Physical violence by husbands: Magnitude, disclosure and help-seeking behavior of women in Bangladesh

Prevalence, pattern, and predictors of formal help-seeking for intimate partner violence against women: findings from India's cross-sectional National Family Health Surveys-3 (2005-2006) and 4 (2015-2016)

BACKGROUND

Help-seeking for intimate partner violence (IPV) requires women to disclose their experiences. For policymakers, low help-seeking threatens the United Nations Sustainable Development Goals (SDGs) of gender equality, good health, and wellbeing. In India, the Prevention of Domestic Violence Against Women Act (PWDVA 2005) was implemented in 2006. Using two rounds of the India National Family Health Survey (NFHS), one before and one after implementation, we examined the prevalence, pattern, and sociodemographic and socioeconomic factors associated with formal help-seeking for IPV.

METHODS

We used univariable and multivariable logistic regression models to assess the prevalence of help-seeking for IPV in the past 12 months and examined associations with different forms of IPV and sociodemographic factors.

RESULTS

The proportion of ever-married women aged 15-49 years who reported physical, sexual, or emotional IPV in the last 12 months increased from 23% in NFHS-3 (2005-2006) to 25% in NFHS-4 (2015-2016). In both surveys, few women sought help. Informal sources of help were preferred over formal sources, which declined from NFHS-3 to NFHS-4 (any help: 24.5 to 13.8%; informal help: 24.1 to 13.4%; and formal help: 1.2 to 1.1%). Women from lower castes and women with children were less likely to seek formal help. Over the two surveys, the odds of formal help-seeking for sexual IPV in the past 12 months remained similar (NFHS-3 aOR 1.9, 95% CI 1.4, 2.5. NFHS-4 aOR 1.9, 95% CI 1.4, 2.6). The odds were slightly higher for emotional IPV (NFHS-3 aOR 2.5, 95% CI 1.8, 3.3. NFHS-4 aOR 2.7, 95% CI 2.0, 3.7) and spousal control (NFHS-3 aOR 2.0, 95% CI 1.4, 3.0. NFHS-4 aOR 2.3, 95% CI: 1.4, 3.7).

CONCLUSIONS

Low disclosure and help-seeking impact a country's social, cultural, economic, and political progress. The PWDVA did not appear to result in increases in help-seeking among women in India who experienced IPV. Further work is needed to understand barriers to help-seeking in the presence of public policy efforts to support women affected by IPV. These may include poor implementation and enforcement of Policy, as well as normalization and justification of gender-based violence. We recommend a deeper understanding of help-seeking across all systems to establish a barometer of help-seeking. An increase in formal or informal help-seeking is an indicator of reduced tolerance of IPV and the enabling environment of the PWDVA 2005 for tracking progress toward the SDGs of gender equality and the eradication of all forms of gender-based violence and discrimination.

Like a Caged Bird: The Coping Strategies of Economically Empowered Women Who Are Victims of Intimate Partner Violence in Bangladesh

This article identifies coping strategies used by economically empowered Bangladeshi women who are victims of intimate partner violence. Interviews were conducted with 19 employed women who experience abuse at the hands of their husbands and with eight community leaders. A "Cultural Biography" approach was used to determine respondents' understanding of cultural phenomena and to gain life histories from victims in order to explore coping strategies in response to the harm experienced. Findings indicate that even though these women have access to financial resources due to their employment, many of them cope with the abuse by continuing to live in the home with the abuser because of the stigma surrounding divorce and the lack of laws that would grant them guardianship of the children or access to their property. Others live with family or friends in order to avoid the harassment experienced by divorcees. The few who sought more formal help from community leaders (4 of the 19) experienced pressure to remain in the marriage and, thus, the cycle of abuse continued. Community leaders supported the perceptions of the respondents emphasizing how cultural expectations for women's role in Bangladesh limit her ability to leave an abusive home, even if she is employed. As presented by Welby's patriarchal theory, we see that public patriarchy (oppression through norms, laws, and other social forces) supports private patriarchy (where men individually dominate their intimate partner), even for those women who are economically empowered.

Barriers to help-seeking from healthcare professionals amongst women who experience domestic violence - a qualitative study in Sri Lanka

BACKGROUND

Domestic violence (DV) is a major global public health problem which is associated with significant adverse consequences. Although Sri Lankan women who experience DV receive treatment from healthcare professionals (HCPs) for DV related physical and psychological problems, disclosure of DV within health services is quite low. This study explored barriers to disclosure of DV to HCPs among Sri Lankan women who experience DV.

METHOD

This qualitative study took place in the Central Province of Sri Lanka. Twenty women who had experienced DV were recruited from Gender Based Violence Centers (Mithuru Piyasa Centers) and a toxicology unit of the two selected hospitals. Participants were purposefully selected using maximum variation sampling technique. In-depth interviews were conducted until data saturation was reached. Interviews were recorded, and analyzed using thematic analysis.

RESULTS

Survivor related barriers to help seeking included women's lack of knowledge and perceptions about the role of HCPs, lack of confidence in HCPs, fear of repercussions, personal attitudes towards DV, and their love and loyalty towards the perpetrator. Women preferred it if HCPs initiated discussions about DV, and they valued it when HCPs could be confidential and protect their privacy, and give enough time for DV related issues during consultations. A perpetrator related barrier was the controlling behavior of the perpetrator. Social stigma and social and cultural norms about the role of women emerged as the socio-cultural constraints to disclosure.

CONCLUSIONS

Barriers to help seeking for DV from HCPs exist at individual, healthcare level, and societal level. Community programs are needed to increase women's access to healthcare services and interventions should be implemented to develop effective, preventive, and supportive strategies at the healthcare system level.

The Association Between Child Marriage and Domestic Violence in Afghanistan

Child marriage and intimate partner violence have been globally recognized as human rights violations. Both indicators can derail an individual's future and have various public health implications. Previous studies have shown an association between child marriage and domestic violence in low- and middle-income countries; however, data in Afghanistan are not known. This study aimed to assess the association between child marriage and domestic violence in Afghanistan. We used nationally representative data collected by the Demographic and Health Surveys to conduct logistic regression analyses. Child marriage was separated into three categories: very early marriage (<15 years), early marriage (15-17 years), and adult marriage (≥18 years). Domestic violence was the response variable and was assessed as any violence, physical violence, emotional violence, and sexual violence. Of the sample (N = 21,324), 15% of the respondents were married before the age of 15; 35% were married between the ages of 15 and 17; and 50% were married as adults. After adjusting for current age, place of residence, and socioeconomic status, the odds of sexual violence were 22% higher among women who married before age 15 compared with those married as adults (OR = 1.22, 95% CI = [1.05, 1.40], p = .005). However, the odds of reporting any violence, physical violence, and emotional violence among those who married as children did not differ compared with those who married as adults. This may be due to a shift in traditional norms or underreporting in Afghanistan. This study adds to the body of research on child marriage and intimate partner violence, and specifically provides novel information on this association in Afghanistan.

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

INTRODUCTION

Violence against women (VAW) affects one in three women globally. In some countries, women are at much higher risk. We examined risk factors for VAW in countries with the highest 12-month prevalence estimates of intimate partner violence (IPV) to develop understanding of this increased risk.

METHODS

For this systematic review, we searched PUBMED, CINAHL, PROQUEST (Middle East and North Africa; Latin America and Iberia; East and South Asia), Web of Science, EMBASE and PsycINFO (Ovid) for records published between 1 January 2000 and 1 January 2021 in English, French and Spanish. Included records used quantitative, qualitative, or mixed-methods, reported original data, had VAW as the main outcome, and focused on at least one of 23 countries in the highest quintile of prevalence figures for women's self-reported experiences of physical and/or sexual violence in the past 12 months. We used critical interpretive synthesis to develop a conceptual model for associations between identified risk factors and VAW.

RESULTS

Our search identified 12 044 records, of which 241 were included for analysis (2 80 360 women, 40 276 men, 274 key informants). Most studies were from Bangladesh (74), Uganda (72) and Tanzania (43). Several quantitative studies explored community-level/region-level socioeconomic status and education as risk factors, but associations with VAW were mixed. Although fewer in number and representing just one country, studies reported more consistent effects for community-level childhood exposure to violence and urban residence. Theoretical explanations for a country's high prevalence point to the importance of exposure to other forms of violence (armed conflict, witnessing parental violence, child abuse) and patriarchal social norms.

CONCLUSION

Available evidence suggests that heightened prevalence of VAW is not attributable to a single risk factor. Multilayered and area-level risk analyses are needed to ensure funding is appropriately targeted for countries where VAW is most pervasive.

PROSPERO REGISTRATION NUMBER

The review is registered with PROSPERO (CRD42020190147).

Help seeking behavior by women experiencing intimate partner violence in india: A machine learning approach to identifying risk factors

BACKGROUND

Despite the low prevalence of help-seeking behavior among victims of intimate partner violence (IPV) in India, quantitative evidence on risk factors, is limited. We use a previously validated exploratory approach, to examine correlates of help-seeking from anyone (e.g. family, friends, police, doctor etc.), as well as help-seeking from any formal sources.

METHODS

We used data from a nationally-representative health survey conducted in 2015-16 in India, and included all variables in the dataset (~6000 variables) as independent variables. Two machine learning (ML) models were used- L-1, and L-2 regularized logistic regression models. The results from these models were qualitatively coded by researchers to identify broad themes associated with help-seeking behavior. This process of implementing ML models followed by qualitative coding was repeated until pre-specified criteria were met.

RESULTS

Identified themes associated with help-seeking behavior included experience of injury from violence, husband's controlling behavior, husband's consumption of alcohol, and being currently separated from husband. Themes related to women's access to social and economic resources, such as women's employment, and receipt of maternal and reproductive health services were also noted to be related factors. We observed similarity in correlates for seeking help from anyone, vs from formal sources, with a greater focus on women being separated for help-seeking from formal sources.

CONCLUSION

Findings highlight the need for community programs to reach out to women trapped in abusive relationships, as well as the importance of women's social and economic connectedness; future work should consider holistic interventions that integrate IPV screening and support services with women's health related services.

Help-seeking behaviour and associated factors among women who experienced physical and sexual violence in Ethiopia: evidence from the 2016 Ethiopia Demographic and Health Survey

BACKGROUND

Violence against women remains devastatingly pervasive and remained unchanged over the past decade. Violence against women is preventable and help-seeking of women subjected to violence is an entry point. So, this study assessed help-seeking behaviour and associated factors among women who experienced physical and sexual violence in Ethiopia.

METHOD

Using the 2016 Ethiopia Demographic and Health Surveys (EDHS), this paper analyzes the determinants of help-seeking behavior of women subjected to violence in Ethiopia. EDHS used a two-stage stratified cluster sampling technique. From 642 communities, a total of 1540 (weighted) reproductive age women were included in the analysis. Simple descriptive, bivariable and multivariable logistic regression analysis were employed. Statistical significance was set at a p-value of less than 0.05.

RESULTS

Only 22.5% of the women who experienced violence sought help. Being aged 30 and above, working in sales, or an agricultural job, being in the richest wealth quintile, and experiencing severe violence were associated with increased help-seeking behaviour. Living in a rural area, having a husband who attended primary, secondary, and higher education, having a husband working in a professional job and agriculture were factors associated with lower odds of help-seeking behaviour.

CONCLUSION

In Ethiopia below one-fourth of women who were subject to violence sought help. Socio-demographic factors and severity of the violence were associated with help-seeking. Preventing child marriages and reducing poverty as well as increased employment and education for women enhance help-seeking behaviour by the women. Interventions could include creating awareness, law enforcement, and support for victims.

Aging, care and dependency in multimorbidity: how do relationships affect older Bangladeshi women's use of homecare and health services?

Gender issues can create major barriers to healthcare utilization for older women with multimorbidity, especially in developing countries like Bangladesh. Elderly rural women in Bangladesh, are the poorest of the poor, and the women with multimorbidity live in a regulated family atmosphere. This study explored the relationship dimensions of older women with multimorbidity in homecare and their utilization of health services. To gain a deeper understanding of these complex issues, a qualitative case study was conducted. Semi-structured, in-depth interviews were conducted with 11 health staff and 22 older women with multimorbidity, living in three residential communities of the Sylhet District, Bangladesh. Our analysis used critical thematic discourse, a technique developed from Axel Honneth's recognition-and-misrecognition theory. Seven relationship dimensions have been identified, and grouped under three major themes: intimate affairs [marital marginalization and parent-children-in law dynamics]; alienation in community relationships [patriarchal sibling relationships, neighborhood challenges, and gender inequality in interactions]; and legal disconnections [ignorance of rights and missed communication]. Our findings revealed a lack of understanding of the women's multimorbid care needs and patriarchal marginalization in family. This lack of understanding together with poor peer-supports in healthcare is perpetuated by misrecognition of needs from service providers, resulting in a lack of quality and poor utilization of homecare and health services. Understanding the high needs of multimorbidity and complexities of older women's relationships can assist in policy decisions. This study deepens our understanding of the ways gender inequality intersects with cultural devaluation to reduce the well-being of older women in developing countries.

Intimate partner violence and social connection among married women in rural Bangladesh

BACKGROUND

Intimate partner violence (IPV) is high among married women in Bangladesh. Social isolation is a well-established correlate of women's exposure to IPV, but the role of such factors in low-income and middle-income countries is not well understood. In this study, we explore whether social connection is protective against IPV among married women in rural Bangladesh.

METHODS

Data were drawn from a multistage, stratified, population-based longitudinal sample of 3355 married women in rural Bangladesh, who were surveyed on individual and contextual risk factors of IPV. Negative binomial regression models were used to estimate the association between three different domains of social connection (natal family contact, female companionship and instrumental social support), measured at baseline in 2013, and the risk of three different forms of IPV (psychological, physical and sexual), approximately 10 months later, adjusted for woman's level of education, spouse's level of education, level of household wealth, age and age of marriage.

RESULTS

Adjusted models showed that instrumental social support was associated with a lower risk of past year psychological IPV (risk ratio (RR)=0.84, 95% CI 0.769 to 0.914), sexual IPV (RR=0.90, 95% CI 0.822 to 0.997) and physical IPV (RR=0.81, 95% CI 0.718 to 0.937). Natal family contact was also associated with a lower risk of each type of IPV, but not in a graded fashion. Less consistent associations were observed with female companionship.

CONCLUSION

Our findings suggest that social connection, particularly in the form of instrumental support, may protect married women in rural Bangladesh from experiencing IPV.

Help-Seeking Behaviors of Intimate Partner Violence Victims: A Cross-National Analysis in Developing Nations

There is a dearth of research on help-seeking behaviors of intimate partner violence (IPV) victims, especially within developing nations. The current study uses the nationally representative population-based Demographic and Health Surveys (DHS) of 31 nations to address this gap in the literature. Specifically, the study (a) assesses the extent to which IPV victims sought help in developing nations, (b) investigates from whom IPV victims sought help, and (c) evaluates individual and national factors that influence the likelihood of help seeking among IPV victims in developing nations. Given the hierarchical structure of the data, multilevel modeling techniques are used (individual level N = 65,530; national level N = 31). Descriptive findings revealed 34.88% of IPV victims engaged in help-seeking behaviors and the majority of victims who sought help reached out to family members (63.10%). Few IPV victims (3.24%) sought help from formal institutions. Results from the hierarchical generalized linear regression models indicated the severity of abuse, attitudes toward IPV, and indicators of empowerment all affected the likelihood of help seeking. National-level factors, including whether the nation had a law against IPV, were not significant. While providing formal services is important, policies designed to help IPV victims must recognize and address cultural barriers that may inhibit help-seeking behaviors. Because the majority of IPV victims sought help from informal support networks, it is important that individuals in these extended networks receive information about gendered norms and IPV so they can extend help and respond appropriately to family and friends.

Marital Experiences and Depression in an Arranged Marriage Setting

Understanding the consequences of marital experiences for individual mental health provides insight into how social relationships shape individual wellbeing. Using newly available, clinically validated diagnostic interviews with more than 10,000 respondents integrated with the longitudinal Chitwan Valley Family Study (CVFS), we assess the associations between marital experiences, intimate partner violence (IPV), and mental health and how they differ by gender in a setting of universal marriage-Nepal. Particularly novel, we integrate measures of arranged marriage, IPV, and marital quality into a single comprehensive analysis of the marital experiences shaping subsequent depression. This study reveals that becoming married can be positively associated with major depressive disorder (MDD) for women. IPV is a strong and independent risk factor for depression, but it only mediates a small portion of the consequences of marriage on depression. Among women, having no say at all in the selection of a spouse is also a strong and independent risk factor for depression, and IPV can only mediate a small portion of the consequences of arranged marriage on depression. We also investigate the associations between the positive (i.e., husband-wife emotional bond) and negative (i.e., spousal criticism and disagreement) dimensions of marital quality and depression. Frequent spousal disagreement significantly increases depression for women, but strong husband-wife emotional bond is not significantly associated with depression. Overall, the associations between marital experiences and mental health should be understood as contingent on both gender and the social contexts of marriage. Depending on these factors, specific marital experiences have the potential to increase transitions to depression, not just protect from depression.

Prevalence, associated factors, and disclosure of intimate partner violence among mothers in rural Bangladesh

BACKGROUND

The purpose of this study is to assess the prevalence and associated factors of physical and sexual intimate partner violence (IPV) among married women of reproductive age in a rural population in northeast Bangladesh. In addition, we examined women's sharing and disclosure of violence experience with others.

METHODS

This cross-sectional study uses data from a household survey of 3966 women conducted in 2014 in the Sylhet District of Bangladesh. Interviews were completed in respondent's homes by trained local female interviewers.

RESULTS

Twenty-nine percent (28.8%, 95% CI 27.4-30.3%) of the women reported ever experiencing physical or sexual IPV by their spouse; 13.2% (95% CI 12.1-14.3%) reported physical or sexual IPV in the past year. Of the 13.2%, 10.1% (95% CI 9.2-11.1%) reported experiencing physical IPV and 4.6% (95% CI 4.0-5.3%) reported sexual IPV. In a combined model, the adjusted odds of having experienced physical or sexual IPV in the past year were higher for women who were raised in households with history of IPV (AOR = 4.35, 95% CI 3.26-5.80); women with no formal education (AOR = 1.76, 95% CI 1.30-2.37); women whose husbands had no formal education (AOR = 1.63, 95% CI 1.22-2.17); Muslim (AOR = 1.63, 95% CI 1.03-2.57); women younger than age 30 (AOR = 1.53, 95% CI 1.11-2.12); and women who were members of an NGO or microcredit financial organization (AOR = 1.38, 95% CI 1.04-1.82). Wealth, parity, number of household members, and pregnancy status (pregnant, postpartum, neither pregnant nor postpartum) were not associated with physical or sexual IPV after adjusting for other factors. Data on disclosure was available for women who reported experiencing physical violence in the last year; only 31.8% of victims told someone about the violence they had experienced and 1% reported to police, clerics, health workers, or a counselor altogether.

CONCLUSIONS

In rural northeast Bangladesh, a high proportion of women of reproductive age experience physical or sexual IPV. Women do not often speak of these experiences, especially to anyone outside of family. Interventions aimed at preventing future IPV and addressing current IPV should focus on women who witnessed IPV in childhood, as well as younger women and less educated couples.

TRIAL REGISTRATION

This study was registered as a Clinical Trial (Identifier: NCT01702402). https://clinicaltrials.gov/ct2/show/NCT01702402.

Coping with domestic violence: women's voices in Bangladesh

Purpose

This paper aims offer a benchmark by providing an account of women's experiences with domestic violence in Bangladesh and develops illustrations on coping with abuse.

Design/methodology/approach

A case study design was adopted, applying an emic perspective in employing a qualitative research approach to explore and describe women's experiences with and perceptions about domestic violence and their ways of coping in Sherpur District, Bangladesh. In total 25 recently married women participants were purposively sampled by snowballing. In-depth interview data facilitated a latent thematic content analysis.

Findings

The findings indicate that women adopt a range of responses to domestic violence. Two key aspects of coping surfaced in the narratives: (1) emotion-driven and (2) problem-driven approaches to abusive situations. Findings point to a range of research issues that require further study such as domestic violence and taboo; somatization; structural gender inequalities; male perpetrators; family dynamics and the intersections of these issues and contexts.

Originality/value

A more proactive way of coping resulted in resilience amidst an abusive environment, whereas passive ways of coping led to a life in distress. It is important however, to understand ways of coping as a continuum rather than a dichotomy.

The Social Network of Victims of Domestic Violence: A Network-Based Intervention Model to Improve Relational Autonomy

This study aims to understand when and how domestic violence victims' relational autonomy changes and to propose an intervention model stemming from the findings. Using qualitative and social network analysis, we study the actions of network members, as well as changing features of victims' networks. Results show that victims base their decisions on their expectations toward others, and on a desire to preserve their autonomy. Their relational autonomy tends to increase when they leave abusive partners and stay in shelters, but maintaining relational diversity proves challenging once they exit shelters. A network-based model of intervention that aims to improve the victims' relational autonomy is proposed.

Seeking Help in Domestic Violence Among Muslim Women in Muslim-Majority and Non-Muslim-Majority Countries: A Literature Review

OBJECTIVE

Women from different backgrounds and cultures are at risk of domestic violence. Disclosing the abusive experience and seeking help is not straightforward and easy and might be a complicated and long-term process. Muslim women, like other groups of women, may face various barriers to disclose abusive relationships and for seeking help. Some of the barriers may be common for the majority of Muslim women in different contexts, while others might be related to women's situations and the wider society they live. To identify these barriers and make recommendations for future studies, this article reviews related papers conducted in both Muslim-majority and non-Muslim-majority countries.

METHOD

A critical systematic review of the literature was conducted for identifying Muslim women's barriers in disclosing abuse and seeking help.

RESULTS

Twenty-one studies met the inclusion criteria. The main identified barriers are discussed into under four themes: social context, family context, individual factors, and expectations of service providers.

CONCLUSIONS

Although the researchers tried to investigate various barriers in seeking help, many of them have not focused on structural obstacles. Besides, in many Muslim-majority countries, the issue has not been explored. Therefore, the results of the current article will not apply to those countries. Recommendation for future research comprises more qualitative research compatible with the women's cultures and backgrounds in different societies, focusing more on structural and cultural factors to explore and find women's barriers to seek help.

Identification of abuse experiences of South Asian women in the US and women in Mumbai, India

The authors describe the experiences of abuse drawn from in-depth interviews conducted with 20 South Asian women in the United States and a sample of 21 abused women in Mumbai, India. We describe five major themes that identify the nature of domestic violence experienced in these two contexts, barriers to help-seeking and exiting abuse, and the process of ending the abusive relationship. The research sheds light on the similarities and differences in the two contexts. We outlined the similarities in the following themes (a) type of abuse, (b) treatment of children (c) abandonment. We found differences in the following themes (d) joint meeting, (e) back and forth between natal and marital home.

Gender Norms and Beliefs, and Men's Violence Against Women in Rural Bangladesh

Prevention of violence against women requires understanding men's controlling attitudes and behaviors toward women. In Bangladesh, while the incidence of men's violence against women is alarmingly increasing, existing research to understand the determinants of men's violent behavior resulted in contradictory findings. The current study explores rural Bangladeshi men's support for gender norms, beliefs, and attitudes concerning violence against women, and looks at how these are influenced by men's age, marital status, education, and affiliation with organizations that promote gender equality. The study also attempts to understand men's bystander attitudes and responses to incidents of violence against women. Using the theoretical framework of hegemonic masculinity, the study was conducted among a sample of 1,200 men and women. Results indicate that in the study areas, young, unmarried men are less supportive to gender norms, beliefs, and attitudes that promote violence against women. Positive association was observed with men's educational attainment and affiliation with nongovernmental organization (NGO) interventions. Regardless of age, marital status, or education, men's bystander response toward intervening to prevent violence against women was found to be low. Women showed similar level of support for inequitable gender norms, beliefs, and attitudes. Analysis of the findings using a hegemonic masculinity lens reveals more complicated dynamics of power and hegemonic control at work that perpetuate men's violence against women. Based on the findings, the study also identifies possible strategies for violence prevention interventions in Bangladesh.

Is unintended birth associated with physical intimate partner violence? Evidence from India

A growing number of studies have tested the association between intimate partner violence (IPV) and the unintendedness of pregnancy or birth, and most have suggested that unintendedness of pregnancy is a cause of IPV. However, about nine in every ten women face violence after delivering their first baby. This study examined the effects of the intendedness of births on physical IPV using data from the National Family Health Survey (2015-16). The multivariate logistic regression model analysis found that, compared with women with no unwanted births (2.9%), physical IPV was higher among those women who had unwanted births (6.9%, p<0.001), followed by those who had mistimed births (4.4 %, p<0.001), even after adjusting for several women's individual and socioeconomic characteristics. Thus, the reduction of women with mistimed and unwanted births could reduce physical IPV in India. The study highlights the unfinished agenda of family planning in the country and argues for the need to integrate family planning and Reproductive, Maternal and Child Health Care (RMNCH) services to yield multi-sectoral outcomes, including the elimination of IPV.

Women economic empowerment via cash transfer and microcredit programs is enough to decrease intimate partner violence? Evidence from a systematic review

Intimate partner violence (IPV) is a worldwide public health problem. Many proposals aiming to eliminate its occurrence include the empowerment of women through their socio-economic development. In this context, some studies suggested that microcredit programs (MP) and cash transfer programs (CTP) are initiatives that can also reduce the risk of IPV. Others pointed to an opposite effect. The objective of this study was to investigate the influence of women's economic empowerment in MP and CTP on the risk of physical, psychological and sexual violence through a systematic review. Papers/documents selection was conducted by two researchers according to the following criteria: published in English, Portuguese or Spanish; primary data; assessing the effect of MP or CTP on IPV; in heterosexual couples; on women beneficiaries of the intervention; using a comparator group eligible for an MP or CTP; and focusing on risk IPV as the outcomes. Our results showed that the impact of MP are mixed when it comes to physical and physical/sexual violence. Even so, the review suggests that the effect of MP on sexual violence is trivial or nonexistent. Regarding the impact of CTPs, the present study showed that the effects on physical, physical/sexual, psychological, and sexual violence were also heterogeneous. Women more empowered and with some autonomy could be at risk. Despite that, participation in the empowerment program should be encouraged for poor women and families. However, parallel interventions to lead with IPV should be addressed to the main actions to reduce the risk of increasing IPV prevalence in certain scenarios.

Exploring the Relationship Between Stigma, Stigma Challenges, and Disclosure Among Slum-Dwelling Survivors of Intimate Partner Violence in Kenya

This article uses survey data from 131 women living in urban slums in Kenya to explore associations between stigma, stigma challenges, empowerment, and disclosure of intimate partner violence (IPV). A total of 81.7% of women reported informal or formal disclosure of IPV. A bystander offering help and experiencing stigma were associated with significant increases in the odds of informal and formal disclosure. There were also significant positive associations between participating in financial decision-making, membership in survivor support groups, and formal disclosure. Results suggest that interpersonal, community, and structural challenges to stigma interfere with stigma as a barrier to disclosure.

Intimate partner violence and depression in rural Bangladesh: Accounting for violence severity in a high prevalence setting

Intimate partner violence (IPV) against women is highly prevalent globally, and is associated with adverse health outcomes, including depression. Though women living in low- and middle-income countries (LMICs) face a larger burden of IPV, little is known about whether IPV increases the risk of depression among non-pregnant women and in contexts of high prevalence. Within the setting of rural Bangladesh, this study examined the relationship between the severity of marital IPV against women and the risk of depression. Data were drawn from a nationally-representative study focused on individual and contextual determinants of IPV among married women aged 16-37 years in rural Bangladesh, collected through a multistage, stratified sample in 77 villages in 2014 (n=3290). Multivariable log-binomial regression models were used to estimate the association between the severity of IPV (operationalized as the frequency of different acts of psychological, physical, and sexual abuse, as well as injury due to IPV) and risk of major depressive episode (MDE) using the Edinburgh Postnatal Depression Scale (EPDS). One in six women (16.8%) met the criteria for MDE. Past year IPV was endemic; psychological (77.2%) was most common, followed by sexual (58.8%) and physical (44.4%). Nearly a third of women experienced IPV-related injury. There was a positive dose-response relationship between severity of each type of IPV and MDE above the lowest level of exposure. In adjusted models, the highest levels of psychological (RR=2.27, 95% CI: 1.62, 3.17), physical (RR=2.44, 95% CI: 1.94, 3.08), and sexual (RR=1.65, 95% CI: 1.08, 2.52) IPV severity remained significantly associated with MDE, as well as experiencing IPV-related injury (RR=1.72, 95% CI: 1.23, 2.40). In rural Bangladesh, the severity of all types of marital IPV against women is strongly related to increased risk of MDE. Results suggest the limited utility of standard dichotomous IPV indicators in high prevalence settings.

An Assessment of the Prevalence, Perceived Significance, and Response to Dowry Solicitation and Domestic Violence in Bangladesh

The current study focuses on the prevalence of two pervasive gender-related crimes in Bangladesh: dowry solicitation and domestic violence. We assess victim perceptions of how these two crimes rank in significance compared with other types of crimes experienced and the actions victim households took in response. Our research builds on prior qualitative studies by making use of nation-wide household survey data, collected by the World Bank, to examine dowry and domestic violence in the context of all legal conflicts experienced by households in every administrative region of the country. The analyses show that both dowry solicitation and domestic violence rank in the top five most common crimes, including violent and non-violent crimes. Women report more experiences of dowry solicitation and domestic violence, with urban females most frequently disclosing both. Among the households that experienced multiple types of violent and non-violent crimes, 55.9% of dowry and 70.8% of domestic violence victims reported another crime ranked higher in significance. Of the households that considered these two crimes the most serious they experienced, 56.1% of dowry and 32.5% of domestic violence households took no action at all in response. Among the households that took action, most eschewed both police and state judicial institutions. Choosing to act alone or with the help of family members was the most frequent response. The findings illustrate the need for governance reforms in Bangladesh and may inform state and non-state improvement initiatives.

What psycho-social factors determine intimate partner violence of men against women? A social cognitive theory-based study

Despite the multidimensionality of intimate partner violence (IPV) against women, there is a lack of research on the perspectives of men toward the phenomenon. Our aim in this cross-sectional study was to examine the predictability of social cognitive theory in explaining men's violent behaviors against women. We find among a sample of 576 Iranian married men showed a reciprocal determinism between outcome expectancy, attitude toward IPV, and observational learning in formation of men's IPV against women. Therefore, the interactive associations of cognitive and environmental factors, as a comprehensive approach, should be considered while studying the determinants of IPV against women among men.

Physical partner violence, women's economic status and help-seeking behaviour in Dar es Salaam and Mbeya, Tanzania

Background: Women’s responses to partner violence are influenced by a complex constellation of factors including: psychological attachment to the partner; context of the abuse; and structural factors, all of which shape available options for women outside of the relationship.

Objective: To describe women’s responses to physical partner violence; and to understand the role of women’s economic resources on their responses.

Methods: Cross-sectional data from Dar es Salaam and Mbeya, Tanzania. Multivariate logistic regression was used to explore the relationship between women’s economic resources and their responses to violence.

Results: In both sites, among physically abused women, over one-half experienced severe violence; approximately two-thirds had disclosed the violence; and approximately 40% had sought help. Abused women were more likely to have sought help from health services, the police and religious leaders in Dar es Salaam, and from local leaders in Mbeya. Economic resources did not facilitate women’s ability to leave violent partners in Dar es Salaam. In Mbeya, women who jointly owned capital assets were less likely to have left. In both sites, women’s sole ownership of capital assets facilitated help-seeking.

Conclusion: Although support services are being scaled-up in Tanzania, efforts are needed to increase the acceptability of accessing such services.

Associations of intimate partner violence with screening for mental health disorders among women in urban Bangladesh

OBJECTIVES

We examined the association between intimate partner violence (IPV) and screening for depression in Bangladesh, a country with high prevalence of IPV and lack of data, awareness and provider infrastructure for mental illness.

METHODS

We used data from a representative sample of 11,202 women from the 2006 Bangladesh Urban Health Survey. Elements of social learning theory were used to examine the association. Additionally, we examined the interaction effect of experiencing IPV and justification of IPV on screening for mental health disorders.

RESULTS

Results indicate that women who experienced IPV were significantly more likely to be screened for mental health disorders (AOR = 2.09; 95% CI = 1.86-2.34). However, the direction of this association is reversed for women who justify various forms of IPV to varying degrees.

CONCLUSIONS

These findings reflect the importance of how women's perception of violence may influence their mental health. Our results indicate a counter-intuitive association, given that we found that women's justification of IPV is adaptive for them in terms of preventing symptoms of mental health problems and have potential to inform future public health policy and research.

The implications of community responses to intimate partner violence in Rwanda

Intimate partner violence (IPV) has significant impacts on mental health. Community-focused interventions have shown promising results for addressing IPV in low-income countries, however, little is known about the implications of these interventions for women’s mental wellbeing. This paper analyses data from a community-focused policy intervention in Rwanda collected in 2013–14, including focus group discussions and in-depth interviews with community members (n = 59). Our findings point to three ways in which these community members responded to IPV: (1) reconciling couples experiencing violence, (2) engaging community support through raising cases of IPV during community discussions, (3) navigating resources for women experiencing IPV, including police, social services and legal support. These community responses support women experiencing violence by helping them access available resources and by engaging in community discussions. However, assistance is largely only offered to married women and responses tend to focus exclusively on physical rather than psychological or emotional forms of violence. Drawing on Campbell and Burgess’s (2012) framework for ‘community mental health competence’, we interrogate the potential implications of these responses for the mental wellbeing of women affected by violence. We conclude by drawing attention to the gendered nature of community responses to IPV and the potential impacts this may have for the mental health of women experiencing IPV.

Is Women's Empowerment Associated With Help-Seeking for Spousal Violence in India?

Violence against women by their husbands is a problem for women worldwide. However, the majority of women do not seek help. This article presents findings from a national survey in India on empowerment-related correlates of help-seeking behaviors for currently married women who experienced spousal violence. We examined individual-, relationship-, and state-level measures of empowerment on help-seeking from informal and formal sources. Findings indicate that help-seeking is largely not associated with typical measures of empowerment or socio-economic development, whereas state-level indicators of empowerment may influence help-seeking. Although not a target of this study, we also note that injury from violence and the severity of the violence were among the strongest factors related to seeking help. Taken together, the low prevalence of help-seeking and lack of strong individual-level correlates, apart from severe harm, suggests widespread barriers to seeking help. Interventions that affect social norms and reach women and men across social classes in society are needed in addition to any individual-level efforts to promote seeking help for spousal violence.

Attitudes towards help-seeking for sexual and gender-based violence in humanitarian settings: the case of Rwamwanja refugee settlement scheme in Uganda

BACKGROUND

Sexual and gender-based violence (SGBV) remains a silent epidemic in many humanitarian settings with many survivors concealing their experiences. Attitudes towards help-seeking for SGBV is an important determinant of SGBV service use. This paper examined the association between attitudes towards seeking care and knowledge and perceptions about SGBV among men and women in a humanitarian setting in Uganda.

METHODS

A cross-sectional survey was conducted from May to June 2015 among 601 heads of refugee households (261 females and 340 males) in Rwamwanja Refugees Settlement Scheme, South West Uganda. Analysis entails cross-tabulation with chi-square test and estimation of a multivariate logistic regression model.

RESULTS

Results showed increased odds of having a favorable attitude toward seeking help for SGBV among women with progressive attitudes towards SGBV (OR = 2.78, 95% CI: 1.56-4.95); who felt that SBGV was not tolerated in the community (OR = 2.03, 95% CI: 1.03-4.00); those who had not experienced violence (OR = 2.08, 95% CI: 1.06-4.07); and those who were aware of the timing for post-exposure prophylaxis (OR = 3.08, 95% CI: 1.57-6.04). In contrast, results for men sample showed lack of variations in attitude toward seeking help for SGBV for all independent variables except timing for PEP (OR = 2.57, 95% CI: 1.30-5.10). Among individuals who had experienced SGBV, the odds of seeking help was more likely among those with favorable attitude towards seeking help (OR = 4.22, 95% CI: 1.47-12.06) than among those with unfavorable help-seeking attitudes.

CONCLUSION

The findings of the paper suggest that targeted interventions aimed at promoting awareness and progressive attitudes towards SGBV are likely to encourage positive help-seeking attitudes and behaviors in humanitarian contexts.

A family-based model for Iranian women's health: a grounded theory study

Background

In many societies, women are vulnerable to specific situations and inequalities, which may negatively impact their own and their family's health. The purpose of this qualitative study was to explore Iranian women's perspectives on this issue and to develop a categorical model for their health.

Methods

The study was conducted using a grounded theory approach via 25 semi-structured interviews.

Results

The results revealed that family dynamism was the core variable and identified four main categories: understanding of health, reduction of women's health, the pleasure and difficulties of motherhood, cultural and/or social factors influencing women's health.

Conclusion

Policymakers should consider policies that empower women, reduce gender inequality and provide social security to maximize the probability of women being healthy.

Intergenerational Transmission of Marital Violence: Results From a Nationally Representative Sample of Men

The present study assesses the association between childhood exposure to parental violence and perpetration of marital violence as adults among a representative sample of 3,396 men in Bangladesh. We used secondary analysis of survey data from the nationally representative Bangladesh Demographic and Health Survey 2007 to examine factors associated with perpetration of martial violence among 3,396 ever-married men between the ages of 16 and 50 years. Outcome measure, marital violence perpetration, was measured using a modified Conflict Tactics Scale, and predictor variables included childhood exposure to parental violence, justification of marital violence, marital duration, religion, and demographic variables. Results indicate that marital violence perpetration is significantly associated with childhood exposure to marital violence, suggesting a cycle of violence that is maintained across generations. Implications for policy and practice are discussed.

Prevalence and predictors of help-seeking for women exposed to spousal violence in India - a cross-sectional study

Background

Spousal violence against women is prevalent in India (29%). Studies from various countries have shown that few women exposed to intimate partner violence or spousal violence seek help, especially in low-income countries. The objective of this study was to estimate the prevalence and predictors of help-seeking among women in India who have experienced various types of spousal violence.

Methods

Cross-sectional data on 19,125 married, separated, divorced or widowed women in India who had experienced physical or sexual violence at the hands of their husbands were obtained from the India National Family Health Survey III 2005–2006. Bivariate and multivariate logistic regression analyses were carried out.

Results

Less than one fourth (23.7%) of married, separated, divorced or widowed women in India who had experienced some form of physical or sexual spousal violence had sought help, but only 1% had sought help from formal institutions. Help-seeking was most prevalent in women who had been exposed to a combination of physical, sexual and emotional abuse (48.8%) and the least prevalent in women who had experienced sexual violence only (1.5%). Experience of severe violence and violence resulting in injury were the strongest predictors of help-seeking. Having education, being Christian or an acknowledged adherent of another minority religion - mainly Buddhism and Sikhism (Islam not included), getting married after the age of 21 and living in the South region were also associated with seeking help. Women in the North and Northeast regions were less likely to seek help, as were women with children and women who thought that a husband could be justified in hitting his wife.

Conclusions

Very few Indian women who experience spousal violence seek help. The characteristics of the violence are the strongest predictors of help-seeking, but sociodemographic factors are also influential. We recommend efforts to ensure educational attainment for girls, prevention of child marriages, and that police officers and health care staff should be educated about intimate partner violence and in how to respond to women who seek help. It is important to tackle norms and attitudes surrounding violence against women, as well as attitudes to women who disclose violence.

Electronic supplementary material

The online version of this article (10.1186/s12905-017-0453-4) contains supplementary material, which is available to authorized users.

Intimate Partner Violence and Help-Seeking

Abstract. Intimate partner violence (IPV) is a global social concern: many women are affected by this phenomenon and by the difficulty of putting an end to it. This review of the literature aims to identify help-seeking facilitating and inhibiting factors in response to IPV. It was carried out on the PsycINFO and Medline databases using the following keywords: “intimate partner violence,” “domestic violence,” “help-seeking,” and “help-seeking barrier.” Ninety out of 771 eligible publications were included on the basis of inclusion criteria. The results highlight that (1) research on this phenomenon is very recent and underdeveloped in Europe, (2) theoretical and conceptual frameworks are poorly developed and extended, (3) there is a significant impact of violence characteristics (e.g., severity, type) on help-seeking, and (4) help-seeking is a complex and multifactorial process influenced by a wide range of factors simultaneously individual and social. To conclude, these findings lead us to propose a psychosocial conceptualization of the help-seeking process by indicating how the levels of explanation approach in social psychology can be applied to this field of research in order to increase our understanding of this phenomenon.

Help-Seeking Behavior Among Moroccan, Romanian, and Ecuadorian Women Experiencing Intimate Partner Violence in Spain

This study aims to identify different types of response to intimate partner violence (IPV) and help-related seeking behavior among Spain's most numerous immigrant groups-Moroccans, Romanians, and Ecuadorians. Women reporting physical, sexual and/or psychological violence by a current or former intimate partner (n = 194) were selected from a cross-sectional study based on 1,607 surveys (2011). There are 84% of surveyed battered women who reported seeking help through informal and/or formal channels. The most frequently reported informal help-seeking behavior was talking with the abusive partner (from 63% to 83%). Moroccans identified social services (29.6%) and health care (25.9%) professionals as their most frequently used formal resources when seeking help. Approximately 32% of Ecuadorians and Romanians declared having reported their partners to the police. Among all of the women, seeking help through formal channels was more probable in cases where the severity of IPV was high (adjusted odds ratio = 5.69, 95% confidence interval [2.29, 14.12]). It is needed to increase professionals' opportunities to intervene in cases of IPV before they become severe.

Women's Perceptions and Experiences of Domestic Violence: An Observational Study From Hyderabad, Pakistan

This community-based observational study of 1,325 women seen for antenatal care examined how women in Pakistan define violence against women (VAW), with an emphasis on domestic violence, what an acceptable response to violence is, reasons for remaining silent, and whether participants are willing to disclose incidents of domestic violence to others. Nearly half of the study participants believed that physical violence was VAW. Verbal abuse, controlling behavior by the husband, conflict with in-laws, overburdening domestic work, and threatening to leave or remarry were also considered VAW. However, only five respondents (0.4%) considered sexual abuse to be VAW. Most women who screened positive for domestic violence responded by remaining silent or verbal fighting back. None sought professional help. Women who decided to remain silent feared that the abuse would escalate or that responding would not help them. Women cited social stigma and concerns about the impact of the violence on children as reasons for not disclosing violent incidents to others or seeking professional help. Women's lack of autonomy further reduced their ability to take steps against violence. Although societal norms, particularly patriarchal beliefs and women's subordination to men, likely explain women's tolerance of abuse, their recognition of physical abuse as violence indicates that they do not necessarily believe it is always justified. Educational interventions to drive changes in the social norms around gender violence along with effective and enforceable legal measures are likely required to ensure women's safety.

Men's Report of Domestic Violence Perpetration in Bangladesh: Correlates From a Nationally Representative Survey

This study provides an examination of the antecedents of domestic violence perpetration among a nationally representative sample of men in Bangladesh using an ecological model. Secondary analysis of survey data from nationally representative Bangladesh Demographic and Health Survey is used to examine potential antecedents of perpetration of domestic violence in a sample of 3,371 ever-married men between the ages of 15 and 54 years. Outcome measure is perpetration of domestic violence as measured by a modified Conflict Tactics Scale (CTS), and predictor variables include maternal domestic violence, egalitarianism, marital age, number of household members, wealth index, marital duration, and demographic variables. Men who reported maternal domestic violence had 0.13 greater probability of perpetrating domestic violence compared with men who did not report maternal domestic violence, men who were egalitarian had 0.04 greater probability of perpetrating domestic violence compared with men who were not egalitarian, men in larger households were less likely to report domestic violence. At the same time, the probability of domestic violence perpetration was 0.07 smaller for men who were married at age 36 years and older, as compared with men who were married between the ages of 16 and 20 years, as well as men who were married for more than 5 years when compared with men married for 0 to 4 years. Finally, the probability of domestic violence perpetration was 0.17 smaller for men who were married between the ages of 21 and 25 years and 0.10 smaller for men married between the ages of 26 and 35 years, compared with men who married below the legal marital age of 21. This study provides support for the use of an ecological model to explain domestic violence perpetration in the context of Bangladesh to suggest a multipronged holistic effort to address this insidious social problem and prevent its intergenerational transmission.

Participant Recruitment and Engagement in Automated eHealth Trial Registration: Challenges and Opportunities for Recruiting Women Who Experience Violence

BACKGROUND

Automated eHealth Web-based research trials offer people an accessible, confidential opportunity to engage in research that matters to them. eHealth trials may be particularly useful for sensitive issues when seeking health care may be accompanied by shame and mistrust. Yet little is known about people's early engagement with eHealth trials, from recruitment to preintervention autoregistration processes. A recent randomized controlled trial that tested the effectiveness of an eHealth safety decision aid for New Zealand women in the general population who experienced intimate partner violence (isafe) provided the opportunity to examine recruitment and preintervention participant engagement with a fully automated Web-based registration process. The trial aimed to recruit 340 women within 24 months.

OBJECTIVE

The objective of our study was to examine participant preintervention engagement and recruitment efficiency for the isafe trial, and to analyze dropout through the registration pathway, from recruitment to eligibility screening and consent, to completion of baseline measures.

METHODS

In this case study, data collection sources included the trial recruitment log, Google Analytics reports, registration and program metadata, and costs. Analysis included a qualitative narrative of the recruitment experience and descriptive statistics of preintervention participant engagement and dropout rates. A Koyck model investigated the relationship between Web-based online marketing website advertisements (ads) and participant accrual.

RESULTS

The isafe trial was launched on September 17, 2012. Placement of ads in an online classified advertising platform increased the average number of recruited participants per month from 2 to 25. Over the 23-month recruitment period, the registration website recorded 4176 unique visitors. Among 1003 women meeting eligibility criteria, 51.55% (517) consented to participate; among the 501 women who enrolled (consented, validated, and randomized), 412 (82.2%) were accrued (completed baseline assessments). The majority (n=52, 58%) of the 89 women who dropped out between enrollment and accrual never logged in to the allocated isafe website. Of every 4 accrued women, 3 (314/412, 76.2%) identified the classified ad as their referral source, followed by friends and family (52/412, 12.6%). Women recruited through a friend or relative were more likely to self-identify as indigenous Māori and live in the highest-deprivation areas. Ads increased the accrual rate by a factor of 74 (95% CI 49-112).

CONCLUSIONS

Print advertisements, website links, and networking were costly and inefficient methods for recruiting participants to a Web-based eHealth trial. Researchers are advised to limit their recruitment efforts to Web-based online marketplace and classified advertising platforms, as in the isafe case, or to social media. Online classified advertising in "Jobs-Other-volunteers" successfully recruited a diverse sample of women experiencing intimate partner violence. Preintervention recruitment data provide critical information to inform future research and critical analysis of Web-based eHealth trials.

CLINICALTRIAL

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000708853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000708853 (Archived by WebCite at http://www.webcitation/6lMGuVXdK).

Association of intimate partner violence with sociodemographic factors in married women: a population-based study in Iran

Intimate partner violence (IPV) is a neglected public health issue in Iran. This study was conducted among married women residing in urban Rasht (northern Iran), to estimate the prevalence and frequency of different forms of IPV from husband and their associations with socio-demographic factors. We carried out a population-based cross-sectional survey with cluster sampling design from February to October 2015. The samples consisted of married women aged ≥ 18 years with total household in Rasht city (north Iran) as the sample frame. We administered the Revised Conflict Tactics Scale (CTS-2) to estimate prevalence of past-year IPV. Of 2091 women, 57.1% had suffered psychological aggression, 27.6% physical abuse, 26.6% sexual abuse, and 6.9% injury. A significant association with IPV was found for women with, age ≤ 40 years, unemployed, low education, husband's addiction and rented-householders. Women who experienced physical abuse, had less age at marriage than women without violence. Also women with sexual coercion had less length of marriage than other non-abused women. On logistic regression, the strongest predictor of psychological, physical and sexual abuse was unemployment of spouse, whereas for injury it was low educational level (<12 years) of women. Our findings suggest that risk of IPV is high in our population. There is an obvious need of preventive and treatment activities. Our findings point at that various forms of abuse are different from each other in terms of differing characteristics of the perpetrators and it might be that also different strategies are needed to reduce and prevent these violence. Confirmation by further research is needed.

Disclosure and help seeking behavior of women exposed to physical spousal violence in Dhaka slums

BACKGROUND

Despite high prevalence of intimate partner violence (IPV) and its adverse social and health consequences, the rate of help seeking for IPV is generally low. Although the level of IPV is much higher in urban slums of Bangladesh, the level and nature of help seeking of the victims are unknown. This paper aims to address this gap in the literature.

METHODS

Using a cross-sectional survey conducted between August 2011-February 2012, we explored disclosure of violence, help seeking behavior, and their correlates among randomly selected currently married women aged 15-29 in Dhaka slums (n = 2604).

RESULTS

About 60 % of the currently married women reported past year spousal physical violence, but only 21 % disclosed and 19 % sought any help. High acceptance of violence was the main reason for not seeking help. Help was most commonly sought from informal sources (89 %). Any education, frequent and severe physical abuse, and presence of children increased the likelihood of disclosure and help seeking. Most survivors from slum who disclosed also sought help.

CONCLUSIONS

Despite widespread physical abuse, many survivors never sought help. Wide acceptance of violence hampering help seeking needs to be challenged. Increasing disclosure would also enhance help seeking. Awareness rising regarding rights of women to live a violence free life is essential. Although many services are available in the urban area, information about these services needs to be available to women. Promoting education is important in increasing both disclosure and service uptake.

Violence Against Widows in Nepal: Experiences, Coping Behaviors, and Barriers in Seeking Help

Widows are a vulnerable population in Nepal. This study examined Nepalese widows' experiences of violence, their coping strategies, and barriers faced in seeking help. Study participants were recruited from Women for Human Rights, an NGO in Nepal. A stratified purposive sampling approach was used to select 51 widows and 5 staff members for in-depth interviews. Twenty-seven women who experienced violence were included in this analysis. Data were analyzed and synthesized using a thematic analysis procedure. Widows reported a range of violent experiences perpetrated by family and community members that spanned psychological, physical, and sexual abuse. Women dealt with abusive experiences using both adaptive (e.g., attempting to move ahead, seeking social support, using verbal confrontation) and maladaptive coping strategies (e.g., suicidal thoughts or self-medication). However, they faced barriers to seeking help such as insensitivity of the police, perceived discrimination, and general lack of awareness of widows' problems and needs. Findings highlight the need for interventions across the individual, family, community, and policy levels. Avenues for intervention include creating awareness about widows' issues and addressing cultural beliefs affecting widows' lives. Furthermore, efforts should focus on empowering widows, promoting healthy coping, and addressing their individual needs.

Impact of the spread of mass education on married women's experience with domestic violence

This paper investigates the association between mass education and married women's experience with domestic violence in rural Nepal. Previous research on domestic violence in South Asian societies emphasizes patriarchal ideology and the widespread subordinate status of women within their communities and families. The recent spread of mass education is likely to shift these gendered dynamics, thereby lowering women's likelihood of experiencing domestic violence. Using data from 1775 currently married women from the Chitwan Valley Family Study in Nepal, we provide a thorough analysis of how the spread of mass education is associated with domestic violence among married women. The results show that women's childhood access to school, their parents' schooling, their own schooling, and their husbands' schooling are each associated with their lower likelihood of experiencing domestic violence. Indeed, husbands' education has a particularly strong, inverse association with women's likelihood of experiencing domestic violence. These associations suggest that the proliferation of mass education will lead to a marked decline in women's experience with domestic violence in Nepal.

Circumstances leading to intimate partner violence against women married as children: a qualitative study in Urban Slums of Lahore, Pakistan

BACKGROUND

Child marriage (<18 years) is prevalent in Pakistan which is associated with negative health outcomes including intimate partner violence (IPV). Our aim is to describe the types and circumstances of IPV against women who were married as children in urban slums of Lahore, Pakistan.

METHODS

Women of reproductive age (15-49 years) who were married prior to 18 years, for at least 5 years were recruited from most populous slum areas of Lahore, Pakistan. Themes for the interview guide were developed using published literature and everyday observations of the researchers. Interviews were conducted by trained interviewers in Urdu language and were translated into English. The interviews were tape-recorded, transcribed, analyzed and categorized into themes.

RESULTS

All 19 participants were married between 11 and 17 years. Most respondents were uneducated, poor and were working as housemaids. Majority of participants experienced verbal abuse, and threatened, attempted and completed physical violence by their husbands. A sizeable number of women reported unwanted sexual encounters by their husbands. Family affairs particularly issues with in-laws, poor house management, lack of proper care of children, bringing insufficient dowry, financial problems, an act against the will of husband, and inability to give birth to a male child were some of the reasons narrated by the participants which led to IPV against women.

CONCLUSIONS

Women married as children are vulnerable to IPV. Concerted efforts are needed from all sectors of society including academia, public health experts, policy makers and civil society to end the child marriage practice in Pakistan.

An approach to mental health in low and middle income countries: a case example from urban India

Women in low and middle income countries (LMICs) facing poverty, challenging living conditions and gender inequality often express their emotional difficulties through physical health concerns and seek care at primary health facilities. However, primary care providers in LMICs only treat the physical health symptoms and lack appropriate services to address women's mental health problems. This paper, presents data from the counseling component of a multilevel, research and intervention project in a low income community in Mumbai, India whose objective was to improve sexual health and reduce HIV/STI risk among married women. Qualitative data from counselor notes shows that poor mental health, associated with negative and challenging life situations, is most often expressed by women as gynecological concerns through the culturally-based syndrome of tenshun. A path analysis was conducted on baseline quantitative data that confirmed the relationships between sources of tenshum, emotional status and symptoms of common mental disorders (CMDs). Based on these findings, the authors propose a need for culturally appropriate primary care services for LMICs that would integrate mental and physical health. This approach would reduce mental health morbidity among women through early intervention and prevention of the development of CMDs.

Food Insecurity Mediates the Effect of a Poverty-Alleviation Program on Psychosocial Health among the Ultra-Poor in Bangladesh

BACKGROUND

Poor psychosocial health is a major global burden. A challenge to improving psychosocial health is that its associations with risk factors are complicated, inadequately understood, and difficult to modify, and/or require action outside the health sector.

OBJECTIVE

We capitalized on the quasi-experimental assignment of a poverty-alleviation program for the ultra-poor in Bangladesh to investigate how this program affected 2 aspects of psychosocial health; distress, (i.e., the negative cognitive appraisal of stress) and subjective well-being (i.e., satisfaction with domains of life), and the importance of food insecurity as a mediator relative to other stressors and economic status.

METHODS

The study was conducted in 3 northern districts of Bangladesh where the program operated. The ultra-poor households were selected through a multistage selection process. The economically better-off households were excluded during the process and included as study controls. The program supported women by providing income-earning opportunities, strengthening sociopolitical livelihood, and building self-awareness and self-confidence. Data were collected in 2006 from 209 women on demography, psychosocial health, and stressors (i.e., domestic violence, food insecurity, economic status, perceived economy, and emotional social constraints). Data collected in 2002 from the same individuals were used to control for the baseline differences between groups. By using path analysis we showed the direct and indirect effects of the program on distress and well-being.

RESULTS

The program positively affected psychosocial health by alleviating stressors. The indirect effect of the program contributed 74% in reducing distress and 30% in improving well-being. Food insecurity was by far the most important mediator, explaining 50% of indirect effect on distress and 66% of the indirect effect on well-being.

CONCLUSION

Food insecurity is modifiable and an appropriate target for poverty-alleviation and agricultural programs. These findings suggest programmatic and policy attention to the social dimensions of poor psychosocial health, particularly to food insecurity as a central cause.

Community economic status and intimate partner violence against women in bangladesh: compositional or contextual effects?

In this research, we used a multi-level contextual-effects analysis to disentangle the household- and community-level associations between income and intimate partner violence (IPV) against women in Bangladesh. Our analyses of data from 2,668 women interviewed as part of the World Health Organization (WHO) multi-country study on women's health and domestic violence against women showed that household income was negatively associated with women's risk of experiencing IPV. Controlling for residence in a low-income household, living in a low-income community was not associated with women's risk of experiencing IPV. These results support a household-level, not community-level, relationship between income and IPV in Bangladesh.

Domestic violence against women in Eastern Sudan

Background

Violence against women is one of the major public health problems in both developed and developing worlds. The aim of this study was to investigate the prevalence of current (occurred in one year preceding the survey) domestic violence and socio-demographic factors associated with domestic violence against women.

Methods

This was a cross sectional household survey (face to face interview) conducted in Kassala, eastern Sudan, from 1^st March to 1^st June 2014. Multivariable analyses were performed, Confidence intervals of 95% were calculated and P < 0.05 was considered significant.

Results

Of the 1009 women, 33.5% (338) reported current experience of physical violence and, of these 338 women, 179 (53%) and 159 (47%) reported moderate and severe form of physical violence respectively. The prevalence of sexual coercion, psychological violence and verbal insult was 17% (172\1009), 30.1% (304\1009) and 47.6% (480\1009) respectively. In the majority of cases, violence was experienced as repeated acts, ie, more than three times per year. For verbal insult 20.1% (203\480) and 27.5% (277\480) reported yelling and shouting respectively. Again 251 (24.9%) and 270 (26.8%) women reported that they experience divorce threat and second marriage threat respectively. In logistic regression model, husband’s education (OR = 1.5; CI = 1.0-2.1; P = 0.015), polygamous marriage (OR = 1.9; CI = 1.3-2.9; P = 0.000), and husband’s alcohol consumption (OR = 13.9; CI = 7.9-25.4; P <0.000) were significantly associated with domestic violence.

Conclusions

Domestic violence was found to be highly prevalent in eastern Sudan and strongly associated with the educational status, polygamous marriage and husband’s alcohol consumption. We recommend more research to include men.