Intimate Partner Violence Causes And Prevention Pdf
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- Interventions to Prevent Intimate Partner Violence
- Intimate partner violence: causes and prevention
- Intimate partner violence: causes and prevention
Handbook of Injury and Violence Prevention pp Cite as. Intimate partner violence IPV became widely recognized as a health and social problem in the s. The accumulated body of research indicates that IPV is very common. The goal of this chapter is to discuss and review the various prevention efforts that have been undertaken to reduce IPV perpetration.
Interventions to Prevent Intimate Partner Violence
Metrics details. Intimate partner violence IPV against women is a global public health and human rights concern. Despite a growing body of research into risk factors for IPV, methodological differences limit the extent to which comparisons can be made between studies.
We used data from ten countries included in the WHO Multi-country Study on Women's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites, in order to inform the design of IPV prevention programs. Standardised population-based household surveys were done between and One woman aged years was randomly selected from each sampled household.
Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. Secondary education, high SES, and formal marriage offered protection, while alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood, increased the risk of IPV. The strength of the association was greatest when both the woman and her partner had the risk factor.
IPV prevention programs should increase focus on transforming gender norms and attitudes, addressing childhood abuse, and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention. Peer Review reports. Intimate partner violence IPV against women is a global human rights and public health concern.
In addition to being a concern in its own right, IPV is associated with a range of adverse physical, mental, sexual and reproductive health outcomes [ 2 — 8 ].
Studies in various countries have identified a range of factors that influence IPV risk [ 9 — 13 ], but in some cases, protective factors in one setting may be ineffective or actually increase risk in another [ 14 ]. For the purposes of intervention development, there is considerable interest in identifying a set of risk and protective factors for IPV that behave consistently across settings, to maximise chances of intervention success and minimise chances of inadvertently doing harm.
It is difficult to make comparisons between settings using existing individual studies as differences in identified risk factors may either be methodological artefacts or a real reflection of contrasting phenomena. Selected Demographic and Health Surveys [ 12 , 15 ] have added a Domestic Violence Module; however, country-level adaptations to the module and interviewer training procedures still limit their comparability.
Standardisation is very important in a research field where even individual interviewer effects have a profound effect on level of disclosure[ 16 ]. We use population-based data from the WHO Multi-Country Study on Women's Health and Domestic Violence, which was specifically designed to better understand the factors associated with violence in different settings.
Comparability of data was maximised through use of a standardised questionnaire, standardised interviewer training and data-collection procedures across all participating sites, and a rigorous set of quality control procedures. We drew on current models of IPV risk, including those of Heise [ 17 , 18 ] and Jewkes [ 19 ] to develop a 'relationship' approach to assessing IPV risk.
The characteristics and experiences of both the victim and the perpetrator are considered - in terms of what happened to each before they entered into the relationship, and their relative situations within the relationship - alongside features and dynamics of the relationship itself See Figure 1.
Our goal is to identify factors that appear to consistently increase or decrease risk of partner violence across settings, and to identify where there are differences in patterns of association between sites. Details of the study methods, sampling, response rates, and prevalence of different types of partner violence in each setting have been reported elsewhere [ 1 ] see Additional file 1.
In five countries surveys were done in the capital or another large city and one predominantly rural province. In the other five countries, only one site was surveyed because of logistical and financial considerations.
Trained female interviewers completed interviews with one randomly selected woman aged from each sampled household. Specially developed ethical guidelines emphasised the importance of ensuring confidentiality and privacy, both to protect the safety of respondents and field staff and to improve the quality of the data [ 20 ]. Ethical approval for the study was obtained from WHO's ethical review group WHO Secretariat Committee for Research in Human Subjects , from the local institutions and, where necessary, national ethical review boards.
Currently- or previously-partnered women were asked a series of questions about whether they had ever experienced specific violent acts see Figure 2 , and if so whether this had happened in the 12 months preceding the survey. Those who had experienced partner violence during their lifetime but not in the past year were excluded from the analysis so as not to dilute associations. Variables were conceptualised as 'prior to relationship' if they preceded the relationship or 'current situation' if they related to the current situation within the relationship.
We used bivariate logistic regression to estimate the crude associations between each exposure variable and IPV, and to select variables for the multivariate analysis.
Multivariate logistic regression was then used to model factors associated with past year IPV, separately for 'prior to relationship' characteristics, and 'current situation' variables. This chronological separation allowed us to explore the effects of the early-life exposures independently of the later-life variables, which may be on the causal pathway and thus attenuate the associations between early-life experiences and later IPV. Clustering of outcomes in each site was 'small' all intra-class correlation coefficients were less than 0.
As our overall aim was to identify similarities and differences in patterns of association between settings, we did not attempt to fit the most parsimonious model for each site. Neither did we place too much emphasis on the statistical significance of individual associations. Instead we focused on exploring the extent to which, keeping all other features of the model constant, patterns of associations were similar or different between sites. When reporting results, we consider odds ratios OR between 0.
We use the terms risk- and protective-factors loosely to indicate the direction of association with IPV rather than to imply causality, as we are analysing cross-sectional data. In total, having excluded women reporting lifetime but not past-year experience of violence, and those with missing data for key variables in the models, 15, women were included in the 'prior to relationship' analyses, and 15, in the 'current situation' analyses see Tables 1 and 2. Percentage distributions and adjusted odds ratios for all variables in the multivariate models are presented in Table 1 prior to relationship , and Tables 2 and 3 current relationship.
Bivariate analysis of educational level indicated a reduction in IPV risk associated with secondary education for both the woman and her partner, but showed less consistent evidence of a protective effect of primary education. Therefore, when considering the woman and her partners' education in combination, we focused on complete versus incomplete secondary education except for Bangladesh, Ethiopia and Tanzania where we examined primary completion because of extremely low secondary school enrolment.
Achieving secondary education or primary for Bangladesh, Ethiopia and Tanzania by either the woman or her partner was associated with decreased IPV in almost two thirds of the sites 3 significant for each partner , when compared to situations where neither the woman nor her partner completed the level.
This most highly educated exposure group also had the lowest ORs for IPV in 10 out of 14 sites, compared to couples where one or both had not completed the level.
A history of abuse was strongly associated with the occurrence of IPV, with reports of abuse of the woman's mother, her partners' mother, or both compared to no known reported abuse of either mother being associated with increased risk of IPV in all sites 10 sites significant for women, 10 for partners, 12 for both. Evidence from bivariate analysis in most sites showed that women who did not know whether their partners had histories of abuse were also at increased risk of IPV compared to those who reported their partners did not have these experiences.
These exposure categories often contained small numbers of women. Since CSA has also been linked to other intervening variables in the model, such as low educational attainment[ 22 ], the fact that CSA remains highly significant in the final model confirms it's importance as a risk factor for IPV. While small numbers in the extreme exposure categories for the abuse variables result in very wide confidence intervals for some of the ORs, the consistency of 'dose-response' patterns observed for all variables in this model provides compelling evidence of the combined importance of childhood experiences of both the woman and her partner in relation to IPV in later life.
Younger age of women was strongly associated with increased risk of past year IPV in all sites significant in A similar pattern was seen in bivariate analysis for partner's age but this variable was excluded from multivariate models due to its strong correlation with the woman's age. In contrast, associations between IPV and an age-gap of at least 5 years between the woman and her partner were weak in most settings and the direction of the effect was context dependent.
Older age of the woman was often associated with increased risk of IPV, but in only three out of fifteen sites was older age of the partner associated with increased risk of IPV. Weak associations were also seen in the other direction for age-gaps favouring either the woman or her partner. There was some suggestion that inequality in educational level between a woman and her partner may increase her risk of experiencing IPV.
This was true in nine out of 15 sites where the woman had the higher level of education 1 significant , and the same where her partner had the higher level. Associations tended to be weak, however, and some were also observed in the opposite direction. There was no consistent pattern of association between IPV and relative employment status.
However, non-significant associations in opposite directions are also observed for these variables. Higher socioeconomic status SES was associated with decreased IPV in fourteen sites significant in 8 sites when comparing the highest status group to the lowest. This variable was more strongly associated with IPV before adjustment for other variables that may confound or mediate the effects of socioeconomic status on IPV risk. Both a woman's experience of non-partner violence and her partner's involvement in fights with other men emerged as strong risk factors for IPV.
These factors were more strongly associated with IPV risk in the bivariate analysis. It is likely that both IPV and non-partner violence share common antecedents, such as CSA in the case of women, or a history of antisocial personality and alcohol abuse among men, which may account for all or part of this association [ 23 , 24 ]. There was some suggestion that those in newer relationships were at increased risk of IPV, with higher levels of IPV in relationships of less than five years compared to longer relationships, in half of the sites mostly non-significant.
There were also several sites where weak associations in the opposite direction were seen for the newest relationships 5. A woman's participation in her choice of husband was associated with IPV differently across sites. In 6 out of 15 sites her lack of participation was associated with higher levels of IPV 3 significant , while in 8 sites it was associated with decreased IPV 1 significant. Payment of dowry and bride price compared to no marital exchange was associated with IPV in some sites, though patterns of risk were difficult to interpret.
In the 6 sites where dowry was paid, it was associated with higher levels of IPV in 4 sites 3 significant and lower IPV in 1 site not significant. Bride price was associated with decreased IPV in 4 sites 2 significant and increased IPV in two sites neither significant.
Women whose husbands had more than one wife were at increased risk of IPV in all 6 sites where polygamy is practised 3 statistically significant.
The same was true for women who reported not knowing whether their husbands had other wives, compared to those who knew. Despite the wide variations in the prevalence of IPV across the study sites, many risk factors appear to affect IPV risk similarly, with secondary education, high SES, and formal marriage offering protection, and alcohol abuse, cohabitation, young age, attitudes supporting wife beating, outside sexual relationships, experiencing childhood abuse, growing up with domestic violence, and perpetrating or experiencing other forms of violence in adulthood, increasing the risk of IPV.
We also found that the strength of the association was greater when both the woman and her partner had the risk or protective factor, suggesting the possibility of achieving greater prevention impact through targeting programs to couples most at risk. Overall, our analysis demonstrates far more consistency in risk and protective factors across sites than reported by Hindin and Kishor in their analysis of violence among couples from 10 recent Demographic and Health Surveys DHS [ 12 ].
Among the factors they examined, only alcohol consumption by the husband and exposure to inter-parental violence were consistently associated with a woman's risk of violence in her current relationship.
The WHO study explored a wider range of potential risk and protective factors and was able to exert greater control over the training of interviewers and study implementation. Research has shown that disclosure of partner violence is highly influenced by interviewer factors as well as privacy and context of the interview--factors that are more difficult to control in national surveys designed for other purposes [ 16 , 25 , 26 ].
For this reason, underreporting and misclassification of abuse cases may have obscured some of the associations in the DHS analysis. Our analysis confirms that completing secondary education has a protective effect on IPV risk, whereas primary education alone fails to confer similar benefits [ 27 ]. Results suggesting increased protection when both women and their partners complete secondary education, and those pointing towards increased IPV risk where there is disparity in educational attainment, confirm the importance of promoting equal access to education for boys and girls, as recommended by target 4 of the Gender Equality Goal of the Millennium Development Goals.
Even if it is not an independent or proximate risk factor but one that is partially confounded by or mediated through other factors as suggested by the multivariate analysis , socioeconomic status of households should be taken into account when designing and targeting IPV intervention programmes [ 27 ].
Early life experiences of abuse including the physical abuse of boys and the sexual abuse of girls emerge as consistently strong risk factors for IPV. In order to intervene in this inter-generational cycle of abuse, interventions must address childhood abuse and respond appropriately to children who have witnessed IPV against their mothers.
Although the importance of the sexual abuse of children and the witnessing of marital violence by children has been documented in other studies, the potential importance of the physical abuse of boys has received less attention and merits further exploration.
The consistent association between IPV and other forms of violence against women also point to the need for integrated responses to violence across sectors and programmes [ 30 , 31 ]. For example, programming to support children exposed to marital violence, may help reduce their risk of violence in later life. Male behaviours commonly associated with 'traditional' masculinity [ 32 ], such as having many sexual partners, controlling female behaviour, and fighting other men, are strongly associated with IPV across all sites.
Women having children from another partnership, or, in some settings, working when her partner does not, also appear to increase her risk of IPV. These results highlight the need to engage with men and women to challenge norms around what is expected of, and deemed acceptable behaviour for both men and women. Promising research from Brazil, South Africa and Uganda highlights the potential impacts on partner violence, of programmes that tackle models of masculinity and address issues of gender norms [ 33 ].
Problematic alcohol use, among both women and their partners, is consistently and strongly associated with IPV. While it is difficult to establish the temporality of the observed associations, this relationship has been repeatedly been demonstrated in studies of IPV [ 12 , 34 — 36 ]. Health services, police and addiction programmes may therefore provide important entry points to identify and refer people who may be at risk of IPV.
Intimate partner violence: causes and prevention
The physical, psychological and social consequences of domestic violence DV for the victim and her family have been, and probably remain, inadequately investigated and understood. Studies in different countries have revealed how serious the consequences of DV can be, and have led international organizations concerned with health care e. Many governments have established plans to reduce DV, although this does not mean that they include this de facto problem among their political priorities. Ensuring the availability of reliable data that reflect the context of each country with regard to the prevalence of DV and its consequences for individuals, families and society may be the best argument in support of calls for a global commitment to face this problem effectively. The effects on physical health that earlier studies have documented most clearly are as follows:. Violence during this period increases the risk of spontaneous abortion, low birth weight and perinatal death. In the long term, DV leads to alterations believed to be related with prolonged stress, such as digestive tract disorders irritable bowel syndrome, loss of appetite, vomiting, etc , headache, backache, abdominal pain, chest pain, bone and muscle pain, and unspecific physical symptoms.
Intimate partner violence: causes and prevention
Not a MyNAP member yet? Register for a free account to start saving and receiving special member only perks. A vital part of understanding a social problem, and a precursor to preventing it, is an understanding of what causes it. Research on the causes of violence against women has consisted of two lines of inquiry: examination of the characteristics that influence the behavior of offenders and consideration of whether some women have a heightened vulnerability to victimization.
Domestic violence also named domestic abuse or family violence is violence or other abuse in a domestic setting, such as in marriage or cohabitation. Domestic violence is often used as a synonym for intimate partner violence , which is committed by one of the people in an intimate relationship against the other person, and can take place in heterosexual or same-sex relationships, or between former spouses or partners. In its broadest sense, domestic violence also involves violence against children, teenagers, parents, or the elderly. It takes multiple forms, including physical , verbal , emotional , economic , religious , reproductive , and sexual abuse , which can range from subtle, coercive forms to marital rape and to violent physical abuse such as choking, beating, female genital mutilation , and acid throwing that results in disfigurement or death.
Risk factors are linked to a greater likelihood of intimate partner violence IPV perpetration. They are contributing factors, but might not be direct causes. A combination of individual, relational, community, and societal factors contribute to the risk of becoming a perpetrator of IPV.