Improving estimation of the association between alcohol use and intimate partner violence in low-income and middle-income countries

2020 ◽  
pp. injuryprev-2019-043433
Author(s):  
M Claire Greene ◽  
Lori Heise ◽  
Rashelle J Musci ◽  
Andrea L Wirtz ◽  
Renee Johnson ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Alcohol Use ◽  
Low Income ◽  
Partner Violence ◽  
Fold Increase ◽  
Intimate Partner ◽  
Middle Income ◽  
Middle Income Countries ◽  
Country Level ◽  
Female Literacy

BackgroundAlcohol use is a consistent correlate of intimate partner violence (IPV) in low-income and middle-income countries (LMICs). However, the magnitude of this association differs across studies, which may be due to contextual and methodological factors. This study aims to estimate and explore sources of heterogeneity in the association between alcohol use and IPV in 28 LMICs (n=109 700 couples).MethodsIn nationally representative surveys, partnered women reported on IPV victimisation and male partner’s alcohol use. We estimated the relationship between alcohol use and IPV using logistic regression and full propensity score matching to account for confounding. Country-specific ORs were combined using a random-effects model. Country-level indicators of health and development were regressed on ORs to examine sources of variability in these estimates.ResultsPartner alcohol use was associated with a 2.55-fold increase in the odds of past-year IPV victimisation (95% CI 2.27 to 2.86) with substantial variability between regions (I2=70.0%). Countries with a low (<50%) prevalence of past-year alcohol use among men displayed larger associations between alcohol use and IPV. Exploratory analyses revealed that colonisation history, religion, female literacy levels and substance use treatment availability may explain some of the remaining heterogeneity observed in the strength of the association between alcohol use and IPV across countries.ConclusionPartner alcohol use is associated with increased odds of IPV victimisation in LMICs, but to varying degrees across countries. Prevalences of male alcohol use and cultural factors were related to heterogeneity in these estimates between countries.

scholarly journals Intimate partner violence in 46 low-income and middle-income countries: an appraisal of the most vulnerable groups of women using national health surveys

2020 ◽  
Vol 5 (1) ◽  
pp. e002208 ◽  
Author(s):  
Carolina V N Coll ◽  
Fernanda Ewerling ◽  
Claudia García-Moreno ◽  
Franciele Hellwig ◽  
Aluisio J D Barros
Keyword(s):  
Intimate Partner Violence ◽  
Low Income ◽  
Partner Violence ◽  
Health Surveys ◽  
Household Wealth ◽  
Intimate Partner ◽  
Vulnerable Groups ◽  
Demographic And Health Surveys ◽  
Middle Income ◽  
Middle Income Countries

IntroductionIntimate partner violence (IPV) against women is a critical public health issue that transcends social and economic boundaries and considered to be a major obstacle to the progress towards the 2030 women, children and adolescents’ health goals in low-income and middle-income countries (LMICs). Standardised IPV measures have been increasingly incorporated into Demographic and Health Surveys carried out in LMICs. Routine reporting and disaggregated analyses at country level are essential to identify populational subgroups that are particularly vulnerable to IPV exposure.MethodsWe examined data from 46 countries with surveys carried out between 2010 and 2017 to assess the prevalence and inequalities in recent psychological, physical and sexual IPV among ever-partnered women aged 15–49 years. Inequalities were assessed by disaggregating the data according to household wealth, women’s age, women’s empowerment level, polygyny status of the relationship and area of residence.ResultsNational levels of reported IPV varied widely across countries—from less than 5% in Armenia and Comoros to more than 40% in Afghanistan. Huge inequalities within countries were also observed. Generally, richer and more empowered women reported less IPV, as well as those whose partners had no cowives. Different patterns across countries were observed according to women’s age and area of residence but in most cases younger women and those living in rural areas tend to be more exposed to IPV.ConclusionThe present study advances the current knowledge by providing a global panorama of the prevalence of different forms of IPV across LMICs, helping the identification of the most vulnerable groups of women and for future monitoring of leaving no one behind towards achieving the elimination of all forms of violence among women and girls.

scholarly journals Voices from low-income and middle-income countries: a systematic review protocol of primary healthcare interventions within public health systems addressing intimate partner violence against women

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019266 ◽  
Author(s):  
Marcos Claudio Signorelli ◽  
Stav Hillel ◽  
Daniel Canavese de Oliveira ◽  
Beatriz Paulina Ayala Quintanilla ◽  
Kelsey Hegarty ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Health Systems ◽  
Low Income ◽  
Partner Violence ◽  
Intimate Partner ◽  
Risk Of Bias ◽  
Middle Income ◽  
Public Health Systems ◽  
Middle Income Countries

IntroductionIntimate partner violence (IPV) considerably harms the health, safety and well-being of women. In response, public health systems around the globe have been gradually implementing strategies. In particular, low-income and middle-income countries (LMIC) have been developing innovative interventions in primary healthcare (PHC) addressing the problem. This paper describes a protocol for a systematic review of studies addressing the impacts and outcomes of PHC centre interventions addressing IPV against women from LMIC.Methods and analysisA systematic search for studies will be conducted in African Index Medicus, Africa Portal Digital Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Index Medicus for the Southeast Asia Region, IndMed, Latin American and Caribbean Health Science Literature Database (LILACS), Medecins Sans Frontieres, MEDLINE, Minority Health and Health Equity Archive, ProQuest, PsycINFO, Scientific Electronic Library Online, (SciELO) and Social Policy and Practice. Studies will be in English, Spanish and Portuguese, published between 2007 and 2017, addressing IPV against women from LMIC, whose data quantitatively report on the impacts and outcomes for survivors and/or workers and/or public health systems preintervention and postintervention. Two trilingual reviewers will independently screen for study eligibility and data extraction, and a librarian will cross-check for compliance. Risk of bias and quality assessment of studies will be measured according to: (1) the Cochrane Collaboration’s tool for assessing risk of bias for randomised controlled trials and (2) the Methodological Index for Non-Randomised Studies (MINORS). Data will be analysed and summarised using meta-analysis and narrative description of the evidence across studies. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols(PRISMA P) guidelines.Ethics and disseminationThis systematic review will be based on published studies, thus not requiring ethical approval. Findings will be presented in conferences and published in a peer-reviewed journal.PROSPERO registration numberCRD42017069261.

scholarly journals Husband’s Alcohol Use, Intimate Partner Violence, and Family Maltreatment of Low-Income Postpartum Women in Mumbai, India

2016 ◽  
Vol 33 (14) ◽  
pp. 2241-2267 ◽  
Author(s):  
Jennifer A. Wagman ◽  
Balaiah Donta ◽  
Julie Ritter ◽  
D. D. Naik ◽  
Saritha Nair ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Alcohol Use ◽  
Low Income ◽  
Partner Violence ◽  
Access To Health Care ◽  
Scale Up ◽  
Intimate Partner ◽  
Design Strategies ◽  
Cross Sectional ◽  
Increased Risk

Husbands’ alcohol use has been associated with family-level stress and intimate partner violence (IPV) against women in India. Joint family systems are common in India and IPV often co-occurs with non-violent family maltreatment of wives (e.g., nutritional deprivation, deprivation of sleep, blocking access to health care). Alcohol use increases for some parents following the birth of a child. This study examined 1,038 postpartum women’s reports of their husbands’ alcohol use and their own experiences of IPV (by husband) and non-violent maltreatment from husbands and/or in-laws. We analyzed cross-sectional, quantitative data collected in 2008, from women (ages 15-35) seeking immunizations for their infants <6 months at three large urban health centers in Mumbai, India. Crude and adjusted logistic regression models estimated associations between the independent variable (husbands’ past month use of alcohol) and two dependent variables (postpartum IPV and maltreatment). Overall, 15% of husbands used alcohol, ranging from daily drinkers (10%) to those who drank one to two times per week (54%). Prevalence of postpartum IPV and family maltreatment was 18% and 42%, respectively. Prevalence of IPV among women married to alcohol users was 27%. Most abused women’s husbands always (27%) or sometimes (37%) drank during violent episodes. Risk for IPV increased with a man’s increasing frequency of consumption. Women who lived with a husband who drank alcohol, relative to non-drinkers, were more likely to report postpartum IPV, aOR = 2.0, 95% confidence interval (CI) = [1.3, 3.1]. Husbands’ drinking was marginally associated with increased risk for family maltreatment, aOR = 1.4, 95% CI = [1.0, 2.1]. Our findings suggest that men’s alcohol use is an important risk factor for postpartum IPV and maltreatment. Targeted services for Indian women contending with these issues are implicated. Postpartum care offers an ideal opportunity to screen for IPV, household maltreatment, and other health risks, such as husband’s use of alcohol. There is need to scale up proven successful interventions for reducing men’s alcohol use and design strategies that provide at-risk women protection from alcohol-related IPV.

Structural Context and the Role of Positive Deviance From Community Norms in Shaping Risk for Sexual Intimate Partner Violence in 32 Low- and Middle-Income Countries

2020 ◽  
pp. 088626052092750
Author(s):  
Nicholas Metheny ◽  
Rob Stephenson
Keyword(s):  
Social Capital ◽  
Intimate Partner Violence ◽  
Partner Violence ◽  
Intimate Partner ◽  
Positive Deviance ◽  
Middle Income ◽  
Middle Income Countries ◽  
Community Norms ◽  
Structural Environment ◽  
Sexual Intimate Partner Violence

Community norms provide social scripts and pathways to accruing social capital that can alter a woman’s risk of experiencing sexual intimate partner violence (IPV). These norms are in turn influenced by the structural environment in which they exist. Missing from the literature is an understanding of how an individual’s departure from community norms—positive deviance—influences the risk of sexual IPV and how this effect may vary across structural environments. Demographic and Health Survey data from 32 low- and middle-income countries (LMIC) were stratified into six structural environments by two fundamental structural factors: level of gender inequality and prevalence of sexual IPV. To examine how transcending community norms shape the odds of reporting sexual IPV across environments, six identical multilevel models were fit including statistical deviation from 13 community norms as key covariates. Positive deviance from community norms is associated with both increased and decreased odds of reporting sexual IPV and the nature of these relationships vary by structural environment. Positive deviance had a greater effect on reporting sexual IPV in highly unequal societies. Positive deviance from fertility preferences and controlling behavior was associated with increased odds of sexual IPV across contexts. The accrual of social capital and differences in female autonomy across environments may be two ways positive deviance alters sexual IPV risk. A better understanding of how the salience of community norms varies by structural environment and how transcending these norms shapes the risk for sexual violence may help highlight pathways for interventions to change restrictive social norms and increase female empowerment without increasing the risk of sexual IPV.

Wealth Inequality and Intimate Partner Violence: An Individual and Ecological Level Analysis Across 20 Countries

2021 ◽  
pp. 088626052110163
Author(s):  
Samuel Kebede ◽  
Anne-Laura Van Harmelen ◽  
Andres Roman-Urrestarazu
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Wealth Inequality ◽  
Intimate Partner ◽  
P Value ◽  
Demographic And Health Surveys ◽  
Middle Income ◽  
Middle Income Countries ◽  
Economic Position ◽  
Low And Middle Income

Intimate Partner Violence (IPV) has been linked to poor health. Economic position may be an important risk factor for IPV. We examined the association between economic position and IPV at country and individual levels. We analyzed Demographic and Health Surveys data of 187,716 ever-partnered women between ages 10 and 59 from 20 low- and middle-income countries. We calculated direct age-standardized 12-month prevalence of physical IPV and performed ecological analysis using Gini coefficients and Concentration indexes to assess correlation with 12-month prevalence of physical IPV. We conducted multivariable logistic regression for each country to assess the association between wealth status and physical IPV and a meta-analysis of the regression model to present results across countries. Compared to the Poorest quintile, odds of IPV among wealthier quintiles varied by country. In the Middle quintile, India had significantly reduced IPV (OR 0.75, 95%CI: 0.68-0.83). In the Richer and Richest quintiles, 4 and 6 countries had significant reductions in IPV, respectively. Only Mozambique was found to have significant increased IPV in the wealthiest quintile (OR 2.51, 95%CI: 1.45-4.38). Gini coefficient and physical IPV had a correlation coefficient of 0.502 ( p value 0.033), while Concentration index had –0.276 ( p value .253). Standardized prevalence for physical IPV ranged from 1.58% to 18.91%. Findings suggest that the relationship between wealth and IPV vary considerably in the included low- and middle-income countries, and that risk of IPV may not necessarily be higher among women in lower wealth brackets. Mozambique was the only country with increased odds of IPV among the Richest group as compared to the Poorest group. This study provides evidence IPV may transcend economic boundaries, and that studies looking at the link between inequality and IPV are paramount for designing adequate preventative policies.

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