A/HRC/17/26 Consequently, addressing the concerns of women requires an understanding that a one-sizefits-all programmatic approach is inadequate for recognizing the intra-gender differences among women. 44. Inadequate attention has been focused on the hierarchies that are maintained by or reflected in the institutions and structures involved in creating, maintaining, and normalizing violence against women as discrimination against women. To the extent that women’s social and economic reality is different from men’s, non-discrimination and equality norms recognize the legitimacy of special measures to address these differences, in the quest to eliminate violence and discrimination against women. This creates a situation in which violence against women is recognized, but it does little to dislodge the male norm according to which personhood, non-discrimination and equality continue to be understood. 45. In addition, religious, traditional and cultural practices are sometimes instrumentalized both to justify and to perpetrate discrimination and violence against women. Moreover, the prerogatives of patriarchy often include perpetrating violence against women in contexts including in family settings and war situations. 46. The World Health Organization recognizes violence against women as a major public health problem which can result in “a wide range of physical, mental, sexual and reproductive, and maternal health problems.”13 Health practitioners identify gender-based violence as having especially wide-ranging consequences on women’s lives and “include the psychological impact of violence, loss of personal freedom, diminished capacity to participate in public life, and a dramatically increased risk of acquiring HIV and other STIs.”14 Women who are already lacking health care and medical treatment due to economic, social, political and geographic barriers are at greater risk of chronic, and possibly fatal, effects of violence. 47. Women who are lacking social and cultural capital, due to their minority or immigration status, language barriers, religious or ethnic affiliation, sexual orientation and/or gender identity or educational attainment, are also at greater risk of long-term health consequences. They may be denied proper health or medical services, they may fear the consequences of asking for medical assistance, they may receive improper or low quality care, or they may live in places where no health services are available. Women who suffer from cognitive and/or physical disabilities are further negatively impacted since the stigma of disability is persistent in most countries, and they therefore may not be viewed as requiring care, or may live in places where no specialized care is available. 48. The economic costs of violence are difficult to estimate globally. However, there is agreement that violence against women severely impacts a woman’s ability to participate fully and capably in reproductive and productive roles, and this negatively affects household, community, and national well-being. The cost of violence against women cuts across public and private sectors in all societies, including the legal, health, educational, social services, and labour sectors. The categories of costs include both direct and indirect tangible and intangible costs. Also, economic hierarchies often render women especially vulnerable to physical and economic violence. 49. The multiplicity of forms of violence against women as well as the fact that this violence frequently occurs at the intersection of different types of discrimination makes it necessary to adopt multifaceted strategies. This approach has conceptual and practical 13 14 12 Available from http://www.who.int/mediacentre/factsheets/fs239/en/index.html Allan Rosenfield, Caroline Min and Joshua Bardfield, pp. 3-4 “Global women’s health and human rights: an introduction”, in Women’s Global Health and Human Rights, edited by Padmini Murthy and Clyde Lanford Smith, Jones & Bartlett Publishers, Sudbury, Massachusetts (2010).