亲密伴侣对妇女的暴力行为：一项持久而紧迫的挑战 | Lancet

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Intimate partner violence is a huge challenge worldwide that has considerable implications for women's health and wellbeing, as well as the wellbeing of families and communities that are affected by such violence and the underlying inequitable gender norms. Even though the Sustainable Development Goals call for the elimination of violence against women and girls by 2030, evidence from several countries suggests that the burden of intimate partner violence has actually increased during the COVID-19 pandemic.1, 2, 3

The negative effect of the pandemic on intimate partner violence is alarming given that its global prevalence was already high. In The Lancet, Lynnmarie Sardinha and colleagues4 provide new prevalence estimates of physical or sexual, or both, intimate partner violence targeting women at the global, regional, and national level drawing on a comprehensive overview of 333 eligible studies conducted between 2000 and 2018, including a sample of almost 1·8 million women. These authors estimate a global prevalence of 27% for lifetime physical or sexual, or both, intimate partner violence (13% in the past year before the survey) and highlight substantial variation across regions and over the life course.

These new estimates emphasise the magnitude of the challenge of targeting intimate partner violence, and present novel findings around cross-regional prevalence. The majority of research analysing prevention interventions for intimate partner violence is conducted in high-income countries, or in sub-Saharan Africa and south Asia; for example, two systematic reviews of economic and empowerment interventions for the prevention and reduction of intimate partner violence reported only five studies conducted outside of these three regions, of 27 studies in total.5, 6 However, the highest prevalence of lifetime intimate partner violence reported in the analysis by Sardinha and colleagues4 was in Oceania, a region that is rarely examined in intimate partner violence research; and Andean Latin America, another region generally under-represented in the literature, also showed high rates. Clearly, an expansion of the geographical scope of intimate partner violence research has the potential to make a substantial contribution to the understanding of the worldwide drivers of this violence.

In addition, these findings highlight the importance of more carefully analysing the evolution of intimate partner violence and other related forms of violence targeting girls and women over the life course. The authors report particularly high rates of violence affecting adolescents, because nearly a quarter of female adolescents between the ages of 15 and 19 have already experienced intimate partner violence. One limitation to this analysis (which is noted in the paper) is that surveys of intimate partner violence rely on respondents self-reporting their own partnered status, and the definition of partnered might be interpreted differently in different contexts and by different respondents; particularly among younger women or girls who are not necessarily stably partnered or cohabiting.

Moreover, exposure to other forms of violence not assessed in this study—namely, dating violence, school-based violence from peers or educators, and violence from other family members—is also high for adolescents and youth.7 This high prevalence makes it even more important to measure exposure to violence of all types (including but not limited to intimate partner violence), and identify interventions that can holistically target the experience of intimate partner violence as well as other forms of violence, building on new work rigorously evaluating prevention interventions for school-based violence.8, 9

Another limitation of this analysis is that it does not provide estimates of violence for subpopulations that other literature has identified as particularly vulnerable to violence, including disabled girls and women10, and girls and women living with HIV.11, 12 A focus on these vulnerable groups is also an important direction for future research; although data limitations and variations in how this information is collected across contexts might render more systematic estimates impossible at this stage, and therefore incorporating these dimensions into data surveillance systems might be a useful step moving forward.

The literature analysing the effectiveness of strategies to prevent and reduce intimate partner violence in low-income and middle-income countries has expanded rapidly in previous years. Much of this literature is now encapsulated in the RESPECT framework13 and its implementation plan.14 Clearly, given the scale of intimate partner violence in 2018, as summarised in this analysis, and the fact that evidence suggests that violence has increased further during the COVID-19 pandemic, it is crucial to focus on exploring methods by which prevention interventions for intimate partner violence can be deployed at scale using available human resources, and integrated into existing health, educational, and social protection systems. This comprehensive new data should only re-emphasise the urgency of developing, evaluating, and scaling strategies for the prevention and reduction of intimate partner violence for women around the world, particularly the most vulnerable.

全文翻译（仅供参考）

亲密伴侣暴力是世界范围内的一项巨大挑战，对妇女的健康和福祉以及受此类暴力和潜在的不平等性别规范影响的家庭和社区的福祉具有重大影响。尽管可持续发展目标呼吁到 2030 年消除针对妇女和女孩的暴力行为，但来自几个国家的证据表明，在 COVID-19 大流行期间，亲密伴侣暴力的负担实际上有所增加。1、2、3 _ _ _ _

鉴于全球流行率已经很高，这种流行病对亲密伴侣暴力的负面影响令人担忧。在《柳叶刀》杂志上，Lynnmarie Sardinha 及其同事4根据对 2000 年至 2018 年间进行的 333 项符合条件的研究的全面概述，提供了在全球、区域和国家层面针对女性的身体暴力或性暴力或两者兼有的亲密伴侣暴力的新流行率估计，包括近 1·800 万女性的样本。这些作者估计，亲密伴侣暴力的终生身体暴力或性暴力或两者兼有的全球流行率为 27%（在调查前的过去一年中为 13%），并强调了不同地区和整个生命过程中的巨大差异。

这些新的估计强调了针对亲密伴侣暴力的挑战的严重性，并提出了有关跨区域流行的新发现。大多数分析亲密伴侣暴力预防干预措施的研究是在高收入国家或撒哈拉以南非洲和南亚进行的；例如，对预防和减少亲密伴侣暴力的经济和赋权干预措施进行的两项系统评价仅报告了在这三个地区之外进行的五项研究，共 27 项研究。5 , 6然而，在 Sardinha 及其同事的分析中报告的终生亲密伴侣暴力发生率最高4曾在大洋洲，这是一个在亲密伴侣暴力研究中很少被检查的地区；安第斯拉丁美洲，另一个在文献中代表性不足的地区，也显示出高比率。显然，扩大亲密伴侣暴力研究的地理范围有可能对了解这种暴力的全球驱动因素做出重大贡献。

此外，这些发现强调了更仔细地分析亲密伴侣暴力和其他相关形式的暴力在生命过程中针对女孩和妇女的演变的重要性。作者报告说，影响青少年的暴力发生率特别高，因为近四分之一的 15 至 19 岁女性青少年已经经历过亲密伴侣暴力。该分析的一个限制（在论文中指出）是亲密伴侣暴力调查依赖于受访者自我报告自己的伴侣状态，并且伴侣的定义可能在不同的背景下和不同的受访者有不同的解释；特别是在不一定稳定伴侣或同居的年轻女性或女孩中。

此外，本研究未评估的其他形式的暴力——即约会暴力、来自同龄人或教育工作者的学校暴力以及来自其他家庭成员的暴力——对青少年和青年的影响也很高。7这种高流行率使得衡量所有类型的暴力（包括但不限于亲密伴侣暴力）的暴露程度变得更加重要，并确定可以全面针对亲密伴侣暴力以及其他形式的暴力经历的干预措施，建立关于严格评估校园暴力预防干预措施的新工作。8 , 9

该分析的另一个限制是，它没有提供其他文献认为特别容易受到暴力侵害的亚群的暴力估计，包括残疾女孩和妇女10，以及感染艾滋病毒的女孩和妇女。11 , 12关注这些弱势群体也是未来研究的重要方向；尽管数据的局限性和跨环境收集信息的方式可能会导致现阶段无法进行更系统的估计，因此将这些维度纳入数据监控系统可能是向前迈出的有用一步。

分析低收入和中等收入国家预防和减少亲密伴侣暴力战略有效性的文献在前几年迅速扩大。这些文献中的大部分现在都包含在 RESPECT 框架13及其实施计划中。14显然，鉴于本分析总结的 2018 年亲密伴侣暴力的规模，以及有证据表明在 COVID-19 大流行期间暴力进一步增加的事实，重点探索对亲密伴侣进行预防干预的方法至关重要可以利用可用的人力资源大规模部署伴侣暴力，并将其纳入现有的卫生、教育和社会保护系统。这一全面的新数据只会再次强调制定、评估和扩大战略以预防和减少世界各地妇女，尤其是最弱势妇女的亲密伴侣暴力的紧迫性。

原文链接：

https://doi.org/10.1016/S0140-6736(22)00190-8

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