The scientist who showed that violence can change
- 第一吃瓜网 University
Prof. Rachel Jewkes, the NSTF-South32 Lifetime Awardee, has spent over 30 years turning violence against women into a rigorous public health field globally.
It was 1981, and Professor Rachel Jewkes was never meant to come to South Africa.
At 17, while arranging a gap year through a British volunteer organisation, she had been clear: she was prepared to go almost anywhere, but not to apartheid South Africa.
Instead, she was offered a health placement in what she was told was the “newly independent” African country of Transkei. By the time she realised that Transkei’s supposed independence was part of apartheid’s homeland system, she was virtually on a plane to South Africa.
The 9-month volunteer placement shaped her early adult life. Jewkes spent time at a tuberculosis hospital that included a leprosy unit. Many of the patients had lost sensation in their feet and legs and developed chronic ulcers. They needed shoes, warm clothing, wound care and human engagement.
She helped make protective footwear, cared for ulcers, found wool for patients who crocheted, and taught physics to nurses. The patients received some medical treatment, she recalls, but in most other respects they had been neglected.
“It was more containment than care,” she recalls. Jewkes left South Africa enraged.
On her second day back in England, she found the headquarters of the Anti-Apartheid Movement in London and asked to join. She became involved in its health committee, eventually leading it for more than a decade and serving for seven years as the organisation’s national vice-chair.
The missing piece
Jewkes trained as a medical doctor at St Thomas’ Hospital in London before moving into public health.
“I decided that was the place for me,” she says. “I wanted to be involved in population-level health. I wanted to think about policy, health services, clinical practice, prevention and the difficult process of turning evidence into something that could tangibly improve people’s lives,” she says.
Jewkes returned to South Africa permanently in December 1994, months after the country’s first democratic election, and took up a position at the South African Medical Research Council.
She was employed to establish a women’s health research focus within the Centre for Epidemiological Research in Southern Africa. The programme began with Jewkes and a young researcher, Naeema Abrahams, who would eventually succeed her as director of what became the SAMRC Gender and Health Research Unit.
At first, they had to work out who they were and what a women’s health research programme in a new democracy should investigate.
One of the first answers emerged from a study of teenage pregnancy.
The planned questionnaire reflected the accepted explanations of the time: girls became pregnant because they lacked knowledge about fertility, were careless about contraception or struggled to access clinics.
Jewkes agreed to join the study on one condition. Before finalising the questionnaire, the researchers would conduct open-ended interviews and listen to the girls themselves.
They interviewed 24 pregnant teenagers.
Twenty-three spoke about being raped, forced into sex or beaten.
“We suddenly thought, ‘Oh my goodness, we have a piece that is missing from the whole way in which we conceptualise young people, sexuality and girls’ sexual risk,’” Jewkes recalls.
Questions about violence were hurriedly added to the larger survey. The results confirmed what the girls had said: forced sex and rape were among the most important reasons they had become pregnant.
“That missing piece would shape the course of my career.”
At the time, violence against women was surrounded by silence. A woman being slapped or beaten by her partner might be regarded as unpleasant, but not necessarily as a public health concern with consequences for her body, mind, children and future. Jewkes and her team set about changing that.
Building a science where little existed
There was almost no dedicated funding for violence against women research.
Jewkes initially had to locate the work within broader concerns about crime and violence. In 1997, she secured a small grant for population-based household research in the Eastern Cape, Limpopo and Mpumalanga.
The findings established that violence was widespread across populations.
But before violence can be prevented, it must first be measured.
Jewkes and her collaborators went on to develop methods for measuring rape perpetration among men in the general population, bringing into view sexual violence that had never reached a police station or courtroom.
They studied violent masculinities, childhood trauma, gender power, alcohol use, poverty and inequality. They examined how violence affected women’s physical and mental health, their risk of HIV, their economic security and the lives of their children.
The small women’s health focus grew into the Gender and Health Research Unit, now the second-largest unit at the SAMRC and one of the largest research groups on violence against women in the world.
The country’s extraordinary burden of violence created urgent questions. But it also produced some of the world’s most important science on how violence begins, how it moves between generations and how it may be interrupted.
The brilliance of South African science
Jewkes is careful to recognise the people who helped shape her methods. She singles out SAMRC statistician Carl Lombard, who showed her how national studies using cluster sampling could answer questions that routine statistics could not.
The same methodological thinking could be applied to incomplete abortion, rape cases at police stations, murder investigations or femicide.
South African researchers also had to become unusually versatile.
In London or Washington, a scientist might be able to bring in a specialist to design an intervention, another to evaluate it and someone else to help translate the findings into policy. In South Africa, those people often did not exist.
“You had to learn how to develop an intervention to be able to do intervention work,” Jewkes says.
Her team learnt to design national studies, conduct qualitative research, develop interventions, run randomised trials, write policy, create clinical guidelines and work with government.
South Africa’s depth of trauma made simplistic explanations impossible. Violence could not be reduced to bad individuals or a single cultural practice. It had to be understood within the country’s history of inequality, fractured families, political violence, economic exclusion, patriarchy and institutional failure.
Taking the country’s pulse
Perhaps the clearest example is South Africa’s national femicide surveillance.
Jewkes is widely regarded as the doyenne of femicide research. Together with Abrahams and their colleagues, she helped build what is arguably the most sophisticated national femicide surveillance record in the world.
Femicide is the murder of women and girls, often by a current or former intimate partner. But ordinary murder statistics cannot reliably tell researchers who killed a woman, what her relationship was to the perpetrator, whether sexual violence was involved, or how the circumstances of her death changed over time.
To obtain that information, researchers must collect it themselves. They go to mortuaries, examine forensic records, work with police investigators and reconstruct cases one by one.
The Gender and Health Research Unit first studied women murdered in 1999. It repeated the work for 2009, 2017 and 2020–2021, when the researchers wanted to understand the effects of the COVID-19 period. Funding has now been secured for a fifth national data point examining deaths in 2025.
“South Africa is the only country with this depth of repeated national femicide surveillance based on primary data collection.”
Every study asks the same stark question: has South Africa become safer for women?
The answer has not always been no.
The surveillance showed that femicide roughly halved between 1999 and 2009, with much of that improvement sustained in later years. The proportion of femicides committed with firearms also fell sharply. Jewkes links this decline, at least in part, to stronger firearm regulation and better enforcement following changes to gun laws.
There were also periods when poverty eased somewhat, social protection expanded and state institutions functioned more effectively.
But there has been a worrying shift: Jewkes says the proportion of femicides involving firearms rose again in the 2020–2021 data. South Africa also experienced a wider increase in murder after COVID-19. She connects this deterioration to worsening poverty and unemployment, the erosion of firearm control and a broader breakdown in law enforcement during the years of state capture.
“We made such progress, and we lost it all,” Jewkes laments.
Is violence going to be with us forever?
Tragically, South Africa remains one of the most unequal societies in the world. Economic dependence makes it harder for women to leave abusive partners. Unemployment and hopelessness place enormous pressure on households and relationships. Patriarchal ideas continue to position women as subordinate and violence as a legitimate expression of masculine authority.
Then there is apartheid’s legacy.
The migrant labour system separated parents from children and men from their families. Forced removals destabilised communities. Political and state violence normalised the use of force. Many children grew up amid separation, fear and insecurity.
“Trauma can affect the developing brain, emotional regulation, trust and attachment. It can make it more difficult to form secure relationships and take advantage of already limited educational and economic opportunities,” says Jewkes.
Boys exposed to violence may have a greater risk of perpetrating it later. Girls may face a greater risk of becoming victims in their adult relationships. Children who witness severe violence against their mothers may carry psychological, social and economic consequences into their own futures.
From counting violence to preventing it
Having helped establish the scale and drivers of violence, Jewkes became increasingly impatient with research that stopped at description.
“Now we’ve established its prevalence,” she says. “Our focus shouldn’t be on the count. It should be on finding out how we prevent it.”
She led a major evaluation of Stepping Stones, a participatory intervention originally developed for HIV prevention in Uganda and adapted for South Africa.
The programme worked with young people in the Eastern Cape, using discussion, reflection and role play to challenge gender norms, improve communication and reduce harmful sexual behaviour.
The results, published in 2008, provided the first trial evidence that an intervention could reduce men’s perpetration of intimate partner violence.
Jewkes then led the global What Works to Prevent Violence Against Women and Girls programme, which supported 17 projects across 13 countries in Africa and Asia.
In many cases, the researchers first had to develop the intervention before they could evaluate it. The programme tested approaches involving gender transformation, livelihoods, schools, communities, workplaces and conflict-affected populations.
It dramatically expanded the global evidence base.
Today, Jewkes says, around half of the literature on violence-prevention interventions comes from sub-Saharan Africa. This is an extraordinary scientific contribution from a region too often positioned only as a recipient of knowledge generated elsewhere.
The evidence shows that well-designed interventions can reduce violence, sometimes substantially.
But Jewkes refuses to oversell the findings.
Only around 40% of the interventions studied achieved statistically significant reductions. Even successful programmes do not reduce violence to zero. There is also too little evidence about whether the effects last five, seven or ten years.
Research funding usually supports one project. When the study ends, there is often no money to apply what was learnt, refine the intervention and test it again.
“We need a pipeline of research and intervention: implement, test, refine and then redo it,” she says.
Knowledge must lead somewhere
Jewkes has repeatedly carried her work across the difficult distance between a published finding and something that changes a health service, professional practice or government response.
Her advice to researchers seeking greater impact is practical.
“I think you need to build long-term relationships with policymakers,” she says.
Policymakers are more likely to listen when researchers understand what they need and can offer something that helps them do their work better.
“It’s terribly difficult to have policy impact when you just come in cold.”
When somebody in the Department of Health says that a clinical guideline is needed but they lack the time or capacity to develop it, the researcher must sometimes be prepared to help lead the process.
That may mean convening people, drafting policy, negotiating disagreements, revising documents, developing training and staying involved until the knowledge can actually be used.
South Africa’s national approach to post-rape care shows what this looks like.
Training for healthcare workers was once highly fragmented. One organisation might offer an hour on conducting a rape examination, while another offered two days.
Jewkes and her colleagues brought together the organisations and experts providing this training and asked a more fundamental question: what does a healthcare worker need to know to care properly for somebody who has been raped?
Healthcare professionals needed to address physical injuries, HIV and infection risks, pregnancy, psychological trauma and the survivor’s immediate safety. They needed to collect and document evidence correctly. They also needed to feel prepared to give evidence in court.
The group concluded that proper training required a two-week curriculum.
Instead of producing another competing programme, Jewkes’ team brought the different training providers into the writing process. This created wider agreement and ownership.
South Africa became one of relatively few countries with a comprehensive national curriculum for post-rape care.
What happens after violence?
Jewkes believes that while enormous effort has gone into understanding and preventing violence, too little research has examined how society should respond to women already living with severe abuse.
What actually helps a woman become safe?
What enables her to leave an abusive partner and remain out of the relationship?
How do financial dependence, housing, children, fear and inadequate services limit her options?
South Africa has a potentially powerful protection order system through its domestic violence courts. Yet many women who could benefit from it remain unable to access it, or do not receive the protection they need.
The question is not simply why women stay. It is what makes leaving practically possible.
This is now at the centre of Jewkes’ largest research project.
Over 18 months, her team recruited nearly 10,000 women who had experienced severe intimate partner violence from four sites across South Africa. The women are being followed over time, together with groups of their children.
“The first depressing thing was how easy it was to recruit enormous numbers of women experiencing severe violence in just four sites,” Jewkes says.
Close to three-quarters of the women reported that a partner had attempted to kill them.
The project is examining attempted femicide, help-seeking, women’s efforts to leave, the barriers they encounter and the longer-term consequences of abuse. By following children as well, it is also asking how violence is carried into the next generation and what might finally break that cycle.
At the same time, Jewkes continues to help lead South Africa’s femicide surveillance, including its fifth national study.
“Always an optimist”
The NSTF-South32 Lifetime Award recognises a body of work that helped create a scientific field.
When Jewkes began studying gender and violence, she was warned that the subject would not be recognised as serious science. Researchers working on gender could not expect to publish in leading journals, she was told.
She and her colleagues proved otherwise.
They developed original methodologies, conducted national surveillance, designed interventions, ran rigorous trials, shaped health policy and built one of the world’s largest research units focused on violence against women.
The work influenced The Lancet, the World Health Organization, governments and violence-prevention programmes across continents. It also helped establish sub-Saharan Africa as a global centre of knowledge rather than merely a site where international research is conducted.
Is Jewkes hopeful for the future?
“Always an optimist.”
Her work shows the almost impossible task of solving violence, but it also shows that it responds to systems change, such as firearm regulation, functioning institutions and social protection. It responds to prevention programmes and the quality of services available to survivors.
* Jewkes is Executive Scientist: South African Medical Research Council (SAMRC) and Honorary Professor: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.