WOMEN!AND!GIRLS!! ASSESSING!INDICATORS! OF!PROGRESS! TOWARD! THE!BEIJING!PLATFORM!FOR!ACTION!!

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1 WOMENANDGIRLS ASSESSINGINDICATORS OFPROGRESS TOWARD THEBEIJINGPLATFORMFORACTION VIOLENCEAGAINSTWOMEN:RISKSFACTORS&HEALTHIMPLICATIONS OCTOBER22,2014 PRODUCEDBY:MUIRJ,DEICHSELE,MANHARTL,KOHLERP WomenandGirls ViolenceAgainstWomen:RiskFactors&HealthImplications UniversityofWashingtonSTARTProgram,October2014 1

2 PURPOSE TheBill&MelindaGatesFoundationhaspartneredwiththeClintonFoundationtocreateanInternet portal that highlights progress made toward the 1995 Beijing Platform for Action. In support of this project,thestartteamwasengagedbythefoundationtodevelopaninventoryofindicatorswithclear connections to the Beijing Platform and sufficient levels of data availability and quality for data visualizations.inanextensionofthatwork,thisprojectaimstosummarizecurrentliteratureregarding risk factors for and health consequences resulting from Violence Against Women (VAW) around the world. We present two separate overview summaries addressing major areas of research on (a) the mostcommonlyidentifiedriskfactorsforand(b)healthoutcomesresultingfromvaw. METHODS Toidentifyscholarlyarticlesandofficialreportsrelevanttoriskfactorsforand/orhealthoutcomesof VAW, the START team conducted a targeted search of the academic and grey literature using a combination of systematic and snowball literature review methods. Searches of PubMed and Google ScholarwereconductedfromSeptember22,2014toOctober15,2014. Thetargetedsearchfocusedonmultibcountrystudies,systematicreviews,andarticlesfromhighbprofile journals. Articles that were written prior to 2000 (with a few exceptions), and/or papers written in languagesotherthanenglish,wereexcludedfromfurtherreview.allabstractsfromrelevanttitlesthat werereturnedfromthesearcheswerescannedtoidentifyfullbtextarticlesorreportsforinclusioninthe overview summaries. Following the targeted search, the START Team searched references within key articlesandreportstoidentifyadditionalsources.themostcomprehensive,relevantand/orlandmark documents were selected for further review and extraction of information. Risk factors summaries primarilyfocusedonriskforfemaleexperienceofviolenceasopposedtomaleperpetrationofviolence. Itisalsoimportanttonotethatnotallbspecificoutcomesfromeveryactofviolenceagainstwomenare presentedhere.thisdocumentservesasasummaryofthemostcommonhealthconsequencesdueto violenceagainstwomenexposure. WomenandGirls ViolenceAgainstWomen:RiskFactors&HealthImplications UniversityofWashingtonSTARTProgram,October2014 2

3 VIOLENCEAGAINSTWOMEN: RISKFACTORS&HEALTHIMPLICATIONS BACKGROUND ViolenceAgainstWomen(VAW)isoneofthemostpervasive, yetunderrecognizedhumanrightsviolationsintheworld. (1) Of women aged 15 or older around the world, population based studies estimate 30%$ have$ experienced$ intimate$ partner$ violence (2) $ and$ 7%$ have$ experienced$ non5partner$ sexual$violence$in$their$lifetime. (3) VAWoccursinallcountries irrespective of social economic, cultural or religious group, howevertheprevalencevaries.inhighburdenareas,as$many$ as$ 71% (2) $ and$ 21% (3) $ of$ women$ have$ experienced$ intimate$ partner$ and$ non5partner$ sexual$ violence, respectively, in theirlifetime. Identificationofriskfactorsandhealthoutcomesarecritically importantforinformingstrategiestopreventvariousactsof VAW. (4) This summary offers a brief review of current literature and understanding of the risk factors and health consequencesrelatedtoviolenceagainstwomen. % TheDeclarationontheEliminationofViolenceAgainstWomen,adoptedbytheUNGeneralAssemblyin 1993,definesVAWas$"any%acts%of%gender%based%violence%that%results%in,%or%is%likely%to%result%in,% physical,%sexual%or%psychological%harm%or%suffering%to%women,%including%threats%of%such%acts%coercion% or%arbitrary%deprivation%of%liberty,%whether%occurring%in%public%or%private%life." (5)% RISKFACTORS VIOLENCEAGAINSTWOMENINCLUDES: Intimatepartner/domestic/family violenceorspousalabuse(physical, sexualand/orpsychological) Nonbintimatesexualabuse Systematicrapeduringconflict Forcedprostitution,trafficking,sexual exploitation Femalegenitalmutilation(FGM) Dowrybrelatedviolence Forcedmarriageorcohabitation Femicideandhonorkillings Femaleinfanticideanddeliberate neglectofgirls There is no# single# predictor for VAW. (4, 6) Risk factors often have inconsistent relationships with VAW, (7) especially in different countries and regions; (8) and the relationships between some risk factors and violence are multib directional. (8) Furthermore, risk factors do not operateinisolation;rather,theyareembedded inbroadersocialandeconomiccontexts. (1,4,7,9b 11) Ecologicalframeworks(Figure1)areusedto holistically describe how a number of risks combinetoraisethelikelihoodofvaw. (4,7,9b12) Currently,mostoftheidentifiedriskfactorsare at the individual or relationship# level. The scarcity of community and societal level risk factors is thought to be due to a lack of research, rather than an absence of influential community and societal level risks. More research is needed to identify factors that influencevawatbothcommunityandsocietal levels. (4) FIGURE1.ANECOLOGICALFRAMEWORK Society Community Relahonship Individual WomenandGirls ViolenceAgainstWomen:RiskFactors&HealthImplications UniversityofWashingtonSTARTProgram,October2014 3

4 INDIVIDUALLEVEL Demographic characteristics, beliefs and attitudes,andpersonalhistorymayincreasethe likelihoodofvaw. (4,6b9,11,13) Youngerindividuals are at greater risk for VAW. (4, 8, 11b16) Evidence from seven countries suggests that% younger% women% havehigherriskforexperiencingvaw% andthat%thisriskdeclineswithage. (8) %% Across six studies, women with less% education hada2to5bfoldincreaseinriskofexperiencing violence. (4, 6, 17b19) A study from India finds that the odds of experiencing violence among women without any education were 5.6 times higher than for women with a college education. (17) Women living in households at% or% below% the% poverty% line% were 5 times more likely to experience violence (7, 20) and women at lower socioeconomic levels are at greater risk to experienceseverevaw. (4,6,13,17,18,21,22) Witnessing% inter?parental% violence was positivelyassociatedwithexperiencingvawin 12sitesoftheWHOmultibcountrystudyandin additional studies. (6b8, 11, 12, 23b25) A history of% childhood% abuse for women or their partners wasconsistentlyassociated with increased risk ofvawacrosswhomultibcountrysites. (6,10,25) A systematic review of 11 studies found that alcohol% abuse% wasassociatedwitha4.6times increaseintherisk%ofvaw,similarfindingsare reported related to substance abuse in general. (4,6b8,10,11,26) MenwhobelievethatVAWisacceptablehavea twobfoldincreaseinriskofvawperpetration. (4) InIndia,awoman sacceptanceofmistreatment was associated with increased risk of VAW% (odds ratio=1.2). (27) % Other studies indicate that risks are higher where a higher proportion of women agree that there are circumstances wherevawisacceptable. (4,6,11,12) RELATIONSHIPLEVEL Male% partner% behavior including multiple partners and heavy drinking increases the risk forintimatepartnerviolence. (12,21,23,28) Disparity% between% partners in education and agewasalsofoundtobeassociatedwithvaw. InIndia,womenwithmoreeducationthantheir husbands were 1.2 times more likely to experience VAW compared to those with educational parity. (17) A study from China finds anincreaseinriskofvawamongcoupleswith anagedifferenceof10yearsorgreater. (29) COMMUNITYLEVEL Acomparativestudyof16societieswitheither high or low rates of intimate partner violence, found that societies with the lowest levels of intimate partner violence were those that had% community% sanctions% against it, and where abusedwomenhad%access%to%sanctuary. (4,24,30) SOCIETALLEVEL Several studies suggest that VAW is more common in societies that reflect traditional% gender% norms and maintain patriarchy or gender% inequality in economic and decision making authority. For example, VAW occurred in about 11% of couples with a dominant husband compared to 3% of couples with greaterequalityintheirrelationships. (7,10,11) BUFFERS AlthoughVAWispervasive,itisnotubiquitous. Societies exist where VAW is virtually unheard of, suggesting that it is possible to minimize VAW. (1,10) Findingsfromseveralstudiesindicate that women who were% more% highly% educated% (secondary schooling or higher) were 20 55% lesslikelytobevictimsofviolence, (4,8,31b33) and men who were more highly educated were approximately 40% less likely to perpetrate violence. (4, 34) Other factors that may buffer againstriskinclude: (8,10,35,36) Healthyparentingasachild Supportive family and/or living within extendedfamily/familystructure (8) Belongingtoanassociation Women s ability to recognize risk WomenandGirls ViolenceAgainstWomen:RiskFactors&HealthImplications UniversityofWashingtonSTARTProgram,October2014 4

5 HEALTHIMPLICATIONS While the prevalence and forms of violence against women varies within and between communities, countries and regions, the resulting health consequences appear to be similar across all settings. Furthermore, the specific consequence or its severity may be affected by situational factors such as gender inequality; poverty; cultural or religious practices;availabilitytoaccesshealthcare,legal andothersupportservices;andlegalandpolicy environments. Health consequences can be grouped into four categories: physical, sexual andreproductive,mentalandbehavioral. PHYSICALHEALTH The WHO# multi8country# study# on# women s# health# and# domestic# violence reports that the prevalence of injury from physical violence amongeverbabusedwomenrangesfrom19%in Ethiopia to 55% in provincial Peru. Physical violencecanresultinminorsoft%tissue%damage (bruises, welts, lacerations, abrasions) or more serious%injuries(brokenbones,injuriestohead, eyes,ears,chestandabdomen),whichcanlead to limited% mobility$ or disability. (37) Globally, women experiencing intimate partner violence (IPV)areabout1.6timesmorelikelytoreport% difficulties% walking% and/or% completing% daily% activities%inthepast4weeks. (38) % Experiencing physical or sexual violence can also result in long lasting chronic% health% problems.womenexperiencingabusearemore likely than other women to report a range of chronic% pain (headaches, chronic pelvic pain, backpain,abdominalpain)andgastrointestinal$ disorders (including irritable bowel syndrome). (39) In the most severe cases, violence against women can lead to death. Male intimate partners commit 30b70% of all murders of womeninawiderangeofsettings, (22,40) whilein certainpartsoftheworldwomenaretargeted and killed by close family members as a result of perceived sexual transgressions. (37, 41) Death due to violence against women includes femicide, honor killings, female infanticide and deliberateneglectofgirls. SEXUALANDREPRODUCTIVEHEALTH Sexual and reproductive health problems are themostconsistent,longestlasting,andlargest physical health difference between abused women and nonbabused women. Sexual violence and intimate partner violence, separately, are associated with higher rates of gynecological% disorders,# vaginal% infection,# urinary% tract% infections, and sexual% dysfunction. (20, 22, 39) A US based study showed that women who experience intimate partner violence are at three times higher risk for gynecological problems compared to nonb abusedwomen. (42) Physical intimate partner violence or forced sexualintercourseputswomenatanestimated 70% higher risk for unintended pregnancy as compared to women with no history of abuse. (43) Violenceduringpregnancycanleadto many complications for women and children, suchasmiscarriage,#stillbirth,#low?birth?weight or preterm% births. (22, 39) Globally, women who have experienced partner violence have 16% greater odds of having a lowbbirth weight baby. (44) Femalegenitalmutilation(FGM)causesserious health consequences with no health benefits. SpecificconsequencesassociatedwithFGMare vaginal# bleeding and pain, risk of infection, general obstetric% complications, and perinatal% death. Women experiencing FGM are nearly twiceaslikelytoexperiencesexual%dysfunction such as pain during intercourse. Experiencing less%sexual%satisfaction,orlack%of%sexual%desire, arealsocommon. (45,46) WomenandGirls ViolenceAgainstWomen:RiskFactors&HealthImplications UniversityofWashingtonSTARTProgram,October2014 5

6 MENTALHEALTH Physicalandsexualviolenceareassociatedwith a greater risk of adverse mental health outcomes among women. The most common are depression,# suicide# attempts,# post? traumatic# stress% disorder, other stress and anxiety$disorders,#sleep%or%eating%disorders#and# psychosomatic% disorders. (20, 22, 37, 39) In two separate meta analyses, women who experience intimate partner violence were at twotimeshigherriskfordepressiveoranxiety episodes,experiencedsignificantlyhigherlevels ofemotionaldistress,andweremorethanfour timesmorelikelytocommitsuicide. (44,47) BEHAVIORALHEALTH Women who experience physical or sexual abuse in childhood are also more likely to exhibit highbrisk behaviors such as, alcohol,% tobacco% and% drug% abuse% and# unsafe% sexual% behavior (including multiple sexual partners, choosing abusive partners later in life, and lower rates of contraceptive and condom use). (22,39) NONbHEALTHIMPACTSOFVIOLENCE AGAINSTWOMEN Violence against women has economic% effects as well as an impact% on% children. Among womeninnagpur,india,13%hadtoforgopaid work because of abuse with an average of 7 workdaysperincident,and11%wereunableto perform household chores following an event involving physical violence. (22) These effects on womenhaveadditionalandsubsequentimpact on the life course of their children, starting as early as at birth. Adverse birthboutcomes (i.e., lowbbirthweight,prematurebirth)increasethe risk of death, morbidity, and disability for the child. (48) Additionally, witnessing marital violence puts a child at increased risk for a range of emotional and behavioral issues including, anxiety, depression, poor school performance,andphysicalhealthcomplaints. (22) WomenandGirls ViolenceAgainstWomen:RiskFactors&HealthImplications UniversityofWashingtonSTARTProgram,October2014 6

7 Risk%Factors% Sources% Summary%% Strength%of%Evidence% Individual%Level& && && && Demographic&Characteristics:&Young&Age,&Low& Education,&Marital&Status,&Socioeconomic& Status/Poverty,&Autonomy,&Number&of&Children& (4,&6X11,&13X 21,&24,&37,&49X 52)& Characteristics&associated&with&lower&social,&economic,&or&political& status&are&frequently&associated&with&an&increased&likelihood&of&vaw.& Some&relationships&are&multidirectional&(e.g.,&poverty&is&a&risk&factor& for&vaw,&but&vaw&may&also&increase&risk&of&staying&in&poverty).& Moderate:&Generally&consistent&evidence&across& multiple&studies,&but&there&are&also&a&few&conflicting& studies&for&some&risk&factors&& Pregnancy,&HIV&Diagnosis,&and&Sex&Work& (4,&20,&53X57)& Unplanned&pregnancy,&engaging&in&sex&work,&and&HIV&Diagnosis&may& increase&risk&of&vaw.& Exposure&to&Child&Maltreatment:&Physical&Abuse,& Sexual&Abuse,&and&IntraXparental&Violence& (4,&6,&8,&10,&11,& 25,&37,&50,&51,& 58)& (4,&6X8,&10,&11,& 20,&49,&58)& Experiencing&or&witnessing&physical&or&sexual&abuse&as&a&child&is& associated&with&increased&risk&of&vaw.& Moderate:&Generally&consistent&findings&across& studies,&but&rigor&of&analysis&within&studies&varies& from&statistical&analysis&to&observational&% Strong:&Consistent&evidence&across&multiple&studies.& Substance&Abuse&& Abuse&of&illicit&drugs&and/or&alcohol&is&generally&found&to&have&a&very& Strong:&Generally&consistent&evidence&across& strong&association&with&increased&risk&and&severity&of&vaw.& multiple&studies& Level&of&Empowerment&and&Social&Support& (4,&10,&37,&59)& Increases&in&empowerment&and&connection&to&social&support&is& Moderate:&Consistency&across&studies,&but&more& associated&with&decreased&likelihood&of&vaw.& research&is&required.& Acceptance&of&Violence& (4,&6,&11,&50,& Attitudes&and&beliefs&that&justify&or&accept&violence&are&strongly& Strong:&Consistent&evidence&across&multiple&studies.& 58)& correlated&with&vaw.& Exposure&to&Prior&Abuse/Victimization&& (4,&6,&11,&20,& Past&experience&with&violence&increases&risk&of&experiencing&and/or& Strong:&Consistent&evidence&across&multiple&studies.& 37,&49)& perpetrating&violence.& Relationship%Level& & && && Male&Partner&Behavior:&Multiple&Partners;&Alcohol& (4,&6,&21,&23,& Men&with&multiple&partners&and&heavy&drinkers&are&more&likely&to& Strong:&Consistent&evidence&across&multiple&studies.& Abuse& 28,&49,&51)& perpetrate&vaw&and&engage&in&other&risk&behaviors.& Relationship&Quality& (12)& Measured&as&frequent&quarrels&and&partner&controlling&behavior& Moderate:%Consistent&across&multiple&sites&in&IPV& study&of&young&and&adolescent&women% Partner&Disparities& (4,&8,&11,&17,& Disparities&in&age,&occupational&attainment&and&education&between& Moderate:&General&consistency&across&studies,&but& 20,&29,&37)& partners&may&increase&risk&of&vaw.& more&research&is&required.& Community%Level& & && && Weak&Community&Sanctions& (4,&20,&24,&30)& Presence&or&absence&of&community&sanctions&may&impact&the& Moderate:&Consistency&across&some&studies.& prevalence&of&vaw&in&a&given&community& Neighborhood&Characteristics:&& (4,&24,&37,&51,& 58)& A&variety&of&neighborhood&characteristics&(e.g.,&unemployment,&female& literacy;&acceptance&of&violence;&female&autonomy&and&education)&are& associated&with&higher&rates&of&vaw.& Moderate:&Consistency&across&some&studies,&but& more&research&is&required.& Societal%Level& & && && Social&Norms&Supportive&of&Violence& (4,&10,&11,&20,& 37,&58)& Societies&that&favor&traditional&gender&norms&and&are&supportive&of& violence&increase&&risk&for&vaw& Poor:&Alluded&to&in&studies,&but&rarely&tested& empirically.&requires&additional&research& Ideologies&of&Male&Sexual&Entitlement& (4,&10,&11,&20,& 58)& Ideologies&of&male&sexual&entitlement&increase&risk&for&VAW& Poor:&Alluded&to&in&studies,&but&rarely&tested& empirically.&requires&additional&research& Weak&Legal&Sanctions& (4,&20,&58)& Weak&legal&sanctions&increase&risk&for&VAW& Poor:&Alluded&to&in&studies,&but&rarely&tested& empirically.&requires&additional&research& Lack&of&Legislation&on&IPV& (4,&58)& Lack&of&legislation&may&increase&risk&for&VAW& Poor:&Alluded&to&in&studies,&but&rarely&tested& empirically.&requires&additional&research% Protective&Marriage&Law& (4,&58)& Societies&lacking&protective&marriage&laws&increase&risk&for&VAW& Poor:&Alluded&to&in&studies,&but&rarely&tested& empirically.&requires&additional&research% Women&and&Girls Violence&Against&Women:&Risk&Factors&&&Health&Implications&& University&of&Washington&START&Program,&October&2014& & 7&

8 Health%Implications%% Sources% Summary% Strength%of%evidence% Physical% && && && Chronic&pain& (20,&22,&37,&39,& Victims&are&more&likely&to&report&chronic&pain,&headaches,&memory&loss& Strong:%Well&established&with&IPV% 44)& Fibromyalgia& (22)& Victims&are&more&likely&to&report&fibromyalgia& Poor:%Etiology&not&established% Gastrointestinal&disorders& (20,&22,&37,&44)& Victims&are&more&likely&to&have&gastrointestinal&disorders&possibly&linked&to&stress& Strong:%Well&established&with&IPV% Poor&health& (20,&22,&37X39)& Victims&are&more&likely&to&report&poor&or&very&poor&health&& Moderate:&Difficult&outcome&to&measure& Bruises,&welts,&lacerations,&abrasions& (20,&22,&37,&44)& 42%&of&IPV&victims&were&injured&by&partner& Strong:%Well&established% Broken&bones,&injuries&to&ears&and& eyes& (22,&37,&44)& At&least&20%&of&everXinjured&women&reported&injuries&to&eyes&and&ears& Moderate:&Might&not&be&higher&than&other& populations& Limited&mobility,&disability& (20,&22,&37,&38)& Suggests&long&term&effects;&low&reporting&by&region& Moderate:&Established&with&IPV& Death:&suicide,&homicide,&femicide& (22,&39,&40,&44)& Roughly&40%&of&murdered&women&are&killed&by&an&intimate&partner& Moderate:&Missing&strong&data&in&LMICs& Sexual%and%reproductive% & && && STI&&&HIV& (20,&22,&39)& Victims&of&IPV&are&at&1.5X2.0&times&higher&risk&& Strong:&Well&established&with&IPV& Gynecologic&disorders& (20,&22,&39)& Associated&with&sexual&assault&and&IPV& In&the&US&victims&of&IPV&had&3&times&risk&of&gynecologic&problems& UT,&vaginal&bleeding,&infections& Sexual&dysfunction&(decreased&sexual& desire&or&pain&on&intercourse)& (20,&38,&39,&44,& 46)& (20,&22)& Related&to&forced&sex&and&FGM& Primarily&associated&with&violent&sexual&assault.&& Women&with&FGM&are&1.5&times&more&likely&to&experience&sexual&dysfunction& Moderate:%Well&established&with&FGM;&associated& with&violent&assault& Moderate:%Well&established&with&FGM&and&forced&sex&& Moderate:%Well&established&with&FGM,&associated& with&violent&assault& Infertility& (22)& Associated&with&IPV& Poor:%Etiology&not&established& Unintended&pregnancy& (20,&22,&39)& May&occur&through&forced&intercourse&or&difficulty&negotiation&condoms&or&other& contraceptives& Moderate:%Established&with&disempowerment& Low&birth&weight/preXterm&birth& (22,&39)& Babies&of&pregnant&victims&1.4&times&likely&to&be&premature,&1.2&times&likely&to&be& Moderate:&Established&with&IPV& low&birth&weight& Miscarriage,&spontaneous&abortion,& (20,&22,&37)& Abused&women&are&more&likely&to&report&having&had&a&miscarriage& Moderate:&Established&with&IPV& still&birth& Mental% & && && Depression&&&anxiety& (20,&22,&39,&44)& Victims&are&at&2&times&higher&risk&for&depression& Strong:&Well&established&for&most&types&of&VAW&& PTSD& (20,&22,&44)& After&rape;&more&likely&if&injured&during&rape&or&with&history&of&depression&or& Moderate:%Established&with&trauma&& alcohol&abuse& Eating&and&sleep&disorders& (20,&22,&39)& Associated&with&rape&and&sexual&assault& Moderate:%Established&with&trauma& Suicidal&behavior&and&selfXharm& (20,&22,&37,&38,& Victims&were&significantly&more&likely&to&have&thought&about&suicide& Strong:%Well&established&for&IPV&in&several&meta& 44)& analyses& Emotional&distress& (20,&22,&37,&39)& Victims&show&significantly&higher&levels&of&emotional&distress& Strong:&Well&established&for&most&VAW& Behavioral% & && && Alcohol,&smoking&and&substance& abuse& Unsafe&sexual&behavior;&including& less&condom&use& (20,&22,&39,&44)& (20,&22)& Childhood&abuse&is&associated&with&alcohol,&smoking&and&substance&abuse&later&in& life.&&associated&as&both&risk&factors&and&health&outcomes&of&ipv& Childhood&abuse&associated&with&early&sexual&activity,&multiple&sex&partners,&lower& rates&of&contraceptive&and&condom&use.&& Strong:&Well&established&with&most&VAW& Moderate:%Established&with&childhood&abuse,& consistently&in&several&reviews.% Women&and&Girls Violence&Against&Women:&Risk&Factors&&&Health&Implications&& University&of&Washington&START&Program,&October&2014& & 8&

9 Women&and&Girls Violence&Against&Women:&Risk&factors&&&Health&Implications&& University&of&Washington&START&Program,&October&2014& & 9& REFERENCES& 1.& Heise&L,&Ellsberg&M,&Gottmoeller&M.&A&global&overview&of&genderSbased&violence.&Int&J&Gynaecol& Obstet.&2002&Sep;78&Suppl&1:S5S14.&PubMed&PMID:& &Epub&2002/11/14.&eng.& 2.& Devries&KM,&Mak&JY,&GarciaSMoreno&C,&Petzold&M,&Child&JC,&Falder&G,&et&al.&Global&health.&The& global&prevalence&of&intimate&partner&violence&against&women.&science.&2013&jun&28;340(6140):1527s8.& PubMed&PMID:& &Epub&2013/06/22.&eng.& 3.& Abrahams&N,&Devries&K,&Watts&C,&Pallitto&C,&Petzold&M,&Shamu&S,&et&al.&Worldwide&prevalence&of& nonspartner&sexual&violence:&a&systematic&review.&lancet.&2014&may&10;383(9929):1648s54.&pubmed& PMID:& &Epub&2014/02/18.&eng.& 4.& WHO,&London&School&of&Hygiene&and&Tropical&Medicine.&Preventing&intimate&partner&and&sexual& violence&against&women:&world&health&organization;&2010&[updated&2013s08s13&08:42:58;&cited&2014&30& September].&Available&from:& 5.& United&Nations:&General&Assembly.&Declaration&on&the&Elimination&of&Violence&Against&Women& New&York1993&[cited&2014&10&October].&Available&from:& 6.& Abramsky&T,&Watts&CH,&GarciaSMoreno&C,&Devries&K,&Kiss&L,&Ellsberg&M,&et&al.&What&factors&are& associated&with&recent&intimate&partner&violence?&findings&from&the&who&multiscountry&study&on& women's&health&and&domestic&violence.&bmc&public&health.&2011;11:109.&pubmed&pmid:& & PMCID:&Pmc &Epub&2011/02/18.&eng.& 7.& Heise&L.&Violence&Against&Women:&An&Integrated,&Ecological&Framework.&1998&1998S06S01.&en.& 8.& Kishor&S,&Johnson&K.&Profiling&Domestic&Violence;&A&MultiSCountry&Study:&Measure&DHS;&June& 2004.&Available&from:& Documents.cfm.& 9.& Crowell&NA,&Burgess&AW.&Understanding&Violence&Against&Women.&1996&1996.&English.& 10.& Heise&L,&Ellsberg&M,&Gottemoeller&M.&Ending&Violence&Against&Women.&Population&Reports&Series& L:&Issues&in&World&Health.&1999&(11).& 11.& Johnson&H,&Nevala&S,&Ollus&N.&Violence&Against&Women:&&An&International&Perspective:&New&York,& NY&&Springer&Science+Business&Media,&LLC;&2008.& 12.& Stockl&H,&March&L,&Pallitto&C,&GarciaSMoreno&C.&Intimate&partner&violence&among&adolescents&and& young&women:&prevalence&and&associated&factors&in&nine&countries:&a&crossssectional&study.&bmc&public& Health.&2014;14:751.&PubMed&PMID:& &PMCID:&Pmc &Epub&2014/07/26.&eng.& 13.& HoltzworthSMunroe&A,&Smutzler&N,&Bates&L.&A&brief&review&of&the&research&on&husband&violence&S& Part&III:&Sociodemographic&Factors,&Relationship&Factors,&and&Differing&Consequences&of&Husband&and& Wife&Violence.&Aggression&and&Violent&Behavior.&1997&1997;2(3):285S307.& 14.& Harwell&TS,&Spence&MR.&Population&surveillance&for&physical&violence&among&adult&men&and& women,&montana&1998.&am&j&prev&med.&2000&nov;19(4):321s4.&pubmed&pmid:& &epub& 2000/11/07.&eng.& 15.& Romans&S,&Forte&T,&Cohen&MM,&Du&Mont&J,&Hyman&I.&Who&is&most&at&risk&for&intimate&partner& violence?&a&canadian&populationsbased&study.&j&interpers&violence.&2007&dec;22(12):1495s514.&pubmed& PMID:& &Epub&2007/11/13.&eng.& 16.& Vest&JR,&Catlin&TK,&Chen&JJ,&Brownson&RC.&Multistate&analysis&of&factors&associated&with&intimate& partner&violence.&am&j&prev&med.&2002&apr;22(3):156s64.&pubmed&pmid:& &epub&2002/03/19.& eng.& 17.& Ackerson&LK,&Kawachi&I,&Barbeau&EM,&Subramanian&SV.&Effects&of&individual&and&proximate& educational&context&on&intimate&partner&violence:&a&populationsbased&study&of&women&in&india.&am&j&

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