The Nicaraguan network of women against violence: using research and action for change

Pathways to change: Three decades of feminist research and activism to end violence against women in Nicaragua

This paper presents the results of nearly three decades of partnership between feminist researchers and activists to prevent violence against women and girls (VAWG) in Nicaragua. A household survey conducted in 1995 in León, the country's second-largest city, revealed that 55 per cent of women had experienced lifetime physical intimate partner violence (IPV), and 27 per cent had experienced IPV in the last 12 months. The study results were instrumental in changing domestic violence laws in Nicaragua. A follow-up study in 2016 found a decrease of 63 per cent in lifetime physical IPV and 70 per cent in 12-month physical IPV. This paper examines possible explanations for the reduction, including the policy reforms resulting from feminist advocacy. We compare risk and protective factors for physical IPV, such as changes in women's attitudes towards violence, their use of services, and knowledge of laws, using data from both the 1995 and 2016 surveys, as well as three waves of Demographic and Health Surveys. We conclude that the decline in IPV can be partially attributed to the efforts of the Nicaraguan women's movements to reform laws, provide services for survivors, transform gender norms, and increase women's knowledge of their human rights.

Intimate Partner Violence Among Women of Reproductive Age in Nicaragua: Results From a Nationwide Survey

This article aims to identify the factors associated with intimate partner violence (IPV) using data from the latest available nationwide survey in Nicaragua. A secondary analysis of the 2011-2012 Nicaraguan Demography and Health Survey (ENDESA 2011-2012) was conducted. A total of 12,605 women aged 15-49 years who had reported being married or united were included. IPV (yes/no) was defined as the outcome variable, and it was considered if a woman suffered verbal, psychological, physical, or sexual violence during the previous 12 months. Crude and adjusted odds ratios with 95% CI were calculated using a bivariate and multivariate logistic regression model. A p value <.05 was considered statistically significant and did not correct p values for multiple testing. The overall prevalence of IPV was 17.5%. Women living in urban setting (AOR: 1.51, 95% CI: 1.26-1.80), women who self-identify as native (AOR: 1.34, 95% CI: 1.34-1.61) or women who have a history of abuse as a child (AOR: 1.96, 95% CI: 1.69-2.27) were more likely to suffer IPV compared to their counterparts. Age was found to be a protective factor for IPV. Variables such as educational level and wealth index, do not report any association with IPV. Our findings shows that IPV in Nicaragua continues to be a frequent event. The results provide evidence of drivers for IPV at a national level. These findings are useful for the design of intervention policies and strategies for the prevention of IPV.

Long-term change in the prevalence of intimate partner violence: a 20-year follow-up study in León, Nicaragua, 1995-2016

Introduction

Although intimate partner violence (IPV) affects an estimated one out of three women globally, evidence on violence prevention is still scarce. No studies have measured long-term change in larger populations over a prolonged period.

Methods

The aim of this study was to measure changes in the prevalence of IPV in León, Nicaragua, between 1995 and 2016. The 2016 study interviewed 846 ever-partnered women aged 15 to 49 regarding experiences of physical, sexual and emotional IPV. These findings were analysed together with comparable data collected from 354 women in 1995. Multivariate logistic regression modelling was carried out on a pooled data set to identify differences between the two studies while controlling for potential confounding factors.

Results

Lifetime physical IPV decreased from 54.8 to 27.6 per cent (adjusted OR (AOR) 0.37; 95% CI 0.28 to 0.49) and 12-month prevalence of physical IPV decreased from 28.2 to 8.3 per cent (AOR 0.29; 95% CI 0.20 to 0.42), respectively. Similar decreases were found in lifetime and 12-month emotional IPV. No significant difference was found in the prevalence of lifetime sexual violence between the two time periods.

Conclusions

The results suggest that the reduction in IPV was not due to demographic shifts, such as increased education or age, but reflects a true decrease in the prevalence of IPV. The decrease is not likely to have occurred on its own, and may be attributable to multisectoral efforts by the Nicaraguan government, international donors and the Nicaraguan women’s movement to increase women’s knowledge of their rights, as well as access to justice and services for survivors during this time period.

What Women Think Should Be Done to Stop Intimate Partner Violence in Ghana

This aricle expands scholarship on intimate partner violence in Ghana by discussing what should be done to stop it, using data from the Northern region. The data came from 53 survey participants who provided useful responses to an open question: "what should we do to stop intimate partner violence"? The 53 respondents were part of 443 women non-randomly sampled at public health centers across the region to participate in a survey on intimate partner violence. Although the survey used a questionnaire, responses to the open question constituted qualitative data for this article. All 53 written responses were typed out verbatim into a Microsoft word document to generate a transcript for analysis. Responses entered in the transcript were numbered to distinguish one from another. Each numbered unit of text represented the complete response of a participant. Data were content-analyzed and reduced to five meaning categories for interpretation and conclusion-drawing. These are: provide behavior change support to couples; institute and enforce legal sanctions against perpetrators; empower women; provide public education for social change; and pray and preach against violence. Discussion of the findings is situated within discourse analysis and the article concludes with a note on implications for policy and practice.

Latinos’ Perspectives and Experiences With Intimate Partner Violence

This qualitative study, utilizing focus group interviews with community members and in-depth interviews with victims and perpetrators, explored Latinos’ beliefs and perceptions of IPV in Oklahoma City, Oklahoma, as a basis for developing culturally appropriate intimate partner violence (IPV) services for this population. The findings from these interviews suggest that this community recognizes IPV as a problem and is aware of the multiple dimensions, potential causes, and negative consequences of IPV. In general, participants perceived family and neighbors as preferring to not get involved in situations of IPV. However, family was also expected to, and often did, provide tangible support to victims. Directions for developing prevention programs for this population and future research are suggested.

Prevention of violence against women and girls: what does the evidence say?

In this Series paper, we review evidence for interventions to reduce the prevalence and incidence of violence against women and girls. Our reviewed studies cover a broad range of intervention models, and many forms of violence--ie, intimate partner violence, non-partner sexual assault, female genital mutilation, and child marriage. Evidence is highly skewed towards that from studies from high-income countries, with these evaluations mainly focusing on responses to violence. This evidence suggests that women-centred, advocacy, and home-visitation programmes can reduce a woman's risk of further victimisation, with less conclusive evidence for the preventive effect of programmes for perpetrators. In low-income and middle-income countries, there is a greater research focus on violence prevention, with promising evidence on the effect of group training for women and men, community mobilisation interventions, and combined livelihood and training interventions for women. Despite shortcomings in the evidence base, several studies show large effects in programmatic timeframes. Across different forms of violence, effective programmes are commonly participatory, engage multiple stakeholders, support critical discussion about gender relationships and the acceptability of violence, and support greater communication and shared decision making among family members, as well as non-violent behaviour. Further investment in intervention design and assessment is needed to address evidence gaps.

The supportive process for ending intimate partner violence after pregnancy: the experience of Nicaraguan women

This grounded theory study found that Nicaraguan mothers exposed to intimate partner violence (IPV) during pregnancy eventually acted to protect their children and themselves. They experienced ending abuse as an empowerment process characterized by a cognitive change in women's attitudes toward partner abuse and the emergence of help-seeking strategies that lead to ending violence with or without ending the relationship. This process was facilitated by a supportive environment that challenged abusive behaviors as well as being asked about abuse during their last pregnancy. Although environmental changes can facilitate ending abuse, Nicaragua's public institutions must be strengthened to reach women in need.

Ending intimate partner violence after pregnancy: findings from a community-based longitudinal study in Nicaragua

Background

Although reducing intimate partner violence (IPV) is a pervasive public health problem, few longitudinal studies in developing countries have assessed ways to end such abuse. To this end, this paper aims to analyze individual, family, community and societal factors that facilitate reducing IPV.

Methods

A longitudinal population-based study was conducted in León, Nicaragua at a demographic surveillance site. Women (n = 478) who were pregnant between 2002 and 2003 were interviewed, and 398 were found at follow-up, 2007. Partner abuse was measured using the WHO Multi-country study on women's health and domestic violence questionnaire. Women's socio demographic variables, perceived emotional distress, partner control, social resources, women's norms and attitudes towards IPV and help-seeking behaviours were also assessed. Ending of abuse was defined as having experienced any abuse in a lifetime or during pregnancy but not at follow-up. Crude and adjusted odds ratios were applied.

Results

Of the women exposed to lifetime or pregnancy IPV, 59% reported that their abuse ended. This finding took place in a context of a substantial shift in women's normative attitudes towards not tolerating abuse. At the family level, no or diminishing partner control [OR_adj 6.7 (95%CI 3.5-13)] was associated with ending of abuse. At the societal level, high or improved social resources [OR_adj 2.0 (95%CI 1.1.-3.7)] were also associated with the end of abuse.

Conclusion

A considerable proportion of women reported end of violence. This might be related to a favourable change in women's norms and attitudes toward gender roles and violence and a more positive attitude towards interventions from people outside their family to end abuse. Maintaining and improving social resources and decreasing partner control and isolation are key interventions to ending abuse. Abuse inquiring may also play an important role in this process and must include health care provider's training and a referral system to be more effective. Interventions at the community level are crucial to reducing partner violence.

State of the science: violence prevention efforts in developing and developed countries

Violence is an important global public health problem that claims the lives of over 1.6 million people each year and results in numerous other health and social consequences. It is also a preventable health problem. This paper provides an overview of the current status of prevention efforts in developing and developed countries, describes what is known about the effectiveness of different approaches and highlights some of the important challenges in building the evidence-base for violence prevention programmes. Research conducted to date shows an imbalance in the emphasis of prevention programmes across the different types of violence. This imbalance is reflected in the timing of response, the nature and level of influence of interventions and programmes and the outcomes studied. Promising and effective approaches have been identified, but many more still require rigorous testing, particularly in developing countries. The current state of the science in violence prevention reveals both progress and a number of remaining challenges.

Bearing witness: ethics in domestic violence research

Epidemiological research involving people has inherent risks. The Council for International Organization of Medical Sciences provides guidance on the ethical principles of epidemiological research, including respect for people, non-maleficence, beneficience, and justice. In this article we discuss the challenges of applying each principle to population research on domestic violence, an issue in which poorly designed research could put women in violent relationships at substantial risk. Main concerns include ensuring safety of respondents in a context in which many live with their abuser, protecting confidentiality when breaches could provoke an attack, and ensuring the interview process is affirming and does not cause distress. The inherent risks entailed in research can only be justified if the interview is used to provide information on available services and is a source of immediate referral when necessary, if high-quality data are obtained, and if findings are used to raise awareness of, and improve services for, women who experience domestic violence.

Impact of a rural domestic violence prevention campaign

Domestic violence is a prevalent health problem that in rural areas is further complicated by limited services, social isolation and the lack of privacy. Little is known about the impact of public health education on awareness, attitudes and behavior of the general public regarding domestic violence. This study sought to measure change in societal attitudes and behavioral intention in response to a seven-month public health education campaign targeting domestic violence in a rural county. From October 1998 to April 1999, the campaign used radio advertisements, posters, mailings to libraries and clergy, printed media articles, printed advertisements and health facility modifications. A random-digit-dialing telephone survey was used to evaluate attitudinal and behavioral changes in the intervention and comparison counties before and after the campaign. The response rates for the pre- (n =378) and postcampaign (n=633) surveys were 73 percent and 65 percent, respectively. Statistically significant increases in slogan and advertising recognition occurred in the intervention county (P=0.03), particularly among men recalling the campaign slogan (P=0.006). In a vignette regarding actions to be taken if the neighbor next door was abusing a partner, significant increases occurred in the intervention county in the percentage of respondents who thought that most people would talk to the victim (P=0.04), consult with friends (P=0.002) or talk to a doctor (P=0.004). Domestic violence agency hotline calls in the intervention county doubled following the campaign. Local public health education campaigns in a rural setting may be a valuable adjunct to national efforts, especially in reaching men.

Candies in hell: women's experiences of violence in Nicaragua

The aim of this study was to describe the characteristics of domestic violence against women in León, Nicaragua. A survey was carried out among a representative sample of 488 women between the ages of 15-49. The physical aggression sub-scale of the Conflict Tactics Scale was used to identify women suffering abuse. In-depth interviews with formerly battered women were performed and narratives from these interviews were analysed and compared with the survey data. Among ever-married women 52% reported having experienced physical partner abuse at some point in their lives. Median duration of abuse was 5 years. A considerable overlap was found between physical, emotional and sexual violence, with 21% of ever-married women reporting all three kinds of abuse. Thirty-one percent of abused women suffered physical violence during pregnancy. The latency period between the initiation of marriage or cohabitation and violence was short, with over 50% of the battered women reporting that the first act of violence act took place within the first 2 years of marriage. Significant, positive associations were found between partner abuse and problems among children, including physical abuse. Both the survey data and the narrative analysis pointed to extreme jealousy and control as constant features of the abusive relationship. Further, the data indicate that battered women frequently experience feelings of shame, isolation and entrapment which, together with a lack of family and community support, often contribute to women's difficulty in recognizing and disengaging from a violent relationship. These findings are consistent with theoretical conceptualisations of domestic violence developed in other countries, suggesting that, to a large degree, women's experiences of violence transcend specific cultural contexts.

Sexual abuse during childhood and adolescence among Nicaraguan men and women: a population-based anonymous survey

AIMS

The objective was to describe experiences of sexual abuse occurring before 19 years of age among men and women in León, Nicaragua and to explore the possible association to later sexual risk behavior.

METHOD

A sub-sample of literate urban men and women 25-44 years of age was selected from a representative sample of households in León. After an invitation to a public health event, 154 men (53% of the invited) and 213 women (66% of those invited) participated in giving written answers to an anonymous questionnaire.

RESULTS

Twenty percent of men and 26% of women reported that they had experienced sexual abuse. Women had been victims of attempted or completed rape twice as often as men, 15% as compared to 7%. Thirty-three percent of the abuse towards boys and 66% of the abuse towards girls was committed by family members. Women who had experienced attempted or completed rape were more likely to later have had a higher number of sexual partners compared to non-abused or moderately abused women.

CONCLUSIONS

Sexual abuse of children and adolescents of both sexes is common in Nicaragua. The results underscore the urgent need to address this serious problem more openly, and to make more resources available for the prevention of sexual abuse and for support to victims.

Ethical and methodological issues in conducting research on gender-based violence in Southern Africa

International experience of carrying out research on violence against women among women who may have experienced such violence and among men who may have been violent has raised a number of ethical issues, which appear in sharp focus. This paper is based on the collective experiences derived from involvement in three large gender-based violence surveys in South Africa and one in Zimbabwe. These are broadly concerned with the safety of researchers and research subjects from violence arising because of the research project, risks of traumatisation of both respondents and researchers as violent experiences are recounted; impact of work on violence as an issue in researchers' own relationships; risks of under-reporting the extent of violence experienced or perpetrated; and the need for research efforts to be followed up in ways beneficial to women experiencing violence, such as increased support, public information, and law and policy changes. This paper discusses how these issues have pertained and been addressed in research on gender-based violence in Southern Africa and consider lessons for this and other sensitive areas of reproductive and sexual health research.

Wife abuse among women of childbearing age in Nicaragua

OBJECTIVES

This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in León, Nicaragua.

METHODS

A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age.

RESULTS

The lifetime prevalence of spousal violence was 52% among ever-married women (n = 360). Spousal violence was significantly positively associated with poverty, parity, urban residence, and history of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation.

CONCLUSIONS

Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims.