International studies and survey data confirm that sexual and gender-based violence (SGBV) is a widespread problem with serious repercussions in terms of personal suffering, health complications, disability, and death for women, children and men, in addition to having significant costs for healthcare systems and society at large (USAID, 2006, UNFPA/AIDOS, 2003). Gender-based violence has been defined as involving men and women in which the female is usually the victim and which is derived from unequal power relations between men and women (USAID, 2010a). Based on documentation of occurrences of conflict zone violence perpetrated by women on men and other women (Johnson et al., 2010) and recorded cases of male victimization, Lawry (2011) has broadened the definition to include any harm including sexual violence to an individual that is perpetrated against their will and is a result of power imbalances. Programs designed to prevent SGBV and provide treatment for victims can help achieve Millennium Development Goals #3. promote gender equality and empower women; #4. reduce child mortality; #5 improve maternal health; and #6. combat HIV/AIDS.  Multiple global partners, such as WHO, USAID, UNFPA, RHRC, UNHCR, IPAS, IPPF, and Promundo have been developing programs targeting SGBV. The Global Health Initiative’s (GHI) first principle to ‘Implement a woman- and girl-centered approach’ by supporting long-term systemic changes to remove barriers and increase access to quality health services for women and girls is consistent with interventions to reduce SGBV. GHI strategies to engage men in RH, gender equity programs, training health providers on gender issues, and engaging civil society in partner countries to address gender equity in health care can help reduce SGBV against females and against males (GHI, 2010).

SGBV can include physical, sexual, and psychological/emotional violence, rape and sexual abuse, child sexual abuse, child marriage, female genital cutting, marital rape, dowry-related violence, female infanticide, femicide, sexual harassment, forced prostitution, sex trafficking, and sexual violence used during war or conflicts as forms of intimidation and torture (USAID, 2006; Bloom, 2008; Lawry, 2011).  The prevalence of SGBV is high across many regions and countries, including many developing countries.  Based on DHS survey data from nine countries, Kishor and Johnson (2004) found the reported prevalence of any type of violence against women ages 15 to 49 ranged from 21 to 59 percent. Intimate partner violence is the most common type of SBGV and Kishor and Johnson (2004) reported that overall one in six women had been physically assaulted or raped by husbands or intimate partners. Women, children, and men in conflict zones and those displaced in emergency or refugee settings are at increased risk, as well as members of the lesbian, gay, bisexual, and transgender (LGBT) population (Ard and Makadon, 2011). Reporting on SGBV in conflict zones, Lawry (2010) found staggering rates as high as 39 percent of females and 23 percent of males had suffered SGBV in Ituri and South and North Kivu in the Democratic Republic of the Congo, between one-fourth to one-half million females in Rwanda were raped during the 1994 genocide, 76 percent of male political prisoners in El Salvador have suffered SGBV, and 80 percent of male camp detainees in Sarajevo reported sexual violence while in camp.

SGBV has effects on women’s reproductive health through a number of pathways including early and/or unintended pregnancy, general and psychological health issues and reduced productivity, as well as increased risk for sexually transmitted diseases (STIs) and HIV. Violence during pregnancy poses an immediate risks to the pregnant women and can lead to adverse pregnancy outcomes (Pool, et. al., 2014). Risks for male victims can include STIs and HIV, general and psychological health concerns, substance abuse, reduced productivity, and reassertion of their masculinity by repeating their own victimization but in the role of perpetrator. Policies and programs to prevent and respond to SGBV have been initiated worldwide and involve a range of sectors in order to address underlying factors including cultural norms perpetuating gender inequality and the more immediate determinants, such as behavior change (Bloom, 2008). In terms of improving health services for victims of SGBV, USAID (2010b) recommends a ‘systems approach’ that promotes broad reforms throughout the health organization. When monitoring and evaluating (M&E) SGBV interventions, Watts (2008) recommends the importance of a mixed-methods approach that uses quantitative and complementary qualitative methods with a clear conceptual framework to guide evaluation, multiple forms of evidence, and costing data to determine and support feasibility of scale-up.

Indicator Selection

The ten core indicators selected for this database cover a range of SGBV topics from policy and legislation to access, quality and utilization of services, beliefs about SGBV and gender norms, to prevalence of SGBV among men and women.  Indicators have been drawn from several sources including DHS, the guide from  WHO/UNFPA (2008) on monitoring universal access to reproductive health and from the compendium of indicators on ‘Violence Against Girls and Women,’ (Bloom, 2008).  The compendium of indicators was designed for quantitative assessment of program performance at community, regional and national levels. Because some areas of SGBV can be captured better through qualitative methods, see Ellsberg and Heise (2005) for a discussion on when and how to conduct qualitative research. There are a number of challenges in M&E, such as potential reporting bias related to gender and cultural norms. In general, SBGV tends to be underreported by both females and males, with male victims even less likely to report violence than females. Following interventions, women may feel more comfortable in reporting violence making it appear that the intervention is associated with an increase in violence, while men may be less likely to admit to perpetrating violence (Watts (2008). Watts also notes that reliable evidence on impact of interventions is difficult to collect and the use of control groups or communities can be complicated.

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References:

Ard K and Makadon HJ. Addressing Intimate Partner Violence in Lesbian, Gay, Bisexual, and Transgender Patients. Journal of General Internal Medicine. 2011, August: 26(8): 930-933.

Bloom S, 2008, Violence against Women and Girls: A Compendium of Monitoring and Evaluation Indicators, Chapel Hill, NC: MEASURE Evaluation. https://www.data4impactproject.org/publications/violence-against-women-and-girls-a-compendium-of-monitoring-and-evaluation-indicators/

Ellsberg MC and Heise L, 2005, Researching Violence against Women: A Practical Guide for Researchers and Activists, Washington, DC: WHO, PATH. http://www.path.org/files/GBV_rvaw_complete.pdf

Kishor S and Johnson K, 2004, Profiling Domestic Violence- A multi-country study, Calverton, MD: ORC Macro.

Pool MS, Otupiri E, Owusu-Dabo E, de Jonge A, and Agyemang C. Physical violence during pregnancy and pregnancy outcomes in Ghana.  BMC Pregnancy and Childbirth. 2014, February 14(71).