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.”
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