When the water is poor, people get sick: they have diarrhea; their growth is stunted; they die. When the air is poor, people get sick: they cough; they cannot leave their beds; they die. However, they do not look sick when there is lead in their blood. You cannot look at a child who has an unhealthy blood lead level (BLL) and say, "This is not right. Something must be done," because in most cases, there is nothing to see.
Lead (Pb) exposure—which is making headlines in the U.S. because of recent events in Flint, Michigan-- is a major source of critical environmental health risks. But the problem is subtle: Affected children do not perform as well in school. They are late to read. They are slow to learn how to do tasks. Perhaps a few more children are born with cognitive deficits. Perhaps these children have less impulse control. Perhaps they exhibit more violence.
These symptoms are not always understood as an environmental or a public health problem – or indeed a development problem. Instead, people will say it is an issue of morals or of education. They will discipline the children, and then they will take themselves to task and ask how and why they are failing to raise these children correctly. Furthermore, they will have no idea that the problem is in the children’s blood.
Young children are particularly vulnerable to lead exposure. Studies have documented that exposure leads to neuropsychological impacts in children--including impaired intelligence, measured as intelligence IQ losses--at blood lead levels even lower than 5 micrograms of lead per deciliter of blood (µg/dL). So, clearly, the effect occurs at even very low BLLs.
At the time, the country was still opening up to the outside world, and the Bank had just set up a small office there. I recently returned to Vietnam after 15 years, this time as the Bank’s Global Lead for Land. I saw a completely different country: while the old city charm is still there, Hanoi has transformed to the point that it is really difficult to recognize… as if I had landed in Japan, China, or any other Southeast Asian country.
The airport used to be one gate; now, it is a modern airport not much different from any airport in Western Europe or the United States. I remember that, when I worked in Vietnam in the mid-90s, GDP per capita was averaging US$200, and around 50% of people lived in extreme poverty. Today, GDP per capita has soared to about US$2000, while extreme poverty has dropped to around 3% according to the US$1.9/day extreme poverty line... An impressive achievement in less than 20 years.
My trip to Vietnam had the goal of helping the government modernize and automate the land administration system. In the early 90s, the country launched an ambitious reform program to transform the land use model from communal farming to individual household ownership by breaking up the communal land structure and distributing land to individual households. This reform was then credited with changing Vietnam from a net importer of rice to one of the largest rice exporters in the world in only a few years.
In accordance with the Land Law of 1993, the first Land Use Certificates (LUCs) issued under the program were in the name of the “head of household”, i.e. in the name of men only. Later on, the Vietnamese government, with support from the World Bank, strove to change things around by issuing LUCs bearing both the wife’s and the husband’s names.
The global #16Days of Activism Against Gender-based Violence campaign started on November 25 with the International Day for the Elimination of Violence Against Women, and ended on International Human Rights Day, which was celebrated on December 10.
Throughout those #16Days, the World Bank’s message was clear: Violence against Women and Girls (VAWG) is a global pandemic that has or will affect 1 in 3 women in their lifetime. Violence is not only a personal struggle for the victims, but also has severe consequences on social and economic outcomes.
As part of the World Bank's involvement in the #16Days of Activism against Gender-Based Violence campaign, we'll be holding a discussion this Monday, December 7 at 9:30 a.m. EST (14:30 GMT) to look at how we can end violence against women and girls. Moderated by journalist Joanne Levine, it'll include gynecologist and Sakharov Prize winner Denis Mukwege, M.D.; pediatrician Nadia Hashimi; Imam Yahya Hendi from Georgetown University; the president of the Representation Project, Kristen Joiner; and World Bank Vice President for the Africa Region, Makhtar Diop.
Follow the live stream here and participate through the live blog hosted by experts in gender issues here at the Bank.
In Jordan, the violence against girls and women embodies the problem. The Jordanian government’s Population and Family Health Survey captures only a portion of the scale of violence against women. Social norms are at play; roughly 70% of Jordanian women think there are circumstances that justify a husband beating his wife. Over one-third (34%) of Jordanian women report that they have experienced some form of physical violence since the age of 15. One in three Jordanian women experienced some form of emotional, physical, and/or sexual violence from their spouse, and almost 1 in 10 experience sexual violence at least once in their lifetime.
One of the major concerns resulting from the survey is that almost half (47%) the women reporting violence did not seek any type of help, with less than 5% taking steps to address sexual violence. Very few women seek help from medical providers, police, lawyers or social service organizations.
Over the past four years the World Bank Group has been collaborating with the Justice Center for Legal Aid (JCLA) -- a Jordanian civil society organization -- to pilot legal aid services for poor Jordanians as well as Syrian, Iraqi and Palestinian refugees. As is often the case, poverty status is a strong indicator of the likelihood of violence in Jordan. Poorer women were more likely to report all types of violence, and higher frequency of such violence. They are also more likely to believe such violence is justified.
The legal aid program provides awareness/information, counseling and legal representation by a lawyer to aid the poor in addressing legal problems. The majority of JCLA beneficiaries – just over 70% - are women. And one of the ‘justice gaps’ identified by JCLA is in providing effective legal services to female victims of violence.
Jordan adopted legislation to protect victims of domestic violence in 2008, giving victims, for the first time, access to protection orders – one of the most effective tools in addressing violence. Victims can also receive direct compensation. It also provided confidential proceedings and procedures to detain alleged abusers. A specialized institution – the Family Protection Department of the Ministry of Interior – was established to implement the reform, providing access to multiple services, including complaints/investigation, medical care and social counseling.
Yet the law left a number of gaps in place. It applies only to perpetrators living with the victims, so ex-husbands, boyfriends and brothers may not be covered, and the survey shows they are often the ones committing the abuse. It also leaves in place a heavy focus on reconciliation, to the possible detriment of protecting the victims. Lack of shelters for victims, along with the inability to link requests for child custody and child support with protection orders, may prevent many women from seeking help.
To date, JCLA’s assistance has been focused primarily around awareness and information for victims. This focus is now about to grow. With the assistance of the World Bank Group, JCLA is launching an initiative to provide more comprehensive services to women victims of violence. The plans include establishing a referral system in the Family Protection Department and placing a legal aid lawyer at each of the Department’s in-take centers.
What do we hope to achieve? There are several opportunities. The overarching goal is to ensure poor women can access services and achieve some level of justice to address the violence they suffer. More specifically, the referral system should aid in providing victims the legal services they need to initiate and navigate criminal proceedings, including obtaining and enforcing protection orders. Victims will also have assistance addressing legal problems commonly linked to domestic violence, such as divorce, child custody, child support and alimony.
As a lawyer, I volunteer my time representing poor persons, including women seeking protection orders, at the Superior Court here in Washington, D.C. I understand the importance of providing legal assistance to female victims of domestic violence, and am encouraged to see such an initiative launched in Jordan.
While the context of conflict and the climate of impunity that prevails create an enabling space for violations, perpetration of gender-based violence is ultimately tied to pervasive norms and dynamics that exist prior to conflict that sanction and reinforce men’s dominance over women and girls (or in some instances, marginalized or socially weaker men).
Numerous studies demonstrate that even after conflict ends, violence often continues in the home, as men who have experienced high levels of trauma and displacement during conflict are often likely to use violence against women and children. Dislocated from normative roles as providers and protectors, men’s experiences of conflict, trauma and deprivation contribute to feelings of disempowerment and loss of respect and authority.
Feelings of frustration, loss in self-esteem, depression, and disaffection can all manifest in negative coping behaviors, including aggression and partner conflict—whether physical, sexual, psychological or emotional violence—as men attempt to reassert themselves and their authority in the home.
In order to address the drivers of gender-based violence, therefore, prevention and mitigation initiatives must tackle these entrenched dynamics and in particular should engage men and boys as critical partners in facilitating pathways for positive social change. This emphasis recognizes the multiple roles men play not just as perpetrators, but also as husbands and family members, as witnesses, as service providers, as community leaders and decision makers, and in some cases, as survivors themselves.
Importantly, attention to men’s experiences in conflict should not obviate the need to address the enormous challenges confronting female survivors of violence, nor is it meant to distract attention or resources away from gender-based violence response and empowerment programming targeting women and girls. But in order to better protect women and girls in these fragile spaces, we need to improve our understanding on how to work more effectively with men and boys to transform harmful dynamics that perpetuate, rationalize and justify violence.
Responding to this need, the World Bank supported several innovative initiatives working with men to address conflict-related gender-based violence in the Africa region. Through the LOGiCA trust fund, we partnered with Promundo—a leading organization working globally with men and boys to advance more equitable gender norms and positive models of masculinity—to test operational approaches on effective engagement of men and boys in gender-based violence programming in Goma and Luvungi in DRC, and in Burundi.
In partnership with Care Burundi, Women-for-Women International, Heal Africa and the Institute for Higher Education in Mental Health, Promundo developed and piloted group therapeutic and psycho-educational tools drawing from global best practices. Group therapy meetings were held weekly for 10-15 weeks with training modules intended to improve social bonds, promote shared decision-making and respect, promote positive, non-violent models of conflict resolution and coping mechanisms, and heal individual trauma. While the program predominantly targeted male participants, group sessions sometimes included female partners as well.
Findings from associated evaluations were overwhelmingly positive, demonstrating improvements across a range of behaviors including reductions in stress and violence in the home, reductions in alcohol abuse and drinking, improved ability to manage frustration and aggression, increased sharing of income between men and women, and improved couple relations. Creating a safe space for men to engage also enabled formation of social relationships between participants, and many groups elected to continue the weekly meetings even after formal conclusion of the program.
Given the success of the pilot interventions, Promundo has since xpanded this work into a new initiative, entitled Living Peace: Men Beyond War, which currently is being implemented in DRC. Evidence emerging from this work also has important implications for post-conflict recovery programming in other fields, including demobilization and reintegration of ex-combatants, migration and forced displacement and interventions targeting youth at risk of engaging in violence.
While questions remain about sustainability of behavior change in the longer run, as well as effectiveness when brought to scale, this work presents an important contribution to our understanding of how to effectively engage men in preventing and mitigating against violence in communities and critically, within the home.
Why is the World Bank sponsoring a fashion show in India and an art show in Bangladesh? The answer is simple, we’re trying to find new approaches – creative approaches – to prevent gender-based violence (GBV).
Gender-based violence is a pervasive issue. On average, 30% of women who have been in a relationship report that they have experienced some form of physical or sexual violence by their partner. Worldwide, 720 million women and 156 million men married before the age of 18, with child marriage most common in South Asia and Sub-Saharan Africa. A 20-country study—where over 4,000 women and men were asked their views on gender differences — revealed that norms, beliefs and attitudes play a critical role in dictating behavior for both women and men, and the consequences for not keeping to these norms is often violence.