Gender-Based Violence is a Never to be Forgotten Social Determinant of Health: A Narrative Literature Review

Abstract

Gender-based violence (GBV) has been internationally recognized as a serious and pervasive phenomenon affecting women’s lives and health. The World Health Organization (WHO) reports that about 30% of women have experienced worldwide some form of violence. GBV (in addition to clearly visible immediate effects) induces long-term effects, including an increased incidence of many noncommunicable diseases such as diabetes or cancer. In the last few years, it has also been demonstrated that the signs of violence interfere with genome plasticity and gene expression through epigenetic mechanisms. The underestimation of the problem does not allow us to put in place preventive health mechanisms that could cushion the damage (prevent post-traumatic stress disorders—PTSDs—and the evaluation of epigenetic changes) to avoid the onset of the diseases. Appropriate interventions could reduce many of these long-term health effects while failure to intervene could be a significant source of health inequalities. The aim of this narrative review is to summarize the available evidence on the relationship between GBV, its long-term effects on health, and as victims’ living conditions, and socioeconomic position of determining both.

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1
Chapter
Gender-Based Violence is a Never
to be Forgotten Social Determinant
of Health: A Narrative Literature
Review
AnnaMariaGiammarioli, EloiseLongo
and RaffaellaBucciardini
Abstract
Gender-based violence (GBV) has been internationally recognized as a serious
and pervasive phenomenon affecting women’s lives and health. The World Health
Organization (WHO) reports that about 30% of women have experienced world-
wide some form of violence. GBV (in addition to clearly visible immediate effects)
induces long-term effects, including an increased incidence of many noncom-
municable diseases such as diabetes or cancer. In the last few years, it has also been
demonstrated that the signs of violence interfere with genome plasticity and gene
expression through epigenetic mechanisms. The underestimation of the problem
does not allow us to put in place preventive health mechanisms that could cushion
the damage (prevent post-traumatic stress disorders—PTSDs—and the evaluation
of epigenetic changes) to avoid the onset of the diseases. Appropriate interventions
could reduce many of these long-term health effects while failure to intervene could
be a significant source of health inequalities. The aim of this narrative review is to
summarize the available evidence on the relationship between GBV, its long-term
effects on health, and as victims’ living conditions, and socioeconomic position of
determining both.
Keywords: equal rights, health disparities, social determinants of health, gender-based
violence, intimate partner violence
1. Introduction
Gender-based violence (GBV) refers to harmful acts directed against a person
based on their gender, sexual orientation, or gender identity. GBV is a severe violation
of human rights and a life-threatening health that include physical, sexual, psycho-
logical, and socioeconomic violence, including sexual harassment and stalking [1].
Both women and men, as well as people who do not fit within the narrow param-
eters of the assigned societal gender-based roles, may experience GBV but worldwide
the majority of victims of GBV are women and girls. Even in the case of lesbian, gay,

Women’s Health Problems - A Global Perspective
2
bisexual, and transgender (LGBT) people, violence is predominantly suffered by
women (LGBT women and transgender men), who the assailants perceive as a chal-
lenge to socially constructed norms. For this reason, although this is incorrect, GBV
and violence against women and girls (VAWG) are used interchangeably [1]. Both
VAWG and GBV are based on hierarchical and unequal structural power relations that
are rooted in norms, roles, and relationships between socioeconomic groups as well as
in socially constructed characteristics of women and men, which in turn influence vio-
lence and abuse [2, 3]. In the last few decades, GBV has increasingly been recognized as
a public health problem affecting almost all health outcomes throughout life (including
mental health and noncommunicable diseases such as diabetes or cancer). In many
countries, violence against LGBT women and its health effects are not adequately
investigated and are certainly underreported, so the available data for LGBT women
are further much more limited than those for non-LGBT women. In this chapter we
focused on the health effects produced by violence against non-LGBT women, assum-
ing that they are similar for LGBT women (hereinafter both referred to as women).
Our aim is to summarize the available evidence on the relationship between GBV
and its long-term health effects, arguing that many of these health effects could be
avoided by helping victims of violence with recovery interventions. We would also
like to point out that women living in environments with limited social, educational,
and economic opportunities (in addition to being at increased risk of multiple forms
of violence) have fewer opportunities to access GBV recovery interventions. GBV
turns out to be a key indicator of health inequalities and we suggest that it should start
to be considered a social determinant of health.
2. Materials and methods
A narrative literature review was conducted to seek to examine a collection of
qualitative and quantitative studies. A narrative literature review is particularly
useful as a means of linking together studies from different fields and methodologies
in order to develop a more comprehensive, intersecting, and overarching synthesis.
There are some possible limitations in this analysis and some articles that talk about
GBV may not be covered in this narrative review.
For the purpose of this study, we used a search on the following online data-
bases: PubMed/MEDLINE and Google Scholar. In PubMed/MEDLINE, we used
the Boolean operators, “AND” and OR, to link keywords and MeSH headers as
shown below: i) (Gender-based violence OR intimate partner violence OR domestic
violence) AND (post-traumatic stress disorder OR psychological stress OR stress-
related disorders OR mental health OR trauma, nervous system OR disease OR
illness); ii) (Gender-based violence OR intimate partner violence OR domestic
violence) AND (health veterans OR women veterans OR veterans OR military sexual
trauma); iii) (Gender-based violence OR intimate partner violence OR domestic
violence) AND (epigenomics OR epigenesis, Genetic OR epigenetic); iv) (Gender-
based Violence OR intimate partner violence OR domestic violence) AND (health
service accessibility OR health personnel OR health personnel education); v)
(gender-based violence OR intimate partner violence OR domestic violence) AND
(social determinant of health OR health disparities OR health equity). In Google
Scholar we searched articles not indexed in PubMed/MEDLINE. The terms used and
their combinations were similar to those utilized in the PubMed/MEDLINE research.
We focused all searches from January 2000 to January 2023. Some references were

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Gender-Based Violence is a Never to be Forgotten Social Determinant of Health: A Narrative…
DOI: http://dx.doi.org/10.5772/intechopen.110651
not identified using the online databases but were obtained through reference lists
of other articles. Reports from World Health Organization (WHO) and United
Nations were downloaded from the official websites, and web addresses have been
reported in the references. The criteria for inclusion in the research are the following:
scientific articles and/or papers written in English and/or Italian and with human
subjects. We excluded expert opinions, case reports, studies on abused children, and
studies addressing the effects of violence on LGBT communities. Two authors were
involved in the search and screening process of scientific articles and/or papers.
3. Patriarchal culture and international conventions to tackle
gender-based violence
GBV is not a private matter, but it concerns the whole of society. It is a phenom-
enon that has deep roots entrenched in a social context that feeds on prejudice and
stereotypes and is not limited to the dramatic cases of femicide. Secular patriarchal
structures and attitudes make lasting progress difficult. Most societies have been
shaped by religious doctrine whereby attitudes and systems that promote male
dominance have become the norm. This doctrine has distorted sacred scriptures by
selecting texts where women are subordinate and inferior to men. Alongside these
patriarchal systems, violence in society has also been normalized, and factors of social
poverty have amplified violence. GBV is accepted in many spheres of social life [4].
According to WHO, sex-gender inequalities are deeply rooted in society [5] and
are both cause and consequence of violence, so social prevention measures aim to
achieve cultural change in attitudes and behaviors of men and women and eradicate
prejudices, attitudes, and habits based on negative gender stereotypes [6].
Over the past decades, international institutions and organizations have focused
on promoting women’s rights, complaining, and warring against GBV. As a result,
essential declarations and resolutions have been issued, and the most significant ones
are listed below in chronological order:
• The international Convention on the Elimination of All Forms of Discrimination
against Women (CEDAW), adopted in 1979 by the United Nations General
Assembly, defines discrimination against women as.
“…any distinction, exclusion or restriction made based on sex which has the effect or
purpose of impairing or nullifying the recognition, enjoyment or exercise by women,
irrespective of their marital status, based on equality between men and women, of
human rights and fundamental freedoms in the political, economic, social, cultural,
civil or any other field” [7].
• The Council of Europe Convention is the first international treaty that specifically
addresses violence from a gender perspective. “Preventing and combating violence
against women and domestic violence (also known as The Istanbul Convention)
“…. any act of violence based on sex, or the threat of such acts, which produces or is likely
to produce physical, sexual, or psychological harm or suffering, coercion or arbitrary
deprivation of liberty, whether in the public or private lives of women” [6];
• The Beijing World Conference on Women and its Platform for Action specify
that “… violence against women is the manifestation of the historical difference in

Women’s Health Problems - A Global Perspective
4
power within gender relations such inequality has resulted and results in systematic
discrimination against them, we call upon, therefore, governments to make greater
efforts regarding the quantification and evaluation of its consequences on women’s
health” [8];
• The World Health Organization (WHO) report on violence is defined as “a huge,
global health problem” and urges health services to make more significant efforts
“to provide comfort to women who experience acts of physical violence and sexual
abuse” [9];
• The WHO World Report on Violence and Health presents the first comprehen-
sive global-scale analysis of the problem of violence [10].
Prevention of GBV has been included as a target in the 2030 United Nations
Agenda for Sustainable Development (Goal 5), and many countries are working in
this direction. However, we all still have a long way to go [11].
Human rights conventions and declarations obligate countries that have ratified
them to treat GBV as a human rights violation and to define laws and actions to tackle
the phenomenon. Regrettably, much more often than desired, this applicability has
been undermined by social conditioning and structural and organizational barriers
in many countries. The tradition of a patriarchal culture that still feeds the practice
of possession in the affective relationship prevents one from reading the imbalance
of man/woman relationships that is at the root of violence. It is, therefore, important
to recognize the signs of mistreatment and abuse in its various forms: psychological,
physical, economic, social, and cultural.
4. Different forms of gender-based violence
Although violence disproportionately affects women living in low- and lower-
middle-income countries, GBV runs across all cultures, social classes, and ethnicities
everywhere in the world.
As previously described, it is an expression of unequal power relations,
underpinned by social norms and beliefs linked to dominance, power, and abuse
of authority, and formalized through social institutions’ laws, policies, and
regulations [12, 13]. GBV can take many forms, including physical, psychologi-
cal, and sexual violence; social violence, which cuts survivors off from their
communities or social groups, and economic violence, which results in economic
deprivation[1].
Depending on the types of relationship between the victim and the perpetrator
of violence (e.g., known versus unknown, intimate versus acquaintance), women
have experienced intimate partner violence (IPV) and non-intimate partner vio-
lence (NPV). The Centers for Disease Control and Prevention (CDC) defines IPV
as physical violence or psychological aggression perpetrated by a current or former
partner [14]. At the same time, NPV is violence perpetrated by a person with whom
the victim has only a passing acquaintance. As many studies show, IPV fits into a
broader spectrum of possible violence that occurs within the home and involves
not only spouses or partners but also the father with respect to the daughter or
other relatives and family members who may perpetrate acts of violence on female
relatives [15].

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The World Health Organization (WHO) reports that about 30% of women
worldwide (1 in 3 women) have experienced some form of physical and sexual
violence by an intimate partner or non-partner sexual violence or both, with
severe consequences on physical and psychological health [16]. Data are even
more alarming in poorer countries where women who have experienced physical
and/or sexual violence in their lifetime account for around 37%, with some of
these countries having a prevalence of up to one in two. In addition, the infor-
mation regarding violence is often not collected or under-reported due to the
women’s reluctance to declare violence, given that the victims are often blamed
for what happened to them and the phenomenon is undoubtedly underestimated
worldwide. In many countries, the situation is even worse concerning violence
against LGBT women, which is not adequately investigated and is certainly
under-reported.
Differently from what one is prepared to believe, the World Health Organization
(WHO) reports that globally IPV is the most common type of GBV, as on average
27% of women worldwide have experienced physical and/or sexual violence from
their intimate partner [16]. The prevalence estimates of intimate partner violence
range from 20% in the Western Pacific, 22% in high-income countries and Europe,
25% in the WHO regions of the Americas to 33% in the WHO African region, 31%
in the WHO Eastern Mediterranean region, and 33% in the WHO South-East Asia
region [16]. The variations in prevalence can be explained by the fact that different
multilevel factors (including individual, relational, community, and social aspects)
may interact with each other to increase or reduce the risk of being a victim of
IPV [12, 13, 17]. IPV is also characterized by systematic underreporting due to the
tendency of victims not to verbalize or report the abuse they have suffered, which
makes it extremely difficult to estimate the burden of disease associated with
incidents of IPV.
An understudied and underestimated phenomenon is also violence in pregnancy.
Widespread is the stereotype that pregnancy has a protective function with respect
to violence [18–20]. The data, however, contradict this reality. According to the
WHO, worldwide one in four women has been victim of some form of violence
during pregnancy [10]. The underestimation is probably due to women’s reluctance
to report violence suffered by their partners during the period of expecting a son/
daughter. Nevertheless, several studies highlight how episodes of violence and
sexual abuse suffered in the past and not sufficiently and psychologically treated are
reactualized in pregnancy or during childbirth, a phenomenon so-called “surviving
women,” that is still little studied [21]. Domestic partner violence during pregnancy
is associated with adverse health outcomes—fatal and nonfatal—for the pregnant
woman and her baby because of direct physical trauma as well as the physiological
effects of current or past abuse-related stress on the growth and development of the
fetus [22, 23].
Data show that every type of emergency and crisis may exacerbate existing vio-
lence against women. This also happened during the COVID-19 pandemic where the
lockdown and its social and economic impacts have increased the exposure of women
to abusive partners and known risk factors [24, 25]. Before the pandemic, the Human
Development Office for the United Nations Development Program (UNDP) reported
that only 107 of 195 countries had data available on IPV [26]. Today, despite the huge
efforts made to monitor the increase of IPV due to the pandemic, research has yet to
establish exactly the estimates of IPV during the lockdown and in periods other than
the pandemic outbreak.

Women’s Health Problems - A Global Perspective
6
5. Gender-based violence has long-term as well as immediate health
effects
GBV has immediate and long-term health effects and different levels of severity,
where fatal outcomes such as femicide are the most severe form. Among victims of
violence, many women often report immediate physical injuries such as bruises,
lacerations, and burns to the head, neck, or face but also fractures and broken bones
or teeth. Until a few years ago, the connection between long-term health effects and
GBV was often lost and only in the last few years, attention has been paid to this
aspect. Among the long-term effects, in addition to those concerning sexual and
reproductive spheres (sexual infections and gynecological problems, pregnancy
complications, and unintended pregnancy), we would like to emphasize that victims
of violence are at high risk of many physical diseases, such as asthma, irritable bowel
syndrome, frequent headaches, chronic pain, diabetes, and mental health problems
[16, 27]. Among mental health consequences, victims can manifest chronic mental
illness, post-traumatic stress disorder (PTSD), depression, and anxiety [28, 29].
PTSD symptoms may include severe anxiety, flashbacks, nightmares, symptoms of
increased arousal, such as irritability or anger, or symptoms of persistent avoidance
of trauma-related situations [30]. Sexual abuse and victimization from multiple
forms of violence have also been associated with greater odds of cervical cancer
diagnoses, as victims have an increased risk of acquiring a sexually transmitted
infection such as human papilloma virus [31, 32]. Experiencing violence has also
been associated with harmful use of alcohol and drug abuse, smoking, and eating
disorders, which in turn predispose individuals to a higher risk of noncommunicable
diseases [33].
5.1 The body’s adaptive response to trauma
The human body can cope or maintain stability during changes and excessive
exposure to stress and/or traumatic events such as GBV. This body’s adaptive response
can occur through complex neuronal, neuroendocrine, and immune responses [see
[34] for a comprehensive review]. It is nonspecific as, whatever the nature of the
stressor, the mechanism triggered is always the same. Although discussing the body’s
adaptive response mechanisms is not the focus of this chapter, some notions can be
briefly summarized. The threat evokes a physical and emotional reaction (also known
as fight or flight); the sympathetic nervous system (SNS), the hypothalamic–pitu-
itary–adrenal (HPA) axis, and the cardiovascular system are activated and these,
in turn, affect the immune system [29]. When the danger is perceived as overcome,
the parasympathetic nervous system (PSNS) acts to return to a state of normal basal
equilibrium. Prolonged exposure to trauma, such as violence or painful memories,
can prevent the body’s adaptive response from switching off.
When the trauma pain is deep and its impact persists, increased production of
stress hormones can wear down the body, keeping it in an unstable or weakened state.
When this happens, the body is more susceptible to adverse health conditions such as
cardiovascular disease, chronic pain, pregnancy complications, PTSD, and anxiety.
The inability to minimize or stop adaptive response activity can lead to serious long-
term health consequences. This is well known and it is recommended to assist trauma
survivors (e.g. due to natural disasters such as tornadoes, hurricanes, fires, and floods
or abused children, holocaust survivors, or stressors faced by members of military
service in war, etc...) in an ongoing process of healing and recovery.

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5.2 Gender-based violence, post-traumatic stress disorders, and epigenetic
modifications
Several studies have shown that violent experiences affect genome regulation and
expression by epigenetic modification as response to trauma [35–37].
Over the past two decades, a body of research has expanded rapidly and provided
good evidence about the underlying biological mechanisms regulating the relationship
between the risk of developing PTSD and epigenetic modifications consistent with
perturbations with the HPA axis [38]. Epigenetics refers to changes in gene expres-
sion (active versus inactive genes) that do not involve changes to the underlying DNA
sequence. Epigenetic changes include DNA methylation, modifications of histone
proteins, and small RNA-mediated gene silencing (miRNAs), affecting gene expression.
Epigenetics is an important part of biology as it regulates development and adaptations
during the life of an organism as the epigenome dynamically responds to the environ-
mental influences. In the last few years, several studies have demonstrated that stressors,
incorrect lifestyles, and/or adverse psychosocial environments may influence epigenetic
mechanisms by altering the epigenetic pattern of DNA methylation and/or chromatin
structure. As previously mentioned, the remarkable growth in understanding epigenetic
mechanisms and the impact of epigenetics on contemporary biology has added insight
into the molecular processes that connect the brain with behavior, neuroendocrine
responsiveness, and immune outcome [39]. Scientific studies have also highlighted the
relationship between PTSD and the presence of epigenetic marks in genes regulating the
HPA axis [37, 40, 41]. A starting point for understanding better the correlation between
GBV, epigenetics, and PTSD was the finding that abused women veterans’ health is
poorer than that of their active duty military and non-abused civilian counterparts.
In some countries, great attention has been given to the GBV suffered by the women
veterans and this has created a critical priority for clinicians, researchers, and policy-
makers to better understand the impact of violence on women’s health. Studies on war
veterans have widely demonstrated that violence can impact women’s health by inducing
molecular modifications at the epigenetic level, which in turn can contribute to the onset
of mental, physical, and chronic diseases [42, 43]. Until now, few studies have examined
the relationship between PTSD, epigenetic changes, and GBV in nonveteran women.
Although few studies have examined the relationship between PTSD, epigenetic
changes, and GBV beyond those on veteran women, nevertheless some exciting
considerations can be drawn. Studies on nonveteran women have confirmed correla-
tions between PTSD symptoms and epigenetic signatures (differential hyper-meth-
ylation) of trauma/stress-related genes [37]. Past and present violence and trauma
can remain imprinted in the genome through epigenetic modifications, increasing
the risk to women’s health [35, 36]. Epigenetic changes due to parental experience of
violence can be transferred to offspring through prenatal and postnatal epigenetic
modifications indicating that epigenetic changes, although theoretically reversible,
are heritable [35, 36, 44]. Importantly, the potentially reversible nature of epigenetic
modifications suggests that trauma-induced epigenetic effects could be not neces-
sarily permanent and that specific interventions could reduce the high prevalence of
poor health among victims of violence and their children.
Nevertheless, this field of research is relatively young and there are still many
questions that need to be elucidated concerning violence-induced epigenetic effects
and their impact on women’s health and/or health of their offspring. Currently, it is
hard to find longitudinal studies or research studies for any of the health associations
with GBV and epigenetic modifications in civilian women.

Women’s Health Problems - A Global Perspective
8
6. The social context and social determinant of health
Currently, many countries show reluctance to define specific recovery interven-
tions for GBV victims or interventions to prevent GBV. People who grow up and live
in environments with limited social, educational, and economic opportunities, in
addition to being at greater risk of multiple forms of violence, have fewer opportuni-
ties to access the process of healing and recovery [45]. Evidence-based research shows
that PTSD onset appears to be influenced by the type, duration, and severity of vio-
lence and the processes put in place to recover and heal the kind of trauma suffered
[38,45]. GBV has immediate and long-term health effects, but socioeconomic factors
can influence (and in some cases worsen) the health outcomes of specific groups of
people based on their social position. Social and economic factors between countries
and within the same country, in addition to put women at greater risk of multiple
forms of violence, can determine the unequal treatment of women victims of violence
where women belonging to less advantaged people may not have adequate psychologi-
cal and health support for the recovery and/or treatment of trauma. Health is the
result of multiple factors or determinants of health that significantly influence health,
whether positive or negative. In addition to biological characteristics, social factors
are just as important to health outcomes and the likelihood of generating diseases.
WHO defines social determinants of health (SDH) as “the conditions in which people
are born, grow, live, work, and age [46]. SDH perspective is based on all factors that
can make people healthy or not healthy, including education, income, labor market
position, ethnicity, and gender bias.
Extensive research has shown that people who are less advantaged in terms of
socioeconomic position have worse health (and shorter lives) than those who are
more advantaged. Disparities in social, educational, and economic opportunities
are the fundamental cause of health inequalities [46]. Health inequalities are widely
recognized as a public health problem as they determine a significant share of poten-
tially avoidable mortality and morbidity. The 2008 report of the WHO Commission
on Social Determinants of Health (CSDH) “Closing the gap in a generation” provided
a comprehensive synthesis of knowledge and evidence on health inequalities and a
set of recommendations to develop comprehensive and integrated policies to contrast
them [47].
The Service for Sexual and Domestic violence (when present) has long denounced
this. Women who are less advantaged in terms of socioeconomic position and/or liv-
ing in contexts where GBV victims are not supported by recovery interventions often
face GBV trauma by using drugs, drinking alcohol, smoking, or overeating, further
worsening their health condition. Research studies show that about 90% of women
with substance use disorders have experienced physical or sexual violence [48]. The
effects of violence on health have been underestimated and there is still a reluctance
to consider violence as a problem to be addressed at a social, economic, and health
level. In other words, it is a problem to consider GBV as a social determinant of health.
7. Network approach to cope with health effects of gender-based violence
The prevention of, and response to GBV, requires coordinated action across mul-
tiple sectors, including psychologists, social workers, lawyers, territorial associations,
and other professionals but in this subsection, we focus our attention on healthcare
professionals.

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The WHO encourages the development of prevention and awareness programs
to help reduce the prevalence of GBV, as well as establishing health services for GBV
victims’ care (particularly on mental health) and educating communities to take
advantage of available care. In 2013, to address the issue of women’s reluctance to
declare violence, WHO published the clinical and policy guidelines “Responding
to Intimate Partner Violence and Sexual Violence against Women” [49]. Guidelines
recommended that healthcare professionals should ask about GBV, whenever there is
an identified risk or health condition that GBV may have caused. Healthcare profes-
sionals play a unique role in coping health effects of GBV as they are often the first
contact for abused women in healthcare services [50]. Victims of violence approach
service providers in different institutional settings, with varying levels of aware-
ness. Victims often do not find the words to tell what is happening to them, or they
can be in hospital for other needs, and operators should be able to decode narratives
and understand latent needs, which in turn have linked to the identification of GBV
survivors. Healthcare professionals are ideally placed to identify and provide sup-
port to GBV victims and help prevent the long-term health consequences associated
with violence. As evidenced by several studies worldwide, many barriers can prevent
healthcare professionals from identifying and responding adequately to women who
suffer violence. The first of all is the lack of adequate training, which makes health-
care professionals insecure in taking any initiative to ask for information about GBV
[51, 52]. Healthcare professionals with insufficient training to respond to the victim
of GBV may be miscommunicating and cause harm, such as arguing that women
should leave an abusive relationship without providing survivors with a safety plan
or considering the survivor’s point of view [51, 52]. Other common barriers are lack
of time, privacy, and resources. Some healthcare professionals had reported fear of
offending women when they asked about violence. Another essential aspect of break-
ing down these barriers is creating a multidisciplinary network, including lawyers,
psychologists, social workers, territorial associations, and other professionals to
identify and support victims of GBV correctly [53].
8. Conclusion
GBV is based on prejudices and stereotypes handed down over centuries that
require slow and very long times to be changed and geographically diversified inter-
ventions (both socioeconomic and cultural). Thus, GBV prevention can be promoted
by considering individual, relationship, community, and societal risk and protective
factors. In the last few years, sociocultural interventions have increased awareness
of the various forms of violence that can occur (physical, sexual, psychological, and
socioeconomic) and have activated processes of critical reflection on gender bias and
stereotypes still rooted in society. Unfortunately, this is still not enough and an equity
lens should be applied to all processes to prevent GBV and to remove all systemic
barriers that prevent people from accessing adequate health care (after violence)
due to their social, economic, gender, or cultural characteristics. The prevention of,
and response to GBV, requires coordinated action across multiple sectors, in which
health is one of the most relevant. All women who have been exposed to violence have
increased risks of getting sick, indicating that violence can be considered a social
determinant of health. All women who have been exposed to violence should be able
to obtain comprehensive and gender-sensitive health services. All women should
be able to address the physical and mental health consequences of their experience

Women’s Health Problems - A Global Perspective
10
Author details
AnnaMariaGiammarioli1*, EloiseLongo2 and RaffaellaBucciardini1
1 Center of Global Health, National Institute of Health, Rome, Italy
2 Department of Neuroscience, National Institute of Health, Rome, Italy
*Address all correspondence to: anna.giammarioli@iss.it
and all women should be helped in their recovery from the traumatic event. GBV is
a multicausal problem influenced by social, economic, cultural, psychological, legal,
and biological factors. Particular attention should be given to interventions for the
assistance of GBV victims within each country to avoid that the unequal distribution
of economic, social, and environmental conditions could penalize less advantaged
women in society.
At the same time, we know that cases of GBV are significantly underreported,
and new strategies should be evaluated to help GBV victims make reporting easier,
safer, and more confidential. In this context, interesting results have been obtained by
providing specific training to healthcare professionals.
Finally, they are essential for both the existence of international protocols and
guidelines with clear procedures and the creation of a network of experts involved in
the issue of violence both locally and nationally for bringing out the phenomenon—
mostly underreported and underestimated—and guaranteeing support, listening,
acceptance, and protection to women. GBV is widespread worldwide, and its result-
ing health problems are preventable issues that must pose serious challenges to public
health and policy.
Conflict of interest
The authors declare no conflict of interest.
© 2023 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of
the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.

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