Community-level correlates of intimate partner violence against women globally: a systematic review

Intimate partner violence (IPV) against women is a problem facing women around the world, one that has implications for women's health and well-being. The relationship between communities and the occurrence of IPV is an expanding area of research. Although a large number of community characteristics have been examined in relation to IPV, the research as a whole lacks a coherent theoretical focus or perspective. In this systematic review, we provide a comprehensive synthesis of the evidence regarding the community-level correlates of IPV against women. In our review of peer-reviewed research published between January 1, 1990 and January 31, 2011, we identify key community-level correlates, detect gaps, and offer recommendations for future research. Recognizing a difference in approach between U.S. and non-U.S. based research and an over-reliance on a primarily urban, U.S.-based perspective on communities and IPV, we advocate for a global perspective that better reflects the social and economic fabric of communities around the world. Specifically, future research should focus on the most promising, but currently under-studied, community-level correlates of IPV against women, namely gender inequality, gender norms, and adapted measures of collective efficacy/social cohesion.     

Unperceived intimate partner violence and women's health

Objective

Women who experience intimate partner violence (IPV) often do not perceive themselves as abused. This study sought to estimate the health effects of unperceived IPV (uIPV), taking violence-free women as the reference, and to compare the effects of uIPV with those of perceived IPV (pIPV).

Method

We performed a cross-sectional population study through telephone interviews of 2835 women aged 18 to 70 years living in the region of Madrid and having an ongoing intimate partner relationship or contact with a former partner in the preceding year. Based on 26 questions from the Conflict Tactics Scale-1 and the Enquête Nacional sur les Violences envers les Femmes en France and the question “Do you feel abused by your partner?” a variable was constructed in three categories, namely, the absence of IPV, uIPV and pIPV. Using logistic regression, we analyzed the association between health problems, medication use, health-service utilization and IPV (perceived and unperceived) vis-à-vis the absence of IPV.

Results

There were 247 cases of uIPV and 96 of pIPV (prevalences of 8.8% and 3.4%, respectively). The multivariate analysis showed that a substantial number of the outcomes explored were associated with uIPV, pIPV, or both. The highest odds ratios (ORs) were obtained for depression (Patient Health Questionnaire-9 ≥ 10) (uIPV: OR 3.4, 95% CI 2.4-3.8; and pIPV: 4.1, 95%CI 2.5-6.8). In most problems, the ORs did not significantly differ between the two types of IPV.

Conclusions

uIPV is 2.6 times more frequent than pIPV and is associated with at least as many health problems as pIPV.     

Overlapping intimate partner violence and sex trading among high-risk women: Implications for practice

Despite research indicating higher than average rates of intimate partner violence (IPV) across groups of vulnerable women, less is known about the prevalence and types of IPV experienced by women who trade sex for money, drugs, shelter or food, a high risk group for poor health and psychosocial outcomes. Using a cross-sectional design and multivariate logistic regression analyses, this study examined the relationship between IPV and sex trading in a convenience sample of 346 HIV-negative, drug-involved women in relationships, recruited during 2005–2010 in New York City. About 41% and 36% of participants reported lifetime and recent IPV, respectively, by their main partner, with significant differences by recent engagement in sex trading (p < 0.01). Results of multivariate analyses indicated that sex trading was associated with recent severe physical or sexual IPV (OR = 3.07, p < 0.01) and that depression, having ever been married, child sexual abuse, and income were associated with IPV (p < 0.05). Women who reported childhood sexual abuse and recent sex trading had a 7.37 higher odds (p < 0.01) for reporting severe physical or sexual IPV compared to those who reported neither. Findings highlight the need to expand screening and interventions among women who trade sex.     

Associations between intimate partner violence,violence-related policies,and HIV diagnosis rate among women in the United States

PurposeTo assess the association between state-level intimate partner violence (IPV) prevalence and HIV diagnosis rates among women in the United States and investigate the modifying effect of state IPV health care policies.MethodsData on HIV diagnosis rates were collected from HIV surveillance data from 2010 to 2015, and IPV prevalence data were collected from the National Intimate Partner and Sexual Violence Survey from 2010 to 2012. States were coded for IPV health care policies on training, screening, reporting, and insurance discrimination.ResultsStates with higher IPV prevalence was associated with higher HIV diagnoses among women (B = 0.02; 95% confidence interval [CI] = 0.003, 0.04; P = .02). State policies were a significant effect modifier (B = −0.05; 95% CI = −0.07, −0.02; P < .001). Simple slopes revealed that the association between IPV and HIV diagnosis rates was stronger in states with low IPV protective health care policies (B = 0.09; CI = 0.06, 0.13; P < .001) and moderate IPV protective policies (B = 0.05; 95% CI = 0.02, 0.07, P < .001), but not in states with high IPV protective policies (B = −0.009; 95% CI = −0.04, 0.02; P = .59).ConclusionsHIV prevention programs should target IPV and link to community resources. IPV-related policies in the health care system may protect the sexual health of women experiencing IPV.     

Responses to intimate partner violence in Kakuma refugee camp: Refugee interactions with agency systems

Intimate partner violence (IPV) has been recognised as a significant problem amongst forcibly displaced communities, and great progress has been made by the United Nations High Commission for Refugees (UNHCR) in responding to IPV and other forms of sexual and gender based violence. However, they have not always effectively engaged refugee communities in these activities, with potentially negative consequences for the health and protection of women.     

Maternal outcomes of intimate partner violence during pregnancy: study in Iran

Objectives

To investigate the prevalence of intimate partner violence (IPV) against pregnant women and its relationship with adverse maternal outcomes, including preterm labour, abortion, caesarean section, antenatal hospitalization and vaginal bleeding, in the West Azerbaijan, Iran.

Study design

Cross-sectional design.

Methods

In total, 1300 pregnant women, aged 18–39 years, who were referred to hospitals in the Iranian cities of Miandoab and Mahabad in the province of West Azerbaijan in 2009–2010 were recruited for this study by a convenience sampling method. Participants were asked to share their experiences of IPV during pregnancy and adverse maternal outcomes.

Results

Of these pregnant women, 945 (72.8%) reported that they had experienced IPV during their last pregnancy. A significant association was found between IPV and preterm labour [adjusted odds ratio (adjOR) 1.54, 95% confidence interval (CI) 1.16–2.03], caesarean section (adjOR 11.84, 95% CI 6.37–22.02), antenatal hospitalization (adjOR 6.34, 95% CI 3.82–10.52) and vaginal bleeding (adjOR 1.51, 95% CI 0.9–2.3).

Discussion

This study demonstrated a high prevalence of IPV during pregnancy, and found that IPV was associated with adverse maternal outcomes including preterm labour, caesarean section, antenatal hospitalization and vaginal bleeding. This adds to the existing literature and can be used to inform healthcare practices in developing countries. Medical, health and surgical services for pregnant women should consider screening for IPV, and providers should be aware that IPV victims are at increased risk for adverse outcomes. Services should also develop links with the Battered Women's Movement; such programmes now exist in many countries.     

Emotional intimate partner violence experienced by men in same-sex relationships

Intimate partner violence research has focused almost exclusively on physical and sexual intimate partner violence in opposite-sex relationships, paying little attention to the intimate partner violence experienced by men in same-sex relationships. Emerging research focusing on intimate partner violence among male-male couples has focused largely on physical and sexual violence, with little consideration of the unique forms of emotional violence experienced by gay men. Ten focus-group discussions with gay and bisexual men were conducted to examine perceived typologies, antecedents and experiences of emotional violence that occur between male partners. Participants described emotional violence as the most threatening form of intimate partner violence, driven largely by factors including power differentials, gender roles and internalised homophobia. Results indicate that gay and bisexual men perceive emotional intimate partner violence to be commonplace. A better understanding of emotional violence within male-male relationships is vital to inform intimate partner violence prevention efforts and the more accurate measurement of intimate partner violence for gay men.     

Association between intimate partner violence and HIV status among Haitian Women

ABSTRACT

The prevalence of intimate partner violence (IPV) among women living in Haiti increased from 25% in 2006–29% in 2012, with escalating reports of crisis in the last several years. We examined the association between IPV and HIV status among these women in Haiti. Participants were drawn from a larger sample of women (n?=?513) with a history of IPV. Women living with HIV (n?=?55) were matched to uninfected women (n?=?110) to form a control group. Attitudes towards gender roles, mental and physical well-being, and partner violence were assessed and compared. Logistic regressions were utilised to calculate multivariable-adjusted odds ratios. Women living with HIV were more likely to report more severe forms of psychological violence (p?<?0.01), and severe physical violence (p?<?0.0001). Women who experienced severe forms of IPV were 3.5 times more likely to have an HIV positive status compared to those who did not experience severe IPV (p?<?0.0001). There were significant associations between severe forms of IPV, and HIV status among Haitian women. IPV severity should be integrated into eligibility screening for biomedical strategies of prevention such as pre-exposure prophylaxis (PrEP) among Haitian women.     

Motivational interviewing and intimate partner violence: a randomized trial

PurposeTo determine if motivational interviewing (MI) improves self-efficacy (primary outcome), depressive symptoms (secondary outcome), and stage-of-readiness-to-change (secondary outcome) among women in abusive relationships.MethodsRandomized controlled trial among women who experienced intimate partner violence in a current relationship over the past 12 months. Subjects were recruited from two family planning clinics (December 2007 to May 2010). The intervention included an initial face-to-face session and three telephone sessions administered 1-, 2-, and 4-months postenrollment, each using MI to identify personal goals. Controls were referred to community-based resources. Outcomes were measured by self-administered questionnaires before randomization and 6 months later. Modified intent-to-treat analyses of completed participants were conducted using multivariate analysis of variance for continuous outcomes and polytomous logistic regression for categorical outcomes.ResultsThree hundred six eligible women were enrolled (recruitment rate = 64%); 204 completed the 6-month follow-up (completion rate = 67%). Depressive symptoms decreased to a greater extent in MI than referral women (P = .07). Self-efficacy and stage-of-readiness-to-change increased more in MI than referral women, but these differences were not statistically significant.ConclusionsWith a lower than projected sample size, our findings did not achieve statistical significance at the 5% level but suggest a beneficial effect of the MI intervention on reducing depressive symptoms.     

Intimate partner violence and help-seeking: The role of femicide news

Exploiting high-frequency data from the Italian anti-violence helpline, police reports of domestic abuse and maltreatments, and a unique geolocalized dataset on killings of women, we show that the news coverage of a femicide triggers an increase in help-seeking behavior. The effect is detectable in the period following the news and in the province where the femicide has occurred. Additionally, help-seeking increases more when the general interest and news coverage are higher. These findings are consistent with a model in which femicide news increase expectations about future intimate partner violence in case no action is taken. Our results imply that recurrent information campaigns and public discussion can foster help-seeking from survivors of gender-based violence.     

The independent contribution of individual-, neighbourhood-, and country-level socioeconomic position on attitudes towards intimate partner violence against women in sub-Saharan Africa: A multilevel model of direct and moderating effects

We examined associations between country, neighbourhood, and individual socioeconomic position (SEP) and attitudes towards intimate partner violence against women (IPVAW). We applied multivariable multilevel logistic regression analysis on Demographic and Health Survey data for 165,983 women and 68,501 men nested within 7465 communities from 17 countries in sub-Saharan Africa collected between 2003 and 2007. Contrary to expectation women were 34% more likely to justify IPVAW than men. We found that sex moderates associations of individual-, neighbourhood-, and country-level SEP with attitudes towards IPVAW. There was a significant positive interaction effect between sex and education attainment; women with no education were more likely to justify IPVAW than men with no education. Negative sex interaction with household wealth status indicates that differences in attitude are less pronounced among women. Unemployed men were more likely to justify IPVAW. Interaction effects indicate that the association of neighbourhood socioeconomic disadvantage with attitudes was more pronounced among women than among men. The association of country-level SEP with attitudes towards IPVWA was inconclusive. There was some evidence that neighbourhood modified the association between individual SEP and attitudes towards IPV. Also, there was cross-level interaction between country and neighbourhood SEP. Neighbourhood and individual SEP were independently associated with attitudes towards IPVAW. The relationship with country-level SEP was inconclusive. The findings underscore the need to implement public health prevention/intervention strategies not only at the level of individual SEP but also at the neighbourhood level.     

Detecting intimate partner violence during pregnancy: awareness-raising indicators for use by primary healthcare professionals

BACKGROUND: Given the deleterious consequences of intimate partner violence (IPV) for gestation, it is important to promote a more effective and amicable approach that engenders greater receptiveness, stimulates more open communication and, ultimately, facilitates addressing the problem. In this regard, active primary care professionals need to be educated about the different profiles of violence found in domestic environments. The aim of this study is to make the identification of those subgroups of pregnant women most likely to be living in IPV situations both practical and simple. Its ultimate goal is to give healthcare professionals who work directly with the public the tools to anticipate such events. To this end, this study presents a profile of IPV during pregnancy according to different characteristics observed among primary health service users. METHODS: Five hundred and twenty-seven women who carried children to term in Rio de Janeiro were interviewed. A Portuguese version of the Revised Conflict Tactics Scale (CTS2) was used to detect IPV. Several sociodemographic factors, life habits and reproductive health characteristics of pregnant women and their partners were scrutinized. Prevalence projections by subgroup were obtained using a multinomial logit model. RESULTS: The projected prevalences for negotiation, psychological violence, minor physical violence and severe physical violence were, respectively, 0.1% [95% confidence interval (CI) 0.0-0.6], 2.6% (95%CI 0.7-6.9), 7.0% (95%CI 1.7-18.5) and 90.3% (95%CI 77.2-96.8) for the extreme scenario, i.e. women <20 years of age, non-White, living in house with inadequate garbage disposal, previous history of abortion, reporting fear of someone, reporting lack of affective social support, and reporting drug use by woman or spouse. In the absence of these characteristics, the projected prevalences were 51.3% (95%CI 38.5-64.6), 40.0% (95%CI 28.5-51.9), 7.6% (95%CI 4.2-12.7) and 1.1% (95%CI 0.3-2.4), respectively. CONCLUSION: This study found that knowledge of certain characteristics of pregnant women who attend health services can alert professionals to the high probability of IPV, facilitating early identification of the problem and subsequent implementation of proactive measures.     

A scoping review of interventions to address intimate partner violence in sub-Saharan African healthcare

ABSTRACT

Intimate partner violence (IPV) is a widespread global health problem, with negative effects on women’s health and HIV transmission and treatment. There is little evidence on how to address IPV effectively in lower-resourced healthcare settings, particularly those that are impacted by significant HIV epidemics. We conducted a scoping review to provide an overview of the literature on IPV screening and intervention programmes in sub-Saharan African healthcare. The included studies used mainly qualitative methods. We identified five main themes: the acceptability to female clients, the importance of confidentiality, provider concerns, barriers due to gender norms, and need for referrals and comprehensive services. Research in this field is limited, and a robust research agenda is needed to provide effective IPV interventions for women seeking healthcare in sub-Saharan Africa.     

Violence against women by their intimate partner and common mental disorders

The World Health Organization considers gender violence a cause of anxiety, depression and suicidal thoughts among women. This study investigated the association between violence committed against women by their intimate partners, defined by psychologically, physically and sexually abusive acts, and common mental disorders, assessed by using the Self Reporting Questionnaire (SRQ-20). A population-based household survey was carried out among women aged 15–49 years in two sites: São Paulo, the largest Brazilian city, and Zona da Mata of Pernambuco, a region with both urban and rural areas in the Northeast of the country. A large proportion of women reported violence (50.7%). The most frequent forms were psychological violence alone (18.8%) or accompanied by physical violence (16.0%). The prevalence of mental disorders was 49.0% among women who reported any type of violence and 19.6% among those who did not report violence (p < 0.0001). After adjustment for demographic and socioeconomic characteristics, the nature of the relationship, stressful life events and social support, all the forms of violence studied, with the exception of sexual violence alone or accompanied by either physical or psychological violence (p = 0.09), were significantly associated with mental disorders: physical violence alone (OR 1.91; CI 95% 1.2–3.0), psychological violence alone (OR 2.00; CI 95% 1.5–2.6), sexual violence alone or accompanied by either physical or psychological violence (OR 1.80; CI 95% 0.9–3.6), both psychological and physical violence (OR 2.56; CI 95% 1.9–3.5) and all three forms of violence (OR 2.68; CI 95% 1.8–4.0).This is the first population-based study on the association between intimate partner violence and mental health in Brazil. It contributes to the existing body of research and confirms that violence, frequently experienced by women in the country, is associated with mental disorders. Policies and strategies aimed at reducing gender-based violence are necessary for preventing and reducing anxiety and depression among women.     

2575名在校大学生亲密伴侣暴力现况研究

目的 了解大学生恋爱中的性行为和亲密伴侣暴力行为情况,探讨亲密伴侣暴力与大学生其他部分心理行为的关系.方法 采取整群抽样的方法,对合肥和芜湖市3所高校2575名在校大学生进行问卷调查,内容包括恋爱情况、遭受亲密伴侣暴力情况、抑郁症状、自尊、学校生活满意度和自杀相关心理行为.x2检验和方差分析探讨不同恋爱经历大学生心理行为状况的差异.结果 2575名大学生中46.9%有过恋爱经历;男生高于女生,大二、三年级学生高于大一年级学生(x2值分别为44.13、161.84,P值均<0.05).目前正在恋爱的大学生中21.1%报告与现在的恋人发生过性行为,其中仅有21.8%(34/156)每次都使用安全套,11.5%(18/156)从不采用任何避孕措施,18.6%(29/156)与现在恋人(女友)发生性行为而怀孕,孕后到正规医院进行处理的比例仅占48.3%(14/29).有过恋爱经历的大学生中,遭受躯体暴力、心理暴力、性暴力、总暴力的报告率分别为18.0%、33.6%、5.1%、37.1%;男生遭受躯体暴力、心理暴力、总暴力的比例均高于女生,女生遭受性暴力的比例高于男生(x2值分别为70.21、13.25、14.04、5.77,P值均<0.05).在遭受过亲密伴侣暴力的大学生中,有74.2%(345/446)经历过3次以上亲密伴侣暴力.经历过亲密伴侣暴力的大学生抑郁症状得分最高,自尊和学校生活满意度得分最低(F值分别为4.00、16.39和8.76,P值均<0.05),自杀意念、自杀计划、自杀准备、自杀未遂的报告率均最高(x2值分别为13.80、9.72、8.52、11.96,P值均<0.05).结论 大学生恋人间性行为发生率较高,且保护意识缺乏;大学生亲密伴侣暴力现象较常见,且与其他不良心理行为关系密切.

Abstract：

Objective To investigate the prevalence of love affairs and intimate partner violence,and to explore the relationship between intimate partner violence and other mental health and risk behavior in college students.Methods Three universities were selected using cluster sampling method in Hefei and Wuhu.Totally.2575 college students completed an anonymous questionnaire.Intimate partner violence,depression,satisfaction of school life,self-esteem,suicidal psychology and behavior were evaluated to estimate the relationship between intimate partner violence and mental health/risk behavior.Results There were 46.9%students reported that they had intimate partner currently or in the past.The rate of having intimate partner in male students was higher than that in female students(x2=44.13,P<0.001).And the rates were higher in sophomores and juniors than in freshmen(x2=161.84,P<0.05).There were 21.1% students had sexual behavior with their intimate partners.But only 21.8%(34/156)intimate partners reported that they used condom every time.There were 11.5%(18/156)intimate partners reported that they never took any contraception.There were 18.6%(29/156)students reported that they were pregnant or led to their girlfriend becoming pregnant,but only less than 50.0% adolescents induced abortion in a legal hospitals.The rates of being the victim of physical assault,emotional abuse,sexual coercion,the total intimate partner violence were 18.0%,33.6%,5.1%.37.1%.The rates of being the victim of physical assault,emotional abuse,total intimate partner violence in male adolescents were higher than those in female adolescents,but the rate of sexual coercion was on the contrary(x2=70.21,13.25,14.04,5.77,P<0.05).Among the intimate partners who had suffered from intimate partner,74.2%(345/446)students had underwent more than 3 times.and 47.1% had underwent more than 2 types of intimate partner violence.The score of depression was highest in the victims of intimate partner violence,but the scores of self-esteem and school life satisfaction were on the contrary(F=4.00,16.39,8.76,P<0.05).The rates of suicidal ideation,suicidal plan,suicidal preparative and attempted suicide were highest in the victims of intimate partner violence(x2=13.80,9.72,8.52,11.96,P<0.05).Conclusion The rate of having sexual behavior with their intimate partners was high in college students,but their self-protection awareness was insufficient.In the present study,a high prevalence of intimate partner violence among university students was observed,and highlighted a need for attention to the other mental health and risk behavior in adolescents with intimate partner violence.     

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.     

Formal and informal help-seeking associated with women's and men's experiences of intimate partner violence in Canada

While numerous studies have documented the prevalence, correlates, and consequences of intimate partner violence (IPV); most of this research has used a criminal justice framework that has focused on acts of physical violence. However, critics argue that this narrow conceptualization of IPV belies the heterogeneity in this experience with respect to the nature of coercive control in the relationship. Moreover, they contend that the different types of abusive and controlling relationships not only have a different etiology, health consequences, and help-seeking characteristics, they also have a different relationship by gender. This study examined the extent to which different patterns of violence, abuse, and control were differentially associated with formal and informal help-seeking in a national Canadian sample. Data from the 2004 General Social Survey were analyzed, which included 696 women and 471 men who reported physical or sexual violence by a current or ex-spouse or common-law partner. The most commonly reported formal sources for women and men were health professionals (i.e., doctors, nurses, counselors, psychologists) and the police. For women, informal sources (i.e., family, friends, neighbors) were commonly reported across all IPV subgroups. However, the importance of almost all of the formal sources (e.g., health professionals, police, lawyers, shelters, crisis centers) increased as the severity of the violence and control increased. Shelters and crisis centers were also reported by a notable proportion of women who experienced the most severe pattern of violence and control. For men, both formal and informal sources were more commonly reported by those who experienced moderate violence and control compared with those who experienced relatively less severe acts of physical aggression. The results suggest that research that more sensitively examines people's experiences of violence and control can help identify their health, social, and safety needs; and ultimately better inform the development of programs and services aimed at addressing these needs.     

Intimate partner violence in Europe: design and methods of a multinational study

Objective

To describe the design, methods, procedures and characteristics of the population involved in a study designed to compare Intimate Partner Violence (IPV) in eight European countries.

Methods

Women and men aged 18–65, living in Ghent-Belgium (n = 245), Stuttgart-Germany (n = 546), Athens-Greece (n = 548), Budapest-Hungary (n = 604), Porto-Portugal (n = 635), Granada-Spain (n = 138), Östersund-Sweden (n = 592), London-United Kingdom (n = 571), were sampled and administered a common questionnaire. Chi-square goodness of fit and five-age strata population fractions ratios for sex and education were computed to evaluate samples’ representativeness.

Results

Differences in the age distributions were found among women from Sweden and Portugal and among men from Belgium, Hungary, Portugal and Sweden. Over-recruitment of more educated respondents was noted in all sites.

Conclusion

The use of a common research protocol with the same structured questionnaire is likely to provide accurate estimates of the general population IPV frequency, despite limitations in probabilistic sampling and restrictions in methods of administration.