2000). They used mass media, lobbying efforts, and social mobilization to pressure Ministers of Justice and Safety, members of those departments, the Task Team in charge of implementing the legislation, the police, and the judiciary. Based largely on key informant interviews, Usdin et al. (2000) concluded that the campaign contributed to more timely and effective implementation of the act.

## **Individual behavior change strategies**

## **_Campaigns to increase public awareness of and support for women’s legal rights_**

An essential component of effective legislative reform is to raise awareness of and build support for new laws among the general population. Increasing access to justice requires that women know their rights and feel that they can exercise them. Thus, many NGOs have launched media and legal literacy campaigns to raise awareness of new legislation and encourage women to exercise their rights. Wellevaluated initiatives include Soul City (South Africa) and the Nicaraguan Network of Women against Violence. Both have demonstrated an impact on knowledge of and attitudes towards women’s rights through large population-based surveys, including raising awareness that violence against women is a crime, and knowledge of specific legislation (Scheepers, 2001; Scheepers and Christophides, 2001; Muirhead, Kumaranayake, and Watts, 2001; Ellsberg, Liljestrand and Winkvist, 1997; Velzeboer et al., 2003).

# **HEALTH**

## **Background**

Historically, the health sector was slow to recognize the public health implications of violence against women. Even today, many medical and nursing schools do not adequately prepare professionals to recognize or respond to the health consequences of domestic violence, rape or sexual abuse; providers often view violence against women as a social problem and hesitate to discuss physical or sexual violence with patients; and many organizations do not equip personnel to respond appropriately to girls and women who disclose violence (Heise, Ellsberg and Gottemoeller, 1999). Mensch, Bruce and Greene (1998) argue that most reproductive health initiatives for young people have assumed that sexual activity is voluntary and therefore have aimed to help young people “make better and more responsible decisions.” This approach ignores evidence that large numbers of girls and young women experience forced sex and/or cannot negotiate sex, condom use or other contraceptives without fear of physical violence (Jejeebhoy and Bott, 2003).

Overlooking the health implications of gender-based violence is not just a missed opportunity. Women sometimes disclose intimate partner violence, rape or sexual abuse to heath care providers, and providers who respond by blaming the victim may inflict severe emotional trauma. Providers who view violence as a social rather than a health issue may fail to provide holistic care, to recognize women in danger, or to provide necessary, even life-saving care, such as STI prophylaxis. Moreover, health systems that do not protect patient confidentiality may put women at risk of additional violence from partners or other family members. Growing evidence suggests that public health policies, institutions and programs must pay more attention to gender-based violence not only as a public health problem in and of itself, but also as a key component of the HIV/AIDS pandemic.

## **Overview of health sector initiatives**

In recent years, the health sector has launched many gender-based violence initiatives (see Table 2.2). Countless health care organizations have begun to improve the quality of care they provide to survivors of gender-based violence. Public health programs have a long history of working to change sexual attitudes, norms and behaviors, and they have begun to apply those strategies to violence prevention. Despite the 25