Assignment Prompt & Instructions
**files (9)**
– ## The_role_of_structural_and_int1.PDF
– Impact_of_intimate_partner_vio.PDF
– Life_constraints_and_psycholog.PDF.pdf
– The_role_of_structural_and_int.PDF
– An_Eight_State_Study_on_the_Re.PDF
– An_advocacy_intervention_progr.pdf
– Why_do_they_Stay_Examining_Con.PDF
– Defining_success_for_survivors.PDF
– Examining_the_Impact_of_Durati.PDF
**## The_role_of_structural_and_int1.PDF**
EDITORIAL Open Access
The role of structural and interpersonal
violence in the lives of women: a conceptual
shift in prevention of gender-based violence
Stephanie Rose Montesanti
Explanations for violence against women (VAW) have
developed in a wide variety of disciplines including, soci-
ology, psychology, social work and public health. Theor-
ies of VAW range from individual and relationship level
explanations to socio-cultural and political explanations
for why violent acts towards women are committed.
Feminist scholars, for instance, focus their attention to
male-dominated social structures and socialization prac-
tices that teach men and women gender-specific roles
that can influence violence and abuse against women
[1]. One of the most common forms of violence against
women is interpersonal violence (IPV). IPV refers to
everyday violence such as sexual and physical assault
that occurs between family members, intimates, or
acquaintances.
The UN Declaration was the first international state-
ment that defined violence against women within a
broader gender-based framework and identified the fam-
ily, the community and the state as major sites of
gender-based violence. The statement was rooted in
feminist analysis of social inequality. According to the
UN Declaration, violence against women involves:
Any act of gender-based violence that results in, or is
likely to result in physical, sexual or psychological harm
or suffering to women, including threats of such acts,
coercion or arbitrary deprivation of liberty, whether
occurring in public or in private life. (p.1)
Gender-based violence (GBV) can include domestic
violence, sexual harassment, sexual violence and rape.
GBV is a deliberately broad term in order to recognize
the gendered elements in nearly all forms of violence
against women and girls, whether it is perpetrated
through sexual violence or through other means. The
use of the term ‘gender-based violence’ provided a new
context in which to examine and understand the
phenomenon of violence against women. It shifted the
focus from women as victims of violence to gender and
the unequal power relationships between women and
men that are created and maintained through gender
stereotypes. A gender perspective on violence against
women addresses the similarities and differences in the
violence experienced by women and men in relation to
vulnerabilities, violations and consequences.
In response to this declaration, various efforts have
been made to respond to reduce and eliminate this vio-
lence experienced by women. Significant attention has
been paid in the Northern hemisphere and high income
countries such as Canada and the U.S. to the provision
of social services to victims of GBV, such as strengthening
and maintaining women’s safety and their involvement in
social, political and economic activities. Changes have also
been made to justice sector responses, and to treatment
for perpetrators of GBV.
Interventions in low and middle-income countries
have focused on primary prevention strategies to reduce
the prevalence and incidence of violence against women
and girls. These prevention programs use a wide range
of approaches, including group training, social commu-
nication, community mobilization, and livelihood strat-
egies. Microfinance and cash transfer programs in
countries such as South Africa, Kenya and Ecuador have
reported reductions in the rates of IPV [2, 3]. Commu-
nity mobilization programs in Uganda and Sub-Saharan
Africa that aim to reduce violence at the population-
level through changes in public discourse, practices, and
norms for gender and violence, demonstrated not only
reductions in physical and sexual partner abuse, but also
reduced incidence of HIV/AIDS [4, 5].
These responses, however, have largely turned to under-
standings of GBV that place the causes, consequences and
costs at an individual level [6]. With the launch of the
World Health Organization (WHO) Multi-Country StudyCorrespondence: montesan@ualberta.ca
School of Public Health, University of Alberta, Edmonton, AB, Canada
© 2016 Montesanti. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Montesanti BMC Women's Health (2015) 15:93
DOI 10.1186/s12905-015-0247-5
[http://crossmark.crossref.org/dialog/?doi=10.1186/s12905-015-0247-5&domain=pdf](http://crossmark.crossref.org/dialog/?doi=10.1186/s12905-015-0247-5&domain=pdf)
[mailto:montesan@ualberta.ca](mailto:montesan@ualberta.ca)
[http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)
[http://creativecommons.org/publicdomain/zero/1.0/](http://creativecommons.org/publicdomain/zero/1.0/)
on Women’s Health and Domestic Violence in 2005, the
number of IPV prevalence studies increased. This research
primarily from the health and medical fields has largely
focused on individual or relationship level factors to the
exclusion of factors operating at a broader societal level
[7, 8]. Prevalence studies from the around the world have
shown that IPV has a number of health consequences for
that include, injury, chronic pain, sexually-transmitted dis-
eases, depression, post-traumatic stress disorder, to name
a few [9–15]. Though this research has contributed to
an understanding of the prevalence [16], consequences
[9, 17], and costs [18, 19] associated with IPV against
women; its focus has been on individual behaviors and
health outcomes, ignoring how patterns of violence are
connected to social systems and social institutions.
Any analysis of violence “must recognize the primacy
of culturally constructed messages about the proper
roles and behavior of men and women and the power
disadvantaged women bring to relationships by virtue
of their lack of access to resources.”[14]
In this thematic series, the authors provide an in-
depth analysis of how social systems and institutions in-
fluence interpersonal violence that disproportionately
harms women. Structural violence has been defined as
the social arrangements that put individuals and popula-
tions in harm’s way…the arrangements are structural be-
cause they are embedded in the social, political and
economic organization of our social world; they are vio-
lent because they cause injury to people (typically, not
those responsible for perpetuating such inequalities)
[20]. Structural violence includes “a host of offensives
against human dignity: extreme and relative poverty, so-
cial inequalities ranging from racism to gender inequal-
ity, and the more perverse forms of violence that are
uncontestably human rights abuses” [21]. In adopting a
structural violence approach to understand GBV in a
variety of contexts and events, our analysis underscores
the importance of historical and social contexts that in-
fluence IPV towards women.
Structural violence is marked by unequal access to the
determinants of health (e.g., housing, good quality health
care, unemployment, education), which then creates
conditions where interpersonal violence can occur and
shape gendered forms of violence that place women in
vulnerable positions. Gender is inescapably embedded in
social systems and institutions. For instance, Parikh
(2012) illustrates how a macro-level structural interven-
tion (increase in the age of consent law at national and
local levels) intended to address gendered HIV risk in
Uganda has the unintended consequence of reinforcing
gender–based social hierarchies [22]. Despite the stated
aim of protecting young women, the law reinstates patri-
archal privilege and the regulation of adolescent female
sexuality. Moreover, research pertaining to gender tends
to regard the categories of “men” and “women” as dis-
tinct categories, not just in their biological make-up but
also in their gender-specific role socialization.
This thematic series originated through the Canadian
Institute for Health Research (CIHR) Institute of Gender
Health (IGH) Roundtable on Violence, Gender and
Health on January 28–29, 2010, in Ottawa, to discuss
the current state of research on gendered violence and
health. Participants at the meeting identified two re-
search priorities: (1) the need to conduct contextualized
research on how social systems and institutions perpetu-
ate and reproduce gender-based violence against women
and impact various dimensions of health; and (2) the
need to examine individual-level characteristics and
population-level influences on gender-based violence.
Initial discussions at this meeting brought together a
team of researchers to develop a comparative program
of research to advance our understanding of structural
and systemic violence in gender-based violence and
women’s health inequities in the Canadian context,
which includes an analysis of appropriate interventions
to prevent future occurrences of violence against
women.
This thematic series will advance scholarly knowledge
on the two research priorities noted above, and under-
score new ways of thinking about structural and inter-
personal violence, and how they are related and manifest
in the lives of women. The series will include a collec-
tion of empirical and theoretical papers that engage a
variety of methodological approaches and signal the
growing challenges in thinking through, and responding
to, gender-based violence. It will demonstrate the need
for researchers to continue interrogating categories in
their analyses, including gender and sex. Also urging re-
searchers and policy makers to think beyond an individ-
ualized focus on the causes, consequences and costs of
violence and abuse, to the implementation of interven-
tions, in the form of health and social services and pol-
icies, that consider the contexts in which people’s lives
are experienced.
Received: 17 September 2015 Accepted: 7 October 2015
References
1. Yllo K. Through a Feminist Lens: Gender, Diversity, and Violence: Extending
the Feminist Framework In Current Controversies on Family Violence.
California: Sage Publications; 2005.
2. Haushofer J, Shapiro J. Household Response to Income Changes: Evidence
from an Unconditional Cash Transfer Program in Kenya Massachusetts
Institute of Technology. 2013.
3. Kim JC, Watts CH, Hargreaves JR. Understanding the impact of a
microfinance-based intervention on women’s empowerment and the
reduction of intimate partner violence in South Africa. Am J Public Health.
2007;97:1794–802.
4. Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, et al.
Findings from the SASA! Study: a cluster randomised controlled trial to
assess the impact of a community mobilisation intervention to prevent
Montesanti BMC Women's Health (2015) 15:93 Page 2 of 3
violence against women and reduce HIV risk in Kampala, Uganda. BMC
Med. 2014;12:122.
5. Faye MM, Moreau A, Cabral J, Benga H, Cissé F, Mane B, et al. The TOSTAN
Program: Evaluation of a Community Based Education Program in Senegal.
Population Council: Washington; 2004.
6. Dominguez S, Menjivar C. Beyond individual and visible acts of violence: a
framework to examine the lives of women in low-income neighborhoods.
Women’s Stud Int Forum. 2014;44.
7. Kiss L, D’Oliveira AF, Zimmerman C, Heise L, Schraiber LB, Watts C. Brazilian
policy responses to violence against women: government strategy and the
help-seeking behaviors of women who experience violence. Health Hum
Rights. 2012;14(1):E64–77.
8. Thurston WE, Vissandjee B. An ecological model for understanding culture as a
determinant of women’s health. Critical Public Health. 2005;15(3):229–42.
9. Ansara DL, Hindin M. Psychosocial consequences of intimate partner
violence for women and Men in Canada. Journal of Interpersonal Violence.
2011;26(8):1628–45.
10. Campbell J, Jones AS, Dienemann J, Kub J, Schollenberger J, O’Campo P,
et al. Intimate partner violence and physical health consequences. Arch
Intern Med. 2002;162:1157–63.
11. Campbell J. Health consequences of intimate partner violence. Lancet.
2002;359(9314):1331.
12. Cohen MM, Maclean H. Violence Against Canadian Women. In:
Desmeules M, Stewart D, Kazanjian A, Maclean H, Payne J, Vissandjée B,
editors. Women’s Health Surveillance Report: A Multidimensional Look
at the Health of Canadian Women. Ottawa: Canadian Institute for
Health Information; 2004.
13. Fox AM, Jackson SS, Hansen NB, Gasa N, Crewe M, Sikkema KJ. In their own
voices: a qualitative study of women’s risk for intimate partner violence and
HIV in south africa. Violence Against Women. 2007;13(6):583–602.
14. Heise L. Violence against women: an integrated, ecological framework.
Violence Against Women. 1998;4:262–90.
15. Lacey KK, McPherson MD, Samuel PS, Sears KP, Head D. The impact of
different types of intimate partner violence on the mental and physical
health of women in different ethnic groups. J Interpers Violence.
2013;28(2):359–85.
16. Stöckl H, March L, Pallitto C, Garcia-Moreno C, WHO Multi-country Study
Team. Intimate partner violence among adolescents and young women:
prevalence and associated factors in nine countries: a cross-sectional study.
BMC Public Health. 2014;14:751.
17. Beydoun HA, Beydoun MA, Kaufman JS, Lo B, Zonderman AB. Intimate
partner violence against adult women and its association with major
depressive disorder, depressive symptoms and postpartum depression: a
systematic review and meta-analysis. Soc Sci Med. 2012;75.
18. CDC, Costs of Intimate Partner Violence against Women in the United
States. Centres for Disease Control and Prevention, National Center for
Injury Prevention and. Atlanta: Control; 2003.
19. Sorenson S. Funding public health: the Public’s willingness to Pay for
domestic violence prevention programming. Am J Public Health.
2003;93:1934–8.
20. Farmer PE, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical
medicine. Plos Med. 2006;3(10), e449.
21. Farmer PE. Pathologies of Power: Health, Human Rights, and the New War
on the Poor. Berkeley: University of California Press; 2005.
22. Parikh SA. They arrested me for loving a schoolgirl: ethnography, HIV, and a
feminist assessment of the age of consent law as a gender-based structural
intervention in Uganda. Soc Sci Med. 2012;74(11):1774–82.
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**## The_role_of_structural_and_int1.PDF**
EDITORIAL Open Access
The role of structural and interpersonal
violence in the lives of women: a conceptual
shift in prevention of gender-based violence
Stephanie Rose Montesanti
Explanations for violence against women (VAW) have
developed in a wide variety of disciplines including, soci-
ology, psychology, social work and public health. Theor-
ies of VAW range from individual and relationship level
explanations to socio-cultural and political explanations
for why violent acts towards women are committed.
Feminist scholars, for instance, focus their attention to
male-dominated social structures and socialization prac-
tices that teach men and women gender-specific roles
that can influence violence and abuse against women
[1]. One of the most common forms of violence against
women is interpersonal violence (IPV). IPV refers to
everyday violence such as sexual and physical assault
that occurs between family members, intimates, or
acquaintances.
The UN Declaration was the first international state-
ment that defined violence against women within a
broader gender-based framework and identified the fam-
ily, the community and the state as major sites of
gender-based violence. The statement was rooted in
feminist analysis of social inequality. According to the
UN Declaration, violence against women involves:
Any act of gender-based violence that results in, or is
likely to result in physical, sexual or psychological harm
or suffering to women, including threats of such acts,
coercion or arbitrary deprivation of liberty, whether
occurring in public or in private life. (p.1)
Gender-based violence (GBV) can include domestic
violence, sexual harassment, sexual violence and rape.
GBV is a deliberately broad term in order to recognize
the gendered elements in nearly all forms of violence
against women and girls, whether it is perpetrated
through sexual violence or through other means. The
use of the term ‘gender-based violence’ provided a new
context in which to examine and understand the
phenomenon of violence against women. It shifted the
focus from women as victims of violence to gender and
the unequal power relationships between women and
men that are created and maintained through gender
stereotypes. A gender perspective on violence against
women addresses the similarities and differences in the
violence experienced by women and men in relation to
vulnerabilities, violations and consequences.
In response to this declaration, various efforts have
been made to respond to reduce and eliminate this vio-
lence experienced by women. Significant attention has
been paid in the Northern hemisphere and high income
countries such as Canada and the U.S. to the provision
of social services to victims of GBV, such as strengthening
and maintaining women’s safety and their involvement in
social, political and economic activities. Changes have also
been made to justice sector responses, and to treatment
for perpetrators of GBV.
Interventions in low and middle-income countries
have focused on primary prevention strategies to reduce
the prevalence and incidence of violence against women
and girls. These prevention programs use a wide range
of approaches, including group training, social commu-
nication, community mobilization, and livelihood strat-
egies. Microfinance and cash transfer programs in
countries such as South Africa, Kenya and Ecuador have
reported reductions in the rates of IPV [2, 3]. Commu-
nity mobilization programs in Uganda and Sub-Saharan
Africa that aim to reduce violence at the population-
level through changes in public discourse, practices, and
norms for gender and violence, demonstrated not only
reductions in physical and sexual partner abuse, but also
reduced incidence of HIV/AIDS [4, 5].
These responses, however, have largely turned to under-
standings of GBV that place the causes, consequences and
costs at an individual level [6]. With the launch of the
World Health Organization (WHO) Multi-Country StudyCorrespondence: montesan@ualberta.ca
School of Public Health, University of Alberta, Edmonton, AB, Canada
© 2016 Montesanti. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Montesanti BMC Women's Health (2015) 15:93
DOI 10.1186/s12905-015-0247-5
[http://crossmark.crossref.org/dialog/?doi=10.1186/s12905-015-0247-5&domain=pdf](http://crossmark.crossref.org/dialog/?doi=10.1186/s12905-015-0247-5&domain=pdf)
[mailto:montesan@ualberta.ca](mailto:montesan@ualberta.ca)
[http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)
[http://creativecommons.org/publicdomain/zero/1.0/](http://creativecommons.org/publicdomain/zero/1.0/)
on Women’s Health and Domestic Violence in 2005, the
number of IPV prevalence studies increased. This research
primarily from the health and medical fields has largely
focused on individual or relationship level factors to the
exclusion of factors operating at a broader societal level
[7, 8]. Prevalence studies from the around the world have
shown that IPV has a number of health consequences for
that include, injury, chronic pain, sexually-transmitted dis-
eases, depression, post-traumatic stress disorder, to name
a few [9–15]. Though this research has contributed to
an understanding of the prevalence [16], consequences
[9, 17], and costs [18, 19] associated with IPV against
women; its focus has been on individual behaviors and
health outcomes, ignoring how patterns of violence are
connected to social systems and social institutions.
Any analysis of violence “must recognize the primacy
of culturally constructed messages about the proper
roles and behavior of men and women and the power
disadvantaged women bring to relationships by virtue
of their lack of access to resources.”[14]
In this thematic series, the authors provide an in-
depth analysis of how social systems and institutions in-
fluence interpersonal violence that disproportionately
harms women. Structural violence has been defined as
the social arrangements that put individuals and popula-
tions in harm’s way…the arrangements are structural be-
cause they are embedded in the social, political and
economic organization of our social world; they are vio-
lent because they cause injury to people (typically, not
those responsible for perpetuating such inequalities)
[20]. Structural violence includes “a host of offensives
against human dignity: extreme and relative poverty, so-
cial inequalities ranging from racism to gender inequal-
ity, and the more perverse forms of violence that are
uncontestably human rights abuses” [21]. In adopting a
structural violence approach to understand GBV in a
variety of contexts and events, our analysis underscores
the importance of historical and social contexts that in-
fluence IPV towards women.
Structural violence is marked by unequal access to the
determinants of health (e.g., housing, good quality health
care, unemployment, education), which then creates
conditions where interpersonal violence can occur and
shape gendered forms of violence that place women in
vulnerable positions. Gender is inescapably embedded in
social systems and institutions. For instance, Parikh
(2012) illustrates how a macro-level structural interven-
tion (increase in the age of consent law at national and
local levels) intended to address gendered HIV risk in
Uganda has the unintended consequence of reinforcing
gender–based social hierarchies [22]. Despite the stated
aim of protecting young women, the law reinstates patri-
archal privilege and the regulation of adolescent female
sexuality. Moreover, research pertaining to gender tends
to regard the categories of “men” and “women” as dis-
tinct categories, not just in their biological make-up but
also in their gender-specific role socialization.
This thematic series originated through the Canadian
Institute for Health Research (CIHR) Institute of Gender
Health (IGH) Roundtable on Violence, Gender and
Health on January 28–29, 2010, in Ottawa, to discuss
the current state of research on gendered violence and
health. Participants at the meeting identified two re-
search priorities: (1) the need to conduct contextualized
research on how social systems and institutions perpetu-
ate and reproduce gender-based violence against women
and impact various dimensions of health; and (2) the
need to examine individual-level characteristics and
population-level influences on gender-based violence.
Initial discussions at this meeting brought together a
team of researchers to develop a comparative program
of research to advance our understanding of structural
and systemic violence in gender-based violence and
women’s health inequities in the Canadian context,
which includes an analysis of appropriate interventions
to prevent future occurrences of violence against
women.
This thematic series will advance scholarly knowledge
on the two research priorities noted above, and under-
score new ways of thinking about structural and inter-
personal violence, and how they are related and manifest
in the lives of women. The series will include a collec-
tion of empirical and theoretical papers that engage a
variety of methodological approaches and signal the
growing challenges in thinking through, and responding
to, gender-based violence. It will demonstrate the need
for researchers to continue interrogating categories in
their analyses, including gender and sex. Also urging re-
searchers and policy makers to think beyond an individ-
ualized focus on the causes, consequences and costs of
violence and abuse, to the implementation of interven-
tions, in the form of health and social services and pol-
icies, that consider the contexts in which people’s lives
are experienced.
Received: 17 September 2015 Accepted: 7 October 2015
References
1. Yllo K. Through a Feminist Lens: Gender, Diversity, and Violence: Extending
the Feminist Framework In Current Controversies on Family Violence.
California: Sage Publications; 2005.
2. Haushofer J, Shapiro J. Household Response to Income Changes: Evidence
from an Unconditional Cash Transfer Program in Kenya Massachusetts
Institute of Technology. 2013.
3. Kim JC, Watts CH, Hargreaves JR. Understanding the impact of a
microfinance-based intervention on women’s empowerment and the
reduction of intimate partner violence in South Africa. Am J Public Health.
2007;97:1794–802.
4. Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, et al.
Findings from the SASA! Study: a cluster randomised controlled trial to
assess the impact of a community mobilisation intervention to prevent
Montesanti BMC Women's Health (2015) 15:93 Page 2 of 3
violence against women and reduce HIV risk in Kampala, Uganda. BMC
Med. 2014;12:122.
5. Faye MM, Moreau A, Cabral J, Benga H, Cissé F, Mane B, et al. The TOSTAN
Program: Evaluation of a Community Based Education Program in Senegal.
Population Council: Washington; 2004.
6. Dominguez S, Menjivar C. Beyond individual and visible acts of violence: a
framework to examine the lives of women in low-income neighborhoods.
Women’s Stud Int Forum. 2014;44.
7. Kiss L, D’Oliveira AF, Zimmerman C, Heise L, Schraiber LB, Watts C. Brazilian
policy responses to violence against women: government strategy and the
help-seeking behaviors of women who experience violence. Health Hum
Rights. 2012;14(1):E64–77.
8. Thurston WE, Vissandjee B. An ecological model for understanding culture as a
determinant of women’s health. Critical Public Health. 2005;15(3):229–42.
9. Ansara DL, Hindin M. Psychosocial consequences of intimate partner
violence for women and Men in Canada. Journal of Interpersonal Violence.
2011;26(8):1628–45.
10. Campbell J, Jones AS, Dienemann J, Kub J, Schollenberger J, O’Campo P,
et al. Intimate partner violence and physical health consequences. Arch
Intern Med. 2002;162:1157–63.
11. Campbell J. Health consequences of intimate partner violence. Lancet.
2002;359(9314):1331.
12. Cohen MM, Maclean H. Violence Against Canadian Women. In:
Desmeules M, Stewart D, Kazanjian A, Maclean H, Payne J, Vissandjée B,
editors. Women’s Health Surveillance Report: A Multidimensional Look
at the Health of Canadian Women. Ottawa: Canadian Institute for
Health Information; 2004.
13. Fox AM, Jackson SS, Hansen NB, Gasa N, Crewe M, Sikkema KJ. In their own
voices: a qualitative study of women’s risk for intimate partner violence and
HIV in south africa. Violence Against Women. 2007;13(6):583–602.
14. Heise L. Violence against women: an integrated, ecological framework.
Violence Against Women. 1998;4:262–90.
15. Lacey KK, McPherson MD, Samuel PS, Sears KP, Head D. The impact of
different types of intimate partner violence on the mental and physical
health of women in different ethnic groups. J Interpers Violence.
2013;28(2):359–85.
16. Stöckl H, March L, Pallitto C, Garcia-Moreno C, WHO Multi-country Study
Team. Intimate partner violence among adolescents and young women:
prevalence and associated factors in nine countries: a cross-sectional study.
BMC Public Health. 2014;14:751.
17. Beydoun HA, Beydoun MA, Kaufman JS, Lo B, Zonderman AB. Intimate
partner violence against adult women and its association with major
depressive disorder, depressive symptoms and postpartum depression: a
systematic review and meta-analysis. Soc Sci Med. 2012;75.
18. CDC, Costs of Intimate Partner Violence against Women in the United
States. Centres for Disease Control and Prevention, National Center for
Injury Prevention and. Atlanta: Control; 2003.
19. Sorenson S. Funding public health: the Public’s willingness to Pay for
domestic violence prevention programming. Am J Public Health.
2003;93:1934–8.
20. Farmer PE, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical
medicine. Plos Med. 2006;3(10), e449.
21. Farmer PE. Pathologies of Power: Health, Human Rights, and the New War
on the Poor. Berkeley: University of California Press; 2005.
22. Parikh SA. They arrested me for loving a schoolgirl: ethnography, HIV, and a
feminist assessment of the age of consent law as a gender-based structural
intervention in Uganda. Soc Sci Med. 2012;74(11):1774–82.
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**## The_role_of_structural_and_int1.PDF**
EDITORIAL Open Access
The role of structural and interpersonal
violence in the lives of women: a conceptual
shift in prevention of gender-based violence
Stephanie Rose Montesanti
Explanations for violence against women (VAW) have
developed in a wide variety of disciplines including, soci-
ology, psychology, social work and public health. Theor-
ies of VAW range from individual and relationship level
explanations to socio-cultural and political explanations
for why violent acts towards women are committed.
Feminist scholars, for instance, focus their attention to
male-dominated social structures and socialization prac-
tices that teach men and women gender-specific roles
that can influence violence and abuse against women
[1]. One of the most common forms of violence against
women is interpersonal violence (IPV). IPV refers to
everyday violence such as sexual and physical assault
that occurs between family members, intimates, or
acquaintances.
The UN Declaration was the first international state-
ment that defined violence against women within a
broader gender-based framework and identified the fam-
ily, the community and the state as major sites of
gender-based violence. The statement was rooted in
feminist analysis of social inequality. According to the
UN Declaration, violence against women involves:
Any act of gender-based violence that results in, or is
likely to result in physical, sexual or psychological harm
or suffering to women, including threats of such acts,
coercion or arbitrary deprivation of liberty, whether
occurring in public or in private life. (p.1)
Gender-based violence (GBV) can include domestic
violence, sexual harassment, sexual violence and rape.
GBV is a deliberately broad term in order to recognize
the gendered elements in nearly all forms of violence
against women and girls, whether it is perpetrated
through sexual violence or through other means. The
use of the term ‘gender-based violence’ provided a new
context in which to examine and understand the
phenomenon of violence against women. It shifted the
focus from women as victims of violence to gender and
the unequal power relationships between women and
men that are created and maintained through gender
stereotypes. A gender perspective on violence against
women addresses the similarities and differences in the
violence experienced by women and men in relation to
vulnerabilities, violations and consequences.
In response to this declaration, various efforts have
been made to respond to reduce and eliminate this vio-
lence experienced by women. Significant attention has
been paid in the Northern hemisphere and high income
countries such as Canada and the U.S. to the provision
of social services to victims of GBV, such as strengthening
and maintaining women’s safety and their involvement in
social, political and economic activities. Changes have also
been made to justice sector responses, and to treatment
for perpetrators of GBV.
Interventions in low and middle-income countries
have focused on primary prevention strategies to reduce
the prevalence and incidence of violence against women
and girls. These prevention programs use a wide range
of approaches, including group training, social commu-
nication, community mobilization, and livelihood strat-
egies. Microfinance and cash transfer programs in
countries such as South Africa, Kenya and Ecuador have
reported reductions in the rates of IPV [2, 3]. Commu-
nity mobilization programs in Uganda and Sub-Saharan
Africa that aim to reduce violence at the population-
level through changes in public discourse, practices, and
norms for gender and violence, demonstrated not only
reductions in physical and sexual partner abuse, but also
reduced incidence of HIV/AIDS [4, 5].
These responses, however, have largely turned to under-
standings of GBV that place the causes, consequences and
costs at an individual level [6]. With the launch of the
World Health Organization (WHO) Multi-Country StudyCorrespondence: montesan@ualberta.ca
School of Public Health, University of Alberta, Edmonton, AB, Canada
© 2016 Montesanti. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Montesanti BMC Women's Health (2015) 15:93
DOI 10.1186/s12905-015-0247-5
[http://crossmark.crossref.org/dialog/?doi=10.1186/s12905-015-0247-5&domain=pdf](http://crossmark.crossref.org/dialog/?doi=10.1186/s12905-015-0247-5&domain=pdf)
[mailto:montesan@ualberta.ca](mailto:montesan@ualberta.ca)
[http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)
[http://creativecommons.org/publicdomain/zero/1.0/](http://creativecommons.org/publicdomain/zero/1.0/)
on Women’s Health and Domestic Violence in 2005, the
number of IPV prevalence studies increased. This research
primarily from the health and medical fields has largely
focused on individual or relationship level factors to the
exclusion of factors operating at a broader societal level
[7, 8]. Prevalence studies from the around the world have
shown that IPV has a number of health consequences for
that include, injury, chronic pain, sexually-transmitted dis-
eases, depression, post-traumatic stress disorder, to name
a few [9–15]. Though this research has contributed to
an understanding of the prevalence [16], consequences
[9, 17], and costs [18, 19] associated with IPV against
women; its focus has been on individual behaviors and
health outcomes, ignoring how patterns of violence are
connected to social systems and social institutions.
Any analysis of violence “must recognize the primacy
of culturally constructed messages about the proper
roles and behavior of men and women and the power
disadvantaged women bring to relationships by virtue
of their lack of access to resources.”[14]
In this thematic series, the authors provide an in-
depth analysis of how social systems and institutions in-
fluence interpersonal violence that disproportionately
harms women. Structural violence has been defined as
the social arrangements that put individuals and popula-
tions in harm’s way…the arrangements are structural be-
cause they are embedded in the social, political and
economic organization of our social world; they are vio-
lent because they cause injury to people (typically, not
those responsible for perpetuating such inequalities)
[20]. Structural violence includes “a host of offensives
against human dignity: extreme and relative poverty, so-
cial inequalities ranging from racism to gender inequal-
ity, and the more perverse forms of violence that are
uncontestably human rights abuses” [21]. In adopting a
structural violence approach to understand GBV in a
variety of contexts and events, our analysis underscores
the importance of historical and social contexts that in-
fluence IPV towards women.
Structural violence is marked by unequal access to the
determinants of health (e.g., housing, good quality health
care, unemployment, education), which then creates
conditions where interpersonal violence can occur and
shape gendered forms of violence that place women in
vulnerable positions. Gender is inescapably embedded in
social systems and institutions. For instance, Parikh
(2012) illustrates how a macro-level structural interven-
tion (increase in the age of consent law at national and
local levels) intended to address gendered HIV risk in
Uganda has the unintended consequence of reinforcing
gender–based social hierarchies [22]. Despite the stated
aim of protecting young women, the law reinstates patri-
archal privilege and the regulation of adolescent female
sexuality. Moreover, research pertaining to gender tends
to regard the categories of “men” and “women” as dis-
tinct categories, not just in their biological make-up but
also in their gender-specific role socialization.
This thematic series originated through the Canadian
Institute for Health Research (CIHR) Institute of Gender
Health (IGH) Roundtable on Violence, Gender and
Health on January 28–29, 2010, in Ottawa, to discuss
the current state of research on gendered violence and
health. Participants at the meeting identified two re-
search priorities: (1) the need to conduct contextualized
research on how social systems and institutions perpetu-
ate and reproduce gender-based violence against women
and impact various dimensions of health; and (2) the
need to examine individual-level characteristics and
population-level influences on gender-based violence.
Initial discussions at this meeting brought together a
team of researchers to develop a comparative program
of research to advance our understanding of structural
and systemic violence in gender-based violence and
women’s health inequities in the Canadian context,
which includes an analysis of appropriate interventions
to prevent future occurrences of violence against
women.
This thematic series will advance scholarly knowledge
on the two research priorities noted above, and under-
score new ways of thinking about structural and inter-
personal violence, and how they are related and manifest
in the lives of women. The series will include a collec-
tion of empirical and theoretical papers that engage a
variety of methodological approaches and signal the
growing challenges in thinking through, and responding
to, gender-based violence. It will demonstrate the need
for researchers to continue interrogating categories in
their analyses, including gender and sex. Also urging re-
searchers and policy makers to think beyond an individ-
ualized focus on the causes, consequences and costs of
violence and abuse, to the implementation of interven-
tions, in the form of health and social services and pol-
icies, that consider the contexts in which people’s lives
are experienced.
Received: 17 September 2015 Accepted: 7 October 2015
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Injury Prevention and. Atlanta: Control; 2003.
19. Sorenson S. Funding public health: the Public’s willingness to Pay for
domestic violence prevention programming. Am J Public Health.
2003;93:1934–8.
20. Farmer PE, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical
medicine. Plos Med. 2006;3(10), e449.
21. Farmer PE. Pathologies of Power: Health, Human Rights, and the New War
on the Poor. Berkeley: University of California Press; 2005.
22. Parikh SA. They arrested me for loving a schoolgirl: ethnography, HIV, and a
feminist assessment of the age of consent law as a gender-based structural
intervention in Uganda. Soc Sci Med. 2012;74(11):1774–82.
Submit your next manuscript to BioMed Central
and take full advantage of:
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at
www.biomedcentral.com/submit
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