If the term “silent epidemic” has ever meant anything when describing gender-based violence, a new study from the American Journal of Epidemiology suggests that is the only designation to properly describe the current nature of this global problem.
The study, led by Tia Palermo, an assistant professor of Preventative Medicine in the program of Public Health at Stony Brook University, aimed to quantify the magnitude of underreporting of gender-based violence like domestic abuse or sexual assault. Palermo and her two co-authors, Amber Peterman, an assistant research professor of Public Policy at the University of North Carolina at Chapel Hill, and Jennifer Bleck, a PhD student in the Department of Community and Family Health at the University of South Florida, found that, on average, just seven percent of women who experienced violence ever reported to a formal source such as a doctor, the justice system, or a social service provider. In 20 of the 24 countries they analyzed, most women told no one at all.
This study comes on the heels of a report published in the magazine Science earlier this year that found one in three women globally in 2010 experienced violence at the hands of an intimate partner.
Peterman said she was especially struck that the reporting rates were so low even with the recent progress made in research, advocacy and publicity about the prevalence and harmful consequences of gender-based violence. She mentioned the uproar in India one year ago after the brutal sexual assault and murder of a 23-year old New Delhi woman traveling home on a bus as well as more recent cases receiving extensive media attention in Kenya and elsewhere.
“That’s really kind of a powerful look at the hidden nature of this still,” she said, “with all the advocacy, with all the advances that have been made in the last couple of years.”
While experts agree that, for those working in the field, this information is not surprising, the study’s value cannot be overlooked, for it demonstrates through high-quality research how vastly underreported this crime is. The numbers are compelling, and they lay bare not only how many victims continue to suffer in silence and obscurity, but also the inadequacy of many of the systems meant to protect women from such violence.
“It challenges the current investment or the current strategy that has been used globally in terms of focusing on trying to reform formal institutional responses to domestic violence,” said Lori Heise, a senior lecturer at the London School of Hygiene and Tropical Medicine. “While clearly that’s important, I think we are really missing the boat.”
Instead, Heise thinks resources should be recalibrated to also focus on the first responders.
“The first responders are basically friends and family members,” said Heise, an expert on intimate partner violence and a member of the core research team of the World Health Organization’s Multi-Country Study on Women’s Health and Domestic Violence, published in 2005. Palermo’s new study shows that informal reports of this sort dwarfed those that women made to authorities.
“What you see is that if women reach out to anyone for help, that’s where they go. And that is consistent across all of the countries in the world.”It is especially the case in low-income, underdeveloped, or fragile states “where the formal institutions don’t work for anyone,” she said, “much less for abused women.”
To gather their findings, the authors compared data from developing nations that participated in the U.S.-funded Demographic and Health Surveys between 2000-2011. The survey, conducted roughly every five years, asks similar questions worldwide about gender-based violence and whether respondents sought any help. This allowed the researches to reliably compare responses from almost 94,000 women aged 15-49 who experienced gender-based violence in Latin America and the Caribbean, India and East Asia, Central Asia and Eastern Europe, and Africa. They discovered that, depending on the country and region, data from health systems or police reports may underestimate the extent of these sorts of crimes by as much as 11- to 128-fold.
The report is unique, Palermo said, because it is among the few peer-reviewed studies to evaluate reporting and disclosure rates and it covers more countries than previous analyses.The report also attempts to tease out factors among women that might predict whether they disclose violence or not.
The authors found that older women, those who were formerly married and those living in urban areas, tended to report at higher rates than younger, currently or never married, and rural-dwelling women.
Mary Ellsberg, director of the Global Women's Institute and a professor of Global Health at George Washington University, said that the report alludes to what she has found to be the main predictor of disclosure: that it is the severity of violence that most determines whether or not women seek help when they are abused.
“You don’t go to the police until it is a life or death matter, really” she said.“When you think you are literally trying to save your life and the lives of your children.”
That is often because formal sources like the police or medical providers can be unsupportive and insensitive to women who come to them for help, experts say. This may explain the extremely low reporting rates in India, lowest of all the countries compared, where less than one percent of women came forward to report violence to any formal source.
“Women don’t trust the formal sector,” said Ravi Verma, director of the Asia Regional Office in New Delhi of the D.C.-based International Center for Research on Women. “The police system is deeply entrenched into the same notions of patriarchy and gender inequitable perspectives and women don’t feel comfortable that they will be heard or their report will be taken in the right spirit.”
Embarrassment, fear, a belief that disclosure was pointless, and the notion that women must endure violence because it is a normal part of life, were among the reasons the authors found for women’s decision not to report. Dr. Claudia Garcia-Moreno, the lead specialist for Gender Rights and Gender-based Violence in the Department of Reproductive Health and Research at the World Health Organization, said that changing attitudes and norms around this type of violence is essential.
“I think that acceptance of this as a normal thing, which we found in our study both among the men but also the women themselves, that it’s OK for a man to beat his wife if she didn’t do ‘x’ or ‘y’ or she didn’t have the food ready,” she said, referring to the WHO Multi-Country study, “I think that’s a really, really important thing to address.”
Like campaigns to get people to stop smoking or drinking and driving, Moreno said efforts to change violent behaviors against women will require more than one solution. At the WHO, she said they are especially focused on health systems and recently released a set of guidelines for practitioners to better respond to victims of gender-based violence.
Palermo and her co-authors found the highest formal reporting rates in Colombia (26 percent), Bolivia, (nearly 16 percent), and Tanzania (also almost 16 percent). The highest regional average was in Latin America and the Caribbean at just under 14 percent.
While still low, these higher rates of disclosure in Latin American likely stem from the efforts of the women’s movement there to raise awareness among the public and governments that violence against women is a serious problem, said Ellsberg, who lived and worked in Nicaragua for 20 years. This, in turn, has led to more laws and programs to address the issue than in many other parts of the world, although implementation remains weak, she said.
Informal reporting rates to family and friends were highest in the Ukraine, at about 60 percent, and Zambia, at just under 50 percent. Still, globally an average of less than 37 percent of women even reported to these sources.
The authors recommend that next steps should include efforts to end impunity for perpetrators; making gender-based violence, including in intimate relationships, a criminal offense; reducing stigma for victims; and establishing one-stop centers for survivors to receive legal, medical and social services.
Going forward, Peterman said researchers should focus on which interventions prevent violence against women from occurring in the first place.
“We’ve done a good job now at bringing out the prevalence and incidence and a lot of the health and social and economic impacts that violence has had on women and communities and men,” she said. “But we are really kind of at the beginning of the research on understanding which interventions are most promising.”