Targeting Violence against Women in Bolivia and Vietnam
Sexual and gender-based violence is a pervasive global health and rights problem rooted deeply in societal beliefs about the role of women and the low status of women and girls compared to men and boys. Most commonly, men are the perpetrators of such acts of violence, which can be physical, sexual, or psychological. When the aggressor is someone the woman or girl knows intimately, such violence is referred to as intimate partner violence or domestic violence. The Council is working around the world to strengthen and integrate health and other services to fully respond to the needs of women who experience sexual and gender-based violence. Council scientists recently reported on studies in Bolivia and Vietnam that explore gender-based violence and seek to help survivors.
Intimate partner violence (IPV) and sexually transmitted infections (STIs) are epidemics that disproportionately affect women. Council researchers and their colleagues surveyed pregnant women attending antenatal clinics in three provinces in Bolivia to determine the prevalence of IPV and the association between IPV and infection with syphilis. This survey is one of the first large-scale studies on the co-occurrence of IPV and STIs in Latin America and the first conducted in Bolivia.
After routine syphilis testing during antenatal care, women were asked four questions to assess their experience of physical and sexual violence:
1. In the last year, were you hit, slapped, kicked, or otherwise physically hurt frequently?
2. Who was the person who hit you?
3. Within the last year, did someone force you to have sexual intercourse against your will?
4. Who was this person?
Of the 6,002 women who responded and had a syphilis test, 20 percent (1,227 women) reported physical or sexual abuse, or both, committed by their partner in the past year. Women who reported IPV were twice as likely as women who did not to test positive for syphilis--8 percent versus 4 percent--a statistically significant result that remained significant after controlling for socioeconomic factors.
"Sexual and physical violence by a male partner may increase a woman's risk for STIs because the power imbalance in the relationship may diminish her ability to negotiate condom use or refuse sex," said Sandy Garcia, country director of the Population Council's Mexico City office and a researcher on the study. "In our study, additional sociodemographic factors significantly associated with positive syphilis tests--for example, number of previous pregnancies and male partners' education level--are similar to those significantly associated with a history of IPV. This suggests that both problems emerge from the same socioeconomic and cultural contexts."
The Council scientists concluded that Bolivia's new maternal and infant health program in antenatal clinics, which includes universal syphilis screening, should also provide screening and follow-up care for new mothers who have experienced IPV. "Antenatal clinics are important locations for addressing a number of sensitive health issues, including intimate partner violence and STIs," says Garcia. "Among pregnant women, antenatal clinics often serve as a first encounter with the medical system and provide a less stigmatizing environment than an STI clinic."
Over the last decade, the Population Council has provided technical assistance to the Hanoi Health Department in Vietnam to tackle gender-based violence. The Council helped develop and introduce procedures to assist health workers in screening for gender-based violence (GBV) and to support survivors by providing or referring them for services. A pilot project at Duc Giang Hospital, which arose from this collaboration, is the first model in the Vietnamese health system that systematically screens for GBV and provides treatment and referrals. The project included the establishment of the Women's Center for Counseling and Health Care at the hospital. …