Violence against women is one of the most pervasive human rights violations in the world. Globally, more than one in three women have experienced either intimate partner violence or non-partner sexual violence in their lifetime. Violence against women exists in all countries and the consequences are exacerbated by each woman’s personal circumstances, such as race, sexual orientation, gender identity, ethnicity, disability and economic status.

But the perpetrators of this violence aren’t just individuals. Violence against women is so ingrained that it’s institutionalized. May 28 is the International Day of Action for Women’s Health—a day advocates have commemorated since 1987 and a reminder that action for women’s health matters. This year, the focus is on institutional violence.

What Does Institutional Violence Look Like?

Institutional violence refers to social systems and structures that oppress and discriminate against women, preventing their access to health care, government support, or justice, among other rights. In the field of abortion access, where we at Ipas work, institutional violence exists across a spectrum and has increasingly garnered international attention from human rights groups and bodies. Abortion is totally banned in five countries in the world and is restricted and regulated—often in ways that undermine women’s most basic needs—in many others. This is especially dire given that unwanted pregnancies are themselves too often the result of violence: sexual abuse, rape, incest, sexual torture, and sexual slavery.

Institutional violence looks like the horrific kidnapping and abuse of the Chibok girls in Nigeria—dozens of whom are now reportedly pregnant, as a result of being forced into “marriages” with their kidnappers and repeatedly raped. Any sense of urgency on the state’s part to rescue or protect the girls was clearly lacking. Institutionalized violence plays out in the case of a 10-year-old girl in Paraguay who was raped by her stepfather and denied abortion by her country’s government. This has left her in grave danger: The World Health Organization reports that the risk of maternal death in Latin America is four times higher among adolescents younger than 16, with 65 percent of cases of obstetric fistula occurring in the pregnancies of adolescents. Her case, too, reflects a pattern: In Paraguay every two days a child between 10 and 14 gives birth.

These instances are just two representations of government neglect to protect women and girls from institutional violence. They illustrate nations’ continuous failure to respond urgently when it comes to saving women’s lives.

In addition, our research shows that in nations with restrictive laws and practices where reproductive rights are concerned, women may be subjected to the emotionally and physically taxing process of the local justice system. Soon after abortion services or postabortion services are performed in the public health system, they may be reported to the police. The police investigate while the woman is vulnerable in a medical setting, with the physician given the power to interrogate her about whether she self-induced the abortion. Women have been handcuffed to their stretchers as they recovered from hemorrhages caused by miscarriages, obstetrical complications, or unsafe abortion, and were investigated as they were recovering. This is a form of cruel and unusual punishment that disproportionately affects, discriminates against, and stigmatizes more vulnerable women, since they are the ones seeking emergency care in public health facilities to treat unsafe abortion complications.

Just the threat of arrest is a coercive practice sometimes used against women in need of urgent postabortion care. For example, if a woman cannot pay her hospital bill, she can be arrested in her hospital bed and forced to wait there until a public defender is summoned. In one case in Brazil, the period between arrest and release lasted three months! For three months, a woman was handcuffed to her bed in a public hospital.

In general, in public health systems around the world, women often experience delayed care, prolonged fasting, social isolation, lack of information and communication, explicit discrimination, and even damning words and attitudes from health-care professionals. In nations with restrictive settings, women seeking abortion or postabortion care are subjected to sharp curettage performed without anesthesia. For that matter, there are often few suitable reproductive health facilities in countries all over the world, which highlights the lack of priority and infrastructure for quality care—itself another example of institutionalized violence against women.

We Have to Act

The Women’s Global Network for Reproductive Rights (WGNRR) coordinates the global campaign on institutional violence on May 28. Today and every day, we must act. We need laws that promote responsiveness to the needs of women and girls who have been victims of gender-based violence. Policy efforts must focus on the need to remove restrictive laws that criminalize abortion and remove barriers that impede access to the full continuum of reproductive health care.

At the global level, Ipas partner efforts to guarantee access to safe and legal abortion services in conflict settings, especially in cases where sexual violence has been used as a weapon of war to force the displacement of populations internally and across borders, must be supported. Women and children have been targeted both inside and outside refugee and internally displaced persons (IDP) camps and settlements, as well as surrounding villages and towns. Prevention and response is hampered by continued insecurity, the proximity of refugees to unsafe borders, presence of armed groups, access restrictions, lack of documentation of survivors, and funding gaps.

At Ipas, our strategies focus on working with providers, communities, and local and regional organizations to develop multiple strategies in order to eliminate barriers, promote policy, and implement legal and systemic change to protect women’s right to sexual autonomy and informed choices. This will help ensure that all people have equal access to comprehensive sexual and reproductive health education, services and information—including contraceptive counseling, a wide range of contraceptive methods, emergency contraception, safe abortion, and quality emergency obstetric care—as part of their right to live free from violence. Every woman deserves that.