Population reports: Ending violence against women

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Series L, Number 11 Issues in World Health
HIGHLIGHTS
What lies behind violence?................8
Culture: a double-edged sword.......10
Child sexual abuse is widespread...12
Violence harms women in many
different ways.................................18
*Pullout guide:
What Health Providers Can Do.....21
Responding to violence:
Lessons learned..............................36
Contents
Editors' Summary ................................1
The World Takes Notice....................3
Intimate Partner Abuse.......................5
Sexual Coercion..................................9
Impact on Reproductive Health.......13
Threats to Health and Development18
Health Providers Play a Key Role....26
An Agenda for Change.....................32
Bibliography......................................38
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staff can be reached by e-mail at
change@genderhealth.org or at
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Volume XXVII, Number 4
December 1999
Ending Violence
Against Women
Around the world at least one woman in every
three has been beaten, coerced into sex, or oth-
erwise abused in her lifetime. Most often the
abuser is a member of her own family. Increas-
ingly, gender-based violence is recognized as a
major public health concern and a violation of
human rights.
The effects of violence can be devastating to a woman's reproduc-
tive health as well as to other aspects of her physical and mental
well-being. In addition to causing injury, violence increases
women's long-term risk of a number of other health problems,
including chronic pain, physical disability, drug and alcohol abuse,
and depression. Women with a history of physical or sexual abuse
are also at increased risk for unintended pregnancy, sexually
transmitted infections, and adverse pregnancy outcomes. Yet victims
of violence who seek care from health professionals often have
needs that providers do not recognize, do not ask about, and do not
know how to address.
What Is Gender-Based Violence?
Violence against women and girls includes physical, sexual,
psychological, and economic abuse. It is often known as “gen-
der-based” violence because it evolves in part from women's
subordinate status in society. Many cultures have beliefs, norms, and
social institutions that legitimize and therefore perpetuate violence
against women. The same acts that would be punished if directed at
an employer, a neighbor, or an acquaintance often go unchallenged
when men direct them at women, especially within the family.

2
Two of the most common forms of violence against women are abuse
by intimate male partners and coerced sex, whether it takes place in
childhood, adolescence, or adulthood. Intimate partner abuse,also
known as domestic violence, wife-beating, and battering,is almost
always accompanied by psychological abuse and in one-quarter to
one-half of cases by forced sex as well. The majority of women who are
abused by their partners are abused many times. In fact, an atmosphere
of terror often permeates abusive relationships.
How Health Care Providers Can Help
Health care providers can do much to help their clients who are victims
of gender-based violence. Yet providers often miss opportunities to help
by being unaware, indifferent, or judgmental. With training and support
from health care systems, providers can do more to respond to the
physical, emotional, and security needs of abused women and girls.
First, health care providers can learn how to ask women about violence
in ways that their clients find helpful. They can give women empathy
and support. They can provide medical treatment, offer counseling,
document injuries, and refer their clients to legal assistance and support
services.
Family planning and other reproductive health care providers have a
particular responsibility to help because:
$Abuse has a major,although little recognized,impact on women's
reproductive health and sexual well-being;
$Providers cannot do their jobs well unless they understand how
violence and powerlessness affect women's reproductive health and
decision-making ability;
$Reproductive health care providers are strategically placed to help
identify victims of violence and connect them with other community
support services.
Providers can reassure women that violence is unacceptable and that
no woman deserves to be beaten, sexually abused, or made to suffer
emotionally. As one client said (379), “Compassion is going to open up
the door. And when we feel safe and are able to trust, that makes a lot
of difference.”
Societal Responses
Health workers alone cannot transform the cultural, social, and legal
environment that gives rise to and condones widespread violence
against women. Ending physical and sexual violence requires long-term
commitment and strategies involving all parts of society. Many
governments have committed themselves to overcoming violence
against women by passing and enforcing laws that ensure women's
legal rights and punish abusers. In addition, community-based strategies
can focus on empowering women, reaching out to men, and changing
the beliefs and attitudes that permit abusive behavior. Only when
women gain their place as equal members of society will violence
against women no longer be an invisible norm but, instead, a shocking
aberration.
This report was prepared by Lori Heise, Mary
Ellsberg, Lic. Med. Sci., and Megan
Gottemoeller, MPH, of the Center for Health
and Gender Equity (CHANGE). Bryant Robey,
Editor. Stephen M. Goldstein, Managing Editor.
Vera M. Zlidar, Research Analyst. Design by
Linda D. Sadler. Production by John R. Fiege,
Merridy Gottlieb, Peter Hammerer, and Deborah
Maenner.
The assistance of the following reviewers is
appreciated: Michal Avni, Suzanna Banwell,
Susan Brems, Jackie Campbell, Holly-Fluty
Dempsey, Flor de Maria Giusti, Lauren
Goodsmith, Julia Kim, Sunita Kishor, Michael
Koenig, Mary P. Koss, Laurie Liskin, Sandra L.
Martin, Alice Payne Merritt, Susan A. Notar,
Naana Otoo Oyortey, Patricia Paluzzi, Bertha
Pooley, Malcolm Potts, Vijayendra Rao, Pramilla
Senanayake, Nafissatou Diop-Sidibé, J. Joseph
Speidel, Karen Welch, A. J. Alonzo Wind, and
Cathy Zimmerman.
Suggested citation: Heise, L., Ellsberg, M. and
Gottemoeller, M. Ending Violence Against Women.
Population Reports, Series L, No. 11. Baltimore,
Johns Hopkins University School of Public Health,
Population Information Program, December 1999.
Population Information Program
Center for Communication Programs
The Johns Hopkins University
School of Public Health
Phyllis Tilson Piotrow, Ph.D., Director, Center for
Communication Programs and Principal Investiga-
tor, Population Information Program (PIP)
Ward Rinehart, Project Director, PIP
Anne W. Compton, Deputy Director, PIP, and Chief,
POPLINE Digital Services
Hugh M. Rigby, Associate Director, PIP, and Chief,
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Jose G. Rimon II, Deputy Director, Center for
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Population Communication Services, developing
family planning communication strategies, projects,
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POPULATION REPORTS 3
The World Takes Notice
Violence against women is the most pervasive yet least
recognized human rights abuse in the world. It also is a
profound health problem, sapping women's energy,
compromising their physical health, and eroding their
self-esteem. Despite its high costs, almost every society in
the world has social institutions that legitimize, obscure,
and deny abuse. The same acts that would be punished if
directed at an employer, a neighbor, or an acquaintance
often go unchallenged when men direct them at women,
especially within the family.
For over two decades women's advocacy groups around
the world have been working to draw more attention to the
physical, psychological, and sexual abuse of women and
to stress the need for action. They have provided abused
women with shelter, lobbied for legal reforms, and chal-
lenged the widespread attitudes and beliefs that support
violent behavior against women (209).
Increasingly, these efforts are having results. Today,
international institutions are speaking out against gen-
der-based violence (see box, p. 5). Surveys and studies are
collecting more information about the prevalence and
nature of abuse. More organizations, service providers, and
policy-makers are recognizing that violence against
women has serious adverse consequences for women's
health and for society.
A growing number of reproductive health programs and
practitioners understand that they have a key role to play
in addressing violence, not only in helping individual
victims but also in preventing abuse. As more becomes
known about the scope of gender-based violence and the
reasons behind it, more programs are finding ways to
address it.
What Is Violence Against Women?
The term “violence against women” refers to many types
of harmful behavior directed at women
and girls because of their sex. In 1993 the
United Nations offered the first official
definition of such violence when the
General Assembly adopted the
Declaration on the Elimination of
Violence Against Women. According to
Article 1 of the declaration, violence
against women includes:
Any act of gender-based violence that
results in, or is likely to result in,
physical, sexual or psychological harm
or suffering to women, including threats
of such acts, coercion or arbitrary
deprivations of liberty, whether
occurring in public or private life. (444)
There is increasing consensus, as reflected
in this declaration, that abuse of women
and girls, regardless of where and how it
occurs, is best understood within a
“gender” framework because it stems in
part from women's and girls' subordinate
status in society.
Article 2 of the UN Declaration clarifies
that the definition of violence against
women should encompass, but not be limited to, acts of
physical, sexual, and psychological violence in the family
and the community. These acts include spousal battering,
sexual abuse of female children, dowry-related violence,
rape including marital rape, and traditional practices
harmful to women, such as female genital mutilation
(FGM). They also include nonspousal violence, sexual
harassment and intimidation at work and in school,
trafficking in women, forced prostitution, and violence
perpetrated or condoned by the state, such as rape in war.
This issue of Population Reports focuses principally on two
types of violence: (1) abuse of women within marriage and
other intimate relationships and (2) coerced sex, whether
it takes place in childhood, adolescence, or adulthood.
This focus reflects the types of abuse most dominant in the
lives of women and girls around the world.
Other forms of abuse,such as trafficking in women, rape
during war, female infanticide, and FGM,are also impor-
tant. They are not included in this report, however,
because they deserve separate consideration (see, for
example, Population Reports, Female Genital Mutilation: A
Reproductive Health Concern, Supplement to Series J, No.
41, October 1995). Limiting the focus of the report to
intimate partner violence and sexual coercion makes it
possible to discuss these issues and appropriate program
responses in more depth.
Violence against women is different from interpersonal
violence in general. The nature and patterns of violence
against men, for example, typically differ from those
against women. Men are more likely than women to be
victimized by a stranger or casual acquaintance. Women
are more likely than men to be victimized by a family
member or intimate partner (55, 96, 212, 258, 436). The
fact that women are often emotionally involved with and
financially dependent upon those who abuse them has
profound implications for how women experience violence
and how best to intervene.
Hesperian Foundation (54)
Around the world, a growing number of people are speaking out about the widespread problem of violence
against women, including both physical and psychological abuse by intimate partners and sexual abuse.
Many health providers are getting the message.

POPULATION REPORTS
4
Sample
% of Adult Women Physically
Assaulted by an Intimate Partner
Region, Place & Year of Field
Work (Ref. No.) Coverage Size Popu-
Lation* Age
In Pre-
vious 12
Months
In Cur-
rent Re-
lationship
Ever (in
Any Rela-
tionship)
ARFICA, SUB-SAHARAN
Ethiopia 1995
(110)
..............
Meskanena
Woreda
673
2
15+
10
h
45
Kenya 1984
+
87
(362)
............
Kisii District
612
7
15+
42
Nigeria 1993P
(331)
..............
Not stated
1,000
1
31
a
South Africa 1998 (235) ......... Eastern Cape
Mpumalanga
Northern Province
396
418
465
3
3
3
18+49
18+49
18+49
11b
12b
5b
20b
29b
20b
South Africa 1998 (281) ......... National 5,077 2 15+49 6 13
Uganda 1995+96 (33)............ Lira & Masaka Districts 1,660 2 20+44 41
Zimbabwe 1996 (464)............ Midlands Province 966 1 18+ 17c
ASIA & PACIFIC
Australia 1996 (490).............. National 6,300 1 3c8c
Bangladesh 1992 (407) ........... National (villages) 1,225 2<50 19 47
Bangladesh 1993+95 (422)...... Nasimagar Thana 3,611 2 32
Bangladesh 1993 (255) ........... Jessore & Sirajgonj (rural) 10,368 2 15+49 42d
Cambodia 1996P (325) .......... Phnom Penh & 6 prov. 1,374 3 16
India 1993+94 (233) ............. Tamil Nadu
Uttar Pradesh 859
983 2
215+39
15+39 37
45
India 1995+96 (288) ............. Uttar Pradesh, 5 dist. 6,695 4 15+65 30
India 1999 (496) .................. 6 states 9,938 3 15+49 14e40/26f
Korea, Rep. of 1989 (253)....... National 707 2 20+ 38/12f
New Zealand 1994 (272) ........ National 2,000 617+ 21g35g
Papua N. Guin. 1982 (437) .... National, rural (villages) 628 3** 67
Papua N. Guin. 1984 (366) .... Port Moresby (low income) 298 3** 56
Philippines 1993 (323) .......... National 8,481 5 15+49 10d
Philippines 1998 (57) ............ Cagayan de Oro City &
Bukidnon Province 1,660 2 15+49 26
Thailand 1994 (215).............. Bangkok 619 4 20
EUROPE
Moldova 1997 (410).............. National 4,790 3 15+44 7+ 14+
Netherlands 1986 (383).......... National 989 1 20+60 21/11a,f
Norway 1989P (403) ............. Trondheim 111 3 20+49 18
Switzerland 1994+96 (178)..... National 1,500 2 20+60 6g21g
Turkey 1998 (223)................. E and SE Anatolia 599 1 14+75 58a
United Kingdom 1993P (308) .. North London 430 1 16+ 12a30a
LATIN AMERICA & CARIBBEAN
Antiquea 1990 (200) ............. National 97 1 29+45 30c
Barbados 1990 ( 494)............. National 264 1 20+45 30a,g
Bolivia 1998 (338) ................ 3 districts 289 1 20+ 17a
Chile 1993P (268) ................ Metro. Santiago & prov. 1,000 2 22+55 26/11f
Chile 1997 (312) .................. Santiago 310 2 15+49 23
Colombia 1995 (337) ............ National 6,097 2 15+49 19
Mexico 1996 (363)................ Metro. Guadalajara 650 3 15 27
Mexico 1996P (191) .............. Monterrey 1,064 315+ 17g
Nicaragua 1995 (130) ............ León 360 3 15+49 27/20f52/37f
Nicaragua 1995 (163, 312) ..... Managua 378 3 15+49 33/28f69
Nicaragua 1998 (386) ............ National 8,507 3 15+49 12/8f28/21f
Paraguay 1995+96 (105)......... Nat’l, except Chaco reg. 5,940 3 15+49 10
Peru 1997 (188) ................... Metro. Lima (middle and
low income) 359 2 17+55 31
Puerto Rico 1995+96 (105)..... National 4,755 3 15+49 13b
Uruguay 1997 (440) .............. Montevideo & Canelones 545 2** 22+55 10g
NEAR EAS & NORTH AFIRCA
Egypt 1995+96 (132) ............. National 7,121 3 15+49 16d34b
Israel 1994 (197) .................. West Bank & Gaza Strip
(Palestinians) 2,410 2 17+65 52/37f
Israel 1997P (196)................. Arab, except Bedouin 1,826 2 19+67 32
NORTH AMERICA
Canada 1993 (378)................ National 12,300 118+ 3c,g 29c,g
Canada 1991+92 (367) .......... Toronto 420 1 18+64 27a
Table 1
Physical Assault on
Women by an
Intimate Male
Partner
Selected Population-
Based Studies,
1982+1999
Percentages rounded to whole
numbers
“P” after year indicates the year of
publication for studies not
reporting the field work dates.
*Population of respondents:
1 = all women
2 = currently married/partnered
women
3 = ever-married/partnered
women
4 = married men reporting on
own use of violence against
spouse
5 = women with a pregnancy
outcome
6 = all men reporting on own use
of violence against partners
7 = married women; half with
pregnancy outcome, half
without
**Nonrandom sampling tech-
niques used.
aSample group included women
who had never been in a rela-
tionship and therefore were not in
exposed group.
bRate of partner abuse among
ever-married/ partnered women,
recalculated from author's data.
c Although sample includes all
women, rate of abuse is shown for
ever-married/partnered wo- men
(N not given).
dPerpetrator could be family
member or close friend.
eSevere abuse
fAny physical abuse/severe physical
abuse only
gPhysical or sexual assault
hIn past 3 months
Compiled by the Center for
Health and Gender Equity
(CHANGE) for Population Reports
United States 1995+96 (436)... National 8,000 118+ 1.3a22a

POPULATION REPORTS 5
Intimate Partner Abuse
Worldwide, one of the most common forms of violence against women
is abuse by their husbands or other intimate male partners. Partner
violence occurs in all countries and transcends social, economic,
religious, and cultural groups. Although women can also be violent and
abuse exists in some same-sex relationships, the vast majority of partner
abuse is perpetrated by men against their female partners.
While research into intimate partner abuse is in its early stages, there is
growing agreement about its nature and the various factors that cause it.
Often referred to as “wife- beating,” “battering,” or “domestic violence,”
intimate partner abuse is generally part of a pattern of abusive behavior
and control rather than an isolated act of physical aggression. Partner
abuse can take a variety of forms including physical assault such as hits,
slaps, kicks, and beatings; psychological abuse, such as constant
belittling, intimidation, and humiliation; and coercive sex. It frequently
includes controlling behaviors such as isolating a woman from family and
friends, monitoring her movements, and restricting her access to
resources.
Magnitude of the Problem
In nearly 50 population-based surveys from around the world, 10% to over
50% of women report being hit or otherwise physically harmed by an
intimate male partner at some point in their lives (see Table 1). The data
in Table 1 refer only to women who have been physically assaulted.
Research into partner violence is so new that comparable data on
psychological and sexual abuse by intimate partners are few.
Physical violence in intimate relationships almost always is accompanied
by psychological abuse and, in one-third to over one-half of cases, by
sexual abuse (59, 75, 131, 258, 272). For example, among 613 abused
women in Japan, 57% had suffered all three types of abuse,physical,
psychological, and sexual. Only 8% had experienced physical abuse
alone (485). In Monterrey, Mexico, 52% of physically abused women had
also been sexually abused by their partners (191). In León, Nicaragua,
among 188 women who were physically abused by their partners, only
5 were not also abused sexually, psychologically, or both (131).
Most women who suffer any physical aggression generally experience
multiple acts over time. In the León study, for example, 60% of women
abused in the previous year were abused more than once, and 20%
experienced severe violence more than six times. Among women
reporting any physical aggression, 70% reported severe abuse (130). The
average number of physical assaults in the previous year among currently
abused women surveyed in London was seven (308); in the US in 1997,
three (436).
In surveys of partner violence, women usually are asked whether or not
they have experienced any of a list of specific actions, such as being
slapped, pushed, punched, beaten, or threatened with a weapon. Asking
behavioral questions,for example, “Has your partner ever physically
forced you to have sex against your will?”,yields more accurate
responses than asking women whether they have been “abused” or
“raped” (127). Surveys generally define physical acts more severe than
slapping, pushing, shoving, or throwing objects as “severe violence.”
Measuring “acts” of violence does not describe the atmosphere of terror
that often permeates abusive relationships. For example, in Canada's
1993 national violence survey one-third of women who had been
World Organizations Speak Out
In the 1990s violence against women has emerged as a
focus of international attention and concern:
• In 1993 the UN General Assembly passed the
Declaration on the Elimination of Violence Against
Women, UN Resolution 48/104 (444).
• At both the 1994 International Conference on
Population and Development (ICPD) in Cairo and
the 1995 Fourth World Conference on Women in
Beijing, women's organizations from around the
world advocated ending gender violence as a high
priority (479). The Cairo Programme of Action
recognized that gender violence is an obstacle to
women's reproductive and sexual health and rights,
and the Beijing Declaration and Platform for Action
devoted an entire section to the issue of violence
against women.
• In March 1994 the Commission on Human Rights
appointed the first Special Rapporteur on Violence
Against Women and empowered her to investigate
abuses of women's human rights (479).
• In 1994 the Organization of American States (OAS)
negotiated the Inter-American Convention to
Prevent, Punish and Eradicate Violence Against
Women. As of 1998, 27 Latin American countries
had ratified the convention (82).
• In May 1996 the 49th World Health Assembly
adopted a resolution (WHA49.25) declaring violence
a public health priority (479). WHO is sponsoring,
together with the Center for Health and Gender
Equity (CHANGE) and the London School of
Hygiene and Tropical Medicine, a multicountry
study on women's health and domestic violence.
• In September 1998 the Inter-American Development
Bank (IDB) brought together 400 experts from 37
countries to discuss the causes and costs of domestic
violence, and policies and programs to address it.
The IDB currently funds research and demonstration
projects on violence against women in six Latin
American countries.
• In 1998 UNIFEM launched regional campaigns in
Africa, Asia/Pacific, and Latin America designed to
draw attention to the issue of violence against
women globally (502). UNIFEM also manages The
Trust Fund in Support of Actions to Eliminate
Violence Against Women, an initiative that has
disbursed US$3.3 million to 71 projects around the
world since 1996 (503).
• In 1999 the United Nations Population Fund
declared violence against women “a public health
priority” (445).

POPULATION REPORTS
6
Table 2. Approval of Wife-Beating
Percentage by Rationale, Selected Studies, 1985+1999
Country & Year (Ref. No.) Respondents
She
Neglects
Children
and/or
House
She
Refuses
Him Sex
He
Suspects
Her of
Adultery
She
Answers
Back or
Disobeys
Brazil (Salvador, Bahia) 1999
(348) M
F
,
,
,
,19a
11a
,
,
Chile (Santiago) 1999 (348) M
F
,
,
,
,12a
14a
,
,
Colombia (Cali) 1999 (348) M
F
,
,
,
,14a
13a
,
,
Egypt 1996 (132) Urban F
Rural F 40
61 57
81
,
,59
78
El Salvador (San Salvador) 1999
(348) M
F
,
,
,
, 5a
9a
,
,
Ghana 1999b (23) M
F
,
,43
33
,
,
,
,
India (Uttar Pradesh) 1996 (319) M, , , 10+50
Israel (Palestinians) 1996c
(195) M,28 71 57
New Zealand 1995 (272) M1 1 5d 1e
Nicaragua 1999f (386) Urban F
Rural F 15
25 5
10 22
32
,
,
Papua New Guinea 1985 (39) High school F
High school M
,
,
,
,
,
,59g
63g
Singapore 1996 (83) M,5 33h4
Venezuela (Caracas) 1999 (348) M
F
,
,
,
, 8a
8a
,
,
F = Female M = Male e”She won't do what she is told.”
Note: , indicates this question not asked fAlso, 11% of urban women and 23% of
a”An unfaithful woman deserves to be beaten” rural women agreed “husband is justified
bAlso, 51% of men and 43% of women agreed: in beating” his wife if she goes out without
“husband is justified in beatingª his wife if she his permission.
uses family planning without his knowledge. g”She speaks disrespectfully to him.”
cAlso, 23% agreed “wife-beating is justified” if h”She is sexually involved with another man.” she does
not respect her husband's relatives. Compiled by the Center for Health and Gender
d”He catches her in bed with another man.” Equity for Population Reports
Physically assaulted by a partner said that they
had feared for their lives at some point in the
relationship (378). Women often say that the
psychological abuse and degradation are even
more difficult to bear than the physical abuse
(57, 58, 96).
Dynamics of Abuse
Many cultures hold that men have the right to
control their wives' behavior and that women
who challenge that right,even by asking for
household money or by expressing the needs of
the children,may be punished. In countries as
different as Bangladesh, Cambodia, India,
Mexico, Nigeria, Pakistan, Papua New Guinea,
Tanzania, and Zimbabwe, studies find that
violence is frequently viewed as physical
chastisement,the husband's right to “correct”
an erring wife (10, 39, 94, 189, 204, 233, 303,
341, 407, 488). As one husband said in a fo-
cus-group discussion in Tamil Nadu, India, “If it
is a great mistake, then the husband is justified
in beating his wife. Why not? A cow will not be
obedient without beatings” (233).
Justifications for violence frequently evolve
from gender norms,that is, social norms about
the proper roles and responsibilities of men and
women (94). Typically, men are given
relatively free reign as long as they provide
financially for the family. Women are expected
to tend the house and mind the children and to
show their husbands obedience and respect. If
a man perceives that his wife has somehow
failed in her role, stepped beyond her bounds,
Table 3. Help-Seeking by Physically
Abused Women
Selected Studies, 1993+1999
% of Abused Women Who:
Country & Year (Ref. No.) Never Told
Anyone Contacted
Police Told
Freinds Told
Family
Bangladesh 1993 (255).................. 68 , , 30
Canada 1993 (240)........................ 22 26 45 44
Cambodia 199P (325).................... 34 1 33 22
Chile 1993 (268)........................... 30 16 14 32a
Egypt 1995+96 (132)..................... 47 , 3 44
Ireland 1995P (330) ...................... ,20 50 37
Moldova 1997 (410)...................... , 6 30 31
Nicaragua 1998 (386).................... 37 17 28 34
United Kingdom 1993P (308) ........ 38 22 46 31
a 32% told her family, 21% told his family.
“P” after year indicates year of publication for studies not reporting field work dates.
Compiled by the Center for Health and Gender Equity for Population Reports
or challenged his rights, then he may react violently.
Worldwide, studies identify a consistent list of events that
are said to “trigger” violence. These include: not obeying
her husband, talking back, not having food ready on time,
failing to care adequately for the children or home,
questioning him about money or girlfriends, going some-
where without his permission, refusing him sex, or
expressing suspicions of infidelity (10, 39, 189, 204, 233,
303, 341, 407, 451, 488). All of these constitute transgres-
sion of gender norms.
In many developing countries women share the notion
that men have the right to discipline their wives by using
force (see Table 2). In rural Egypt, for example, at least
80% of women say that beatings are justified under
certain circumstances (132). One of the circumstances
that women most often cite is refusing a man sex (23,
103, 132, 386). Not surprisingly, refusing sex is also one
of the reasons women cite most often as triggering
beatings (248, 322, 475, 488).
Societies often distinguish between just and unjust reasons
for violence, as well as between acceptable and

POPULATION REPORTS 7
unacceptable amounts of aggression. The notion of “just cause”
permeates findings on violence in many countries. Certain
individuals, usually husbands and elders, may have the right to
chastise a woman physically for certain transgressions, but only
within limits. If a man oversteps these limits by becoming too
violent or for beating a woman without “just cause,” others
have cause to intervene (189, 210, 368, 407). As a woman in
Mexico put it, “If I have done something wrong..., nobody
should defend me. But if I haven't done something wrong, I
have a right to be defended” (189).
Even where culture itself grants men substantial control over
female behavior, abusive men generally exceed the norm (240,
382, 386). For example, data from the Nicaragua Demographic
and Health Survey (DHS) show that, among women who were
abused physically, 32% had husbands who scored high on a
scale of marital control compared with only 2% among women
who were not abused physically. The scale included such
behavior as the husband's continually accusing his wife of
being unfaithful and limiting her access to family and friends
(386).
Women's Response to Abuse
Most abused women are not passive victims but use active
strategies to maximize their safety and that of their children
(62, 119, 202, 258). Some women resist, others flee, and still
others attempt to keep the peace by capitulating to their
husbands' demands. What may seem to an observer to be lack
of response to living with violence may in fact be strategic
assessment of what it takes for the woman to survive in the
marriage and to protect herself and her children.
A woman's response to abuse is often limited by the options
available to her (119). Women consistently cite similar reasons
that they remain in abusive relationships: fear of retribution,