1
|
Raj A, Dehingia N, Singh A, McAuley J, McDougal L. Machine learning analysis of non-marital sexual violence in India. EClinicalMedicine 2021; 39:101046. [PMID: 34401685 PMCID: PMC8350001 DOI: 10.1016/j.eclinm.2021.101046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Machine learning techniques can explore low prevalence data to offer insight into identification of factors associated with non-marital sexual violence (NMSV). NMSV in India is a health and human rights concern that disproportionately affects adolescents, is under-reported, and not well understood or addressed in the country. METHODS We applied machine learning methods to retrospective cross-sectional data from India's nationally-representative National Family Health Survey 4, a demographic and health study conducted in 2015-16, which offers 4000+ variables as potential independent variables. We used Least Absolute Shrinkage and Selection Operator (lasso) or L-1 regularized logistic regression models as well as L-2 regularized logistic regression or ridge models; we conducted an iterative thematic analysis (ITA) of variables generated from a series of regularized models. FINDINGS Thematic analysis of regularized models highlight that past exposure to violence was most predictive of NMSV, followed by geography, sexual behavior, and poor sexual and reproductive health knowledge. After these, indicators largely related to resources and autonomy (e.g., access to health services, and income generating) were associated with NMSV. Exploratory analysis with the subsample of never married adolescents 15-19 years old, a population with higher representation of recent NMSV, further emphasized the role of wealth and mobility as key correlates of NMSV, along with poor HIV knowledge, tobacco use, higher fertility preferences, and attitudes accepting of marital violence. INTERPRETATION Findings indicate the validity of machine learning with iterative theme analysis (ITA) to identify factors associated with violence. Findings were consistent with prior work demonstrating associations between NMSV and other violence experiences, but also showed novel correlates such as lower SRH knowledge and service utilization and, for girls, norms and preferences suggesting more restrictive gender norms. Sexual and reproductive health, gender equity and safety focused interventions are important for addressing NMSV in India, particularly for adolescents.
Collapse
Affiliation(s)
- Anita Raj
- Center on Gender Equity and Health, Department of Medicine, University of California San Diego, San Diego, CA, USA
- Corresponding author.
| | - Nabamallika Dehingia
- Center on Gender Equity and Health, Department of Medicine, University of California San Diego, San Diego, CA, USA
- Joint Doctoral Program-Public Health, San Diego State University and University of California San Diego, San Diego, CA, USA
| | - Abhishek Singh
- International Institute of Population Sciences, Mumbai, India
| | - Julian McAuley
- Department of Computer Science, School of Engineering, University of California San Diego, San Diego, CA, USA
| | - Lotus McDougal
- Center on Gender Equity and Health, Department of Medicine, University of California San Diego, San Diego, CA, USA
| |
Collapse
|
2
|
Kayser GL, Chokhandre P, Rao N, Singh A, McDougal L, Raj A. Household sanitation access and risk for non-marital sexual violence among a nationally representative sample of women in India, 2015-16. SSM Popul Health 2021; 13:100738. [PMID: 33665330 PMCID: PMC7903128 DOI: 10.1016/j.ssmph.2021.100738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/07/2020] [Accepted: 01/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of household sanitation, specifically toilet facilities, can adversely affect the safety of women and girls by requiring them to leave their households to defecate alone and at night, leaving them more vulnerable to non-marital sexual violence. This study analyzes the association between household sanitation access and past year victimization from non-marital sexual violence (NMSV) in India. METHODS We analyzed 74,698 women age 15-49 from whom information on NMSV was collected in India's National Family Health Survey 2015-16 (NFHS-4). We used multivariable logistic regression to test the relationship between women's household sanitation access and recent NMSV experience, controlling for socioeconomics (SES;e.g., age, marital status, caste, wealth, employment), for the total sample and stratified by rural/urban, given lower access to sanitation and lower NMSV in rural contexts. RESULTS We found that 46.2% of households in our sample lacked their own private sanitation facilities (58.0% rural; 24.5% urban) and were forced to openly defecate (37.3%) or walk to a shared sanitation facility (8.9%), and 0.45% of women report NMSV in the last 12 months (0.33% rural; 0.68% urban). Our multivariable model indicated no significant association between having private household sanitation facilities and NMSV for the total sample, but stratified analyses indicate a significant association for rural but not urban women. In rural India, those who lack private household sanitation, compared to those with a household toilet, have significantly greater odds of NMSV (AOR = 2.45; p < 0.05). These findings persist after accounting for demographics including age and marital status, socio-economic factors related to marginalization (e.g., caste, wealth), women's employment, and the overall climate of the state. CONCLUSION Findings from this study support prior research suggesting that poor access to sanitation is associated with women's risk for NMSV in rural India. This may be via increased exposure, and/or as a marker for greater vulnerability to NMSV beyond what is explained by other SES indicators. Solutions can include increased access to private household sanitation and more targeted NMSV prevention in rural India.
Collapse
Affiliation(s)
- Georgia Lyn Kayser
- Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego (UCSD), La Jolla, CA, USA
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, UCSD, La Jolla, CA, USA
| | - Praveen Chokhandre
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India
| | - Namratha Rao
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, UCSD, La Jolla, CA, USA
| | - Abhishek Singh
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India
- GENDER Project, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India
| | - Lotus McDougal
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, UCSD, La Jolla, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, UCSD, La Jolla, CA, USA
- Department of Education Studies, Division of Social Science, UCSD, La Jolla, CA, USA
| |
Collapse
|