Intimate Partner Violence against Women in West Ethiopia: Magnitude, Associated Factors, Health Effects, and Community Perceptions.
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Date
2012-10
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Addis Ababa University
Abstract
Background
Intimate partner violence against women is a psychological, physical, and sexual abuse directed
towards spouses. Globally it is the most pervasive yet underestimated human rights violation.
Intimate partner violence against women is known to undermine the physical, mental and
reproductive well-being of women and children. Since much of this is hidden inside the home, it
is difficult to document it and work towards its prevention. Empirical data are needed to take
appropriate measures in curbing the problem.
Objective
The overall aim is to assess the magnitude, associated factors and adverse health effects of
intimate partner violence against women, and explore the community’s perception towards such
violence in East Wollega Zone, West Ethiopia.
Methods
Community-based cross-sectional and case-control studies were conducted from January to June,
2011 using standard World Health Organization multi-country study questionnaire. To assess the
magnitude, associated factors, and adverse health effects of intimate partner violence against
women, a sample of 1540 ever married/cohabiting women aged 15-49 years was randomly
selected from urban and rural settings of the study area. To examine the association between
intimate partner violence against women and under-five deaths, a sample of 858 biological
mothers aged 15-49 years (286 cases and 572 controls) was included. Cases were biological
mothers of the under-five deceased within two years preceding the survey, whereas controls were
biological mothers of live under-five matched by age and sex of the child as well as area of
residence. Data were double-entered into Epi DATA and analyzed using SPSS version 19 and
STATA 11 and principally analyzed using logistic regression models.
Online databases were searched from the earliest entry to December 2010 for systematic review
and meta-analysis to assess the effect of intimate partner violence against women on under-five mortality. On the final search, 11 studies from developing countries were inputted into Metaesy
add-in for MS Excel version 1.0.4 software for meta-analysis. Random effect model using
DerSimonian and Laird's (DL) estimator was used to calculate the pooled estimates of the
studies.
In addition, a total of 12 focus group discussions involving 55 men and 60 women were
conducted from December, 2011 to January, 2012 to explore the perceptions of the community
towards intimate partner violence against women. Discussants were purposively selected from
the study area. The analyses followed the procedure for qualitative thematic content analysis.
Results
Lifetime and current (last 12 months) prevalence of intimate partner violence against women
showed 76.5%; 95% CI, 74.4 to 78.6% and 72.5%; 95% CI, 70.3 to 74.7%, respectively. The
joint occurrences of psychological, physical, and sexual violence were 56.9%. The patterns of
the three forms of violence are similar across the time periods. Rural residents (AOR, 0.58; 95%
CI, 0.34 to 0.98), literates (AOR, 0.65; 95% CI, 0.48 to 0.88), and women autonomy (AOR,
0.46; 95% CI, 0.27 to 0.76) were at decreased likelihood to have lifetime intimate partner
violence against women. Yet, older women were nearly four times (AOR, 3.36; 95% CI, 1.27 to
8.89) more likely to report the incident. On the other hand, marriage by abduction (AOR, 3.71;
95% CI, 1.01 to 13.63), male polygamy (AOR, 3.79; 95% CI, 1.64 to 8.73), spousal alcoholic
consumption (AOR, 1.98; 95% CI, 1.21 to 3.22), spousal hostility (AOR, 3.96; 95% CI, 2.52 to
6.20), and previous witnesses of parental violence (AOR, 2.00; 95% CI, 1.54 to 2.56) were
factors associated with an increased likelihood of intimate partner violence against women.
Nearly two-thirds (64.1%) of physically abused women had injuries to their body parts. The vast
majority (93.3%) experienced symptom of mental distress. Sixty four percent of the abused
women compared to 41.7% of the non-abused ever had symptom of sexually transmitted
infections. Furthermore, 16% and 7.2% of the abused women had unintended pregnancy and
termination of pregnancy, respectively while only 11.3% and 4.8% of the non-abused had the
same respectively. On the other hand, 82.2% of the cases and 68.6% of the controls ever
experienced at least an incident of intimate partner violence against them while 61.9% and 50.9% of the respective groups had ever experienced all forms of intimate partner violence.
Intimate partner violence against women is independently associated with symptoms of mental
distress, sexually transmitted infections, unintended pregnancy and termination of pregnancy.
Mothers who have ever experienced controlling behavior in marriage were more than four times
(AOR, 4.27; 95% CI, 0.97 to 18.89) as likely as mothers who did not to have under-five
mortality. In addition, mothers who experienced two forms of violence at the same time were
more than two times (AOR, 2.24; 95% CI, 1.31 to 3.85) as likely as mothers who did not to have
under-five mortality. Ever experiences of the three forms of maternal intimate partner violence
were more than two and half times (AOR, 2.55; 95% CI, 1.66 to 3.92) as likely to have the same.
Similar effect was observed in meta-analysis, with the mean effect size, 0.23; 95% CI, 0.16 to
0.32 is significantly different from zero and the value of pooled Odds Ratio, 1.34; 95% CI, 1.12
to1.46).
In focus group discussions, most of the discussants confirmed that the community has divergent
views on the acceptance of intimate partner violence against women. The act is acceptable in
circumstances of practicing extra marital sexual affairs and suspected sexual infidelity. Most
discussants perceived that the majority of women in their area tolerate the incident due to
traditional beliefs, norms and attitudes of the community and very few, including victims, defend
themselves against violent husbands/partners. Biased arbitration is marked by excluding women
from reconciliatory local elders. The suggested measures by the community to stop or reduce
violence against women targeted provision of education for individuals, family, community, and
society.
Conclusion
In their lifetime, three out of four women experienced at least an incident of intimate partner
violence against them. In the study area, various socio-demographic and behavioral factors are
associated with intimate partner violence against women. Moreover, intimate partner violence
against women negatively affects the physical, mental and sexual/reproductive health of women.
Further, it is independently associated with under-five mortality. Measures suggested by the community to stop or prevent the act were focused on provision of education about women’s
right to individuals, family, community, and society.
Recommendations
There are needs for an urgent attention at all levels including policymakers, stakeholders and
professionals to alleviate the situation. Involving men in maternal and child health programs
could be one strategy to address the issue of intimate partner violence against women. Moreover,
efforts to dispel myths, misconceptions and beliefs of the community should be strengthened.
Finally, extensive national studies are encouraged to address the issues of intimate partner
violence against women and under-five mortality.
Description
Keywords
Intimate partner violence, Women, Risk factors, Health effects, Community perception, West Ethiopia