Beliefs of Sri Lankan medical students about wife beating

Socioeconomic and Geographic Correlates of Intimate Partner Violence in Sri Lanka: Analysis of the 2016 Demographic and Health Survey

Intimate partner violence (IPV) is a serious public health issue and violation of human rights. The prevalence of IPV in South Asia is especially pronounced. We examined the associations between socioeconomic position (SEP), geographical factors and IPV in Sri Lanka using nationally representative data. Data collected from Sri Lanka's 2016 Demographic and Health Survey were analysed using multilevel logistic regression techniques. A total of 16,390 eligible ever-partnered women aged 15-49 years were included in the analysis. Analyses were also stratified by ethnicity, type of violence, neighbourhood poverty and post-conflict residential status for selected variables. No schooling/primary educational attainment among women (OR 2.46 95% CI 1.83-3.30) and their partners (OR 2.87 95% CI 2.06-4.00), financial insecurity (OR 2.17 95% CI 1.92-2.45) and poor household wealth (OR 2.64 95% CI 2.22-3.13) were the socioeconomic factors that showed the strongest association with any IPV, after adjusting for age and religion. These associations predominately related to physical and/or sexual violence, with weak associations for psychological violence. Women living in a post-conflict environment had a higher risk (OR 2.96 95% CI 2.51-3.49) of IPV compared to other areas. Ethnic minority women (Tamil and Moor) were more likely to reside in post-conflict areas and experience poverty more acutely compared to the majority Sinhala women, which may explain the stronger associations for low SEP, post-conflict residence and IPV found among Tamil and Moor women. Policies and programs to alleviate poverty, as well as community mobilisation and school-based education programs addressing harmful gender norms may be beneficial. Trauma informed approaches are needed in post-conflict settings. Further exploratory studies investigating the complex interplay of individual, household and contextual factors occurring in this setting is required.

Cross-Cultural Differences in Student Attitudes Toward Intimate Partner Violence: A Systematic Review

Intimate partner violence (IPV) is a major human rights and public health problem which occurs at exceptionally high rates among tertiary students. Attitudes toward IPV are increasingly being recognized as a key risk factor for IPV and targeted in IPV prevention programs on college and university campuses. Understanding the influence of culture on attitudes toward IPV is necessary to change attitudes supportive of IPV and ultimately reduce the occurrence of IPV in the student population. This review sought to systematically identify, appraise, and synthesize research studies examining cross-cultural differences in attitudes toward IPV among tertiary students. A comprehensive search of nine electronic databases was conducted from inception to 15 May 2019. Studies were required to have compared attitudes toward IPV (e.g., acceptance or justification of IPV) among two or more cultural groups (based on country, race, or ethnicity) of tertiary students. Eighteen articles met eligibility criteria for the review, representing over 6,800 students. The studies provide considerable evidence that student attitudes toward IPV differ across cultures. Students in the United States and ethnic majority students in the United States generally showed less accepting attitudes toward IPV than their counterparts in other countries and ethnic minority groups. The particular contexts in which IPV is justified may reflect cultural values and norms. The findings have important implications for prevention and intervention strategies aimed at improving attitudes toward IPV among tertiary students.

'Even though a man takes the major role, he has no right to abuse': future male leaders' views on gender-based violence in Sri Lanka

Background: Distinct gender roles influence gender inequality and build the foundation for gender-based violence. Violence against women is a major public health problem in all societies, and a violation of human rights. Prevalence surveys on gender-based violence have been published from Sri Lanka, but qualitative studies on men’s perceptions are lacking.

Objectives: The aim of this study was to explore young educated Sri Lankan men’s perceptions of violence against women.

Methods: Seven focus-group discussions were held. Men at the end of their university studies were purposefully selected. A topic guide was used, covering various scenarios of violence against women. Qualitative content analysis was carried out.

Results: Four categories were developed through the analytic process: fixed gender roles – patriarchal values are accepted in society, female mobility control, and slowly changing attitudes; violence not accepted but still exists – sexual harassment exists everywhere, different laws for different people, female tolerance of violence, and men’s right to punish; multiple factors cause violence – alcohol, violent behavior is inherited, violence culturally accepted, low education, and lack of communication; and prevention of violence against women – both parents must engage and socialize girls and boys equally, life skills education, premarital counselling, working places value clarification, and more women in politics and boards are suggested.

Conclusions: Medical and management students, possible future male leaders of the country, have suggestions of prevention strategies in life skills to reduce gender-based violence and to increase knowledge of health consequences with the aim of changing attitudes.

The effect of a community based health promotion intervention to change gender norms among women in a rural community in Sri Lanka

BACKGROUND

Gender norms practiced by respective societies increase the risk of violence by men against women. To date, there is a dearth of research evidence on changing gender norms through health promotion approaches around the globe, including in Sri Lanka. This study provides an evaluation of effectiveness of a health promotion intervention in changing the acceptance of gender norms among women.

METHODS

A quasi-experimental study was conducted in two rural villages in Anuradhapura district in Sri Lanka including women who have a child under five years of age. One village was allocated to receive an intervention developed based on a health promotion approach and the other village was a control. A community based mechanism to question selected gender norms among women was developed as the intervention. The pre- and post-intervention assessments of the level of acceptance of gender norms were done using an interviewer administered questionnaire and by using focus group discussions.

RESULTS

Following the intervention, acceptances of prominent gender norms were changed significantly among the women receiving the intervention method. The control group showed no changes towards the acceptance of gender norms during this period. Women in the intervention group had higher levels of self-reported positive behavior changes and greater understanding of gender concepts compared to the control group.

CONCLUSION

The acceptance of gender norms among women in rural villages in Sri Lanka can be changed by a community based intervention targeting gender norms.

Beliefs About Wife Beating Among Social Work Students in Taiwan

Based on an integrative framework, this study addresses the beliefs that a group of social work students from Taiwan had about wife beating. A self-administered questionnaire was filled out by 790 students (76.5% female, 23.5% male) spanning all 4 years of undergraduate studies. The results show that male students exhibited a greater tendency than their female counterparts to justify wife beating and to hold battered women responsible for violence against them. This tendency was also found among students who held traditional attitudes toward women, students who held patriarchal expectations of marriage, and students who had witnessed interparental violence in childhood. In addition, male students and students with traditional attitudes toward women exhibited the strongest tendency to believe that wives benefit from beating. Conversely, female students expressed more willingness than their male counterparts to help battered women, as did students who held liberal attitudes toward women and students who held egalitarian expectations of marriage. Furthermore, female students and those with liberal attitudes toward women tended to hold violent husbands responsible for their behavior, and to express support for punishing violent husbands. This article concludes with a discussion of the study's limitations and the results' implications for future research on the topic.

Impact of Adverse Childhood Experiences on Intimate Partner Violence Perpetration among Sri Lankan Men

In Sri Lanka, over one in three women experience intimate partner violence (IPV) victimization in their lifetime, making it a serious public health concern. Adverse childhood experiences (ACEs) such as child abuse and neglect, witnessing domestic violence, parental separation, and bullying are also widespread. Studies in Western settings have shown positive associations between ACEs and IPV perpetration in adulthood, but few have examined this relationship in a non-Western context. In the present study, we examined the association of ACEs with IPV perpetration among Sri Lankan men surveyed for the UN Multi-Country Study on Men and Violence in Asia and the Pacific. We found statistically significant positive associations between the number of ACE categories (ACE score) and emotional, financial, physical, and sexual IPV perpetration among Sri Lankan men. We analyzed the contributions of each ACE category and found that childhood abuse was strongly associated with perpetration of IPV in adulthood, with sexual abuse associated with the greatest increase in odds of perpetration (Adjusted odds ratio 2.36; 95% confidence interval: 1.69, 3.30). Witnessing abuse of one’s mother was associated with the greatest increase in the odds of perpetrating physical IPV (AOR 1.82; 95% CI: 1.29, 2.58), while lack of a male parental figure was not associated with physical IPV perpetration (AOR 0.76; 95% CI: 0.53, 1.09). These findings support a social learning theory of IPV perpetration, in which children who are exposed to violence learn to perpetrate IPV in adulthood. They also suggest that in Sri Lanka, being raised in a female-headed household does not increase the risk of IPV perpetration in adulthood compared to being raised in a household with a male parental figure. The relationship between being raised in a female-headed household (the number of which increased dramatically during Sri Lanka’s recent civil war) and perpetration of IPV warrants further study. Interventions that aim to decrease childhood abuse in Sri Lanka could both protect children now and reduce IPV in the future, decreasing violence on multiple fronts.

Intimate Partner Violence in a Lebanese Population Attending Gynecologic Care: A Cultural Perspective

Occurrence of intimate partner violence (IPV) against women in the Lebanese society has been largely ignored by local legal and religious authorities. Our aim is to estimate the prevalence of IPV among married Lebanese women, and investigate perception of abuse, referral patterns, and measures taken to deal with abusive situations. In this cross-sectional study, married women aged 20 to 65 presenting to the American University of Beirut Medical Center for gynecological care were interviewed on various forms of IPV. Out of 100 women invited to participate, 91 consented to take part in the survey of whom 37 (40.67%) gave a history of physical abuse, 30 (33.0%) of sexual abuse, 59 (64.8%) of verbal abuse, and 17 (18.7%) of emotional abuse. Spouse-imposed social isolation was reported in 20 (22.0%) women, and economic abuse in 30 (33.0%). Reasons for deciding to stay in an abusive relationship were "lack of any family or social support" (40.5%), "lack of financial resources" (40.5%), and "fear that the partner may take away the children" (37.8%). Women expressed satisfaction with their spouse's treatment irrespective of the existence of various forms of violence. A significant increase in the risk of weapon use against wife was correlated with decreased monthly income of the household, whereas a protective effect was conferred by an increased number of children. This study highlights the need for routine screening in health care settings for better identification of victims of violence. The selective conventional perception of abuse and the reactive normalization of violence observed indicate the necessity for culturally informed interventional strategies to complement screening.

Attitudes towards justifying intimate partner violence among married women in Bangladesh

This study examines women's attitude towards intimate partner violence among 331 Bangladeshi women in five selected disadvantaged areas of Dhaka city. This study used a shorter version of the Inventory of Beliefs about Wife Beating (IBWB) to measure women's attitude towards intimate partner violence. The results revealed that the mean score on the wife-beating scale of 15 items was 7.81 (SD = 4.893). Significant amounts of the variance (42.9%) in women's attitude towards intimate partner violence can be attributed to respondent's education (B = -0.60, p < 0.001), husband's education (B = -1.251, p < 0.01), exposure to mass media (B = -1.251, p < 0.01), respondent's current age (B = 0.081, p < 0.05), age at marriage (B = 0.215, p < 0.01), intimate partner violence victimization within the last 12 months (B = -1.533, p < 0.001) and women receiving micro-credit (small-scale loan or financial assistance) (B = -2.214, p < 0.001). The paper concludes with a discussion of the implications of the findings.

Attitudes Toward and Justification for Wife Abuse Among Syrian Medical and Nursing Students

Purpose:

To explore the perceptions of and attitudes toward violence and beliefs of contextual justification of wife abuse among Syrian medical and nursing students.

Design and Method:

A descriptive, cross-sectional design was used. The Perceptions of and Attitudes toward Wife Abuse Questionnaire was used to collect data from a convenience sample of 621 medical and nursing students from three public universities in Syria.

Results:

Only 18.4% of the students had positive attitudes toward interpersonal violence reflecting low tolerance to wife beating and use of physical force for problem solving and child discipline, and 16.1% did not justify wife beating. Medical, older, female students, from urban areas, with more educated parents, and those who did not experience violence or witness violence between their parents had significantly more positive attitudes toward wife abuse and significantly less justification of wife beating ( p < .05).

Conclusion and Implications:

Education about violence against women of future medical and nursing students is the responsibility of medical and nursing educators and health policy makers, who have to acknowledge the influence of the sociocultural factors in shaping student’s attitudes toward wife abuse and develop strategies to enhance these attitudes at the early stages of professional preparation.

Toward an integrative theoretical framework for explaining beliefs about wife beating: a study among students of nursing from Turkey

An integrative theoretical framework was tested as the basis for explaining beliefs about wife beating among Turkish nursing students. Based on a survey design, 406 nursing students (404 females) in all 4 years of undergraduate studies completed a self-administered questionnaire. Questionnaires were distributed and collected from the participants during their attendance of core courses. The results revealed that between 8% and 27% of the students expressed some level of willingness to justify wife beating, between 8% and 11% showed a tendency to believe that battered women benefit from beating, and between 10% and about 29% indicated that battered women are responsible for their beating. However, more than 88% of the students expressed willingness to help battered women, more than 63% of them indicated that violent husbands are responsible for their behavior, and about 28% or more showed a tendency to support punishing violent husbands. The results also indicated that significant amounts of the variance in the students' beliefs about wife beating can be attributed to their patriarchal ideology, to their exposure to family violence during childhood and adolescence, and to their traumatic symptoms. The article concludes with a discussion of the implications of the results for future research on the topic. Emphasis is placed on developing a more integrative theoretical approach for explaining beliefs about wife beating, and on the professional socialization of nursing students.

Palestinian physicians' misconceptions about and approval of wife abuse

The article presents the results of a study that examined Palestinian physicians' misconceptions about abused wives and abusive husbands and the extent to which Palestinian physicians approve of wife abuse. Self-administered questionnaires were completed by 396 physicians. The results revealed that between 10% and 49% of the Palestinian physicians held misconceptions about abused wives and between 15% and 63% held misconceptions about abusive husbands. The findings also revealed that substantial percentages of physicians tended to approve of moderate and severe violence against wives. Significant amounts of the variance in the physicians' approval of moderate and severe wife abuse can be attributed to their exposure to family violence and to their patriarchal ideology-variance over and above that which can be explained by the physicians' sociodemographic characteristics. The limitations of the study are discussed, as are the implications of the results for future research and theory development on the approaches of professionals toward wife abuse.

Posttraumatic stress disorder among Sri Lankan University students as a consequence of their exposure to family violence

The article presents the results of a study on the association between exposure to family violence (i.e., witnessing interparental violence and experiencing parental violence) during childhood and adolescence and adult posttraumatic stress disorder (PTSD). The study was conducted among a self-selected convenience sample of 476 students from Sri Lanka, using a self-administered questionnaire. The findings indicate that the more participants witnessed interparental violence and the more they experienced parental violence, the more they exhibited PTSD symptoms. Moreover, the findings reveal that participants' exposure to family violence explains a significant amount of the variance in their PTSD over and above the variance that can be attributed to their sociodemographic characteristics (age, gender, number of siblings, and family's socioeconomic status) and to their perceptions of the environment and functioning of their families. The limitations of the study and recommendations for future research are discussed.

Rates and psychological effects of exposure to family violence among Sri Lankan university students

OBJECTIVES

The study had two objectives: to examine the rates of exposure to family violence among students in a non-Western society, with Sri Lanka as a case study and to examine the psychological effects of their exposure.

METHOD

Four hundred seventy six medical students in Sri Lanka were surveyed. A self-administered questionnaire was utilized, which included two forms of the Conflict Tactics Scales (CTS) to measure the extent to which the students witnessed interparental violence and experienced parental violence in childhood and adolescence. Additional instruments included the Trauma Symptom Checklist (TSC-33), which measures dissociation, anxiety, depression, and sleep disturbance, and the Family Functioning in Adolescence Questionnaire (FFAQ), which measures the students' perceptions of the functioning and environment in their families.

RESULTS

Between 16% and 18% of the participants indicated that they had witnessed at least one act of interparental psychological aggression, and between 2% and 16% indicated that they had witnessed at least one act of interparental physical violence before the age of 18. Between 11% and 84% of the participants had experienced at least one act of parental psychological aggression, and between 2% and 22% had experienced at least one act of parental physical violence during childhood. Significant amounts of the variance in participants' dissociation, anxiety, depression, and sleep disturbance were explained by their witnessing interparental violence and experiencing parental violence.

CONCLUSIONS

The present study provides strong evidence that the rates of family violence in a non-Western society (i.e., Sri Lankan families) are within the range of violence found in Western societies. In addition, the psychological effects of exposure to family violence in non-Western societies are similar to those in Western societies, although the relevance of familial, cultural, and political contexts as well as socio-demographic characteristics to those effects in non-Western societies should be taken into consideration.

PRACTICE IMPLICATIONS

Counseling centers at universities should focus on developing better routine screening to reach students who are victims of family violence. The importance of sensitivity to risks associated with asking students about these problems should be taken into consideration. Interventions should aim to increase the students' safety, to alleviate the mental health consequences of their exposure to family violence, and to help those victims to develop productive help-seeking behaviors and coping resources to ensure their safety. Collaboration between the university and community and within the university for the benefit of those victims may help in facilitating the indentification of and intervention with students' victims of family violence.