Intimate partner violence among women in Spain: the impact of regional-level male unemployment and income inequality.

BACKGROUND: Intimate partner violence (IPV) against women is a complex worldwide public health problem. There is scarce research on the independent effect on IPV exerted by structural factors such as labour and economic policies, economic inequalities and gender inequality. OBJECTIVE: To analyse the association, in Spain, between contextual variables of regional unemployment and income inequality and individual women's likelihood of IPV, independently of the women's characteristics. METHOD: We conducted multilevel logistic regression to analyse cross-sectional data from the 2011 Spanish Macrosurvey of Gender-based Violence which included 7898 adult women. The first level of analyses was the individual women' characteristics and the second level was the region of residence. RESULTS: Of the survey participants, 12.2% reported lifetime IPV. The region of residence accounted for 3.5% of the total variability in IPV prevalence. We determined a direct association between regional male long-term unemployment and IPV likelihood (P = 0.007) and between the Gini Index for the regional income inequality and IPV likelihood (P < 0.001). Women residing in a region with higher gender-based income discrimination are at a lower likelihood of IPV than those residing in a region with low gender-based income discrimination (odds ratio = 0.64, 95% confidence intervals: 0.55-0.75). CONCLUSIONS: Growing regional unemployment rates and income inequalities increase women's likelihood of IPV. In times of economic downturn, like the current one in Spain, this association may translate into an increase in women's vulnerability to IPV.

Social and immigration factors in intimate partner violence among Ecuadorians, Moroccans and Romanians living in Spain.

BACKGROUND: Intimate partner violence (IPV) against women occurs in all countries, all cultures and at every level of society; however, some populations may be at greater risk than others. The aim of this study was to explore IPV prevalence among Ecuadorian, Moroccan and Romanian immigrant women living in Spain and its possible association with their personal, family, social support and immigration status characteristics. METHODS: Cross-sectional study of 1607 adult immigrant women residing in Barcelona, Madrid and Valencia (2011). Prevalence rates and adjusted odds ratios (AORs) were calculated, with current IPV being the outcome. Different women's personal (demographic), family, social support and immigration status characteristics were considered as explicative and control variables. All analyses were separated by women's country of origin. RESULTS: Current IPV prevalence was 15.57% in Ecuadorians, 10.91% in Moroccans and 8.58% in Romanians. Some common IPV factors were found, such as being separated and/or divorced. In Romanians, IPV was also associated with lack of social support [AOR 5.96 (1.39-25.62)] and low religious involvement [AOR 2.17 (1.06-4.43)]. The likelihood of current IPV was lower among women without children or other dependents in this subgroup [AOR 0.29 (0.093-0.92)]. CONCLUSION: The IPV prevalence rates obtained for Moroccan, Romanian and Ecuadorian women residing in Spain were similar. Whereas the likelihood of IPV appeared to be relatively evenly distributed among Moroccan and Ecuadorian women, it was higher among Romanian women in socially vulnerable situations related to family responsibilities and the lack of support networks. The importance of intervention in the process of separation and divorce was common to all women.

Intimate Partner Violence against Women during the COVID-19 Lockdown in Spain.

AIMS: To analyze the temporal and geographical distribution of different indicators for the evolution of intimate partner violence against women (IPV) before, during and after the COVID-19 induced lockdown between March and June 2020 in Spain. METHODS: Descriptive ecological study based on numbers of 016-calls, policy reports, women killed, and protection orders (PO) issued due to IPV across Spain as a whole and by province (2015-2020). We calculated quarterly rates for each indicator. A cluster analysis was performed using 016-call rates and protection orders by province in the second quarters of 2019 and 2020. ANOVAs were calculated for clustering by province, unemployment rates by province, and the current IPV prevalence. RESULTS: During the second quarter of 2020, the highest 016-call rate was recorded (12.19 per 10,000 women aged 15 or over). Policy report rates (16.62), POs (2.81), and fatalities (0.19 per 1,000,000 women aged 15 or over) decreased in the second quarter of 2020. In the third quarter, 016-calls decreased, and policy reports and POs increased. Four clusters were identified, and significant differences in unemployment rates between clusters were observed (F = 3.05, p < 0.05). CONCLUSIONS: The COVID-19 lockdown fostered a change in IPV-affected women's help-seeking behavior. Differences between the volume of contacts made via 016-call and the policy reports generated provide evidence for the existence of barriers to IPV-service access during the lockdown and the period of remote working. More efforts are needed to reorganize services to cope with IPV in non-presential situations. The provinces with the highest 016-call and PO rates were also those with the highest rates of unemployment, a worrying result given the current socioeconomic crisis.

Identifying sociodemographic differences in Intimate Partner Violence among immigrant and native women in Spain: a cross-sectional study.

OBJECTIVES: To analyze whether sociodemographics and social support have a different or similar effect on the likelihood of Intimate Partner Violence in immigrants and natives, and to estimate prevalences and associations between different types of IPV depending on women's birthplace. METHODS: Cross-sectional study of 10,048 women (18-70 years) attending primary healthcare in Spain (2006-2007). OUTCOME: Current Intimate Partner Violence (psychological, physical and both). Sociodemographics and social support were considered first as explicative and later as control variables. RESULTS: Similar Intimate Partner Violence sociodemographic and social support factors were observed among immigrants and natives. However, these associations were stronger among immigrants, except in the case of poor social support (adjusted odds ratio natives 4.36 and adjusted odds ratio immigrants 4.09). When these two groups were compared, immigrants showed a higher likelihood of IPV than natives (adjusted odds ratios 1.58). CONCLUSION: Immigrant women are in a disadvantaged Intimate Partner Violence situation. It is necessary that interventions take these inequalities into account.

[Sociodemographic profile of women affected by intimate partner violence in Spain]. / Perfil sociodemográfico de las mujeres afectadas por violencia del compañero íntimo en España.

OBJECTIVE: To determine the prevalence of reported intimate partner violence (IPV) and to analyze the main sociodemographic characteristics of affected women. METHODS: We performed a cross-sectional study based on the Spanish National Health Survey of 2006. The sample comprised 13,094 women who agreed to answer questions about violence (87.2% of the total interviewees). Bivariate and multivariate analyses were performed. The dependent variable was reported IPV and the independent variables were educational level, employment, marital status, living arrangements with the partner or analogous individual, number of children at home, nationality (Spanish vs. foreign women) and age. RESULTS: IPV was reported by 1% (n=128) of the sample. Women with primary school education or without studies (odds ratio [OR]: 3.63 [1.90-6.92]), with three or more children (OR: 3.51 [1.78-6.90]), and those who were separated or divorced (OR: 2.81 [1.89-4.97]) were most likely to experience IPV when the effect of the remaining variables was controlled. The likelihood of IPV was also higher in women born outside Spain (OR: 2.83 [1.87-4.28]). CONCLUSIONS: IPV seems not to affect Spanish and foreign women equally. The characteristics most closely associated with women affected by IPV were educational level, the number of children at home and marital status. The sensitivity of current measures against IPV should be considered in relation to the needs of affected women.

[Mortality due to intimate partner violence in foreign women living in Spain (1999-2006)]. / Mortalidad por violencia del compañero íntimo en mujeres extranjeras residentes en España (1999-2006).

OBJECTIVES: To describe the distribution of mortality due to intimate partner violence (IPV) in foreign women living in Spain and to explore the potentially greater risk of dying from IPV in this group. METHODS: We performed a retrospective ecological study of deaths from IPV registered by the Women's Institute of Spain (1999-2006). Mortality rates and Poisson models for relative risk and 95% confidence intervals were calculated. RESULTS: The average risk of dying from IPV in foreign women was 5.3 times greater than that in Spanish women. In the years studied, the increased risk in foreign women was 2 to 8 times greater than that in Spanish women. CONCLUSION: Foreign women living in Spain are especially vulnerable to death from IPV. Further research on the causes of this phenomena and strategies involving health services are needed.

[Temporary distribution of reports and murders because of partner violence during the period 1998-2006, Spain]. / Distribución temporal de las denuncias y muertes por violencia de género en España en el período 1998-2006.

BACKGROUND: Intimate Partner Violence (IPV) has received special attention in the spanish political agenda. Despite the importance of developed interventions, empirical evidence about their effectiveness is scarce. The aim of this study is to explore the temporary distribution of Intimate Partner Violence (IPV) reports and murders and to identify possible changes in the risk of dying and reporting by IPV from the Spanish law against gender violence of December of 2004. METHODS: We performed a descriptive study based on statistics of The Woman's Institute and The Divorced and Separated Women Federation. CALCULATIONS: IPV mortality and reports rates by years and periods around the law (1998-2004 vs. 2005-2006); Poisson Regression; and, Epidemic index by months -Ratio between the actual number of IPV murders and reports in a given month and the median number of cases in the same month in the five preceding years- and underlying epidemic index -annual average of the scores of the epidemic index of reports and murders. RESULTS: The epidemic index trends permit us to observe that the problem has decreased since 2005. Nevertheless, the possibility of reporting IPV between 2005 and 2006 is 1.6 times upper that between 1998 and 2004. The risk of dying by this cause does not show statistically significant changes. CONCLUSION: The possibility of reporting IPV has been increased in Spain throughout the time. However, the risk of dying stays. Although still it is soon for the evaluation of the impact of the law in this epidemic, we could say that its effectiveness for the reduction of IPV mortality seems limited.

[Gender development inequalities epidemiology in Spain (1990-2000)]. / Epidemiología de las desigualdades del desarrollo de género en España (1990-2000).

BACKGROUND: Gender is an important health determinant for public health policies. This study describes the changes in gender development inequalities in Spain and its autonomous regions from 1990 to 2000. METHODS: An ecological study using the Human Development Index (HDI) and the Gender Development Index (GDI) was done. IDG both men and women was analysed according to indexes of education, income and life expectancy at birth. RESULTS: Although the GDI has had an increase of 5,05% in the 90 s, 51,5% of the population was located above the global GDI of Spain in 1990, moreover this number decreased to 46,3% in 2000. Gender inequalities have been reduced both at national and regional levels. The regions with the lowest increase were Asturias (3.37%), Cantabria (3.68%) and Baleares Islands (3.71%). The regions with the highest increase were Madrid (6,46%) and Extremadura (6,75%). All the autonomous regions showed a number of GDI lower than the value of HDI. Both sexes achieved similar increase in life expectancy (Men: 5% and Women: 4%). An unequal variation was detected according to the autonomous region (Basque Country; Men: 7% and Women: 3%; Madrid; Men:8% and Women:5%). Women have improved their educational level in comparison to men (Men: 3% and Women: 6%). In the 90 s, men obtained more income than women, but women improved their situation three times more than men. CONCLUSIONS: Inequalities in Human Development analysed by gender have been reduced in the 90 s in Spain. However, the improvement of education, income and life expectancy occurred only in some autonomous regions. This situation shows the differences among Spanish autonomous regions.

[The impact of gender inequality on intimate partner violence in Spain]. / El impacto de la desigualdad de género en la violencia del compañero íntimo en España.

OBJECTIVE: To explore the geographical distribution of mortality due to intimate partner violence (IPV) and reports of IPV according to the gender development index (GDI) of Spanish provinces. METHODS: We performed an ecological study, based on GDI by provinces, of deaths from IPV and official complaints of IPV made by women between 1997 and 2004. The sources were the "Report on Human Capital and Human Development in Spain", the "Home Affairs Statistics Yearbook", and the web page of the Federation of Separated and Divorced Women. Provinces were divided into 2 groups according to whether their GDI score was above or below the mean GDI score for Spain (0.895). Mortality rates by age and rates of official complaints of IPV were calculated for the two groups of provinces (high and low GDI). Relative risks and their confidence intervals were calculated to analyze the risk of dying from or reporting IPV in low GDI provinces compared with that in high GDI provinces. RESULTS: The risk of death due to IPV was higher in women living in low GDI provinces than in those living in high GDI provinces (RR = 1.328; 95% CI, 1.253-1.406). Furthermore, the risk of reporting IPV was higher in low GDI provinces than in high GDI provinces (RR = 1.468; 95% CI, 1.462-1.474). CONCLUSION: Despite the trend to develop IPV strategies focused on individual causes, our results suggest that to tackle this problem, strategies for promoting gender equity in Spain are required.

[Validation of the Spanish Version of Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS)]. / Validación de la versión española del cuestionario Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS).

BACKGROUND: At the international level PREMIS -"Physician Readiness to Manage Intimate Partner Violence Survey"- is amongst the most comprehensive instruments to evaluate primary health care professionals' readiness. The aim of this study is to assess the reliability, internal consistency and construct validity of the Spanish version of this questionnaire. METHODS: After translation, back translation and assessment of content validity of the questionnaire, 200 questionnaires were distributed to medical doctors and nurses working in 15 primary health care centres located in 4 autonomous regions (Comunidad Valenciana, Castilla León, Murcia, Cantabria), in 2013. Cronbach's alpha, intraclass correlation and rho Spearman coefficients were calculated. RESULTS: the Spanish version of PREMIS encompasses 64 items. Cronbach's alpha coefficient was greater than or close to 0.7 in most of indices. Intraclass correlation coefficient of 0.87 and Spearman coefficient of 0.67 showed a high reliability. All correlations for the scale of Opinions, which is the only one that was considered factorial structure of the questionnaire PREMIS, were higher than 0.30. CONCLUSIONS: the Spanish version of PREMIS obtained good internal validity, high reliability and predictive self-reported capacity of medical practitioners and nurses in Intimate Partner Violence cases in PHC centers.

Application of the Putting Women First protocol in a study on violence against immigrant women in Spain.

In this paper, we describe our experience of using the Putting Women First protocol in the design and implementation of a cross-sectional study on violence against women (VAW) among 1607 immigrant women from Morocco, Ecuador and Romania living in Spain in 2011. The Putting Women First protocol is an ethical guideline for VAW research, which includes recommendations to ensure the safety of the women involved in studies on this subject. The response rate in this study was 59.3%. The prevalence of VAW cases last year was 11.7%, of which 15.6% corresponded to Ecuadorian women, 10.9% to Moroccan women and 8.6% to Romanian women. We consider that the most important goal for future research is the use of VAW scales validated in different languages, which would help to overcome the language barriers encountered in this study.

Social determinants and health effects of low and high severity intimate partner violence.

PURPOSE: We sought to analyze whether the sociodemographic profile of battered women varies according to the level of severity of intimate partner violence (IPV), and to identify possible associations between IPV and different health problems taking into account the severity of these acts. METHODS: A cross-sectional study of 8,974 women (18-70 years) attending primary healthcare centers in Spain (2006-2007) was performed. A compound index was calculated based on frequency, types (physical, psychological, or both), and duration of IPV. Descriptive and multivariate procedures using logistic regression models were fitted. RESULTS: Women affected by low severity IPV and those affected by high severity IPV were found to have a similar sociodemographic profile. However, divorced women (odds ratio [OR], 8.1; 95% confidence interval [CI], 3.2-20.3), those without tangible support (OR, 6.6; 95% CI, 3.3-13.2), and retired women (OR, 2.7; 95% CI, 1.2-6.0) were more likely to report high severity IPV. Women experiencing high severity IPV were also more likely to suffer from poor health than were those who experienced low severity IPV. CONCLUSIONS: The distribution of low and high severity IPV seems to be influenced by the social characteristics of the women involved and may be an important indicator for estimating health effects. This evidence may contribute to the design of more effective interventions.

[Gender-based violence against immigrant and Spanish women: scale of the problem, responses and current policies]. / Violencia de género en mujeres inmigrantes y españolas: magnitud, respuestas ante el problema y políticas existentes.

OBJECTIVE: To compare the prevalence of gender-based violence among immigrant and Spanish women. To describe their responses to this problem and the possible differences. To identify specific interventions to deal with gender-based violence in immigrant women in Spain. METHODS: We performed a cross-sectional survey through a self-administered questionnaire in 10,202 women attending primary care in Spain (2006-2007). A content analysis was performed of the follow-up report of law 1/2004 of integral protection measures against gender violence sent by each Spanish region (2005) and the most recent regional laws and acts. RESULTS: The prevalence of gender-based violence was 14.3% in Spanish women and 27.9% in immigrant women. The likelihood of gender-based violence was higher in immigrant (odds ratio adjusted: 2.06; 95% confidence interval: 1.61-2.64). Immigrant women more frequently reported that they had denounced their intimate partners and that they did not know how to manage the situation. Some Spanish regions have already started interventions to overcome access barriers to social and health services, but only three have provided data on the number of immigrant women who received economic and occupational help up to 2005. CONCLUSIONS: Inequalities were observed in the prevalence of gender-based violence according to country of origin, with immigrant women being more frequently affected. Immigrant women more frequently denounce their intimate partners than Spanish women but this action does not guarantee effective results. Other specific interventions have been identified in some autonomous regions of Spain but these interventions need to be evaluated to ensure that they benefit immigrant women.