Understanding gender-based violence perpetration to create a safer future for women and girls
Authors: Michele R Decker, Elizabeth Miller, Samantha Illangasekare, Jay G Silverman
Journal: The Lancet Global Health (2013)

Worldwide, one in three women experience gender-based violence,1WHOGlobal and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization, Geneva2013Google Scholar which imparts physical, mental, and sexual health morbidities. It also causes mortality—more than a third of homicides of women are attributable to male partners.2Stockl H Devries K Rotstein A et al.The global prevalence of intimate partner homicide: a systematic review.Lancet. 2013; (published online June 19.)http://dx.doi.org/10.1016/S0140-6736(13)61030-2PubMed Google Scholar These data justifiably create global outrage, accentuated by horrific recent high-profile cases, including the brutal gang rape of a student in New Delhi, and the attempted assassination of Pakistani student and education activist Malala Yousafzai. However, mounting of an effective, evidence-based, sustainable response to gender-based violence has proven elusive, partly because of the paucity of data for the population that we need to understand the most: the perpetrators of gender-based violence. Most research into such violence focuses on victimisation, which provides invaluable insight into survivors' experiences, risk factors, and needs for support. However, to put a stop to this global pandemic demands a fundamental understanding, and modification, of the behaviour of gender-based violence perpetrators. Population-based data for men's violence perpetration and its root causes are scarce and are mostly limited to Africa.3Jewkes R Sikweyiya Y Morrell R Dunkle K Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study.PLoS One. 2011; 6: e29590Crossref PubMed Scopus (176) Google Scholar, 4Tsai AC Leiter K Heisler M et al.Prevalence and correlates of forced sex perpetration and victimization in Botswana and Swaziland.Am J Public Health. 2011; 101: 1068-1074Crossref PubMed Scopus (49) Google Scholar Analyses of the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific presented in The Lancet Global Health5Fulu E Jewkes R Roselli T et al.Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.Lancet Global Health. 2013; (published online Sept 10.)http://dx.doi.org/10.1016/S2214-109X(13)70074-3Summary Full Text Full Text PDF Scopus (298) Google Scholar, 6Jewkes R Fulu E Roselli T et al.Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.Lancet Global Health. 2013; (published online Sept 10.)http://dx.doi.org/10.1016/S2214-109X(13)70069-XGoogle Scholar represent a major advancement in that they describe the epidemiology of perpetration of the main forms of gender-based violence—intimate partner violence and non-partner rape—in a large and generalisable sample from the world's most populous region. Such violence perpetration, including rape by multiple perpetrators, was prevalent, with 25–80% of the men studied perpetrating physical, sexual, or both types of intimate partner violence, and 3–27% committing single perpetrator non-partner rape. The findings offer much-needed direction for prevention and intervention. Targeting of interventions is essential. More than half of non-partner rape perpetrators first did so as adolescents,6Jewkes R Fulu E Roselli T et al.Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.Lancet Global Health. 2013; (published online Sept 10.)http://dx.doi.org/10.1016/S2214-109X(13)70069-XGoogle Scholar which affirms that young people are a crucial target population for prevention of rape. The finding that gender-based violence perpetration was associated with other key global health issues (eg, substance use and depression)5Fulu E Jewkes R Roselli T et al.Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.Lancet Global Health. 2013; (published online Sept 10.)http://dx.doi.org/10.1016/S2214-109X(13)70074-3Summary Full Text Full Text PDF Scopus (298) Google Scholar, 6Jewkes R Fulu E Roselli T et al.Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.Lancet Global Health. 2013; (published online Sept 10.)http://dx.doi.org/10.1016/S2214-109X(13)70069-XGoogle Scholar suggests the potential usefulness of integrated interventions. Childhood trauma and witnessing of gender-based violence were also influential factors,5Fulu E Jewkes R Roselli T et al.Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.Lancet Global Health. 2013; (published online Sept 10.)http://dx.doi.org/10.1016/S2214-109X(13)70074-3Summary Full Text Full Text PDF Scopus (298) Google Scholar, 6Jewkes R Fulu E Roselli T et al.Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.Lancet Global Health. 2013; (published online Sept 10.)http://dx.doi.org/10.1016/S2214-109X(13)70069-XGoogle Scholar which supports the idea that those exposed to violence during youth should be prioritised for prevention and interventions. Importantly, as reported in other settings,7Jewkes R Nduna M Jama Shai N Dunkle K Prospective study of rape perpetration by young South African men: incidence & risk factors.PLoS One. 2012; 7: e38210Crossref PubMed Scopus (48) Google Scholar, 8Dunkle KL Jewkes RK Nduna M et al.Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa.AIDS. 2006; 20: 2107-2114Crossref PubMed Scopus (240) Google Scholar, 9Decker MR Seage 3rd, GR Hemenway D et al.Intimate partner violence functions as both a risk marker and risk factor for women's HIV infection: findings from Indian husband-wife dyads.J Acquir Immune Defic Syndr. 2009; 51: 593-600Crossref PubMed Scopus (142) Google Scholar perpetration of both intimate partner violence and non-partner rape was linked closely to sexual risk behaviour (eg, having several sexual partners), supporting the suggestion that these behaviours were informed by underlying norms supportive of men's sexual entitlement and dominance in sexual decision-making. As is the case in more generalised HIV epidemic settings, the concurrence of gender-based violence perpetration and sexual risk behaviour hold significant implications for sexually transmitted infections and HIV.8Dunkle KL Jewkes RK Nduna M et al.Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa.AIDS. 2006; 20: 2107-2114Crossref PubMed Scopus (240) Google Scholar Clear value exists in integrated interventions that address both gender-based violence and sexually transmitted infections and HIV. Moving forward, anal rape perpetration is also crucial to this risk constellation in view of the HIV transmission efficiency of anal intercourse, especially when forced, and emerging evidence of its links with gender-based violence.10Madhivanan P Krupp K Reingold A Correlates of intimate partner physical violence among young reproductive age women in Mysore, India.Asia Pac J Public Health. 2011; (published online Dec 20.)https://doi.org/10.1177/1010539511426474Crossref PubMed Scopus (19) Google Scholar Also crucial, and consistent with previous research,3Jewkes R Sikweyiya Y Morrell R Dunkle K Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study.PLoS One. 2011; 6: e29590Crossref PubMed Scopus (176) Google Scholar are the effects of gender-inequitable attitudes and sexual entitlement on gender-based violence perpetration. Sustained reductions in gender-based violence perpetration need transformation of culturally and socially reinforced norms that promote and maintain gender inequities. These norms, which are expressed by individuals and informed by, maintained, and codified at the social or structural level, effectively create a culture in which male perpetration of gender-based violence is tolerated at best and expected at worst. Such individual attitudes and social norms need to be addressed within an evidence-based approach to reduce gender-based violence.11WHOPromoting gender equality to prevent violence against women. World Health Organization, Geneva2009Google Scholar In other low-income and middle-income settings, sexual health interventions targeting gender equity and relationship dynamics led to promising reductions in men's perpetration of,12Jewkes R Nduna M Levin J et al.Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial.BMJ. 2008; 337: a506Crossref PubMed Scopus (542) Google Scholar and women's experiences of, intimate partner violence.13Kim JC Watts CH Hargreaves JR et al.Understanding the impact of a microfinance-based intervention on women's empowerment and the reduction of intimate partner violence in South Africa.Am J Public Health. 2007; 97: 1794-1802Crossref PubMed Scopus (376) Google Scholar Youth-oriented programmes, such as Coaching Boys Into Men, also address gender norms, with promising results including increased equitable attitudes14Miller E, Das M, Tancredi DJ, et al. Evaluation of a gender-based violence prevention program for student athletes in Mumbai, India. J Interpers Viol (in press).Google Scholar and reduced self-reported gender-based violence perpetration.15Miller E Tancredi DJ McCauley HL et al.One-year follow-up of a coach-delivered dating violence prevention program: a cluster randomized controlled trial.Am J Prev Med. 2013; 45: 108-112Summary Full Text Full Text PDF PubMed Scopus (133) Google Scholar This intervention evidence base both shows the mutability of gender-based violence and the attitudes that enable it, and provides a basis for interventions that can be adapted for other geocultural settings. Gender transformative policy and cultural reforms are also crucial to change prevailing norms and customs that devalue women and girls. Implementation and enforcement of non-discriminatory policies and practices that require gender equity in inheritance, property rights, education, and civil liberties, and that otherwise reduce women's social and economic reliance on men, are imperative. The 2010 launch of UN Women indicates a building worldwide momentum to ensure that these goals become reality. Without such reforms, successful and sustained modification of the individual, family, and community norms that enable gender-based violence perpetration is unlikely. With one in three women affected by gender-based violence,1WHOGlobal and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization, Geneva2013Google Scholar support services remain essential and should not be supplanted by prevention of perpetration. Instead, national and international gender-based violence responses should be simultaneously committed to perpetration prevention and accountability, and to survivor support. Moreover, findings of heterogeneity of patterns and predictors of gender-based violence across settings support the need for local tailoring in collaboration with community practitioners and stakeholders. Without effective reduction of male gender-based violence perpetration, women's health, wellbeing, and safety will continue to suffer worldwide. The findings from this multi-country study5Fulu E Jewkes R Roselli T et al.Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.Lancet Global Health. 2013; (published online Sept 10.)http://dx.doi.org/10.1016/S2214-109X(13)70074-3Summary Full Text Full Text PDF Scopus (298) Google Scholar, 6Jewkes R Fulu E Roselli T et al.Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.Lancet Global Health. 2013; (published online Sept 10.)http://dx.doi.org/10.1016/S2214-109X(13)70069-XGoogle Scholar provide local, national, and international policymakers with the evidence base and mandate to create meaningful and sustainable reforms. The challenge now is to turn evidence into action, to create a safer future for the next generation of women and girls. We declare that we have no conflicts of interest. Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the PacificRape perpetration committed by men is quite frequent in the general population in the countries studied, as it is in other countries where similar research has been undertaken, such as South Africa. Prevention of rape is essential, and interventions must focus on childhood and adolescence, and address culturally rooted male gender socialisation and power relations, abuse in childhood, and poverty. Full-Text PDF Open AccessPrevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the PacificPerpetration of IPV by men is highly prevalent in the general population in the sites studied. Prevention of IPV is crucial, and interventions should address gender socialisation and power relations, abuse in childhood, mental health issues, and poverty. Interventions should be tailored to respond to the specific patterns of violence in various contexts. Physical and sexual partner violence might need to be addressed in different ways. Full-Text PDF Open Access