Empowerment, partner's behaviours and intimate partner physical violence among married women in Uganda

Social network correlates of IPV acceptance in rural Honduras and rural Uganda

We investigated the household-level social network correlates of acceptance of intimate partner violence (IPV) in rural, agrarian settings of Honduras and Uganda, two low-income countries with unequal access to resources based upon gender. We collected complete social network data in each location (Honduras in 2014 and Uganda in 2012), across a diverse range of relationships, and then created a measure of household cohesion by calculating the degree to which members of a household nominated each other as important social connections. Our measure of IPV acceptance was based on 4 questions from the Demographic Health Survey to assess the conditions under which a person believes that it is acceptable for a man to perpetrate physical violence against his wife or partner and we coded a person as positive on IPV acceptance if they answered positively to any of the four questions. We used logistic regression to calculate the odds that an individual accepted IPV given (1) household level cohesion and (2) the proportion of the household that accepts IPV. We found individuals from more cohesive households were less likely to accept IPV controlling for the overall level of IPV acceptance in the household. Nevertheless, those in households more accepting of IPV were more likely to personally accept IPV. In stratified analyses, when household IPV acceptance was especially high, the benefit of household cohesion with respect to IPV was attenuated. The design and implementation of interventions to prevent IPV should consider household structure and norms rather than focusing only on individuals or couples.

•

Attitudes towards intimate partner violence are associated with its perpetration.

•

Social cohesion has been shown to be protective against violence.

•

We look at household cohesion and violence acceptance in Honduras and Uganda.

•

Those within socially cohesive household are less likely to accept partner violence.

•

This finding depends on the level of violence acceptance within the household.

Does exposure to interparental violence increase women's risk of intimate partner violence? Evidence from Nigeria demographic and health survey

Background

Exposure to interparental violence (EIPV) has been identified as a risk factor for intimate partner violence (IPV). However, studies in Nigeria have rarely and specifically examined exposure to interparental violence as a predictor of IPV. The objective of the study was to examine the relationship between exposure to interparental violence and women’s experience of intimate partner violence.

Methods

The 2013 Nigeria Demographic and Health Survey (NDHS) women recode dataset was analysed. The weighted sample size was 19,925 women aged 15–49 years. The outcome variable was women’s experience of at least one type of IPV measured by combining partner physical, sexual and emotional violence experienced by the surveyed women. The main explanatory variable was exposure to interparental violence measured by response to question on whether a woman witnessed her father ever beat her mother. Individual/relationship and community characteristics were selected for statistical control in the study. The multilevel mixed-effect regression was applied in three models using Stata version 12. Model 1 was based solely on interparental violence, while individual/relationship factors were included in Model 2. In Model 3, all research variables were included.

Results

The study revealed that less than one-tenth of the women witnessed interparental violence, and women exposed to interparental violence compared with non exposed women had higher prevalence of all forms of IPV. In Model 1, women exposed to interparental violence were more than five times as likely as non exposed women to experience IPV (OR = 5.356; CI: 3.371–8.509). In Model 2, women exposed to interparental violence were nearly five times as likely as non exposed women to experience IPV (OR = 4.489; CI: 3.047–6.607). In Model 3, women exposed to interparental violence were four times as likely as non exposed women to experience IPV (OR = 4.018; CI: 2.626–6.147).

Conclusion

The study provided additional evidence that exposure to interparental violence increase women’s risk of IPV in Nigeria. Reducing future prevalence of intimate partner violence may require social and behaviour change communication (SBCC) that not only change perception of children who witnessed interparental violence, but also help them to overcome intergenerational effects of interparental aggression.

Relationship between empowerment and wealth: trends and predictors in Kenya between 2003 and 2008-2009

OBJECTIVES

This study aimed to examine the association between women's empowerment and wealth over time in Kenya.

METHODS

Kenya Demographic and Health Surveys (DHS) for 2003 and 2008-2009 were used. Eligible women and men were either married or living with a partner. Two scales were used for empowerment: female participation in decision-making, and attitudes toward domestic violence against female partners. Hierarchical linear models were used based on theoretical blocks of covariates.

RESULTS

In a sample of 9847 women and 3207 men, results showed empowerment increased over time. After adjustment, female partners' reporting greater empowerment on either scale remained significantly associated with increased wealth, (urban: β = 0.04, p value < 0.05; β = - 0.06, p value < 0.01) and (rural: β = 0.04, p value < 0.01, β = - 0.07, p value < 0.01). Based on male partners' responses, female partners' participation in decision-making was associated with increased wealth in rural regions (β = 0.04, p value < 0.01), and agreement with domestic violence towards a female partner was significantly associated with a decrease in wealth in urban regions (β = - 0.08, p value < 0.01).

CONCLUSIONS

Women's empowerment has increased over time in Kenya and is associated with increased family wealth. The association varies by gender of respondent and rural/urban residence.

Evaluation of the Responsible, Engaged, and Loving (REAL) Fathers Initiative on Physical Child Punishment and Intimate Partner Violence in Northern Uganda

Violence against women and violence against children in Uganda are recognized as significant public health concerns. Exposure to violence at home as a child can increase the likelihood of perpetrating or experiencing violence later in life. These two forms of violence share similar risk factors and often, but not always, co-occur at the household level. Parenting programs have shown promise in reducing physical child punishment. Targeting men has also been proven effective in transforming attitudes related to gender roles and expectations and intimate partner violence (IPV) against women. The REAL Fathers Initiative is a 12-session father mentoring program implemented by volunteers that is designed to reduce child exposure to violence at home, breaking the cycle of intergenerational violence. Evaluation results comparing survey data among men exposed to the intervention and those unexposed demonstrate significant reductions in IPV at end line (aOR 0.48, CI 0.31, 0.76, p < 0.001) and over the longer term follow-up (aOR 0.47, CI 0.31, 0.77, p < 0.001) and significant reductions in physical child punishment at long-term follow-up (aOR 0.52, CI 0.32, 0.82, p < 0.001).

Why Do Women Justify Violence Against Wives More Often Than Do Men in Vietnam?

Intimate partner violence (IPV) harms the health of women and their children. In Vietnam, 31% of women report lifetime exposure to physical IPV, and surprisingly, women justify physical IPV against wives more often than do men. We compare men's and women's rates of finding good reason for wife hitting and assess whether differences in childhood experiences and resources and constraints in adulthood account for observed differences. Probability samples of married men ( n = 522) and women ( n = 533) were surveyed in Vietnam. Ordered logit models assessed the proportional odds for women versus men of finding more "good reasons" to hit a wife (never, 1-3 situations, 4-6 situations). In all situations, women found good reason to hit a wife more often than did men. The unadjusted odds for women versus men of reporting more good reasons to hit a wife were 6.55 (95% confidence interval [CI] = [4.82, 8.91]). This gap disappeared in adjusted models that included significant interactions of gender with age, number of children ever born, and experience of physical IPV as an adult. Having children was associated with justifying wife hitting among women but not men. Exposure to IPV in adulthood was associated with justifying wife hitting among men, but was negatively associated with justification of IPV among women. Further study of the gendered effects of resources and constraints in adulthood on attitudes about IPV against women will clarify women's more frequent reporting than men's that IPV against women is justified.

Associations between quantitative measures of women's empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world

Research on the association between women's empowerment and maternal and child health has rapidly expanded. However, questions concerning the measurement and aggregation of quantitative indicators of women's empowerment and their associations with measures of maternal and child health status and healthcare utilization remain unanswered. Major challenges include complexity in measuring progress in several dimensions and the situational, context dependent nature of the empowerment process as it relates to improvements in maternal and child health status and maternal care seeking behaviors. This systematic literature review summarizes recent evidence from the developing world regarding the role women's empowerment plays as a social determinant of maternal and child health outcomes. A search of quantitative evidence previously reported in the economic, socio-demographic and public health literature finds 67 eligible studies that report on direct indicators of women's empowerment and their association with indicators capturing maternal and child health outcomes. Statistically significant associations were found between women's empowerment and maternal and child health outcomes such as antenatal care, skilled attendance at birth, contraceptive use, child mortality, full vaccination, nutritional status and exposure to violence. Although associations differ in magnitude and direction, the studies reviewed generally support the hypothesis that women's empowerment is significantly and positively associated with maternal and child health outcomes. While major challenges remain regarding comparability between studies and lack of direct indicators in key dimensions of empowerment, these results suggest that policy makers and practitioners must consider women's empowerment as a viable strategy to improve maternal and child health, but also as a merit in itself. Recommendations include collection of indicators on psychological, legal and political dimensions of women's empowerment and development of a comprehensive conceptual framework that can guide research and policy making.

Socio-cultural inhibitors to use of modern contraceptive techniques in rural Uganda: a qualitative study

Introduction

Family planning is one of the cost-effective strategies in reducing maternal and child morbidity and mortality rates. Yet in Uganda, the contraceptive prevalence rate is only 30% among married women in conjunction with a persistently high fertility rate of 6.2 children per woman. These demographic indicators have contributed to a high population growth rate of over 3.2% annually. This study examines the role of socio-cultural inhibitions in the use of modern contraceptives in rural Uganda.

Methods

This was a qualitative study conducted in 2012 among men aged 15-64 and women aged 15-49 in the districts of Mpigi and Bugiri in rural Uganda. Eighteen selected focus group discussions (FGDs), each internally homogeneous, and eight in-depth interviews (IDIs) were conducted among men and women. Data were collected on sociocultural beliefs and practices, barriers to modern contraceptive use and perceptions of and attitudes to contraceptive use. All interviews were tape recoded, translated and transcribed verbatim. All the transcripts were coded, prearranged into categories and later analyzed using a latent content analysis approach, with support of ATLAS.ti qualitative software. Suitable quotations were used to provide in-depth explanations of the findings.

Results

Three themes central in hindering the uptake of modern contraceptives emerged: (i) persistence of socio-cultural beliefs and practices promoting births (such as polygamy, extending family lineage, replacement of the dead, gender-based violence, power relations and twin myths). (ii) Continued reliance on traditional family planning practices and (iii) misconceptions and fears about modern contraception.

Conclusion

Sociocultural expectations and values attached to marriage, women and child bearing remain an impediment to using family planning methods. The study suggests a need to eradicate the cultural beliefs and practices that hinder people from using contraceptives, as well as a need to scale-up family planning services and sensitization at the grassroots.

Gender relations, sexual behaviour, and risk of contracting sexually transmitted infections among women in union in Uganda

BACKGROUND

Sexually transmitted infections (STIs) are a major reproductive and public health concern, especially in the era of HIV/AIDS. This study examined the relationship between sexual empowerment and STI status of women in union (married or cohabiting) in Uganda, controlling for sexual behaviour, partner factors, and women's background characteristics.

METHODS

The study, based on data from the 2011 Uganda Demographic and Health Survey (UDHS), analysed 1307 weighted cases of women age 15-49 in union and selected for the domestic violence module. Chi-squared tests and multivariate logistic regressions were used to examine the predicators of STI status. The main explanatory variables included sexual empowerment, involvement in decision making on own health, experience of any sexual violence, condom use during last sex with most recent partner, number of lifetime partners and partner control behaviours. Sexual empowerment was measured with three indicators: a woman's reported ability to refuse sex, ability to ask her partner to use a condom, and opinion regarding whether a woman is justified to refuse sex with her husband if he is unfaithful.

RESULTS

Results show that 28 % of women in union reported STIs in the last 12 months. Sexual violence and number of lifetime partners were the strongest predictors of reporting STIs. Women's sexual empowerment was a significant predictor of their STI status, but, surprisingly, the odds of reporting STIs were greater among women who were sexually empowered. Reporting of STIs was negatively associated with a woman's participation in decision-making with respect to her own health, and was positively associated with experience of sexual violence, partner's controlling behaviour, and having more than one life partner.

CONCLUSIONS

Our findings suggest that, with respect to STIs, sexual empowerment as measured in the study does not protect women who have sexually violent and controlling partners. Interventions promoting sexual health must effectively address negative masculine attitudes and roles that perpetuate unhealthy sexual behaviours and gender relations within marriage. It is also important to promote marital fidelity and better communication within union and to encourage women to take charge of their health jointly with their partners.

Empowerment, intimate partner violence and skilled birth attendance among women in rural Uganda

BACKGROUND

There is limited research on how the empowerment of women and intimate partner violence (IPV) are associated with skilled birth attendance (SBA) among rural women in Uganda. Therefore, the aim of this paper was to investigate the association between women's empowerment, their experience of IPV and SBA in rural Uganda.

METHODS

Using data from the Uganda Demographic and Health Survey (UDHS), we selected 857 rural women who were in union, had given birth in the last 5 years preceding the survey and were selected for the domestic violence (DV) module. Frequency distributions were used to describe the background characteristics of the women and their partners. Pearson's chi-squared (χ (2)) tests were used to investigate the associations between SBA and women's empowerment; and partners' and women's socio-demographic factors including sexual violence. Multivariable logistic regression analyses were used to examine the association between SBA and explanatory variables.

RESULTS

More than half (55 %) of the women delivered under the supervision of skilled birth attendant. Women's empowerment with respect to participation in household decision-making, property (land and house) (co)ownership, IPV, and sexual empowerment did not positively predict SBA among rural women in Uganda. Key predictors of SBA were household wealth status, partners' education, ANC attendance and parity.

CONCLUSIONS

For enhancement of SBA in rural areas, there is a need to encourage a more comprehensive ANC attendance irrespective of number of children a woman has; and design interventions to enhance household wealth and promote men's education.

Determinants of Intimate Partner Violence in Sub-Saharan Africa: A Review of Prevention and Intervention Programs

Intimate partner violence (IPV) in sub-Saharan Africa affects 36% of the population. Several African countries rank among the highest globally. In this article, we present evidence on the prevalence, determinants, and impact of IPV across several sub-Saharan African countries interpreted against the backdrop of social ecological theory. We also describe prevention or intervention programs tested in different regions of Africa, selecting only those programs which were published in a journal outlet and which met a high criteria of implementation and methodology (n = 7). Based on our review of the empirical literature, some risk factors for violence documented in Western societies are the same in Africa, including poverty, drinking, a past history of child abuse or posttraumatic stress disorder, and highly traditional gender role beliefs. Low education is also associated with IPV for both women and men. In Africa, partner abuse intersects with the HIV pandemic, making violence prevention especially urgent. African programs to prevent IPV are often incorporated with HIV prevention; community building and community engagement are emphasized more in Africa than in North America or Europe, which invoke more individually focused approaches. Some programs we review lowered HIV exposure in women; others contributed to reduced violence perpetration among men. The programs show sufficient promise to recommend replication and dissemination in sub-Saharan Africa.

Partners' controlling behaviors and intimate partner sexual violence among married women in Uganda

Background

Studies on the association between partners’ controlling behaviors and intimate partner sexual violence (IPSV) in Uganda are limited. The aim of this paper was to investigate the association between IPSV and partners’ controlling behaviors among married women in Uganda.

Methods

We used the 2011 Uganda Demographic and Health Survey (UDHS) data, and selected a weighted sample of 1,307 women who were in a union, out of those considered for the domestic violence module. We used chi-squared tests and multivariable logistic regressions to investigate the factors associated with IPSV, including partners’ controlling behaviors.

Results

More than a quarter (27%) of women who were in a union in Uganda reported IPSV. The odds of reporting IPSV were higher among women whose partners were jealous if they talked with other men (OR = 1.81; 95% CI: 1.22-2.68), if their partners accused them of unfaithfulness (OR = 1.50; 95% CI: 1.03-2.19) and if their partners did not permit them to meet with female friends (OR = 1.63; 95% CI: 1.11-2.39). The odds of IPSV were also higher among women whose partners tried to limit contact with their family (OR = 1.73; 95% CI: 1.11-2.67) and often got drunk (OR = 1.80; 95% CI: 1.15-2.81). Finally, women who were sometimes or often afraid of their partners (OR = 1.78; 95% CI: 1.21-2.60 and OR = 1.56; 95% CI: 1.04-2.40 respectively) were more likely to report IPSV.

Conclusion

In Uganda, women’s socio-economic and demographic background and empowerment had no mitigating effect on IPSV in the face of their partners’ dysfunctional behaviors. Interventions addressing IPSV should place more emphasis on reducing partners’ controlling behaviors and the prevention of problem drinking.