The recognition of the right to bodily integrity, including the right to be free from sexual and physical coercion and violence is a key component of the sexual and reproductive rights agenda and a major focus of recent international agreements-such as the Programme of Action of the 1994 International Conference on Population and Development (ICPD). Both the threat and the reality of gender-based violence (GBV) severely undermine women's sexual and reproductive health (RH) and autonomy. Because women are frequently denied, though the use of violence or fear of violence, their right to refuse unwanted sex or to determine when and with whom they engage in sexual activity, they are routinely exposed to the possibility of sexually transmitted infections, including HIV/AIDS, and a host of other adverse reproductive health outcomes, such as miscarriage, maternal death, low birth weight, and uterine rupture.

The Center for Health and Gender Equity (CHANGE) is working to identify a range of ethical and rights-based reproductive health interventions that respond to physical and sexual violence and coercion. Our work reflects the need for multi-level strategies to address the issue of gender-based violence within reproductive health programs. We recognize the critical importance of the social and cultural context -- and the central role of the local women's movement -- in the development and maintenance of integrated reproductive health and GBV responses in diverse settings. Our work is intended to guide reproductive health programs in designing and implementing policies, programs, and services that respond ethically and effectively to GBV. By so doing we seek to improve programs' ability to:

At the same time, we aim to strengthen the global response to gender-based violence and assist the health care sector-- ranging from donors to providers-- in developing strategic, rights-based responses to GBV that are consonant with the empirical evidence, theory and ethics of violence prevention and response. Our specific approach to achieving these goals is threefold.

First, we are developing a conceptual framework for the integration of gender violence into reproductive health programs. Our framework is based on reproductive rights paradigms and offers a flexible and portable set of universal questions intended to guide the development of context-specific integrated GBV/hr responses-- from program design to monitoring and evaluation and everything in between-- that are relevant to local needs. By delineating such an approach, we intend to catalyze support for such programming not only as the "right" thing to do, but also as a practical approach to empowering women and improving their reproductive health and well-being.

Additionally, we are developing strategic partnerships with local and international organizations that are implementing programs to address gender-based violence against women in concert with reproductive health programs.