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Implications of Gender Violence for Health And CWbLbPPe as Public Disclosure Authorized .2--55 121U World Bank Discussion Papers Public Disclosure Authorized -Violence Against W;Vonmen The Hidden Health Burden Public Disclosure Authorized Lori L. Heise XXT;t ofl lllif Pit-ancrivu *andJ Ad n'en e rm ai n J and Adrienne Germain Public Disclosure Authorized Recent World Bank Discussion Papers No. 1'9' l9 rrtnor Chnrershipa/ofAdjitenit Pl'rrants andtthefl'hnnal El2onoy *iRer.;m Joiui -I Johnson ard Subliman S. Wasw No. 2(3 S,ociallyniatnecture Consrnacrionin the .Sahel:Optionsf ir Improvuik Current Practices.Beniard Abcil; and Jean-Marie Lanrtrn No. 2111 1 Trbariizatin.. AgricuwlsralDrivedlopment. and Land.-llioation. I)ip;ias Blhadra arid Antznuio SalazarPR Br2ndlo No. 2(12 AlakzngAlodnOd &rfr Anic Tinkcr and Marjone A. Koblinskv No. 2(13 Poerrry Reductionin East.4sia: TlheSilent Revolution. FndaJohanscn No. 2134 MUana.ginthke C-itil Sevtcen:77li Les,in. ol-Re/orn in IndiustrialCouuitnes. Iarbara Nuiberg No. 2115 1ksitniug a Systen of labor Market Statisticsand lnjormnation.Robhrt S. Goldfiarband Arvil V. Adamis No. 21(6 Informiaion echinologyira Wl-orldBatik lxudirn : Increasingthe Developmental Impact. Nalg Hanna and Sandor boySon No. 2117 Pr-oceedingso.fa Confrrence on C:urency Substiiurion and Currency Boardj. Edited by Nissan Liviatan No. 2(08 DevelopingeEI&ertive Em:rplolyment Serv'ices. i)avid Fretwell and Susan Goldberg No. 2119 l:r'obviri Legal Iramenorksfi.r PrivateSector Derelopnrrenrin Central and EasternlEurope. Cheryl W- Gray and AssociatEs No. 21(1 .M1arneBiotecihtnolqgy and 1X veeIspir, countries. Raymond A. Zilinskas and Carl Gustaf Lundin No. 211 Reriealizint. AqtricrltUral Researchlin dheSalel: A. PrtposedFramewvorkifir Action. Jan Wcijenberg. Josut~Dionie. Michacl Fuchs-Carsch. Adolphe Kn. and Jacques Lerort No. 212 InstitutrionalOptions rr tie Prevision oj !fh srnctrure.Christine Kcssides No. 213 nTe(Contributions ofinfiustrutaure to EFconoic Dleelopmnent:A Reieu-of Experienceand Political Implicarions. Christine Kcssidcs No. 214 Fromn.- lacroeconomicCorrection to Public SectorReform: The Critical Role of Evaltiation.Eduardo Wiesncr D. No. 215 Ch'ina: Reforn ard Devfelopmeitin 1992-93. Pctcr Harrold and lkajiv LII No. 216 The RefornmofPublic ErpperditiuresforAgricdtkure. Bonni van Blarcomn.Odin Knudscn. andJohn Nash No. 217 .M1anagingFishery Resoulrres:Proceedings of a SymposiiumCo-Sponsored by tile WtorldBank and Prruvian M1inistryof Fisleries heldin lima, Peru.June 1992. Eduardo A. Loayza No. 218 Cooperatites and the Breakupof Lar.e MerchanizedFarms: ThcoreticalPerspectives and Empirical Evidence.Klaus W. I)einingcr No. 219 De'elop-menr.f Rural FinancialM arketsin aSub-Saharan.Afiica SabapathyThillairajah No. 22(1 7he M1aritimeTransport Crisis. HansJ. Peters No. 221 Policy-Based Finanice: theE.xperience ofPostuwarjapar. ThcJapanese Devclopment Bank and The Japan Economic Research Institutc No. 222 MllacrocconomicManagement in China: Proccedingesof a Conferencein DalianrJune 1993. Edited by Pctcr Harrold. E. C. Hva. and Lou jiwci No. 223 fire Development ofrkic Private Sector in a Small LEconiomyin Transition: nheCase of Monqolia. Hongijoo Hahm No. 224 Towardan EnvironmentalStrategyfor Asia. Carter Brandon and RarmeshRamankuty No. 225 "rFortressEuzrope and Other XMythsabout 7Trade:Potliies toward'Merdctandise lrnportsin tlle EC and Other Mlfajor IndustrralEconomnies (and Whlat They Mteanfor DevelopingCountries). Jean Bancth No. 226 Mlfongolia:Finanrcirn? Education durin. E conomicTransition. Kin Bing Wu No. 227 Cities wititout Land Mklarkets:Lessons oft/re railed SocialistExperiment. Alain Bertaud and Bcrtnnd Rcnaud (Continued on the inside back cover.) 2 55 1231World Bank Discussion Papers V iolence Against Wvomen The Hidden Health Burden Lori L. Heise with Jacqueline Pitanguy and Adrienne Germain The World Bank Washington, D.C. Copyright C 1994 The International Bank for Reconstruction and Development/THE WORLDBANK 1818 H Street, N.W. Washington, D.C. 20433, U.S.A. All rights reserved Manufactured in the United States of America First printingjuly 1994 Discussion Papers present rcsults of country analysisor research that are circulated to cncourage discussion and commnentwithin the development community. To prescnt these results witl the least possible delay, the typescript of this paper has not been prepared in accordance with the procedures appropriate to fornal printed texts, and the World Bank accepts no responsibility for errors. Some sources cited in this paper may be informal documents that are not readily available. The findings, interpretations, and condusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affliated organizations, or to members of its Board of Executive Directors or the countries they represent. The World Bank does not guarantee the accuracy of the data induded in this publication and accepts no responsibility whatsocver for any consequence of their use. Any maps that accompany the text have been prepared solely for the convenience of readers; the designations and presentation of material in them do not imply the expression of any opinion whatsoever on the part of the World Bank, its affiliates,or its Board or member countries concerning the legal status of any country, territory, city, or area or of the authorities thereof or concerning the delimitation of its boundaries or its national affliation. The naterial in this publication is copyrighted. Requests for permission to reproduce portions of it should be sent to the Office of the Publisher at the address shown in the copyright notice above. The World Bank encourages dissernination of its work and will normally give permission promppdyand, when the reproduction is for noncommercial purposes, without asking a fee. Pernission to copy portions for clIssroom use is grnted dtrough the Copyright Clearance Center, Inc., Suite 910, 222 Rosewood Drive, D:nvers, Massachusetts01923, U.SA. The complete baddist of publications from the World Bank is shown in the annual Index of PAiblications, which contains an alphabetical tide list (with full ordering information) and indexes of subjects, authors, and countries and regions. The latest edition is available free of charge from the Distribution Unit, Office of the Publisher, The Wodd Bank, 1818 H Street, N.W., Washington, D.C. 20433, U.S.A., or from Publications, The Wodd Bank, 66, avenue d'1ena, 75116 Paris, France. ISSN: 0259-210X Lori L. Heise is director of dte Violence, Health and Development Project, Pacific Institute for Womreis Health, Washington, D.C. jacqueline Pitanguy is president and founder of CEPIA (Ctizenship, Studies, Infonnation and Action), Rio dejareiro, Brazil. Adrienne Germain is vice president of the International Women's Health Coalition, New York. At the time of writing, al were consultants to the World Bank's Population, Health and Nutrition Department Library of Congress Cataloging-in-Publication Data Heisi, Lori. Violence against women: the hidden health burden / Lori L. Heise withjacqueline Pitanguy and Adrienne Germain. p. cnL - (World Bank discussion papers ; 255) Includes bibliogrphical references (p. ). ISBN 0-8213-2980-4 1. Wife abuse-Health aspects. 2. Wouien-Crimes against-Health aspects. 3- Sex crimes-Health aspects. I. Pitanguy, Jacqueline. [I. Germain, Adrienne. III. International Bank for Reconstruction and Dcvclopment [V. Tide. V. Serics. HV6626.H38 1994 362.1'968582200973-dc2O 9427745 CIP "Wife beating is an accepted custom ...we are wasting our time debating the issue." Comment made by parliamentarian duringfloor debates on wife battering in Papua New Guinea ("Wife Beating," 1987). 'A wife marriedis like a pony bought;rIll ride her and whip her as I like." Chinese proverb (Croll 1980). "Women should wear purdah [head-to-toe coverini to ensure that innocent men do not get uecessarily excited by women's bodies and are not unconsciously forced into becoming rapists. If women do not want to fall prey to such men, they should tske the necessary precautions instead of forever blaming the men." Comment made by a parliamentarian of the ruing BanrsanNational Party duringfloor debates on reform of rape laws in Malaysia (Heise 1991). 'The boys never meant any harm to the girls. They just wanted to rape." Statement by the deputy principal of St. Kizito's boarding school in Kenya after 71 girls were raped and 19 others died in an attack by boys in the school ascribed to the girls' refusal to join them in a strike against the schol's headnaster (P'rlez 1991). Breast bruised, brains battered, Skin scarred, soul shattered, Can't scream-neighbors stare, Cry for help-no one's there. Stanza from a poem by Nenna Nehru, a battered Indian woman (APDC 1989). "The child was sexually aggressive." Justification given by a judge in British Colwnbia, Canada, for suspending the sentence of a 33-year-old man who had sexually assaulted a three-year-old girl (Canada, House of Commons 1991). "Are you a virgin? If you are not a virgin, why do you complain?This is normal." Response by the assistant to the public prosecutor in Peru when nursing student Betty Fernande reportedbeing sexually molested by police officers while in custody (Kirk 1993). u.l Contents Foreword vii Acknowledgments viii Abstract ix 1. Introduction 1 2. The scope and evolution of the problem 3 Definition of violence against women 3 Dimensions of the problem 4 3. A primer on violence against women 14 4. Health consequences of gender-based violence 17 Health effect of abuse
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