Wednesday, December 10, 2025

Violence against women and children among top health threats: New global study reveals disease burden far larger than previously estimated

Institute for Health Metrics and Evaluation

Globally, among women aged 15-49, intimate partner violence (IPV) and sexual violence against children (SVAC) ranked fourth and fifth, respectively, among all health risks for premature death and disability; among men, SVAC ranked 11th.

New evidence links exposure to violence to a large range of health conditions that include and extend well beyond mental health disorders. SVAC is linked to 14 health conditions, including suicide, substance use disorders, and diabetes; IPV is linked to eight negative health outcomes, including mental health conditions, physical injuries, and HIV.

Estimates indicate that IPV is responsible for over 20% of health loss due to anxiety, self-harm, and interpersonal violence injuries and homicide among women, while SVAC is a major driver of the overall burden of schizophrenia, bipolar disorder, bulimia nervosa, and conduct disorder.

SEATTLE, Wash. Dec. 9, 2025 – Sexual violence against children and intimate partner violence against women are two of the most devastating yet persistently underrecognized global health challenges and rank among the top risks for mortality and morbidity worldwide, according to research published in The Lancet today.

For the first time, researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine comprehensively mapped the broad spectrum of health outcomes linked to sexual violence against children (SVAC) and intimate partner violence (IPV) among females in 204 countries and territories. The new analysis is part of the Global Burden of Disease (GBD) 2023 study that provides refined prevalence estimates and reveals an attributable disease burden far greater than previously understood.

“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.

GBD 2023 Expands Health Outcomes Linked to SVAC and IPV

Researchers incorporated new evidence into the GBD 2023 study, showing SVAC and IPV are linked to a wider spectrum of health outcomes than previously recognized and resulting in significantly greater estimates of health loss. SVAC was linked to 14 conditions, while IPV was associated with eight negative health outcomes.

“By expanding the recognized adverse health outcomes linked to sexual and physical violence, we are deepening our understanding of a crisis that has remained in the shadows,” said Dr. Flor. “The burden is staggering—and has been systematically overlooked in global health priorities.”

Health Outcomes Linked to SVAC	Health Outcomes Linked to IPV
Abortion and miscarriage	Abortion and miscarriage
Alcohol abuse disorder*	Anxiety disorders
Anxiety disorders	Drug use disorders
Asthma	HIV/AIDS*
Bipolar disorder	Major depressive disorder*
Bulimia nervosa	Maternal hemorrhage
Conduct disorder	Interpersonal violence (homicide and injuries)*
Drug use disorders	Self-harm
HIV/AIDS
Major depressive disorder*
Schizophrenia
Self-harm
Sexually transmitted infections (not HIV)
Type 2 diabetes

*Previously studied in past GBD cycles

The Scale: A Hidden Epidemic in Plain Sight

In 2023, over 1 billion people aged 15 and older were estimated to have experienced sexual assault during childhood, and 608 million girls and women in this age group have ever endured physical or sexual violence from an intimate partner. 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. DALYs represent the total years of healthy life lost due to both premature mortality and years lived with disability.

These risks were shown to be especially devasting 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, and close in ranking to iron deficiency (ranked second), a longstanding focus of women’s health interventions.

“Most other conditions affecting a billion people and ranking in the top five health threats dominate the global health agenda,” said co-author of the study Professor Emmanuela Gakidou, from IHME. “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.”

For men, SVAC ranked 11th among all health risks. In the GBD high-income region, which includes countries in Europe, Latin America, North America, and Oceania, SVAC’s contribution to health loss ranked fourth overall, comparable to the disease burden imposed by smoking (ranked fifth), a risk factor that has experienced substantial declines in recent decades as a result of comprehensive, evidence-based control measures, strong policy commitments, and coordinated global action.

The Health Consequences: Deaths, Mental Health Disorders, and More

In 2023, SVAC was associated with 290,000 deaths worldwide, predominantly from suicide, HIV/AIDS, and type 2 diabetes. Among SVAC’s 14 negative health outcomes, mental health disorders—especially anxiety among women and schizophrenia among men—contributed most to lost healthy years, alongside self-harm, notably in South Asia. Substance use disorders were also significant, especially among males in high-income locations.

IPV accounted for over 20% of healthy life lost to anxiety and self-harm among women and was linked to 145,000 deaths, mostly from homicide, suicide, and HIV/AIDS. Alarmingly, the authors 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. Of the eight health outcomes associated with IPV, anxiety and major depressive disorder were the largest contributors to this overall burden, measured in DALYs, for women across most world regions, except in sub-Saharan Africa, where HIV/AIDS was predominant.

“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.”

The Investment Gap: A Moral and Public Health Imperative

The study highlights the fact that violence is preventable through effective interventions such as comprehensive legislation and enforcement, trauma-informed health care, school-based prevention, community engagement, economic empowerment, and coordinated action across sectors. Despite methodological advances, IPV and SVAC occurrence, as well as their associated impacts, are likely still underestimated due to stigma and underreporting.

“Rigorous data like this bring long-overdue clarity to the scale and consequences of violence experienced by women and children,” says Dr. Anita Zaidi, Gender Equality President, Gates Foundation. “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. This analysis shows exactly where the needs are greatest. Acting on it is essential to break cycles of trauma that carry forward for generations.”

Journal

The Lancet

Article Title

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

Article Publication Date

9-Dec-2025

Call to increase funding for ‘invisible’ Deaf victim-survivors of domestic abuse

Heriot-Watt University

image:
Professor Jemina Napier, Chair of Intercultural Communication at Heriot-Watt University.
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Credit: Heriot-Watt University

A new report warns Deaf women experiencing domestic abuse in Scotland remain “effectively invisible” due to the chronic absence of specialist services and a lack of coordinated national support. Researchers say this gap leaves deaf victim-survivors without meaningful access to safety and advocacy.

Led by Heriot-Watt University and the University of Edinburgh, the British Academy-funded Sign LOUD report highlights that Scotland currently has no national dedicated British Sign Language (BSL) support services for Deaf victim-survivors of domestic abuse, despite evidence that Deaf women are two to three times more likely to experience abuse than the general population.

The report recommends establishing a BSL Equally Safe Advisory Group, bringing together Deaf community organisations, domestic abuse organisations, and officials responsible for the Scottish Government’s Equally Safe strategy and BSL National Plan. This group would work on action to improve the response of all frontline services as well as dedicated specialist support.

Professor Jemina Napier, Chair of Intercultural Communication in Heriot-Watt’s School of Social Sciences is Principal Investigator for the research who said: “Deaf women have been overlooked for years, despite being at high risk and having distinct language access needs. Aside from a small, fixed-term pilot across Angus, Tayside and Perthshire led by the Dundee-based charity Deaf Links, there is no dedicated service in Scotland. This must change.”

While specialist services exist in England such as SignHealth and the Cambridgeshire Deaf Association, Scotland relies solely on the temporary initiative operated by Deaf Links in Tayside and Women’s Aid groups, which are limited to local regions.

Deaf mothers and signing practitioners included in the study stressed the urgent need for support for both deaf and hearing children affected by domestic abuse. Many reported situations where children were expected to interpret during safeguarding conversations, placing them in highly stressful and inappropriate roles.

Dr Claire Houghton, the Co-Investigator on the study and a Senior Lecturer in Social Policy and Qualitative Research at the University of Edinburgh, said: “We heard repeatedly about children being asked to interpret conversations between their deaf mothers and statutory service providers in domestic abuse situations.

“This compromises safeguarding and emotional wellbeing for both deaf mothers and their children. National support must include provision for children.”

Among its other findings, the report calls for dedicated, long-term funding for domestic abuse services that are offered directly in BSL for Deaf women and families, echoing recommendations from the Scottish Government’s Independent Strategic Review of Funding and Commissioning of Services on Violence Against Women and Girls. It also highlights a need for improved access in BSL to mainstream (hearing) services through interpreters.

A parliamentary roundtable hosted by MSP Karen Adam was recently held in Holyrood to discuss the findings and explore how Scotland can deliver equitable support for Deaf women and children.

“Deaf women and children have been hidden in plain sight,” Professor Napier said. “If we want services to be truly equitable, we must recognise their needs and act.”

Karen Adam MSP for Banffshire & Buchan Coast said the report not only identified the problems but offered a way forward.

”Deaf women experiencing domestic abuse are too often hit by a double trauma of the abuse itself, and then the barriers they face in getting help in their own language,” she said.

“The Sign LOUD project has shone a light on that reality and made it impossible to ignore.

“I hosted the roundtable in Parliament because these findings now need to be turned into action, on BSL access, on specialist support, and on making sure Deaf women and their children are properly supported in the systems meant to protect them.

“I’m very pleased that the Deputy First Minister joined us in her capacity as Minister for Languages, because language policy and BSL provision are absolutely central to making sure that safety, support and justice are genuinely accessible to Deaf women and their children.”

The 32-page study gathered first-hand accounts from of six Deaf mothers who are victim-survivors and five signing practitioners who use BSL to support Deaf women.

Among the Sign LOUD team supporting this activity was Lucy Clark, a Deaf victim-survivor who is a researcher and advocate of domestic abuse in the deaf community.

“As a survivor, I see many gaps that continue to delay recovery for BSL users,” she said.

“We urgently need greater awareness of the importance of specialist support for Deaf women and children, including access to qualified BSL interpreters and services that demonstrate real Deaf Awareness.

“BSL resources must expand so we can reach more people, break down barriers, and ensure that BSL is properly recognised and valued.”

Adding their insight to the project was Tasnim Ahmed, Operations Manager of the Scottish Ethnic Minority Deaf Charity and a Deaf victim-survivor who was a participatory consultant for the report, who said: “Being involved in this research has shown me just how urgent the need is for specialist support for Deaf women, particularly those from ethnic minority communities. Accessible, culturally appropriate services in BSL could make a real difference - helping women and children access safety, support, and advocacy with dignity and equality."

The Sign LOUD report is being publicly launched on International Human Rights Day which is observed every year on December 10 to commemorate the United Nations’ adoption of the Universal Declaration of Human Rights in 1948. It serves as a global reminder of the fundamental rights and freedoms owed to every person, and a call to action to protect them.

Members of the Sign LOUD team at the Scottish Parliament including some of the research participants, pictured alongside Scotland’s Deputy First Minister, Kate Forbes MSP and Karen Adam MSP.

Credit

Heriot-Watt University

Male bonobos track females’ reproductive cycle to maximize mating success

Female sexual swelling is an unreliable fertility signal, but males can time matings anyway

Peer-Reviewed Publication

PLOS

Male bonobos track females’ reproductive cycle to maximize mating success — image:
Male–male agonistic interaction during a mating attempt in wild bonobos.
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Credit: Heungjin Ryu (CC-BY 4.0, https://creativecommons.org/licenses/by/4.0/)

Male bonobos can decipher females’ unreliable fertility signals, allowing them to focus their efforts on matings with the highest chance of conception, according to a study by Heungjin Ryu at Kyoto University, Japan, and colleagues publishing December 9th in the open-access journal PLOS Biology.

In most mammals, females are only receptive to mating during ovulation, allowing males to time their mating efforts to maximize the chances of conception. But in some primates, such as bonobos (Pan paniscus), females become sexually receptive and display a conspicuous pink swelling around the genitals for a prolonged period of time.

To investigate how males cope with this unreliable fertility signal, researchers studied a group of wild bonobos at Wamba in the Luo Scientific Reserve in the Democratic Republic of the Congo. During daily observations, they recorded sexual behaviors and visually estimated the status of each female’s genital swelling. They also used filter paper to collect urine samples of the females, allowing them to measure estrogen and progesterone levels and estimate the timing of ovulation. They found that ovulation probability peaked between 8 and 27 days after females reached maximum swelling, making it difficult for males to predict. Despite this, males’ sexual advances were closely aligned with the timing of ovulation. Males concentrated their mating efforts on females that had reached maximum swelling earlier, and whose infant offspring were older — two key sources of information indicating a higher probability of ovulation.

The results show that males focus their mating efforts on the most fertile females by combining information about the timing of swelling and reproductive history. Because male bonobos can effectively estimate female fertility despite an unreliable signal, there has likely been little evolutionary pressure for the signal to become more precise. This may explain how this system has been maintained over evolutionary time, the authors say.

The authors add, “In this study, we found that bonobo males, instead of trying to predict precise ovulation timing, use a flexible strategy—paying attention to the end-signal cue of the sexual swelling along with infant age—to fine-tune their mating efforts. This finding reveals that even imprecise signals can remain evolutionarily functional when animals use them flexibly rather than expecting perfect accuracy. Our results help explain how conspicuous but noisy ovulatory signals, like those of bonobos, can persist and shape mating strategies in complex social environments.”

“The male bonobos weren’t the only ones paying close attention to sexual swelling—we spent countless days in the rainforest at Wamba, DRC doing exactly the same thing! All that watching, sweating, and scribbling in our notebooks eventually paid off. By tracking these daily changes, we uncovered just how impressively bonobos can read meaning in a signal that seems noisy and confusing to us.”

In your coverage, please use this URL to provide access to the freely available paper in PLOS Biology: https://plos.io/4r584R0

Citation: Ryu H, Hashimoto C, Hill DA, Mouri K, Shimizu K, Furuichi T (2025) Male bonobo mating strategies target female fertile windows despite noisy ovulatory signals during sexual swelling. PLoS Biol 23(12): e3003503. https://doi.org/10.1371/journal.pbio.3003503

Author countries: Japan

Funding: This study was supported by the Global Environment Research Fund (D-1007 to TF) of the Japanese Ministry of the Environment, the Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research (22255007 to TF; https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-22255007/, and 25304019 to CH; https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-25304019/), and the JSPS Asia-Africa Science Platform Program (2012–2014 to TF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Male bonobos track females’ reproductive cycle to maximize mating success [VIDEO]

In this clip, the beta male Nobita carefully looks at the sexual swelling of the female Sala while they forage for fungi on the forest floor. Male bonobos take this task seriously—watching and checking swelling changes so they do not miss potential ovulatory periods.

Credit

Heungjin Ryu (CC-BY 4.0, https://creativecommons.org/licenses/by/4.0/)

Male bonobos track females’ reproductive cycle to maximize mating success [VIDEO]

In this video, two male bonobos and one female engage in a mating-related conflict. The beta male, Nobita, solicits copulation from a female, Fuku. Once they begin copulating, the alpha male, Kitaro—Nobita’s younger brother—attempts to intervene. Despite his efforts, Nobita and Fuku continue and complete the copulation. Afterward, Fuku becomes upset and briefly chases Kitaro.

Credit

Heungjin Ryu (CC-BY 4.0, https://creativecommons.org/licenses/by/4.0/)