Violence against women and children emerges as major global health crisis
A groundbreaking global study reveals that intimate partner violence and sexual violence against children rank among the top health threats worldwide, contributing to over 50 million disability-adjusted life years annually. The research fundamentally challenges persistent views of these forms of violence as primarily social issues, positioning them instead as critical public health priorities demanding immediate, comprehensive intervention.
Unprecedented scale of health burden revealed
Researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine have produced the most comprehensive analysis to date of health outcomes linked to intimate partner violence (IPV) against women and sexual violence against children (SVAC). Published in The Lancet on 9 December 2025, the study examined 204 countries and territories from 1990 to 2023, dramatically expanding understanding of these violence types’ true health impacts.
The findings paint a stark picture: in 2023, an estimated 608 million women aged 15 and older had experienced physical or sexual violence from an intimate partner, whilst over one billion people aged 15 and older had experienced sexual violence during childhood. These exposures together contributed to more than 50 million disability-adjusted life years (DALYs) globally – 32.2 million from SVAC and 18.5 million from IPV.
“These findings fundamentally challenge the persistent view of SVAC and IPV as primarily social or criminal justice issues and underscore their status as major public health priorities,” said Dr Luisa Sorio Flor, lead author and assistant professor at IHME. “By expanding the recognised adverse health outcomes linked to sexual and physical violence, we are deepening our understanding of a crisis that has remained in the shadows. The burden is staggering – and has been systematically overlooked in global health priorities.”
Devastating impact on young people
The research reveals particularly devastating consequences for young and middle-aged individuals. Among women aged 15–49 years, IPV and SVAC ranked as the fourth and fifth leading risk factors for loss of healthy life globally, outranking many well-known threats such as high fasting plasma glucose or elevated blood pressure. For men in this age group, SVAC ranked 11th among all health risks.
Professor Emmanuela Gakidou from IHME noted: “Most other conditions affecting a billion people and ranking in the top five health threats dominate the global health agenda. These findings make the case irrefutable: violence is not simply a social problem that occasionally impacts health, it is a leading cause of death and disability demanding comprehensive public health action.”
In high-income regions, SVAC’s contribution to health loss ranked fourth overall, comparable to the disease burden imposed by smoking – a risk factor that has experienced substantial declines through comprehensive, evidence-based control measures and coordinated global action.
Expanded spectrum of health consequences
The GBD 2023 study incorporated new evidence showing SVAC and IPV are linked to a substantially wider spectrum of health outcomes than previously recognised. SVAC was associated with 14 health conditions, including mental health disorders, substance use disorders, and chronic diseases such as type 2 diabetes and asthma. IPV was linked to eight negative health outcomes, including anxiety disorders, major depressive disorder, self-harm, HIV/AIDS, maternal complications, and interpersonal violence.
Mental health disorders accounted for the greatest share of disease burden amongst survivors. For IPV, anxiety disorders and major depressive disorder were the largest contributors to DALYs, accounting for 5.43 million and 3.96 million DALYs respectively in 2023. For SVAC, self-harm and schizophrenia were the leading causes of attributable burden, with 6.71 million and 4.15 million DALYs respectively.
“Given the wide range of health conditions associated with SVAC and IPV, survivors will continue to require both immediate and long-term care from health systems worldwide,” explained Dr Flor. “Violence prevention is not enough: we must also identify, protect, rehabilitate, and support survivors, and the health sector is central to these efforts.”
Fatal consequences and urgent protection needs
The study documented 290,000 deaths worldwide associated with SVAC in 2023, predominantly from suicide, HIV/AIDS, and type 2 diabetes. IPV accounted for 145,000 deaths, mostly from homicide, suicide, and HIV/AIDS. Alarmingly, the researchers estimated that nearly 30,000 women were killed by their partners in 2023 alone, highlighting an urgent need for enhanced protection for at-risk individuals.
IPV accounted for more than 40% of interpersonal violence DALYs amongst women globally, with this proportion reaching nearly 70% in North Africa and the Middle East. “This underscores the urgent need for enhanced protective measures for at-risk individuals,” the authors write in their conclusion.
Regional disparities and geographical patterns
The research revealed substantial geographical disparities in both exposure rates and disease burden. Sub-Saharan Africa had the highest rates of DALYs attributable to both SVAC and IPV, driven largely by high prevalence rates and the substantial burden of HIV in this region. Countries with the highest age-standardised prevalence of IPV were primarily located within sub-Saharan Africa and southeast Asia, whilst for SVAC, the highest regional prevalence was observed in south Asia and sub-Saharan Africa, followed by high-income regions.
However, DALY rates for IPV and SVAC were also elevated across high-income regions compared with other super-regions, reflecting the large burden of substance use disorders and non-communicable diseases in these settings. Amongst males aged 15–49 years in the high-income super-region, SVAC burden ranked fourth.
Urgent call for increased investment
Dr Anita Zaidi, Gender Equality President at the Gates Foundation, emphasised the need for immediate action: “Rigorous data like this bring long-overdue clarity to the scale and consequences of violence experienced by women and children. The evidence is unmistakable: these harms are far more pervasive and far more damaging to health than previously understood, and they demand immediate action from country leaders.”
The study highlights that violence is preventable through effective interventions such as comprehensive legislation and enforcement, trauma-informed healthcare, school-based prevention, community engagement, and economic empowerment. Despite this, most countries still lack the essential resources, effective legislation, and robust enforcement mechanisms necessary to combat violence.
Currently, less than 1% of aid spending targets gender-based violence, indicating a substantial gap in prioritising this issue within global health agendas. The researchers strongly advocate integrating both prevention measures and survivor support into broader public health initiatives that also address mental health disorders, substance misuse, suicide, homicide, and HIV.
Methodological advances and limitations
The study represents substantial methodological improvements over previous GBD iterations. Researchers incorporated 195 new sources of data to refine IPV prevalence estimates and an additional 211 sources to enhance SVAC prevalence estimates. They also introduced substantive methodological advances, including revising the SVAC definition to extend the age range of exposure from before 15 years to before 18 years, aligning with international classifications of violence against children.
To address differential reporting challenges, the team adjusted SVAC estimates for differential reporting across survey modes, recognising that survey administration methods significantly impact disclosure rates. They employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC, synthesising data from a comprehensive systematic review of seven electronic databases covering studies from 1970 to 2024.
However, the authors acknowledge several limitations. Prevalence data were self-reported and prone to under-reporting due to the sensitive nature of these topics and associated stigma. Substantial gaps remain across geographical regions and time periods, particularly in the North Africa and Middle East super-region. The wide uncertainty intervals for some exposure estimates highlight considerable statistical uncertainty, especially in data-sparse settings.
The analysis focused exclusively on physical or sexual IPV against women and SVAC, not encompassing psychological abuse, coercive control, or other forms of violence against children and women. The authors note that future work should consider the overlapping and unique health effects of additional forms of violence, as the most effective policies and intervention strategies might differ.
Path forward for global health
“Quantifying the disease burden attributable to IPV and SVAC is essential for enabling timely and effective interventions,” the authors conclude. “Moreover, by leveraging the GBD comparative framework, we position IPV and SVAC alongside other major health threats, moving beyond viewing them solely as social or criminal concerns.”
The research demonstrates that eliminating exposure to these risks could avert millions of DALYs annually, primarily through reductions in the burden of mental health disorders, self-harm, interpersonal violence, substance use, and infectious diseases such as HIV. The substantial contributions of IPV and SVAC to the burden of mental disorders – a leading cause of health loss for which effective preventive measures remain limited – underscores the need to incorporate these risks into strategic plans targeting this cluster of conditions.
“Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year,” the authors state. “Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC amongst public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors.”
Reference
GBD 2023 Intimate Partner Violence and Sexual Violence against Children Collaborators. (2025). Disease burden attributable to intimate partner violence against females and sexual violence against children in 204 countries and territories, 1990–2023: A systematic analysis for the Global Burden of Disease Study 2023. The Lancet. Published online December 9, 2025. https://doi.org/10.1016/S0140-6736(25)02503-6
