INTERNATIONALBANK FOR WORLD BANK R E T C N O E N STRUCTION PM AND DEVELO January 2005 No. 60 A regular series of notes highlighting recent lessons emerging from the operational and analytical program of the World Bank`s Latin America and Caribbean Region ADDRESSING GENDER-BASED VIOLENCE IN LATIN AMERICA AND THE CARIBBEAN: A CRITICAL REVIEW OF INTERVENTIONS Andrew Morrison, Mary Ellsberg and Sarah Bott Violence against women is a grave social and human rights ling behavior, degrading treatment and threats; (iii) sexual concern affecting virtually all societies. It is often referred to violence, including coerced sex, or being forced into sexual as gender-based violence (GBV) because it is rooted in activities that are considered degrading or humiliating; and women's lack of power in relationships and in society relative (iv) economic violence, such as restricting access to financial to men. GBV has serious consequences for women's health or other resources with the purpose of controlling or subju- and lives, and imposes significant economic costs. gating a person. This new paper by the World Bank and Both men and women can be victims or PATH analyzes the most common forms perpetrators of violence, but the charac- of gender-based violence--intimate part- teristics of violence commonly commit- ner violence and sexual coercion--in ted against women and men differ. Latin America, emphasizing good prac- Women are more likely to be physically tice interventions to prevent violence assaulted or murdered by someone they against women or help its survivors or know, often a family member or intimate perpetrators. The paper summarizes data partner. They are also at much greater on the extent of GBV, and reviews risk risk of being sexually assaulted or ex- factors, health consequences and socio- ploited, in childhood, adolescence or as economic costs. It describes good practice adults. interventions in the justice, health and education sectors, and multi-sectoral in- Prevalence estimates for intimate part- terventions to empower women economi- ner violence vary widely among coun- cally and socially, improve access to ser- tries, and sometimes even between stud- vices for GBV survivors, and transform ies in the same countries. Data from 15 community norms about GBV. It looks at countries in Latin America and the Car- (i) laws and policies; (ii) institutional re- ibbean (LAC) show rates of physical forms; (iii) community-level interven- abuse by a partner ranging up to 69 tions; and (iv) individual behavior change percent of all women, with up to 47% of strategies in each sector. It distills recom- women reporting being victims of mendations for priority actions. sexual assault during their lifetime. In- ternationally, 8-26% of women and girls report having been Scope, magnitude, risk factors and impacts of sexually abused as children or adults. An estimated one of Gender-Based Violence every three women globally is beaten, raped or otherwise abused during her lifetime (Heise, Ellsberg et al. 1999). GBV includes, but is not limited to: (i) physical violence, GBV is a complex phenomenon, shaped by forces operating such as slapping, kicking, hitting, or use of weapons; (ii) at the individual, relationship, community and societal levels. emotional violence, such as systematic humiliation, control- Key risk factors include witnessing or suffering abuse as a 1 child, exposure to violence as a child, male control of Good practice interventions household decision-making and wealth, cultural norms that support violence as a way of resolving conflicts or support male dominance over women, low educational levels of men The results of hundreds of published and unpublished studies and women, and policies and laws that discriminate against and reviews were distilled to draw out the lessons learned on women. Male abuse of alcohol is an important trigger. the interventions that seem to work best in preventing vio- lence against women. While few interventions have been GBV has serious consequences for women's health and well- rigorously evaluated, evaluation evidence is cited where it is being, ranging from fatal outcomes, such as homicide, suicide available. and AIDS-related deaths to non-fatal outcomes such as physical injuries, chronic pain syndrome, gastrointestinal Justice sector disorders, gynecological problems, unwanted pregnancy, miscarriage, low birth-weight of children and sexual dysfunc- The justice sector can help prevent intimate partner violence tion. Sexual abuse in childhood and adolescence is associated and sexual violence in a number of ways: by sanctioning with higher risk of subsequent victimization, early sexual those who perpetrate crimes against women; increasing activity, substance abuse, and multiple sexual partners. Re- awareness throughout society that physical or sexual violence searchers have also documented negative outcomes among against women is considered a crime; strengthening women's children of women who experience violence, including in- rights with regard to marriage, divorce, property and child creased levels of child mortality and emotional and behav- custody; increasing women's access to the legal system; ioral problems. GBV causes significant economic costs from increasing the range of interventions to protect victims; lower worker productivity and incomes, disability, lost years correcting procedural and evidentiary problems in criminal of life, and lower rates of accumulation of human and social prosecutions; and reducing mistreatment of women and chil- capital. And it generates other forms of violence now and in dren by law enforcement institutions themselves. the future. In LAC, efforts to improve laws and policies have focused on: (i) drafting and ratifying international conventions that provide an overarching legal framework to support na- United Nations Definition of Violence against Women tional legislation (notably the Inter-American Convention on the Prevention, Punishment ad Eradication of Violence The term "violence against women" refers to any act of GBV Against Women, known as the Belém do Para conven- that results in, or is likely to result in, physical, sexual or tion), and (ii) enacting new specialized legislation on GBV psychological harm or suffering to women, including threats or reforming national civil and criminal codes. The of such acts, coercion or arbitrary deprivation of liberty, overwhelming lesson from legislative reform is that whether occurring in public or private life. Accordingly, changing the law is only the first step in a long process; violence against women encompasses but is not limited to the much legislation has been implemented poorly or not at following: all. a) Physical, sexual and psychological violence occurring in Several promising initiatives have been undertaken in the the family, including battering, sexual abuse of female chil- region to sensitize and train police, judges and other law dren in the household, dowry-related violence, marital rape, enforcement personnel to improve knowledge, attitudes female genital mutilation and other traditional practices harm- and practices related to GBV. Other important justice ful to women, non-spousal violence and violence related to sector initiatives include: improving services to victims of exploitation; GBV within justice sector reform projects; creating women's police stations; improving the medico-legal re- b) Physical, sexual and psychological violence occurring sponse to GBV; and improving knowledge of women's within the general community, including rape, sexual abuse, right to live free of violence. sexual harassment and intimidation at work, in educational institutions and elsewhere, trafficking in women and forced Health sector prostitution; Many Latin American countries have enacted laws and c) Physical, sexual and psychological violence perpetrated or policies outlining the responsibilities of the health sector in condoned by the State, wherever it occurs. cases of violence against women, but many health profes- sionals are unfamiliar with them. Acts of violence against women also include forced steriliza- tion and forced abortion, coercive/ forced use of contracep- In the last decade, there have been many initiatives to tives, female infanticide and prenatal sex selection. strengthen the health sector's response to GBV. The most common activities carried out include: screening for Beijing Declaration and Platform for Action abuse, risk assessment, providing medical care, document- ing violent events and their health consequences, counsel- 2 ing, referrals to a network of service providers, and commu- · Train all teachers and school staff to detect and prevent nity-focused prevention initiatives. sexual abuse, and involve parents and communities; · Focus on changing boys' norms and behaviors, not on Many NGOs have also launched programs to promote com- teaching girls to defend themselves. Use edutainment munity-wide changes in attitudes and practices related to as a tool and provide opportunities to practice desired gender norms and violence against women--often as a behaviors. component of HIV/AIDS prevention or reproductive health programs. The few that have been carefully evaluated suggest Multi-sectoral approaches that community-level approaches can be effective in chang- ing violence-related attitudes and behaviors. Improving coordination between sector-specific approaches, "Edutainment"--using radio and television to promote civil society initiatives and government institutions is a changes in attitudes and behaviors--has worked well for critical part of an effective strategy for addressing GBV. A other issues and is now being tried for violence prevention. study by PAHO in 10 Central American and Andean countries found that poor coordination across agencies and institutions Many health sector-based programs have attempted to change meant that women had to negotiate through complex and individual behaviors by working with individual men and sometimes contradictory information and requirements when boys. Some programs report a seeking care and support. positive impact on men's self- reported attitudes and behaviors, Most Latin American govern- but most information is still pre- ments have established national liminary or based on evaluations commissions to improve inter- without control groups or sectoral coordination and monitor baseline data. progress in developing national plans and policies on violence. Education sector Although there are no rigorous evaluations, qualitative reports Sexual harassment is widespread suggest that the existence of a in educational settings in many national plan on violence against parts of the world, but data re- women creates commitment and main scarce for the LAC region. political space for dialogue be- Schools--and more broadly the tween civil society and the state. educational system and commu- nities--can help prevent GBV Services for survivors of GBV by: reforming education sector provided through multi-sectoral laws and policies, improving initiatives include telephone schools' institutional response to hotlines, emergency shelters, po- GBV, and mobilizing communi- lice intervention, legal assistance, ties in support of girls' safety and counseling, psychological care, rights. support groups, income-genera- tion programs, programs for Promising policy interventions by batterers, and child welfare ser- Education Ministries include: (i) vices. Support groups (such as preparing a national action plan organized by CEFEMINA in to combat GBV in schools; (ii) Costa Rica and Flora Tristán Cen- developing a code of conduct for ter in Peru) appear effective and teachers that, among other elements, prohibits gender vio- low-cost in reaching large numbers of women. Research has lence in schools; (iii) developing policies on how to deal with documented the impact of comprehensive services in LAC on teacher misconduct, including investigative mechanisms; and the proportion of women who know about services and who (iv) covering violence against women and harassment within seek help, but not yet on whether these services reduce the health and sexual education programs for students. probability of revictimization. There is little regional experience to draw on, but successes in A relatively new approach is to develop community-based other regions suggests these priority actions: networks for coordinating services to victims, improving access to justice and promoting violence prevention. Some · Collect more data on the prevalence of GBV in networks comprise only governmental agencies such as the schools; criminal justice sector, social welfare and education. Others (like the Nicaraguan Network of Women Against Violence) · Develop a strong zero-tolerance policy on sexual vio- coordinate civil society response to violence. A third type lence and harassment in schools; integrates public and private agencies addressing GBV. These 3 networks can greatly enhance the quality of care provided to survivors, and help mobilize public support for survivors and decrease tolerance of violent behavior. Community-based educational activities can increase women's knowledge of legal and social rights and empower them to seek help for abuse. They can also challenge the underlying beliefs that justify women's subordination and the use of violence for settling conflicts. Changing attitudes, however, is easier than changing behaviors. Promoting non- violent and equitable relationships between men and women Policy Research Working Paper 3438 is the key to preventing future violence. Addressing Gender-Based Violence in the Latin Conclusions and recommendations America and the Caribbean Region: A Criticsal Re- view of Interventions The review identifies "guiding principles" (Guedes 2004) for Andrew Morrison work on GBV: Mary Ellsberg Sarah Bott · Ensure that all programs and projects prioritize survi- vors' safety and autonomy; The World Bank Latin America and the Caribbean Region · Employ a human rights perspective that explicitly chal- Poverty Sector Unit lenges prevailing norms that make violence acceptable October 2004 within a society; · Ensure that interventions are culturally appropriate be- fore transferring them from another cultural context. Abstract Morrison, Ellsberg and Bott present an overvew of There are other important conclusions as well. It is essential gender-based violence (GBV) in Latin America, with to focus on preventing GBV, not just on services for its special emphasis on good practice interventions to survivors. Prevention is best achieved by empowering prevent GBV or offer services to its survivors or women and reducing gender disparities, and by changing perpetrators. Intimate partner violence and sexual coer- norms and attitudes that foster violence. Young people appear cion are the most common forms of GBV and these are more open to changing their attitudes about violence, so the types of GBV that they analyze. targeting youth is a good long-run strategy. Interventions should employ a multi-sectoral approach and work at differ- GBV has serious consequences for women's health and ent levels: individual, community, institutional, and national well-being, ranging from fatal outcomes, such as homi- laws and policies. More rigorous evaluations are needed to cide, suicide and AIDS-related deaths, to non-fatal inform decisions, demonstrate the impact of programs, and outcomes, such as physical injuries, chronic pain justify the allocation of more resources to address GBV. syndrome, gastrointestinal disorders, complications during pregnancy, miscarriage, and low birth-weight About the Authors of children. GBV also poses significant costs for the economies of developing countries, including lowered The source document for this piece is a collaborative effort worker productivity and incomes, and lowered rates of between the World Bank and PATH. Andrew Morrison is a acumulation of human and social capital. The authors Senior Economist with the Poverty Group of the Latin America examine good practice approaches in justice, health and the Caribbean Region of the World Bank. Mary Ellsberg is and multisectoral approaches. with PATH and Sarah Bott is a Consultant. PATH (http://www.path.org) is an international, nonprofit orga- Download the full report at nization thsat creates sustainable, culturally relevant solutions, http://www.worldbank.org/lacgender enabling communities worldwide to break longstanding cycles of poor health. About "en breve" The authors would like to thank Lisa Bhansali, Sandra Cesilini, Teresa Genta-Fons, and Andrea Guedes, who offered very Subscribe to "en breve" by sending an email to helpful comments and suggestions. en_breve@worldbank.org 4