Henrica A. F. M. Jansen

Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence

BACKGROUND Violence against women is a serious human rights abuse and public health issue. Despite growing evidence of the size of the problem, current evidence comes largely from industrialised settings, and methodological differences limit the extent to which comparisons can be made between studies. We aimed to estimate the extent of physical and sexual intimate partner violence against women in 15 sites in ten countries: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania. METHODS Standardised population-based household surveys were done between 2000 and 2003. Women aged 15-49 years were interviewed and those who had ever had a male partner were asked in private about their experiences of physically and sexually violent and emotionally abusive acts. FINDINGS 24,097 women completed interviews, with around 1500 interviews per site. The reported lifetime prevalence of physical or sexual partner violence, or both, varied from 15% to 71%, with two sites having a prevalence of less than 25%, seven between 25% and 50%, and six between 50% and 75%. Between 4% and 54% of respondents reported physical or sexual partner violence, or both, in the past year. Men who were more controlling were more likely to be violent against their partners. In all but one setting women were at far greater risk of physical or sexual violence by a partner than from violence by other people. INTERPRETATION The findings confirm that physical and sexual partner violence against women is widespread. The variation in prevalence within and between settings highlights that this violence in not inevitable, and must be addressed.

Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study

BACKGROUND This article summarises findings from ten countries from the WHO multi-country study on womens health and domestic violence against women. METHODS Standardised population-based surveys were done between 2000 and 2003. Women aged 15-49 years were interviewed about their experiences of physically and sexually violent acts by a current or former intimate male partner, and about selected symptoms associated with physical and mental health. The women reporting physical violence by a partner were asked about injuries that resulted from this type of violence. FINDINGS 24,097 women completed interviews. Pooled analysis of all sites found significant associations between lifetime experiences of partner violence and self-reported poor health (odds ratio 1.6 [95% CI 1.5-1.8]), and with specific health problems in the previous 4 weeks: difficulty walking (1.6 [1.5-1.8]), difficulty with daily activities (1.6 [1.5-1.8]), pain (1.6 [1.5-1.7]), memory loss (1.8 [1.6-2.0]), dizziness (1.7 [1.6-1.8]), and vaginal discharge (1.8 [1.7-2.0]). For all settings combined, women who reported partner violence at least once in their life reported significantly more emotional distress, suicidal thoughts (2.9 [2.7-3.2]), and suicidal attempts (3.8 [3.3-4.5]), than non-abused women. These significant associations were maintained in almost all of the sites. Between 19% and 55% of women who had ever been physically abused by their partner were ever injured. INTERPRETATION In addition to being a breach of human rights, intimate partner violence is associated with serious public-health consequences that should be addressed in national and global health policies and programmes.

What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women's health and domestic violence

BackgroundIntimate partner violence (IPV) against women is a global public health and human rights concern. Despite a growing body of research into risk factors for IPV, methodological differences limit the extent to which comparisons can be made between studies. We used data from ten countries included in the WHO Multi-country Study on Womens Health and Domestic Violence to identify factors that are consistently associated with abuse across sites, in order to inform the design of IPV prevention programs.MethodsStandardised population-based household surveys were done between 2000 and 2003. One woman aged 15-49 years was randomly selected from each sampled household. Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. We performed multivariate logistic regression to identify predictors of physical and/or sexual partner violence within the past 12 months.ResultsDespite wide variations in the prevalence of IPV, many factors affected IPV risk similarly across sites. Secondary education, high SES, and formal marriage offered protection, while alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood, increased the risk of IPV. The strength of the association was greatest when both the woman and her partner had the risk factor.ConclusionsIPV prevention programs should increase focus on transforming gender norms and attitudes, addressing childhood abuse, and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention.

Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women's health and domestic violence against women

Suicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on womens health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000-2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15-49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city); lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25-50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour.

Intimate partner violence, abortion, and unintended pregnancy: Results from the WHO Multi‐country Study on Women's Health and Domestic Violence

To explore how intimate partner violence (IPV) is associated with unintended pregnancy and abortion in primarily low‐ and middle‐income countries.

Violence against women by their intimate partner and common mental disorders.

The World Health Organization considers gender violence a cause of anxiety, depression and suicidal thoughts among women. This study investigated the association between violence committed against women by their intimate partners, defined by psychologically, physically and sexually abusive acts, and common mental disorders, assessed by using the Self Reporting Questionnaire (SRQ-20). A population-based household survey was carried out among women aged 15-49 years in two sites: São Paulo, the largest Brazilian city, and Zona da Mata of Pernambuco, a region with both urban and rural areas in the Northeast of the country. A large proportion of women reported violence (50.7%). The most frequent forms were psychological violence alone (18.8%) or accompanied by physical violence (16.0%). The prevalence of mental disorders was 49.0% among women who reported any type of violence and 19.6% among those who did not report violence (p<0.0001). After adjustment for demographic and socioeconomic characteristics, the nature of the relationship, stressful life events and social support, all the forms of violence studied, with the exception of sexual violence alone or accompanied by either physical or psychological violence (p=0.09), were significantly associated with mental disorders: physical violence alone (OR1.91; CI 95%1.2-3.0), psychological violence alone (OR 2.00; CI 95% 1.5-2.6), sexual violence alone or accompanied by either physical or psychological violence (OR1.80; CI95% 0.9-3.6), both psychological and physical violence (OR 2.56; CI 95% 1.9-3.5) and all three forms of violence (OR 2.68; CI 95% 1.8-4.0). This is the first population-based study on the association between intimate partner violence and mental health in Brazil. It contributes to the existing body of research and confirms that violence, frequently experienced by women in the country, is associated with mental disorders. Policies and strategies aimed at reducing gender-based violence are necessary for preventing and reducing anxiety and depression among women.

Interviewer Training in the WHO Multi-Country Study on Women’s Health and Domestic Violence

The importance of a sound research strategy for measuring and understanding violence against women cross-culturally is well recognized. However, the value of specialized interviewer training to attain these data is not always fully appreciated. This article describes interviewer selection and training in the World Health Organization (WHO) Multi-Country Study on Women’s Health and Domestic Violence and highlights their importance. Such training ensures high-quality data and cross-country comparability, protects the safety of respondents and interviewers, and increases the impact of the study. Moreover, women are not only willing to share experiences with trained and empathetic interviewers but also find the interview a positive experience.

RESPONDING TO VIOLENCE AGAINST WOMEN: WHO's Multicountry Study on Women's Health and Domestic Violence

The World Health Organization (WHO), in response to the lack of data on the magnitude and nature of violence against women, initiated a multicountry study on womens health and domestic violence. The WHO study, implemented in eight countries, was the first global effort to gather reliable and comparable data on domestic violence and womens health across countries. The study also demonstrates how carefully developed and applied research can act as a useful intervention at many levels of society and government and for all participants, researchers as well as respondents. The study further illustrates how partnering with researchers and womens organizations to collect evidence of the magnitude, consequences, and determinants of domestic violence can help strengthen national efforts to address violence against women and can act as a facilitating force for change.

Intimate Partner Violence and the Relation Between Help-Seeking Behavior and the Severity and Frequency of Physical Violence Among Women in Turkey:

This study explores the severity and frequency of physical violence from an intimate partner experienced by 15- to 59-year-old women and their help-seeking behavior by using data from the “National Research on Domestic Violence Against Women in Turkey.” Chi-square tests and logistic regression analyses were conducted to compare the relationship between severity and frequency of violence and women’s characteristics. Of all ever-partnered women, 36% have been exposed to partner violence; almost half of these experienced severe types of violence. Women used informal strategies to manage the violence instead of seeking help from formal institutions. Help-seeking behavior increases with increased severity and frequency of violence.

Exploring risk factors associated with intimate partner violence in Vietnam: results from a cross-sectional national survey

ObjectivesEmpirical evidence documents that some risk factors for intimate partner violence (IPV) are similar across contexts, while others differ considerably. In Vietnam, there was a need to investigate risk factors for IPV to support evidence-based policy and programming.MethodsUsing the dataset gathered in the 2010 National Study on Domestic Violence against Women, forty variables were explored in logistic regression analysis, including socio-demographic characteristics of women and their husbands, other experiences with violence, husband’s behaviours, family support, and context-specific variables such as the sex of their children.ResultsFifteen independent factors remained strongly associated with IPV. Significant risk was associated with husbands’ behaviour that supports male power (extra-marital relationships; fighting with other men) and alcohol use. Violence experienced in childhood increased the likelihood of women experiencing and of men perpetrating IPV. Notable was further the association with women’s higher financial contribution to the household and lack of association with not having sons.ConclusionsThe findings support theories describing how underlying gender and power imbalance are fundamental causes of IPV and indicate the need for context-specific interventions.