Since marital rape has such profound health consequences for women, the health care system is an appropriate place to provide primary and secondary prevention interventions. This chapter begins with the challenges and limitations in using a women’s rights/legal systems perspectives, a strictly power and control analysis of the issue of marital rape, and the equally problematic and changing gender norms approach even in collaboration with on-the-ground partners. The original Sanctions and Sanctuary framework, developed by Dorothy Counts, Judith Brown, and this author, was based on anthropological evidence on eight societies in 1992. Studies from the United States have revealed significant associations between contextual variables reflecting neighborhood poverty and risk of domestic violence. The chapter updates the Sanctions and Sanctuary framework and its implications. The updated framework includes new theoretical and research evidence to provide the foundation for application of ways to “move the needle” for norms about marital rape and hitting wives to prevent wife beating from becoming wife battering.