Gender differences in health and illness sue of growing concern. Given that women universally occupy a lower socioeconomic status, poor women, es- pecially those in female-headed households, are most adversely affected by economic adjustment policies. Health-sector reforms have sought to strengthen pri- vate financing, to decentralize services, and to improve service-delivery through private sources. A central question is whether, in the interests of cost cutting and efficiency, costs will be transferred from the remunera- ted economy to the unremunerated economy, where women predominate. In this section, we use the example of violence against women to demonstrate the impact of gender on the economic consequences of illness. The section does not separate the discussion clearly into develop- ing and industrialized countries (although examples of both are cited) because domestic violence is a universal phenomenon found in all cultures and at every level of society, and the effects are similar, although they may vary in intensity and severity. Partner violence is main- ly aggression by men against women and children, al- though men are also victims of domestic violence. In the United States, it is estimated that males constitute only 10-15% of victims (84). Relatively little information is available on the cumulative economic impact of domestic violence but there is growing evidence that it adversely affects women and children’s mental health and opportuni- ties for a productive life. Among low-income groups, poverty may exacerbate marital disagreements, and it may be more difficult for poor women to leave vio- lent situations because they have less access to outside help or accommodation (1). It is well-known that vio- lent partners frequently obstruct efforts of women to seek help for themselves and their children, and poor women have little economic power in such situations. The impact of domestic violence is magnified in areas with fewer material resources (85). There may also be substantial under-reporting among the higher socioeco- nomic groups. Victims of domestic violence have more difficul- ty keeping a job because they often miss work due to physical injury. Many female victims of physical or sexual violence are unable to work because of their in- juries, or are stalked or harassed at work. The fear and discomfort entailed affects their ability to perform, and they may also be forced to leave their job when the situ- ation becomes unbearable. Women who resist a harass- ing male colleague or superior may be dismissed (86). Children who witness domestic violence exhibit many of the same emotional and behavioural prob- 55 lems as children who have been sexually or physically abused, including poor school performance and somat- ic health complaints. Those who have been abused are more likely to be abusive as adults. The cycle of pover- ty, gender violence, poor health, and limited economic opportunities is perpetrated throughout the generations (87). In developing countries, women who are totally de- pendent for economic livelihood upon their husbands are particularly affected when they suffer domestic abuse. In a study in Mexico, women at risk of abuse and who lived with their own parents or in an extended family were much more likely to be protected from it than those who lived in a nuclear family situation (88). Those who were unable, for economic reasons, to leave their husbands were the worst-off and least able to es- cape the situation. Finkler explains that poor Mexican men also suffered a different kind of abuse: being looked down upon in society, their dignity is challenged, and they may try to compensate for their frustration through mistreating those who cannot retaliate. In India, dowry-related violence, sometimes lead- ing to deaths by murder or suicide, is increasingly be- ing documented. Dowry, a Hindu tradition, was origi- nally a way for parents to share their inheritance with their daughters who were not allowed to inherit prop- erty. As Fischbach and Herbert observe, this practice has become a ‘crucial marital transaction’ and a way to ‘get rich quick’ (85). Bridal abuse is a way of put- ting pressure on her family to give them more of their assets, and when a wife is unable to provide them, she may resort to suicide or be killed. Women rarely seek medical help, mainly because of shame. A study in Bangladesh found, for example, that 66% of women were silent about their experience, mainly because of culturally-endorsed acceptance of violence or fear of stigma and greater harm (89). In Uganda as well, lack of economic autonomy was an important reason that women stayed in abusive relationships, “…many of the women experienced poverty so severe that they had lit- erally no option but to remain with husbands who rou- tinely battered them. Their worth and social acceptance was found in marriage and children, making separation or divorce almost impossible” (90). Another pervasive form of violence against women is rape. This is considered to be among the most under- reported health problems in the world (85), a crime that can have serious psychological, social and economic consequences. In several parts of the world, women who have been raped may be seen as having brought dishonour on their families. In some countries, rape