Global WHO survey: poor physical and mental health more prevalent among women who have experienced intimate partner violence.

ED FROM Ellsberg M, Jansen H, Heise L, et al. Intimate partner violence and women’s physical and mental health in the WHO multicountry study on women’s health and domestic violence: an observational study. Lancet 2008;371:1165–72. Correspondence to: Dr C Garcia-Moreno, Department of Reproductive Health and Research, WHO, 20 Avenue Appia, 1211 Geneva 27-CH, Switzerland; [email protected] Source of funding: World Health Organisation; Governments of the Netherlands, Norway, Sweden, Switzerland, and UK; Rockefeller Foundation; Urban Primary Health Care Project of the Government of Bangladesh; Swedish Agency for Research Cooperation with Developing Countries (SAREC/Sida); United Nations Fund for Population Activities (UNFPA); and Trocaire. c Additional notes are published online only at http://ebmh.bmj.com/content/vol11/ issue4 C O M M EN TA R Y E llsberg and colleagues provide compelling data characterising the association between disease burden and intimate partner violence (IPV)—a prevalent but under-recognised human rights violation. The study included a large sample of women from 10 countries and found a high prevalence of IPV (15%–71% of women reported lifetime physical and/or sexual IPV victimisation), and strong associations between IPV victimisation and injury, emotional distress, suicidal ideation, suicide attempts, functional limitations and poor health. Despite some limitations in the design (eg, crosssectional) and measurement (eg, physical and sexual violence were pooled as a single exposure), the study elucidates a crucial finding that irrespective of cultural and social context, IPV victimisation in women presents a significant disease burden extending beyond physical injury. In spite of this, prevention efforts are hampered by gender inequities, poverty, societal structures that support violence against women and a lack of funding. Prevention efforts are needed that address gender inequities and structures that constrain women’s rights, improve services for women victimised by violence, and ensure adequate allocation of dollars to support organisations and research addressing violence against women. The reality of limited infrastructure in middle and low resource countries calls for innovation and coordinated participation from key stakeholders. Promising global violence prevention strategies include: (1) targeting families in which women have little decision-making power and changing attitudes and behaviours that perpetuate violence, such as the Raising Voices program in Uganda and Tanzania; and (2) linking income generating programmes to curricula on gender inequity, reproductive health and HIV/AIDS prevention, like the IMAGE programme in South Africa. Emphasising men’s role in ending violence against women and intervening with youth are also priorities; a school-based programme reduced teen dating violence up to 4 years after implementation. Without urgent prevention efforts, the violence pandemic will continue. Amy E Bonomi, PhD, MPH Human Development and Family Science, The Ohio State University, Columbus, Ohio, USA Nancy Glass, PhD, MPH, RN Center for Global Health, Johns Hopkins University, Baltimore, Maryland, USA Competing interests: None. 1. Foshee VA, Bauman KE, Ennett ST, et al. Assessing the long-term effects of the Safe Dates program and a booster in preventing and reducing adolescent dating violence victimization and perpetration. Am J Public Health 2004;94:619–24. Prevalence 128 EBMH November 2008 Vol 11 No 4 group.bmj.com on April 11, 2017 Published by http://ebmh.bmj.com/ Downloaded from