Hi I'm Nancy Glass I'm a professor at Johns Hopkins University School of Nursing, and I'm going to focus today on the issue of confronting gender based violence as a healthcare professional. So as an overview of the presentation, we'll first focus on gender based violence as a human rights violation, from a global perspective. And we'll use it as an example the case of intimate partner violence. And then we'll briefly touch on the global prevalence of gender based violence, which will be followed up on later on in the course. So let's define gender based violence. Certainly, we hear it used interchangeably with violence against women. And mostly that is done because globally, women and girls are most at risk and most affected by gender based violence. In 1993, the United Nations General Assembly defined the term violence against women as any act of gender based violence that results in, or is likely to result in, physical, sexual or psychological harm. And that includes the threat of such acts, coercion, deprivation of liberty, and that means occurring in public life in the larger community or in private life, oftentimes in the home. So further with the definition. So the UN referred to gender based violence because such violence is often rooted in gender inequality and is often tolerated and condoned by laws, institutions and community norms. So we know that there are many countries that still allow marital rape, and wouldn't prosecute marital rape. And there's institutions that don't protect the victims or survivors. And there's also norms such as forced marriage or female genital cutting that are harmful practices for women, but are often condoned as cultural practices. So GBV is not only a manifestation of gender inequality in a community, but often serves to reinforce it. Gender based violence comes in many forms throughout the life. It occurs from early childhood, as neglect or abuse. It can occur as forced early marriage, or other harmful practices, and certainly in dating or intimate partner relationships. We know of wife sharing, and then sexual assault or rape, for example, in the conflict setting. So, it is important, when we define gender based violence, to also talk about boys and men. because certainly boys and men experience diverse forms of physical and sexual violence in their lifetimes. But we will pay special attention to women and girls in this presentation. But as a health care provider, we need to make sure that we provide services equitably to sexual and gender minorities, such as men who have sex with men, and transgendered persons. Because certainly violence exists in those communities as well. So in framing gender based violence as a human rights violation, the United Nations Declaration of Human Rights in 1945 declared that human rights apply to all human beings without distinction of gender. Although at this time, in the mid 40s, the UN did not specifically address issues related to women, or violence against women. It was in 1979, when the Convention on Elimination of All Forms of Discrimination Against Women that we first really start to talk about women should be able to live free from trafficking, from prostitution. But we did not explicitly address issues of intimate partner violence, sexual abuse, incest, or rape. So, in the early 90s work continued in the Declaration on the Elimination of Violence Against Women. And through to 1995 with the Beijing Declaration and all platforms called for action and the declaration defined violence against women, including violence within the family, as a human rights issue. So as an example, we're going to look at cases of intimate partner violence. Intimate partner violence, violence by an intimate partner, exempted intimate partner, is the violence that is the most common experienced by women in their lifetime. So, intimate partner violence is defined as any behavior within an intimate relationship, so a dating relationship, doesn't have to be a marriage, that causes physical, psychological, or sexual harm to those in the relationship. So it includes physical aggression, psychological abuse, such as the threats of physical violence, humiliation in front of others, forced intercourse or other forms of sexual coercion. And then controlling behaviors that often include stalking, harassment, and other forms of coercive control. So, Dr. Campbell here at Johns Hopkins talks about intimate partner violence is repeated physical and/or sexual assault within a context of coercive control. And it's important as health care professionals not to conceptualize violence as a syndrome or a diagnosis. But as a risk factor for many health or social problems that women and girls may experience. So framing gender based violence within the human rights violation, within a human rights violation context, let's look at intimate partner violence for example. And it is clearly a violation of the rights articulated in the UN Article 3, the right to personal security. Certainly as a woman or a girl in a family that experiences violence and abuse, they don't have the right to personal security. They don't feel safe in their own home. They don't feel safe reaching out to community members often for security. And in more severe cases, we've all heard of these cases, women may also experience violations such as that of Article 4, which defines slavery, where they're sexual slaves and used by the family or community. And then there's also torture, where we could define what women experience in severely abusive relationship as torture. Because oftentimes the relationship is increasing frequency and severity across the lifetime, or across the relationship. So the ongoing patterns of physical and sexual violence in a woman's life results in the abusive partner or ex-partner assuming that their rights and their privileges. And then resulting in lowering the status of women to, within this context, less than a human being, they're taking her rights away So abusive partners or ex-partners who inflict physical violence, sexual violence, or emotional abuse. They can also be coercively controlling the woman's environment, so depriving her of resources that are critical for survival. Depriving her of the income she earns. Requiring her to give her paycheck over. Refusing to provide safe and secure housing. Or if she leaves the relationship she won't have the resources to have housing. Limiting her access to friends and families, which could be her only support system, or requiring her to work in unsafe environments, requiring her, or forcing her into prostitution, or a sexual exploitation. Limiting her food, threatening the children, or reducing the security of the children also they could also engage in trafficking or sexual slavery with children. So there's many ways that the abusive partner, ex-partner can inflict harm on their partners and their family. And defining it with the human rights framework is essential. Also, in our communities we know that there are often time insufficient governmental and institutional response. And that can include the healthcare system, the justice system and the social services system. And by not responding to the violence in our community, by not protecting and increasing the safety of children and adults, and that certainly is women and girls but also men and boys, then we are denying these people their basic human rights. And for example, if a woman is attempting to leave an abusive relationship and she can't meet her basic needs and living needs, then she is not able to be safe in our community. And for many women, there are very few options to leave abusive relationships. And so as a community, holding perpetrators accountable is critical to enforcing human rights. So as a global perspective, the vast majority of women, as I noted earlier, experience violence at the hands of an intimate or and ex-intimate partner. Or someone they know in the family or an acquaintance. It's much rarer for a women to report a stranger has assaulted them. Certainly it occurs, but it's often men who report that the violence that they experience is from a stranger. And importantly, one out of every three women worldwide, 30% of women, will be physically or sexually violated, or psychologically abused during her lifetime by an intimate or ex-intimate partner. And in some countries, we know that the rate goes up to 70% women in their lifetime will experience violence by a partner or ex-partner. So it's critical, as we know women and girls are frequent users of the health care system, certainly in the childbearing ages, that we as health care providers are prepared to assess, treat, and refer women for services related to violence. And also understand that violence is a violation of their rights as humans and work to establish systems that protect those rights. Thank you.