The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”. This is a major public health problem globally, and a violation of womens humans’ rights: estimates published by WHO indicate that globally about 1 in 3 (30%) of women worldwide have been subjected to either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime. This is two to three times higher for autistic women.

The human rights violated by gender-based violence include the right to life; the right not to be subject to torture or to cruel, inhuman or degrading treatment or punishment; the right to equal protection according to humanitarian norms in time of international or internal armed conflict; the right to liberty and security of person; the right to equal protection under the law; and the right to equality in the family.

Gender violence is also very present in the UK. The number of reported rapes continues to climb (between 2021 and 2022 there was a 35% rise), and yet conviction rates remain extremely low. Similarly, despite increased awareness, the rate of femicide shows no sign of decline. And the pandemic prompted a huge increase in calls to domestic abuse helplines.

What are the consequences?
Violence against women has severe consequences on women’s physical, mental, sexual, and reproductive health. The rates of depression, anxiety disorders, eating disorders, suicide and homicide, unplanned pregnancies, sexually transmitted infections, gynaecological problems, and HIV are higher in women who have experienced violence compared to women who have not, as well as many other health problems that can last after the violence has ended.

What is being done?
There is growing evidence on what works to prevent violence against women, based on well-designed evaluations. In 2019, WHO and UN Women with endorsement from 12 other UN and bilateral agencies published RESPECT women – a framework for preventing violence against women aimed at policy makers. Each letter of RESPECT stands for one of seven strategies: Relationship skills strengthening; Empowerment of women; Services ensured; Poverty reduced; Enabling environments (schools, work places, public spaces) created; Child and adolescent abuse prevented; and Transformed attitudes, beliefs and norms.

The health sector can:

• advocate to make violence against women unacceptable
• provide comprehensive services and train healthcare professionals to support survivors, with medical treatment, emotional support, and appropriate referral
• promote gender equality and provide comprehensive sexual health education.

One of the most important global movements is the International Day for the Elimination of Violence against Women, observed annually on November 25th. This day also marks the beginning of the 16 Days of Activism against Gender-Based Violence, an international campaign that runs up to December 10th, Human Rights Day. The campaign, initiated in 1991 by activists at the Women’s Global Leadership Institute, has become a crucial organising strategy for individuals and organisations worldwide.
Closer to home, the UK government has introduced a number of measures in recent years to tackle violence against women, and to help protect them from harm. Actions taken by the government include:

• Legislation such as the Domestic Abuse Act 2021, the Police, Crime, Sentencing and Courts Act 2022, the Health and Care Act 2022, and the Marriage and Civil Partnership (Minimum Age) Act 2022 (the latter was introduced as a private member’s bill)
• Legislation on online safety and supporting a private member’s bill on protection against sex-based harassment
• Publishing strategies and reviews to tackle violence against women, and seeking to improve evidence and data collation to help drive policy.

What about autistic women?
Between 60 and 90% of autistic women report some form of serious sexual assault or domestic violence. Why are the rates so high? Interviews with autistic women and healthcare professionals suggest that being autistic can mean greater vulnerability, due to multiple factors:

• Being less able to recognise something being unusual or see hidden messages in people’s behaviours
• Feeling less able to communicate a lack of consent or desire to leave a situation
• Having fewer friends to talk to about one’s experiences and check whether the treatment from the abuser was normal (autistic women often ended up staying in abusive relationships longer than they felt they should have, because they lacked the social support to recognise the danger and/or violence, and then to end the relationship)
• Are more likely to have poor family models to base relationships on
• Are more likely to shut down during abuse, which may make it harder for them to escape the situation
• May attract partners who are manipulative, bully-like, or have mental ill health themselves.

Autistic women are also more likely to face difficulties following the abuse, with rates of PTSD being particularly high. Many report finding it difficult to recognise what happened as wrong even after the abuse, and finding socialising following hurtful relationships as more exhausting and difficult. They also are more likely to suppress trauma related thoughts, which has been shown to lead to longer-lasting harm. Finally, they are less likely to seek support or be able to communicate what has happened, and they may present trauma symptoms differently to non autistic individuals, so healthcare professionals can fail to recognise it.

What needs to be done?

• Relationship and sexual education. Lack of sexual knowledge is a significant predictor of sexual victimisation, but actual knowledge partially mediates that risk. A 2021 study on psychosexual knowledge and education found that autistic adults had less sex-related knowledge and higher rates of victimisation, and research also shows that autistic adults and caregivers universally report dissatisfaction with the sexual education provided by schools due to a lack of autism accommodations in the content and teaching style. We need sexual education specific to autistic women.
• Policy change. Policies around intimate partner violence and sexual assault need to be updated to account for the different ways in which neurodivergent people may discuss their experiences, rather than looking for ‘standard narratives’ as an indicator of a need for support.
• Better training. Healthcare providers need to be trained to better support autistic female survivors – to provide adjustments in medical treatment and support and to understand the different and very specific ways trauma can impact autistic women.
• Shared experiences and advocacy. Knowing you are not alone is empowering, for anyone, autistic or not. We need to make more people aware of what is happening, and to, safely and appropriately, raise the voices of survivors.

I think these changes are critical everywhere – not just nationally, but internationally.