Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia

A resource package

1.3. Causes of gender-based violence

It is widely understood that GBV – be it in the form of isolated acts or systematic patterns of violence - is not caused by any single factor. Rather, it is a combination of several factors that increase the risk of a man committing violence and the risk of a woman experiencing violence.

Figure 1: Ecological Framework for Understanding Violence against Women

The “ecological framework” developed by Heise distinguishes risk factors at four levels: the individual, the relationship, the community and the structural level (Heise 1998, cited in WHO 2005). These factors are associated with an increased likelihood that an individual will become a victim or a perpetrator of violence. This model offers a comprehensive framework for understanding the risk factors of GBV and their interplay, and may therefore be used as a guide for designing interventions in the fields of prevention and response (WHO/LSHTM 2010).

  • Individual-level factors are biological and personal history factors that increase the risk of violence. For example, a low level of education, young age (early marriage) and low-economic status/income have been associated as risk factors for both experiencing and perpetrating intimate partner violence. Past experiences of violence also play a role; exposure to sexual abuse and intra-parental violence during childhood as well as a history of experiencing (for women) or perpetrating (for men) violence in previous intimate relationships increases the likelihood of violence in future relationships. Pregnant women are also at high risk of experiencing violence by an intimate partner. While several studies point to a strong association between harmful use of alcohol and the perpetration of intimate partner violence and sexual violence, there is only weak evidence for a truly causal relationship between the use of alcohol and the perpetration of violence. Attitudes also play an important role; there is a strong correlation between women and men perceiving violence as acceptable behaviour and their exposure to intimate partner and sexual violence (as both, survivors and perpetrators) (WHO/LSHTM 2010 with multiple references).
  • Relationship-level factors contribute to the risk of GBV at the level of relationships with peers, intimate partners and family members. For instance, men having multiple partners are more likely to perpetrate intimate partner violence or sexual violence. Such men are also more likely to engage in risky behaviours with multiple sexual partners by refusing condoms, exposing themselves and their intimate partners to a higher risk of HIV infection. Other factors associated with an increased risk of intimate partner violence include partnerships with low marital satisfaction and continuous disagreements, as well as disparities in education status between the partners. Furthermore, family responses to sexual violence that blame women and concentrate on restoring “lost” family honour, rather than punishing men, create an environment in which rape can occur with impunity (WHO/LSHTM 2010 with multiple references).
  • Community-level factors refer to the extent of tolerance towards GBV in contexts at which social relationships are embedded, such as schools, workplace or the neighbourhood. Research found that societies that had community sanctions against violence, including moral pressure for neighbours to intervene, in place and where women had access to shelter or family support had the lowest levels of intimate partner and sexual violence. While intimate partner and sexual violence do cut across all socio-economic groups, several studies found women living in poverty to be disproportionately affected; however, it has not been clearly established whether it is poverty as such that increases the risk of violence or rather other factors accompanying poverty. Rather, poverty can be seen as a “marker” for a variety of social conditions that combine to increase the risk faced by women. For instance, rural women living in poverty who work in the fields or collect firewood alone may be at a higher risk of rape. Poverty may also put women under pressure to find or maintain jobs and in turn render them vulnerable to sexual coercion, or push them in to occupations that carry a high risk of sexual violence, such as sex work (WHO/LSHTM 2010).
  • Society-level factors include the cultural and social norms that shape gender roles and the unequal distribution of power between women and men. Intimate partner violence occurs more often in societies where men have economic and decision-making powers in the household and where women do not have easy access to divorce and where adults routinely resort to violence to resolve their conflicts. Further, ideologies of male sexual entitlement that are common in many cultures exclude the possibility that a woman is entitled to make autonomous decisions about participating in sex and to refuse a man’s sexual advances and are used to legitimize the use of sexual violence. Social breakdown due to conflicts or disasters further increase the risk of rape in conflict and post-conflict situations (WHO/LSHTM 2010 with multiple references).

Table 5 provides an overview of common risk factors for both, intimate partner violence and sexual violence associated with the ecological model. For information on further risk factors contributing to an increased risk of either intimate partner or sexual violence, see WHO/LSHTM 2010.

Table 5: Common risk factors for intimate partner violence and sexual violence