To live free from violence is a sexual and reproductive right. Just over a year ago, the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) elaborated on the definition of gender-based violence (GBV). The updated 2017 definition “expands the understanding of violence to include violations of sexual and reproductive health rights.” This is because the fulfillment of sexual and reproductive health rights is critical for women, girls and other vulnerable groups to be able to achieve all other human rights.

Living free from violence and being able to access comprehensive reproductive health care, including contraception, is one of the most important factors in a person’s ability to determine their trajectory in life. Violence exponentially impacts the ability to access necessary and often life-saving sexual and reproductive health services. When people think of the interaction of sexual and reproductive health and violence, the immediate thought is often of intimate partner violence (IPV) or GBV. That makes sense given that an estimated 1 in 3 women globally experience physical or sexual violence, mostly by an intimate partner.

But IPV and GBV exist on a wider spectrum of violence that includes collective violence committed by groups of individuals, such as social, political or economic violence. We witness this broader violence in situations of humanitarian emergencies, displacement and open conflict, as well as with general insecurity, like gang violence. It also exists in a structural form: the institutionalized discrimination, racism and stigma that individuals face in accessing health care. While violence can physically bar access to clinics or contraceptives, it also impedes the achievement of sexual and reproductive health and rights. These rights include the right to health care, the right to life and privacy, as well as freedom from gender discrimination and ill-treatment.

Experiences of violence create multi-tiered barriers to meeting sexual and reproductive health needs, which disproportionately affect the most vulnerable. For example, in El Salvador, PAI is documenting the role of violence as a barrier to sexual and reproductive health and rights. Despite relatively wide availability of contraceptive commodities, in recent years there has been a spike in adolescent pregnancy, attributed to GBV and harmful norms. Additionally, gang violence, sexual assault, femicide, and institutional gender-based violence against women—reflected in the country’s total abortion ban—all interact with deeply entrenched machismo. Unless the government tackles these issues holistically from the angles of health, education, gender and protection, efforts to improve sexual and reproductive health and rights will be thwarted.

From a development perspective, violence is an indicator of poor sexual and reproductive health outcomes. Without addressing these violations, a country cannot achieve its development goals, let alone its duties enshrined in international human rights law. Additionally, foreign donor governments—like the United States in the case of El Salvador—have largely disregarded rights-based development programming that takes gender into account. Failure to meet the needs of the most vulnerable serves to reinforce existing cycles of harmful gender norms, policies and practice, all of which must be changed, per the 2017 CEDAW recommendation, to reduce GBV.

Suffering violence is a clear violation of the sexual and reproductive health rights guaranteed by international human rights law. And violence itself, in all its different forms, hinders access to the enjoyment of those rights. In a development response, we therefore cannot isolate violence and its gendered dimensions, nor can we tick the box of contraceptive availability and walk away from the structures that perpetuate GBV.