Intimate partner violence and symptoms of reproductive tract infections among married Indian women

Association Between Women's Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand

IMPORTANCE

Intimate partner violence (IPV) is increasingly recognized as a contributing factor for long-term health problems; however, few studies have assessed these health outcomes using consistent and comprehensive IPV measures or representative population-based samples.

OBJECTIVE

To examine associations between women's lifetime IPV exposure and self-reported health outcomes.

DESIGN, SETTING, AND PARTICIPANTS

The cross-sectional, retrospective 2019 New Zealand Family Violence Study, adapted from the World Health Organization's Multi-Country Study on Violence Against Women, assessed data from 1431 ever-partnered women (63.7% of eligible women contacted) in New Zealand. The survey was conducted from March 2017 to March 2019, across 3 regions, which accounted for approximately 40% of the New Zealand population. Data analysis was performed from March to June 2022.

EXPOSURES

Exposures were lifetime IPV by types (physical [severe/any], sexual, psychological, controlling behaviors, and economic abuse), any IPV (at least 1 type), and number of IPV types.

MAIN OUTCOMES AND MEASURES

Outcome measures were poor general health, recent pain or discomfort, recent pain medication use, frequent pain medication use, recent health care consultation, any diagnosed physical health condition, and any diagnosed mental health condition. Weighted proportions were used to describe the prevalence of IPV by sociodemographic characteristics; bivariate and multivariable logistic regressions were used for the odds of experiencing health outcomes by IPV exposure.

RESULTS

The sample comprised 1431 ever-partnered women (mean [SD] age, 52.2 [17.1] years). The sample was closely comparable with New Zealand's ethnic and area deprivation composition, although younger women were slightly underrepresented. More than half of the women (54.7%) reported any lifetime IPV exposure, of whom 58.8% experienced 2 or more IPV types. Compared with all other sociodemographic subgroups, women who reported food insecurity had the highest IPV prevalence for any IPV (69.9%) and all specific types. Exposure to any IPV and specific IPV types was significantly associated with increased likelihood of reporting adverse health outcomes. Compared with those unexposed to IPV, women who experienced any IPV were more likely to report poor general health (adjusted odds ratio [AOR], 2.02; 95% CI, 1.46-2.78), recent pain or discomfort (AOR, 1.81; 95% CI, 1.34-2.46), recent health care consultation (AOR, 1.29; 95% CI, 1.01-1.65), any diagnosed physical health condition (AOR, 1.49; 95% CI, 1.13-1.96), and any mental health condition (AOR, 2.78; 95% CI, 2.05-3.77). Findings suggested a cumulative or dose-response association because women who experienced multiple IPV types were more likely to report poorer health outcomes.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of women in New Zealand, IPV exposure was prevalent and associated with an increased likelihood of experiencing adverse health. Health care systems need to be mobilized to address IPV as a priority health issue.

The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature

AIM

The long-term effects of intimate partner violence (IPV) on physical health outcomes and health-related behaviors are underresearched in comparison to the effects on mental health and pregnancy. This systematic review examines the recent research in this area from 2012 through 2019.

METHODS

SCOPUS, PubMed, EBSCOhost, and gray literature were searched using the key words "intimate partner violence" and "health." To meet inclusion criteria, studies needed to be original research and focus on IPV during adulthood and its effects on the physical health or health-related behaviors of women. Fifty-two studies were qualitatively analyzed, with results grouped into broad categories of effects, including cardiovascular, endocrine, infectious diseases, and health screening.

RESULTS

IPV was shown to have negative effects on physical health outcomes for women, including worsening the symptoms of menopause and increasing the risk of developing diabetes, contracting sexually transmitted infections, engaging in risk-taking behaviors including the abuse of drugs and alcohol, and developing chronic diseases and pain. It also has significant effects on human immunodeficiency virus outcomes, worsening CD4+ cell depletion. Results varied regarding the effects of IPV on cardiovascular health outcomes.

CONCLUSION

The result of this review demonstrates that women who have experienced violence and abuse are at significantly increased risk of poor health outcomes in a variety of areas and so require specialized and tailored primary care. This review highlights significant gaps in this field of research, particularly in relation to cardiovascular disease, endocrine dysfunction, and neurological symptoms and conditions. It demonstrates a need for additional long-term studies in this field to better inform the health care of women who have experienced IPV and to establish the physiological mediators of these outcomes.

Association of intimate partner violence and other risk factors with HIV infection among married women in India: evidence from National Family Health Survey 2015-16

Background

Human immunodeficiency virus (HIV) infection remains an important public health concern in many countries. It is fuelled by gender inequality and disparity, which has resulted in a fundamental violation of women’s human rights. This study aims to find out the association of intimate partner violence (IPV) and other risk factors with the prevalence of HIV infection among married women in India.

Methods

This study is based on data from the India National Family Health Survey (2015–16). Bivariate analysis has been performed to estimate the prevalence of HIV. Logistic regression analysis is conducted to find out the association between IPV, factors such as having alcoholic husband and lifetime partner, and HIV infection among currently married women.

Results

Married women who had faced physical, sexual, and emotional violence from their husbands/partners were almost twice more likely to have tested HIV positive compared to married women who did not face violence [OR: 2.14, CI: 1.08–4.50]. The odds of testing for HIV positive was significantly higher among the married women experiencing IPV and having alcoholic husband [OR: 4.48, CI: 1.87–10.70] than those who did not experience IPV and had non-alcoholic husband. The use of condom did not show any significant association with HIV infection. Again, having more than one lifetime partner had a positive association with HIV infection compared to those with one partner [OR: 2.45, CI: 1.21–4.16].

Conclusions

The study revealed that factors such as experiencing all types of IPV, having an alcoholic husband, increased number of lifetime partners, being sexually inactive, belonging to vulnerable social groups, and urban place of residence are important risk factors of HIV infection among married women in India. The results also suggest that gender-based violence and an alcoholic husband may represent a significant factor of HIV infection among married women and interventions should on focus such vulnerable populations.

Women's experience of intimate partner violence and uptake of Antenatal Care in Sofala, Mozambique

Intimate partner violence (IPV) is associated with negative physical and mental health outcomes. Although maternal health services, especially antenatal care (ANC), can act as a link to IPV resources, women experiencing IPV likely have reduced uptake of ANC due to social and emotional barriers. Poor ANC uptake can also further exacerbate adverse pregnancy outcomes. However, there is limited research examining the association between IPV and ANC within the context of Mozambique. Using data from a study conducted to assess the impact of membership in savings groups on maternal health service utilization in Mozambique (N = 205), we investigated the association between IPV and uptake of ANC. Pearson chi-square and logistic regression were employed to examine the association between IPV and ANC service utilization. The mean age of the participants was 33.4 years (SD = 11.88). Overall, 47.3%, 83.4%, and 51.7% of the participants reported experiencing IPV, receiving at least one ANC, and four or more ANC, respectively. Women who reported experience of IPV had lower odds of receiving both at least one (AOR 0.31 [95% CI:0.12–0.82]) and four or more ANC (AOR 0.50 [95% CI: 0.27–0.92]). Women who reported experience of IPV also had lower odds of receiving ANC from skilled personnel (AOR 0.32 [95% CI: 0.10–0.90]). Experience of IPV showed significant association with reduced ANC service utilization among women in the study area. Further study is needed to assess whether the negative association between IPV and ANC service utilization is also a causal relationship, the evidence which will then help guide a comprehensive intervention effort to improve maternal health services use.

Lifetime Spousal Violence Victimization and Perpetration, Physical Illness, and Health Risk Behaviours among Women in India

The aim of this study was to assess the association between lifetime spousal violence victimization, spousal violence perpetration, and physical health outcomes and behaviours among women in India. In the 2015⁻2016 National Family Health Survey, a sample of ever-married women (15⁻49 years) (N = 66,013) were interviewed about spousal violence. Results indicate that 29.9% of women reported lifetime spousal physical violence victimization and 7.1% lifetime spousal sexual violence victimization (31.1% physical and/or sexual violence victimization), and 3.5% lifetime spousal physical violence perpetration. Lifetime spousal violence victimization and lifetime spousal violence perpetration were significantly positively correlated with asthma, genital discharge, genital sores or ulcers, sexually transmitted infections (STIs), tobacco use, alcohol use, and termination of pregnancy, and negatively associated with daily consumption of dark vegetables. In addition, lifetime spousal violence victimization was positively associated with being underweight, high random blood glucose levels, and anaemia, and negatively correlated with being overweight or obese. Lifetime spousal violence perpetration was marginally significantly associated with hypertension. The study found in a national sample of women in India a decrease of lifetime physical and/or sexual spousal violence victimization and an increase of lifetime spousal physical violence perpetration from 2005/5 to 2015/6. The results support other studies that found that, among women, lifetime spousal physical and/or sexual spousal violence victimization and lifetime spousal physical violence perpetration increase the odds of chronic conditions, physical illnesses, and health risk behaviours.

Correlates of domestic violence experience among recently-married women residing in slums in Pune, India

The high risk of experiencing domestic violence (DV) among married women in India who reside in slum communities underscores the need for effective, evidence-based, and culturally-tailored primary prevention. To inform such DV primary prevention strategies for this population, we herein aimed to identify correlates of DV experience in early marriage. Utilizing a cross-sectional design, potential correlates of DV experience were explored among a geographically-clustered random sample of 100 recently-married women residing in slums in Pune, India. In multivariable regression, DV experience was associated with less educational attainment by the participant’s spouse (standardized β = -0.281, p = 0.004), less satisfaction of the spouse’s family with the maanpaan (wedding-related gifts provided by the bride’s family) they received at the time of marriage (standardized β = -0.298, p<0.001), poorer conflict negotiation skills (standardized β = -0.308, p<0.001), and greater acknowledgement of DV occurrence in family and friends (standardized β = 0.436, p<0.001). These correlates suggest strategies that could be incorporated into future DV primary prevention interventions for this vulnerable population (i.e. promoting completion of formal education of boys alongside girls, mitigating causes of familial dowry harassment, improving conflict negotiation skills, and challenging norms surrounding DV).

Women's Work, Gender Roles, and Intimate Partner Violence in Nigeria

The purpose of this study was to determine the contribution of women's labor force participation to the risk of intimate partner violence (IPV) victimization in the past 12 months, using data for 20,635 currently married women aged 15-49 years from the 2013 nationally representative Nigeria Demographic and Health Survey. Multilevel logistic regression models of sexual and physical IPV, with interactions between women's work and social norms regarding traditional gender roles, were developed. Approximately 23% of women aged 15-49 years reported IPV victimization in the past 12 months. Results revealed that non-cash work relative to unemployment was positively associated with both forms of IPV victimization, after controlling for other factors. Women's engagement in cash work was positively correlated with sexual IPV. The positive association between cash work and physical IPV victimization was significantly larger for women who resided in localities with greater male approval of wife beating. In localities where husband-dominated decision making was more common, a spousal education gap that favored husbands was more positively associated with sexual IPV. The findings call for integrated IPV prevention and economic empowerment programs that consider gender norms and gender-role beliefs and are adapted to the locality setting, in order to promote social environments in which women can reap the full benefits of their economic empowerment.

The Development and Validation of the Indian Family Violence and Control Scale

The high prevalence of domestic violence (DV) among married women in India and associated negative health repercussions highlight the need for effective prevention strategies and tools to measure the efficacy of such interventions. Literature supporting differing manifestations of DV by culture underscores the need for a culturally-tailored scale to more effectively measure DV in the Indian context. We therefore aimed to develop and validate such a tool, the Indian Family Violence and Control Scale (IFVCS), through a mixed-methods study. The psychometric development of IFVCS is herein discussed. After field pre-testing and expert review, a 63-item questionnaire was administered to a random sample of 630 married women from May-July 2013 in Pune, India. The item response theory approach for binary data to explore the IFVCS structure suggested that IFVCS is reliable, with the majority of items having high (>0.5) and significant factor loadings. Concurrent validity, assessed by comparing responses to IFVCS with the validated, abridged Conflict Tactics Scale-2, was high (r = 0.899, p<0.001) as was the construct validity, demonstrated by its significant association with several established DV correlates. Therefore, initial assessment of the IFVCS psychometric properties suggests that it is an effective tool for measuring DV among married women in India and speaks to its capacity for enhancing understanding of DV epidemiology and for evaluating the effectiveness of future DV interventions.

An approach to mental health in low and middle income countries: a case example from urban India

Women in low and middle income countries (LMICs) facing poverty, challenging living conditions and gender inequality often express their emotional difficulties through physical health concerns and seek care at primary health facilities. However, primary care providers in LMICs only treat the physical health symptoms and lack appropriate services to address women's mental health problems. This paper, presents data from the counseling component of a multilevel, research and intervention project in a low income community in Mumbai, India whose objective was to improve sexual health and reduce HIV/STI risk among married women. Qualitative data from counselor notes shows that poor mental health, associated with negative and challenging life situations, is most often expressed by women as gynecological concerns through the culturally-based syndrome of tenshun. A path analysis was conducted on baseline quantitative data that confirmed the relationships between sources of tenshum, emotional status and symptoms of common mental disorders (CMDs). Based on these findings, the authors propose a need for culturally appropriate primary care services for LMICs that would integrate mental and physical health. This approach would reduce mental health morbidity among women through early intervention and prevention of the development of CMDs.

How well does the World Health Organization definition of domestic violence work for India?

Domestic violence (DV) is reported by 40% of married women in India and associated with substantial morbidity. An operational research definition is therefore needed to enhance understanding of DV epidemiology in India and inform DV interventions and measures. To arrive at a culturally-tailored definition, we aimed to better understand how definitions provided by the World Health Organization and the 2005 India Protection of Women from Domestic Violence Act match the perceptions of behaviors constituting DV among the Indian community. Between September 2012 and January 2013, 16 key informant interviews with experts in DV and family counseling and 2 gender-concordant focus groups of lay community members were conducted in Pune, India to understand community perceptions of the definition of DV, perpetrators of DV, and examples of DV encountered by married women in Pune, India. Several key themes emerged regarding behaviors and acts constituting DV including 1) the exertion of control over a woman's reproductive decision-making, mobility, socializing with family and friends, finances, and access to food and nutrition, 2) the widespread acceptance of sexual abuse and the influences of affluence on sexual DV manifestations, 3) the shaping of physical abuse experiences by readily-available tools and the presence of witnesses, 4) psychological abuse for infertility, dowry, and girl-children, and 5) the perpetration of DV by the husband and other members of his family. Findings support the need for a culturally-tailored operational definition that expands on the WHO surveillance definition to inform the development of more effective DV intervention strategies and measures.