An analysis of changes in the prevalence and patterns of intimate partner violence against women in seven Asian countries.

BACKGROUND: Assessments of changes in prevalence and patterns of violence against women are critical to inform prevention and response approaches and to monitor progress towards elimination. Most countries in the Asia Region have data on violence and several have completed second and third waves of surveys. This study sought to assess and compare the prevalence and patterns of physical and/or sexual partner violence in seven Asian countries with at least two rounds of comparable national-level data. METHODS: We conducted primary descriptive analyses using Demographic and Health data from India, Nepal, and Pakistan (South Asia), and from Cambodia, the Philippines, Timor-Leste, and extracted data from reports from Vietnam (Southeast Asia). We examined differences in partner violence by type of violence, reference periods, severity of violence, and age group. Pearson chi-square tests and Mantel-Haenszel test for trend were used to assess whether differences between time points were significant (p < 0.05). RESULTS: Prevalence and patterns of violence vary across countries and sub-regions. In Southeast Asia, women in Cambodia and Vietnam experienced increasing and relatively high levels of sexual violence alongside declining physical violence. Reported levels of violence were lowest in the Philippines and prevalence showed consistent declines. Timor-Leste stands out as having the highest prevalence of physical partner violence, and there were consistently significant increases in estimates. Women in South Asia experienced predominantly physical violence and there were consistent declines in all three countries, though physical violence increased among older women in India. CONCLUSIONS: Data from Asian countries where more than one prevalence survey had been done provided a unique opportunity to analyse differences in estimates of violence against women at two time points. Deeper analyses into types and severity of violence revealed that overall prevalence estimates hid more complex patterns. There are clear limitations in using survey data to understand the nuances which highlighted the need for depth analysis identifying contextual factors of violence to inform situation specific policies and interventions for the greatest impact. It is also clear that more than two data points are necessary to identify change over time, and interventions driving or preventing that change.

Unequal power relations and partner violence against women in Tanzania: a cross-sectional analysis.

BACKGROUND: Research on factors associated with partner violence against women is often framed within the context of gender inequality and power imbalances between husbands and wives-inequalities that are considered products of broader structural systems. Tanzania, a patriarchal society where high levels of partner violence exists, has gone through rapid economic and social changes over the past two decades. Increasing numbers of women are seeking paid work, and men's ideals of manhood have reshaped with evidence of extra marital relations and alcohol use. Nationally representative population-based data documents 46.2% of ever-married women have experienced physical or sexual partner violence in their lifetime; 29.6% in the past year. In order to plan appropriate interventions to end violence against women, factors consistently associated with abuse need to be understood. METHODS: This study uses "couples" data from the 2015 Tanzania Demographic and Health Survey to examine correlates of past year partner violence against women. Multivariate regression analysis was used to explore individual and relational-level variables-including socio-demographic characteristics and history of abuse among women, partner behavioural characteristics, and indicators of gender and economic inequality-among 1278 married and cohabiting couples. RESULTS: At the individual level, women's experiences of non-partner violence (sexual abuse by a non-partner and witnessing violence in childhood) was strongly associated with risk and highlights that all forms of violence against women serve to keep them subordinated. Partner behavioural characteristics (polygamy and problematic alcohol use) were also associated with risk. Household socio-economic status, however, was not significantly associated with women's risk in the final multivariate model. At the relational-level, men's age difference of 10 or more years; and any employment (compared to none/unpaid) were associated with lower risk. When considering attitudes tolerant towards wife abuse, the strongest association with risk of violence was when both partners held tolerant views. CONCLUSION: The findings support the assertions of violence being associated with women's prior/additional experiences of abuse and with men's harmful expressions of masculinity. In addition to interventions that focus on transforming gender norms and attitudes (at the individual and community levels), addressing economic, legal and political structural barriers are also required.

Changes in the Correlates for Intimate Partner Violence Against Women in Vietnam: Evidence From the 2010 and 2019 National Prevalence Surveys.

This study sought to understand whether the risk and protective factors associated with current partner violence changed in Vietnam using findings from two comparable surveys conducted in 2010 and 2019. Fifteen (2010) and 17 (2019) factors were significantly associated with violence, and the level of consistency was high-nonpartner sexual violence, respondent and partner prior abuse, men's expressions of masculinity, and indicators of low economic status continue to put women at risk. Gender-transformative approaches that address power inequalities, foster positive parenting, and promote the political and social influence of women are required and should be adapted to the Vietnam context.

Help-seeking behaviour of Serbian women who experienced intimate partner violence.

OBJECTIVE: This study aimed to identify whom women in Serbia approach for help in case of intimate partner violence (IPV), their reasons for seeking help and their satisfaction with the received help. METHODS: A cross-sectional, population-based household survey of a random sample of women aged 15-49 years was conducted in Belgrade (WHO Multi-country Study on Women's Health and Domestic Violence against Women). A standard questionnaire was administered by trained interviewers through face-to-face interviews. RESULTS: The questionnaire was completed by 1456 women and 1196 of them ever had an intimate partner. Almost one in four ever-partnered women reported experiencing either physical and/or sexual violence, at least once in their life. Among these abused women, ≈ 22% had ever sought help from formal institutions. Police and health services were most commonly approached (12% and 10% of abused women, respectively). Satisfaction with services was highest for health services and legal advice and lowest for police and social services. Women sought help especially when violence had a severe impact on them or when they saw that their children suffered. Women who did not seek help stated that they believed that the violence was bearable or had ended. Other reasons for not seeking help were fear of undesirable consequences of seeking help and lack of trust in institutions. CONCLUSIONS: From the abused women's perspective, health care services are the institutions with the highest potential to help women in cases of IPV. Developing a comprehensive health sector response is of critical importance to ensure appropriate care and referral.

Risk factors for violence against women in high-prevalence settings: a mixed-methods systematic review and meta-synthesis.

INTRODUCTION: Violence against women (VAW) affects one in three women globally. In some countries, women are at much higher risk. We examined risk factors for VAW in countries with the highest 12-month prevalence estimates of intimate partner violence (IPV) to develop understanding of this increased risk. METHODS: For this systematic review, we searched PUBMED, CINAHL, PROQUEST (Middle East and North Africa; Latin America and Iberia; East and South Asia), Web of Science, EMBASE and PsycINFO (Ovid) for records published between 1 January 2000 and 1 January 2021 in English, French and Spanish. Included records used quantitative, qualitative, or mixed-methods, reported original data, had VAW as the main outcome, and focused on at least one of 23 countries in the highest quintile of prevalence figures for women's self-reported experiences of physical and/or sexual violence in the past 12 months. We used critical interpretive synthesis to develop a conceptual model for associations between identified risk factors and VAW. RESULTS: Our search identified 12 044 records, of which 241 were included for analysis (2 80 360 women, 40 276 men, 274 key informants). Most studies were from Bangladesh (74), Uganda (72) and Tanzania (43). Several quantitative studies explored community-level/region-level socioeconomic status and education as risk factors, but associations with VAW were mixed. Although fewer in number and representing just one country, studies reported more consistent effects for community-level childhood exposure to violence and urban residence. Theoretical explanations for a country's high prevalence point to the importance of exposure to other forms of violence (armed conflict, witnessing parental violence, child abuse) and patriarchal social norms. CONCLUSION: Available evidence suggests that heightened prevalence of VAW is not attributable to a single risk factor. Multilayered and area-level risk analyses are needed to ensure funding is appropriately targeted for countries where VAW is most pervasive. PROSPERO REGISTRATION NUMBER: The review is registered with PROSPERO (CRD42020190147).

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 women's 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.

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.

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

OBJECTIVES: Empirical 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. METHODS: Using 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. RESULTS: Fifteen 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. CONCLUSIONS: The findings support theories describing how underlying gender and power imbalance are fundamental causes of IPV and indicate the need for context-specific interventions.

Geographical variations in the prevalence of HIV and other sexually transmitted infections in rural Tanzania.

The prevalence and incidence of HIV and other sexually transmitted infections (STIs) were recorded in two lake-island and eight rural mainland communities in Mwanza, Tanzania. The prevalence and incidence of HIV and syphilis were lower on the islands, but this pattern was not seen for herpes simplex virus type-2, gonorrhoea, chlamydia, male urethritis or antenatal prevalences of Trichomonas vaginalis. Island men reported fewer sexual partners than mainland men but no differences were found for women. Island men were more likely to be circumcised, island women less mobile and there were differences in marriage patterns. Possible explanations for the differences in HIV and syphilis include: slower introduction of HIV into the islands because of geographical isolation, more core-group sexual contact on the mainland, higher prevalence of male circumcision on the islands and differences in marital status. Differences in transmission dynamics may lead to geographical patterns that vary between STIs.

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.

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

OBJECTIVE: To explore how intimate partner violence (IPV) is associated with unintended pregnancy and abortion in primarily low- and middle-income countries. METHODS: Population data are presented from 17 518 ever-partnered women participating in the WHO Multi-country Study on Women's Health and Domestic Violence in 15 sites in 10 countries. Using multiple logistic regression analyses, associations between physical and/or sexual partner violence and abortion and unintended pregnancy were explored. RESULTS: Women with a history of IPV had significantly higher odds of unintended pregnancy in 8 of 14 sites and of abortion in 12 of 15 sites. Pooled estimates showed increased odds of unintended pregnancy (adjusted OR 1.69; 95% CI, 1.53-1.86) and abortion (adjusted OR 2.68; 95% CI, 2.34-3.06), after adjusting for confounding factors. Reducing IPV by 50% could potentially reduce unintended pregnancy by 2%-18% and abortion by 4.5%-40%, according to population-attributable risk estimates. CONCLUSION: IPV is a consistent and strong risk factor for unintended pregnancy and abortion across a variety of settings. Unintended pregnancy terminated through unsafe abortion can result in death or serious complications. Therefore, reducing IPV can significantly reduce risks to maternal and reproductive health.

Factors associated with intimate partner violence against women in Serbia: a cross-sectional study.

BACKGROUND: This study aimed to identify factors associated with intimate partner violence against women living in Belgrade, Serbia. METHOD: A cross-sectional, population based household survey was conducted in Belgrade as part of the WHO Multi-country Study on Women's Health and Domestic Violence, using a standard questionnaire. Face-to-face interviews were conducted with 1456 women aged 15-49 years. Data used in this study were from a subset of 886 women who ever cohabited with their male intimate partners. The association between various factors at individual and relationship levels and reported physical or sexual partner violence, or both, was assessed by univariate and multivariate logistic regression analysis. RESULTS: Multivariate logistic regression modelling revealed that partner violence was significantly associated with a number of factors relating to the male partner: daily alcohol consumption (AOR 4.25, 95% CI 1.78 to 10.11), having affairs (AOR 3.97, 95% CI 1.62 to 9.57), fighting with other men (AOR 3.62, 95% CI 1.91 to 6.88), his mother having experienced spousal abuse (AOR 2.71, 95% CI 1.40 to 5.23) and he himself being beaten as a child (AOR 3.14, 95% CI 1.48 to 6.63). Among the factors related to the women, only forced or unwanted first sexual intercourse was independently associated with exposure to partner violence (AOR 2.50, 95% CI 1.05 to 5.96). CONCLUSION: The majority of factors associated with intimate partner violence related to the male partner; in particular his childhood experiences of violence in his own family. Long-term violence prevention programmes should target boys growing up in families with domestic violence.