NEW YORK — Gender violence, manifested essentially as violence against women — although it is generally unrecognized and underreported — is one of the most significant epidemics in the world today. That violence against women is considered normal behavior in many countries does not diminish its seriousness or its negative impact on the physical and mental health of women worldwide. Its persistence in many countries amid other obvious social measures of progress indicates the need to confront it with urgent and effective policies.

Domestic violence, violence that occurs in the home or within the family, is perhaps the most common kind of gender violence and affects women regardless of age, education or socioeconomic status. Although it is widespread, there are few precise figures of the extent of this phenomenon.

In every country where reliable studies have been conducted, statistics show that between 10 and 50 percent of the women studied report that they had been physically abused by an intimate partner during their lifetime.

According to a study carried out in the United States, violence against women is responsible for a large percentage of medical visits and for approximately one-third of emergency-room visits. Another study found that U.S. domestic violence is the most frequent cause of injury to women treated in emergency rooms — more common than motor vehicle accidents and robberies combined.

This situation has led public health experts to consider violence against women as a global public health issue, one that requires a public health approach in the policies aimed at its elimination.

Worldwide, violence against women is as frequent a cause of death and disability among women of reproductive age as cancer, and a greater cause of ill health than traffic accidents and malaria together. In the U.S., 25 percent of female psychiatric patients who attempt suicide are victims of domestic violence, as are 85 percent of women in substance abuse programs. Studies in Pakistan, Australia and the U.S. show that women victims of domestic violence suffer more depression, anxiety and phobias than women who have not been abused.

Various factors (cultural, economic and social, as well as shame and fear of retaliation) contribute to women’s reluctance to report these acts. Moreover, the legal and criminal system make this process difficult or complicated. Frequently, fear keeps women trapped in abusive relationships. It has been found that almost 80 percent of all serious injuries and deaths among women victims of violence occur when they try to leave a relationship, or after they have left.

The belief that men have a right to abuse women tends to perpetuate violent situations. In that sense, domestic violence exemplifies perverse power relationships in which violence is used by one person to control another. When these kind of relationships become established, people become conditioned to accept violence as a legitimate means of settling conflicts, both within the family and in society at large, thus perpetuating a vicious cycle. Violence begets violence, and often does irreparable damage to the family and to the social structure.

Although physical and sexual violence are easier to see, other forms of violence include emotional abuse, such as verbal humiliation, threats of physical aggression or abandonment, economic blackmail and forced confinement to the home. For many women, psychological abuse and humiliation are even more devastating than physical violence.

Sexual violence has harmful effects on women’s health and well-being. Sexual violence increases women’s risk of contracting sexually transmitted diseases, including AIDS, through forced sexual relations or because of the difficulty in persuading men to use condoms. In addition, sexual violence increases the number of unplanned pregnancies and may lead to various gynecological problems such as chronic pelvic pain and painful intercourse.

A large proportion of women are beaten while they are pregnant. Comparative studies of battered and nonbattered pregnant women revealed that the former have twice the risk of miscarriage and four times the risk of having low-birth-weight babies. In India, a study of maternal deaths carried out in 400 village and seven hospitals showed that 16 percent of all deaths during pregnancy were due to domestic violence.

Some communities around the world are developing innovative strategies to deal with domestic violence. In India and Bangladesh, salishe — a traditional system of local justice — is used to address this problem. When a woman is beaten, the West Bengali nongovernment organization Shramajibee Mahila Samity sends a female organizer to the village to discuss the situation with the individuals and families involved and helps find a solution, which is then formalized in writing by a local committee.

Increasingly the health sector is being urged to consider domestic violence as a serious health problem and to research the causes, consequences and ways to prevent it. Alhough doctors and health personnel can greatly help the victims, in many cases they are not trained to diagnose abuse accurately. Such a multi-causal problem demands a multifaceted response, with the involvement of different sectors (legal, educational, labor, justice, criminal and public health) in the search for solutions.

For too long violence against women has remained a hidden epidemic. Now is the time to bring it out into the open and seriously deal with it.

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