Sexual violence against children and intimate partner violence against women remain significant yet underrecognized global health challenges, according to new research published in The Lancet. The study, conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine, is part of the Global Burden of Disease (GBD) 2023 project. It provides a comprehensive analysis of the health outcomes linked to these forms of violence across 204 countries and territories.
Researchers found that sexual violence against children (SVAC) is associated with 14 different health conditions, while intimate partner violence (IPV) among females is linked to eight negative health outcomes. The study reveals that these exposures contribute to a much greater disease burden than previously recognized.
"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."
In 2023, estimates suggest that over one billion people aged 15 and older had experienced sexual assault during childhood, and 608 million girls and women in this age group had suffered physical or sexual violence from an intimate partner. Together, SVAC and IPV accounted for more than 50 million disability-adjusted life years (DALYs) globally—32.2 million from SVAC and 18.5 million from IPV. DALYs measure years of healthy life lost due to premature death or living with disability.
Among women aged 15-49 years, both IPV and SVAC ranked as the fourth and fifth leading risk factors for loss of healthy life worldwide, surpassing risks such as high fasting plasma glucose or elevated blood pressure. Iron deficiency was ranked second among women's health threats.
"Most other conditions affecting a billion people and ranking in the top five health threats dominate the global health agenda," said 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 was identified as the eleventh most significant risk factor for poor health. In high-income regions including Europe, Latin America, North America, and Oceania, SVAC's impact on health loss was comparable to smoking—a risk factor that has seen declines through coordinated policy efforts.
The report states that in 2023 there were approximately 290,000 deaths worldwide related to SVAC, mainly due to suicide, HIV/AIDS, and type 2 diabetes. Mental disorders like anxiety among women and schizophrenia among men contributed most significantly to lost healthy years associated with SVAC; self-harm was also notable especially in South Asia.
IPV accounted for over one-fifth of healthy life lost due to anxiety and self-harm among women globally and was linked to about 145,000 deaths—mostly homicides, suicides, or HIV/AIDS cases—with nearly 30,000 women reportedly killed by their partners last year.
"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 study notes that effective interventions exist—including legislation enforcement, trauma-informed healthcare approaches, school-based prevention programs, community engagement strategies, economic empowerment initiatives—and require coordinated action across sectors. Researchers caution that actual rates may be higher than reported due to stigma-related 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 from the 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."
