1. Preventing violence against women: An evidence-informed perspective Claudia García-Moreno World Health Organization 57 th Commission on the Status of Women

2. What do we know? More data than ever before, particularly on intimate partner violence The causes of partner violence are multiple and intertwined – factors interact at multiple levels to place women at risk of abuse More knowledge of risk and protective factors and of promising approaches to prevention ─Interventions can reduce acceptability & levels of violence over programmatic timeframes At country level, multiple entry points for intervention

3. Many risk factors for intimate partner violence Individual & relationship Experiences of childhood abuse, growing up in violent household Problematic alcohol use by male partner Acceptance of violence as means to resolve conflict Low education level Community level Acceptability of wife beating Norms supporting male authority / control over women Norms of family privacy/acceptability of divorce Lack of social sanction for violence Societal level Lack of economic rights & entitlements for women, including access to formal wage employment Discriminatory family law & limited acceptability of divorce for women Inequality in access to higher education Level of economic development

4. Intervening at different levels Individual characteristics and behaviour Choice in partner(s) Couples & families Socio-economic conditions Laws & Policies Communities Countries Cultural & Social Gender Norms Transforming harmful gender norms: 1. Mass Media 2. Community mobilization 3. Peer and participatory education with men and boys. 4. Gender equitable attitudes in schools Empowering women: 1.Integrated gender, microfinance & HIV training 2. Securing property rights 3. Conditional Cash transfers Promoting GE laws & policies: 1. Laws against violence 2. Training law enforcement 3. National standards on post- rape care 4. Reducing access to alcohol

5. What works to prevent partner violence? Review evidence of association and promising interventions to address: Social norms around gender and violence Women's economic and social empowerment Childhood exposure to violence Harmful alcohol use Legal and justice system interventions

6. 1. Changing Social Norms Evidence of link acceptability of violence male authority/dominance over women Promising interventions Awareness campaigns – e.g. “We Can”, "It's Not Ok" Small group transformational change efforts, often supplemented with community-based activities – eg Stepping Stones; Programme H; IMAGE programme Social norms marketing and “edutainment programmes” e.g. Soul City, Sexto Sentido; Breakthrough’s “Bell Bijao” Campaign Population level social change programming e.g. SASA!

7. Examples of prevention interventions Community focused Soul City SASA! Uganda Both sexes: Stepping Stones, S. Africa Sexto sentido, Nicaragua Men Program H (Brazil) Yari Dhoshi (India) We Can Women IMAGE SisterAct Program M

8. 2.Women’s social & economic empowerment Evidence of link Secondary education protective Employment, ownership or cash or assets may decrease risk Some effects context specific, depending on factors related to partner and/or broader social norms Promising interventions Evidence that combined livelihood & empowerment programmes achieve impact (e.g. IMAGE, South Africa) Some evidence that economic empowerment interventions reduce violence, although context specific Evaluation of impact of cash transfer programmes on partner violence are just beginning

9. In South Africa combined micro-credit & gender training intervention (IMAGE) cut levels of intimate partner violence by a half over 2 years Among participants: Past year experience of IPV reduced by 55% Households less poor Improved HIV communication Among younger women: 64% higher uptake HIV testing 25% less unprotected sex Pronyk et al. The Lancet Dec. 2006, Pronyk et al AIDS 2008

10. 3. Childhood exposure to violence Evidence of link Strong evidence that child abuse (physical and/or sexual) and witnessing marital violence increase risk of perpetration Poor parenting and gender socialization help reproduce negative child outcomes (including partner violence) across generations Promising interventions Parenting programmes shown to reduce negative child outcomes, including precursors to partner violence, in randomized studies Current programmes target harsh parenting, child maltreatment and exposure to parental violence (home visitation)

11. 4. Harmful use of alcohol Evidence of link Not sufficient or necessary, but where present it increases frequency and severity Promising interventions Early identification and brief counselling by health workers has been shown to reduce harmful drinking Reduce alcohol availability –Recent studies from the US and Australia have found clear link between outlet density and domestic violence –Meta-analysis of 122 studies confirms that increasing alcohol taxes decreases harmful drinking Community based interventions Alcohol misuse treatment has been shown to reduce frequency and severity of partner violence

12. 5. Legal and justice system interventions Women’s police stations – Mixed evidence Informal justice and rights-based initiatives –Novel strategies being applied in southern countries: mobile courts; working with village dispute resolution systems need to be evaluated Protection Orders –Research from the United States suggests that protective orders do reduce repeat violence for some victims some of the time; no studies have evaluated protective orders in southern countries Pro-arrest policies –Arrest may have a modest effect on recidivism for some men, especially first-time domestic violence offenders with no other history of criminal conduct –No evidence outside of high-income countries

13. Recommendations We need: –national strategies that are tailored around a local understanding of the problem –to implement what works and theoretically-informed best practice, using all entry points possible (building on strategic opportunities of all agencies to achieve impact) –to escalate intervention research –to develop services for victims in tandem with rolling out prevention interventions –to ensure coordination across strategies for maximum impact High level political support globally, nationally and within communities is essential

14. Violence against women is preventable. Let's do it together!!

15. Sources and acknowledgements WHO/LSHTM, 2010 Preventing intimate partner and sexual violence against women. Geneva: WHO http://www.who.int/reproductivehealth/publications/vi olence/en/index.html Heise L, 2012 What works to prevent partner violence http://strive.lshtm.ac.uk/resources/what-works- prevent-partner-violence-evidence-overview Acknowledgements Lori Heise and Charlotte Watts, Centre for Gender Violence and Health, LSHTM