Analysis Violence

Gender-Based Violence in Latin America and the Caribbean: What Are the Real Numbers?

Jimena Valades

There is critical importance in documenting acts of violence against women—systematically, carefully, and over time.

This piece is cross-posted from the International Planned Parenthood Federation/Western Hemisphere Region.

If an act of violence is perpetrated, but is never reported or documented, did it happen at all?

Of course the answer is “yes.” There are many reasons why survivors may not report incidents of violence, including fear of retaliation, stigma, or disillusion with law enforcement. Surveys from Costa Rica, Paraguay, and Peru show that up to 20 percent of women experience sexual assault, yet few to none report it to police. And many survivors actually do report incidents of violence but are met with ineffective judicial systems that parlay impunity or data monitoring systems that act like black holes, swallowing up evidence of the tragedy they have endured. Either way, we know that whatever statistics we do have about gender-based violence represent just a fraction of the harsh reality.

It is critically important to document acts of violence against women, systematically, carefully, and over time, not only to bear witness to the human rights abuses that far too many women experience daily worldwide, but also to understand the prevalence, nature, and root causes of such abuses so that we may be more effective in stemming them—both through laws and policies and through prevention and response programs.

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While numerous country-level studies on gender-based violence in Latin America and the Caribbean exist, there is a need for more up-to-date and comprehensive national prevalence data, as well as qualitative research into causes and risk and protection factors. In short, we need to do better at uncovering the full picture of gender-based violence in order to better address it. Further, a persistent lack of comparability between national studies in the region has hampered the ability to draw broader, meaningful conclusions. How do we zoom out to the bigger picture to understand violence regionally—its causes, what has been effective at preventing it, its costs, and more? How can we share successful prevention and response strategies across countries?

A new study released in January by the Pan American Health Organization (PAHO) attempts to do just this, re-analyzing studies from 12 countries in the region and, for the first time, revealing a broader and more in-depth picture of both the prevalence and nature of violence in that part of the world.

While globally it is estimated that one in three women will experience physical, sexual, or psychological violence in her lifetime, this rate is both higher and lower across different areas of Latin America and the Caribbean. For instance, more than half (53 percent) of ever-married women in Bolivia reported having experienced some type of violence by their intimate partner during their lifetime. The rate of intimate partner violence reported was lower, just 17 percent, in the Dominican Republic. Emotional abuse of women by intimate partners is also epidemic region-wide, and is closely linked to the incidence physically abuse. Nearly half (47.8 percent) of women in Nicaragua reported experiencing emotional abuse by a partner in their lifetime.

While more information is needed, we are just now beginning to uncover a picture of the complex root causes and risk factors for violence against women in the region. After controlling for a number of factors in the region, PAHO researchers found that the risk factors most closely associated with violence by a partner include being divorced or separated, having a high number of children, and if a woman’s father was abusive to her mother. This seems like an odd grouping, but it’s a key finding, because it can help direct our attention father up the causal chain of violence to focus our programming efforts on critical risk factors.

Documenting the stories of women who experience various forms of violence, qualitatively, is also important. Last year, the Nobel Women’s Initiative led a fact-finding mission to Mexico, Honduras, and Guatemala to document violence against women—in particular sexual violence perpetrated by the state and the mining industry against women’s human rights defenders.

Women from these countries stepped forward courageously to provide testimony, oftentimes at their own peril, of their experiences of violence—with their sisters bearing witness—enabling new, nuanced documentation of this epidemic.

There have also been other efforts across Latin America to support increased reporting of violence among survivors, such as through the increased establishment of all women police forces and courts specialized to address violence against women issues.

There are many reasons to be hopeful that increased data can help catalyze meaningful change, though there are reality checks left and right. While 97 percent of countries in the region have laws on domestic violence, fewer than half include explicit references to marital rape. In November, after decades of advocacy, the Law Against Violence Against Women was passed in Nicaragua. Yet the country recorded 85 femicides in 2012, and new instances of sexual violence across the region make the news every day.

Despite the persistence of these abuses, the importance of documenting violence against women and collecting sound data remains. As data collection improves and more studies are done documenting this epidemic at the country and regional level, we may actually see what seems like an uptick in violence against women. This may or may not be the case. Since gender-based violence is so often hidden and under-reported, the more we dig, the more we will find. But an accurate picture is essential to the achievement of our end-goal: eliminating all forms of violence against women and girls in Latin America and the Caribbean.

Commentary Sexual Health

The Hidden Reality of Cancer in Latin America and the Caribbean

Mandy Van Deven

In poor countries, cervical cancer is often the most common cancer-related death among women, or even the leading cause of death for women, period.

In Latin America and the Caribbean, cancer is a rapidly growing and increasingly deadly epidemic. A new study published in The Lancet Oncology estimates that by 2030, 1.7 million cases of cancer will be diagnosed in the region, and more than a million people will die from cancer each year. Among the most life threatening—and preventable—of these diseases is cervical cancer, which claims the lives of approximately 300,000 women worldwide each year.

Cervical cancer mortality rates are seven times greater in Latin America and the Caribbean than in North America. In poor countries, many women with cervical cancer reach health services only after the disease has reached an untreatable, advanced stage, condemning them to a painful death. Unlike other non-communicable diseases, cervical cancer has an easy, effective, and inexpensive fix: providing low-cost vaccinations for human papillomavirus (HPV), which is the cause of virtually all cases of cervical cancer, and implementing screening techniques to detect cervical cancer in its early, treatable stages. The number of cervical cancer deaths is particularly alarming because the disease is entirely preventable, treatable, and thus curable.

In Bolivia, where the burden of cervical cancer is high and the health response to solve the problem is low, vaccinating adolescent girls against HPV infection can have a huge impact and save thousands of lives. In partnership with the government and a Gardasil access program, Centro de Investigación, Educación y Servicios has been able to vaccinate more than 75,000 girls at schools, health centers, and mobile clinics. But providing vaccines is only part of the comprehensive strategy that is necessary to fight this disease.

Two years ago, Elba Luz Villalobos Navarro arrived at a mobile clinic in rural El Salvador complaining of severe pain throughout her stomach and pelvis. During an exam, the staff at Asociación Demográfica Salvadoreña (ADS) learned that a doctor in a public health clinic had previously told the 62-year-old woman she displayed signs of cervical cancer. But the doctor failed to adequately explain the severity of this diagnosis or that it required treatment. Elba returned home and the cancer continued to grow—until she could no longer tolerate the pain and sought care from ADS.

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“I thank god for everything they did for me,” said Elba. “Without their help, I would have died.”

Women like Elba who live in developing nations account for more than 80 percent of all new cases of cervical cancer worldwide. In poor countries, cervical cancer is often the most common cancer-related death among women, or even the leading cause of death for women, period. The high cost of screening has proved to be a significant barrier to care for women in low-resource environments, but a recent innovation has made a big difference.

Like Bolivia, Haiti is among the countries with the highest prevalence of cervical cancer in the world. After the 2010 earthquake, Profamil pioneered the use of a low-cost visual inspection technique, which allows medical professionals to detect pre-cancerous legions with the help of a common household item: vinegar.

Visual inspection eliminates the need for laboratories and requires only a small amount of inexpensive equipment. Because it provides women with immediate test results, it is possible to both screen and treat women during the same visit, which is particularly important for women who must travel long distances in order to access health services. Visual inspection is a screening method that was developed specifically for low-resource settings, and it can drastically reduce the incidence of cervical cancer in places like Haiti.

“Early detection and timely treatment are critical to effectively eradicating this preventable disease,” said Dr. Vicente Díaz, deputy director of the International Planned Parenthood Federation/Western Hemisphere Region. “Even one cervical cancer death is too many.”

With proven solutions within reach, we all have an obligation to change the course of this disease in Latin America and the Caribbean by building political will of governments and allocating the resources needed to end this eradicable disease. The question is no longer how but when we will ensure that comprehensive cervical cancer prevention, detection, and treatment programs are available to save the lives of all women, regardless of where they live.

Analysis Violence

Addressing Violence Against Women Living With HIV in Latin America and the Caribbean

Dinys Luciano

Violence against women living with HIV has increasingly been recognized in Latin America and the Caribbean as a key issue, but there remain challenges as well as opportunities to place it at the core of the policymaking process.

“All the women living with HIV in my organization have been subjected to various forms of violence before and after diagnosis, from sexual violence, psychological, economic to institutional violence.”

This was one testimonial from a consultation conducted by the Athena Network and the Global Coalition on Women and AIDS.

Such testimonies of violence are not isolated.

In Chile, 77 out of 100 women have experienced violence, mostly at the hands of partners, fathers, and to a lesser extent strangers.

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In Guatemala, women living with HIV reported that when disclosing their HIV status, they experienced increased violence from their partners, relatives, community members, and service providers.

In Panama, 35 percent of the  82 HIV-positive women involved in a study had been victims of abuse; 33 percent indicated that their family discriminated against them due to their HIV serostatus, 51 percent said that their confidentiality had been violated, and 15 percent stopped going to the HIV Treatment Clinic for that reason.

In El Salvador, 41 percent of women reported at least one form of stigma and discrimination, compared to 34 percent of transgender people and 23 percent of men.

And in the Dominican Republic, 42 percent of women reported physical violence, 37 percent emotional violence, and 22 percent sexual violence from their partners.

Yet, as in all regions, deep gender inequality means that violence against women is not always recognized by those who experience it. Olive Edwards, a facilitator at the Jamaican Community of Positive Women, said, “When we started to have a focused discussion on violence against women living with HIV, the women in our groups (where we usually vent about acts of discrimination) were silenced. … We are bound by a culture of gender inequality and norms that increase our vulnerability to violence and HIV.”

A recent report, the result of a collaboration between the Latin American and Caribbean Movement of Positive Women (MLCM+) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), highlights violence throughout a woman’s life as an important underlying determinant of her vulnerability to HIV.

Drawing on interviews with women living with HIV in 14 countries, the report suggests that women’s vulnerability to HIV and its consequences may be increased by the lack of institutional responses and support to women experiencing violence. Violence within families and communities is normalized, and women internalize this attitude. Fear of violence can influence women’s decisions regarding disclosing their status, accessing services, changing their place of residence, accessing education for their children, participating in the labor market, and in interpersonal relationships with relatives, partners, and neighbors. Importantly, contextual factors such as armed conflict and violence, and racial discrimination are vital when examining the lives of women living with HIV.

How can this gap in awareness best be addressed? Back in 2006, the Center for Women’s Global Leadership found that a key gap is the “lack of systematic mechanisms for mutual learning between women’s organizations and HIV organizations.” Seven years later, this is still the case. When a draft of a document called “Ethical consideration for an integral response to human rights, HIV and violence against women,” published by a project of the Inter-American Commission of Women, was presented to a gathering of women living with HIV in Central America, discussions quickly turned to how the participants feel the wider women’s movement in the region is failing to address the specific issue of violence against women with HIV.

Yet we argue also that the failings are not just within the broader women’s movement; governments too must integrate policies and programs to address violence against women living with HIV within their fiscal policies. In the Latin American and Caribbean region, 23 out of 32 countries reported that they are implementing activities on violence against women as part of their current HIV national strategies. However, only 15 countries currently include a specific budget line for women in their HIV strategic national plan.

Fortunately, there is reason for optimism, given a strong regional history of participatory, community, and human rights work, as well as the political will and momentum evident in a number of initiatives in the region. The Inter-American Commission of Women project called Human Rights, HIV, and Violence Against Women in Central America: Integrated Responses is one such initiative, as are the collaborations between ICW Global and Latina and Development Connections, which have focused on violence against women with HIV since 2007. Organizations of people, and specifically women, living with HIV are taking a stand on violence, including RedBol in Bolivia, Red de Mujeres Guatemaltecas Positivas en Acción, and Genesis Positivo Panama, as are REDLACTRANS, a regional transgender network, and REDTRASEX, a network of sex workers.

Such examples are seeds of hope. Yet given the dimensions and social implications of violence against women living with HIV, urgent measures are still needed to strengthen such initiatives through intersectoral collaboration, research, policy dialogue, and capacity building.

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