Intimate partner violence is the most common kind of aggression experienced by women worldwide. In Japan, the concept of the battered wife now also includes the battered parent or grandparent. This phenomenon is now so widespread that it has become a global public health issue.

After the National Police Agency changed its policies on domestic violence in 2011, there has been a dramatic surge in the number of reported cases, from 28,158 in 2009 to 49,533 in 2013. A significant portion of women suffered physical violence and an important proportion among them also suffer from psychological violence. However, because of cultural norms, many women do not report the abuse.

In 2015, a government report stated that 10 percent of women had been victims of harassment or stalking, and 29 percent among them said that they feared for their lives. Of 3,544 respondents to a government survey, 11 percent of women said that they had experienced harassment from the opposite sex, while 4 percent of men admitted the same. Of all those surveyed, just 10 percent of women reported the cases to the police and only 3 percent of men.

Because children often are caught in the middle of such disputes, they are also affected by this phenomenon. A government survey found that 27 percent of those surveyed said that their children had also been victims of such violence, particularly of a psychological nature. Children who grow up in families where there is domestic violence are prone to a wide range of behavioral and emotional disturbances. One of three abused children becomes an adult abuser or victim. Oftentimes, the scars on children may last for several years.

The extent of this phenomenon is equally serious in most countries. In Russia, for example, more than 14,000 women are killed every year in acts of domestic violence. And in China, according to a national survey, one-third of the country’s 270 million households cope with domestic violence. Domestic violence is also rife in most African countries. According to a U.N. report, domestic violence in Zimbabwe accounts for more than 60 percent of murder cases in court. In Kenya and Uganda, 42 percent and 41 percent respectively of women surveyed reported having been beaten by their husbands.

Domestic violence is widespread in the Arab world as well. Studies carried out show that 70 percent of violence occurs in big cities, and that in almost 80 percent of cases those responsible are the heads of families, such as fathers or elder brothers. Both fathers and elder brothers, in most cases, assert their right to punish their wives, children and other members of the family as they see fit.

Because of the extent of this phenomenon, a global momentum for more effective action is building, according to the medical magazine the Lancet. In March of 2013, 103 member states at the 57th session of the Commission on the Status of Women gathered at the U.N. headquarters in New York and agreed to end violence against women and girls and to protect their human rights and fundamental freedoms.

Female victims of violence suffer a wide variety of health problems such as organ and bone damage, miscarriage, exacerbation of chronic illness, gynecological problems and sexually transmitted diseases including HIV/AIDS. In addition, they are more susceptible to a variety of mental health problems such as depression, post-traumatic stress disorder, sleep and eating disorders, emotional distress and suicide. The percentage of women worldwide who are battered during their pregnancy is 25 percent to 45 percent. Domestic violence by a partner has also been associated with higher rates of infant and child mortality and morbidity.

Violence against women also has a high economic cost for society. According to the United Nations, the cost of domestic abuse in the United States exceeds $5.8 billion per year: $4.1 billion for direct medical and health care services and nearly $1.8 billion for productivity losses. This kind of violence results in almost 2 million injuries and nearly 1,300 annual deaths. However, at the global level, the response continues to be inadequate. In the U.S., for example, there are more animal shelters than shelters for battered women.

In addition to the World Health Organization, domestic violence as a public health issue has been recognized by organizations such as the Inter-American Commission of Women of the Organization of American States. “Health systems should be the main door for detection, treatment and support for victims of violence against women,” states Carmen Barroso, director of the International Planned Parenthood Federation in the Western Hemisphere.

Ending global violence against women will require passing and systematically enforcing appropriate legislation.

In the case of Japan, the country should improve its mechanisms for assessing, reporting and responding more effectively to this most important problem.

Cesar Chelala, a medical doctor who often writes on humanitarian issues, is the author of “Maternal Health” and “Adolescents’ Health,” both publications of the Pan American Health Organization.

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