Washington — Aissata Cisse is a pediatrician in Africa, but many of her patients are adult women. While practicing in Niger and most recently in Senegal, Cisse saw women who were abused by their husbands or intimate partners. These women were trying to take care of their children, but she knew they needed help first.

Cisse realized she would have to provide several services to the women, so she organized a group of specialists that could provide various services, including legal and psychological. “I counsel women, listen to them, and I give advice. It is my job.”

She knows that in most cases, the woman is the victim of a man whose father abused his mother. “It is a cycle, and it will continue,” she said, eventually affecting the children of the mother who shows up at her door.

In 1999, The United Nations General Assembly designated November 25 as the International Day for the Elimination of Violence Against Women.

In remarks to the U.N. Commission on the Status of Women in February 2008, U.N. Secretary-General Ban Ki-moon said at least one out of three women in the world is likely to be beaten, coerced into sex or otherwise abused in her lifetime.

“Violence against women is an issue that cannot wait,” he said. “No country, no culture, no woman young or old is immune to this scourge.”

Cisse, who recently came to the United States to get a master’s degree in public health, believes domestic violence stems from cultural and economic factors, such as a trend toward smaller families.

A May 2008 United Nations report cites a worldwide shift from extended families to nuclear families. Cisse says she has seen this change leave abused women with no one to turn to, and with no one to hold the abuser accountable.

According to the 2006 United Nations report titled In-Depth Study on All Forms of Violence against Women, such cultural barriers are common. “Male violence against women is generated by socio-cultural attitudes and cultures of violence in all parts of the world, and especially by norms about the control of female reproduction and sexuality.”

THE INTERNATIONAL FIGHT AGAINST DOMESTIC ABUSE

Numerous government and nongovernmental organizations throughout the world are working to end domestic violence, according to the U.N. report. The United States assists countries through grants from the U.S. Department of Justice, the U.S. Agency for International Development, the U.S. Department of State and others.

One of the priorities is to train law enforcement agencies and courts to recognize the problem and treat it appropriately. The training also helps break down social barriers, according to judges and lawyers who have worked directly with police officers, prosecutors, judges and legislators outside the U.S.

Susan Block, a retired circuit court judge in St. Louis, has traveled to Lithuania, among other countries, to train judges and help them develop civil protection orders that would be enforceable within the system. She also has helped prosecutors come up with ways to prosecute without the victim’s testimony, as some victims are reluctant to testify against their abusers.

She gave police officers ideas for tactics, such as using “excitable utterances” as evidence even if the victim is not in court. “If the woman called an emergency number or said excitable things to police, the police officer could use it.”

She found younger police officers most receptive. “They said they became police officers to help people, and they were anxious to do something about this.”

Wanda Lucibello, a special-victims prosecutor in New York, has hosted many international delegations and traveled to many countries, including Grenada, Belize, South Africa and Zimbabwe, to provide training.

Because Lucibello works with one of several family justice centers sponsored by the U.S. Justice Department around the United Statees, she often presents the justice center model — providing many services in one place — in other countries.

In some countries, she finds gender inequality “so powerful. It is an additional hurdle to get through.” She also finds that some of her trainees have had personal experiences with domestic violence within their own families, or they recognize some of the characteristics in themselves.

In many cases, her international training involves helping police and prosecutors take domestic violence seriously, but often she finds more distress than resistance.

“They share the same frustrations and concerns as police officers [in the United States],” such as the victim not wanting to press charges against the abuser.

She also offers ideas for successful prosecution. “I compare it to gathering evidence as though they were handling an arrest for a homicide, [in that] there is no victim [from whom to obtain information]. That gets them excited because they have a way of looking at it.”

Judge Ramona Gonzales of the La Crosse County, Wisconsin, Circuit Court has taught “Domestic Violence 101” in Guam and other places.

“We tell them what they need to be sensitive to and what questions to ask — has the victim been isolated from her family and friends?”

She stresses that domestic violence goes beyond the physical attack. “It is about power and control.” The fear, she said, is that the controlling behavior won’t reach the judicial system “until you have a homicide or suicide or both.”