Gender-Based Violence: A Crucial Challenge for Public Health

Abstract

This article attempts to summarize the situations of gender-based violence, a major public health issue. Due to the unequal power relations between men and women, women are violated either in family, in the community or in the State. Gender-based violence takes different forms like physical, sexual or psychological/ emotional violence. The causes of gender-based violence are multidimensional including social, economic, cultural, political and religious. The literatures written in relation to the gender-based violence are accessed using electronic databases as PubMed, Medline and Google scholar, Google and other Internet Websites between 1994 and first quarter of 2013 using an internet search from the keywords such as gender-based violence, women violence, domestic violence, wife abuse, violence during pregnancy, women sexual abuse, political gender based violence, cultural gender-based violence, economical gender-based violence, child sexual abuse and special forms of gender-based violence in Nepal. As GBVs remain one of the most rigorous challenges of women's health and well-being, it is one of the indispensable issues of equity and social justice. To create a gender-based violence free environment, a lot works has to be done. Hence, it is suggested to provide assistance to the victims of violence developing the mechanism to support them.

Full text

VOL.11 | NO. 2 | ISSUE 42 | APRIL- JUNE 2013
Page 179
Review Arcle
Gender-Based Violence: A Crucial Challenge for Public
Health
Sanjel S
Department of Community Medicine
Kathmandu University School of Medical sciences
Dhulikhel, Kavre
Corresponding Author
Seshananda Sanjel
Department of Community Medicine
Kathmandu University School of Medical sciences
Dhulikhel, Kavre
E-mail: sanjel.sn@gmail.com
Citaon
Sanjel S. Gender-Based Violence: A Crucial
Challenge for Public Health. Kathmandu Univ Med J
2013;42(2):179-184.
ABSTRACT
This arcle aempts to summarize the situaons of gender-based violence, a major
public health issue. Due to the unequal power relaons between men and women,
women are violated either in family, in the community or in the State. Gender-based
violence takes dierent forms like physical, sexual or psychological/ emoonal
violence. The causes of gender-based violence are muldimensional including
social, economic, cultural, polical and religious. The literatures wrien in relaon
to the gender-based violence are accessed using electronic databases as PubMed,
Medline and Google scholar, Google and other Internet Websites between 1994
and rst quarter of 2013. The keywords such as gender-based violence, women
violence, domesc violence, wife abuse, violence during pregnancy, women
sexual abuse, polical gender based violence, cultural gender-based violence,
economical gender-based violence, child sexual abuse and special forms of gender-
based violence in Nepal were used for internet search. As GBVs remain one of
the most rigorous challenges of women’s health and well-being, it is one of the
indispensable issues of equity and social jusce. To create a gender-based violence
free environment, a lot works has to be done. Hence, it is suggested to provide
assistance to the vicms of violence developing the mechanism to support them.
KEYWORDS
Gender-based violence, sexual violence, special forms of gender-based violence in
Nepal, women violence
INTRODUCTION
Gender-based violence (GBV) is a major public health
and human rights concern throughout the world.1,2 GBVs
include any act of verbal or physical force, coercion or
life-threatening deprivaon, directed at an individual
woman or girl that causes physical or psychological harm,
humiliaon, or arbitrary deprivaon of liberty and that
perpetuates female subordinaon.3 GBVs arise from
unequal power relaons between men and women and
connue to be reinforced by the entrenched patriarchal
values system of idenfying women as inferior to men
which prevail illiteracy, poverty, and low status of women
in the society.4,5 The GBVs take dierent forms for example
physical, sexual, and psychological/ emoonal.2,4,6 The
domesc violence remains common in all demographic
groups.6 A history of alcohol abuse, violence in the
abuser’s family of origin, emoonal insecurity, ansocial
features, borderline personality disorders, youthfulness,
low educaonal aainment and low socioeconomic status
all put an individual at risk of becoming abusive for men,
and past witnessing of their father beang their mother,
poor mental health and poor family work status exaggerate
the circumstances of being abused for women.6,7 GBV is a
considerable cause of female morbidity and mortality and
it has only recently begun to be recognized as an issue
for public health.4,6,7 Whereas, Nepal has made strong
normave and legal commitments to ending gender-
based violence and raed internaonal convenons/
treaes, recent events painfully illustrate it is me for
concrete naonal acon with eecve implementaon
and reinforcement of commitments, norms and laws.8
Moreover, gender-based violence is recognized and
addressed as a prime barrier to reproducve health.9
METHODS
This arcle reviews the literature in gender-based violence.
A major public health issue is highlighted, and challenges
and key issues and implicaons were proposed. Electronic
databases such as PubMed, Medline and Google scholar
were searched to get scienc arcles. For specic points,
not accessible in the scienc literature Google and other
Internet Websites were searched to access the arcles
between 1994 and rst quarter of 2013. Documents
published on World Health Organizaon (WHO), United
Naons Populaon Fund (UNFPA), Ministry of Health (MoH)
websites were also accessed to assess relevant reports and
papers. Published and unpublished organizaonal reports,
relevant arcles and some grey literature were also

KATHMANDU UNIVERSITY MEDICAL JOURNAL
Page 180
included in this arcle. The computerized database were
used to search the arcles which were related to gender-
based violence using an internet search from the following
keywords: gender-based violence, women violence,
domesc violence, wife abuse, violence during pregnancy,
women sexual abuse, polical gender based violence,
cultural gender-based violence, economical gender-based
violence, child sexual abuse and special forms of gender-
based violence in Nepal.
Gender Based Violence
GBV is widespread cung across classes, races, ages,
religions and naonal boundaries.10,11 Women are facing
violence at home, work place, market, road, bus, school,
campus, hotel, oce, law, policy, program, health,
business and court and so on.12,13 Persistent patriarchy
and dominance of Hindu religion and culture has treated
women as a second class cizen from the very beginning.
Furthermore, Hindu scripture also suggest that fathers,
husbands and even sons should control women.13
Gender-based violence take many forms: 1) Physical abuse
for example hing, slapping/ bing/ shoving, destroying
her property, using a weapon/ other objects to threaten or
hurt her and denying her access to a health care provider.
Sexual violence usually coincides with the physical violence.
2) Psychological/ emoonal abuse for example threatening
to take the children away from her, the threat could be to
leave with the children or to call child protecon services,
stalking/ harassing her, controlling her me and what she
does, isolang her from family/ friends and threatening to
hurt someone she cares for. 3) Verbal abuse for example
calling her names, other verbal means of aacking her
self-esteem and humiliang her in the presence of others.
4) Sexual abuse for example denying sexual inmacy or
forcing her into unwanted sexual acts, forcing her to get
pregnant or to have an aboron and infecng her with
sexually transmied infecons. 5) Spiritual abuse for
example beliling her spiritual beliefs and not allowing her
to aend the place of worship of her choice. 6) Financial
abuse for example liming access to family nances.14-16
Abuse against women happens because abusers have
learned to be abusive by watching others in the family and
society; abusers have found that it is an eecve way of
establishing or regaining control; societal atudes and
norms support the use of violence to control others; and
powerful gender-based inequalies in society support the
noon that woman abuse is a private maer and permit
people to look the other way when it happens.14,17,18 Hence,
most of the me, women are more oen assaulted by
someone known to the family, correspondingly pregnancy
does not cause abuse but it is clearly a risk period associated
with this.14,19
The violence is commonly experienced by women at
various phases of the life cycle from prenatal period,
infancy, childhood, adolescence, reproducve age
to old age in dierent forms.4,13 The vicms of sexual
abuse, rape and domesc violence are at increased risk
of suicide, depression, drug and alcohol abuse, STDs,
HIV/ AIDS, hypertension, chronic pelvic pain, irritable
bowel syndrome, asthma, gynecological problems, and
a variety of psychiatric disorders.4,12,20-22 In addion, the
raped women are rejected by their families and their
communies, among them those who had a child from
rape, widowhood, husband abandonment and gang rape
have more risk of rejecon.23 Besides, rape results not
only in physical and psychological trauma, but can destroy
family and community structures.23,24
Gender-based Violence in the Family level
Gender-based Violence in the Family is also known as the
domesc violence, in which social, economic, and gender
issues are increasingly recognized as signicant factors.11
In domesc violence, women are vulnerable to infancide,
genital mulaon, a child’s marriage without her consent,
dowry-related violence, baering and sexual abuse.15,16
There are other addional causes of GBV in the family
for example Inter-caste marriage, husband listen to other
family members, sexual dissasfacon, unemployment,
polygamy, extramarital relaon of husband, suspicious
atude, gambling, dowry and widowhood resulng in
psychological abuse, physical violence and, sexual abuse
and harassment. Surprisingly, the main perpetrator is
the inmate partner and the family members.25 The
husband is the most common perpetrator and the sexual
domesc violence is increased with increased age,
employed for cash and marital relaonship (divorced,
separated, or widowed) with the next most common is a
former husband, somemes a stranger and occasionally a
relave.16,26 Women’s risk of physical and sexual violence is
related to tradional gender norms for example husbands’
age, educaon level, women’s economic independence,
husbands’ being unfaithful, husbands’ using alcohol,
husbands’ ghng with other men, husbands’ having
witnessed domesc violence as a child and living in rural
areas.26-29 The women experience dierent types of health
problem due to domesc violence for example chronic
condions like irritable bowel syndrome and chronic pain
syndrome; mental health problem, reproducve health
problem, physical health problem due to severe beang,
backache, problem in vision and poor subjecve health and
the women even iniate negave health behavior like start
to smoke and take alcohol.20,30
Violence during Pregnancy
Studies revealed that GBV oen gets worse during
pregnancy occurring more frequently than placenta praevia
or gestaonal diabetes.14 Women who are pregnant may
be abused by their current or ex-husbands, partners, lovers
or boyfriends, or by their caregivers, parents, siblings,
children or other relaves for example the in-laws.14,29 The
contribung factors for the violence during pregnancy are
women’s educaon, husband’s educaon/ occupaon,
parity, birth order/ interval, unintended pregnancy, age of

VOL.11 | NO. 2 | ISSUE 42 | APRIL- JUNE 2013
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Review Arcle
women at marriage/ pregnancy, ethnicity/ caste/ religion,
family size/ structure, women’s status in the household,
and women’s knowledge/ atude/ belief/ culture.31,32
Experts and abuse survivors have suggested a wide
variety of explanaons for examples the abuser is jealous
towards the fetus considering the fetus an interloper in
the relaonship, feels loss of power and control over a
woman, dislike a woman’s increased aenon from family
and health care providers during pregnancy. Moreover,
the abuse during pregnancy is caused by stress related to
an unwanted/ unplanned pregnancy, marriage because
of the pregnancy, pregnancy perceived as a nancial and
emoonal burden, conict about the pregnancy between
the woman and her husband, anger at his partner’s
decreased energy and ability to care for the abuse,
ambivalent about the pregnancy, resentment because
of increased responsibilies associated with a child/
another child, angry because the pregnancy makes her less
aracve to him, frustrated because the pregnancy may
change her sexual behavior toward him, anger about her
need to reduce her workload or take maternity leave.13,14,33
The proporon of women experiencing violence during
pregnancy is higher in women having three or more
children, illiteracy, poverty, residing rural and Terai areas of
Nepal.16,33,34 The violence during pregnancy threatens the
goal of safe Motherhood for all women and consequently
experience high maternal morbidity and mortality.4,15,33
On the other hand, man’s violent behavior may worsen
when his partner is pregnant and they have to do with the
dominant image some men have of themselves which is
challenged by the realizaon that women have capacies
men cannot share and that society depends on women
for its own survival through childbearing. In addion,
pregnancy oen limits sexual intercourse and may cause
sexual frustraon in the man.15,33 Spectacularly, an issue
that has not as yet been resolved is whether pregnancy
actually enhances the risk of domesc violence, or simply
increases the chances to idenfy it through aendance
at antenatal care.15,36 Abuse start during pregnancy and
connue or change the paern. Abuse are in dierent form
like; control, limit, delay or deny her access to prenatal
care; use her pregnancy as a weapon in emoonal abuse
by refusing sex on the grounds that her pregnant body
appears unaracve to him, denying that the child is not
his, refusing to support her during the pregnancy, refusing
to support her during the childbirth; nancially abuse by
refusing her access to money to buy food and supplies;
restrict her access to food; and force her to work beyond
her endurance during pregnancy.6,14,15,34
Violence during pregnancy escalates during a women’s
gestaon with serious consequences not only for the
women but also for the fetus and ulmately for the child
raising both the maternal and fetus adverse eects for
example fetal death, low birth weight neonate, preterm
delivery and small size for gestaonal age in fetus, and
maternal mortality, mental health problems, kidney
infecons, less gain of weight during pregnancy and
more likely to undergo operave delivery in pregnant
women.6,15,36,36 The GBV during pregnancy is associated with
the empowerment of women and has been highlighted as
a signicant problem that needs to be addressed by health
care professionals.16,33
Gender-based Violence in the Community level
In the community, women can be subjected to sexual
harassment at work, prostuon, pornography and
tracking. Addionally, migrant women are especially
vulnerable given their minority and oen illegal status.15,37
Female vicms of sexual violence are considered as having
lost their honor in the community.15,24 A girl’s honor is
perceived as a delicate asset that must be preserved,
even at high cost, and if a girl fails to protect herself or
gets vicmized, not only she loses respect but also the
family and even the enre village feel a sense of shame.
As a consequence, there are cases where women have
been doubly vicmized for having reported violence they
suered and sgmazed within their own communies.16,24
Also, boys sleep with many girls and they remain
presgious but girls become (regarded as) prostute.13,33,38
Furthermore, widow women face much more problems
than the women who are staying with her husband.4,13,33,38
Physical, sexual and psychological violence occur within the
general community include baery, rape, sexual assault,
sexual harassment and inmidaon in school, in work, in
transportaon and in treatments. The exploitaon and
commercializaon of women’s bodies which is related
to increased poverty, is mainly a result of unrestrained
economic liberalism.
Gender-based Violence in the State level
Women are vulnerable to violence even by the State,
whether in prisons or in situaons of armed conict,
when rape is used as an instrument of war.17,40 One of
the main obstacles for women seeking jusce is limited,
and in some places non-existent support structures for
vicms of sexual violence.38,40 Furthermore, the exisng
legal framework for addressing sexual violence has been
cricized by human rights and other organizaons as
inadequate. Firstly, the denion of rape is narrow and
focuses on issues of ‘consent’ rather than ‘invasion of
body’. Secondly, rape includes only penetraon by sexual
organ, and does not allow for other forms of penetraon,
such as oral sex or penetraon by objects. Thirdly, the 35-
day statute of limitaons is too short, especially where a
vicm is oen too traumazed and frightened to come
forward within such a short period of me. In cases where
women do try to press charges, they oen face pressure
by the perpetrators and in some cases their communies
to withdraw the charges in the name of social harmony.
In some instances the police refuse to le a case because
there is no medical report, while the doctor refuses to do a
forensic examinaon in the absence of a First Informaon
Report.24,41 The existence of complicated and expensive legal
processes, where condenality is lacking, prevent women

KATHMANDU UNIVERSITY MEDICAL JOURNAL
Page 182
from seeking jusce.42 Addionally, chauvinist atudes
that downplay the seriousness of violence against women
also appear to inuence decisions to arrest, prosecute and
convict perpetrators. The apparent failure of the police and
judicial system to support invesgaon and prosecuon of
cases of sexual violence reinforces the culture of impunity
on which sexual violence thrives. Today, Nepal sll lacks an
integrated support model for vicms of sexual violence,
encompassing access to healthcare, psychosocial support
and legal aid.37,43 Besides, physical, sexual and psychological
violence are too oen perpetrated or tolerated by states
extremely disturbing as regards women’s right to their
economic autonomy and their freedom of choice. Women
are considered second class beings, of lesser value, hence,
deprived of their fundamental rights.
The Government of Nepal has made signicant
improvements in the formulaons of laws, policies and plan
of acons aer the end of historical Rana rule incorporang
the gender-based violence issue in the rst Civil Code 1964
and subsequent formulaon and endorsement of laws,
acts, acon plans, policies and strategies. The eorts are
Human Tracking Control Act 1986; the Constuon of
Nepal 1990; the Naonal Plan of Acon against Tracking
in Children and Their Commercial Sexual Exploitaon 2001;
the Naonal Plan of Acon against Tracking in Children
for Sexual and Labor Exploitaon 2001; the Naonal Plan
of Acon for Gender Equity and Women’s Empowerment
(Beijing Conference 1995). In addion, other endeavor are
Naonal Expert Commiee’s Recommendaons on the
implementaon of CEDAW 2004; Women’s Commission
Act 2006; Interim Constuon of Nepal 2007; Human
Tracking (Control) Act 2007 (the restructuring of Human
Tracking Control Act 1986); the Naonal Women’s
Commission ve-year Strategic Plan 2009-2014; and the
Domesc Violence (Oence and Penales) Act 2009. But
the implementaon of those supporng enes is poor as
a result there is high magnitude of gender-based violence
in Nepal.44
Gender-based Violence in the Conict Situaons
At some point in armed-conict situaons, the right to life,
the right to liberty and security of the person, the right
to freedom from torture or cruel/ inhuman/ degrading
punishment/ treatment, the right to be free from sexual
violence, the right to peaceful assembly, and the right of
children to special protecon in armed conict, including a
prohibion on their recruitment into the armed forces are
violated.10,11,42,43,45 In addion, the violence commied by
the state and the rebels increase including displacement,
unlawful killing, torture, enforced disappearance, sexual
violence and long-term arbitrary arrest from both the state
and the rebel sides.24,43,46 During the conict situaon the
sexual violence of girls and women increase immensely from
both state security personnel and the rebels devastang
their day to day works.40,49 Besides, internally displaced
women, and women near army barracks, even tracked
or coerced for forced sex workers which goes up as a result
of lack of economic security and support system.39,48 In
the conict situaon the sexual violence is commied by
non-family members including pares to the conict and
the neighbors due to lack of or limited security systems
at the community, absence of male members at home
and increased authority of insurgents and armed forces,
making them prime target of sexual and gender based
violence.24,43,47,48 As a result, there exists ‘conict wives’
phenomenon where such ‘wives’ were considered impure
and immoral in the community once their ‘protectors’ le,
resulng in ostracizaon and sgmazaon for them and
any children from the relaonship.39 During the conict,
there is not only conict-related sexual violence, but also
non-sexual violence such as domesc violence for example
captures of women and the girls by both the state security
force and the rebel forces, hence, the needs and demands
of the survivors should be looked at.37,48,49
Special forms of Gender-based Violence in Nepal
An unequal gender relaon pervasive in the Nepalese
society, has been a key in legimizing violence against
women.35,39 Besides, taboos surrounding sexual violence
in Nepalese society and the general culture of silence are
the biggest challenge to assess problem and endeavor
accordingly making it dicult to document sexual violence
without risk of causing harm to the vicms.12,37,39 Studies
in Nepal indicate that a strong patriarchal element lies
at the heart of Nepalese society being reportedly at the
root of social and gender discriminaon.12,20,48 In addion,
ndings suggest that patriarchal atudes and deep-rooted
stereotypes that discriminate against women remain
entrenched in the social, cultural, religious, economic/
polical instuons, structures of Nepalese society, and
in the media, thereby, legimang the same.41,50 Violence
against women is socially accepted as ‘normal’ and remains
high in Nepal.12,20,42 Furthermore, women from Muslim
community are not culturally allowed to parcipate
in a range of social acvies.12,50 Some of the socially
ill pracces have insgated to the vulnerable status of
women and children such as child marriage; dowry system:
oering cash or kind during wedding; Deuki: an ancient
custom pracced in the far western regions of Nepal in
which a young girl is oered to the local Hindu temple
to gain religious merit; Jhuma: a tradion of oering the
second daughter to the monastery in the Himalaya region
of Nepal; Chaupadi: tenng women in a segregated and
unhygienic huts during menstrual period in mid-western
and far-western region of Nepal, Badi: a low sub-castes
tradionally praccing prostuon; Kumari: the girl who is
worshipped is not allowed to go out of the temple where
she is worshipped unl puberty aer that they are replaced
by another Kumari but she should not marry for lifelong;
and Kamlari: sending girl bonded-labour are sll prevalent
in Nepalese sociees.20,41,42,50 Among them, Deuki, Jhuma,
Chhaupadi and Kamlari experience all types of violence
frequently and consequently encounter more physical and
mental health problems.20,42,51

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Review Arcle
IMPERATIVE IMPLICATION
At the moment, it is me to set strategies as to provide help
to the vicms of violence developing the mechanism to
idenfy them, enhance social support, conduct screening
and referral of vicms, implement behavioral intervenons,
implement improve legal provisions and the research
so that gender-based violence is totally eliminated with
collaboraon between the government and civil society
including the community.4,8,13,15,16,45 This iniave should
be to ensure the safety and autonomy of the violence
survivors’ assuring the relevance and appropriateness to
the local seng.2,23,33 Constuon of Nepal guarantees
the right to constuonal remedy for those whose
fundamental rights have been violated as has explicitly
prohibited all forms of discriminaon on the ground of
gender declaring GBV a crime and has commitment to
eliminate all forms of GBVs and ensure gender equality
by rafying the UN Convenon on the Eliminaon of All
Forms of Discriminaon Against Women (CEDAW) and
several other related internaonal instruments but due to
the absence of strict implementaon of these instruments
GBVs recurrently happen. Although Nepal raed the
CEDAW and formulated Domesc Violence Act and a 5-year
naonal strategy and acon plan for ending gender-based
violence, and put the GBV in place the strong normave
and legal commitments to ending gender-based violence
and legal binding itself to put the CEDAW provisions into
pracce, sll there are setbacks in the implementaon of
these commitments. The latest NDHS 2011 incorporated
GBV as an issue of assessment. Furthermore, there are
only a few researches conducted on GBVs and no research
covering all geographical areas and ecological regions is
being held yet.52-54 Thus, more researches in this area are
ancipated.
CONCLUSION
GBVs remain one of the most serious social, legal and
health challenges for the 21st century. It is a major public
health problem and has a serious impact on women’s
health and well-being. It is one of the indispensable issues
of equity and social jusce. It happens in all the sengs like
family, community and state hence, has to be dealt with
involving all the sectors. Much work remains to be done
to create an environment free of gender-based violence.
Raising awareness level of all the sengs involving all the
mechanisms of society have to be encouraged. Concerning
to the current vicms, a mechanism has to be developed
for idenfying, enhancing social support, screening and
referral and legal provisions.
REFERENCES
1. UNIFEM. UNIFEM’s Partnerships with Regional Organizaons to
Advance Gender Equality; 2009.
2. USAID. Addressing Gender-Based Violence through USAID’s Health
Programs: A Guide for Health Sector Program Ocers; July 2006.
3. Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence
and health. Lancet 2002;360:1083-8.
4. Heise L. Gender-based Abuse: The Global Epidemic. Cad Saúde Públ,
Rio de Janeiro 1994;10((suppl 1)):135-45.
5. Ragnarsson A, Townsend L, Ekstro¨m AM, Chopra M, Thorson A.
The construcon of an idealised urban masculinity among men with
concurrent sexual partners in a South African township Global Health
Acon 2010;3(5092):1-7.
6. Cook J, Bewley S. Acknowledging a persistent truth: domesc violence
in pregnancy. J R Soc Med 2008;101:358-63.
7. Pitpitan EV, Kalichman SC, Eaton LA, Cain D, Sikkema KJ, Skinner D,
MH, Wa, Pieterse D. Gender-based violence, alcohol use, and sexual
risk among female patrons of drinking venues in Cape Town, South
Africa. J Behav Med 2012.
8. The Rising Nepal. Ending Domesc Violence. [2012]. hp://www.
gorkhapatra.org.np/rising.detail.php?article_id=55434&cat_id=7
Editorial (serial on the Internet).
9. USAID. Gender-Based Violence: Impediment to Reproducve Health;
2010. Available from: hp://www.igwg.org/igwg_media/gbv-
impediment-to-RH.pdf.
10. 1UN. United Naons General Assembly: Declaraon on the
eliminaon of violence against women. New York: United Naon
1993.
11. Populaon Council. Sexual and Gender-based Violence in Africa:
Literature Review. Nairobi: Populaon Council Sub-Sararan Africa
Region; February 2008.
12. Upadhayay CK. Country Presentaon on Gender Based Violence in
Nepal: Presented in Gender Based violence Re-examine Workshop
Philippines. Kathmandu Nepal 2010 Oct 14: 24-13.
13. Heise L, Ellsberg M, Gomoeller M. A global overview of gender-
based violence. Internaonal Journal of Gynecology and Obstetrics
2002;78(1):S5–S14.
14. Jamieson BL. A Handbook for Health and Social Service Professionals
Responding to Abuse During Pregnancy. Oawa, Ontario, K1A 1B4,
Canada: Minister of Public Works and Government Services Canada;
1999.
15. Benagiano G, Carrara S, Filippi V. Social and ethical determinants of
human sexuality: 2. Gender-based violence. The European Journal of
Contracepon and Reproducve Health Care August 2010;15:220–31.
16. Ministry of Health and Populaon (MOHP) [Nepal] NE, and ICF
Internaonal Inc. Nepal Demographic and Health Survey 2011
Kathmandu, Nepal; March 2012.
17. Karmaliani R. HS, Hirani S, Asad N, Cassum L. Violence against Women
in Pakistan: Contribung Factors and New Intervenons. Mental
Health Nursing 2012;33:820–6.
18. Lee-Koo K. Gender-Based Violence Against Civilian Women in
Posnvasion Iraq: (Re) Policizing George W. Bush’s Silent Legacy.
Violence Against Women 2011;17(12):1619–34.
19. Kalisya LM, Jusn PL, Kimona C, Nyavandu K, Eugenie MK, Lusi
Jonathan KM et.al. Sexual Violence toward Children and Youth in
War-Torn Eastern Democrac Republic of Congo. PLoS ONE January
18, 2011;6(1):e15911.
20. Sharma S. Domesc violence in Nepali society: Root Cause and
Consequences A research report. KathmanduMay 2007.
21. Pandey S, Lin Y. Adjusted Eects of Domesc Violence, Tobacco use,
and Indoor Air Polluon from Use of Solid Fuel on Child Mortality.
Matern Child Health J ;13 Oct 2012.

KATHMANDU UNIVERSITY MEDICAL JOURNAL
Page 184
22. Lang DL, Salazar LF, DiClemente RJ, Markosyan K. Gender Based
Violence as a Risk Factor for HIV-Associated Risk Behaviors Among
Female Sex Workers in Armenia. AIDS Behav 2013;17:551–8.
23. Kelly JT, Betancourt TS, Mukwege D, Lipton R, VanRooyen MJ.
Experiences of female survivors of sexual violence in eastern
Democrac Republic of the Congo: a mixed-methods study. Conict
and Health 2011;5(25):1-8.
24. UNHCR. An analysis of conict-related violaons of internaonal
human rights law and internaonal humanitarian law between
February 1996 and 21 November 2006. Geneva; 2012.
25. Rahman M, Nakamura K, Seino K, Kizuki M. Inmate partner violence
and use of reproducve health services among married women:
evidence from a naonal Bangladeshi sample. BMC Public Health
2012;12(913):1-12.
26. Haya EN, Högberg U, Hakimi M, Ellsberg MC, Emmelin M. Behind the
silence of harmony: risk factors for physical and sexual violence among
women in rural Indonesia BMC Women?’?s Health 2011;11(52):1-8.
27. Marn LS, Moracco KE, Garro J, Tsul AO, Kupper LL, Chase JL et.al.
Domesc violence across generaons: Findings from northern India.
Internaonal Journal of Epidemiology 2002;31:560-72.
28. Maman S, Yamanis T, Kouyoumdjian F, Wa M, Mbwambo J. Inmate
Partner Violence and the Associaon With HIV Risk Behaviors Among
Young Men in Dar es Salaam, Tanzania. Journal of Interpersonal
Violence 2010;25(10):1855–72.
29. Laisser RM, Nystro¨m L, Lindmark G, Lugina HI, Emmelin M. Screening
of women for inmate partner violence: a pilot intervenon
at an outpaent department in Tanzania. Global Health Acon
2011;4(7288):1-12.
30. Shrivastava PS, Shrivastava SR. A Study of Spousal Domesc Violence
in an Urban Slum of Mumbai. Int J Prev Med. January 2013 4(1):27-
32.
31. Simkhada B, van Teijlingen ER, Porter M, Simkhada P. Factors aecng
the ulizaon of antenatal care in developing countries: systemac
review of the literature. Journal of Advanced Nursing 12 October
2007;61(3):244–60.
32. Simkhada B, Porter MA, van Teijlingen ER. The role of mothers-in-law
in antenatal care decision-making in Nepal: a qualitave study. BMC
Pregnancy and Childbirth 2010;10(34).
33. Perera J, Gunawardane N, Jayasuriya V. Review of Research Evidence
on Gender Based Violence (GBV) in Sri Lanka; 2011.
34. Ray AM, Salihu HM. The impact of maternal mortality intervenons
using tradional birth aendants and village midwives J Obstet
Gynaecol January 2004;24(1):5-11.
35. Nasreen HE, Kabir ZN, Forsell YEdhborg M. Prevalence and associated
factors of depressive and anxiety symptoms during pregnancy: A
populaon based study in rural Bangladesh. BMC Women?’?s Health
2011;11(22):1-9.
36. UNCT-Nepal. Joint UNCT Input on Nepal for the Report of the
Secretary General to the Security Council on the Implementaon of
SCR 1820 on Women, Peace and Security April 2009. Kathmandu:
UNCT-Nepal; April 2009.
37. Regmi PR, van Teijlingen ER, Simkhada P, Acharya DR. “Boys Remain
Presgious, Girls Become Prostutes”: Socio-Cultural Context of
Relaonships and Sex among Young People in Nepal. Global Journal
of Health Science April 2010; 2(1):60-72.
38. WOREC. Violence against Women in Nepal: A Complex and Invisible
Reality. Kathmandu; 2006.
39. UNIFEM. Women, War, Peace [internet].
40. Concluding Observaons on GBV: Nepal. Kathmandu; 2008.
41. WOREC. Adolescents and Youth Speak about Violence and its Impact:
A Case Study in Eastern Nepal. Kathmandu; 2003.
42. UNFPA C. Vicm of a rape in 2002 speaking to OHCHR-Nepal, during
the assessment mission in Achham District. Kathmandu; May 2009.
43. Stark L, Ager A. A Systemac Review of Prevalence Studies of Gender-
Based Violence in Complex Emergencies. Trauma, Violence, and
Abuse 2011;12(3):127-34.
44. Joshi SK, Swahnberg K. Tracking of Women and Girls from Nepal
to India for Prostuon: What is Known About its History, Nurturing
Factors, Health Eects and Prevenon? Nurturing Factors, Health
Eects and Prevenon 2010.
45. Keygnaert I, Veenburg N, Temmerman M. Hidden violence is silent
rape: sexual and gender-based violence in refugees, asylum seekers
and undocumented migrants in Belgium and the Netherlands.
Culture, Health & Sexuality. May 2012;14(5):505–20.
46. Putnam FW. Ten-Year Research Update Review: Child Sexual Abuse. J
Am Acad Child Adolesc Psychiatry March 2003;42(3):269–78.
47. UNIFEM S. Sexual and Gender Based Violence during Conict and
Tradional Period: Jhapa and Morang Districts: A Research Report.
Kathmandu; 2008.
48. Orach CG, Musoba N, Byamukama N, Mutambi R, Aporomon JF,
Luyombo A et.al. Percepons about human rights, sexual and
reproducve health services by internally displaced persons in
northern Uganda. African Health Sciences October 2009;9(special
issue 2):s72-s80.
49. FWLD. Domesc Violence against Women in Nepal: Concept, History
and Exisng Laws. Kathmandu; 2008.
50. Third Eye Volunteer in Nepal. Special forms of gender-based
violence in Nepla [cited 2013 March 22]. Available from: hp://
volunteersummernepal.org/deuki-pratha.
51. GoN, editor. Interim Constuon of Nepal Kathmandu: Government
of Nepal; 2007.
52. Josh SK, Swahnberg K. Women and girls tracking from Nepal to India
for prostuon: what is known about its history, nurturing factors,
health eects, and prevenon?2012.
53. Joshi SK, Kharel J. Violence against Women in Nepal -- An Overview.
The Free Library [serial on the Internet] 2008. Available from: hp://
www.thefreelibrary.com/Violence Against Women in Nepal -- An
Overview-a01073875052.
54. Joshi SK. Violence against women in Nepal: Role of health care
workers. Kathmandu Univ Med J 2009;7 (2)(26): 89-90.