In most of the world, 29 percent to 62 percent of women have suffered physical or sexual violence at the hands of an intimate partner. More often than not, the violence is severe. For half of these women, the abuse continues.
The appalling numbers come from a remarkable study led by World Health Organization researchers Claudia Garcia-Moreno, MD; Henrica A.F.M. Jansen, PhD; and colleagues. The researchers trained a small army of more than 500 female interviewers who met with more than 24,000 15-to 49-year-old women at 15 sites in 10 countries.
The women, randomly selected to represent the region in which they lived, spoke privately with the interviewers. The interviewers were armed with fake questionnaires in case a husband burst into the room. Sometimes they held decoy interviews with male household members to keep them busy while they spoke with the women.
"One of the very striking things we found during the study was that 20 percent to 60 percent of the women mentioned they had never talked with anybody else about this before," Jansen tells WebMD. "A woman in Peru said being interviewed made her feel herself to be a vessel -- a container for capturing all these stories for women. She thought that was a huge responsibility."
The women's stories came in 14 different languages, but the message was the same.
"Women are at more risk from their intimate partners than from strangers or men in the street," Garcia-Moreno tells WebMD. "Four out of five women who report violence report abuse by a partner. It is said that the streets are not safe -- but it is the homes that are not safe for most women. This is still a very hidden problem."
Controlling Men, Abused Women
Overall, a woman's risk of ever having suffered physical or sexual violence ranged from 15 percent in the urban city of Yokohama, Japan, to 71 percent in the rural province of Butajira, Ethiopia. In most areas, this risk was between 29 percent and 62 percent.
In general, women in industrialized regions were less likely to report ongoing abuse than were women in rural areas. This suggests that women in these areas have more options for escaping abusive partners.
Women with more education and more income were less likely to report abuse. Even so, education and wealth do not protect women from intimate-partner abuse.
In most areas, there was more physical violence than sexual violence, although Garcia-Moreno says it was harder for women to talk about sexual violence. Many of the women interviewed were surprised to find out that violence of any kind is unacceptable.
"We found, in countries where domestic violence is a part of daily life, that the interview for the first time made women realize that what they were undergoing was not normal," Jansen says. "A woman in Bangladesh said she thought every husband would beat his wife and have sex against her will."
One factor strongly linked to partner violence is controlling behavior by men. This behavior includes keeping a woman from seeing friends, restricting a woman's contact with her family, insisting on knowing where she is at all times, becoming angry if she speaks with another man, and expecting her to get his permission before seeking medical care.
"We are not sure if the controlling behaviors are part of violence or a predictor of violence," Jansen says.
Male controlling behavior is part of the process that includes violence, says Dick Bathrick, LMFT, co-founder of the abuse-prevention group Men Stopping Violence.
"It stems from men's sense of male privilege: the belief we have the right to control and dominate in relationships with women," Bathrick tells WebMD.
In the U.S., few men condone actual violence against women. Yet many of us will recognize ourselves in Bathrick's description of controlling behavior.
"Male control includes taking up space with words," he says. "We assume that when we are in an interaction with women, we have the right to speak first and speak most -- and we claim that we are authorities, that we know the truth about what is right or wrong."
U.S.Men and Violence
The U.S. was not one of the nations included in the WHO study. However, a 1998 survey found that 31 percent of American women report at least one episode of physical or sexual violence committed by a husband or boyfriend.
"There is certainly greater awareness in the U.S. that there is men's violence against women, and that it is epidemic," Bathrick says. "There is nonetheless this virulent strain of disrespect for women in our society."
Will things ever change? All of the experts who spoke with WebMD say yes.
"More and more men -- and, what is encouraging, younger men in particular -- have begun to take a look at the overall social and moral injustice of looking at and treating women this way," Bathrick says. "We believe it is in our interest as men to treat women with respect so they can be fully who they need to be. These are the women we want to be in relationships with."
"Many societies still see violence against women as a part of life, a part of marriage -- but it is not," Garcia-Moreno says. "Political, business, and religious leaders -- particularly male leaders -- need to speak out and challenge these norms."
But change doesn't come from the top down. Whether violence against women continues depends on what we, as individuals, are willing to do.
"As individuals we need to make it known that violence against women is not acceptable," Garcia-Moreno says. "Women in abusive situations need support. How people respond to women in these situations is critical. We looked at what women do, at who they see when they need help. By and large, they do not go to the police or to social services -- they talk to friends and family. And if they do not get a response, it sets them back. So everybody can take responsibility for this. If you are ever faced with someone who needs support, you can play a major role."
Garcia-Moreno and colleagues report their findings in the Oct. 7 issue of The Lancet.
By Daniel J. DeNoon, reviewed by Louise Chang, MD
SOURCES: Garcia-Moreno, C. The Lancet, Oct. 7, 2006; vol 368: pp 1260-1269. The Commonwealth Fund, Health Concerns across a Woman's Lifespan: 1998 Survey of Women's Health, May 1999. Claudia Garcia-Moreno, MD, ccoordinator for gender, HIV/AIDS, and violence, World Health Organization, Geneva. Henrica A.F.M. Jansen, PhD, epidemiologist, World Health Organization, Geneva.Dick Bathrick, MA, LMFT, director of programs, Men Stopping Violence, Atlanta.