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The Burden of Other Forms of Interpersonal Violence

ENLACE HOMICIDE INTERPERSONAL VIOLENCE TECHNICAL NOTES ABOUT

 

Interpersonal violence is a leading cause of mortality and disability, and a public health issue in the Region of the Americas.

In 2019, interpersonal violence was ranked as the third cause of disability-adjusted life years, the second cause of years of life lost due to premature mortality, and the ninth cause of mortality in the total population.

For more information on mortality due to interpersonal violence, please also see the Homicide data topic.

Topic content

Non-fatal interpersonal violence in the total population

Violence against women and girls: prevalence of intimate partner violence

 

Non-fatal interpersonal violence in the total population

This visualization presents the level and trends related to Disability-Adjusted Life Years (DALYs) and Years Lived with Disability (YLDs) due to interpersonal violence, disaggregated by age, sex and location (including regional, subregional and national levels) in the Region of the Americas from 2000 to 2019.  

The burden of interpersonal violence

In addition to numerous deaths, interpersonal violence in the Region of the Americas results in injuries and ill-health.

In 2019, interpersonal violence accounted for:

  • 1,123 disability-adjusted life years per 100,000 population (1,948 years per 100,000 population in men, and 299 years per 100,000 population in women); and
  • 63 years lived with disability per 100,000 population (84.7 years per 100,000 population in men, and 42.7 years per 100,000 population in women) 

The top 20% of countries with the highest DALYs rates due to interpersonal violence are:

  • El Salvador
  • Honduras
  • Venezuela
  • Trinidad and Tobago
  • Belize
  • Colombia
  • Brazil

The top 20% of countries with the highest YLD rates due to interpersonal violence are:

  • Honduras
  • El Salvador
  • Venezuela
  • Colombia
  • Uruguay
  • Haiti
  • Argentina

INDICATOR DEFINITION

Indicators: Disability-Adjusted Life Years (DALYs), and Years Lived with Disability (YLDs)  death rates due to interpersonal violence per 100 000 population.

Measure: DALYs, YLDs

Metric: Rate

Unit of measurement: Years per 100,000 population

Definition:

Interpersonal violence is defined as the ‘‘Unlawful death inflicted upon a person with the intent to cause death or serious injury”. This definition contains three elements characterizing the killing of a person as intentional homicide:
1. The killing of a person by another person (objective element);
2. The intent of the perpetrator to kill or seriously injure the victim (subjective element);
3. The unlawfulness of the killing, which means that the law considers the perpetrator liable for the unlawful death (legal element).

This definition states that, for statistical purposes, all deaths corresponding to the three above criteria should be considered as intentional homicides, irrespective of definitions provided by national legislations or practices.

According to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), Interpersonal violence includes the following ICD-10 codes: X85-Y09, Y871.

Method of estimation: The estimates of homicide rates draw on data provided by countries from police, and civil registration and vital statistics systems; data from United Nations Office of Drugs and Crime (UNODC) global studies on homicide; and data from WHO’s Mortality Database. The estimation process used observed death data on homicide, in conjunction with modeling for countries without sufficient data availability or inadequate quality, to compute comparable estimates of homicide rates and numbers across countries.

In several countries, two separate sets of data on intentional homicide are produced, respectively from criminal justice and public health/civil registration systems. When existing, figures from both data sources are reported. Population data are derived from annual estimates produced by the UN Population Division.

Crude death rates were calculated as the total number of victims of intentional homicide (ICD-10 codes: X85-Y09, Y871) recorded in a given year divided by the total population in the same year, multiplied by 100,000. Age-specific death rates were calculated with the same approach by age. Age-standardized death rates were computed by the direct method using the WHO world standard population.

Regional aggregates: Regional and subnational estimates were calculated using national data (number of deaths, number of DALYs, number of YLDs, or number of YLLs) and population estimates from the UN World Population Prospects, 2019 edition. 

Methodological details:

Data sources and methods for estimating deaths and mortality are described in the following documents

Preferred data sources: Civil Registration and Vital Statistics (CRVS) systems.

Interpersonal violence results in a significant number of deaths, injuries and ill-health. The visualization especially highlights the impact that interpersonal violence has on DALYs and YLDs in the Region. 

Yet, violence can be prevented. A four-step public health approach offers a useful framework for preventing violence, including

  1. defining the problem;
  2. identifying causes and risk factors;
  3. designing and testing interventions, and
  4. implement and scale up effective interventions, supported by continuous monitoring and evaluation.

Without attention to violence, the health and well-being for all people at all ages in the Region of the Americas cannot be assured. Preventing and responding to violence is core to achieving the Sustainable Development Goals in the Americas.

The Pan American Health Organization (PAHO) works with partners and Member States to prevent and respond to violence through evidence-based strategies and tools.

PAHO work is informed by:

  • WHO Global plan of action on strengthening the role of the health system, within a national multisectoral response, to address interpersonal violence, in particular against women and girls, and against children (2016);
  • PAHO Regional Strategy and Plan of Action on Strengthening the Health System to Address Violence against Women (2015) as well as multiple other national, regional and global policy frameworks and strategies.

Key priorities are:

  • Raise awareness of the need for action to reduce violence in the Region of the Americas;
  • Identify, synthesize and disseminate evidence on what works to reduce violence;
  • Provide guidance and technical support to countries to develop evidence-based prevention and response capacity;
  • Strengthen partnerships across sectors and stakeholders for violence prevention and response.
  1. WHO. WHO methods and data sources for country-level causes of death 2000-2019. Geneva: World Health Organization; 2020. Available online (accessed 1 February 2021).
  2. WHO. WHO methods and data sources for global burden of disease estimates, 2000-2019. Geneva: World Health Organization, 2020. Available online (accessed 1 February 2021).
  3. PAHO. Methodological Notes, NMH Data Portal. Pan American Health Organization. 2021
  4. PAHO. Topic: Violence Prevention. Pan American Health Organization. Available online (accessed 17 June 2021). 
  5. PAHO. Topic: Violence against children. Pan American Health Organization. Available online (accessed 10 June, 2021).
  6. PAHO. Topic: Violence against women. Pan American Health Organization. Available online (accessed 10 June, 2021).
  7. WHO. Factsheet: Violence Prevention. World Health Organization. Available online (accessed 17 June 2021)
  8. WHO. Global Status Report on Violence Prevention 2014. World Health Organization. Available online (accessed June 10, 2021)
  9. PAHO. Regional Status Report 2020: Preventing and Responding to Violence against Children in the Americas. Pan American Health Organization. Available online (accessed Jun 16, 2021) 
 

Violence against women and girls

Violence against women is a grave human rights violation and public health concern of major proportions. It is associated with serious short- and lifelong physical, sexual, reproductive and mental health consequences for women and girls. Violence against women has significant social and economic costs for women and girls, their families and communities, and nations.

Violence against women and girls takes many different forms, all equally unacceptable.

This interactive data visualization presents data on intimate partner violence in line with WHO’s Violence against Women Prevalence Estimates, 2018. Specifically, it showcases the proportion of ever-partnered women and girls aged 15-49 years who have experienced physical and/or sexual violence by a current or former intimate partner, for example, a husband, boyfriend or similar partner. These prevalence estimates draw on population-based, nationally or sub-nationally representative surveys/studies conducted between 2000-2018.   

Violence against women and girls is a major public health challenge in the Region of the Americas. An estimated 34% of women and girls aged 15-49 years in the Region of the Americas have experienced intimate partner violence and/or sexual non-partner violence in their lifetime. 

Intimate partner violence (IPV) is the most common form of violence against women and girls. According to the 2018 estimates, 25% of women and girls aged 15-49 years in the Region have been subject to physical and/or sexual violence by a current or former intimate partner in their lifetime; and 7% have experienced such violence in the past 12 months. 

IPV prevalence estimates vary across countries in the Region. There is a cluster of countries with comparatively high lifetime prevalence in South America, including:

  1. Bolivia (42%)
  2. Peru (38%)
  3. Ecuador (33%)
  4. Guyana (31%)
  5. Colombia (30%)

It is important to note that there is no protected time in women’s lives. Intimate partner violence can start early in women’s lives. Approximately 21% of women and girls aged 15-25 in the Region have experienced lifetime intimate partner violence. Data similarly suggests that risks continue into older age. Prevalence of lifetime physical and/or sexual intimate partner violence among ever-married/partnered women aged 65-104 years is estimated at 28% in the Region.

It is critical that countries continue to strengthen data collection, reporting and use to inform policy and action to prevent and respond to violence against women. Investing in regular, high-quality surveys on violence against women, improving measurement of the different forms of violence that women in all their diversity are subjected to and strengthening the systematic analysis and use of data are important areas for attention in the Region of the Americas.

Suggested citation:

PAHO. The burden of interpersonal violence in the Region of the Americas, 2000-2019. Pan American Health Organization. 2021

Operational definition of indicators of violence against women and girls

Intimate partner [1] violence (IPV) (physical and/or sexual)

A woman’s self-reported experience of one or more acts of physical or sexual violence, or both, by a current or former husband or male intimate partner since the age of 15 years [2].

  • “Physical IPV” [3] is operationalized as acts that can physically hurt the victim, including, but not limited to: being slapped or having something thrown at you that could hurt you; being pushed or shoved; being hit with a fist or something else that could hurt; being kicked, dragged or beaten up; being choked or burnt on purpose; and/or being threatened with or actually having a gun, knife or other weapon used on you.
  • “Sexual IPV” [4] is operationalized as: being physically forced to have sexual intercourse when you do not want to; having sexual intercourse out of fear for what your partner might do or through coercion; and/or being forced to do something sexual that you consider humiliating or degrading.

Note: Only women who reported being married, cohabiting or having an intimate partner at some point in their lives (i.e. ever-married/partnered) were included in the measure of intimate partner violence as they are considered “at risk” for this form of violence.

Lifetime prevalence [5] of IPV

The proportion of ever-married/partnered women who reported that they had been subjected to one or more acts of physical or sexual violence, or both, by a current or former husband or male intimate partner in their lifetime (defined as since the age of 15 years).

Past 12 months prevalence [5] of IPV (also referred to as recent or current IPV)

The proportion of ever-married/partnered women who reported that they had been subjected to one or more acts of physical or sexual violence, or both, by a current or former husband or male intimate partner within the 12 months preceding the survey.

Footnotes:

  1. The definition of “intimate partner” varies between settings and includes formal partnerships, such as marriage, as well as informal partnerships, such as cohabitation or other regular intimate partnerships. It is important that the denominator is inclusive of all women who could be exposed to intimate partner violence. For the purposes of this analysis, it was accepted whatever definitions of “partner” were used in the surveys/studies that were included in this analysis (see Section 3), which includes current and former husbands, and current and former cohabiting and, in some instances, non-cohabiting male intimate partners.
  2. The age of 15 years was set as the lower age limit for the purposes of these estimates. Most surveys, including the Demographic and Health Surveys (DHS) and specialized surveys on violence against women, include girls and women aged 15 and older in the measure of IPV, to capture the experiences of girls and women in settings where marriage commonly occurs among girls from the age of 15 years.
  3. The Domestic Violence Module of the DHS, the WHO Multi-country Study on Women’s Health and Domestic Violence against Women, and other specialized surveys on violence against women that use the WHO instrument, draw on adapted versions of the Conflict Tactics Scale (52) to measure the prevalence of physical partner violence.
  4. As operationalized in the Domestic Violence Module of the DHS, the WHO Multi-country Study on Women’s Health and Domestic Violence against Women, and other specialized surveys on violence against women that use the WHO instrument.
  5. Prevalence refers to the number of women who have been subjected to violence divided by the number of at-risk women in the study population.

Disclaimer: These operational definitions were taken from the WHO Global Database on the Prevalence of Violence Against Women. Available online.

More information on the WHO Violence against Women Prevalance Estimates, 2018, including a regional fact sheet, can be found at: https://www.who.int/publications/i/item/9789240022256.

Violence against women has devastating consequences for women and girls, their families and communities, and societies. BUT violence against women can be prevented, and its consequences mitigated. We know more than ever before about what works to prevent violence against women.

RESPECT – Preventing violence against women is a package of seven evidence-based strategies that can guide action to eliminate violence against women. Every letter of RESPECT stands for a strategy with the potential to prevent violence against women, including:

R – Relationship skills strengthened. This includes strategies to improve skills in interpersonal communication, conflict management and shared decision-making.

E – Empowerment of women. This includes economic and social empowerment strategies including those that build skills in self-efficacy, assertiveness, negotiation, and self-confidence.

S – Services ensured. This includes a range of essential services for survivors of violence, including health, police, legal, and social services. 

P – Poverty reduced. This refers to strategies targeted to women or the household, whose primary aim is to alleviate poverty.

E – Environments made safe. This includes efforts to create safe schools, public spaces and work environments, among others.

C – Child and adolescent abuse prevented. This includes strategies that establish nurturing family relationships and prevent violence against children.

T – Transformed attitudes, beliefs and norms. This refers to strategies that challenge harmful gender attitudes, beliefs, norms and stereotypes.

  1. WHO. WHO methods and data sources for country-level causes of death 2000-2019. Geneva: World Health Organization; 2020. Available online (accessed 1 February 2021).
  2. WHO. WHO methods and data sources for global burden of disease estimates, 2000-2019. Geneva: World Health Organization, 2020. Available online (accessed 1 February 2021).
  3. WHO. Violence Against Women Prevalence Estimates, 2018. Available online (accessed 4 October 2021).
  4. WHO. RESPECT women: Preventing violence against women. Available online (accessed 4 October 2021).
  5. PAHO. Topic: Violence Prevention. Pan American Health Organization. Available online (accessed 17 June 2021). 
  6. PAHO. Topic: Violence against women. Pan American Health Organization. Available online (accessed 10 June, 2021).

 

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