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Domestic violence is often hidden behind closed and shuttered windows & doors, well away from public view. Occasionally, we may hear a muffled scream, or see the effects of faded golden and purple bruises of a woman or young girl who "walked into a door" or "fell down those stairs...again." Regardless of many years of effort to increase public awareness of domestic violence, its still regarded as a private matter between intimate partners; simply none of our business, and are often told to keep our noses out!

Eventually, police and paramedics arrive at the home of the shuttered windows from which those muffled screams could be heard, but no one cared enough to call 9-1-1; there the police and medics find a woman or young girl often beaten beyond recognition. Pacing about would be the perpetrator, blaming the woman/girl for her part in causing him to get angry. He's hauled off in handcuffs, she's taken to the local hospital ER for treatment.

The Violence Against Women Act, which provides funding to help victims of domestic violence, was signed into law by President Bill Clinton in 1994; following a protracted stall in Congress, President Obama signed into law the re-authorized Violence Against Women Act (VAWA) on March 7, 2013.

If you know someone who may be in need assistance call the National Domestic Violence hotline at 1-800-799-SAFE.

Key Facts About Intimate Partner Violence

• Violence against women - particularly intimate partner violence and sexual violence against women - are major public health problems and violations of women's human rights.
• A WHO multi-country study found that between 15-71% of women aged 15-49 years reported physical and/or sexual violence by an intimate partner at some point in their lives.
• These forms of violence can result in physical, mental, sexual, reproductive health and other health problems, and may increase vulnerability to HIV.
• Risk factors for being a perpetrator also include low education, past exposure to child maltreatment or witnessing violence in the family, harmful use of alcohol, attitudes accepting of violence and gender inequality.
• Risk factors for being a victim of intimate partner and sexual violence include low education, witnessing violence between parents, exposure to abuse during childhood and attitudes accepting violence and gender inequality.
• In high-income settings, school-based programmes to prevent relationship violence among young people (or dating violence) are supported by some evidence of effectiveness.
• In low-income settings, other primary prevention strategies, such as microfinance combined with gender equality training and community-based initiatives that address gender inequality and communication and relationship skills, hold promise.
• Situations of conflict, post conflict and displacement may exacerbate existing violence and present new forms of violence against women.

Introduction

The United Nations defines violence against women as "any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life."

Intimate partner violence refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.

Sexual violence is any sexual act, attempt to obtain a sexual act, or other act directed against a persons sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. It includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part or object.

Scope of the problem

Population-level surveys based on reports from victims provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence in non-conflict settings. The WHO Multi-country study on women's health and domestic violence against women in 10 mainly developing countries found that, among women aged 15-49:

• between 15% of women in Japan and 71% of women in Ethiopia reported physical and/or sexual violence by an intimate partner in their lifetime;
• between 0.3-11.5% of women reported experiencing sexual violence by a non-partner since the age of 15 years;
• the first sexual experience for many women was reported as forced - 17% in rural Tanzania, 24% in rural Peru, and 30% in rural Bangladesh.

Intimate partner and sexual violence are mostly perpetrated by men against girls and women. Child sexual abuse affects boys and girls. International studies reveal that approximately 20% of women and 5-10% of men report being victims of sexual violence as children.

Population-based studies of relationship violence among young people (or dating violence) suggest that this affects a substantial proportion of the youth population. For instance, in South Africa a study of people aged 13-23 years found that 42% of females and 38% of males reported being a victim of physical dating violence.

Risk factors

Factors found to be associated with intimate partner and sexual violence occur within individuals, families and communities and wider society. Some factors are associated with being a perpetrator of violence, some are associated with experiencing violence and some are associated with both.

Risk factors for both intimate partner and sexual violence include:

• lower levels of education (perpetration of sexual violence and experience of sexual violence);
• exposure to child maltreatment (perpetration and experience);
• witnessing family violence (perpetration and experience );
• antisocial personality disorder (perpetration);
• harmful use of alcohol (perpetration and experience);
• having multiple partners or suspected by their partners of infidelity (perpetration); and
• attitudes that are accepting of violence and gender inequality (perpetration and experience).

Factors specifically associated with intimate partner violence include:

• past history of violence ( perpetration and experience;
• marital discord and dissatisfaction (perpetrators and victims).

Factors specifically associated with sexual violence perpetration include:

• beliefs in family honour and sexual purity;
• ideologies of male sexual entitlement; and
• weak legal sanctions for sexual violence.

The unequal position of women relative to men and the normative use of violence to resolve conflict are strongly associated with both intimate partner violence and non-partner sexual violence.

Health consequences

Intimate partner and sexual violence have serious short- and long-term physical, mental, sexual and reproductive health problems for survivors and for their children, and lead to high social and economic costs.

• Health effects can include headaches, back pain, abdominal pain, fibromyalgia, gastrointestinal disorders, limited mobility and poor overall health. In some cases, both fatal and non-fatal injuries can result.
• Intimate partner violence and sexual violence can lead to unintended pregnancies, induced abortions, gynaecological problems, and sexually transmitted infections, including HIV. Intimate partner violence in pregnancy also increases the likelihood of miscarriage, stillbirth, pre-term delivery and low birth weight babies.
• These forms of violence can lead to depression, post-traumatic stress disorder, sleep difficulties, eating disorders, emotional distress and suicide attempts.
• Sexual violence, particularly during childhood, can lead to increased smoking, drug and alcohol misuse, and risky sexual behaviours in later life. It is also associated with perpetration of violence (for males) and being a victim of violence (for females).

Impact on children

• Children who grow up in families where there is violence may suffer a range of behavioural and emotional disturbances. These can also be associated with perpetrating or experiencing violence later in life.
• Intimate partner violence has also been associated with higher rates of infant and child mortality and morbidity (e.g. diarrhoeal disease, malnutrition).

Social and economic costs

The social and economic costs of intimate partner and sexual violence are enormous and have ripple effects throughout society. Women may suffer isolation, inability to work, loss of wages, lack of participation in regular activities and limited ability to care for themselves and their children.

Prevention and response

Currently, there are few interventions whose effectiveness has been proven through well designed studies. More resources are needed to strengthen the prevention of intimate partner and sexual violence, including primary prevention, i.e. stopping it from happening in the first place.

Regarding primary prevention, there is some evidence from high income countries that school-based programmes to prevent violence within dating relationships have shown effectiveness. However, these have yet to be assessed for use in resource-poor settings. Several other primary prevention strategies: those that combine microfinance with gender equality training; that promote communication and relationship skills within communities; that reduce access to, and harmful use of alcohol; and that change cultural gender norms, have shown some promise but need to be evaluated further.

To achieve lasting change, it is important to enact legislation and develop policies that protect women; address discrimination against women and promote gender equality; and help to move towards more peaceful cultural norms.

An appropriate response from the health sector can play an important role in the prevention and response to violence . Sensitization and education of health and other service providers is therefore another important strategy. To address fully the consequences of violence and the needs of victims/survivors requires a multi-sectoral response.

WHO Response to Partner Violence

WHO, in collaboration with a number of partners, is:

• building the evidence base on the scope and types of intimate partner and sexual violence in different settings and supporting countries' efforts to document and measure this violence and its consequences This is central to understanding the magnitude and nature of the problem at a global level;
• strengthening research and research capacity to assess interventions to address partner violence
• developing technical guidance for evidence-based intimate partner and sexual violence prevention and for strengthening the health sector responses to such violence;
• disseminating information and supporting national efforts to advance women's rights and the prevention of and response to intimate partner and sexual violence against women; and
• collaborating with international agencies and organizations to reduce/eliminate intimate partner and sexual violence globally.

Following Reproduced from CNN reporting on recent events surrounding the Vioence Against Women Act

Washington (CNN) -- An expanded Violence Against Women Act won bipartisan approval on Thursday from the U.S. House after Republicans failed to pass their own proposal due to a party split on an issue important to women and minority groups.

The measure was passed by President Barack Obama, who said in a statement that it was "an important step towards making sure no one in America is forced to live in fear." March 7, 2013.

VAWA was originally passed in 1994 and reauthorized since

The act provides support for organizations that serve domestic violence victims. Criminal prosecutions of abusers are generally the responsibility of local authorities, but the act stiffened sentences for stalking under federal law. Supporters credit the act with sharply reducing the number of lives lost to domestic violence over the past two decades. In 2012, the House and Senate were unable to compromise on another extension of the act, with Republicans opposing Democratic attempts to specify inclusion of native Americans, undocumented immigrants and lesbian, transgender and bisexual women.

The plague of violence against women

The Senate version includes legal precedents of expanded sovereignty that could be subject to court challenge.

According to advocacy groups, the Senate version of the Violence Against Women Act approved Tuesday strengthens protections of particular groups of women at particular risk. For example, one in three native women will be raped in their lifetime, according to the Indian Law Resource Center. Three in five will be physically assaulted, and native women also are killed at a rate 10 times the national average, the center said. The National Congress of American Indians addressed the issue in a December 20 letter to Cantor.

Beyond vomiting, how to prevent rape

It described situations in which beatings and rapes by non-native men were declined for prosecution at a federal level and returned to a tribal court as a misdemeanor. Federal law currently prohibits tribal courts from imposing a jail sentence of more than a year, so they generally do not prosecute felonies. In many instances, such cases are dismissed altogether and a defendant can walk free until a grand jury indictment can be obtained. "The federal criminal justice system is simply not equipped to handle local crimes, and this is the primary reason that tribes seek local control over these crimes that are plaguing our communities," the letter said. On undocumented immigrants, Human Rights Watch has found that immigrant farm workers are especially at risk for domestic abuse and argued provisions in the Senate bill "would go some way toward fixing the problem." Those in the LGBT community are another high-risk group that will be affected by the Violence Against Women Act. They experience violence at the same rate as heterosexuals but are less likely to report it. When they do, many are denied services. About 45% of LGBT victims were turned away when they sought help from a domestic violence shelter and nearly 55% of those who sought protection orders were denied them, according to the National Task Force to End Sexual and Domestic Violence Against Women.

Vice President Joe Biden, who helped spearhead the original Violence Against Women Act in 1994 when he was a U.S. senator, said Thursday that domestic violence dropped by 64% since then. "I am pleased that this progress will continue, with new tools for cops and prosecutors to hold abusers and rapists accountable, and more support for all victims of these crimes," Biden said in a statement. See Vice President Biden's Report on Violence Against Women Act here>> (PDF)

CNN's Moni Basu contributed to this report.