Domestic violence against women in India: A systematic review of a decade of quantitative studies

Violence against women in urban slums of India: A review of two decades of research

It is estimated that about one-third of women ever experienced violence in their lifetime. India has experienced steady urban growth accompanying increase of urban populations living in slums. Several studies have reported prevalence of various forms of violence in urban slums. To our knowledge, no systematic review has been conducted exclusively reporting violence against women in India's urban slums. The review aims to synthesise the studies of violence against women conducted in the last two decades (2000-2020). We searched PubMed, Scopus and other relevant search engines to identify articles published between years 2000 and 2020, which focused on Indian women slum dwellers' experiences of violence. We included 14 studies, which satisfied the inclusion criteria in this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was used to assess the studies. The prevalence of any form of violence against women, as reported in the studies, ranged from 15% to 59.3%. The major risk factors identified were husband's alcohol abuse, women justifying the violence inflicted on then, low educational levels of both women and men, dowry issues, age difference between the spouses and termination of a previous pregnancy. It is evident from the review that urban slum women experience persistent violence.

Prevalence and Factors Associated With Intimate Partner Violence Among Young Women Aged 15 to 24 Years in India: A Social-Ecological Approach

Intimate partner violence (IPV) is a critical public health issue that has reached epidemic proportions. Research investigating IPV among young women in India using large-scale population data is lacking. This study examined the prevalence and factors associated with IPV among women aged 15 to 24 years in India through a social-ecological approach. This cross-sectional study analyzed data from the National Family Health Survey, a population-based survey conducted in India from 2005 to 2006. The past-year prevalence of emotional, physical, and sexual forms of IPV, among ever-married women aged 15 to 24 years were computed. Multivariate logistic regression was conducted to evaluate the association of factors at various levels of the social-ecological framework with the past-year experience of emotional, physical, sexual, and any form of IPV. The past-year prevalence of IPV among women aged 15 to 24 years (n = 16,285) was 29%. Physical IPV was the most common, affecting 23% in the past year. The past-year prevalence of sexual IPV among women aged 15 to 24 years at 9.5% was higher than older women. Individual factors significantly associated with the past-year experience of all forms of IPV were the young age at first marriage, parental IPV, and ever had a terminated pregnancy. At the relationship level, husband's controlling behaviors, his consumption of alcohol, and experience of violence from other family members were positively associated with all forms of IPV in the past year. Poverty and acceptance of IPV increased the women's odds of experiencing IPV. IPV was associated with multiple factors occurring at all levels of the social-ecological framework. Actions to prevent and eliminate IPV in India demand multidisciplinary and collaborative efforts that are tailored specifically for adolescents and young women. It is imperative to protect the girls and young women from IPV; it protects the future of India.

Violence against women with mental illness and routine screening: Nurses' knowledge, confidence, barriers and learning needs

Violence against women is a major public health issue and women with mental illness (WMI) are at a double disadvantage. While nurses play a key role in identifying and responding to abused women, research is limited on this issue from India. This qualitative study was aimed to explore nurses' knowledge, confidence, and learning needs in the identification and responding to disclosure of abuse in women with mental illness. The focus group discussions were conducted among nurses (N = 21) working in psychiatry units at a tertiary care center. An interview guide with semi-structured questions was used to collect the data. Five dominant themes and fifteen sub-themes have emerged from qualitative analysis. The dominant themes include; Awareness of abuse among women with mental illness (AWMI), Experiences of recognizing and responding to abuse, Barriers for routine screening for abuse, Educational preparedness, and learning needs, and Prevention of abuse in women with mental illness. The identified barriers include personal related (personal discomfort, lack of knowledge, etc.), job related (Time consuming, not a nurse's job, lack of time, etc.) and organizational (lack of policies and administrative support, etc.). Most of the participants expressed that they lack confidence in the routine screening of women for abuse due to inadequate training. Therefore, it is critical to include a topic on domestic violence in the nursing curriculum and provide ongoing learning opportunities to the nurses through CNE programs, workshops, and conferences.

The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal anxiety among women in Mysore, India: a cross-sectional study

PURPOSE

In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety.

METHODS

Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale.

RESULTS

The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women.

CONCLUSIONS

ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.

Utilization of maternal healthcare services in women experiencing spousal violence in Pakistan: A comparative analysis of 2012-13 and 2017-18 Pakistan Demographic Health Surveys

Background

Pakistan and other developing countries need to address disparities in maternal health care and factors associated with it. This justifies tracking the progress on two important indicators ‘spousal violence’ and ‘maternal health care utilization’ to improve maternal health and achieve Sustainable Development Goals (SDGs) for these nations.

Objective

The objective of this study is to compare the data from the latest two Demographic Health Surveys of Pakistan to identify trends in prevalence of various forms of spousal violence and maternal healthcare utilization and to determine the predictive role of spousal violence in poor maternal health.

Methods

We conducted a retrospective analysis of nationally representative data from the 2012–13 and 2017–18 PDHS. The data used in this analysis is from the domestic violence module and core women’s questionnaire. Spousal violence and sociodemographic background were predictor variables. Terminated pregnancy, number of pregnancy losses, number of antenatal visits for last birth and institutional delivery for last birth were taken as indicators of maternal health. Logistic regression analysis was conducted to test for association between maternal health indicators and various forms of spousal violence after controlling for sociodemographic variables.

Results

Almost one quarter of women experienced physical and emotional violence as revealed by both surveys. Binary analysis revealed that all forms of spousal violence significantly associate with maternal health variables in both surveys. The comparison of results on logistic regression analysis showed that odd ratios were relatively higher for 2012–13 as compared to 2017–18 PDHS. Logistic regression analysis from 2017–18 data showed that experience of less severe physical violence (OR = 1.26; 95% CI, 1.08–1.47), severe physical violence (OR = 1.41; 95% CI, 1.09–1.83), sexual violence (OR = 1.39; 95% CI, 1.02–1.89), physical violence during pregnancy (OR = 1.37; 95% CI, 1.07–1.76) augment the risk of terminated pregnancy. Emotional violence decreases the likelihood for institutional delivery (OR = 0.64; 95% CI, 0.45–0.93) and above than four antenatal visits (OR = 0.54; 95% CI, 0.37–0.79).

Conclusions

Strategies to prevent spousal violence should be at the core of maternal health programs because health sector provides a platform to challenge social norms and promote attitudes that disapprove spousal violence which are essential for promoting gender equality, women empowerment (SDG 3) and improve maternal health (SDG 5).

Can Empathy Offset Low Bystander Efficacy? Effectiveness of Domestic Violence Prevention Narratives in India

Domestic violence stems from deeply rooted patriarchal norms and directly conflicts with humanitarian standards. Given that this issue impacts women across the world, many countries have initiated campaigns to heighten awareness and fight this epidemic. Based on Social Cognitive Theory (SCT), we explored whether narrative health messages might prompt bystanders to intervene (e.g., calling a helpline number) when they encounter domestic violence. Using a sample of participants from India, we found that narratives had a stronger impact on attitude toward the ad and reporting intention than non-narratives and such effects were mediated by feelings of empathy. More importantly, the mediating effects of empathy were significantly greater when bystander efficacy was low rather than high.

South Asian Albertan Men's Understandings of Spousal Violence

This qualitative study investigated understandings of spousal violence among 17 South Asian men residing in Alberta, Canada using focus groups. Thematic analysis revealed men's ignorance about sexual coercion as a form of abuse, although they had a solid understanding of physical and financial abuse. The men identified novel forms of emotional torture, as well as two types of transnational abuses that occur in their communities which have not emerged from previous studies: framing wives for false crimes across international borders and forced participation in family chain migration. Implications for violence prevention, assessment, intervention, and transnational law enforcement are discussed.

Effectiveness of nurses training in routine screening of violence against women with mental illness: A randomized controlled trail

BACKGROUND

Globally, people with mental illness are highly vulnerable to various forms of abuse. Yet, research on routine screening of violence by mental health professionals is limited.

AIM

The aim of this study was to evaluate the impact of training on nurses' attitudes towards routine screening and confidence in implementing routine screening of violence among women with mental illness.

METHODS

A randomized controlled trial design was adopted for the present study. The participants of this study were 68 nurses randomly assigned to either experimental or control group (34 in each group). The experimental group was provided eight interactive sessions based on a Nursing Module on abuse among women with mental illness. The assessments were done in both groups at baseline, after the intervention, at three months and at six months. All assessments were self-rated questionnaires to assess nurses' attitudes and confidence in implementing routine screening of violence attitudes.

RESULTS

The experimental group showed a statistically significant improvement in the attitudes and confidence in implementing routine screening of abuse in women with mental illness (p < 0.05) than the control group. Repeated measures of analysis also revealed statistically significant differences related to attitude and confidence in implementing routine screening of abuse between the groups and within the experimental group at different time points of assessment (p < 0.001).

CONCLUSION

This study concluded that training based on a nursing module improved nurses' attitudes and confidence to conduct routine screening of violence among women with mental illness. However, further studies are necessary to clarify whether the training is effective in implementing in nursing practice.

Mental health and challenges of transgender women: A qualitative study in Brazil and India

Background: Transgender women from low- and middle-income countries (LMICs) are understudied, their coping strategies and struggles underrecognised. Aims: This study aimed to explore the lived experiences of transgender women from two major cities located in Brazil and India, LMICs with high rates of transphobia and gender-based violence. Methods: We conducted a mixed-methods, exploratory study, including focus group discussions (FGDs) and brief survey interviews with 23 transgender women from Hyderabad, India and 12 transgender women from Rio de Janeiro, Brazil. Herein we present the combined (qualitative and quantitative) results related to discrimination, stigma, violence, and suicidality in transgender women's lives. Results: Three major themes emerged from FGDs: stigma and discrimination; violence, and suicidality. Lack of education and working opportunities influence high levels of poverty and engagement in survival sex work by transgender women in both cities. Study participants live in large cities with more than 6 million inhabitants, but transgender women reported chronic social isolation. Participants disclosed frequent suicide ideation and suicide attempts. Brief surveys corroborate FGD findings, identifying high prevalence of discrimination, intimate partner violence, suicidality and low social support. Discussion: Multiple layers of stigma, discrimination, violence and social isolation affect transgender women's quality of life in Hyderabad and Rio de Janeiro. Strategies sensitive to gender and culture should be implemented to tackle entrenched prejudice and social exclusion reported by transgender women. Additional social support strategies, better access to education and employment opportunities are also urgently needed. Improving the availability of evidence-based mental health interventions addressing the high prevalence of suicidality among transgender women from Hyderabad, India and Rio de Janeiro, Brazil should be prioritized.

Gender-Based Violence, Law, Justice and Health: Some Reflections

This article is a response to the Lancet Commission on the Legal Determinants of Health from gendered perspectives and focusing on gender-based violence and abuse. The Lancet Commission sees the role of law as positive, indeed central in providing justice in global contexts, and this contribution explores and unpacks this assertion, drawing on some examples from India and elsewhere. Some feminists have argued that law and justice are incompatible for women, and this is sometimes borne out when we look at legal reforms and interventions in the field of gender-based violence. However, we also explore the ways in which some women have used legal reforms in creative ways to destabilize patriarchal norms, and more broadly, how absence of legal protection can undermine access to rights. We conclude that law can have a symbolic relationship with justice.

Depression, Anxiety, and Stress among Rural South Indian Women-Prevalence and Correlates: A Community-Based Study

Background  The burden of common mental disorders (CMDs) which includes depression, anxiety, and stress-related disorders are on the rise in India. Women in rural areas form one of the high-risk groups with respect to CMDs due to their compromised status of living.

Objective  The aim of the study was to estimate the prevalence of depression, anxiety, and stress, and the predictors to depression among women in rural Puducherry.

Methods  A community-based, cross-sectional study was performed in 2016, among women aged 18 to 59 years, residing in the rural area of Puducherry. Prevalence of CMDs was determined using the Depression Anxiety Stress Scale (DASS)-21. Using a systematic random sampling method, women were interviewed in their houses. The socio-demographic characteristics along with risk factors for depression were captured using a semi-structured proforma. A multivariable logistic regression model was used to determine the predictors of depression.

Results  A total of 301 women were surveyed and their mean age (SD) was 34.9 (10.2) years. The prevalence of depression, anxiety, and stress was found to be 15% (95% CI: 11.3–19.3), 10.6% (95% CI: 7.5–14.5), and 5% (95% CI: 3–8), respectively. Multivariable analysis identified that lesser education and living separately/divorced to be significant predictors for depression in these women.

Conclusion  About one in six adult women living in a rural area was found to be depressed, which is considerably high. This emphasizes the need for screening among women for common mental disorders in primary care settings, especially in rural areas so that early diagnoses happen and thus reduce the impact due to mental disability.

A natural disaster and intimate partner violence: Evidence over time

Natural disasters affect about 200 million people annually. Heightened intimate partner violence (IPV) is a gendered impact of these disruptive events. This study examines prevalence and correlates of IPV in four Indian states-TamilNadu, Kerala, AndhraPradesh, and Karnataka-before and after the Indian Ocean tsunami of 2004. Drawing on three waves of National Family Health Surveys of India-six years before, immediately after, and a decade after disaster, this paper evaluates if TamilNadu and Kerala (severely affected) exhibited higher prevalence of IPV than AndhraPradesh (moderately affected) and Karnataka (not directly affected). Logistic regression analyses determine association between IPV, state of residence (proxy for experience of disaster), and other covariates. To test hypotheses guided by vulnerability theory, IPV was regressed on socio-economic and demographic predictors for states across waves. IPV increased by 48% between 2005 and 2015. Increase in physical (61%) and sexual (232%) violence was highest in TamilNadu; emotional violence increased by 122% in Karnataka. State of residence was associated with IPV in the aftermath of disaster. In 2005, compared to Karnataka, odds of IPV were 98% higher in TamilNadu and 41% higher in Kerala. A decade after, odds were two times higher in TamilNadu than in Karnataka. Belonging to disadvantaged groups predicted higher odds of IPV in the year after disaster. Higher socio-economic status predicted lower odds of IPV, except in Kerala. Data point to ways in which socio-economic and demographic vulnerabilities factor into risk of IPV after disaster. Demographic factors of religion and caste appear to lose significance over time, but socio-economic factors continue to matter. Disaster response strategies seldom work without tackling long-standing inequities. Appropriate support systems for women and minorities in non-disaster situations are critical to ensure their conditions are not exacerbated.

The effect of intimate partner violence on women's mental distress: a prospective cohort study of 3010 rural Indian women

PURPOSE

Intimate partner violence (IPV) encompasses physical, sexual, and psychological abuse, as well as controlling behavior. Most research focuses on physical and sexual abuse, and other aspects of IPV are rarely investigated. We estimated the effect of these neglected aspects of IPV on women's mental distress.

METHODS

We used data from 3010 women living in rural tribal communities in Rajasthan, India. Women completed baseline interviews and were re-interviewed approximately 1.5 years later. We measured IPV with questions adopted from the Demographic and Health Survey's Domestic Violence Module, which asked seven questions about physical abuse, three questions about psychological abuse, and five questions about partner controlling behavior. Mental distress was measured with the 12-item General Health Questionnaire (score range 0-12). We used Poisson regression models to estimate the relation between changes in IPV and mental distress, accounting for time-fixed characteristics of individuals using individual fixed effects.

RESULTS

Women reported an average of 2.1 distress symptoms during baseline interviews. In models that controlled for time-varying confounding (e.g., wealth, other types of abuse), experiencing psychological abuse was associated with an increase of 0.65 distress symptoms (95% CI 0.32, 0.98), and experiencing controlling behavior was associated with an increase of 0.31 distress symptoms (95% CI 0.18, 0.44). However, experiencing physical abuse was not associated with an increase in distress symptoms (mean difference = - 0.15, 95% CI - 0.45, 0.15).

CONCLUSIONS

Psychological abuse and controlling behavior may be important drivers of the relation between IPV and women's mental health.

Community interventions to prevent violence against women and girls in informal settlements in Mumbai: the SNEHA-TARA pragmatic cluster randomised controlled trial

BACKGROUND

In a cluster randomised controlled trial in Mumbai slums, we will test the effects on the prevalence of violence against women and girls of community mobilisation through groups and individual volunteers. One in three women in India has survived physical or sexual violence, making it a major public health burden. Reviews recommend community mobilisation to address violence, but trial evidence is limited.

METHODS

Guided by a theory of change, we will compare 24 areas receiving support services, community group, and volunteer activities with 24 areas receiving support services only. These community mobilisation activities will be evaluated through a follow-up survey after 3 years. Primary outcomes will be prevalence in the preceding year of physical or sexual domestic violence, and prevalence of emotional or economic domestic violence, control, or neglect against women 15-49 years old. Secondary outcomes will describe disclosure of violence to support services, community tolerance of violence against women and girls, prevalence of non-partner sexual violence, and mental health and wellbeing. Intermediate theory-based outcomes will include bystander intervention, identification of and support for survivors of violence, changes described in programme participants, and changes in communities.

DISCUSSION

Systematic reviews of interventions to prevent violence against women and girls suggest that community mobilisation is a promising population-based intervention. Already implemented in other areas, our intervention has been developed over 16 years of programmatic experience and 2 years of formative research. Backed by public engagement and advocacy, our vision is of a replicable community-led intervention to address the public health burden of violence against women and girls.

TRIAL REGISTRATION

Controlled Trials Registry of India, CTRI/2018/02/012047. Registered on 21 February 2018. ISRCTN, ISRCTN84502355. Registered on 22 February 2018.

Changes in Gender Inequality and Intimate Partner Violence From 1958-2003: A Birth Cohort Analysis

This article uses a birth cohort analysis to examine whether the sociopolitical environments in which a woman forms attitudes around intimate partner violence (IPV) influence report of physical, sexual, and emotional IPV, and IPV justification in 25 low- and middle-income countries. Cohort effect is then examined across countries by rate of decline in gender inequality over time as measured by the Gender Inequality Index (GII). Results suggest a birth cohort effect for all types of IPV, with women reporting greater odds of IPV with each successive cohort. This is reversed when countries are stratified by rate of GII decrease, but wanes as the rate slows.

Domestic violence and decision-making power of married women in Myanmar: analysis of a nationally representative sample

BACKGROUND

Women in Myanmar are not considered decision makers in the community and the physical and psychological effect of violence makes them more vulnerable. There is a strong negative reaction, usually violent, to any economic activity generated by women among poorer and middle-class families in Myanmar because a woman's income is not considered necessary for basic survival.

OBJECTIVE

Explore the relationship between domestic violence on the decision-making power of married women in Myanmar.

DESIGN

Cross-sectional.

SETTING

National, both urban and rural areas of Myanmar.

PATIENTS AND METHODS

Data from the Myanmar Demographic and Health Survey 2015-16 were used in this analysis. In that survey, married women aged between 15 to 49 years were selected for interview using a multistage cluster sampling technique. The dependent variables were domestic violence and the decision-making power of women. Independent variables were age of the respondents, educational level, place of residence, employment status, number of children younger than 5 years of age and wealth index.

MAIN OUTCOME MEASURES

Domestic violence and decision-making power of women.

SAMPLE SIZE

7870 currently married women.

RESULTS

About 50% respondents were 35 to 49 years of age and the mean (SD) age was 35 (8.4) years. Women's place of residence and employment status had a significant impact on decision-making power whereas age group and decision-making power of women had a relationship with domestic violence.

CONCLUSION

Giving women decision making power will be indispensable for the achievement of sustainable development goals. Government and other stakeholders should emphasize this to eliminate violence against women.

LIMITATIONS

Use of secondary data analysis of cross-sectional study design and cross-sectional studies are not suitable design to assess this causality. Secondly the self-reported data on violence may be subject to recall bias.

CONFLICT OF INTEREST

None.

A theory of change for community interventions to prevent domestic violence against women and girls in Mumbai, India

Background: We describe the development of a theory of change for community mobilisation activities to prevent violence against women and girls. These activities are part of a broader program in urban India that works toward primary, secondary, and tertiary prevention of violence and includes crisis response and counselling and medical, police, and legal assistance. Methods: The theory of change was developed in five phases, via expert workshops, use of primary data, recurrent team meetings, adjustment at further meetings and workshops, and a review of published theories. Results: The theory summarises inputs for primary and secondary prevention, consequent changes (positive and negative), and outcomes. It is fully adapted to the program context, was designed through an extended consultative process, emphasises secondary prevention as a pathway to primary prevention, and integrates community activism with referral and counselling interventions. Conclusions: The theory specifies testable causal pathways to impact and will be evaluated in a controlled trial.

A theory of change for community interventions to prevent domestic violence against women and girls in Mumbai, India

Background: We describe the development of a theory of change for community mobilisation activities to prevent violence against women and girls. These activities are part of a broader program in urban India that works toward primary, secondary, and tertiary prevention of violence and includes crisis response and counselling and medical, police, and legal assistance. Methods: The theory of change was developed in five phases, via expert workshops, use of primary data, recurrent team meetings, adjustment at further meetings and workshops, and a review of published theories. Results: The theory summarises inputs for primary and secondary prevention, consequent changes (positive and negative), and outcomes. It is fully adapted to the program context, was designed through an extended consultative process, emphasises secondary prevention as a pathway to primary prevention, and integrates community activism with referral and counselling interventions. Conclusions: The theory specifies testable causal pathways to impact and will be evaluated in a controlled trial.

The link between mothers' vulnerability to intimate partner violence and Children's human capital

We propose a conceptual framework to examine the association between mothers' vulnerability to intimate partner violence (IPV) and children's human capital. An important contribution of our framework is that it uses multiple dimensions of human capital and identifies several pathways through which the negative associations of IPV translate to human capital deficits. The conceptual framework is empirically tested using a large-scale representative child-level dataset from India that includes two dimensions of children's human capital - traditional school-based measures of educational attainment, and standardized reading and arithmetic test scores reflecting cognitive ability. Additionally, our study is the first to use an indirect measure of IPV which aims to overcome underreporting bias associated with direct questioning based IPV measures. The results show significant negative correlation between mothers' vulnerability to IPV and children's human capital. The negative association is more pronounced and robust for cognitive outcomes as opposed to the commonly used school-based measures of human capital. As predicted by our conceptual framework, the negative associations are mediated by mothers' poor health and disruption of home environment. We find strong evidence of IPV-exposed children being more likely to experience corporal punishment at school reflecting signs of externalizing behavior. The indirect measure of IPV stands the test of multiple validity and robustness checks.

Primary Prevention of Intimate Partner Violence Among Recently Married Dyads Residing in the Slums of Pune, India: Development and Rationale for a Dyadic Intervention

BACKGROUND

Intimate partner violence (IPV) is frequently experienced by women of low socioeconomic status in India. It is a human rights violation and associated with negative effects on physical and mental well-being, underscoring the need for effective prevention strategies.

OBJECTIVE

This study aimed to develop a dyadic intervention for the primary prevention of IPV among newly married couples residing in slum communities in India.

METHODS

The intervention was developed using a community-based, mixed-methods design rooted in couple-interdependence theory and guided by the intervention mapping (IM) framework. It used the six critical IM steps to inform the content and delivery of the intervention: (1) needs assessment, (2) preparation of matrices of change objectives, (3) selection of theory-based methods and practical applications, (4) production of intervention components and materials, (5) intervention adoption and implementation, and (6) evaluation planning.

RESULTS

The resulting Ghya Bharari Ekatra (Take a Flight Together) intervention is intended to be delivered in 6 weekly sessions by a trained pair of male and female lay community educators to groups of 3 to 5 newly married couples in the community in which they reside. It uses games, discussions, self-reflections, and skill-building exercises to cover the following topics: enhancing relationship quality time, self-esteem and resilience, communication and conflict management, goal setting and implementation, sexual communication and sexual health and reproductive health knowledge, and redefining and challenging norms surrounding IPV occurrence. The formative work guided the protocol, including module duration and timing (2-hour sessions of convenience to participants), ordering of modules (based on potential level of interest and sensitivity of the topics), content (ie, informed scripts of role plays and films), intervention delivery methods (ie, interactive activities), and selection of the interventionists (based on capacity to connect with participants) and venue (community-based, convenient, and safe spaces). Ghya Bharari Ekatra was piloted between January and May 2018, and evaluation is presently underway.

CONCLUSIONS

Ghya Bharari Ekatra is evidence-based, grounded in intervention-mapping, and developed and iteratively refined using a community-based participatory research approach, suggesting it has great potential to be an acceptable and effective solution to preventing IPV among newly married couples.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134.

Epidemiological and spatial characteristics of interpersonal physical violence in a Brazilian city: A comparative study of violent injury hotspots in familial versus non-familial settings, 2012-2014

This study explores both epidemiological and spatial characteristics of domestic and community interpersonal violence. We evaluated three years of violent trauma data in the medium-sized city of Campina Grande in North-Eastern Brazil. 3559 medical and police records were analysed and 2563 cases were included to identify socioeconomic and geographic patterns. The associations between sociodemographic, temporal, and incident characteristics and domestic violence were evaluated using logistic regression. Using Geographical Information Systems (GIS), we mapped victims' household addresses to identify spatial patterns. We observed a higher incidence of domestic violence among female, divorced, or co-habitant persons when the violent event was perpetrated by males. There was only a minor chance of occurrence of domestic violence involving firearms. 8 out of 10 victims of domestic violence were women and the female/male ratio was 3.3 times greater than that of community violence (violence not occurring in the home). Unmarried couples were twice as likely to have a victim in the family unit (OR = 2.03), compared to married couples. Seven geographical hotspots were identified. The greatest density of hotspots was found in the East side of the study area and was spatially coincident with the lowest average family income. Aggressor sex, marital status, and mechanism of injury were most associated with domestic violence, and low-income neighbourhoods were coincident with both domestic and non-domestic violence hotspots. These results provide further evidence that economic poverty may play a significant role in interpersonal, and particularly domestic violence.

Domestic Violence and its Determinants among 15-49-Year-Old Women in a Rural Block in South India

Context:

Domestic violence in Indian setting has five major components: emotional abuse; physical violence; sexual violence; honor killing; dowry-related abuse; and death.

Aims:

The aim of the study was to estimate the prevalence of domestic violence and 3 of its components – emotional abuse, physical violence, and sexual violence among women in the age group of 15–49 years in Kaniyambadi block, rural Vellore, Tamil Nadu and to determine the risk factors of domestic violence.

Settings and Design:

A community-based cross-sectional study among women between the ages 15 and 49 years at the rural setting of Kaniyambadi block, Tamil Nadu.

Results:

Prevalence of all forms of domestic violence among women was 77.5%, and forty percent women were classified as having ever been subjected to severe domestic violence. Prevalence of physical violence was 65.8%, sexual abuse was 17.5%, and emotional abuse was 54.2%. Alcohol consumption by husband (adjusted odds ratio [AOR] 4.37; 1.35, 14.18), controlling behavior by family member (AOR 8.07; 2.47, 26.37), and woman's employment (AOR 4.33; 1.27, 14.77) were statistically significant determinants of domestic violence. Three-fourth (73.1%) of the women felt that being subjected to domestic violence has affected their physical and mental health.

Conclusions:

The high prevalence of domestic violence in our community needs to be addressed as it has tacit implications on socioeconomic well-being, physical and mental health of a woman, her family, and thereby, society as a whole.

Lifetime Spousal Violence Victimization and Perpetration, Physical Illness, and Health Risk Behaviours among Women in India

The aim of this study was to assess the association between lifetime spousal violence victimization, spousal violence perpetration, and physical health outcomes and behaviours among women in India. In the 2015⁻2016 National Family Health Survey, a sample of ever-married women (15⁻49 years) (N = 66,013) were interviewed about spousal violence. Results indicate that 29.9% of women reported lifetime spousal physical violence victimization and 7.1% lifetime spousal sexual violence victimization (31.1% physical and/or sexual violence victimization), and 3.5% lifetime spousal physical violence perpetration. Lifetime spousal violence victimization and lifetime spousal violence perpetration were significantly positively correlated with asthma, genital discharge, genital sores or ulcers, sexually transmitted infections (STIs), tobacco use, alcohol use, and termination of pregnancy, and negatively associated with daily consumption of dark vegetables. In addition, lifetime spousal violence victimization was positively associated with being underweight, high random blood glucose levels, and anaemia, and negatively correlated with being overweight or obese. Lifetime spousal violence perpetration was marginally significantly associated with hypertension. The study found in a national sample of women in India a decrease of lifetime physical and/or sexual spousal violence victimization and an increase of lifetime spousal physical violence perpetration from 2005/5 to 2015/6. The results support other studies that found that, among women, lifetime spousal physical and/or sexual spousal violence victimization and lifetime spousal physical violence perpetration increase the odds of chronic conditions, physical illnesses, and health risk behaviours.

Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India

OBJECTIVES

Female sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of violence.

METHODS

An Integrated Biological and Behavioural Assessment survey was conducted among random samples of FSWs in two districts (Bangalore and Shimoga) in Karnataka state, south India, in 2011. Physical and sexual violence in the past six months, by workplace (client, police, coworker, pimp) or community (stranger, rowdy, neighbour, auto-driver) perpetrators was assessed, as was physical and sexual intimate partner violence in the past 12 months. Weighted, bivariate and multivariate analyses were used to examine associations between violence by perpetrator and HIV/STI risk.

RESULTS

1111 FSWs were included (Bangalore=718, Shimoga=393). Overall, 34.9% reported recent physical and/or sexual violence. Violence was experienced from domestic (27.1%), workplace (11.1%) and community (4.2%) perpetrators, with 6.2% of participants reporting recent violence from both domestic and non-domestic (workplace/community) perpetrators. Adjusted analysis suggests that experience of violence by workplace/community perpetrators is more important in increasing HIV/STI risk during sex work (lower condom use with clients; client or FSW under the influence of alcohol at last sex) than domestic violence. However, women who reported recent violence by domestic and workplace/community perpetrators had the highest odds of high-titre syphilis infection, recent STI symptoms and condom breakage at last sex, and the lowest odds of condom use at last sex with regular clients compared with women who reported violence by domestic or workplace/community perpetrators only.

CONCLUSION

HIV/STI risk differs by the perpetrator of violence and is highest among FSWs experiencing violence in the workplace/community and at home. Effective HIV/STI prevention programmes with FSWs need to include violence interventions that address violence across both their personal and working lives.

Abuso intrafamiliar na infância de homens em processo criminal por violência conjugal

Resumo Objetivo Desvelar o abuso intrafamiliar vivenciado na infância de homens em processo criminal por violência conjugal. Métodos Trata-se de um estudo qualitativo, fundamentado no referencial teórico proposto por Walter Benjamin. A coleta de dados ocorreu por meio de entrevistas com 23 homens que estavam respondendo judicialmente por violência conjugal em uma Vara de Violência Doméstica e Familiar contra Mulher da cidade de Salvador, Bahia, Brasil, as quais foram categorizadas com o apoio do Software Nvivo-11 e organizadas através do Discurso do Sujeito Coletivo. Resultados As falas evidenciaram uma infância marcada pela falta de afeto, vivência de violência física e psicológica, expressa pelas marcas corporais, cárcere privado e amedrontamento, bem como o testemunho da violência conjugal entre os pais. Ao tempo que aponta para o trauma dessa vivência, o estudo alerta que o sujeito coletivo percebe-se reproduzindo, em sua relação conjugal, as mesmas atitudes paternas. Conclusão A experiência de uma infância marcada por violência intrafamiliar sinaliza o caráter intergeracional da violência doméstica, refletida nas relações conjugais abusivas.

Indian novice nurses' perceptions of their role in caring for women who have experienced intimate partner violence

BACKGROUND

intimate partner violence (IPV) is a significant health problem and a gross violation of the human rights of women. Nurses play an important role in providing support for these women. There is limited research on nurses' understanding and perceptions of their role in caring for women with IPV issues in India.

AIM

to assess novice nurses' perceptions of self-efficacy, educational preparedness and their role in this area.

METHODS

this was a cross-sectional descriptive survey carried out among a convenience sample of novice nurses (n=83) at a tertiary care centre using self-reported questionnaires.

RESULTS

a majority of the subjects were confident and had adequate knowledge in dealing with women who have experienced IPV. A significantly positive relationship was found between educational preparedness and self-efficacy and attitudes towards nurses' roles in caring for these women.

CONCLUSION

novice nurses were confident and held positive attitudes towards women who experienced IPV. Yet their self-efficacy in caring for these patients could be improved through continuing education and there is an urgent need to integrate comprehensive training on IPV to improve clinical competencies, including how to refer women for further support.

Correlates of domestic violence perpetration reporting among recently-married men residing in slums in Pune, India

Domestic violence (DV) is prevalent in low-income and slum-dwelling communities in India. To date, the focus of DV prevention in resource-poor settings has largely been with women. We herein aim to identify correlates of DV perpetration to help inform future primary prevention efforts that focus on behavioral change in men. Utilizing a cross-sectional design, potential correlates of DV perpetration were explored among a geographically-clustered random sample of 100 recently-married men residing in slums in Pune, India. In multivariable regression, DV perpetration was associated with less time spent alone in the relationship post-marriage (standardized β = -0.230, p<0.01), not attaining the “husband ideal” (standardized β = -0.201, p<0.05), poor resilience (standardized β = -0.304, p < .01), having limited definitions of behaviors constituting DV (standardized β = -0.217, p<0.05), and reporting greater jealousy if the participant’s spouse were to talk to men outside the family (standardized β = 0.272, p<0.01). The identified correlates should inform components of future DV primary prevention interventions that target men as potential perpetrators or the couple as a unit.

You can't burn the house down because of one bedbug: a qualitative study of changing gender norms in the prevention of violence against women and girls in an urban informal settlement in India

Background: The contribution of structural inequalities and societal legitimisation to violence against women, which 30% of women in India survive each year, is widely accepted. There is a consensus that interventions should aim to change gender norms, particularly through community mobilisation. How this should be done is less clear. Methods: We did a qualitative study in a large informal settlement in Mumbai, an environment that characterises 41% of households. After reviewing the anonymised records of consultations with 1653 survivors of violence, we conducted 5 focus group discussions and 13 individual interviews with 71 women and men representing a range of age groups and communities. We based the interviews on fictitious biographical vignettes to elicit responses and develop an understanding of social norms. We wondered whether, in trying to change norms, we might exploit the disjunction between descriptive norms (beliefs about what others actually do) and injunctive norms (beliefs about what others think one ought to do), focusing program activities on evidence that descriptive norms are changing. Results: We found that descriptive and injunctive norms were relatively similar with regard to femininity, masculinity, the need for marriage and childbearing, resistance to separation and divorce, and disapproval of friendships between women and men. Some constraints on women's dress and mobility were relaxing, but there were more substantial differences between descriptive and injunctive norms around women's education, control of income and finances, and premarital sexual relationships. Conclusions: Programmatically, we hope to exploit these areas of mismatch in the context of injunctive norms generally inimical to violence against women. We propose that an under-appreciated strategy is expansion of the reference group: induction of relatively isolated women and men into broader social groups whose descriptive and injunctive norms do not tolerate violence.

You can’t burn the house down because of one bedbug: a qualitative study of changing gender norms in the prevention of violence against women and girls in an urban informal settlement in India

Background: The contribution of structural inequalities and societal legitimisation to violence against women, which 30% of women in India survived in the last year, is widely accepted. There is a consensus that interventions should aim to change gender norms, particularly through community mobilisation. How this should be done is less clear. Methods: We did a qualitative study in a large informal settlement in Mumbai, an environment in which 41% of the population live. After reviewing the anonymised records of consultations with 1653 survivors of violence, we conducted 5 focus group discussions and 13 individual interviews with 71 women and men representing a range of age groups and communities. We based the interviews on fictitious biographical vignettes to elicit responses and develop an understanding of social norms. We hypothesised that, in trying to change norms, we might exploit the disjunction between descriptive norms (beliefs about what others actually do) and injunctive norms (beliefs about what others think one ought to do), focusing program activities on evidence that descriptive norms are changing. Results: We found that descriptive and injunctive norms were relatively similar with regard to femininity, masculinity, the need for marriage and childbearing, resistance to separation and divorce, and disapproval of friendships between women and men. Some constraints on women’s dress and mobility were relaxing, but there were more substantial differences between descriptive and injunctive norms around women’s education, control of income and finances, and premarital sexual relationships. Conclusions: Programmatically, we hope to exploit these areas of mismatch in the context of injunctive norms generally inimical to violence against women. We propose that an under-appreciated strategy is expansion of the reference group: induction of relatively isolated women and men into broader social groups whose descriptive and injunctive norms do not tolerate violence.

Factors Associated With Domestic Violence Against Women in Iran: An Exploratory Multicenter Community-Based Study

Domestic violence against women committed by intimate partners is a worldwide concern especially in developing countries. The aim of this study was to assess the problem among Iranian women and identify associated risk factors. Using a cross-sectional multicenter design, 1,600 women in six different areas of Iran were surveyed. A measure of domestic violence against women was administered and demographic information collected. Logistic regression models were used to identify factors associated with domestic violence. The prevalence of domestic violence among participants were emotional (64%), physical (28%), and sexual (18%). Higher education (both women and their partners), employment status of partner (being employed), and lower number of children lowered the risk, whereas history of previous marriage (for either women or their partners), unstable marriage, substance abuse, crowded family situation, and lower socioeconomic status increased the risk of domestic violence. There is a high prevalence of domestic violence, particularly emotional, against women by their partners. Preventive measures are recommended such as increasing public awareness, improving in socioeconomic status of families, educating women about what they can do, and encouraging counseling for the couple or the woman alone.

Community resource centres to improve the health of women and children in informal settlements in Mumbai: a cluster-randomised, controlled trial

BACKGROUND

Around 105 million people in India will be living in informal settlements by 2017. We investigated the effects of local resource centres delivering integrated activities to improve women's and children's health in urban informal settlements.

METHODS

In a cluster-randomised controlled trial in 40 clusters, each containing around 600 households, 20 were randomly allocated to have a resource centre (intervention group) and 20 no centre (control group). Community organisers in the intervention centres addressed maternal and neonatal health, child health and nutrition, reproductive health, and prevention of violence against women and children through home visits, group meetings, day care, community events, service provision, and liaison. The primary endpoints were met need for family planning in women aged 15-49 years, proportion of children aged 12-23 months fully immunised, and proportion of children younger than 5 years with anthropometric wasting. Census interviews with women aged 15-49 years were done before and 2 years after the intervention was implemented. The primary intention-to-treat analysis compared cluster allocation groups after the intervention. We also analysed the per-protocol population (all women with data from both censuses) and assessed cluster-level changes. This study is registered with ISRCTN, number ISRCTN56183183, and Clinical Trials Registry of India, number CTRI/2012/09/003004.

FINDINGS

12 614 households were allocated to the intervention and 12 239 to control. Postintervention data were available for 8271 women and 5371 children younger than 5 years in the intervention group, and 7965 women and 5180 children in the control group. Met need for family planning was greater in the intervention clusters than in the control clusters (odds ratio [OR] 1·31, 95% CI 1·11-1·53). The proportions of fully immunised children were similar in the intervention and control groups in the intention-to-treat analysis (OR 1·30, 95% CI 0·84-2·01), but were greater in the intervention group when assessed per protocol (1·73, 1·05-2·86). Childhood wasting did not differ between groups (OR 0·92, 95% CI 0·75-1·12), although improvement was seen at the cluster level in the intervention group (p=0·020).

INTERPRETATION

This community resource model seems feasible and replicable and may be protocolised for expansion.

FUNDING

Wellcome Trust, CRY, Cipla.

Repercussions of imprisonment for conjugal violence: discourses of men

Objective:

to know the consequences that men experience related to incarceration by conjugal violence.

Methods:

qualitative study on 20 men in jail and indicted in criminal processes related to conjugal violence in a Court specialized in Family and Domestic Violence against women. The interviews were classified based on Collective Subject Discourse method, using NVIVO^(r) software.

Results:

the collective discourse shows that the experience of preventive imprisonment starts a process of family dismantling, social stigma, financial hardship and psycho-emotional symptoms such as phobia, depression, hypertension, and headaches.

Conclusion:

due to the physical, mental and social consequences of the conjugal violence-related imprisonment experience, it is urgent to look carefully into the somatization process as well as to the prevention strategies regarding this process.

The Development and Validation of the Indian Family Violence and Control Scale

The high prevalence of domestic violence (DV) among married women in India and associated negative health repercussions highlight the need for effective prevention strategies and tools to measure the efficacy of such interventions. Literature supporting differing manifestations of DV by culture underscores the need for a culturally-tailored scale to more effectively measure DV in the Indian context. We therefore aimed to develop and validate such a tool, the Indian Family Violence and Control Scale (IFVCS), through a mixed-methods study. The psychometric development of IFVCS is herein discussed. After field pre-testing and expert review, a 63-item questionnaire was administered to a random sample of 630 married women from May-July 2013 in Pune, India. The item response theory approach for binary data to explore the IFVCS structure suggested that IFVCS is reliable, with the majority of items having high (>0.5) and significant factor loadings. Concurrent validity, assessed by comparing responses to IFVCS with the validated, abridged Conflict Tactics Scale-2, was high (r = 0.899, p<0.001) as was the construct validity, demonstrated by its significant association with several established DV correlates. Therefore, initial assessment of the IFVCS psychometric properties suggests that it is an effective tool for measuring DV among married women in India and speaks to its capacity for enhancing understanding of DV epidemiology and for evaluating the effectiveness of future DV interventions.