In 2002, the = World Health=20 Organization (WHO) released the World Report on Violence and = Health.=20 This report, the first of its kind, uses a public health approach to = examine=20 global youth violence, child abuse and neglect, violence by intimate = partners,=20 abuse of the elderly, sexual violence, self-directed violence, and = collective=20 violence. It draws from the information, findings, and insight of over = 160=20 experts from approximately 70 countries and from published literature on = violence. The Report views violence through an ecological lens and = discusses=20 biological, social, cultural, economic, and political factors that = influence its=20 occurrence and prevalence.
Developed from = the=20 World Report on Violence and Health, this booklet offers a = synopsis of=20 the Report=92s findings related to global sexual violence. The intent of = this=20 booklet is to promote a better understanding of global sexual violence, = spark=20 new research, and encourage collaborative efforts to prevent sexual=20 violence.
(Krug, et al., 2002) =
Sexual violence = affects=20 millions of people worldwide and represents a serious global public = health=20 problem. Risk factors, rooted in social injustices and inequities = transcend=20 geographical boundaries and individual differences. The costs of sexual = violence=20 are devastating and jeopardize the health of individuals and entire = societies.=20
The National = Sexual=20 Violence Resource Center (NSVRC) recognizes that despite its prevalence = and=20 costs, sexual violence is not inevitable. A major goal of this booklet = is to=20 underscore the opportunity for those working to end sexual violence from = around=20 the world to partner and work together to identify and address its root = causes.=20 Today, a global perspective grows increasingly relevant for advocates = and policy=20 makers the world-over. War adds to the urgency. It not only ravages our = world,=20 people, and economies; war increases the risk of sexual violence. The = needs and=20 experiences of refugees and those that are trafficked illustrate the = importance=20 of building relationships and resources within a global community = context.=20
Advocacy = efforts have grown=20 out of a fundamental understanding of sexual violence as a human rights, = crime=20 victims=92 rights, and social justice issue. Anti-sexual violence = advocates have=20 historically worked to change the social conditions that perpetuate = violence.=20 Building networks has been a crucial part of that work. We have much to = give and=20 gain by examining international public health efforts that aim to end = sexual=20 violence through social change
Definitions of = sexual=20 violence may be influenced by cultural values, social norms, human = rights,=20 gender roles, legal initiatives and crime and may evolve over time. = While=20 defining sexual violence advances our global efforts to identify and = eliminate=20 sexual violence, it must be recognized that all definitions are arrived = at=20 through cultural, socio-political, and geographic lenses. The Report = attempts to=20 build connections between communities and propel our solutions forward = by=20 offering the following definition of sexual violence:
Additionally, = WHO=20 emphasizes that a person who commits sexual violence uses coercion, = which can=20 include =93physical force=85psychological intimidation, blackmail or = other=20 threats=96for instance, the threat of physical harm, of being dismissed = from a job=20 or of not obtaining a job that is sought. It may also occur when the = person=20 aggressed is unable to give consent=96for instance, while drunk, = drugged, asleep=20 or mentally incapable of understanding the situation=94 (Jewkes, = Sen, and=20 Garcia-Moreno, p. 149, 2002).
The Report = presents the=20 following forms of sexual violence (Jewkes, Sen, and Garcia-Moreno, = p. 149,=20 2002):
It asserts that = sexual=20 violence is used as a tool to punish and subjugate individuals for = perceived=20 transgressions of social or moral codes, noting its =93underlying = purpose is=20 frequently the expression of power and dominance over the person = assaulted=94=20 (Jewkes, Sen, and Garcia-Moreno, p. 149, 2002).
According to = the World=20 Health Organization =93the true extent of sexual violence is unknown=94 = (Jewkes,=20 Sen, and Garcia-Moreno, 2002). In part, this is due to the = significant=20 variations in research definitions and methods. There are also = significant gaps=20 in research that keep sexual violence invisible and off of = policymakers=92 agendas=20 (Krug, p. 172, 2002).
Regardless of = these=20 inconsistencies, the Report confirms what many advocates have known: = sexual=20 violence terrorizes women, men, girls, and boys across the globe. The = following=20 examples help illustrate the global prevalence of sexual violence: =
Sexual violence = does not=20 occur in isolation. Risk factors, deeply rooted in social injustices and = inequities, connect sexual violence to other forms of violence across = the globe.=20 Risk factors transcend boundaries and occur in individual, social, = cultural, and=20 economic contexts.
When viewing = sexual=20 violence through a public health lens, both reducing risk factors and = increasing=20 protective factors become paramount. Some of the individual risk factors = found=20 to increase men=92s risk of committing rape include using alcohol and = drugs,=20 lacking inhibitions to suppress associations between sex and aggression, = holding=20 attitudes and beliefs that are supportive of sexual violence and hostile = towards=20 women, associating with sexually aggressive peers, and having = experienced sexual=20 abuse as a child.
Societal risk = factors that=20 contribute to the occurrence of sexual violence and place certain groups = at=20 greater risk include gender-based inequality, magnification of male = honor and=20 entitlement, war, and absent or weak sanctions and human services. =
Gender-based=20
Inequality
Sexual violence is more likely to occur in =
societies=20
with rigid and traditional gender roles: =93in societies where the =
ideology of=20
male superiority is strong=97 emphasizing dominance, physical strength =
and male=20
honor=97rape is more common=94 (Jewkes, Sen, and Garcia-Moreno, p. =
162,=20
2002). In some countries, the concept of gender equality disrupts a =
deep-seated system of inequality, creating social unrest in the =
short-term but=20
empowerment and greater equality for women in the long-term.
Male =
Entitlement=20
Men are more likely to commit sexual violence in =
communities where=20
concepts of male honor and entitlement are culturally accepted and where =
sexual=20
violence goes unpunished. In many countries, the integrity of male honor =
hinges=20
on female sexual purity. The rape of a woman taints the honor of her =
husband=20
and/or family and she will likely face punishment as a way to restore =
the=20
family=92s honor. Punishment may include her marriage to the rapist, =
banishment=20
and/or varying degrees of violence against her, including her murder, or =
=93honor=20
killing.=94 Social ideology entrenched in male entitlement may deny =
women a=20
fundamental right to refuse sex and fail to recognize marital rape as a =
problem.=20
Absent =
or Weak=20
Sanctions and Services
Community tolerance of sexual =
violence is=20
evidenced by the unresponsiveness of systems and services. Sexual =
violence that=20
occurs in certain settings or forms is not recognized as =93sexual =
violence=94 by=20
law in many countries. Evidence provided by victims is often not =
considered to=20
be sufficient for a conviction. Victims do not come forward in many =
places out=20
of fear of being punished by the criminal justice system. =93In some =
places, rape=20
can even occur in public, with passers-by refusing to intervene=94 =
(Jewkes,=20
Sen, and Garcia-Moreno,
p. 161, = 2002).=20 Weak or absent social sanctions and services contribute to and = exacerbate sexual=20 violence. Unresponsive systems fail to hold perpetrators accountable and = fall=20 short of victims=92 needs.
Poverty =
Violence impacts certain groups disproportionately. Poverty =
increases people=92s vulnerabilities to sexual exploitation in the =
workplace,=20
schools, and in prostitution, sex trafficking, and the drug trade. =
People with=20
the lowest socioeconomic status are at greater risk for violence. =
Individuals=20
who lack sufficient economic resources to meet their basic needs, =
specifically=20
women, may have to resort to bartering for essential goods with =
sex.
War=20
The rape and torture of men, women, and children as =
military=20
tactics have been widely documented. Rape has been used as a weapon of =
war and=20
conflict. =93Rape is often used to terrorize and undermine communities, =
to force=20
people to flee, and to break up community structures. Physical and =
psychological=20
effects on victims are far-reaching=94 (Zwi, Garfield, and Loretti, =
p. 218,=20
2002). Refugees who flee conflict and persecution are at extreme =
risk for=20
sexual violence in their new settings, including refugee camps. War =
often=20
depletes economic and social resources and pushes many people into =
prostitution.=20
A public health = approach to=20 ending sexual violence requires a collaborative, multi-disciplinary,=20 multi-level, and holistic strategy. The Report discusses many promising=20 approaches to ending sexual violence, including but not limited to the = efforts=20 described below.
The =
Philippines=20
Task Force
Comprised of doctors, nurses, social scientists, =
and=20
supported by the Department of Health, the Task Force on Social Science =
and=20
Reproductive Health in the Philippines has developed training on gender =
violence=20
for nursing and medical students (Jewkes, Sen, and Garcia-Moreno, p. =
167,=20
2002). This training has become a standard component of nursing and =
medical=20
school curricula. Training modules are designed to increase students=92=20
understanding of the root causes of violence in cultural and gendered =
contexts,=20
help them identify patients and families at risk for violence and to =
prepare=20
them to provide primary and secondary interventions in collaboration =
with other=20
professionals.
Sexual =
Assault=20
Nurse Examiners (SANE)
Located in hospitals or police =
stations,=20
SANE programs provide victims of sexual violence with a wide range of =
services=20
through a collaborative approach that includes rape crisis centers, law=20
enforcement, district attorneys, and medical professionals (Jewkes, =
Sen, and=20
Garcia-Moreno, p. 167, 2002). Sexual Assault Nurse Examiners (SANE) =
provide=20
specialized and comprehensive health care services to victims of sexual=20
violence. SANE programs operate in a number of countries, including =
Canada, the=20
United States, and Malaysia.
Stepping Stones=20
Originally developed in Africa and now used by many parts =
of the=20
developing world, Stepping Stones links HIV/AIDS prevention with sexual =
violence=20
prevention (Jewkes, Sen, and Garcia-Moreno, p. 165, 2002). This =
program=20
is designed for female and male peer groups. A review of Stepping Stones =
in=20
Africa and Asia showed the program=92s success in helping men take =
responsibility=20
for their actions, communicate more effectively, and develop greater =
respect for=20
women. Reductions in rates of violence against women have been reported =
in=20
Cambodia, the Gambia, South Africa, Uganda and the United Republic of =
Tanzania=20
as a result of this program.
Institute for=20
Health and Human Development
South Africa=92s Institute for =
Health=20
and Human Development (IHDC) uses the mass media to promote health and =
prevent=20
violence (Jewkes, Sen, and Garcia- Moreno, p. 168, 2002). =
Prime-time=20
television and radio dramas discuss social and health issues including=20
interpersonal violence, bullying, gang violence, domestic violence, =
rape, and=20
sexual harassment in ways that engage viewers of all ages on emotional =
levels.=20
Of note is a popular children=92s program, Soul Buddyz, that reaches two =
thirds of=20
South African children. In addition to TV and radio, IHDC produces and=20
disseminates booklets that provide more extensive information on various =
topics.=20
IHDC also administers a hotline, through which crisis counseling and =
referral=20
services are provided.
Inter-American=20
Coalition for the Prevention of Violence
The Inter-American =
Development Bank, Organization of American States, Pan American Health=20
Organization, United National Educational, Scientific and Cultural =
Organization,=20
United States Centers for Disease Control and Prevention, and the World =
Bank=20
joined forces to form the Inter-American Coalition for the Prevention of =
Violence to respond to the problem
of violence = (Krug, et=20 al., p. 252, 2002). The coalition supports the public awareness = efforts,=20 research, policy, training, media outreach, collaborative, and = preventive=20 efforts of organizations on a national scale by helping to mobilize = resources=20 and partners at local levels.
Developmental=20
Approaches
There are a number of developmental approaches =
to health=20
promotion and violence prevention. One model that targets children at =
every=20
stage of their development is the Schwartz model (Jewkes, Sen, and=20
Garcia-Moreno, p. 166, 2002). With this tool, health providers =
explore=20
parenting, gender stereotypes, stress, conflict, and violence issues =
with=20
expecting parents. Health providers explore the following issues along=20
children=92s developmental continuum: child sexual abuse, violence in =
the media;=20
=93good and bad=94 touch, sexual aggression; rape myths and facts, =
boundaries and=20
the link between sex, violence, and coercion.
Men as =
Activists=20
Men=92s collective involvement in sexual violence =
prevention is=20
growing, with over 100 groups in the United States alone (Jewkes, =
Sen, and=20
Garcia-Moreno, p. 169, 2002). At the core of the male activist =
movement is=20
the need for men to take responsibility for reducing violence. To that =
end, such=20
groups often work with women=92s groups to raise public awareness about =
violence,=20
promote violence alternatives, explore the meaning of masculinity, and =
provide=20
educational programs in community settings.
Legal =
and Policy=20
Responses
Legal and policy efforts have improved the health =
and=20
quality of life of people throughout the world. In Asia, a broadening of =
legal=20
definitions of rape coupled with mandated state assistance to victims =
has=20
resulted in more victims reporting and coming forward (Jewkes,=20
Sen, and = Garcia-Moreno,=20 p. 170, 2002). Rule 96 of the International Criminal Tribunal for = the=20 former Yugoslavia lends itself as a model for reform elsewhere = (Jewkes, Sen,=20 and Garcia-Moreno, p. 170, 2002). Rule 96 removes the corroboration = requirement in victims' testimony and prohibits prior sexual history of = victims=20 from being admitted as evidence. Policy changes have made a difference = in=20 victims=92 lives and the systems they encounter.
International=20
Rescue Committee
The International Rescue Committee (IRC) =
employs a=20
collaborative model to prevent and address sexualand gender-based =
violence=20
against refugees (Jewkes, Sen, and Garcia-Moreno, p. 171, =
2002).=20
Community workers connect victims to services. Community attorneys =
prosecute=20
perpetrators. IRC has helped refugee populations in Bosnia and =
Herzegovina, the=20
Democratic Republic of the Congo, East Timor, Kenya, Sierra Leone and =
the former=20
Yugoslav Republic of Macedonia.
Child =
Abuse Public=20
Awareness Campaign in Kenya
Coalition members from =
governmental,=20
nongovernmental, and community-based backgrounds came together in 1996 =
to=20
respond to a study that showed a high prevalence of child abuse and =
neglect in=20
Kenya (Runyan, et al., p. 77, 2002). The response was =
three-tiered and=20
included training, advocacy, and child protection efforts. Through =
drama, music,=20
and essay competitions, children shaped the coalition=92s efforts. =
Success is=20
illustrated in a strengthened reporting and management of child abuse =
cases,=20
creation of a legal network for abused children, organization and =
provision of=20
national and regional conferences, and heightened public awareness about =
child=20
abuse and neglect.
Much can and = has been done=20 to address sexual violence, but =93the world has not yet fully measured = the size=20 of the task and does not yet have all the tools to carry it out=94 = (Krug=20 et al., p. 254, 2002). While the report findings reveal gaps in = sexual=20 violence research, prevention, and intervention across the world, there = are=20 clear steps that advocates, researchers, and policy-makers can take to = help=20 light the way forward.
In September = 2004, WHO=20 released Preventing Violence: a Guide to Implementing the = Recommendations of=20 the World Report on Violence and Health to provide step-bystep = conceptual,=20 policy and practical suggestions on how to implement these = recommendations=20 (WHO, 2004). WHO offers a series of concrete recommendations = for=20 multi-level social change that include:
Sexual violence = is a human=20 rights and public health concern that transcends boundaries and incurs a = devastating global human cost. Gender inequalities, male entitlement, = absent=20 and/or weak social sanctions and services, poverty, and war put certain=20 populations at greater risk for sexual violence. Sexual violence = terrorizes=20 individuals throughout the world and undermines communities and systems. = Change=20 is possible through a commitment to the protection of human rights and a = national sexual violence prevention strategy.
The WHO Report = shows that=20 sexual violence is preventable and social change is possible. However, = lasting=20 social change requires the commitment and collaboration of advocates,=20 policy-makers, researchers, medical personnel, educators, police = officers,=20 prosecutors, and other professionals across the globe. Sexual violence=20 prevention requires rigorous advances in research, including the = development and=20 implementation of consistent definitions and methods and the sharing of=20 analyses. Through the commitment of members of society at every level, = new=20 programs and policies can emerge to significantly eliminate sexual=20 violence.
Current =
WHO=20
Initiatives
Following the Report=92s release, WHO launched =
the Global=20
Campaign for Violence Prevention to raise awareness about the problem of =
violence and the value of a public health approach and to encourage =
global=20
action at every level of society. For more information on the campaign, =
visit:=20
For a detailed =
description=20
of how to implement recommendations that were referenced on page 14, =
visit:
Krug, EG et = al., eds.=20 World Report on Violence and Health. Geneva, = World=20 Health Organization, 2002.
Krug, EG et =
al.,=20
The Way Forward: Recommendations for Action. =
In: Krug=20
E., Dahlberg, L., Mercy, J.A., Zwi, A.B., Lozano, R. World Report of =
Violence=20
and Health. Geneva, Switzerland: The World Health Organization. 2002: =
241-254.=20
(Available on the Internet:
Jewkes, R., Sen =
P.,=20
Garcia-Moreno, C. Sexual Violence. In: Krug =
E.,=20
Dahlberg, L., Mercy, J.A., Zwi, A.B., Lozano, R. World Report of =
Violence and=20
Health. Geneva, Switzerland: The World Health Organization. 2002: =
147-181.=20
(Available on the Internet:
Runyan, D. et =
al.=20
Child Abuse and Neglect by Parents and Other=20
Caregivers. In: Krug E., Dahlberg, L., Mercy, J.A., Zwi, =
A.B.,=20
Lozano, R. World Report of Violence and Health. Geneva, Switzerland: The =
World=20
Health Organization. 2002: 147-181. (Available on the Internet:
Zwi, AB, =
Garfield, R.=20
Loretti, A. Collective Violence. In: Krug E.,=20
Dahlberg, L., Mercy, J.A., Zwi, A.B., Lozano, R. World Report of =
Violence and=20
Health. Geneva, Switzerland: The World Health Organization. 2002: =
213-239.=20
(Available on the Internet:
Buchart, A., =
Phinney, A.,=20
Check P., Villaveces A. Preventing violence: a guide to =
implementing=20
the recommendations of the world report on violence and =
health.=20
Department of Injuries and Violence Prevention, world Health =
Organization,=20
Geneva, 2004. (Available on the internet:
The full World =
Report on=20
Violence and Health is available at the World Health Organization=92s =
web site: