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Handbook of WMA Policies
World Medical Association  R-2010-02-2010
WMA RESOLUTION
ON
VIOLENCE AGAINST WOMEN AND GIRLS
Adopted by the 61st
WMA General Assembly, Vancouver, Canada, October 2010
Violence is a worldwide, institutionalised phenomenon, and a complex issue, which
includes many manifestations. The nature of the violence experienced by victims is at least
partly dependent upon the social, cultural, political and economic contexts within which
the victims and their abusers live. Some violence is deliberate, systematic and widespread
while others will experience it in covert circumstances; this is especially true of domestic
violence in settings where women enjoy legislated equal and protected rights to those of
men but culturally still have an increased likelihood of experiencing life-threatening
domestic violence.
There is clear evidence in most countries that men can be and are often the victims of
violence, including intimate partner violence. They are also statistically far more likely to
be the victims of random violence on the streets. Research shows that while men
frequently experience such events, they are not associated with systemic abuse in terms of
denial of rights, which makes the experience of women so much worse in many
cultures. Nothing in this paper suggests that violence against men including boys should
be condoned. Actions to protect women and girls are likely to reduce everyone’s
experience of violence.
DEFINING VIOLENCE
Definitions of violence vary (see footnote), but it is essential that the various forms violence
may take are recognised by policy makers. Violence against women and girls includes
violence within the family, within the community and violence perpetrated by (or condoned
by) the state. Many excuses are given for violence generally and specifically; in cultural
and societal terms these include tradition, beliefs, customs, values and religion. Although
rarely cited the traditional power differential between men and women is also a major
cause.
Within the family and domestic settings violence includes the denial of rights and freedoms
enjoyed by boys and men. This includes female feticide and infanticide, systematic and
deliberate neglect of girls, including poor nutrition and denial of educational oppor-
tunities1
as well as direct physical, psychological and sexual violence. Specific cultural
practices that harm women, including female genital mutilation, forced marriages, dowry
attacks and so-called “honour” killings are all practices that may occur within the family
setting.
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Violence against Women and Girls
Within society, attitudes towards rape, sexual abuse and harassment, intimidation at work
or in education, modern slavery, trafficking and forced prostitution, are all forms of
violence condoned by some societies. One extreme form of such violence is sexual violence
used as a weapon of war. In several recent conflicts (e.g. the Balkans, Rwanda) rape was
both associated with ethnic cleansing and specifically, in some cases, used to introduce
widespread AIDS into a community. The ICRC has examined this issue, and recognises
that sexual violence of this sort may be commonly perpetrated against women and girls.2
Sexual violence or the threat of it can also be used against men, but culturally, women are
more vulnerable and more likely to be targeted. Current conflicts are not based upon battles
fought in far away places, but are increasingly concentrated around dense centres of
population increasing the exposure of women to soldiers and armed groups. In war and in
immediate post-conflict situations, societal fabric can collapse, making women
increasingly vulnerable to group attacks.
Lack of economic independence, and of basic education, also mean that women who
survive abuse are more likely to be or to become more dependent upon the state or society
and less able to support themselves and contribute to that society. Biologically and
behaviourally, women are likely to outlive men; denial of the opportunity to be
economically independent leaves society with a cohort of older, economically dependent
women.
All these forms of violence may be condoned by the state, or it may remain silent on them,
refusing to condemn or act against them. In some cases the state may legislate to allow
violent practices (for example rape within marriage) and itself become a perpetrator.
All human beings enjoy certain fundamental human rights; the examples listed above of
violence against women and girls involve denial of many of those rights, and each abuse
can be examined against the UN convention on human rights (and for children the
Convention on the Rights of the Child).3
In health terms, the denial of rights and the violence itself have health consequences to the
girls and women and to the society of which they are a part. In addition to the specific and
direct physical and health consequences, the general way in which girls and women are
treated can lead to an excess of mental health problems; suicide is the second leading cause
of premature death in women.
CONSEQUENCES OF VIOLENCE
The direct health consequence of the violence depends upon the nature of the act. Female
genital mutilation for example may kill the woman at the time of infliction, may lead to
difficulty in voiding the body of waste products including those of menses, and will give
rise to difficulties in childbearing. It also reinforces the ideological concept of women as
the possessions of men (on its own, a form of abuse) who control their sexuality. Gang rape
or other forms of sexual violence may result in long-term gynaecological, urological and
intestinal difficulties including the development of fistulae and incontinence, which further
diminishes societal support for the abused female.
Handbook of WMA Policies
World Medical Association  R-2010-02-2010
The short and long term mental health consequences of violence may severely influence
later wellbeing, enjoyment of life, function in society and the ability to provide appropriate
care for dependants.
Gathering evidence is an important role for doctors. Currently many countries do not have
mandatory registration of all births, making evidence about infanticide or the effects of
neglect difficult to document. Equally, some countries allow marriage at any age, ex-
posing girls to the high risks associated with childbearing before their own bodies are fully
mature, let alone the mental health risks involved. The health consequences of such poli-
cies and their relationship to other health costs must be better documented.
Denial of good nutritional opportunities leads to generations of women with poorer health,
poorer growth and development leading to women who are less fit to survive pregnancy
and childbirth or to rear their families. Denial of educational opportunities leads to poorer
health for all the family members; good education is a major factor in the mother providing
optimal care for all her family. In addition to being wrong in and of itself, violence against
women is also socially and economically damaging to the family and to society. There are
direct and indirect economic consequences to violence against women that are far greater
than the direct health sector costs.
The costs and consequences of violence, including neglect, against women have been
reported in many fora including by WHO4
. The health consequences to the women, their
children and thus to society are clear and need to be made explicit to policy makers.
WHAT CAN THE WMA DO?
The WMA has a number of policies on violence including the WMA Statement on
Violence and Health and the WMA Statement on Family Violence. This current
(Statement/resolution/ declaration) brings some of these policies together with a
coordinated set of action points for the WMA, NMAs and individual physicians.
As most human beings look first for the advantages to themselves, their families and their
societies in enabling change, making the benefits of change obvious from the beginning
creates a “win:win” solution. Concentrating first on the health aspects, for women, their
children, and the broad family is therefore a useful way to enter the debate.
Doctors have a unique insight into the combined effects upon wellbeing of social, cultural,
economic and political environments. If all persons are to achieve health and wellbeing, all
these factors need to operate positively. The holistic view from doctors can be used to
influence society and politicians. Gaining societal support for improving the rights,
freedom and status of women is essential.
ACTIONS
The WMA:
• Asserts that violence is not only about physical, psychological and sexual violence
but includes abuses such as harmful cultural and traditional practices, and actions
such as complicity in trafficking of women, and is a major public health crisis.
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Violence against Women and Girls
• Recognizes the linkage between better education and other rights for women with
family and societal health and wellbeing and emphasizes that equality in civil
liberties and human rights is a health issue.
• Will prepare briefing and advocacy materials for NMAs to use with national
governments and intergovernmental groups addressing the health and wellbeing
implications of discrimination against women and girls, including adolescents.
This material will include relevant references about the impact of violence on
family wellbeing and on societal financial sustainability.
• Will work with others to prepare and distribute to physicians and other health
workers briefing and advocacy materials dealing with harmful traditional and
cultural practices, including female genital mutilation, dowry, and honour killings,
and emphasizing the health impact as well as the violations of human rights.
• Prepare practical examples of the impact of violence and strategies for reducing it,
such as consensus guidelines that are based upon the best available evidence.
• Will advocate at WHO, other UN agencies and elsewhere for ending discrimination
and violence against women.
• Will work with others to prepare templates of educational materials for use by
individual practitioners for documenting and reporting individual cases of abuse.
• Encourages others to develop free educational materials online to provide guidance
to front line health care workers on abuse and its effects, and on prevention
strategies.
• Encourage legislation that classifies gang rape used as a weapon of war as a crime
against humanity that is eligible for litigation through the jurisdiction of the Inter-
national Criminal Court system.
NMAs should:
• Use and promote the available materials on preventing and treating the
consequences of violence against women and girls and act as advocates within their
own country.
• Seek to ensure that those devising and delivering education to doctors and other
health care workers are aware of the likelihood of exposure to violence, its
consequences, and the evidence on preventative strategies that work, and place
appropriate emphasis on this in undergraduate, graduate and continuing education
of health care workers.
• Recognise the importance of more complete reporting of the sequelae of violence
and encourage the development of training that emphasises violence awareness and
prevention, in addition to using better reporting and research into incidence,
prevalence and health impact of all forms of violence.
• Encourage medical journals to publish more of the research on the complex
interactions in this area, thus keeping it in the professions’ awareness and
contributing to the development of a solid research base and ongoing
documentation of types and incidence of violence.
Handbook of WMA Policies
World Medical Association  R-2010-02-2010
• Encourage medical journals to consider publishing theme issues on violence
including neglect of women and girls.
• Advocate for universal registration of births, and a higher age limit for marriage.
• Advocate for effective implementation of universal human rights.
• Advocate for parental education and support on the care, nurturing, development,
education and protection of children, especially girls.
• Advocate for the monitoring of statistics on children, including both positive and
negative indicators of health and well-being, and social determinants of health.
• Advocate for legislation against specific harmful practices including female
feticide, female genital mutilation, forced marriage, and corporal punishment.
• Advocate for the criminalisation of rape in all circumstances including within
marriage.
• Condemn the use of gang rape as a weapon of war and work with others to
document and report it.
• Advocate for the development of research data on the impact of violence and
neglect upon primary and secondary victims and upon society, and for increased
funding for such research.
• Advocate for the protection of those who speak out against abuse, including
physicians and other health workers.
Physicians should:
• Use the material developed for their education to better inform themselves about
the effects of abuse and the successful strategies for prevention.
• Provide health care and protection to children, (especially in times of crisis) and
document and report all cases of violence against children, taking care to safeguard
the patient’s privacy as much as possible.
• Treat and reverse, where possible, the complications and adverse effects of female
genital mutilation and refer the patient for social support services.
• Oppose the publication or broadcast of victims’ names, addresses or likenesses
without the explicit permission of the victim.
• Assess for risk of family violence in the context of taking a routine social history.
• Be alert to the association between current alcohol or drug dependence among
women and a history of abuse.
• Support colleagues who become personally involved in work to end abuse.
• Work to establish the necessary relationship of trust with abused women and
children including respect for confidentiality.
• Support global and local action to better understand the health consequences both
of abuse and of the denial of rights, and advocate for increased services for victims.
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Violence against Women and Girls
1
At first glance neglect does not seem to equate with violence. But the acceptance of neglect and
the lesser rights given to women and girls are major factors in reinforcing an acceptance of causal
and systematic violence. In that it denies basic rights, many would classify neglect as a form of
violence in and of itself.
2
Rape is considered to be a method of warfare when armed forces or groups use it to torture, in-
jure, extract information, degrade, displace, intimidate, punish or simply to destroy the fabric of the
community, The mere threat of sexual violence can cause entire communities to flee their
homes. from Women and War, ICRC 2008
3
Women’s Health and Human Rights: the Promotion and Protection of Women’s Health through
International Human Rights Law. Rebecca Cook. Presented at the 1999 Adapting to Change Core
Course
4
Women and Health: Today’s Evidence, Tomorrow’s Agenda. WHO November 2009. ISBN 978
92 4 156385 7