Preventing violence against women: An evidence-informed perspective Claudia García-Moreno World Health Organization 57

1. Preventing violence against women: An evidence-informed perspective Claudia García-Moreno World Health Organization 57th Commission on the Status of Women

2. What do we know? • More data than ever before, particularly on intimate partner violence • The causes of partner violence are multiple and intertwined – factors interact at multiple levels to place women at risk of abuse • More knowledge of risk and protective factors and of promising approaches to prevention • Interventions can reduce acceptability & levels of violence over programmatic timeframes • At country level, multiple entry points for intervention

3. Many risk factors for intimate partner violence

4. Intervening at different levels Transforming harmful gender norms: 1. Mass Media 2. Community mobilization 3. Peer and participatory education with men and boys. 4. Gender equitable attitudes in schools Empowering women: 1. Integrated gender, microfinance & HIV training 2. Securing property rights 3. Conditional Cash transfers Socio-economic conditions Individual characteristics and behaviour Choice in partner(s) Cultural & Social Gender Norms Laws & Policies Couples & families Promoting GE laws & policies: 1. Laws against violence 2. Training law enforcement 3. National standards on post-rape care 4. Reducing access to alcohol Communities Countries

5. What works to prevent partner violence? Review evidence of association and promising interventions to address: • Social norms around gender and violence • Women's economic and social empowerment • Childhood exposure to violence • Harmful alcohol use • Legal and justice system interventions

6. 1. Changing Social Norms Evidence of link • acceptability of violence • male authority/dominance over women Promising interventions • Awareness campaigns – e.g. “We Can” , "It's Not Ok" • Small group transformational change efforts, often supplemented with community-based activities – eg Stepping Stones; Programme H; IMAGE programme • Social norms marketing and “edutainment programmes” e.g. Soul City, Sexto Sentido; Breakthrough’s “Bell Bijao” Campaign • Population level social change programming e.g. SASA!

7. Examples of prevention interventions • Community focused • Soul City • SASA! Uganda • Both sexes: • Stepping Stones, S. Africa • Sexto sentido, Nicaragua • Men • Program H (Brazil) • Yari Dhoshi (India) • We Can • Women • IMAGE • SisterAct • Program M

8. 2.Women’s social & economic empowerment Evidence of link • Secondary education protective • Employment, ownership or cash or assets may decrease risk • Some effects context specific, depending on factors related to partner and/or broader social norms Promising interventions • Evidence that combined livelihood & empowerment programmes achieve impact (e.g. IMAGE, South Africa) • Some evidence that economic empowerment interventions reduce violence, although context specific • Evaluation of impact of cash transfer programmes on partner violence are just beginning

9. In South Africa combined micro-credit & gender training intervention (IMAGE) cut levels of intimate partner violence by a half over 2 years Among participants: • Past year experience of IPV reduced by 55% • Households less poor • Improved HIV communication Among younger women: • 64% higher uptake HIV testing • 25% less unprotected sex Pronyk et al. The Lancet Dec. 2006, Pronyk et al AIDS 2008

10. 3. Childhood exposure to violence Evidence of link • Strong evidence that child abuse (physical and/or sexual) and witnessing marital violence increase risk of perpetration • Poor parenting and gender socialization help reproduce negative child outcomes (including partner violence) across generations Promising interventions • Parenting programmes shown to reduce negative child outcomes, including precursors to partner violence, in randomized studies • Current programmes target harsh parenting, child maltreatment and exposure to parental violence (home visitation)

11. 4. Harmful use of alcohol Evidence of link • Not sufficient or necessary, but where present it increases frequency and severity Promising interventions • Early identification and brief counselling by health workers has been shown to reduce harmful drinking • Reduce alcohol availability • Recent studies from the US and Australia have found clear link between outlet density and domestic violence • Meta-analysis of 122 studies confirms that increasing alcohol taxes decreases harmful drinking • Community based interventions • Alcohol misuse treatment has been shown to reduce frequency and severity of partner violence

12. 5. Legal and justice system interventions • Women’s police stations • Mixed evidence • Informal justice and rights-based initiatives • Novel strategies being applied in southern countries: mobile courts; working with village dispute resolution systems need to be evaluated • Protection Orders • Research from the United States suggests that protective orders do reduce repeat violence for some victims some of the time; no studies have evaluated protective orders in southern countries • Pro-arrest policies • Arrest may have a modest effect on recidivism for some men, especially first-time domestic violence offenders with no other history of criminal conduct • No evidence outside of high-income countries

13. Recommendations • We need: • national strategies that are tailored around a local understanding of the problem • to implement what works and theoretically-informed best practice, using all entry points possible (building on strategic opportunities of all agencies to achieve impact) • to escalate intervention research • to develop services for victims in tandem with rolling out prevention interventions • to ensure coordination across strategies for maximum impact • High level political support globally, nationally and within communities is essential

14. Violence against women is preventable. Let's do it together!!

15. Sources and acknowledgements • WHO/LSHTM, 2010 Preventing intimate partner and sexual violence against women. Geneva: WHO http://www.who.int/reproductivehealth/publications/violence/en/index.html • Heise L, 2012 What works to prevent partner violence http://strive.lshtm.ac.uk/resources/what-works-prevent-partner-violence-evidence-overview Acknowledgements Lori Heise and Charlotte Watts, Centre for Gender Violence and Health, LSHTM