As one of the most pervasive human rights violations in the world, gender-based violence has tremendous consequences for women and girls directly affected, for the children who are subjected to or witness these crimes, as well as for other family and community members, and for societies and economies as a whole.
Among these consequences, and the focus of this entry, is the impact of gender-based violence on the freedoms and fundamental rights of women and girls in one critical aspect of their lives: their sexual and reproductive health and rights. Freedom from gender-based violence and freedoms to exercise sexual and reproductive rights are both core elements of women’s empowerment, with impacts across their ability to enjoy all other rights. The same applies for men and boys subjected to sexual violence and abuse, since these are core aspects of any individual’s empowerment and basic freedoms.
The root cause of both violence and restrictions on women’s exercise of their sexual and reproductive rights is the same: systematic gender discrimination and, relatedly, control over women’s sexuality and decision-making. Across the world, violations of these aspects of women’s fundamental human rights go hand in hand, and mark the starkest forms of control and limitation on women’s freedoms and equality. Various forms of gender-based violence are themselves specific violations of sexual and reproductive rights, among them all forms of sexual violence, including marital rape, and any coercive policy or practice that intervenes in women’s informed, autonomous decision-making about their own bodies, sexuality or reproductive choices.
As many as 6 in 10 women experience domestic and/or sexual violence in their lifetime, not to mention rape as a tactic of warfare, with huge impacts on their sexual and reproductive health and rights—including unwanted and early pregnancy (including due to incest and sexual abuse of girls within the family and community), forced pregnancy (including in some conflict and ethnic cleansing contexts), HIV infection and sexually transmitted infections. Women are already 2 to 4 times more likely to become infected during intercourse, a risk which increases during forced sexual acts due to lack of condom use and associated injuries. Violence against women and girls has fueled the feminization of the HIV/AIDS pandemic. Women in abusive and violent situations– including the millions subjected to domestic violence- are not able to have control over basic decisions about contraceptive use to prevent an unwanted pregnancy, much less insist on condom use, including for fear of exacerbated violent reprisals.
Adolescent girls and young women are at especially high risk of both HIV and gender-based violence, in particular, sexual forms of violence. Up to 50 percent of sexual assaults are committed against girls under 16, and roughly thirty percent report that their first sexual experience was forced, a figure that is even higher for girls under 15 (45%). For the estimated 60 million child brides in the world, a form of gender-based violence in itself, for many their wedding night is marked by the beginning of a longer pattern of marital rape, among other forms of domestic abuse and exploitation. Many will also have their sexual and reproductive rights trampled, and be pressured to produce children before their bodies are prepared, with high risks to their health and very survival, not to mention curtailment of their education and own life aspirations. For the 100 million to 140 million girls and women who have undergone female genital mutilation, they run increased risks of various sexual and reproductive health problems, including obstructed labor, childbirth complications, newborn deaths, postpartum bleeding, infections and maternal mortality.
Among the most neglected from of violence is abuse during pregnancy, affecting as many as 1 in 4 pregnant women, yet public policies and health service responses – including those focused on maternal health – are notably absent. Abuse during pregnancy raises the likelihood of premature labor and low birth weight, as well as miscarriage and stillbirth.
In short, violence against women and girls and sexual and reproductive health and rights are inextricably linked, yet responses on the ground are still very limited and disparate, doing a disservice to women and girls who have the right to support and remedies on both fronts as part of a holistic, rights-based and gender-centred approach. The development of the new post-2015 framework offers a critical opportunity to do a lot more, synergistically, (and costeffectively), on both fronts, if integrated approaches and common entry points are utilized and significantly scaled up.
For example, efforts to prevent violence against women and girls–engaging the mass media, educational systems, young people and men, and community mobilization—should consider the importance of universal access to comprehensive sexuality education for all young people, beginning in early ages, as a natural entry point where both sexuality and violence issues can, and should be, addressed together. A rights-based definition of comprehensive sexuality education ensures gender transformative approaches, where not only biology and prevention of pregnancy, sexually transmitted infections and HIV is taught, but young people also build selfesteem and learn to assert themselves in relation to making informed decisions about sexuality, learn how to protect themselves from violent or coercive relations, and importantly, develop attitudes and inter-personal skills conducive to fostering gender equitable norms and behaviours, non-violence and mutual respect. Explicit attention to eliminating gender-based violence must form part of any sexuality education programme. In addition, good practice (in general, but also in comprehensive sexuality education) also means ensuring referral to services for adolescents and youth. These should be services that are equipped and integrate responses to both sexual and reproductive health and gender-based violence against these young age groups, with particular attention to adolescent girls and young women.
Similarly, one way to ensure that in a post-2015 world all victims and survivors of gender-based violence have immediate access to at least a core set of health, social, legal and other critical supports, is to seize upon strategic entry points. All sexual and reproductive health services should include services designed to respond to gender-based violence. This is significant ‘unfinished business’ since the ICPD and Beijing agreements were adopted, as these commitments called for all individuals to have access through the primary health care system to quality and comprehensive sexual and reproductive health information and services, as well as responses to violence against women and girls. The clients of sexual and reproductive health programmes are predominantly women and girls, many of whom are being subjected to violence as they visit the health facility. These are the services that women are most likely to come into contact with, regardless of their socio-economic status, and present a crucial opportunity for services to play a key and potentially high-impact role in ending and mitigating the consequences of violence against women and girls, including facilitating an escape route from violence for women and their children to stop recurrent domestic violence; and by providing quality mental health counseling and post-rape care, including emergency contraception to prevent unwanted pregnancy and HIV following sexual assault, among other supports and referrals–which are ‘core’ sexual and reproductive health service functions of a rights-based, gendered response.
At other levels of public policy, there are especially strategic investments in women’s empowerment and gender equality that are correlated with both reduced violence against women and improving women’s and adolescent girls’ sexual and reproductive health, also because they can serve as ‘protective factors’ that enable women and girls to avoid or escape situations of dominance, violence and exploitation: getting girls through secondary school, women’s economic security and autonomy, and women’s increased participation in decision making at all levels, including local and national political levels to influence policy-making.
The lessons from the MDGs are clear and the post-2015 framework must avoid repeating them: violence against women and girls was ‘missing’ in the MDGs, and it took several years for sexual and reproductive health to be included in the MDGs framework. These are fundamental human rights and freedoms; especially central to the achievement of women’s empowerment and gender equality; and also foundations of human development and human capital accumulation with tremendous ramifications for countries’ poverty eradication, health, productivity, economic prosperity and overall stability and wellbeing. Strong accountability frameworks will be need to track progress on these issues at political, programmatic and financial levels, from local to global levels, with a focus on addressing inequities, and with the meaningful participation of women’s, youth and other civil society groups in ongoing monitoring mechanisms.