Violence towards a woman from an intimate male partner is often recognized to cause injury, but other common outcomes can include gynecological, and gastrointestinal disorders, as well as mental disorders including suicidal tendencies. These observations were discussed in an Article released on April 4, 2008 in The Lancet.

Previous studies of the health effects of partner violence have been primarily based in clinics, rather than in large populations, and have largely centered in North American and Europe. This small sample size and single population, combined with a difficulty in defining and measuring violence, has made comparisons in this area difficult to make.

To learn more about the effects of intimate partner violence on women’s health, a WHO multi-country study was performed between 2000 and 2003. To do this, WHO and partners from all parts of the globe, led by Dr. Claudia Garcia-Moreno, interviewed almost 25,000 women, aged 15-49 years, in multiple countries including: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania.

The women were asked about any experiences of physical or sexually violent acts by an intimate male partner, past or present, and about the resulting symptoms they experienced, both physically and mentally. Women who had experienced physical or sexual partner violence showed generally poorer health than those who had not. Additionally, within a month of being interviewed, many had specific symptoms such as difficulty walking, trouble performing daily activities, pain, memory loss, dizziness, and vaginal discharge. Additionally, women who had experienced such violence at least once in their lives reported increased emotional distress and suicidal thoughts or attempts, in comparison to women who had never been abused in this way. There was no correlation found between these factors and age, education, or marital status.

A notable association was found between this self-reported poor health in the time leading up to the interview and partner violence occurring at any time in the life of the subject. This suggests that, long after the actual violence has ended, the health effects can remain.

The authors were unable to establish a causal relationship because of the nature of the study. That is, it was not clear if the violence caused poor health, or if women with poor health were more likely to have violent partners. However, previous studies suggest that these health problems are the result of abuse rather than a precursor.

In conclusion, the authors call for more attention to be given to this important health issue. “In addition to being a breach of human rights, the high prevalence of partner violence and its associations with poor health – including implied costs in terms of health expenditures and human suffering – highlight the urgent need to address partner violence in national and global health-sector policies and programmes.”

Riyadh K Lafta, of the Mustansiriya Medical School, Baghdad, Iraq, contributed a Comment in the same issue, in which she analyzed more of the challenges faced by those who want to understand the true impact of such domestic violence. “Accurate and comparable data on violence against women are needed to strengthen advocacy efforts, help policy makers understand the problem, and guide the design of preventive interventions. Unfortunately, data-collection efforts that measure the scope and magnitude of the situation of violence against women are hampered by several factors. These include the influence of social and cultural norms in determining what constitutes violence, changes in reported rates of abuse according to the definition of violence used, the way questions are asked, the type of target population, and the setting of the interview. Under-reporting of violence is a common problem for several reasons: minor injuries might pass without being reported; violence is viewed as normal in certain communities; victims are too frightened of their partners to report the incident; sexual abuse and violence are rarely discussed in certain cultures; and verbal assault, an important type of gender violence, is often overlooked or under-researched. Future studies with a longitudinal cohort design should go further to measure the mortality and life expectancy among women who are victims of intimate-partner violence.”

Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study
Mary Ellsberg, Henrica A F M Jansen, Lori Heise, Charlotte H Watts, Claudia García-Moreno, on behalf of the WHO Multi-country Study on Women’s Health and Domestic Violence against Women Study Team*
Lancet 2008; 371: 1165-72
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Intimate-partner violence and women’s health
Riyadh K Lafta
Lancet 2008; 371: 1140-42
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Written by Anna Sophia McKenney