A carga da violência contra as mulheres no Brasil

Abstract

Introduction: Violence against women (VAW) is a significant public health issue, resulting in high morbidity and mortality, and contributing to various health outcomes. Much of the knowledge about VAW in Brazil is based on studies lacking national representativeness and global comparability. To address this gap, it is essential to analyze data from national information systems and surveys integratively and develop new metrics to enhance the understanding of VAW. Objective: Main: To estimate the burden of violence against women in Brazil. Specific: a) To estimate the prevalence and analyze factors associated with violence against women in Brazil; b) To analyze the spatial and temporal trends of the female homicide rate in Brazil and investigate possible associated factors; c) To estimate the burden of disease attributable to violence against women in Brazil. Methodology: This is a quantitative observational study using data from the 2019 National Health Survey, the Mortality Information System, and the Global Burden of Disease Study. The population studied were adult women, and the primary event analyzed was interpersonal violence against them, categorized into three subtypes: psychological, physical, and sexual. The study estimated the prevalence of VAW, the spatiotemporal trend of the female homicide rate, and the Population Attributable Fraction of VAW in Brazil, considering subnational variations. For both prevalence and homicide rates, associations with social, demographic, and health factors were assessed. Results: One in five adult women reported at least one episode of violence in the past 12 months, with psychological violence being the most common subtype, both in isolation and concurrently with other subtypes. Regarding mortality, Brazil’s female homicide rate showed a declining trend but remained high throughout the study period. Sociodemographic factors, particularly black race, lower education level, and living in small municipalities, were associated with both prevalence and mortality related to VAW. Lastly, the three subtypes of violence contributed to adverse health outcomes. Psychological violence accounted for over 10% of Disability-Adjusted Life Years related to Major Depressive Disorder (MDD). Physical and sexual violence were associated with multiple outcomes, notably MDD, abortion, and Sexually Transmitted Infections. All studied indicators varied significantly across regional contexts, with the North and Northeast regions standing out for their high rates. Conclusion: VAW is a critical problem in Brazil, both in its lethal or non-lethal forms, and is unequally distributed, with some women being more vulnerable than others. Preventing violence could significantly reduce the burden of disease, particularly regarding women's mental, sexual, and reproductive health. Reginal variations were noteworthy, suggesting that public policies should prioritize specific areas and promote targeted interventions for preventing violence and managing its consequences.