World

Tracking progress towards a world without violence against women

New data from WHO’s forthcoming Violence Against Women Policy Database show where further efforts are needed to deliver the Global Plan of Action on Violence.

After decades of work to recognize violence against women as a human rights, gender equality and public health priority, WHO Member States endorsed the Global Plan of Action to Strengthen the Role of the Health System within a National Multisectoral Response to Address Interpersonal Violence, in particular Against Women and Girls, and Against Children.

The plan asks countries to strengthen the health systems response to violence against women and girls through four strategic priorities, tracking progress on five areas of measurement.

Violence against women and girls remains devastatingly pervasive and starts alarmingly early, as recent WHO estimates show. Monitoring governments’ commitments to the Global Plan of Action on Violence is an important way to foster accountability towards millions of women and girls subjected to violence.

As the five-year progress report on the Global Plan of Action on Violence is presented at the Seventy-Forth WHO World Health Assembly, WHO shares preliminary analysis from a forthcoming Violence Against Women Policy Database.

For the first time, it shows the extent to which Member States have health policies addressing violence against women and girls – and how these align with WHO guidelines.

Here is what we have learned so far:

Over half (58%) of countries have national health policies that include violence against women and 50% have health sector guidelines responding to violence against women. However, there are differences across the six WHO regions.

Violence against women and girls is rooted in gender inequality, and it can be prevented through urgent and transformational change across societies.

Countries are also doing well in recognizing the need for multisectoral action to prevent and respond to violence against women, with nearly 3 out of 4 countries having national multisectoral plans.

While a little over half (54%) countries include first-line support in their national policies, only 2 out of 5 countries include mental health care and woman-centered principles in line with WHO recommendations.

More progress is needed to ensure the policies and plans addressing violence against women align with principles of woman-centered care. This includes respect for privacy and confidentiality so that health care providers do no harm and enhance the safety of survivors.

WHO recommends that survivors are also offered first-line support to all women who disclose violence. Training of health care providers is essential to ensure such care is empathetic, non-judgmental and meets the practical and emotional needs of survivors. Nearly 3 out of 5 (58%) countries include a commitment to training health care providers to respond to violence against women.

Sexual violence, particularly rape, can lead to pregnancies, sexually-transmitted infections (STIs) and HIV. It can also lead to psychological distress and trauma.

Comprehensive post-rape care means that countries offer at least 3 of the services that WHO advises:

  1. first-line support;
  2. emergency contraception;
  3. STI and HIV post-exposure prophylaxis (PEP); and
  4. safe abortion to the full extent of the law.

However, there is no information about coverage or quality of these services, and a third of countries have no data reported at all. Only 39% of countries reported offering abortion if a woman becomes pregnant as a result of rape.

Sexual violence can have an impact on a woman’s health and well-being long after the violence has occurred or ended. Reducing stigma and providing ongoing support services is crucial.

Evidence shows that challenging norms that uphold male privilege and female subordination, or which condone violence against women, is vital for preventing this violation.

Three out of five countries include ‘transformation’ of attitudes, beliefs and norms as a prevention strategy in their policies.

Adolescent girls and young women are at highest risk of recent (i.e. past 12 months) violence by an intimate partner. Effective prevention strategies need to focus on this unique population. Recognizing this, 55% of countries are fully or partially including adolescent girls and young women in policies.

Strengthening information collection is fundamental for transparency, evidence, accountability – and action.

81% of countries have conducted at least one survey between 2000 and 2018 with data on past 12 months prevalence of physical and/or sexual violence by an intimate partner, according to the largest ever WHO study of the prevalence of violence against women. Five out of the six WHO regions have at least 80% of countries with availability of survey data on past 12 months prevalence of intimate partner violence.

Disaggregating these data by location (urban/rural), ethnicity, and socio-economic status is important for effective policies and programmes.

Addressing violence against women is important to universal health coverage

This is the first source of analysis of how countries’ policies are addressing violence against women as a public health problem. The full policy database, as well as a global status report on health systems response to violence against women, is expected towards the end of 2021.

While it is heartening to see policy commitments that address violence against women reflected across all WHO regions, these commitments must be translated into tangible implementation – including through budgetary allocations. Only 44% of countries report having a national budget line item for the provision of health services for violence against women.

This is particularly critical as we move into the second year of COVID-19, where pandemic measures such as lockdowns and disruptions to vital support services have further increased women’s exposure to violence.

Vast effort is needed to operationalize countries’ policy intentions into measurable change at the service delivery and community levels, to impact women and girls’ lives. Health care providers, parliamentarians, ministries of health and finance are encouraged to use the five year progress report and these policy data to raise awareness, strengthen health services and implement evidence-based prevention strategies addressing violence against women.

As Dr Tedros Adhanom Ghebreyesus, WHO Director-General has said, “To achieve universal health coverage, explicit attention must be given to addressing inequalities, including interventions that counter unequal gender norms and address violence against women.”