Domestic violence and its associated factors among married women of a village development committee of rural Nepal

Perceptions on violence against women and its impacts on mental health and response mechanisms among community-based stakeholders: a qualitative study from Nepal

BACKGROUND

Violence against women (VAW) is a significant public health problem. With the emergence of the COVID-19 pandemic, the frequency and severity of VAW has escalated globally. Approximately one in four women in Nepal have been exposed to either physical, psychological, and/or sexual violence in their lifetime, with husbands or male partners being the perpetrators in most cases. VAW prevention has been under-researched in low- and middle-income countries, including Nepal. This study aims to explore the perspectives of local stakeholders, including healthcare providers and survivors of violence in Madhesh Province. The overarching goal is to provide insights for designing prevention and support programs that are acceptable to communities and cater to the needs of survivors.

METHODS

An explorative qualitative study was conducted in Madhesh Province, southern Nepal. A total of 21 interviews, including 15 in-depth interviews (IDIs) with health care providers, three IDIs with women seeking general or maternal and child health services at health care centres, three key informant interviews with the local stakeholders working in the field of VAW, and one focus group discussion with violence survivors, were conducted in Nepali by trained field interviewers. Interviews were recorded, transcribed, translated into English, and analysed using content analysis.

RESULTS

VAW, particularly physical violence, was a common experience in the study area. Sociocultural traditions such as dowry, child marriages and son preference were identifiable triggers for VAW, causing significant physical injuries and mental health problems, including suicide. Health care providers reported that violence survivors often hide their experiences of violence and do not seek any kind of help. Women feared that violence would increase in frequency and intensity if their perpetrators found out that they had disclosed their experiences of violence to health care providers. Local stakeholders emphasized the importance of engaging community leaders and garnering support from both women and men in interventions designed to reduce VAW and its impacts on mental health.

CONCLUSIONS

Participants reported that verbal and physical violence is often perceived as a normal part of women's lives. Women should be made aware of available support services and empowered and supported to increase access and uptake of these services. Additionally, more individual-based counselling sessions that encourage women to escape violence and its mental health consequences while maintaining privacy and confidentiality are recommended.

Domestic violence against women in Jordan: analysis of the demographic and health survey dataset 2017-2018

This study analyzed the 2017-2018 Jordan Demographic and Health Survey (DHS) database to determine the prevalence of domestic violence (DV) against women in Jordan and its associated sociodemographic factors. The findings revealed that among Jordanian women, the lifetime prevalence of DV by husbands was 25.9%, with emotional (20.6%), physical (17.5%), and sexual (5.1%) violence being prominently reported. DV against women was significantly associated with the age, region, and educational status of women, as well as the wealth index, but not their husbands. While the results suggest a potential reduction in DV estimates compared to the last decade, DV still represents a public health issue in Jordan. The study highlights the direct association of DV with socio-demographic characteristics and provides a gateway to identifying high-risk women and implementing appropriate interventions to reduce DV.

Perception, and Experience of Domestic Violence among Women in a Rural Community in Kaduna State, Nigeria

Background

Domestic violence (DV) occurs in all settings, transcending socio-cultural and demographic profiles. It is pervasive, insidious, carried out in private domain, and usually inflicted by family members. It continues over long period and limits avenues of escape for victims. The aim of this study was to assess the perception and experience of DV among rural women in Sabon Gari LGA of Kaduna State, Nigeria.

Methodology

A cross-sectional descriptive study conducted in Tohu community, Sabon Gari LGA, Kaduna State. Sample size of 365 was determined using Fisher's formula, at p-value, reliability coefficient, confidence interval, degree of freedom, and possible attrition rate of 0.5, 1.96, 95%, 0.05, and 16% respectively. The study population comprised all women of reproductive age group in Tohu. Eligible respondents who had been in the community for at least one year were included in the study, while those who were ill were excluded. A semi-structured, interviewer-administered questionnaire was administered by female research assistants, and data collected was analyzed using SPSS version 21.0. Frequencies and percentages were reported for categorical data. Respondents' perception of DV was assessed using 19 questions across 5domains. Composite score of 0-19 was expected for each respondent. Scores of >10, and <10 were considered to be good, and poor perception of DV respectively. Relationships between variables were determined using appropriate test statistics at p-value <0.05.

Results

Fifty-three percent of respondents have good perception of DV, with age, marital status, and occupation affecting respondents' perception. Seventeen percent of respondents had experienced physical and/or verbal abuse. Marital status and level of education were found to affect respondents' experience of DV.

Conclusion

DV is still rife in rural parts of Nigeria. Civil rights groups should intensify efforts toward awareness creation so that victims can report to the appropriate authorities and the perpetrators prosecuted.

Domestic Coercive Control and Common Mental Disorders Among Women in Informal Settlements in Mumbai, India: A Cross-Sectional Survey

Coercive control behaviors central to the abuse of power appear more frequent than other types of domestic violence, but little is known about its frequency, features, and consequences for women in India. We aimed to examine the prevalence of domestic coercive control and its association with physical, sexual, and emotional domestic violence in the preceding year and symptoms of depression, anxiety, and suicidal thinking. In a cross-sectional survey, we interviewed 4,906 ever-married women aged 18-49 years living in urban informal settlements in Mumbai, India. We developed a 24-item scale of coercive control, assessed physical, sexual, and emotional violence using existing questions, and screened for symptoms of depression with the Patient Health Questionnaire (PHQ9), anxiety with the Generalized Anxiety Disorder (GAD7) questionnaire, and suicidal thinking with questions developed by the World Health Organization. Estimates involved univariable and multivariable logistic regression models and the prediction of marginal effects. The prevalence of domestic coercive control was 71%. In total, 23% of women reported domestic violence in the past 12 months (emotional 19%, physical 13%, sexual 4%). Adjusted models suggested that women exposed to controlling behavior had greater odds of surviving emotional (aOR 2.1; 95% CI 1.7, 2.7), physical (1.4; 1.0, 1.9), and sexual (1.8; 1.1, 3.0) domestic violence in the past 12 months; and higher odds of a positive screen for moderate or severe depression (1.7; 1.3, 2.2), anxiety (2.1; 1.3, 3.1), and suicidal thinking (1.7; 1.2, 2.3), and increased with each additional indicator of coercive control behavior. When women reported 24 indicators of coercive control, the adjusted predicted proportion with moderate or severe depressive symptoms was 60%, anxiety 42%, and suicidal thinking 17%. Inclusion of coercive control in programs to support domestic violence, would broaden our understanding of domestic abuse to resemble most victims experience and improve interventions.

Assessment of domestic violence and its associated factors among ever-married reproductive-age women in Cameroon: a cross-sectional survey

BACKGROUND

Domestic violence (DV) against women is a global issue that affects women in all countries and is a significant contributor to their poor health. Women who have experienced DV, in particular, suffer from the gynecological, nervous system, and stress-related issues. Despite such devastating implications, there is a paucity of data on the prevalence of DV and its associated factors among married reproductive-age women in Cameroon.

METHOD

The data were analyzed by using STATA version 14 from a demographic and health survey conducted in Cameroon in 2018. Both bivariable and multivariable logistic regression analyses were done. Statistical significance was determined using a p-value of less than 0.05 and a 95% confidence range.

RESULT

A total of 4,903 ever-married women were included in the study. The mean age ± standard deviation, of the participants was 31.3 (± 8.4) years with an age range of 15-49 years. The prevalence of DV among ever-married Cameroonian women was 30.5% with 95%CI (29.3%, 31.8%). Women's educational attainment (higher educational level) (AOR = 0.58, 95% CI (0.37, 0.92), p value = 0.02), Husband's educational level (husbands who attended primary educational level (AOR = 1.30, 95% CI (1.01, 1.68), p value = 0.04), a woman who had media exposure regarding DV ( AOR = 0.83, 95% CI (0.0, 0.99), p value = 0.04), a woman whose husband drinks alcohol (AOR = 3.00, 95% CI (2.56, 3.53), p value < 0.001), and the region where the women reside (center without Yaoundé (AOR = 2.48, 95% CI (1.75, 3.52), p value < 0.001), west (AOR = 1.49, 95% CI (1.05, 2.11), p value = 0.02), South (AOR = 1.89, 95% CI (1.31, 2.72), p-value = 0.001), and Yaoundé (AOR = 1.65. 95% CI (1.14, 2.39), p value = 0.009) were factors that were significantly associated to DV committed by a husband in the previous 12 months against ever-married women.

CONCLUSION

The present study revealed that the prevalence of DV among ever-married women in Cameroon is high. Women's educational level, husband's educational level, husband's alcohol drinking status, women's exposure to mass-media about DV, and the region where the woman resides in the country were factors significantly associated with DV.

Prevalence and related factors of intimate partner violence among married women in Garmsar, Iran

BACKGROUND

Intimate partner violence (IPV) is the most common type of domestic violence often used by men against their wives. Due to the destructive and widespread social and health consequences of IPV, the present study aimed to investigate the prevalence and related factors of IPV among married women in Garmsar, Iran.

METHODS

Using multi-stage clusters sampling method, this cross-sectional study included 400 married women in Garmsar, Iran. The data collection process was conducted during October and December 2019 using a researcher-made questionnaire. The content validity of the questionnaire was confirmed using content validity ratio (CVR) and content validity index (CVI) indicators (0.85 and 0.88, respectively). Also, the reliability was confirmed by examining the internal consistency and obtaining a score of 0.93 for Cronbach's alpha. Descriptive and analytical statistics were performed using t-test, analysis of variance (ANOVA), and Tukey's post-hoc test.

RESULTS

Most participants were in the age range of 20-40 years (mean age: 34.9 years). The overall exposure of women to IPV was 56.11%. In addition, the most prevalent types of IPV included legal (24%), social (24%), financial (22%), verbal (16%), physical (13%), emotional (12%), and sexual (11%). The effective factors on the prevalence of IPV included number of children, education level, occupation, and age (P less than 0.05).

CONCLUSIONS

We witnessed that women living in Garmsar faced different types of IPV and their overall exposure to this phenomenon was higher than the national and global average. To resolve the problem, the following measurements are recommended: a careful investigation of the reasons for the spread of IPV, implementing interventions based on reliable evidence, and serious cooperation of the experts and relevant governmental and non-governmental institutions, particularly citizens.

The Role of Socioeconomic Factors on Women's Risk of Being Exposed to Intimate Partner Violence

The most important thing learned about intimate partner violence (IPV) over the last 20 years is that violence is gendered and can be learned after faced and can only be understood in the context of gender inequality. To promote gender equality, a number of legal reforms and policies have been put in place over the last decade. The main problem is that there is relationship between all the socioeconomic and demographic factors. This begs the question, does the high educational level, social and economic status of a woman put her at lower risk of experiencing domestic violence? The study hypothesizes that those socioeconomic factors such as literacy, political rights, urbanization, laws against violence, the annual income of women, and the number of women in the labor force can affect IPV prevalence. The study uses secondary data concerning socioeconomic factors from 26 predominantly Muslim countries in Asia-Pacific and North Africa. Findings from the study show that socioeconomic factors such as literacy, political rights, a higher level of urbanization, and the laws against violence have significant impacts and may decrease the prevalence of IPV. However, other socioeconomic factors such as the annual income of women and increased women in the labor force produced unclear results. The test for collinearity on the impacts of each socioeconomic factor against one another was found to be insignificant.

Antenatal-Based Pilot Psychosocial Intervention to Enhance Mental Health of Pregnant Women Experiencing Domestic and Family Violence in Nepal

Survivors of domestic and family violence (DFV) report poorer quality of life and worsening mental health. This study evaluated the effect of a counseling and education intervention on the mental health and help-seeking behaviors among pregnant women living with DFV. A parallel pilot randomized controlled trial was performed among 140 pregnant women attending an antenatal clinic of a tertiary hospital of Nepal. Using computer-generated random numbers, participants were randomized to the intervention group (a counseling session, an information booklet about DFV, and contact details of the counselor) or a control group (usual care plus a booklet containing contact details of local DFV support services). Outcome measures included mental health, quality of life (QOL), self-efficacy, social support, and safety planning behaviors. Analyses followed intention-to-treat, using the generalized estimating equation model. Intervention participants showed significant improvements in anxiety (β = -3.24, p < .001) and depression (β = -3.16, p < .001) at postintervention. Such improvements were also sustained at follow-up assessment (p < .001). Significant group and time interaction for QOL, social support, use of safety behaviors, and self-efficacy (p < .05) revealed a greater increase in these outcome measures among intervention participants at both follow-up assessments compared with the control group. This pilot integrated intervention showed promising outcomes in improving the mental health, social support, and the use of safety behaviors among women with DFV. This intervention could be incorporated into regular antenatal care as a strategy to identify and support victims of DFV. Larger controlled trials with longer follow-up are needed to support and expand on the current findings regarding the effectiveness of a psychosocial intervention targeting victims of DFV in resource-constrained settings.

Prevalence and Correlates of Intimate Partner Violence among Women Attending Different Primary Health Centers in Aljouf Region, Saudi Arabia

Background and Objectives: Intimate partner violence (IPV) is a serious and widespread problem worldwide. IPV can seriously influence the physical, mental, sexual, and reproductive health of women as well as the welfare of their children. In the Middle East, IPV is pervasive and widely acceptable. The present study was done to determine the prevalence and correlates of IPV among women attending different primary health centers in the Aljouf region, Saudi Arabia. Methods: A cross-sectional study was conducted among 403 Saudi women attending different primary health centers in the Aljouf region, Saudi Arabia. A structured anonymous questionnaire was distributed to the targeted population during a face-to-face interview. Data analysis was done using the SPSS program, version 24. Results: The present study showed that 30.3% of the participants had been exposed to IPV over the last year. Concerning the types of violence, the present study revealed that emotional violence is the highest followed by physical and then sexual violence representing 92.6%, 67.2%, and 44.3%, respectively. The significant predictors of IPV were women with one to three children (OR = 7.322, p-value = 0.006), women with four children or more (OR = 13.463, p-value = 0.006), and women married to husbands with aggressive behavior (OR = 98.703, p-value < 0.001). Not taking the approval on marriage was significantly associated with more exposure to violence (OR = 3.190, p-value = 0.042). In addition, husband smoking status was a significant predictor for IPV (OR = 2.774, p-value = 0.012). However, women married to alcoholic drinkers had a significantly lower risk for exposure to IPV (OR = 0.108, p-value = 0.040). On the other hand, women’s age, marital status, women’s educational level, monthly income in RS, perception of income sufficiency, marriage duration, the age difference between women and their husband, and drug abuse status of the husband were not significant predictors of IPV (p-value ≥ 0.05). Sociocultural effects were the most frequent reason for IPV as reported by the participants (57.4%). The most common consequences of IPV were psychological problems (75.4%) and injuries (42.6%). Women’s reactions to IPV were leaving home (32.8%) or no reaction (36.8%) to retain their marriage. Conclusions: IPV remains an important public health problem among married women in this study area. Urgent interventions including educational and screening programs for Saudi women are required to mitigate the problem.

Predictors of spousal coercive control and its association with intimate partner violence evidence from National Family Health Survey-4 (2015-2016) India

Background

The feminist theory posits that spousal coercive control is not random but a purposeful and systematic men’s strategy to control and dominate their female partners. The frequency of coercive control is more than emotional, physical, and sexual intimate partner violence (IPV). Coercive control is usually mistaken with psychological abuse when it is not and has recently gained independent attention within the spectrum of IPV. The role of socioeconomic factors in determining coercive control and associations between coercive control and form of IPV is less researched.

Objective

We aimed to examine sociodemographic and socioeconomic predictors of spousal coercive control and its association with IPV (past 12-months).

Methods

We analysed data of 66,013 ever-married women aged 15-49 from the National Family Health Survey (NFHS)-4 (2015-2016). Estimates involved bivariate and multivariate logistic regression models, and marginal effects prediction.

Results

The prevalence of spousal coercive control is more commonly reported by 48% of women than the prevalence of IPV 25% (emotional 11%, physical 22%, and sexual 5%) in the past 12 months. Adjusted odds ratio indicate that women having three and more children (aOR 1.1, 95% CI: 1.0-1.2), women work status (1.1; 1.1-1.2), husband’s secondary (1.1; 1.1-1.2) or higher education (1.1; 1.1-1.2), and husband alcohol consumption (1.7; 1.6-1.7) increase the odds of coercive control. In the fully adjusted model coercive control independently increased the likelihood of experiencing emotional (aOR 2.8.; 95% CI: 2.6, 3.1), physical (2.2; 2.1, 2.3), and sexual (2.5; 2.3, 2.8) IPV in the past 12 months; and with an increase in each additional indicator of coercive control acts, the likelihood of physical, sexual, and emotional IPV further increases. When women reported six indicators of coercive control, the predicted proportion of women experiencing emotional 53%, physical 45%, and sexual IPV was 25% in the fully adjusted model.

Conclusion

Coercive control limits women’s social support and contacts contributing to low self-esteem, self-efficacy, and poor mental health. The purpose of this study is to highlight that understudied coercive control is more common than other forms of IPV and is a potential risk factor for physical, sexual, and emotional IPV independently. The inclusion of coercive control in interventions is crucial to prevent form of IPV. Survivals long-term safety and independence can be secured if the current protection law against domestic violence is extended to encompass coercive control.

Intimate partner violence: a cross-sectional study in women treated in the Brazilian Public Health System

Objective:

To determine the prevalence and types of violence suffered by women and to identify the gender attitudes related to the situation.

Methods:

This was a descritive, cross-sectional study incluiding 343 women who were assisted at the Brazilian Public Health System in countryside city in northeastern of Brazil. All participants were volunteers and they invited to participate during consultation at a Basic Health Unit. As participants, they filled out the World Health Organization Violence Against Women Questionnaire and responded to a sociodemographic questionnaire.

Results:

The victims were, on average, 20.3 years old, and 53.2% of them were married. There was a prevalence of 52.9% of psychological violence, 30.5% of physical violence, and 12.3% of sexual violence. Participants reported alcoholism (67%) and jealousy (60.8%) as triggers to violence. The main psychological abuses were insults and humiliation. In terms of physical violence, the major ones were pushes and slaps. The sexual violence most reportedwere sexual intercourse against the will of the woman and sexual intercourse because of fear of the partner. A portion of the participants justified violence due to women’s infidelity, refusal to have sex, and disobedience to her husband.

Conclusion:

Education in gender equality as a measure of opposition to the culture of female subjugation can reflect on the resignification of the violence suffered by them, and not on blaming the victim of violence by an intimate partner.

Psychological violence against women practiced by intimate partners: a cross-sectional study in a rural area of Rio Grande do Sul, Brazil, 2017

OBJECTIVE

To estimate prevalence and factors associated with intimate partner psychological violence against women in a rural area in the state of Rio Grande do Sul, in 2017.

METHODS

This was a cross-sectional population-based study with women aged 18-49 years old and who had had an intimate partner in their lifetime. Questions from the World Health Organization Violence Against Women Study were administered. Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI).

RESULTS

971 women participated. Prevalence of lifetime psychological violence was 17.2% (95%CI 14.9;19.7). Those diagnosed with depression (PR=2.23 - 95%CI 1.70;2.91) and who had consumed alcohol in the last week were more likely to refer lifetime psychological violence (PR=1.53 - 95%CI 1.07;2.17). Single women were more likely to experience psychological violence than married women (PR=1.86 - 95%CI 1.32;2.63).

CONCLUSION

Psychological violence against woman in rural areas was related to mental health and alcohol use.

Controlling Behavior and Intimate Partner Violence: A Cross-Sectional Study in an Urban Area of Delhi, India

Intimate partner violence (IPV) is a widespread issue faced by women across the world. While prevalence and epidemiology of IPV has been studied extensively, its association with controlling behavior has been largely ignored. We carried out this study to assess the prevalence of IPV against married women and its association with sociodemographic factors, justification of violence, and controlling behavior by their spouses in Delhi, India. Five hundred women residing in an urban residential area of Delhi, India, responded to a validated questionnaire asking about IPV and controlling behaviors by their husbands. In our study, 30.6% of women had "ever" experienced IPV, and 43.2% women stated that they had experienced controlling behavior by their husbands. Alcohol consumption by the husband, women's justification of their partner's violence, and controlling behavior by the husbands were significantly associated with the experience of IPV among study participants. Women with a lower education status, not financially employed, those who justified violence or faced any form of violence in their marital life were at higher risk of experiencing controlling behavior from their spouses.

Married Women's Experience of Domestic Violence in Malawi: New Evidence From a Cluster and Multinomial Logistic Regression Analysis

Violence against women is a global issue with estimates indicating that 35% of all women worldwide have experienced either physical and/or sexual intimate partner violence or nonpartner violence in their life time. In Malawi, 42% of ever-married women have experienced some form of violence perpetrated by their current or most recent spouse. A number of studies have investigated intimate partner violence in Malawi within the context of HIV/AIDS, girls' sexual abuse, and psychological distress, and a few studies report on the role of sociocultural factors in influencing gender-based violence. No study has used cluster analysis to systematically analyze different levels of abuse among married women in Malawi. Using the 2015 Malawi Demographic and Health Survey data, we employed cluster analysis and multinomial logistic regression to analyze the distribution of different levels of abuse among married women in Malawi and the key attributes associated with each level of abuse. Correlates of domestic violence significantly differ by levels of abuse and are distributed as follows: controlling behavior (11.8%), general controlling behavior (GCB; 27.1%), moderate physical and emotional abuse (27.2%), and the high and complete abuse (8.5%). Alcohol consumption, ethnicity, and women working status were significantly associated with all four levels of abuse, but age and religion were only associated with controlling behavior and generalized controlling behavior. The strength of association between husband's alcohol consumption, woman's working status, and marriage type and domestic violence increased by level of abuse. On each of these factors, the odds of experiencing violence were lowest in the controlling behavior group and highest in the high physical and emotional abuse group. Policies and programs that are designed to tackle violence against married women in Malawi should incorporate strategies that discourage excessive alcohol consumption, promote messages that women can be bread winners, and discourage polygamous marriage.

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

The main objective of this study was to assess the risk factors and spatial correlates of domestic violence against women of reproductive age in Rwanda. A structured spatial approach was used to account for the nonlinear nature of some covariates and the spatial variability on domestic violence. The nonlinear effect was modeled through second-order random walk, and the structured spatial effect was modeled through Gaussian Markov Random Fields specified as an intrinsic conditional autoregressive model. The data from the Rwanda Demographic and Health Survey 2014/2015 were used as an application. The findings of this study revealed that the risk factors of domestic violence against women are the wealth quintile of the household, the size of the household, the husband or partner's age, the husband or partner's level of education, ownership of the house, polygamy, the alcohol consumption status of the husband or partner, the woman's perception of wife-beating attitude, and the use of contraceptive methods. The study also highlighted the significant spatial variation of domestic violence against women at district level.

Correlates of intimate partner violence in Bhutan: Evidence from the 2012 National Health Survey

Purpose

This paper is to examine the factors associated with partner violence (IPV) in Bhutan.

Design/methodology/approach

The nationally representative National Health Survey data conducted in 2012 was used. The survey included 12,210 women aged 15–75 years. Multiple logistic regression accounting for complex survey design was performed to assess the possible association of the putative factors with physical, sexual, psychological and any IPV experienced in the past 12 months before the survey.

Findings

Alcohol consumption, quarrelling habits and extramarital relationships of husbands/partners were associated with the experience of all types and any IPV. Women performing household chores had increased odds of sexual and any IPV, and those whose husbands had low education levels were more likely to experience physical IPV. Women living in households with >9 members had reduced odds of physical and any IPV. Women married to older husbands/partners were less likely to be psychologically abused. Women from poorer wealth quintiles and who married before reaching 18 years of age also had greater odds of any IPV.

Originality/value

Poor relationship quality, alcohol use, household size, low education, early marriage, poor wealth status and husband’s age were factors associated with one or more types of IPV in Bhutan. Interventions to reduce alcohol use, transform social norms, promote healthy relationships and enhance female empowerment through socio-economic programs may help prevent IPV.

Domestic violence victimisation and its association with mental distress: a cross-sectional study of the Yangon Region, Myanmar

OBJECTIVES

To estimate the prevalence of domestic violence, with subgroups of physical, sexual and emotional violence, among men and women and to assess the association between any lifetime domestic violence (DV) and mental distress among ever-married men and women.

DESIGN

We conducted a cross-sectional study from October to November 2016 using a multistage sampling design. DV questionnaire was adopted from the Demographic and Health Survey programme. Mental distress was estimated using the Hopkins Symptom Checklist-10 (HSCL-10). HSCL-score and DV were the outcome and exposure variables, respectively, in multiple linear regression. Prevalence estimates and associations were presented with a 95% CI and the Wald test.

SETTING

Urban and rural areas of the Yangon region, Myanmar.

PARTICIPANTS

Men and women ages 18 to 49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded.

RESULTS

A random sample of 2383 people was included in the analyses. Among ever-married participants, lifetime (LT) and past-12-month (12M) prevalence of any domestic violence victimisation was higher in women compared with men: LT women: 61.8% (95% CI: 54.3 to 68.9) versus LT men: 42.4% (95% CI: 37.5 to 47.5) and 12M women: 51.2% (95% CI: 44.9 to 57.5) versus 12M men: 37.7% (95% CI: 32.9 to 42.7). Among never-married participants, lifetime physical and sexual violence victimisation rates was higher in men (34.3% and 7.9%) compared with women (19.1% and 6.4%). Mental distress was significantly associated with lifetime DV in women who were afraid of their husbands and men who had wives who exhibited controlling behaviours.

CONCLUSIONS

Domestic violence is prevalent among both men and women and is associated with mental distress. The findings highlight an urgent need to prevent domestic violence in both sexes, including through legal and policy reform and improved mental health services for DV victims.

Domestic violence among married women of reproductive age in Zimbabwe: a cross sectional study

BACKGROUND

Domestic violence does not only violate women's fundamental human rights but it also undermines them from achieving their fullest potential around the world. This study was conducted to assess trends and factors associated with domestic violence among married women of reproductive age in Zimbabwe.

METHOD

This was a cross-sectional study which used secondary data obtained from 2005/06, 2010/11 and 2015 Zimbabwe Demographic and Health Surveys (ZDHS). Respondents ranged from married or living with a partner (15-49 years). Multiple logistic regression analysis was used to examine factors associated with domestic violence.

RESULTS

Out of 4472 women who were currently married, 1907 (42.7%) had ever experienced one form of domestic violence (physical, emotional and sexual violence). Women aged 40-49 was deemed a protective factor against domestic violence. Risk of domestic violence was higher among working women than unemployed women [AOR = 1.35; p ≤ 0.047]. Women who drink alcohol significantly risk experiencing domestic violence compared to their non-drinking counterpart; also women whose husbands drink alcohol were at higher risk of experiencing domestic violence [AOR = 1.35; p ≤ 0.001]. Domestic violence was higher among women whose husbands have ever experienced their fathers beating their mothers and significant for women whose husbands have more than one wife (polygamy) [AOR = 1.35; p ≤ 0.001]. High parity (5 or more children) was also a risk factor for domestic violence among the studied population [AOR = 1.35; p ≤ 0.038].

CONCLUSION

Domestic violence was found to be strongly associated with women whose husbands drink alcohol, products of abusive parents/father beating their mother and/or polygamous marriage (had more than one wife). Domestic violence still remains a challenge and a more biting policy efforts are needed to eradicate this public health canker in Zimbabwe.

'We don't see because we don't ask': Qualitative exploration of service users' and health professionals' views regarding a psychosocial intervention targeting pregnant women experiencing domestic and family violence

Introduction

Given the relative recency of Domestic and Family Violence (DFV) management as a field of endeavour, it is not surprising that interventions for addressing DFV is still in its infancy in developing countries. In order to maximise the success of an intervention, it is important to know which aspects of the intervention are considered important and helpful by service providers and service users. This study, therefore, examined the acceptability of an antenatal-based psychosocial intervention targeting DFV in Nepal and explored suggestions for improving the program in future.

Materials and methods

Intervention participants and health care providers (HCPs) were interviewed using semi-structured interviews. Data were audio-recorded and thematic analysis was used to analyse the data. Final codes and themes were identified using an iterative review process among the research team.

Results

Themes emerging from the data were grouped into domains including perceptions towards DFV, impact of the intervention on women’s lives and recommendations for improving the program. DFV was recognised as a significant problem requiring urgent attention for its prevention and control. Intervention participants expressed that they felt safe to share their feelings during the counselling session and got opportunity to learn new skills to cope with DFV. The majority of the participants recommended multiple counselling sessions and a continued provision of the service ensuring the intervention’s accessibility by a large number of women.

Discussion

This is the first study to document the perspectives of women and HCPs regarding an antenatal-based intervention targeting psychosocial consequences of DFV in Nepal. There was a clear consensus around the need to engage, support and empower victims of DFV and the intervention was well received by the participants. Ensuring good mental health and wellbeing among victims of DFV requires work across individual, organisational and community levels.

Intimate partner physical violence and associated factors in reproductive age married women in Aksum Town, Tigray, Ethiopia 2018, and community based study

Objective

As reports indicated about 1 in 3 of women worldwide have experienced physical violence but there is no enough reports on the current status of the act in Aksum town so this study intended to identify the prevalence and factors associated with physical violence of reproductive age married women in Aksum town Tigray Ethiopia.

Result

A total of 398 women were enrolled in the study and making a response rate of 100%. 112 (28.1%) women had physical violence in their lifetime. Educational level of women (AOR = 2.2; 95% CI 1.28, 6.7), Occupation of women’s (AOR = 3.8; 95% CI 2.32, 12.8), age of husband (AOR = 5.2; 95% CI 2.3, 11.5), husbands having other wife (AOR = 7.8; 95% CI 4.2, 18.9) and husbands having alcohol habits (AOR = 3.8; 95% CI 1.74, 14.7) had significant association with physical violence.

Exposure to domestic violence in women living in Istanbul and Aegean regions: a Turkish sample

Domestic violence (DV) is a serious public health problem in the world. DV against women is also a global problem without cultural, geographic, religious, social, economic or national boundaries. This descriptive cross-sectional study was carried out to determine the situations of DV in women living in Istanbul and the Aegean Region in Turkey. The study population included outpatient clinics of state hospitals both regions. A stratified sampling by age was performed and 1100 women were included into the sample. Data were collected at face-to-face interviews with Domestic Violence Against Women Determination Scale. The mean age of the women living in Istanbul was 41.81 ± 9.75 years and Aegean Region was 33.72 ± 11.38 years. The prevalence of emotional and financial violence were higher in Istanbul and the Aegean Region. The women living in Istanbul got higher scores for Domestic Violence Against Women Determination Scale. The prevalence of the women reporting to suffer from violence from their spouses was 15.4% in Istanbul and 14% in the Aegean Region. While the prevalence of the women suffering from violence was higher in Istanbul, the women in Aegean Region suffered from more severe violence. The violence prevalence was lower among the wives and the husbands with high education levels, employed women and high-income families.

Are interventions focused on gender-norms effective in preventing domestic violence against women in low and lower-middle income countries? A systematic review and meta-analysis

BACKGROUND

One in three women experience intimate partner violence worldwide, according to many primary studies. However, systematic review and meta-analysis of intimate partner violence is very limited. Therefore, we set to summarize the findings of existing primary studies to generate evidence for informed decisions to tackle domestic violence against women in low and lower-middle income countries.

METHODS

Studies were searched from main databases (Medline via PubMed, EMBASE, CINAHL, PopLine and Web of Science), Google scholar and other relevant sources using electronic and manual techniques. Published and unpublished studies written in English and conducted among women aged (15-49 years) from 1994 to 2017 were eligible. Data were extracted independently by two authors, and recorded in Microsoft Excel sheet. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of funnel plot. Statistical analysis was carried out to determine the pooled prevalence using Comprehensive Meta-Analysis software. In addition, sub-group analysis was carried out by study-setting and types of intimate partner violence.

RESULTS

Fifty two studies were included in the systematic review. Of these, 33 studies were included in the meta-analysis. The pooled prevalence of lifetime intimate partner violence was 55% (95% CI: 52, 59%). Of these, main categories were lifetime physical violence [39% (95% CI: 33, 45%); psychological violence [45% (95% CI: 40, 52%)] and sexual violence [20% (95% CI: 17, 23%)]. Furthermore, the pooled prevalence of current intimate partner violence was 38% (95% CI: 34, 43%). Of these, physical violence [25% (95% CI: 21, 28%)]; psychological violence [30% (95% CI: 24, 36%)] and sexual violence [7.0% (95% CI: 6.6, 7.5%)] were the pooled prevalence for the major types of intimate partner violence. In addition, concurrent intimate partner violence was 13% (95% CI: 12, 15%). Individual, relationship, community and societal level factors were associated with intimate partner violence. Traditional community gender-norm transformation, stakeholders' engagement, women's empowerment, intervention integration and policy/legal framework were highly recommended interventions to prevent intimate partner violence.

CONCLUSION

Lifetime and current intimate partner violence is common and unacceptably high. Therefore, concerned bodies will need to design and implement strategies to transform traditional gender norms, engage stakeholders, empower women and integrate service to prevent violence against women.

PROTOCOL REGISTRATION

PROSPERO: 2017: CRD42017079977 .

Counselling-based psychosocial intervention to improve the mental health of abused pregnant women: a protocol for randomised controlled feasibility trial in a tertiary hospital in eastern Nepal

INTRODUCTION

The strong correlation between domestic and family violence (DFV) and mental health has been well documented in studies. Pregnancy is a period when both DFV and mental distress tend to occur and/or accentuate. Although limited, available evidence from developed countries has shown continual support and education as psychological first aid that can reduce DFV and improve mental health. However, there is significantly less number of studies from resource-constrained countries; thus, there continues to be a substantial gap in knowledge and awareness regarding effective interventions for DFV.

METHODS AND ANALYSIS

A two-arm randomised trial with a nested qualitative study has been planned to assess feasibility and treatment effect estimates of a counselling-based psychosocial intervention among pregnant women with a history of abuse. A total of 140 pregnant women who meet the inclusion criteria will be recruited into the study. Block randomisation will be used to allocate women equally into two groups. The intervention group will receive a counselling session, an information booklet and continuous support by a researcher, while women in the control group will receive contact information of local support services. Feasibility measures, such as rates of recruitment, consent and retention, will be calculated. Qualitative interviews with participants and healthcare providers will explore the acceptability and usability of the intervention. Outcome measures, such as psychological distress, quality of life, social support and self-efficacy, will be measured at baseline, 4 weeks postintervention and 6 weeks postpartum.

ETHICS AND DISSEMINATION

This study has obtained ethical approval from the Griffith University Human Research Ethics Committee, the Nepal Health Research Council and the Institutional Review Board of a tertiary hospital in Dharan, Nepal. The findings will be disseminated via peer-reviewed publications and conference presentations and will be used to inform a future multicentre trial.

TRIAL REGISTRATION NUMBER

12618000307202; Pre-results.

Interventions for reducing and/or controlling domestic violence among pregnant women in low- and middle-income countries: a systematic review

BACKGROUND

Domestic violence (DV) during pregnancy is recognized as a global health problem associated with serious health consequences for both the mother and her baby. Several interventions aimed at addressing DV around the time of pregnancy have been developed in the last decade, but they are primarily from developed countries. Low- and middle-income countries (LMICs) are facing both a mounting burden of DV as well as severe resource constraints that keep them from emulating some of the effective interventions implemented in developed settings. A systematic review was conducted to examine the approaches and effects of interventions designed for reducing or controlling DV among pregnant women in LMICs.

METHODS

Electronic databases were systematically searched, and the search was augmented by bibliographic reviews and expert consultations. Two reviewers assessed eligibility and quality of the studies and extracted data independently. The third reviewer was involved to resolve any discrepancies between the reviewers. Due to the limited number of studies and varied outcomes, a meta-analysis was not possible. Primary outcomes of this review included frequency and/or severity of DV and secondary outcomes included mental health, safety behaviours, and use of community resources. In addition, findings from the critical appraisal of studies were utilised to inform the initial draft of Theory of Change (ToC).

RESULTS

Only five studies (two randomized trials and three non-randomized trials) met the eligibility criteria. The interventions consisting of supportive counselling demonstrated a reduction in DV and an improvement in use of safety behaviours. One study has embedded the DV intervention into an existing program on human immunodeficiency virus (HIV). Limited evidence could be drawn for outcomes such as quality of life and the use of community resources.

DISCUSSION

This review attempted to address the knowledge gap by collating evidence on interventions aimed at addressing DV among pregnant women in LMICs. The development of a ToC was critical in understanding how certain activities led to the desired outcomes. This ToC can guide the design of future research and development of practice guidelines. The participatory involvement of the stakeholders is recommended to refine the current ToC to support its further development for practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42017073938.

Adapted tool for the assessment of domestic violence against women in a low-income country setting: a reliability analysis

Background

One-in-three women has experienced domestic violence, which is a serious public health problem and a human right violation. Domestic violence is a common life experience among women in Ethiopia. The tool used to assess violence against women (VAW) has not been validated to assess its consistency. Cronbach's alpha (α, or coefficient alpha) is a measure of internal consistency, or reliability, that is, how closely a set of items are related as a group. Reliability is how well a test measures what it should. Therefore, the aim of this study was to estimate the inter-item correlation (reliability) of the tool adapted from literature.

Methods

A community-based study was conducted in Northwestern Ethiopia between November 15, 2017 and December 31, 2017. A total of 1,269 women at their permanent place of residence (specifically at their households) were recruited using the multistage stratified systematic sampling method. A structured questionnaire was adapted from literature. Also, 12 trained female data collectors collected the data using the face-to-face interview method. Data were entered into EpiData 3.1.0 and exported to SPSS 23.0 for analysis. Descriptive statistical analysis was carried out to estimate the reliability of the response(s).

Results

Overall, Cronbach's alpha was higher than the minimum recommended value of 0.70. Cronbach's alpha for specific sections were 0.764 for women's decision-making autonomy (13 items); women's accepting attitude toward justified wife-beating (five items, 0.894); physical violence (seven items, 0.876); psychological violence (15 items, 0.925); sexual violence (five items, 0.812); and inequitable gender-norms (seven items, 0.867).

Conclusion

The tool used to assess domestic VAW in Northwestern Ethiopia had a high reliability. Therefore, researchers can adapt the tool and further assess its reliability in other settings to have a common and validated tool to study VAW in a low-income countries.

Evaluation of reproductive health status among women referring to rural healthcare centers in Neyshabur (Iran) in 2017

Background

Reproductive health is one of the most important aspects of life. Moreover, rural women constitute the largest demographic in society who are deprived of health services.

Objective

To determine the reproductive health needs of rural women of reproductive age.

Methods

This cross-sectional study was conducted on 405 rural women referring to the rural healthcare centers of Neyshabur, Iran, in 2017. The study population was selected through random multistage sampling technique. Data collection was carried out using a standardized questionnaire, evaluating sexual and reproductive health needs. Data analysis was performed using descriptive statistics in SPSS version 17.

Results

According to the results, 99.2% and 95.5% of the females received prenatal and postpartum healthcare, respectively. In addition, the rate of cesarean section was 30.25% among the rural women. The contraceptive pill was the most known birth control method (88.9%), whereas coitus interruptus was the most frequently used method (28.5%). Moreover, 59.8% of the rural women married at the age of ≤ 18 years. The most known sexually transmitted disease for these women was HIV/AIDS (81.7%), and just more than half of them had a history of colored vaginal discharge over the past 12 months (56.8%). Furthermore, these women reported 33.1% domestic violence over the past year.

Conclusion

The findings of the present study revealed the urgent need for planning programs to improve the reproductive health of rural women.

Domestic violence: a hidden barrier to contraceptive use among women in Nigeria

Background

The nonuse of family planning methods remains a major public health concern in the low-and-middle-income countries, especially due to its impact on unwanted pregnancy, high rate of abortion, and transmission of sexually transmitted diseases. Various demographic and socioeconomic factors have been reported to be associated with the nonuse of family planning methods. In the present study, we aimed at assessing the influence of domestic violence (DV) on contraceptive use among ever married women in Nigeria.

Methods

Data on 22,275 women aged between 15 and 49 years were collected from the most recent Nigeria Demographic and Health Survey conducted in 2013. The outcome variable was contraceptive utilization status, and the main exposure variable was DV, which was assessed by the self-reported experience of physical and psychological abuse. Complex survey method was employed to account for the multistage design of the survey. Data analyses were performed by using bivariate and multivariable techniques.

Results

The mean age of the participants was 31.33±8.26. More than four fifths (84%) of the participants reported that they were not using any contraceptive methods at all. Lifetime prevalence of psychological and physical abuse was, respectively, 19.0% (95% CI =18.0–20.1) and 14.1% (95% CI =13.3–14.9). Women who reported physical abuse were 28% (adjusted odds ratio [AOR] =1.275; 95% CI =1.030–1.578), and those reported both physical and psychological abuse had 52% (AOR =1.520; 95% CI =1.132–2.042) higher odds of not using any contraception.

Conclusion

The rate of contraception nonuse was considerably high and was found to be significantly associated with DV. Thus, the high prevalence of DV may compromise the effectiveness of the family planning programs in the long run. Evidence-based intervention strategies should be developed to protect the health and reproductive rights of the vulnerable women and to reduce DV by giving the issue a wider recognition in public policy making.

Interventions for domestic violence among pregnant women in low- and middle-income countries: a systematic review protocol

BACKGROUND

Violence during pregnancy is a global problem, associated with serious health risks for both the mother and baby. Evaluation of interventions targeted for reducing or controlling domestic violence (DV) is still in its infancy, and the majority of findings are primarily from high-income countries (HICs). Therefore, there is an urgent need for generating evidence of DV interventions among pregnant women in low- and middle-income countries (LMICs).

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be employed to structure the review. A comprehensive search will be carried out via electronic databases including MEDLINE, CINAHL, Scopus, Embase, Web of Science, PsycINFO, and The Cochrane library. Gray literature will also be scrutinized for potential articles. An optimal search strategy has been developed following consultations with subject-matter experts and librarians. This search strategy will be adapted to the different databases. Experimental studies evaluating DV interventions among pregnant women from LMICs will be included in the review. The review will only include literature written in English. Two reviewers will independently screen and assess studies for inclusion in the review. A third author will resolve any discrepancies between the reviewers. Risk of bias will be assessed based on the Cochrane risk of bias assessment tool, and overall quality of the evidence will be judged using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Findings will be presented with the narrative synthesis, and if applicable, they will be further quantified using random-effects meta-analysis. Effect size, risk ratio for dichotomous variables, and standardized mean differences for continuous variables will be calculated for each outcome using Review Manager 5.3.

DISCUSSION

Systematic reviews to evaluate the efficacy of interventions to address DV within the perinatal context have been limited. Hence, no one intervention has emerged as substantially effective towards addressing perinatal DV and associated health consequences. The evidence generated from this systematic review will inform researchers and policy makers about the effectiveness of existing DV interventions among pregnant women in LMICs and provide recommendations for future research in this area. This in turn will contribute towards violence prevention in LMICs.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017073938.

Community based intervention to prevent domestic violence against women in the reproductive age in Northwestern Ethiopia: a protocol for quasi-experimental study

Background

Violence against women is a well understood devastating global pandemic, and human right violation. One in three women experienced intimate partner violence worldwide. In Ethiopia, the level of domestic violence against women is one of the highest in the world. However, Ethiopia is signatory for various conventions and incorporated in legal frameworks. Nevertheless, effective implementation of the existing policy documents, and engaging different stakeholders is very limited. Therefore, we aimed to pilot feasibility of implementing available research evidence and policy documents at community level to prevent domestic violence against women in Awi zone, northwestern Ethiopia.

Methods

A community-based quasi-experimental study design will be employed using mixed method. Multistage stratified systematic sampling and purposive sampling will be used to recruit quantitative and qualitative study participants, respectively. A total of 1,269 women will be participated in the intervention, active comparator and control groups. Pre and post-test quantitative data will be collected using face-to-face interview. Qualitative data will be collected through in-depth, key informant interview and focus group discussions. Intervention: advocacy meeting will be held to persuade local politicians and sustain the implementation of community based intervention to prevent domestic violence against women. Community representatives will be trained to enhance peer education to promote community awareness and engage stakeholders to transform the traditional gender norm within local context. Awareness creation and husband involvement will be made through integrating the intervention with community health extension program. Only husband involvement will not be promoted in the active comparator to test the role of husband involvement on the domestic violence prevention activities. Intervention progress will be monitored regularly. Gathered data will be entered in Epidata and exported to SPSS (23.0) software for analysis. Descriptive statistics, logistic regressions, intention to treat analysis and difference in differences will be computed. Qualitative data will be transcribed, color coded, thematically analyzed and arranged using Nvivo.

Discussion

This interventional study is aimed to design, pilot and translate proven research evidence, agreed conventions and country policy document to real setting implementation. We are expecting to initiate implementation of culturally acceptable intervention through engaging stakeholders. Policy makers, planners and any concerned bodies will be benefited.

Trial registration

ClinicalTrials.gov ID: NCT03265626

Factors Associated With Domestic Violence Against Women in Iran: An Exploratory Multicenter Community-Based Study

Domestic violence against women committed by intimate partners is a worldwide concern especially in developing countries. The aim of this study was to assess the problem among Iranian women and identify associated risk factors. Using a cross-sectional multicenter design, 1,600 women in six different areas of Iran were surveyed. A measure of domestic violence against women was administered and demographic information collected. Logistic regression models were used to identify factors associated with domestic violence. The prevalence of domestic violence among participants were emotional (64%), physical (28%), and sexual (18%). Higher education (both women and their partners), employment status of partner (being employed), and lower number of children lowered the risk, whereas history of previous marriage (for either women or their partners), unstable marriage, substance abuse, crowded family situation, and lower socioeconomic status increased the risk of domestic violence. There is a high prevalence of domestic violence, particularly emotional, against women by their partners. Preventive measures are recommended such as increasing public awareness, improving in socioeconomic status of families, educating women about what they can do, and encouraging counseling for the couple or the woman alone.