# **HEALTH CONSEQUENCES OF GENDER-BASED VIOLENCE**

A growing body of epidemiological evidence documents the consequences of gender-based violence for women’s health and wellbeing, ranging from fatal outcomes, such as homicide, suicide and AIDS-related deaths to non-fatal outcomes such as physical injuries, chronic pain syndromes and gastrointestinal disorders (Heise, Ellsberg, Gottemoeller, 1999). Physical and sexual violence has consequences for women’s mental health, such as post-traumatic stress syndrome, depression, anxiety, and low self-esteem, as well as behavioral outcomes such as alcohol and drug abuse, sexual risk-taking and a higher risk of subsequent victimization.

|**Table 1.1. Health cons**|**equences of intimate partner**|**violence and sexual violen**|**ce by any perpetrator**|
|---|---|---|---|
|**Fatal outcomes**||**Nonfatal outcomes**||
||Physical injuries and chronic<br>conditions|Sexual and reproductive<br>sequelae|Psychological and behavioral<br>outcomes|
|Femicide<br>Suicide|Fractures<br>Abdominal/thoracic injuries|Gynecological disorders<br>Pelvic Inflammatory disease|Depression and anxiety<br>Eating and sleep disorders|
|AIDS-related mortality<br>Maternal mortality|Chronic pain syndromes<br>Fibromyalgia<br>Permanent disability|Sexually-transmitted<br>infections, including HIV<br>Unwanted pregnancy|Drug and alcohol abuse<br>Phobias and panel disorder<br>Poor self-esteem|
||Gastrointestinal disorders<br>Irritable bowel syndrome<br>Lacerations and abrasions|Pregnancy complications<br>Miscarriage / low birth weight<br>Sexual dysfunction|Post-traumatic stress disorder<br>Psychosomatic disorders<br>Self harm|
||Ocular damage|Unsafe abortion|Unsafe sexual behavior|

**Sources:** Adapted from Heise and Garcia Moreno, 2002; and Heise, Ellsberg and Gottemoeller, 1999.

Intimate partner violence and sexual coercion have particularly serious consequences for women’s sexual and reproductive health. Sexual violence may lead to gynecological problems, unwanted pregnancy, chronic pelvic pain, unsafe abortion, and sexual dysfunction. Intimate partner violence has been linked to similar outcomes, as well as complications during pregnancy, miscarriage and low birth-weight (Campbell, 2002). Sexual abuse in childhood and adolescence has been linked to a higher risk of subsequent victimization, early sexual activity, substance abuse, and multiple sexual partners (Felitti et al., 1998; Heise, Ellsberg, and Gottemoeller, 1999; Walker et al., 1999) _._ Some evidence suggests that women who suffer violence are less able to negotiate family planning or condom use (Garcia-Moreno, 2002); consequently, victims of gender-based violence may experience higher rates of unintended pregnancies (Gazmararian et al., 1995) as well as increased vulnerability to sexually-transmitted infections, including HIV/AIDS.

## **_Health consequences for children of women who experience gender-based violence_**

Researchers have also documented negative outcomes among children of women who experience violence. For example, researchers in Nicaragua found that children of women who were physically and sexually abused by their partners were six times more likely than other children to die before the age of five, with one third of all child deaths in this setting being attributed to partner violence (Åsling-Monemi et al., 2003). Some evidence suggests that children who witness violence in the home may be at increased risk for emotional and behavioral problems, such as anxiety, depression and violence towards their peers (Jaffe and Sudermann, 1995); and for perpetrating intimate partner violence and/or sexual violence as adults (Straus, Gelles and Smith, 1990; Kishor and Johnson, 2004).

# **COSTS OF GENDER-BASED VIOLENCE**

Gender-based violence poses significant costs for the economies of developing countries, including lower worker productivity and incomes, lower rates of accumulation of human and social capital, and the generation of other forms of violence both now and in the future. Cost estimates for all the different types 12