Structured Spatial Modeling and Mapping of Domestic Violence Against Women of Reproductive Age in Rwanda

Bayesian spatial modelling of intimate partner violence and associated factors among adult women and men: evidence from 2019/2020 Rwanda Demographic and Health Survey

BACKGROUND

Intimate partner violence (IPV) remains a global public health concern for both men and women. Spatial mapping and clustering analysis can reveal subtle patterns in IPV occurrences but are yet to be explored in Rwanda, especially at a lower small-area scale. This study seeks to examine the spatial distribution, patterns, and associated factors of IPV among men and women in Rwanda.

METHODS

This was a secondary data analysis of the 2019/2020 Rwanda Demographic and Health Survey (RDHS) individual-level data set for 1947 women aged 15-49 years and 1371 men aged 15-59 years. A spatially structured additive logistic regression model was used to assess risk factors for IPV while adjusting for spatial effects. The district-level spatial model was adjusted for fixed covariate effects and was implemented using a fully Bayesian inference within the generalized additive mixed effects framework.

RESULTS

IPV prevalence amongst women was 45.9% (95% Confidence interval (CI): 43.4-48.5%) while that for men was 18.4% (95% CI: 16.2-20.9%). Using a bivariate choropleth, IPV perpetrated against women was higher in the North-Western districts of Rwanda whereas for men it was shown to be more prevalent in the Southern districts. A few districts presented high IPV for both men and women. The spatial structured additive logistic model revealed higher odds for IPV against women mainly in the North-western districts and the spatial effects were dominated by spatially structured effects contributing 64%. Higher odds of IPV were observed for men in the Southern districts of Rwanda and spatial effects were dominated by district heterogeneity accounting for 62%. There were no statistically significant district clusters for IPV in both men or women. Women with partners who consume alcohol, and with controlling partners were at significantly higher odds of IPV while those in rich households and making financial decisions together with partners were at lower odds of experiencing IPV.

CONCLUSION

Campaigns against IPV should be strengthened, especially in the North-Western and Southern parts of Rwanda. In addition, the promotion of girl-child education and empowerment of women can potentially reduce IPV against women and girls. Furthermore, couples should be trained on making financial decisions together. In conclusion, the implementation of policies and interventions that discourage alcohol consumption and control behaviour, especially among men, should be rolled out.

Risk of violence from a current or former partner: Associated factors and classification in a nationwide study in Colombia

Intimate partner violence (IPV) includes assaults that risk a woman's bodily integrity. Intimate partners commit IPV, people with whom the victim shares (or shared) a close personal or sexual relationship. This phenomenon has a great global and national impact. Thus, it is necessary to establish trends of the risk of physical violence to women by their current or former partner in each department of Colombia and its relationship with sociodemographic and health characteristics. This study uses an ecological approach at the departmental level, with victims of intimate partner violence treated at the National Institute of Legal Medicine and Forensic Sciences (INMLyCF). Potential factors were identified through Bayesian factor analysis and were included in the model to estimate risk. The findings show that the Casanare department had the highest risk of producing victims (SMR: 2.545). In departments where the educational level of women is at or below primary school, there is a high-risk β = 0.343 (0.285, 0.397) of them being assaulted. For the departments in which the employment of women is in sales and services or office workers, the associated factor presents a higher risk β = 0.361 (0.201, 0.485), as in the risk related to affiliation with the social security system β = 0.338 (0.246, 0.498), as well as sexual and reproductive life β = 0.143 (0.003, 0.322). The following categories were associated with physical gender violence: no education and low participation in making purchases at home β = 0.106 (0.049, 0.199), low participation in decisions about their health, and visits to family and friends β = 0.240 (0.170, 0.299). Therefore, public health programs should strengthen women's empowerment in household decisions and increase their educational level to reduce this incidence.

Designing and validation of a reproductive health need assessment tool for women experienced domestic violence

Background

Violence as a serious health problem and one of the main manifestations of gender inequality brings about adverse health effects for women. Therefore, it is of utmost importance to recognize the reproductive health status of women subjected to violence in order to provide the health services they need. Considering that one of the ways to determine reproductive health status is the use of valid questionnaires in this field, this study aimed to determine the components of reproductive health in domestic violated women and design a valid and reliable assessment tool.

Methods

The present study was conducted based on a mixed-method design. The first part of the study (qualitative section) was conducted based on conventional content analysis. In this part, unstructured in-depth interviews were conducted with 18 violated women and 9 experts. In the next stage, the item pool was formed and the Reproductive Health Needs of Violated Women Scale was designed based on the review of the literature and the results of the qualitative section with 39 items using the Waltz approach. For psychometric assessment of the above instrument, face and content validity, item analysis, and construct validity were examined using exploratory factor analysis.

Results

Based on the results of factor analysis, the four following factors were extracted with a total variance of 47.62: "men's participation", "self-care", "support and health services", as well as "sexual and marital relationships. The internal consistency of the instrument was calculated at α = 0.70–0.89 and α = 0.94 for different constructs and the whole instrument, respectively. Moreover, intra-cluster correlation coefficients were obtained at ICC = 0.96–0.99 and ICC = 0.98 for constructs and the whole instruments, respectively.

Conclusions

Based on the results of the current study, the present scale is a tool that specifically assesses the reproductive health needs of violated women and has appropriate validity and reliability. The results of the assessment using the aforementioned instruments can be of great help in promoting the reproductive health of women subjected to violence.

Spatial distribution and predictors of domestic violence against women: evidence from analysis of Ethiopian demographic health survey 2016

BACKGROUND

Violence against women particularly that is committed by an intimate partner is becoming a social and public health problem across the world. Studies show that the spatial variation in the distribution of domestic violence was commonly attributed to neighborhood-level predictors. Despite the prominent benefits of spatial techniques, research findings are limited. Therefore, the current study intends to determine the spatial distribution and predictors of domestic violence among women aged 15-49 in Ethiopia.

METHODS

Data from the Ethiopian demographic health survey 2016 were used to determine the spatial distribution of domestic violence in Ethiopia. Spatial auto-correlation statistics (both Global and Local Moran's I) were used to assess the spatial distribution of domestic violence cases in Ethiopia. Spatial locations of significant clusters were identified by using Kuldorff's Sat Scan version 9.4 software. Finally, binary logistic regression and a generalized linear mixed model were fitted to identify predictors of domestic violence.

RESULT

The study found that spatial clustering of domestic violence cases in Ethiopia with Moran's I value of 0.26, Z score of 8.26, and P value < 0.01. The Sat Scan analysis identifies the primary most likely cluster in Oromia, SNNP regions, and secondary cluster in the Amhara region. The output from regression analysis identifies low economic status, partner alcohol use, witnessing family violence, marital controlling behaviors, and community acceptance of wife-beating as significant predictors of domestic violence.

CONCLUSION

There is spatial clustering of IPV cases in Ethiopia. The output from regression analysis shows that individual, relationship, and community-level predictors were strongly associated with IPV. Based upon our findings, we give the following recommendation: The government should give prior concern for controlling factors such as high alcohol consumption, improper parenting, and community norm that encourage IPV that were responsible for IPV in the identified hot spot areas.