Plataforma de Acción de la 4ta Conferencia de la Mujer, Beijing, 1995

Presentación del tema: "Plataforma de Acción de la 4ta Conferencia de la Mujer, Beijing, 1995"— Transcripción de la presentación:

1 Estudio Multi-Céntrico OMS sobre la Salud de las Mujeres y la Violencia Doméstica Contra las Mujeres

2 Plataforma de Acción de la 4ta Conferencia de la Mujer, Beijing, 1995
Declara que “La ausencia de datos y estadísticas adecuadas, desagregadas por sexo, sobre la incidencia de la violencia contra las mujeres dificulta la elaboración de programas y el monitoreo de cambios…" Recomienda “La promoción de investigaciones y recolección de datos sobre la prevalencia de diferentes formas de violencia contra las mujeres, especialmente violencia doméstica, e investigación sobre las causas, la naturaleza y las consecuencias de la violencia contra las mujeres y la efectividad de las medidas implementadas para prevenir y abordar la violencia contra las mujeres." WHO initiated the Multi-country Study on women’s Health and Domestic Violence in 1997 in response to the recommendations of the expert consultation on VAW in 1996 and of the Beijing platform for Action. Both identified the need for reliable data as important factors for enhancing the recognition of the problem among policy makers and for the identification of effective responses….

3 Antecedentes Poca información sobre los diferentes tipos de violencia que sufren las mujeres, especialmente en países no industrializados Dificultad en comparar los datos debido a diferencias de definiciones, formas de medir Problemas de subregistro de datos por razones metodológicas, seguridad Falta de información sobre las consecuencias en salud para las mujeres que viven con violencia Falta información sobre las causas de la violencia

4 Objetivos del estudio Estimar la prevalencia de violencia física y sexual contra las mujeres en varios países. Documentar las asociaciones entre la violencia por pareja íntima y diferentes indicadores de la salud de las mujeres Identificar los factores de riesgo y de protección para la violencia doméstica contra las mujeres y compararlos entre diferentes sitios. Explorar y comparar las estrategias utilizadas por las mujeres que sufren violencia doméstica.

5 Objetivos adicionales
Desarrollar y validar nuevos instrumentos para medir la violencia contra las mujeres desde una perspectiva multi-culturale Mejorar la capacidad de investigadoras e investigadores, y organizaciones de mujeres que trabajan en el campo de la violencia. Promover mayor sensibilidad entre investigadores, tomadores de decisiones y personal de salud en relación a la violencia contra las mujeres Promover un modelo de investigación que es a la vez cientificamente rigoroso, y que refleja los más altos principios éticos Besides the main objectives just mentioned, we are also committed to achieving other more process and action oriented objectives, which are: the development and testing of new instruments for measuring violence cross-culturally increasing national capacity and collaboration among researchers and women's organizations working on violence against women, increasing sensitivity and responsiveness to violence among researchers, policy makers and health providers. And we want to promote a model of participatory research that is ethically sound, fully addressing safety issues and safe-guarding women’s well being [The Study therefore has been designed to achieve also these more “process-oriented” objectives. This has on one hand increased the richness of the Study and on the other the difficulties which are already inherent in any multi-country study. Staying true to this more participatory approach to research has been perhaps the biggest methodological and administrative challenge of the Study.]

6 Un estudio global con más de 24,000 mujeres en 10 países.
A new study published this week by the World Health Organization provides clear evidence that shows how this “minor” social problem is in reality a major public health crisis. The WHO Multi-Country Study on Women’s Health and Domestic Violence against Women represents the first global study to yield truly comparable data on domestic violence and other forms of violence against women. In this study, over 24,000 women in 10 countries, representing regional and cultural diversity, were interviewed, yielding rich and compelling data on the rates and health consequences of abuse. In most countries, the study include two separate sites: the capital or other major city, and a representative more rural province. The total number of sites included was 15. Significantly, the study used state of the art techniques to enhance disclosure and protect women’s safety during the research. Women were asked the same questions, by interviewers all who had all received the same extensive 3 week training.

7 Investigadores principales
Equipo Principal Técnico C. Garcia-Moreno & H. Jansen, OMS C. Watts, London School of Hygiene and Tropical Medicine M. Ellsberg & L. Heise, PATH Comité de Expertos Equipos nacionales de investigación, con instituciones académicas y grupos de mujeres. Comités consultivos en cada pais. The Study is coordinated by a core team of technical advisers, which includes: myself with responsibility for the overall co-ordination of the study and an epidemiologist, Henriette Jansen, based in WHO Charlotte Watts, based in London School of Hygiene and Tropical Medicine, who is senior technical adviser to the Study, and developed the protocol and first draft of the survey instrument, and two other technical experts (Lori Heise and Mary Ellsberg) from the Center for Health and Gender Equity in Washington. Together, we service the needs of the country research teams. A steering committee of international experts on VAW has been established to guide the development and implementation of the study. Each country research team consists of 2 researchers, a statistician and at least one representative from a women’s organization working on VAW. An advisory group or consultative committee has been established in each country, where it does not yet exist, to support the implementation of the study and ensure dissemination of the results.

8 Country Research Teams
Country Research Institution NGO partners Bangladesh: ICDDRB Naripokkho Brazil: University of Sao Paulo Feminist Collective on Health and Sexuality SOS Corpo (Recife) Namibia: Ministry of Health and Social Multimedia Campaign on Services Violence against Women Peru: Universidad Nacional Centro de la Mujer Flora Cayetano Heredia Tristan Tanzania: Muhimbili College of Women’s Research & Medical Sciences Documentation Project Thailand: Mahidol University Foundation for Women Japan: National Institute of Population & Social Security Research

9 Diseño del estudio Estudios cualitativos en cada país (grupos focales, entrevistas a profundidad con sobrevivientes de violencia, informantes claves) Encuesta cuantitativa de hogares con mujeres de años de edad Uno o dos sitios por país: aprox mujeres por sitio Capacitación estandarizada durante 3 semanas Cuestionario desarrollado y validado en 15 idiomas Medidas estrictas de control de calidad Muestreo multi-etapa por conglomerados Entrevista a una mujer por hogar en idioma local the main study consisted of face to face interviews with randomly selected women years of age. This was done in one or two sites per country and involved approx 1500 women per site. The study was carried out in adherence to strict ethical, safety and quality control procedures, resulting in robust data which permits comparison between and within countries. The strength of the methodology that is developed with and tested in very diverse countries and that the method ensures comparability. Special mention should be made of the materials developed such as for the a standardized training of researchers and interviewer and a set of ethical and safety recommendations:. covering confidentiality, training of interviewers, support for respondents and researchers, that we have developed for this study are becoming widely used in others studies on violence against women and other sensitive issues

10 Un marco ecológico para entender las causas de la violencia
Sociedad Comunidad Relación Individuo Cuando se habla de un marco ecológico para comprender la violencia, nos estamos refiriendo a factores que existen en muchos niveles de la sociedad, que promueven o frenan el uso de la violencia contra las mujeres en una sociedad dada, y que influyen en el riesgo de que una mujer específica sea víctima de la violencia. Estos factores tienen lugar a nivel individual, a nivel de la relación y de los hogares, la comunidad y la sociedad.

11 Aspectos éticos Priorizar la seguridad de las mujeres
Proteger la confidencialidad es crítico para asegurar la seguridad de las mujeres y la calidad de los datos. Selección y capacitación especializada, y apoyo continuo para los encuestadores. Tomar acciones para minimizar angustias para las participantes (referencias, información) Garantizar que los hallazgos sean bien interpretados y utilizados para incidir en políticas públicas These guidelines cover each of the topics outlined in this and the next slide and make recommendations. For example on protecting safety: the need for privacy and relocation of the interview if necessary, careful introduction of the study, interviewing only one woman per household, and training of interviewers to change the subject of discussion in case of interruption. On protecting confidentiality: no names on questionnaires, informed consent, findings presented sufficiently agregated, permission and safe-keeping for tapes and photographs. Great emphasis is placed on the careful selection and training on all research team members. This should include good introduction to domestic violence issues, a space for trainers to address their own biases and stereotypes or own experiences of abuse. In terms of supporting the research team, recommendations include: giving interviewers the chance to withdraw without prejudice, having regular briefing sessions with the team, help interviewers understand their role vis a vis women experiencing violence. Minimize distress to participants by asking questions in a supportive and non-judgemental manner, training interviewers to deal with distress and end all interviews positively.

12 Cuestionario sobre la salud de las mujeres y sus experiencias de vida
Sección 1: Encuestada y su comunidad Sección 2: Salud General Sección 3: Salud Reproductiva Sección 4: Los hijos Sección 5: Actual pareja o el más reciente Sección 6: Actitudes sobre roles de género Sección 7: La Encuestas y su pareja Sección 8: Lesiones Sección 9: Impacto y respuestas a la violencia Sección 10: Otras experiencias Sección 11: Autonomía financiera Sección 12: Completamiento de la entrevista The questionnaire for the survey has been developed for use in different cultural settings with a minimum of adaptation. Refer to title of slide: The study is introduced in the community by a different title - as one of the safety measures On this slide are listed the 12 sections or modules. As with other studies on sensitive topics, the tendency will be for respondents to under-report their experiences. Therefor the order of the questionnaire is such that it ensures a careful built up, with the initial sections dealing with less sensitive subjects like information about herself, her community, health, children, then asking about general partner characteristics and attitude questions. By the time the interviewer gets to the section with violence questions, section 7, she has already spent a considerable time with the respondent an atmosphere of good rapport and confidence should have been created. Following up on the violence questions, the woman gets questions on injuries and response strategies. Towards the end of the questionnaire, in the section “other experiences” the respondent is asked among others about childhood sexual abuse.

13 Tipos de violencia estudiados
Violencia por una pareja íntima actual o anterior : Violencia física Violencia sexual Abuso emocional y comportamiento controlador Violencia por otros (padres, vecinos, desconocidos): Violencia física (después de los 15 años) Violencia sexual (después de los 15 años de edad) Abuso sexual en la niñez (antes de los 15 años) The WHO study placed a special emphasis on measuring violence by intimate partners (current of former husbands, men with whom women lived together, regular sexual partners): physical violence, sexual violence and acts of emotional abuse and controlling behaviours by these partners The study also explored physical and sexual violence after the age of 15 by non-partner—such as friends, family members, acquaintances, or strangers. The study further explored child sexual abuse by family members, teachers, strangers and others, in these same women, by asking about their experiences prior to age 15.

14 Cómo se midió la violencia física?
Moderada ¿Le abofeteó o le tiró algo que le pudiera herir? ¿Le empujó o le jaló el pelo? ¿Le golpeó con el puño o con algo que le pudiera herir? ¿Le pateó, arrastró o le dió una golpiza? ¿Le estranguló o le quemó a propósito? ¿Le amenazó o utilizó una arma blanca o de fuego, u otro tipo de arma contra usted? Severa To measure violence by a partner we did not ask women if they had been “abused” or “raped – terms which can be loaded. Instead we asked about specific acts that women may have experienced. We took this approach because past research has shown that asking about specific behaviors is a more effective way to encourage disclosure. Also, by asking about specific acts, we are able to compare the frequency of behaviors across settings without having the data affected by different cultural and individual interpretations of what constitutes “abuse.” or "violence". So for example, to measure physical partner violence, women were asked 6 specific questions [Read them off the slide]. Did your current partner or any other partner ever…. A woman must have experienced one or more of these acts to be considered a victim of physical partner violence. Women are then further subdivided into whether they experience only moderate violence [CLICK] – the first two types of behaviors – or severe violence: beating, kicking use of weapons, etc [CLICK]. As follow on for any of the acts mentioned, we asked about if it happened in the past 12 months and how many times it had happened.

15 Cómo se midió la violencia sexual?
¿Alguna vez le obligó a tener relaciones sexuales cuando Usted no quería, utilizando la fuerza física? ¿Alguna vez tuvo relaciones sexuales cuando no quería por miedo de lo que él haría? ¿Alguna vez fue obligada a realizar algún acto sexual que consideraba humillante o degradante? The study used three questions to measure sexual violence in relationships [Read questions on slide – Note that in many settings the third question is a culturally sensitive way to to capture situations that in some cultures and contexts would not be caught by the first two.] Again, women who had experience any one of the above behaviors are considered to have experienced sexual violence by a partner

16 Resultados sobre la prevalencia, impacto sobre la salud, y respuestas de las mujeres

17 La violencia física y sexual es extremadamente común en las vidas de las mujeres
A key finding of the study is that physical and sexual violence is extremely common in women’s lives. This slide shows results on the prevalence of violence by anyone, partners or others, among adult women – those over 15. We see that between 19% (Japan) and 76% (Samoa) of women have been physically or sexually abused by someone (partner or non-partner) at least once in their lifetime. The levels of violence in most of the sites were between 26% and 60% That’s almost two-thirds of women in some settings.

18 El riesgo principal proviene de su pareja íntima
If we consider these same women who reported physical or sexual abuse by anyone (i.e partner and none partner), and we break down the violence by perpetrator, it becomes clear that women’s greatest risk of violence is from intimate partners (the two lower segments in the bars). Indeed, women are more likely to be beaten or raped by their partners or husbands than by any other person, with in all sites but one between 60% to 95% of abused women reporting abuse by a husband or intimate partner. The only setting that departs from this pattern is Samoa, which is on the far right hand side of the graph. In Samoa, more violence is perpetrated by non-partners than by partners. But the Samoan situation is more a reflection of the extremely high rates of non-partner violence in Samoa rather than a low rate of domestic violence. Fully 65 percent of Samoan women report violence by a non partner, compared to 5 percent of women in Ethiopian province, 7 percent in Japan, and 11 to 12 percent in Thailand, Bangladesh province, and Serbia and Montenegro. In addition to shouldering a high burden of non-partner violence, 46 percent of Samoan women report physical or sexual abuse by an intimate partner.

19 La violencia doméstica es común en todos los sitios, pero la prevalencia varia entre ellos
Japón y Serbia: 4% violencia actual Bangladesh, y provincias en Etiopía, Perú y Tanzania: 30% a 54% violencia actual Another key finding of the study is that while domestic violence is widespread in all settings, the rates do vary dramatically. This graph summarizes data on the prevalence of physical or sexual partner violence in each setting, breaking it down between lifetime rates of violence and the proportion of women who have experienced partner violence within the last 12 months prior to the interview. The black bars, on the lower portion of the graph, represent the proportion of women who have experienced physical and/or sexual violence by a partner in the last 12 months. It is here that the differences in prevalence are most stark. As you can see on the graph (on the right), Only 4 percent of women in Serbia & Montenegro and Japan city have been abused by a partner in the past year compared to (on the left) 54 percent of women in rural Ethiopia or 34 percent of women in provincial Peru—a nine to ten-fold difference. (NB do not emphasize the difference)

20 Prevalencia de violencia doméstica America Latina: violencia física
Como podemos ver en esta diapositiva que muestra los resultados de siete estudios realizados en America Latina, la prevalencia de violencia conyugal puede variar dramaticamente entre paises, e incluso entre barrios y comunidades cercanas. Sin embargo debido a una gran diversidad de métodos para definir y medir la violencia, es difícil aun distinguir cuáles son diferencias reales, y cuáles se atribuyen a factores metodológicos.

21 El embarazo no necesariamente es un período protegido para las mujeres
Me golpeó en la barriga y me hizo abortar gemelos. Fui al hospital con sangrado y ahí me atendieron. Mujer entrevistada en Perú Another key finding is that pregnancy is not necessarily a protected time for women. As this graph demonstrates between 1 to 28 percent of women who have ever been pregnant report being physically abused during at least one pregnancy. Japan has the lowest rate of abuse during pregnancy and Peru province has the highest, with the majority of sites falling between 4 and 12 percent. Across all the sites, between one-quarter to a half of all women who were beaten during pregnancy report being punched or kicked in the abdomen. Significantly, in over 90% of cases the abuser was the biological father of the child the woman was carrying. In most cases, the abuse did not start in pregnancy but was a continuation of violence that was already on-going. There is some evidence, however, that pregnancy may be a relatively protected time in some settings. For example, from our last slide we know that partner violence is extremely common in rural Ethiopia (49% of women in rural Ethiopia report physical violence by a partner). Nonetheless, the rate of violence among pregnant women in Ethiopia is relatively low—with 8 percent of ever pregnant women reporting having been beaten during a pregnancy…. Which is bad enough These words from a woman in Peru illustrate a consequence of such violence [QUOTE]

22 Muchas mujeres internalizan normas que justifican a la violencia
Mi esposo me golpea, tiene relaciones conmigo en contra de mi voluntad y tengo que conformarme. Antes de esta entrevista realmente no pensaba en esto, creía que era natural, y que así se portan los esposos siempre”. Mujer entrevistada en Bangladesh Yet another key finding of the study is the extent to which women internalize social norms that justify abuse. This comes through strongly in the words of this woman interviewed in Bangladesh. She notes: [Read Slide]

23 El porcentaje de mujeres que creen que un hombre tiene el derecho de golpear a su esposa según las circunstancias Wife disobeys Wife refuses sex Bangladesh province 39 23 Brazil city 1 0.3 Brazil province 11 5 Ethiopia province 78 46 Namibia city 13 4 Peru province 26 Samoa 20 7 Serbia & Montenegro 0.6 Thailand province 25 Tanzania province 50 42 The quantitative data tell us that this women’s perception is not unique. In the study, we asked a number of questions to explore prevailing social norms around wife abuse. Specifically, we asked women whether they felt a man was justified in beating his wife under a range of different circumstances– for example, if she disobeyed him, if she was unfaithful, if he was displeased with her cooking or cleaning, etc. This slide summarizes data from a subset of countries on two particular circumstances: if a woman disobeys her husband, and if she refuses him sex. There are a number of noteworthy observations from this data. First off, we see that women do distinguish between different reasons for beating. [Click to show circle] Whereas 39 percent of women in Bangladesh province believe a man is justified in beating a wife if she disobeys, [Click] only 23 percent believe it is ok if she refuses him sex. [Click again] We also see the enormous differences in the degree to which wife beating is normative across settings. In Serbia & Montenegro, only 1 percent of women believe a man is justified in beating his wife if she disobeys, whereas in Ethiopia as much as 78 percent of women believe he is justified.

24 Si su marido la maltrata
Porcentaje de mujeres que opinan que un una mujere tiene derecho de negar el sexo a su marido... Si ella no quiere Si su marido la maltrata Bangladesh province 46 66 Brazil city 94 98 Brazil province 76 92 Ethiopia province 56 Namibia city 82 88 Peru province 49 72 Samoa 28 69 Serbia & Montenegro city 97 Thailand province Tanzania province 26 We see a similar pattern when we examine norms around women’s right to refuse sex from her husband. The slide shows the percentages of women who believe that it is acceptable for a wife to refuse sex from her husband for two different reasons: if she doesn't want it or if her husband mistreats her. Once more we see large difference both among sites as well as differences among the different reasons given. As this slide shows, more women believe that a wife can refuse sex if their husband is mistreating her (right) than if she simply does not want it (left).[Click] – this is the same for all sites Similar to what we saw on the previous slide, in the capital of Brazil and Serbia & Montenegro, almost all women feel that it is acceptable to refuse sex if she doesn't want it. (Just a few percent of women in these settings feel that women must always submit to their husbands sexual desires). [Click] [Click] In contrast, less than 30% of women Samoa and Tanzania province feel that a wife can refuse sex, meaning that in these sites most women believe a wife must be sexually available to their husbands at all times Women’s perceived lack of sexual autonomy in many settings clearly has significant implications for women’s ability to negotiate safer sex and to protect themselves from HIV and other sexually transmitted infections.

25 La violencia aumenta el riesgo para la mujeres de …
Consecuencias fatales homicidio suicidio Muertes maternas Muertes relacionadas con el sida Consecuencias no fatales Físicas mentales Comportamientos nocivos para la salud Salud reproductiva Por ejemplo: Embarazo no deseado Síndrome de dolor crónico lesión depresión Uso de alcohol/drogas ITS/vih Problemas ginecológicos Bajo peso al nacer La violencia sexual y física pueden tener efectos devastadores en la salud de las mujeres y es una importante causa de muerte por homicidio, suicidio, muerte materna y sida, y de una enorme variedad de problemas físicos, mentales y reproductivos, tales como los que se enumeran en esta diapositiva.

26 La violencia de pareja se asocia con peores indicadores de salud general
Sufrí mucho tiempo y tragué mi dolor. Por eso visito constantemente a los médicos y uso medicinas. Nadie debe ser obligado a pasar por esto. Mujer entrevistada en Serbia & Montenegro Las mujeres que han sufrido violencia de pareja experimentan: Peor salud en términos generales Más síntomas de enfermedades física, tales como dolor, pérdida de memoria, mareos, pérdida de memoria, y mareos en los 4 semanas anteriores de la entrevista Más síntomas de problemas emocionales Mayores pensamientos y actos suicidas Más abortos inducidos y espontaneos In terms of impacts on women's health, indeed the WHO Study demonstrates that women who have experienced partner violence have (compared to women who were never abused) Worse general health More symptoms of ill health such as pain, memory loss, dizziness in the past 4 weeks More signs of mental distress More suicidal thoughts and attempts More induced abortions and miscarriage As a woman interviewed in Serbia observed: “I suffered a long time and swallowed my pain. That is why I am constantly visiting doctors and using medicines. No one should have to do this…”

27 Violencia de pareja se asocia con pensamientoa y intentos de suicidio
Me siento mal y lloro mucho. Hay veces que no quiero vivir. Hasta pensé y matarme a mí y a mis hijos, porque pienso que si he sufrido tanto, cuánto más sufrirían mis hijos si ya no estoy ahí con ellos? Mujer entrevistada en Peru As an example, on this slide we see the strong relationship that exists between lifetime experience of physical and sexual partner violence and suicidal thoughts. The black bars represents the percentage of abused women who report suicidal thoughts compared to non abused women (shown in blue). A similar pattern holds true for suicide attempts. As a woman interviewed in Peru observed: “…I don’t feel well and I just cry. There are times that I want to be dead. I even thought of killing myself or poisoning myself and my kids, because I think if I have suffered that much, how much would my kids suffer if I am no longer there…”

28 La violencia actual y anterior está asociada con problemas de salud actuales
Una asociación entre enfermedades actuales y experiencias de violencia previas sugiere que las secuelas de la violencia persisten muchos años después de que la violencia termina. A primary insight from the WHO Study is that the health consequences of violence extend far beyond injury The fact that lifetime experiences of violence are associated with current or present day ill health suggests strongly that the negative consequences of violence can persist long after the violence has ended.

29 La violencia permanece escondida
Si protesto me señalarán en la comunidad y entonces mi hija no podrá casarse.… Si protesto la comunidad me echará la culpa por no aguantar mi situación en silencio. Esta impotencia es una tortura en sí. Mujer de 43 años de Bangladesh 20% hasta 66% de las mujeres nunca habían contado su situación a nadie antes de ser entrevistada en el estudio OMS Another major finding of the study is the degree to which violence remains hidden. Between one fifth to two-thirds of abused women had never told anyone about the violence prior to the WHO interview. The social consequences of disclosing abuse can be severe. As a middle class, urban Bangladeshi woman reports: “If I protest I’ll be marked in the society and then my daughter wouldn’t be able to get married… If I voice my protest the community will blame me for not bearing it in silence. This helplessness is a torture in itself.”

30 La mayoría de mujeres nunca buscan ayuda formal
% In an open question (to which multiple answers could be given), women were asked whom they told about the physical violence they had experienced. On this slide the results are presented per country and site: 2 sites for Brasil, Peru, Thailand, capital (or large city) and province and one site in Namibia and Japan. For each site the blue bar shows that a large proportion of women had not told anyone about the violence: ranges from 21% in Sao Paulo (large city in Brasil) to 46% (almost half) in Nakhonsawan (province in Thailand), which implies many times that the interviewer was the first person they had told about their situation. If women talked about the violence, this was in most cases to friends or parents. presented in this graph (yellow and whitish). Another finding, not in this graph, is that brothers or sisters were also mentioned rather often. However, other categories like their children, priests, health personnel and police were only mentioned by a very small percentage of women. [Local leaders and women NGO’s were hardly ever mentioned in any of the countries. Counsellors were mentioned just in two sites, in Sao Paulo (Brazil) and in Japan, and only by a very small percentage of women.] *Responses from women reporting physical partner violence to multiple response question

31 Buscar ayuda está relacionada con la severidad de la violencia
Porcentaje de mujeres que contaron a alguien % In an open question (to which multiple answers could be given), women were asked whom they told about the physical violence they had experienced. On this slide the results are presented per country and site: 2 sites for Brasil, Peru, Thailand, capital (or large city) and province and one site in Namibia and Japan. For each site the blue bar shows that a large proportion of women had not told anyone about the violence: ranges from 21% in Sao Paulo (large city in Brasil) to 46% (almost half) in Nakhonsawan (province in Thailand), which implies many times that the interviewer was the first person they had told about their situation. If women talked about the violence, this was in most cases to friends or parents. presented in this graph (yellow and whitish). Another finding, not in this graph, is that brothers or sisters were also mentioned rather often. However, other categories like their children, priests, health personnel and police were only mentioned by a very small percentage of women. [Local leaders and women NGO’s were hardly ever mentioned in any of the countries. Counsellors were mentioned just in two sites, in Sao Paulo (Brazil) and in Japan, and only by a very small percentage of women.]

32 El porcentaje de mujer que dejaron su casa, alguna vez, aunque sea por una noche, según la severidad de la violencia %

33 Discusión

34 Lecciones aprendidas Las mujeres están dispuestas a hablar sobre la violencia si se les pregunta en un ambiente de confianza, sin prejuicios , incluso, desean “contar su historia” Importancia de selección y entrenamiento especial para entrevistadores La importancia de invertir en la capacidad de las colaboración entre investigadores y activistas – un nuevo modelo de investigación

35 Tareas Pendientes… Existen metodologías para investigar la violencia doméstica y sexual, hay que sistematizar y lograr que se utilicen de manera consistente, incluyendo normas éticas Desarrollo de indicadores internacionales para monitorear cumplimiento de Estados en los compromisos internacionales (MDM, Indice de Desarrollo Humano, Belén do Pará) Desarrollar métodos para estudio de otras formas de violencia Femicidio/feminicido Violencia sexual en situaciones de conflicto armado Tráfico de mujeres y niñas/explotación sexual Violencia vinculada con el honor/dote/prácticas tradicionales Violencia en el sector educativo

36 Tareas Pendientes… Violencia contra grupos de mujeres específicos (migrantes, maquilas, grupos étnicos minoritarios, mujeres discapacitadas, etc) Más estudios epidemiólogicos para medir el impacto de la violencia en la salud de las mujeres (especialmente con VIH/SIDA) El costo económico de la violencia Mejorar el registro y vigilancia social de los servicios que atienden la violencia (policía, salud, ong´s de mujeres)

37 Tareas Pendientes… cont.
Evalución de impacto de intervenciones (incluyendo diseños ensayos de control aleatoria) Mayor uso de resultados para incidencia en los procesos políticos nacionales e internacionales (CEDAW, CIDH, Informe SG NNUU, Metas de Desarrollo del Milenio, Indice de Desarrollo Humano con perspectiva de género, proceos de auditoría social)

38 Hopefully one day, we can live in a world where all women feel safe in their homes and don't have to sleep in a locked bedroom with a dog to protect them.