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

A resource package

1.1. Definition and forms of gender-based violence

July 30, 2014

The terms of GBV and violence against women are often used interchangeably, as most violence against women is gender-based, and most GBV is inflicted by men on women and girls.

International human rights law documents provide the following definitions of violence against women and GBV (box 1):

Box 1: Defining gender-based violence against women

Violence against women

(…) is “a manifestation of the historically unequal power relations between men and women, which have led to domination over and discrimination against women by men and to the prevention of women’s full advancement. […] [V]iolence against women is one of the crucial social mechanisms by which women are forced into a subordinate position compared with men” (DEVAW, preamble).

(…) “constitutesa violation of human rights and a form of discrimination against women. It means all acts of gender‐based violence that result in, or are likely to result in, physical, sexual, psychological or economic harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life” (Article 1 DEVAW, Article 3 Istanbul Convention).

Gender-based violence is“violence that is directed against a womanbecause she is a woman or that affects women disproportionately” (CEDAW GR 19, Article 3 Istanbul Convention).

Forms and contexts of gender-based violence against women: “Violence against women shall be understood to encompass, but not be limited to, the following:

(a) Physical, sexual and psychological violence occurring in the family; including battering, sexual abuse of female children in the household, dowry-related violence, marital rape, female genital mutilation and other traditional practices harmful to women, non-spousal violence and violence related to exploitation.

(b) Physical, sexual and psychological violence occurring within the general community, including rape, sexual abuse, sexual harassment and intimidation at work, in educational institutions and elsewhere, trafficking in women and forced prostitution;

(c) Physical, sexual and psychological violence perpetrated or condoned by the State, wherever it occurs” (Article 2 DEVAW).

From these international definitions, we may understand the term GBV as follows:

Violence against women is gender-based: It does not occur to women randomly.

Rather, such violence is directed against women because they are women or affects women disproportionately. GBV is a structural problem that is deeply embedded in unequal power relationships between men and women. Such violence is perpetuated by harmful social and cultural expectations about gender roles typically associated with being a woman or being a man, a girl or a boy. It functions as a mechanism for enforcing and sustaining gender inequality. Women and girls who are subjected to violence receive the message that they are worth less than others and that they do not have control over their own lives and bodies. This has direct consequences with respect to their health, employment and participation in social and political life (Kelly 2005).

In order to be able to address violence against women as a gender-based phenomenon and to integrate GBV into the health-care system, it is critical to understand the meaning of gender as opposed to sex.

Box 2: Gender versus sex

  • Sex refers to the biological and physiological differences between men and women. At the same time, it may not always be possible to define sex along the dichotomous lines of male-female only, as is made evident by inter-sex individuals (CEDAW GR 28, MWIA 2002).
  • Gender refers to socially constructed identities, attributes and roles for women and men, and the social and cultural meaning attached to biological differences between women and men that result in hierarchical relationships between women and men and in an unequal distribution of power and rights that favours men and disadvantages women.
  • Gender roles and characteristics do not exist in isolation, but are defined in relation to one another and through the relationship between women and men, girls and boys. While sex and its associated biological functions are programmed genetically, gender roles and the power relations they reflect are a social construct – they vary across cultures and through time, and thus are subject to change (CEDAW GR 28, MWIA 2002).
  • Gender equality implies equality of women and men, without discrimination on the basis of gender. Gender equality encompasses equality of women and men, both, before the law (formal equality) and de facto (substantive equality). Accordingly, state measures to achieve gender equality must go beyond identical treatment of women and men equal before the law. Instead, laws and policies must aim at equal opportunities of women with men, with the ultimate view to achieving equal enjoyment of rights, income levels and participation and influence in decision-making, as well as freedom from violence for both, women and men. This requires effective strategies aimed at overcoming gender-based stereotypes and other root causes of discrimination, with a view to a redistribution of resources and power between men and women (CEDAW GR 25).
  • Gender-based discriminationcan in general be understood as any distinction, exclusion or restriction made on the basis of socially constructed gender roles and norms which prevents a person from enjoying human rights. International law defines gender-based discrimination against women as “any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their marital status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field” (Article 1 CEDAW). Such discrimination can be either direct (when a law, policy or practice explicitly discriminates against women) or indirect (when laws, policies or practices despite being seemingly gender-neutral have a detrimental effect on women) (CEDAW GR 25). States are obliged to eliminate all forms of discrimination against women, no matter whether it is perpetrated by state authorities or private organizations, enterprises or individuals (Article 1 CEDAW, CEDAW GR 19, CEDAW GR 28).

It is important to note that GBV also includes violence perpetrated against men and boys. For instance, boys may become subjected to sexual abuse by family members or trafficked for the purpose of sexual exploitation. There are also instances where men have become survivors of domestic violence – by partners or children (Bloom 2008). In some settings, sexual violence against males may even be more prevalent compared to females, for example, in prisons and the armed forces (WHO 2003). Nevertheless, as highlighted earlier, because of the unequal distribution of power between men and women,women and girls constitute the vast majority of persons affected by GBV,with the majority of perpetrators being male.

Box 3: Gender dimensions of violence against women

  • Gender-based violence mainly affects women and girls.
  • Women and men experience violence in different contexts:while men are more likely to die as a result of armed conflict, violence by strangers and suicide, women are more likely to die at the hands of somebody they know, including intimate partners. 
  • In many societies,prevailing attitudes subordinate women to men and entitle men to use violence to control women. These attitudes serve to justify, tolerate or condone violence against women.
  • Women survivors of violence face specific barriers when seeking access to support services. This is because women have fewer resources and options to access justice, care and support,as a result of discrimination and their lower position in society.
  • Often, legal systems and the authorities implementing the laws ignore or fail to adequately respondto violence against women.

Source: adapted from WHO/PAHO 2012a

Gender based violence is a violation of women’s human rights and a form of discrimination against women

GBV violates a number of women’s rights, including the rightto life, the right not to be subject to torture or to cruel, inhuman or degrading treatment or punishment, the right to equal protection under the law, the right to equality in the family, or the right to the highest standard attainable of physical and mental health (CEDAW 1992).For further information on state obligations under international human rights law, see chapter 2.1.1.

Women experience GBVin all areas of life – both the private and the public sphere.

Violence against women occurs in many settings - the family, at the work place, at school or university, on the street, in political life, or in state institutions such as prisons or health institutions. Perpetrators can therefore be private persons, such as intimate partners, other family members, acquaintances, employers, co-workers, or strangers, as well as state officials, such as police officers, prison guards or soldiers.

While GBV occurs to women in all areas of life, the family is the place where women experience the most violence. According to WHO estimates, nearly one-third (30%) of all women worldwide who have ever lived in a relationship have experienced physical and/or sexual violence from an intimate partner (WHO et al 2013). Furthermore, women are disproportionately affected by killings committed by intimate partners and other family members, as confirmed by the latest UNODC Global Homicide Study: While more women do represent about 20% of homicide victims worldwide, they make up almost two thirds of all persons killed by an intimate partner and other family members (UNODC 2014).

Two terms commonly used to refer to violence experienced by women in the household are domestic violence and intimate partner violence (see box 4):

Box 4 – International definitions of domestic violence and intimate partner violence

Domestic violence means “all acts of physical, sexual, psychological or economic violence within the family or domestic unit or between former or current spouses or partners, whether or not the perpetrator shares or has shared the same residence with the victim.” The two main forms of domestic violence are intimate partner violence between current or former spouses or partners and inter-generational violence, which typically occurs between parents and children (Article 3 Istanbul Convention and Explanatory Report).

Intimate partner violence is defined as “behaviour by an intimate partner that causes physical, sexual or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours. (It) covers violence by both current and former spouses and other intimate partners” (WHO et al 2013).

GBV encompasses a broad range of harmful acts, includingphysical, sexual, psychological and economic violence.

For healthcare professionals, it is important to keep in mind that GBV has many facets. Apart from physical and sexual violence that cause injuries and might therefore be easier to detect, women’s experiences of psychological and economic violence should not be overlooked as they may also have significant negative consequences on women’s health (see chapter 1.7 for more information). Furthermore, women and girls experience harmful practices such as child/early marriage, forced marriages or gender-biased sex-selection. Therefore, it is important for health care professionals to understand and recognize the full range of acts that may constitute GBV (see table 1).

Table 1: Examples of acts of GBV against women

Sources: adapted from Warshaw/Ganley 1996, WHO 2003, WHO 2013

Table 2 provides a snapshot of examples of GBV documented in the EECA region. It does not include domestic and intimate partner violence in their several forms, which are addressed by a range of national prevalence studies (see separate table 4). This table is not exhaustive; nor does it imply that certain forms are common only in the EECA region and/or only in the countries listed as examples.

Table 2: Examples of GBV documented in the EECA region