifetime exposure to violence, including cumulative burden across a range of different types of violence and environments13 and their associations with health outcomes in aging women such as menopause symptoms and cardiovascular and brain health (conditions such as dementia).10
The NPCC’s findings are deeply concerning but not unexpected. We have seen, and written about, the violence epidemic identified by previous reports.14 Yet violence against women and girls continues to increase. According to the United Nations (UN), although the overall number of homicides seems to be decreasing globally, more women and girls were killed in 2022 than in any other year in the previous two decades.15 Surging rates may reflect conflict, humanitarian emergencies, environmental and economic crises, displacement, consequences of legislation such as restrictive abortion laws in the US, increasing online violence, and improved reporting related to greater awareness of gender based violence, and reduced stigma.11516 The surge also highlights a lack of preventive action.
Prevention
Violence against women and girls is preventable.15 Governments must roll out evidence based interventions nationally and evaluate the progress of coordinated efforts across agencies. For example, the UN’s RESPECT framework describes effective strategies, including empowerment, economic security, early intervention, education, and transforming gender attitudes.17 Among adolescents, evidence based primary prevention strategies include bystander interventions, creating protective environments, and teaching healthy relationships.18
The UK has taken steps forward, particularly for younger populations, including mandatory relationship and violence education in schools in England19 and legislating for safer online environments.20 Healthcare provides additional opportunities for prevention or intervention through contact with women of all ages. Providers should implement universal education to patients, alongside training for clinicians and health leaders, on the health harms associated with all forms of violence, to help increase awareness and reduce stigma, and should also provide social and health system resources to all survivors.21
Screening guidelines can inform approaches to identifying and engaging with women who disclose experiencing violence, including those not identified by police or other agencies, and help health providers deliver trauma informed care.22 Unfortunately, standard screening tools for violence rarely query stalking, harassment, and technology facilitated violence. Individuals with minoritised identities (ethnicity, gender, or sexual identity) are at higher risk of these types of violence than other groups, are under-represented in research despite higher risk of exposure, and have been historically marginalised and discriminated against in healthcare systems.7 A focus only on screening may, therefore, disproportionately neglect minoritised women.23
Other public health crises such as fatal car crashes and smoking provide evidence that successfully shifting the curve is possible. Yet, the stringent prevention and cessation strategies long implemented for smoking have not been replicated for intimate partner violence even though violence is a stronger risk factor than smoking for increased disability adjusted life years among women of reproductive age.24
We now have ample evidence documenting the scale and devastating consequences of violence against women. For those who survive, we must better understand the mechanisms that link violence to poor health and intervene early to limit health harms and disease. However, without effective prevention, we will continue to pass the burden and consequences of violence to our daughters.25
Footnotes
Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare no other interests. Further details of The BMJ policy on financial interests are here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf.
Provenance and peer review: Commissioned; not externally peer reviewed.
References
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