Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering

OBJECTIVES: This study estimated the frequency and correlates of intimate partner violence by type (physical, sexual, battering, or emotional abuse) among women seeking primary health care. METHODS: Women aged 18 to 65 years who attended family practice clinics in 1997 and 1998 took part. Participation included a brief in-clinic survey assessing intimate partner violence. Multiple polytomous logistic regression was used to assess correlates of partner violence by type. RESULTS: Of 1401 eligible women surveyed, 772 (55.1%) had experienced some type of intimate partner violence in a current, most recent, or past intimate relationship with a male partner; 20.2% were currently experiencing intimate partner violence. Among those who had experienced partner violence in any relationship, 77.3% experienced physical or sexual violence, and 22.7% experienced nonphysical abuse. Alcohol and/or drug abuse by the male partner was the strongest correlate of violence. CONCLUSIONS: Partner substance abuse and intimate partner violence in the woman's family of origin were strong risk factors for experiencing violence. Efforts to universally screen for partner violence and to effectively intervene to reduce the impact of such violence on women's lives must be a public health priority.     

An Exploration of Maternal Intimate Partner Violence Experiences and Infant General Health and Temperament

Objectives While the women’s health consequences of intimate partner violence have received much research attention, less is known about how maternal abuse experiences affect infant health and well-being. Existing studies have also been unable to examine specific types of intimate partner violence such as psychological aggression, physical abuse, and sexual coercion. This secondary data analysis explored the prevalence, patterns, and types of intimate partner violence within a large cohort of mothers and explored the relationship between maternal intimate partner violence experiences and infant’s general health and temperament at 1 year of age. Methods Existing data were drawn from the Fragile Families and Child Wellbeing study which collected data through surveys conducted shortly after the infant’s birth (baseline) and at 1 year of age (follow-up). Records from 4,141 mothers recruited from 75 hospitals, in 20 cities, in the US were used. Bivariate and multivariate regression analyses were conducted. Results Results show high rates of intimate partner violence. Maternal reports of any intimate partner violence at baseline or follow-up were both significantly associated with increased odds of less than excellent infant general health and difficult temperament. Independent examination of psychological, physical, and sexual abuse revealed differential relationships between the types of intimate partner violence and infant health outcomes. Conclusions Results from this study contribute to our understanding of the infant health threats associated with maternal intimate partner violence experiences. Additional research addressing the complex relationship between maternal abuse experiences and infant health and specific intervention implications is warranted.     

Intimate partner violence among rural South African men: alcohol use,sexual decision-making,and partner communication

Nearly one-third of South African men report enacting intimate partner violence. Beyond the direct health consequences for women, intimate partner violence is also linked to varied risk behaviours among men who enact it, including alcohol abuse, risky sex, and poor healthcare uptake. Little is known about how to reduce violence perpetration among men. We conducted retrospective, in-depth interviews with men (n = 53) who participated in a rural South African programme that targeted masculinities, HIV risk, and intimate partner violence. We conducted computer-assisted thematic qualitative coding alongside a simple rubric to understand how the programme may lead to changes in men's use of intimate partner violence. Many men described new patterns of reduced alcohol intake and improved partner communication, allowing them to respond in ways that did not lead to the escalation of violence. Sexual decision-making changed via reduced sexual entitlement and increased mutuality about whether to have sex. Men articulated the intertwined nature of each of these topics, suggesting that a syndemic lens may be useful for understanding intimate partner violence. These data suggest that alcohol and sexual relationship skills may be useful levers for future violence prevention efforts, and that intimate partner violence may be a tractable issue as men learn new skills for enacting masculinities in their household and in intimate relationships.     

Intimate partner violence and incidence of hypertension in women

PurposeIntimate partner violence, a prevalent stressor for women, may influence the risk of cardiovascular disease. We estimated the association between intimate partner violence and the development of hypertension, an important risk factor for cardiovascular disease, in the Nurses' Health Study II cohort.MethodsIntimate partner violence measures included adult lifetime physical and sexual partner violence and the Women's Experiences with Battering Scale, which ascertained women's subjective experience of recent emotional abuse. Physician-diagnosed hypertension was self-reported on biennial questionnaires. We used Cox proportional hazards models to estimate the association between report of intimate partner violence in 2001 and incidence of hypertension from 2001 through 2007.ResultsOf 51,434 included respondents, 22% reported being physically hurt, and 10% reported being forced into sexual activities at some point in adulthood by an intimate partner. After adjustment for confounders, physical and sexual abuse were not associated with hypertension. However, women reporting the most severe emotional abuse had a 24% increased rate of hypertension (hazard ratio 1.24; 95% confidence interval: 1.02–1.53) compared with women unexposed to emotional abuse.ConclusionsThe risk of hypertension appears to be increased in the small number of women recently exposed to severe emotional abuse.     

Intimate partner violence in the Balkans: the example of Albania

Our aim was to describe the prevalence and associated factors of intimate partner violence in postcommunist countries of South East Europe (SEE). Review of recent reports regarding intimate partner violence in SEE countries as documented in the official Web sites of the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), Minnesota Advocates for Human Rights, Centers for Disease Control, and Medline. In Belgrade, Serbia and Montenegro, the prevalence of physical violence against women has been reported as 69.8%. In a reproductive health survey conducted in 1997 in Moldova, 22% of the women interviewed reported they had been abused by a partner or former partner at some time in their lives. More than 31% of female university students in Macedonia have reported that they had been victims of physical or psychological violence. Data from Albania indicate that spousal physical violence is one of the highest reported internationally. In Tirana, the Albanian capital city, the prevalence of past-year physical intimate partner violence was reported by 37% of women interviewed. The most empowered Albanian women were most likely to experience physical abuse and the least powerful men and those of rural origin were most likely to perpetrate spousal violence. Notwithstanding the lack of well-documented data and the questionability of extent to which the reported results are comparable among different SEE countries, the evidence suggests that intimate partner violence is an important public health problem in transitional countries of SEE. Information on intimate partner abuse can provide valuable clues to primary care and community care practitioners about the health status of female populations.     

Psychological Intimate Partner Violence and Sexual Risk Behavior: Examining the Role of Distinct Posttraumatic Stress Disorder Symptoms in the Partner Violence–Sexual Risk Link

BackgroundResearch has examined how physical and sexual intimate partner violence (IPV) victimization increases sexual risk behavior, yet research is lacking on 1) the effect of psychological IPV on sexual risk behavior and 2) factors through which psychological IPV may be linked to sexual risk behavior.MethodsThe current study examined the relationship between psychological IPV and sexual risk behavior controlling for other forms of IPV (i.e., physical and sexual) in a sample of 186 human immunodeficiency virus (HIV)-negative community women currently experiencing IPV. Further, this study examined the potential mediating effects of four posttraumatic stress disorder (PTSD) symptom severity clusters (i.e., re-experiencing, avoidance, numbing, and hyperarousal) on this relationship.FindingsResults revealed that greater severity of psychological IPV was uniquely and directly related to greater sexual risk behavior. Additionally, of the four PTSD symptom severity clusters, only avoidance symptom severity mediated the relationship between psychological IPV and sexual risk behavior.ConclusionImplications for addressing psychological IPV and PTSD to improve women's sexual health outcomes are discussed.     

Coercive forms of sexual risk and associated violence perpetrated by male partners of female adolescents

CONTEXT: Partner violence is associated with STDs among female adolescents, but the mechanisms underlying this association remain unclear. Sexually coercive and deceptive behaviors of male partners that increase female STD risk may be factors in this relationship. METHODS: A sample of 356 females aged 14–20 who attended adolescent health clinics in Greater Boston between April and December 2006 were assessed for physical and sexual violence perpetrated by male partners and for exposure to sexual risk factors. Adjusted logistic regression models were used to examine the associations between intimate partner violence and standard sexual risk behaviors (e.g., multiple partnerships) and coercive or deceptive sexual risk factors (e.g., coerced condom nonuse). RESULTS: More than two‐fifths of the sample had experienced intimate partner violence. In adjusted analyses, adolescents reporting intimate partner violence were more likely than others to report standard sexual risk behaviors—multiple partners, anal sex and unprotected anal sex (odds ratios, 1.7–2.2). They also were more likely to report coercive or deceptive sexual risk factors—partner sexual infidelity, fear of requesting condom use, negative consequences of condom request, and coerced condom nonuse (2.9–5.3). CONCLUSION: The high prevalence of intimate partner violence against young women attending adolescent clinics strongly indicates the need to target this population for abuse‐related interventions. This need is underlined by the observed association between partner violence and sexual risk involving coercion or deception by male partners. Clinic‐based STD and pregnancy prevention efforts should include assessment of sexual risk factors that are beyond the control of young women, particularly for those experiencing abuse.     

Women's Lives After an HIV-Positive Diagnosis: Disclosure and Violence

Objectives: This research addresses four questions: (1) What role do health care providers play in women's disclosure to others of their HIV-positive status? (2) What are women's concerns and experiences with disclosure? (3) What violence do women living with HIV experience? (4) How is the violence related to their diagnosis and disclosures? Methods: Participants were 310 HIV-positive women enrolled in an HIV primary care clinic in an urban teaching hospital. Women were interviewed once using both quantitative and qualitative methods. Results: Women had known they were HIV-positive for an average of 5.8 years; 22% had an HIV-positive partner; 58% had disclosed their status to more than 10 people; and 68% had experienced physical abuse and 32% sexual abuse as an adult. Fifty-seven percent of the sample reported that a health care provider had told them to disclose to their sex partners. Women who were afraid of disclosure-related violence (29%) were significantly more likely than those who were not to report that a health care provider helped them with disclosure (21% vs. 10%). Although 4% reported physical abuse following a disclosure event, 45% reported experiencing emotional, physical, or sexual abuse at some time after their diagnosis. Risk factors for experiencing abuse after diagnosis were a prior history of abuse, drug use, less income, younger age, length of time since diagnosis, and having a partner whose HIV status was negative or unknown. Conclusions: Identifying women at risk for abuse after an HIV-positive diagnosis is important for those who provide HIV testing and care. Routine screening for interpersonal violence should be incorporated into HIV posttest counseling and continuing primary care services.

     

Physical and mental health effects of intimate partner violence for men and women

BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.     

Exploring the associations between intimate partner violence and women’s mental health: Evidence from a population-based study in Paraguay

Using a nationally representative sample from the 2008 Paraguayan National Survey of Demography and Sexual and Reproductive Health, we examine the association between emotional, physical, and sexual intimate partner violence (IPV) and mental health among women aged 15–44 years who have ever been married or in a consensual union. The results from multivariate logistic regression models demonstrate that controlling for women’s socioeconomic and marital status and history of childhood abuse and their male partners’ unemployment and alcohol consumption, IPV is independently associated with an increased risk for common mental disorders (CMD) and suicidal ideation measured by the Self Reporting Questionnaire (SRQ-20). IPV variables substantially improve the explanatory power of the models, particularly for suicidal ideation. Emotional abuse, regardless of when it occurred, is associated with the greatest increased risk for CMD whereas recent physical abuse is associated with the greatest increased risk for suicidal ideation. These findings suggest that efforts to identify women with mental health problems, particularly suicidal ideation, should include screening for the types and history of IPV victimization.     

Childhood Abuse as a Risk Factor for Adolescent Pregnancy in El Salvador

PURPOSE: To determine whether having been abused as a child increases the risk of adolescent pregnancy in El Salvador and whether intimate partner violence during adolescence affects the association. METHODS: Using data from 3753 women between the ages of 15 and 24 from a nationally representative household health survey of Salvadoran women (FESAL 2002/2003), the association between history of childhood abuse (emotional, physical, or sexual abuse, and witnessing abuse of one's mother) and adolescent pregnancy was explored using multiple logistic regression analyses. The effect of intimate partner violence during adolescence on the relationship was explored among a subgroup of 15-19-year-olds. RESULTS: The risk of adolescent pregnancy was significantly higher among women abused as children. Women who were sexually abused, physically abused, or who experienced any type of abuse had a 48%, 42%, and 31% higher risk, respectively, of adolescent pregnancy than those without a history of abuse, after adjusting for confounding factors. Intimate partner violence during adolescence was also strongly and significantly linked with adolescent pregnancy risk. CONCLUSIONS: This is the first study from a Latin American country to demonstrate a relationship between childhood abuse and adolescent pregnancy. Greater efforts are needed to promote detection of abuse, expand knowledge about sexual and reproductive health, protect vulnerable youth, and to advocate for greater rights and social protections to Salvadoran children and adolescents.     

Barriers to Screening for Intimate Partner Violence

Background: Health care providers play a vital role in the detection of intimate partner violence among their patients. Despite the recommendations for routine intimate partner violence screening in various medical settings, health care providers do not routinely screen for intimate partner violence. The authors wanted to identify barriers to intimate partner violence screening and improve the understanding of intimate partner violence screening barriers among different health care providers. Methods: The authors conducted a systematic review to examine health care providers' perceived barriers to screening for intimate partner violence. By grouping the studies into two time periods, based on date of publication, they examined differences in the reported barriers to intimate partner violence screening over time. Results: The authors included a total of 22 studies in this review from all examined sources. Five categories of intimate partner violence screening barriers were identified: personal barriers, resource barriers, perceptions and attitudes, fears, and patient-related barriers. The most frequently reported barriers included personal discomfort with the issue, lack of knowledge, and time constraints. Provider-related barriers were reported more often than patient-related barriers. Conclusions: Barriers to screening for intimate partner violence are numerous among health care providers of various medical specialties. Increased education and training regarding intimate partner violence is necessary to address perceptions and attitudes to remove barriers that hinder intimate partner violence screening by health care providers.     

Disparities in Intimate Partner Violence Prenatal Counseling: Setting a Baseline for the Implementation of the Guidelines for Women's Preventive Services

Prenatal health care counseling is associated with positive health outcomes for mothers and infants. Moreover, pregnant women are considered a vulnerable population at risk of being victims of intimate partner violence. Pregnancy provides a unique opportunity to identify and refer women experiencing intimate partner violence to community resources; however, in prior research, most women reported that their prenatal care providers did not talk to them about intimate partner violence. Given the importance for providers to offer prenatal health care counseling on intimate partner violence, it is concerning that there is scant knowledge on Asian, Native Hawaiian, and other Pacific Islander mothers'' experiences in this area. The study''s objectives were (a) to determine the proportion of mothers who received prenatal health care counseling on intimate partner violence; and, (b) to examine racial differences of those who received prenatal health care counseling on intimate partner violence. Hawai‘i''s Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2004–08 were analyzed for 8,120 mothers with information on receipt of intimate partner violence prenatal health care counseling. Overall, 47.7% of mothers were counseled on intimate partner violence. Compared to Whites, Native Hawaiians, Japanese, Chinese, and Koreans were significantly less likely to report receiving prenatal health care counseling in intimate partner violence, but the opposite association was observed for Samoans. Intimate partner violence continues to be a significant problem for women, thus, this study''s findings may be used as important baseline data to measure the progress made given the implementation of the new Guidelines for Women''s Preventive Services in intimate partner violence screening and counseling.     

Power, Control, and Intimate Partner Sexual Violence in Haiti

This study sought to determine how power and control in intimate relationships influenced women's exposure to sexual violence. Multilevel modeling was used to determine the risk of partner sexual violence in the past 12 months among 2240 women aged 15–49 years who were currently married or cohabiting. The data were drawn from the 2000 Haiti Demographic and Health Survey. Strong positive effects on intimate partner sexual violence were found for husband's jealousy and perpetration of controlling behavior and women's endorsement of traditional norms concerning a husband's rights to beat his wife. Female dominance in decision making about purchases for daily household needs was positively associated with intimate partner sexual violence but its effects were mediated by relationship quality. The effect of wife's education on intimate partner violence was nonlinear. The analysis also showed that high community female headship rates were independently associated with higher risks of partner sexual violence. The findings highlight the importance of adopting a multidimensional approach to the measurement of power in sexual relationships and the need for programs to work at multiple levels to address gender-based norms and the structural factors that put women at increased risk of sexual violence.     

Common mental disorders and intimate partner violence in pregnancy

OBJECTIVE

To investigate the association between common mental disorders and intimate partner violence during pregnancy.

METHODS

A cross sectional study was carried out with 1,120 pregnant women aged 18-49 years old, who were registered in the Family Health Program in the city of Recife, Northeastern Brazil, between 2005 and 2006. Common mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20). Intimate partner violence was defined as psychologically, physically and sexually abusive acts committed against women by their partners. Crude and adjusted odds ratios were estimated for the association studied utilizing logistic regression analysis.

RESULTS

The most common form of partner violence was psychological. The prevalence of common mental disorders was 71.0% among women who reported all form of violence in pregnancy and 33.8% among those who did not report intimate partner violence. Common mental disorders were associated with psychological violence (OR 2.49, 95%CI 1.8;3.5), even without physical or sexual violence. When psychological violence was combined with physical or sexual violence, the risk of common mental disorders was even higher (OR 3.45; 95%CI 2.3;5.2).

CONCLUSIONS

Being assaulted by someone with whom you are emotionally involved can trigger feelings of helplessness, low self-esteem and depression. The pregnancy probably increased women`s vulnerability to common mental disorders     

Sexual violence against intimate partners in Cape Town: prevalence and risk factors reported by men

OBJECTIVE: To describe the prevalence of and risk factors for the perpetration of sexual violence by men against female intimate partners. METHODS: A cross-sectional study was conducted on 1368 randomly selected men working in three Cape Town municipalities. The men were interviewed with the aid of a questionnaire on current sexual partners in the preceding 10 years, personal and relationship characteristics and the use of violence against their partners. RESULTS: The perpetration of sexual violence against intimate partners in the past 10 years was reported by 15.3% of the men. After adjustment for sociodemographic circumstances, the factors associated with such violence were involvement in physical conflict outside the home, problematic alcohol use, having more than one current partner and abusing partners verbally. While having frequent conflict with partners was important for the risk of sexual violence, only two types of conflict sources were significantly associated with this risk, namely conflict over sexual refusal and conflict when men perceived their authority to be undermined. CONCLUSION: Sexual violence in intimate relations was common. The risk of being sexually violent was associated with the use of violence to solve problems in other settings, having more than one current partner, alcohol abuse and verbally abusing a partner. It was also associated with particular types of conflict stemming from ideas of male sexual entitlement and dominance. Prevention programmes that focus on gender relations and non-violent conflict resolution for men and youths may be useful in combating such sexual violence.     

Prevalence of intimate partner violence and related factors in a local city in Japan

OBJECTIVES: This study sought to assess the prevalence of intimate partner violence in a local city of Fukui Prefecture, and whether the subjects' and their partners' demographic characteristics, alcohol use, and violence experienced in the families in which they were raised might be related risk factors. METHODS: We conducted a mail survey of 1,000 subjects aged 20-69 in the city randomly sampled from the population of 45,220 that were stratified by 10 years of age and sex and pulled 100 from each group. Data from two 248 respondents were eligible for analysis. The self-administered questionnaire included items on; 1) whether they were the victims of physical, sexual, social-economic and psychological violence from their intimate partners, and whether they perpetrated violence or not on their partners; 2) demographic characteristics of the subjects and their partners with information on gender, age, occupation, educational background, annual income, the cohabitants, and their alcohol use; 3) the subjects' experience of violence in the family in which they had grown up; exposure to violence between their parents, and being abused by them. RESULTS: Out of 248 subjects, men accounted for 41.5%. The prevalence rate of any violence experienced from intimate partners was 46.4%, and that of having perpetrated any violence on the partner was 43.1%. Women reported experiencing more "sexual violence" from their partners than did men. In addition, men admitted to more "physical, sexual, and psychological violence" on their partners than women. Those who had themselves been exposed to violence between parents or were victimized by their parents significantly had more experience of violence from their partners and perpetration than those who did not. CONCLUSION: The results suggest that questioning about the experience of violence in the family is useful for the early detection of intimate partner violence.     

Intimate Partner Violence in Southwestern Nigeria: Are There Rural-Urban Differences?

The researchers in this study assessed the prevalence of different types and experience of intimate partner violence among 600 women aged 15 to 49 years in selected rural and urban communities in southwestern Nigeria between October and December, 2007. Lifetime prevalence of intimate partner violence was 64% in the rural and 70% in the urban areas. Controlling behavior was the most frequently reported type of intimate partner violence experienced by both groups of women, and sexual violence was reported least. More urban women reported sexual violence and controlling behaviors than rural women (16.4% versus 11.6% and 57.7% versus 42.0%, respectively). More rural women had experienced physical violence (28% versus 14%). More urban women experienced controlling behaviors, while more rural women experienced physical violence. In both locations, history of partners' involvement in physical fights was significantly associated with reporting sexual violence (rural: odds ratio [OR] = 3.9; 95% confidence interval [CI] 1.2–12.3; urban: OR = 8.4; 95% CI 1.4–51.8). History of alcohol consumption by partners was significantly associated with reporting physical violence (rural: OR = 2.3; 95% CI 1.2–4.4; urban: OR = 3.2; 95% CI 1.4–7.2). However, among rural respondents, younger partners were more likely to perpetuate controlling behavior (OR = 5.1; 95% CI 1.7–15.6) and being in a relationship for ≥10 years was related to psychological and physical violence. Among urban respondents, history of partners' involvement in physical fights was associated with controlling behavior (OR = 8.2; 95% CI 1.1–65.4) and physical violence (OR = 4.5; 95% CI 1.2–17.3). These results suggest that intimate partner violence is a frequent experience in women in both communities, although the types of intimate partner violence experienced differed, and multidisciplinary strategies are required to reduce intimate partner violence.     

Intersections Between Childhood Abuse and Adult Intimate Partner Violence Among Ecuadorian Women

Objectives Strong linkages exist between childhood abuse and adult intimate partner violence (IPV) among women in developed countries. Few studies examine this pattern in developing nations. This study explores the effect of childhood physical and/or psychological abuse on the likelihood of IPV among a national sample of Ecuadorian women of reproductive age. Methods Secondary data analysis was conducted on a subsample of 9,077 Ecuadorian women, utilizing the 2004 Encuesta Demografía y de Salud Materna e Infantil survey. Cross-tabulations and multivariate logistic regression models were utilized to assess whether women who report childhood abuse had a higher likelihood of reporting sexual, physical or psychological IPV during their lifetimes or within the past year. Results Levels of abuse were high. More than 30% of women reported childhood psychological or physical abuse, and 21% experienced both types of abuse. Forty percent of women reported sexual, physical or psychological IPV during their lifetimes, while 15% reported any form of IPV in the past year. The co-occurrence of childhood psychological and physical abuse was highly predictive of all forms of IPV, with less consistent associations for women who reported only physical or only psychological childhood abuse. Conclusions This study suggests that childhood abuse is an important risk factor for IPV victimization among Ecuadorian women. While this analysis supports findings from developed countries, more cross-cultural research about patterns of violence throughout the life course is needed to develop relevant prevention programs.     

The risk of return: Intimate partner violence in Northern Uganda's armed conflict

The physical and psychological consequences of armed conflict and intimate partner violence are well documented. Less research focuses on their intersection and the linkages between domestic violence, gender-based discrimination, and the structural violence of poverty in armed conflict. This paper describes emerging themes from qualitative interviews with young women who have returned from abduction into the Lord's Resistance Army in northern Uganda, many of whom were forcibly given as “wives” to commanders. Their interviews reveal multiple levels of violence that some women experience in war, including physical and sexual violence in an armed group, verbal and physical abuse from extended family members, and intimate partner violence. Striking is the violence they describe after escaping from the rebels, when they are back with their families. The interviews point to how abduction into the armed group may exacerbate problems but highlight the structural factors that permit and sustain intimate partner violence, including gender inequalities, corruption in the police system, and devastating poverty. Findings suggest that decreasing household violence will depend on the strength of interventions to address all levels, including increasing educational and economic opportunities, increasing accountability of the criminal justice system, minimizing substance abuse, and improving the coping mechanisms of families and individuals exposed to extreme violence.