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Wilson IM, Willoughby B, Tanyos A, Graham K, Walker M, Laslett AM, Ramsoomar L. A global review of the impact on women from men's alcohol drinking: the need for responding with a gendered lens. Glob Health Action 2024; 17:2341522. [PMID: 38700277 PMCID: PMC11073422 DOI: 10.1080/16549716.2024.2341522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/07/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Global evidence shows that men's harmful alcohol use contributes to intimate partner violence (IPV) and other harms. Yet, interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men's drinking have not been well articulated, particularly from an international perspective. AIM To document the breadth and nature of harms and impact of men's drinking on women. METHODS A narrative review, using inductive analysis, was conducted of peer-reviewed qualitative studies that: (a) focused on alcohol (men's drinking), (b) featured women as primary victims, (c) encompassed direct/indirect harms, and (d) explicitly featured alcohol in the qualitative results. Papers were selected following a non-time-limited systematic search of key scholarly databases. RESULTS Thirty papers were included in this review. The majority of studies were conducted in low- to middle-income countries. The harms in the studies were collated and organised under three main themes: (i) harmful alcohol-related actions by men (e.g. violence, sexual coercion, economic abuse), (ii) impact on women (e.g. physical and mental health harm, relationship functioning, social harm), and (iii) how partner alcohol use was framed by women in the studies. CONCLUSION Men's drinking results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women's disempowerment. An explicit gendered lens is needed in prevention efforts to target men's drinking and the impact on women, to improve health and social outcomes for women worldwide.
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Affiliation(s)
- Ingrid M. Wilson
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
- Judith Lumley Centre, Latrobe University, Melbourne, Australia
| | - Bree Willoughby
- Centre for Alcohol Policy Research, Latrobe University, Melbourne, Australia
| | - Amany Tanyos
- Centre for Alcohol Policy Research, Latrobe University, Melbourne, Australia
| | - Kathryn Graham
- Institute of Mental Health Policy Research,Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mary Walker
- Politics, Media and Philosophy, Latrobe University, Melbourne, Australia
| | - Anne-Marie Laslett
- Institute of Mental Health Policy Research,Centre for Addiction and Mental Health, Toronto, Canada
| | - Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Abrahams N, Mhlongo S, Chirwa E, Dekel B, Ketelo A, Lombard C, Shai N, Ramsoomar L, Mathews S, Labuschagne G, Matzopoulos R, Prinsloo M, Martin LJ, Jewkes R. Femicide, intimate partner femicide, and non-intimate partner femicide in South Africa: An analysis of 3 national surveys, 1999-2017. PLoS Med 2024; 21:e1004330. [PMID: 38236895 PMCID: PMC10796052 DOI: 10.1371/journal.pmed.1004330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND In most countries, reliable national statistics on femicide, intimate partner femicide (IPF), and non-intimate partner femicide (NIPF) are not available. Surveys are required to collect robust data on this most extreme consequence of intimate partner violence (IPV). We analysed 3 national surveys to compare femicide, IPF, and NIPF from 1999 to 2017 using age-standardised rates (ASRs) and incidence rate ratios (IRRs). METHODS AND FINDINGS We conducted 3 national mortuary-based retrospective surveys using weighted cluster designs from proportionate random samples of medicolegal laboratories. We included females 14 years and older who were identified as having been murdered in South Africa in 1999 (n = 3,793), 2009 (n = 2,363), and 2017 (n = 2,407). Further information on the murdered cases were collected from crime dockets during interviews with police investigating officers. Our findings show that South Africa had an IPF rate of 4.9/100,000 female population in 2017. All forms of femicide among women 14 years and older declined from 1999 to 2017. For IPF, the ASR was 9.5/100,000 in 1999. Between 1999 and 2009, the decline for NIPF was greater than for IPF (IRR for NIPF 0.47 (95% confidence interval (CI) 0.42 to 0.53) compared to IRR for IPF 0.69 (95% CI 0.63 to 0.77). Rates declined from 2009 to 2017 and did not differ by femicide type. The decline in IPF was initially larger for women aged 14 to 29, and after 2009, it was more pronounced for those aged 30 to 44 years. Study limitations include missing data from the police and having to use imputation to account for missing perpetrator data. CONCLUSIONS In this study, we observed a reduction in femicide overall and different patterns of change in IPF compared to NIPF. The explanation for the reductions may be due to social and policy interventions aimed at reducing IPV overall, coupled with increased social and economic stability. Our study shows that gender-based violence is preventable even in high-prevalence settings, and evidence-based prevention efforts must be intensified globally. We also show the value of dedicated surveys in the absence of functional information systems.
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Affiliation(s)
- Naeemah Abrahams
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine: Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Shibe Mhlongo
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esnat Chirwa
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Bianca Dekel
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa
| | - Asiphe Ketelo
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nwabisa Shai
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Leane Ramsoomar
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Shanaaz Mathews
- Children’s Institute, University of Cape Town, Cape Town, South Africa
| | - Gérard Labuschagne
- Department Forensic Medicine & Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Megan Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lorna J. Martin
- Forensic Medicine & Toxicology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa
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Karriker-Jaffe KJ, Blackburn N, Graham K, Walker MJ, Room R, Wilson IM, Waleewong O, Gilchrist G, Ramsoomar L, Laslett AM. Can alcohol policy prevent harms to women and children from men's alcohol consumption? An overview of existing literature and suggested ways forward. Int J Drug Policy 2023; 119:104148. [PMID: 37540918 PMCID: PMC10734562 DOI: 10.1016/j.drugpo.2023.104148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/06/2023]
Abstract
The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.
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Affiliation(s)
| | - Natalie Blackburn
- Center for Health Behavior & Implementation Science, RTI International, Berkeley, CA, USA
| | - Kathryn Graham
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, London/Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mary Jean Walker
- Department of Politics, Media, & Philosophy, La Trobe University, Melbourne, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol & Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Ingrid M Wilson
- Health & Social Sciences, Singapore Institute of Technology, Singapore; Judith Lumley Centre, La Trobe University, Australia
| | - Orratai Waleewong
- International Health Policy Program, Ministry of Public Health, Thailand
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Leane Ramsoomar
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health & Health Systems, University of the Pretoria, Gauteng, South Africa
| | - Anne-Marie Laslett
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Australia
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Ramsoomar L, Gibbs A, Chirwa ED, Machisa MT, Alangea DO, Addo-Lartey AA, Dunkle K, Jewkes R. Pooled analysis of the association between mental health and violence against women: evidence from five settings in the Global South. BMJ Open 2023; 13:e063730. [PMID: 36921941 PMCID: PMC10030569 DOI: 10.1136/bmjopen-2022-063730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES To describe associations between men's poor mental health (depressive and post-traumatic stress symptomatology) and their perpetration of intimate partner violence (IPV) and non-partner sexual violence (NPSV), and women's mental health and their experiences of IPV and NPSV in five settings in the Global South. DESIGN A pooled analysis of data from baseline interviews with men and women participating in five violence against women and girls prevention intervention evaluations. SETTING Three sub-Saharan African countries (South Africa, Ghana and Rwanda), and one Middle Eastern country, the occupied Palestinian territories. PARTICIPANTS 7021 men and 4525 women 18+ years old from a mix of self-selecting and randomly selected household surveys. MAIN OUTCOME MEASURES All studies measured depression symptomatology using the Centre for Epidemiological Studies-Depression, and the Harvard Trauma Scale for post-traumatic stress disorder (PTSD) symptoms among men and women. IPV and NPSV were measured using items from modified WHO women's health and domestic violence and a UN multicountry study to assess perpetration among men, and experience among women. FINDINGS Overall men's poor mental health was associated with increased odds of perpetrating physical IPV and NPSV. Specifically, men who had more depressive symptoms had increased odds of reporting IPV (adjusted OR (aOR)=2.13; 95%CI 1.58 to 2.87) and NPSV (aOR=1.62; 95% CI 0.97 to 2.71) perpetration compared with those with fewer symptoms. Men reporting PTSD had higher odds of reporting IPV (aOR=1.87; 95% CI 1.44 to 2.43) and NPSV (aOR=2.13; 95% CI 1.49 to 3.05) perpetration compared with those without PTSD. Women who had experienced IPV (aOR=2.53; 95% CI 2.18 to 2.94) and NPSV (aOR=2.65; 95% CI 2.02 to 3.46) had increased odds of experiencing depressive symptoms compared with those who had not. CONCLUSIONS Interventions aimed at preventing IPV and NPSV perpetration and experience must account for the mental health of men as a risk factor, and women's experience.
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Affiliation(s)
- Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Health Systems and Public Health, University of the Pretoria, Gauteng, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Department of Psychology, University of Exeter, Exeter, Devon, UK
| | - Esnat D Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mercilene T Machisa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Deda Ogum Alangea
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Adolphina Addoley Addo-Lartey
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Health Systems and Public Health, University of the Pretoria, Gauteng, South Africa
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Jewkes R, Chirwa E, Alangea DO, Addo-Lartey A, Christofides N, Dunkle K, Ramsoomar L, Gibbs A. Pooled analysis of the association between food insecurity and violence against women: Evidence from low- and middle-income settings. J Glob Health 2023; 13:04021. [PMID: 36896806 PMCID: PMC9999307 DOI: 10.7189/jogh.13.04021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Background Intimate partner violence impacts relationships across the socioeconomic spectrum, nonetheless its prevalence is reported to be highest in areas that are most socio-economically deprived. Poverty has direct and indirect impacts on intimate partner violence (IPV) risk, however, one of the postulated pathways is through food insecurity. The aim of this paper is to describe the association between food insecurity (household hunger) and women's experiences, and men's perpetration, of intimate partner violence and non-partner sexual violence in data from Africa and Asia. Methods We conducted a pooled analysis of data from baseline interviews with men and women participating in six Violence Against Women prevention intervention evaluations and present a meta-analysis using mixed-effects Poisson regression models. Data were from South Africa (two studies), Ghana, Rwanda (two data sets), and Afghanistan and comprised interviews with 6545 adult women and 8104 adult men. We assessed food insecurity with the Household Hunger Scale. Results Overall, 27.9% of women experienced moderate food insecurity (range from 11.1% to 44.4%), while 28.8% of women reported severe food insecurity (range from 7.1 to 54.7%). Overall food insecurity was associated with an increased likelihood of women experiencing physical intimate partner violence, adjusted incidence rate ratio (aIRR) = 1.40 (95% CI = 1.23 to 1.60) for moderate food insecurity and aIRR = 1.73 (95% CI = 1.41 to 2.12) for severe food insecurity. It was also associated with an increased likelihood of men reporting perpetration of physical IPV, with aIRR = 1.24 (95% CI = 1.11 to 1.39) for moderate food insecurity and aIRR = 1.18 (95% CI = 1.02 to 1.37) for severe food insecurity. Food insecurity was not significantly associated with women's experience of non-partner sexual violence, aIRR = 1.27 (95% CI = 0.93 to 1.74) for moderate or severe food insecurity vs none, nor men's perpetration of non-partner sexual violence aIRR = 1.02 (95% CI = 0.90 to 1.15). Conclusions Food insecurity is associated with increased physical intimate partner violence perpetration and experience reported by men and women. It was not associated with non-partner sexual violence perpetration, although there was some evidence to suggest an elevated risk of non-partner sexual violence among food-insecure women. Prevention programming needs to embrace food insecurity as a driver of intimate partner violence perpetration, however, non-partner sexual violence prevention needs to be shaped around a separate understanding of its drivers.
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Affiliation(s)
- Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | | | | | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health and Health Systems, University of the Pretoria, Pretoria, Gauteng, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Department of Psychology, University of Exeter, Exeter, Devon, UK
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Morojele NK, Ramsoomar L, Dumbili EW, Kapiga S. Adolescent health series - Alcohol, tobacco, and other drug use among adolescents in sub-Saharan Africa: A narrative review. Trop Med Int Health 2021; 26:1528-1538. [PMID: 34637175 DOI: 10.1111/tmi.13687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Alcohol, tobacco, and other drug (ATOD) use by adolescents are major contributors to death and disability in sub-Saharan Africa (SSA). This paper reviews the extent of adolescents' ATOD use, risk and protective factors, and studies evaluating prevention interventions for adolescents in SSA. It also describes the harms associated with adolescents' ATOD use in SSA, which mainly include interpersonal violence, sexual risk behaviours, and negative academic outcomes. We use the socio-ecological model as our framework for understanding ATOD use risk and protective factors at individual, interpersonal, peer/school, and societal/structural levels. We used two strategies to find literature evaluating ATOD interventions for adolescents in SSA: (a) we sought systematic reviews of adolescent ATOD interventions in SSA covering the period 2000-2020; and (b) we used a comprehensive evidence review strategy and searched for studies that had evaluated ATOD interventions in all SSA countries between 2000 and 2020. Only two community interventions (a brief intervention and an HIV prevention intervention), out of four that were identified, were partially effective in reducing adolescent ATOD. Furthermore, only one school-based intervention (HealthWise), out of six that we uncovered, had any effect on ATOD use among adolescents. Possible reasons why many interventions were not effective include methodological limitations, involvement of non-evidence-based education-only approaches in some studies, and shortcomings in adaptations of evidence-based interventions. The scale of ATOD and related problems is disproportionate to the number of evaluated interventions to address them in SSA. More ATOD interventions need to be developed and evaluated in well-powered and well-designed studies.
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Affiliation(s)
- Neo K Morojele
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa.,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Leane Ramsoomar
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,School of Public Health and Health Systems, University of the Pretoria, Gauteng, South Africa
| | - Emeka W Dumbili
- Institute for Therapy and Health Research, Kiel, Germany.,Department of Sociology and Anthropology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania.,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Ramsoomar L, Gibbs A, Chirwa ED, Dunkle K, Jewkes R. Pooled analysis of the association between alcohol use and violence against women: evidence from four violence prevention studies in Africa. BMJ Open 2021; 11:e049282. [PMID: 34312207 PMCID: PMC8314692 DOI: 10.1136/bmjopen-2021-049282] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To test associations between men's past year alcohol use and patterns of drinking, and their perpetration of intimate partner violence (IPV) and non-partner sexual violence (NPSV). To test the associations between women's reports of partner alcohol use and their experience of IPV, in three countries in Africa. DESIGN Pooled analysis of cross-sectional baseline data from men and women participating in four IPV prevention studies across Africa and Asia. SETTING Data from five data sets generated by four violence against women and girls prevention studies in three countries in sub-Saharan Africa, South Africa, Ghana and Rwanda. PARTICIPANTS 8104 men 18+ years old and 5613 women 18+ years old from a mix of volunteer and randomly selected samples. MAIN OUTCOME MEASURES Studies employed comparable measures of past year alcohol use, harmful alcohol use (Alcohol Use Disorder Identification Test scale) and items from modified WHO Women's Health and Domestic Violence to measure physical IPV and NPSV perpetration among men and IPV experience among women. FINDINGS Overall harmful alcohol use among men was associated with a substantially increased odds of perpetrating physical IPV (adjusted OR (aOR)=3.45 (95% CI 2.56 to 4.64)) and NPSV (aOR=2.64 (95% CI 1.85 to 3.76)) compared with non-drinkers. Women who had seen their partner occasionally drunk (aOR=2.68 (95% CI 2.13 to 3.36)) or frequently drunk (aOR=5.94 (95% CI 4.19 to 8.41)) in the past 12 months had an increased odds of experiencing physical IPV. CONCLUSIONS Alcohol use is associated with increased IPV and NPSV perpetration for men and (physical) IPV experience for women. Reported frequency of IPV and NPSV increase with increasing levels and frequency of alcohol use. Interventions aimed at reducing alcohol may also lead to reductions in IPV and NPSV perpetration and experience.
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Affiliation(s)
- Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Esnat D Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
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Gibbs A, Dunkle K, Ramsoomar L, Willan S, Jama Shai N, Chatterji S, Naved R, Jewkes R. New learnings on drivers of men's physical and/or sexual violence against their female partners, and women's experiences of this, and the implications for prevention interventions. Glob Health Action 2020; 13:1739845. [PMID: 32202227 PMCID: PMC7144308 DOI: 10.1080/16549716.2020.1739845] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/29/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Understanding the drivers of intimate partner violence (IPV), perpetrated by men and experienced by women, is a critical task for developing effective prevention programmes.Objectives: To provide a comprehensive assessment of the drivers of IPV.Methods: A comprehensive review of the drivers of IPV, at the end of a six-year programme of research through the What Works to Prevent Violence Against Women and Girls Global Programme with reference to other important research in the field.Results: Broadly, we argue that IPV is driven by poverty, patriarchal privilege, and the normative use of violence in interpersonal relationships. These factors also increase childhood trauma, poor mental health and substance misuse, and poor communication and conflict in relationships, which in turn impact on IPV. Disability status, and contexts of armed conflict, or post-conflict, further reinforce and exacerbate these risks. We move beyond describing associations towards describing the causal pathways through which these factors operate to increase IPV.Conclusions: Specific recommendations about the future of further research on drivers of IPV include a greater focus on understanding the causal pathways from drivers to IPV and clearly delineating association from causality in studies, particularly for women and girls with disabilities, in armed conflicts, and adolescent girls and young women. To achieve this, we recommend extensive in-depth qualitative research, and complex quantitative modeling studies. Understanding drivers and causal pathways better will enable the identification of points of entry for the development of more effective IPV prevention interventions.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Nwabisa Jama Shai
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Sangeeta Chatterji
- Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ruchira Naved
- Health Systems and Population Studies Division, Icddr,b, Dhaka, Bangladesh
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Cape Town, South Africa
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Ndungu J, Ramsoomar L, Willan S, Washington L, Ngcobo-Sithole M, Gibbs A. Depression, posttraumatic stress disorder (PTSD) and their comorbidity: Implications of adversity amongst young women living in informal settlements in Durban, South Africa. Journal of Affective Disorders Reports 2020. [DOI: 10.1016/j.jadr.2020.100022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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10
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Ndungu J, Washington L, Willan S, Ramsoomar L, Ngcobo-Sithole M, Gibbs A. Risk factors for alcohol and drug misuse amongst young women in informal settlements in Durban, South Africa. Glob Public Health 2020; 15:1322-1336. [PMID: 32493132 DOI: 10.1080/17441692.2020.1775866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Alcohol and drug misuse (ADM) pose a significant disease burden globally. Yet, there remains a gap in understanding risk factors associated with women's ADM, particularly those in marginalised settings. We investigated risk factors associated with ADM amongst young women in urban informal settlements in South Africa. Bivariate and multivariable logistic regression analyses were conducted on a sample of 680 young women assessing associations between sociodemographic factors, mental health, relationship factors and past year ADM. Alcohol misuse was assessed using the 10 item Alcohol Use Disorders Identification Test (AUDIT) scale, with scores ≥8 defining misuse, a single item assessed past year illegal drug use. Alcohol and drug misuse were reported by 23.1% and 31.8% of the women respectively. In multivariable regression, alcohol misuse was associated with experiencing past year non-partner sexual violence, transactional sex with a main partner, past year drug use, and past week depressive symptoms, while drug misuse was associated with alcohol misuse, transactional sex with a casual partner, past year experience of physical and/or sexual IPV and having a functional limitation (disability). Results indicate ADM in informal settlements are shaped by violence and poor mental health. Interventions geared towards strengthening women's economic position and mental healthcare are recommended.
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Affiliation(s)
- Jane Ndungu
- School of Behavioural Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | | | - Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
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Ramsoomar L, Morojele NK, Norris SA. Alcohol use in early and late adolescence among the birth to twenty cohort in Soweto, South Africa. Glob Health Action 2013; 6:19274. [PMID: 23364084 PMCID: PMC3556711 DOI: 10.3402/gha.v6i0.19274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/18/2012] [Accepted: 10/22/2012] [Indexed: 11/21/2022] Open
Abstract
Background Alcohol is a risk factor for the leading causes of mortality and morbidity among young people globally. Youth drinking, initiated in early adolescence and continued into early adulthood, is influenced by maternal socio-demographic factors and maternal education. Limited prospective data exists in South Africa on the prevalence of alcohol use during adolescence and adolescent and maternal
socio-demographic correlates. Objective To examine the prevalence of lifetime alcohol use during early (13 years) and late (18 years) adolescence in Soweto, South Africa, and its association with child and maternal socio-demographic factors. Methods Data on alcohol use in early adolescence (age 13 years) and late adolescence (age 18 years) were collected using self-completed pen and paper and self-completed computer-based questionnaires, respectively. Univariate analyses were conducted on child (gender and number of school years repeated by grade 7), maternal socio-demographic correlates (education, marital status, and age), and household socioeconomic status (SES). Bivariate logistic regression analyses examined associations between alcohol use and all child and maternal socio-demographic factors. Multivariate logistic regression analyses were conducted on all the variables found to be significantly (p<0.10) associated with alcohol use to examine the predictive value on alcohol use at early and late adolescence. Results Lifetime alcohol use increased from 22% at early adolescence to 66% at late adolescence. In multivariate analyses, gender, maternal education, and SES predicted lifetime alcohol use at early adolescence, while gender, maternal education, marital status, and SES were predictive of the same at late adolescence. Conclusion This study aids researchers and practitioners to identify maternal and child socio-demographic
risk profiles for alcohol use to inform policies and programmes.
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Affiliation(s)
- Leane Ramsoomar
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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