Understanding gender-based violence perpetration to create a safer future for women and girls.

Worldwide, one in three women experience genderbased violence, which imparts physical, mental, and sexual health morbidities. It also causes mortality—more than a third of homicides of women are attributable to male partners. These data justifi ably create global outrage, accentuated by horrifi c recent high-profi le cases, including the brutal gang rape of a student in New Delhi, and the attempted assassination of Pakistani student and education activist Malala Yousafzai. However, mounting of an eff ective, evidence-based, sustainable response to gender-based violence has proven elusive, partly because of the paucity of data for the population that we need to understand the most: the perpetrators of gender-based violence. Most research into such violence focuses on victimisation, which provides invaluable insight into survivors’ experiences, risk factors, and needs for support. However, to put a stop to this global pandemic demands a fundamental understanding, and modifi cation, of the behaviour of gender-based violence perpetrators. Population-based data for men’s violence perpetration and its root causes are scarce and are mostly limited to Africa. Analyses of the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacifi c presented in The Lancet Global Health represent a major advancement in that they describe the epidemiology of perpetration of the main forms of gender-based violence—intimate partner violence and non-partner rape—in a large and generalisable sample from the world’s most populous region. Such violence perpetration, including rape by multiple perpetrators, was prevalent, with 25–80% of the men studied perpetrating physical, sexual, or both types of intimate partner violence, and 3–27% committing single perpetrator nonpartner rape. The fi ndings off er much-needed direction for prevention and intervention. Targeting of interventions is essential. More than half of non-partner rape perpetrators fi rst did so as adolescents, which affi rms that young people are a crucial target population for prevention of rape. The fi nding that gender-based violence perpetration was associated with other key global health issues (eg, substance use and depression) suggests the potential usefulness of integrated interventions. Childhood trauma and witnessing of gender-based violence were also infl uential factors, which supports the idea that those exposed to violence during youth should be prioritised for prevention and interventions. Importantly, as reported in other settings, perpetration of both intimate partner violence and nonpartner rape was linked closely to sexual risk behaviour (eg, having several sexual partners), supporting the suggestion that these behaviours were informed by underlying norms supportive of men’s sexual entitlement and dominance in sexual decision-making. As is the case in more generalised HIV epidemic settings, the concurrence of gender-based violence perpetration and sexual risk behaviour hold signifi cant implications for sexually transmitted infections and HIV. Clear value exists in integrated interventions that address both gender-based violence and sexually transmitted infections and HIV. Moving forward, anal rape perpetration is also crucial to this risk constellation in view of the HIV transmission effi ciency of anal inter course, especially when forced, and emerging evidence of its links with gender-based violence. Also crucial, and consistent with previous research, are the eff ects of gender-inequitable attitudes and sexual entitlement on gender-based violence perpetration. Sustained reductions in gender-based violence perpetra tion need transformation of culturally and socially reinforced norms that promote and maintain gender inequities. These norms, which are expressed by individuals and informed by, maintained, and codifi ed at the social or structural level, eff ectively create a culture in which male perpetration of gender-based violence is tolerated at best and expected at worst. Such individual attitudes and social norms need to be addressed within an evidence-based approach to reduce gender-based violence. In other low-income and middle-income settings, sexual health interventions targeting gender equity and relationship dynamics led to promising reductions in men’s perpetration of, and women’s experiences of, intimate partner violence. Youthoriented programmes, such as Coaching Boys Into Men, also address gender norms, with promising results including increased equitable attitudes and reduced Published Online September 10, 2013 http://dx.doi.org/10.1016/ S2214-109X(13)70085-8