Intimate partner violence against women is a global public health problem with many short-term and long-term effects on the physical and mental health of women and their children. The Sustainable Development Goals (SDGs) call for its elimination in target 5.2. To monitor governments’ progress towards SDG target 5.2, this study aimed to provide global, regional, and country baseline estimates of physical or sexual, or both, violence against women by male intimate partners.
Methods
This study developed global, regional, and country estimates, based on data from the WHO Global Database on Prevalence of Violence Against Women. These data were identified through a systematic literature review searching MEDLINE, Global Health, Embase, Social Policy, and Web of Science, and comprehensive searches of national statistics and other websites. A country consultation process identified additional studies. Included studies were conducted between 2000 and 2018, representative at the national or sub-national level, included women aged 15 years or older, and used act-based measures of physical or sexual, or both, intimate partner violence. Non-population-based data, including administrative data, studies not generalisable to the whole population, studies with outcomes that only provided the combined prevalence of physical or sexual, or both, intimate partner violence with other forms of violence, and studies with insufficient data to allow extrapolation or imputation were excluded. We developed a Bayesian multilevel model to jointly estimate lifetime and past year intimate partner violence by age, year, and country. This framework adjusted for heterogeneous age groups and differences in outcome definition, and weighted surveys depending on whether they were nationally or sub-nationally representative. This study is registered with PROSPERO (number CRD42017054100).
Findings
The database comprises 366 eligible studies, capturing the responses of 2 million women. Data were obtained from 161 countries and areas, covering 90{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of the global population of women and girls (15 years or older). Globally, 27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (uncertainty interval [UI] 23–31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of ever-partnered women aged 15–49 years are estimated to have experienced physical or sexual, or both, intimate partner violence in their lifetime, with 13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (10–16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) experiencing it in the past year before they were surveyed. This violence starts early, affecting adolescent girls and young women, with 24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 21–28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of women aged 15–19 years and 26{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (23–30{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of women aged 19–24 years having already experienced this violence at least once since the age of 15 years. Regional variations exist, with low-income countries reporting higher lifetime and, even more pronouncedly, higher past year prevalence compared with high-income countries.
Interpretation
These findings show that intimate partner violence against women was already highly prevalent across the globe before the COVID-19 pandemic. Governments are not on track to meet the SDG targets on the elimination of violence against women and girls, despite robust evidence that intimate partner violence can be prevented. There is an urgent need to invest in effective multisectoral interventions, strengthen the public health response to intimate partner violence, and ensure it is addressed in post-COVID-19 reconstruction efforts.
Funding
UK Department for International Development through the UN Women–WHO Joint Programme on Strengthening Violence against Women Data, and UNDP-UN Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, a cosponsored programme executed by WHO.
Introduction
Intimate partner violence against women is a grave human rights violation and serious global public health concern.
Global health. The global prevalence of intimate partner violence against women.
This violence refers to physically, sexually, and psychologically harmful behaviours in the context of marriage, cohabitation, or any other form of union, as well as emotional and economic abuse and controlling behaviours.
Intimate partner violence can have major short-term and long-term physical and mental health effects, including injuries, depression, anxiety, unwanted pregnancies, and sexually transmitted infections among others, and can also lead to death.
Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.
It is estimated that 38–50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of the murders of women are committed by intimate partners globally.
The COVID-19 pandemic and its associated control measures (ie, lockdowns, mobility restrictions, and curfews) are further exacerbating the already heavy burden of intimate partner violence.
Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series.
The 2030 UN Agenda for Sustainable Development Goals (SDGs), adopted by member countries in 2015, calls for the elimination of violence against women and girls—namely through target 5.2 under goal 5 on gender equality and women’s empowerment.
UN Goal 5: achieve gender equality and empower all women and girls.
The first indicator of this target (5.2.1) specifically focuses on intimate partner violence, requiring countries to regularly report on “the proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner”.
UN Goal 5: achieve gender equality and empower all women and girls.
To understand the true magnitude of the problem and to monitor the progress made globally and by countries individually in addressing violence against women, it is crucial to establish a baseline for the global, regional, and national prevalence estimates of intimate partner violence. The regular collection, analyses, and reporting of robust comparable data is the first necessary step to develop targeted evidence-based, effective, and sustainable intersectoral interventions, policies, and programmes aimed at preventing violence against women. In the last decade, there has been a substantial increase in the number of nationally representative population-based surveys collecting data on intimate partner violence.
A framework to model global, regional, and national estimates of intimate partner violence.
However, the measurement of intimate partner violence across surveys still shows notable variations in the quality of the surveys and types of measures used; for example, the definitions and items used to measure physical, sexual, psychological and other forms of intimate partner violence; women sampled (eg, ever-partnered, currently partnered only, or all women); age groups; and whether current or previous partners are included, making comparability across studies and countries challenging.
A framework to model global, regional, and national estimates of intimate partner violence.
Rigorous statistics and estimates on intimate partner violence that adjust for these variations are key to improving understanding of its prevalence, nature, and effect, and how these differ across age groups, countries, and regions.
The objective of this study is to provide baseline reliable and internationally comparable global, regional, and national prevalence estimates of lifetime and past year physical or sexual, or both, intimate partner violence by male partners against ever-partnered women, based on an analysis of data from population-based studies and surveys conducted between 2000 and 2018.
Results
The WHO Global Database contains 359 studies with information on lifetime intimate partner violence. For this analysis, two studies were excluded because they contained information on psychological violence only, 23 studies were excluded because they did not use act-specific questions, and 27 studies were excluded because they were outside of the study period (2000–18). A total of 307 studies were analysed for the lifetime intimate partner violence prevalence.
The Global Database contains 392 studies with infor-mation on past year intimate partner violence. Two studies were excluded because they contained information on psychological violence only, 29 studies were excluded because they did not use act-specific questions, and 29 studies were excluded because they were outside of our study period (2000–18). A total of 332 studies were analysed.
There were 307 unique studies conducted between 2000 and 2018, from 154 countries and areas, totalling 1 767 802 unique women responses, that were included to estimate the lifetime prevalence of physical or sexual, or both, intimate partner violence against women aged 15 years and older. The estimates for violence that occurred within the past year were informed by 332 studies from 159 countries and areas and 1 763 989 individual responses. In total, 366 unique studies from 161 countries and areas with data on lifetime or past year, or both, intimate partner violence underpin these estimates. For both time periods, these studies were representative of 90{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of the world’s population of ever-partnered women and girls aged 15 years and older.
A framework to model global, regional, and national estimates of intimate partner violence.
The results for the regional analyses by SDG and WHO regions are available in the appendix (pp 3–5). The study characteristics are displayed in table 2.
Table 2Characteristics of included studies on lifetime and past year intimate partner violence conducted between 2000 and 2018
Data presented as n or n/N ({e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}).
Globally, 27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 23–31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of ever-partnered women aged 15–49 years are estimated to have experienced physical or sexual, or both, intimate partner violence at least once in their lifetime (table 3). Among ever-partnered women aged 15 years and older, 26{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (22–30{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) are estimated to have experienced intimate partner violence at least once in their lifetime.
Table 3Global prevalence estimates of lifetime and past year physical or sexual, or both, intimate partner violence among ever-married or ever-partnered women, by age group, in 2018
Data presented as {e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (uncertainty interval {e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}).
Globally, it is estimated that 13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 10–16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of ever-partnered women aged 15–49 years have experienced physical or sexual violence, or both, from an intimate male partner within the year preceding the survey interview. This estimate is 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (8–12{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) for women aged 15 years and older.
The age disaggregated prevalence of physical or sexual, or both, intimate partner violence shows that such violence is already highly prevalent in the youngest age cohort (table 3, figure 1). Almost one in four ever-partnered adolescent girls between the ages of 15 and 19 are estimated to have experienced physical or sexual violence, or both, from an intimate partner since age 15 (24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 21–28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}). The estimated lifetime prevalence of intimate partner violence is high at 26–28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} for women between the ages of 20 and 44 years and is comparatively lower among women older than 60 years, at 23{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (19–31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) for those aged 60–64 years and 23{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (18–30{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) for those aged 65 years and older. The prevalence estimates among the older age groups need to be interpreted with caution given their overlapping UIs. As with lifetime prevalence, physical or sexual, or both, intimate partner violence in the past year was highest among the youngest age cohorts: 16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 14–19{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) among those aged 15–19 years and 16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (13–19{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) among those aged 20–24 years. The estimated prevalence of this type of violence within the past year was substantially lower among ever-partnered women aged 50 years and older, and was lowest among women aged 60–64 years (5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 4–7{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and those aged 65 years and older (4{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 3–7{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}).
Figure 1Global prevalence estimates of lifetime and past year physical or sexual, or both, intimate partner violence among ever-married or ever-partnered women, by age group, in 2018
Regional variations by the Global Burden of Diseases, Injuries, and Risk Factors Study classifications showed that the estimated lifetime prevalence of physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years (the age range for which there is the most data on intimate partner violence) was the highest in Oceania (49{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 38–61{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and central sub-Saharan Africa (44{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 33–55{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), followed by Andean Latin America (38{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 31–46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and eastern sub-Saharan Africa (38{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 31–44{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; table 4). The prevalence of lifetime physical or sexual, or both, intimate partner violence was also high, and more than the global average, in south Asia (35{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 26–46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and north Africa and the Middle East (31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 24–40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}).
Table 4Regional prevalence estimates of lifetime and past year physical or sexual, or both, intimate partner violence among ever-married or ever-partnered women aged 15–49 years, by Global Burden of Disease region, in 2018
Data presented as {e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}). Country estimates are presented in the appendix (pp 6–10). UI=uncertainty interval.
The three regions with lowest lifetime intimate partner violence prevalence estimates were central Europe (16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 12–21{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), central Asia (18{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 13–24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), and western Europe (20{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 15–26{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), although even these rates are still high.
As with the lifetime prevalence of intimate partner violence, the highest prevalence of past year physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years was in the regions of central sub-Saharan Africa (32{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 22–43{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and Oceania (29{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), followed by eastern sub-Saharan Africa (24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–29{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and south Asia (19{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 12–27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; table 4).
Overall, mostly high-income countries including Australasia (3{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 2–5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), western Europe (4{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 3–6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), central Europe (5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 3–6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), southern Latin America (5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 3–8{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), and North America (6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 4–9{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) had the lowest estimated prevalence rates of past year physical or sexual, or both, intimate partner violence among women aged 15–49 years.
Differences in the prevalence of intimate partner violence between the largely higher-income regions and low-income and middle-income regions were much more pronounced for prevalence in the past year compared with lifetime prevalence (figure 2).
Figure 2Map of 2018 lifetime versus past year prevalence of physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years by Global Burden of Disease region and Sustainable Development Goals super region
The appendix (pp 6–10) provides the 2018 prevalence estimates and 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} UIs for lifetime and past year physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years, for every country and area that had at least one available data source that met the inclusion criteria for this analysis.
There was a wide variation in prevalence across countries (figure 3). The median prevalence estimates of lifetime physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years was highest in 19 countries (Kiribati [53{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Fiji [52{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Papua New Guinea [51{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Bangladesh and Solomon Islands [both 50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Democratic Republic of the Congo and Vanuatu [both 47{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Afghanistan and Equatorial Guinea [both 46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Uganda [45{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Liberia and Nauru [both 43{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Bolivia [42{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Gabon, South Sudan, and Zambia [all 41{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Burundi, Lesotho, and Samoa [all 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}]). The median estimates of these countries ranged from 53{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 35–70{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Kiribati, 50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (37–62{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Bangladesh, and 50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (33–67{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in the Solomon Islands, to 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (27–55{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Burundi, 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (21–62{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Lesotho, and 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (25–57{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Samoa. All except two of these 19 countries are in Oceania (excluding Australia and New Zealand), sub-Saharan Africa, or south Asia regions. A further 16 countries (Cameroon and Tuvalu [both 39{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Angola, Kenya, Marshall Islands, Peru, Rwanda, Timor-Leste, and Tanzania [all 38{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Ethiopia, Guinea, and Tonga [all 37{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Sierra Leone [36{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], and India, Federated States of Micronesia, and Zimbabwe [all 35{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}]), mainly from sub-Saharan Africa and south Asia, had the second highest prevalence ranges, with 35–39{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of ever-married or ever-partnered women aged 15–49 years having been subjected to physical or sexual, or both, violence from an intimate partner at least once in their lifetime.
Figure 3Map of prevalence estimates of lifetime physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years, in 2018
The group with the lowest prevalence estimates for lifetime physical or sexual violence, or both (ranging from 10 to 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), includes 12 countries (Georgia and Armenia [both 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Singapore [11{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Switzerland and Bosnia and Herzegovina [both 12{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Albania, Poland, North Macedonia, and Croatia [all 13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], and Cuba, Azerbaijan, and the Philippines [all 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}]). Of the 12 countries, six were in subregions of Europe, with a prevalence between 12 and 13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, and three were countries in western Asia, with prevalence estimates for lifetime physical or sexual violence, or both, of: 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 6–17{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Armenia, 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (6–18{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Georgia, and 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (8–22{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Azerbaijan. The other three countries were: Singapore with 11{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (5–22{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Cuba with 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (8–23{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), and the Philippines with 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (10–21). Four additional countries from Europe and one from central Asia had prevalence between 15 and 16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}.
Figure 4 presents a map with the country-level past year prevalence of physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years. The 14 countries with the highest prevalence estimates of intimate partner violence in the past year (ranging from 25–36{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) were Democratic Republic of the Congo (36{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 23–50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Afghanistan (35{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 22–50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Papua New Guinea (31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–45{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Vanuatu (29{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 16–48{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Equatorial Guinea (29{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 16–46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Solomon Islands (28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 15–46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Timor-Leste (28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Zambia (28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–39{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Ethiopia (27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 17–38{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Liberia (27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 17–40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), South Sudan (27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 13–48{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Uganda (26{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 18–36{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Angola (25{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 14–39{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), and Kiribati (25{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 14–42{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}). There were 14 additional countries (Tanzania [24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Bangladesh, Fiji, Kenya, and Rwanda [all 23{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Burundi, Cameroon, and Gabon [all 22{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Central African Republic, Guinea, and Federated States of Micronesia [21{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], and Nauru, Sierra Leone, and Tuvalu [20{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}]) that had prevalence rates between 20 and 24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, mainly from the sub-Saharan African and Oceania regions.
Figure 4Map of prevalence estimates of past year physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years, in 2018
Of the 30 countries with the lowest prevalence estimates for past year physical or sexual violence, or both (up to 4{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), 24 were high-income countries. 23 of the 30 countries within this lowest prevalence range were in Europe. The other seven were Australia, Canada, Japan, New Zealand, Singapore, Sri Lanka, and Uruguay.
Discussion
Our study confirms that, concerningly, physical or sexual violence, or both, against women by male intimate partners is highly prevalent globally. Overall, we found that more than one in four (27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) ever-partnered women aged 15–49 years had experienced physical or sexual violence, or both, from a current or former intimate partner at least once in their lifetime; and one in seven (13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) had experienced it in the past year. This finding means that in 2018, up to 492 million ever-partnered women aged 15–49 years had been subjected to this type of violence by an intimate partner at least once since the age of 15 years.
This study also draws attention to the high amount of recent or current intimate partner violence experienced by young women, with one in six women (16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) aged 15–24 years estimated to have been subjected to physical or sexual, or both, intimate partner violence within the year preceding the survey. This finding is concerning because adolescence and early adulthood are important life stages in which the foundations for healthy relationships are built; this violence has long-lasting effects on women’s health and overall wellbeing.
Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study.
We found that the lifetime and past year prevalence of physical or sexual, or both, intimate partner violence varied widely across regions and countries, with higher prevalence rates of both types in low-income and middle-income countries and regions than high-income countries. These differences between higher-income and lower-income regions were notably more pronounced with past year prevalence than lifetime prevalence, and the relative differences between lifetime and past year prevalence were smaller in low-income and middle-income countries and regions. It is important to note that there are 28 countries with past year physical or sexual, or both, intimate partner violence prevalence that is substantially higher than the global average. Several of these are countries affected by conflict. These findings are consistent with the different social, economic, and political circumstances that are associated with intimate partner violence and limit women’s ability to leave abusive relationships, such as economic insecurity, gender inequitable norms, high amounts of societal stigma, economic insecurity, discriminatory family law, and inadequate support services.
Attitudes towards domestic violence in 49 low- and middle-income countries: a gendered analysis of prevalence and country-level correlates.
The limitations of these analyses first include the reliance on the availability and quality of existing violence against women survey data and measures. The modelled estimates and UIs presented in this Article are the most accurate that could be derived from the available 2000–18 prevalence data from 161 countries and areas on intimate partner violence. However, although there has been an increase in the number of national population-based surveys with such data, there are gaps in the availability of data in some geographical regions, and not all surveys are recent or use gold standard measures.
Global health. The global prevalence of intimate partner violence against women.
Second, all estimates in this study are based on women’s self-reported experiences of being subjected to intimate partner violence. Given the sensitive nature of the issue, the true prevalence of physical or sexual, or both, intimate partner violence is likely to be higher. Survey design and implementation, including interviewer training, play an important role in enabling disclosure and affect survey results.
WHO Putting women first: ethical and safety recommendations for research on domestic violence against women.
Third, the definition of a partnership is variable across contexts, and we relied on the survey’s definition of a partnership. However, some studies might not have captured all partnership types and this could have affected our estimates, especially among adolescent and younger women.
Fourth, our estimates for women aged 60 years and older are limited by the relative paucity of empirical observations. Because most data, especially for low-income and middle-income countries, came from demographic and health surveys, data availability is skewed towards women of reproductive age in the 15–49 year range. Although this group of women might be at a higher risk of intimate partner violence, there is a need for more and better quality data to optimally capture the violence experienced by older women
Violence against older women: a systematic review of qualitative literature.
and across the life course.
And finally, psychological intimate partner violence has substantial negative effects on women. However, this type of violence could not be included in the current estimation process because of the challenges that exist with variations in definitions, measurement, and non-standardisation across surveys and countries.
Emotional abuse: a neglected dimension of partner violence.
Work by WHO is underway to address these challenges and overcome this limitation.
We need to continue strengthening, standardising, and building capacity for the collection, reporting, and use of data on violence against women to support countries’ efforts and to monitor progress at national, regional, and global levels. We recommend that governments invest in dedicated surveys on violence against women or comprehensive modules with specially trained interviewers and adherence to ethical and safety standards to better estimate the magnitude of violence against women. These improved estimates are crucial to the development of effective prevention policies and programmes. There is a need to develop robust survey measures to better understand violence experienced by women living with multiple forms of discrimination, for example those living with disabilities, indigenous and minority ethnic or migrant women, transgender women, and women in same-sex partnerships, for which there are currently few data.
Addressing violence against women: a call to action.
Despite the limitations in available data, this study unequivocally establishes the persistently high prevalence of intimate partner violence. Notably, intimate partner violence is preventable. There has been a substantial increase in the body of knowledge on what works to prevent violence against women and girls in the last decade.
WHO RESPECT women: preventing violence against women.
This framework, endorsed by 14 agencies and funders, organises evidence-based interventions for the prevention of violence against women through seven strategies. Several high-level initiatives, such as the Action Coalition on Gender-based violence of the Generation Equality Forum, are advocating for and investing in countries to do more when it comes to evidence-based prevention, including developing community-based and school-based interventions that promote gender equality and challenge gender stereotypes and discriminatory norms, reforming discriminatory laws, and ensuring women’s access to formal wage employment and secondary and higher education. Other programmes showing promise with regards to violence prevention focus on transforming attitudes that justify violence against women and promoting more equitable relationships within the family, reducing exposure to violence during childhood and reducing child abuse, and increasing access to cash transfers, particularly women’s access to cash transfers.
UN WomenUNFPAWHOUNDPUNODC Essential services package for women and girls subject to violence.
Although progress has been made in implementing such programmes, this progress is grossly insufficient to meet the SDG target of eliminating violence against women by 2030. This problem is likely to have been further exacerbated by the COVID-19 pandemic that has caused an unprecedented setback in efforts towards the reduction of violence against women.
Violence against women during COVID-19 pandemic restrictions.
Although these estimates are based on pre-COVID-19 survey data, helpline, police, and other service data suggest that the pandemic and its associated lockdowns might have led to further increases in intimate partner violence.
Violence against women during COVID-19 pandemic restrictions.
The full effect of the COVID-19 pandemic will only be known when population-based surveys are able to fully resume. The need to scale up existing interventions and the preparedness of health and other sectors to ensure women’s access to services centered around people who have experienced intimate partner violence and referrals is even more pressing.
Intimate partner violence affects the lives of millions of women, children, families, and societies worldwide. These data clearly show that this violence predates the COVID-19 pandemic and will probably continue long after. Preventing intimate partner violence from happening in the first place is necessary and urgent. Governments, societies, and communities need to take heed, invest more, and act with urgency to reduce violence against women, including by addressing it in post-COVID-19 reconstruction efforts.
LS contributed to the study design, data extraction and curation, investigation, methods, validation, microdata analysis, visualisation, writing the original draft, and reviewing and editing the manuscript. MM-G contributed to the data curation, formal analysis, investigation, methods, validation, visualisation, and reviewing and editing the manuscript. HS contributed to the systematic review design and protocol, the study design, data extraction and curation, investigation, methods, and reviewing and editing the manuscript. SRM contributed to the search strategy design and protocol, study design, data extraction, and curation, investigation, and reviewing the manuscript. CG-M conceptualised the study and contributed to the study design, funding acquisition, investigation, validation, methods, project administration, resources, supervision, and reviewing and editing the manuscript. CG-M had full access to all the data in the study and had final responsibility for the decision to submit for publication.
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