Summary

• Globally, one third of women and girls experience violence during their lifetime

• Violence against women and girls (VAWG) has significant health, economic and social effects for survivors, perpetrators and society more broadly.

• There is moderate and growing evidence that interventions that seek to prevent VAWG from occurring are cost-effective

• VAWG as a cause area has moderate absorbency for more funding, with a number of potentially promising avenues for funding

• There are several key uncertainties that were identified in this report, concerning the scalability of interventions in this area, how interventions would be received by communities and governments, and the comparative and additional benefit of directly addressing VAWG versus its risk factors.

• Overall, this report recommends that VAWG be considered as a new cause area.

Disclaimer: This report represents a shallow dive into this cause area; approximately 20 hours was spent on this report. With more time, several of the key uncertainties presented through the article might be addressed, and more time would be spent analysing potential opportunities for new organisations and funders in this space. However, I would anticipate that this is unlikely to significantly change how promising VAWG is as a cause area

How big a problem is violence against women and girls?

Nearly one third of women and girls aged 15 years of age or older have experienced either physical or sexual intimate partner violence (IPV) or non-partner sexual violence globally, with 13% (10–16%) experiencing it in 2018 alone (Sardinha et al 2022). This figure does not include a number of areas, including sexual harassment, female genital mutilation, trafficking in women or cyber-harassment (UN Women). It is also likely that this figure, due to chronic under-reporting, underestimates the true burden of VAWG,

 The Global Burden of Disease, which includes information on IPV but not VAWG more generally, reports it as the 19th leading burden of disease globally- it is responsible for 8.5 million DALYs and 68 500 deaths annually. In several countries, violence against women is in top 3-5 leading causes of death for young women aged between 15 and 29 (Mendoza et al 2018). In addition to the direct harms of VAWG, it is a significant risk factor for other conditions- VAWG is responsible for 11% of the DALY burden of depressive disorders and 14% of the DALY burden of HIV in women (Healthdata.org).  

Globally, the rates of VAWG are both alarmingly high and have slightly increased over the last 30 years, despite gains in other areas of women’s health, such as maternal care (Think Global Health). Further, there are certain countries and regions of the world (e.g. several Asian countries) that have seen significant increases in the rates of VAWG over the last two decides (Borumandnia et al 2020).  The geographical distribution is shown in the figure below, which takes data from the 2018 WHO Global Database and which was published in The Lancet earlier in 2022 (Sardinha et al 2022)

What effects do violence against women and girls have?

Health costs of violence against women

The health consequences of VAWG are significant; they can be immediate and acute, long-lasting and chronic, and/or fatal. Some of the most common health consequences of VAWG are summarised in the table below.

PhysicalSexual and reproductive

-Acute or immediate physical injuries, including bruises, lacerations, burns, bites, and fractures

- more serious injuries leading to long term disability, including injuries to head, eyes, ears, chest and abdomen

-Gastrointestinal conditions

- chronic pain conditions

-death, including femicide

-unintended/unwanted pregnancy

-unsafe abortion

-sexually transmitted infections, including HIV

-chronic pelvic infection

-fistula

MentalBehavioural

-depression

-sleeping and eating disorders

-stress and anxiety disorders e.g. PTSD

-self harm and suicide

-harmful alcohol and substance abuse

-having abusive partners later in life

-lower rates of contraceptive and condom use

Collating the evidence for the odds ratio (OR) of VAWG for each of these conditions would be valuable but was not prioritised for this shallow report. Instead, here are a select number of statistics related to the health consequences of VAWG:

• Multiple injuries (e.g., broken bones, facial injuries, eye injuries, head injuries, broken or dislocated jaw) were nearly 3 times more likely to be reported in those who experienced past year IPV compared with women who were never abused (OR 2.75; 95% CI:1.98–3.81) (Anderson et al 2015)

• IPV was correlated with an approximately 1.6 OR of suicidal ideation , and a 2.0 OR of depressive symptoms (Devries et al 2013)

• Survivors of VAWG  are significantly more likely than other women to report overall poor health, chronic pain, memory loss, and problems walking and carrying out daily activities (WHO 2005)

Economic costs of violence against women

In 2016, the global cost of violence against women was estimated by the UN to be US$1.5 trillion, equivalent to approximately 2% of the global GDP (UN Women 2016). The economic cost seems to have two major contributing factors:

• Lost economic productivity due to absenteeism and  lost productivity: A study in Ghana (Merino et al 2019) found that for women experiencing any form of violence, the total days of lost productivity was 26 days per woman in the past 12 months. This translated into nearly 65 million days at the national level or equivalent to 216,000 employed women not working, assuming women worked 300 days in the year. Overall, the economy was estimated to lose output equivalent to 5% of its female workforce not working annually due to VAWG. Similar results have been shown in India and Uganda (Puri 2016)

• Increased utilisation of public services: Survivors of VAWG have increased utilisation of public services, including health services, criminal and civil justice systems, housing aid  and child protection costs, as well as specialist services. The European Institute for Gender Equality estimates that this incurs a similar (if not greater) economic cost than lost productivity.