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Bourey C, Bass J, Stephenson R. Women's Employment and Intimate Partner Violence: Understanding the Role of Individual and Community Structural Drivers in Low- and Middle-Income Countries. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6480-6499. [PMID: 36373609 PMCID: PMC10050128 DOI: 10.1177/08862605221134086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Empirical findings on the relationship between women's employment and intimate partner violence (IPV) in low- and middle-income countries (LMICs) are mixed. These varied findings may arise because research thus far has given insufficient attention to how individual attributes and community context shape the pathways between women's employment and IPV. Using publicly available Demographic and Health Survey (DHS) data from 20 LMIC settings (n = 168,995), we investigate (1) how women's employment is associated with past-year IPV and (2) if associations differ by household- or community-level structural drivers of IPV: women's attitudes toward IPV, women's participation in household decision-making, and relative wealth. We fit mixed-effects logistic regression models exploring the total, individual, community, and contextual effects of women's employment on past-year IPV; effect measure modification by structural drivers; and cross-level interactions between community-level structural drivers and individual employment. Our analyses reveal positive associations between total (odds ratio [OR] = 1.31; 95% CI [1.27, 1.35]), individual (OR = 1.23; 95% CI [1.19, 1.27]), community (OR = 1.06; 95% CI [1.06, 1.07]), and contextual effects (OR = 1.04; 95% CI [1.03, 1.05]) of women's employment for IPV. Only individual wealth demonstrated statistically significant effect measure modification for the relationship between individual employment and past-year IPV (ratio of OR = 0.95; 95% CI [0.92, 0.99]). These findings suggest interventions that focus only on increasing women's employment may be associated with harmful increases in the occurrence of IPV, even when these interventions enable a large proportion of women in a community to be employed. Structural interventions that change norms of women's autonomy or attitudes toward IPV at the household or community levels may be insufficient to ameliorate these negative effects, whereas interventions that increase household wealth partly may buffer these effects.
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Affiliation(s)
- Christine Bourey
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judith Bass
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Canedo AP, Morse SM. An Estimation of the Effect of Women's Employment on the Prevalence of Intimate Partner Violence in Mexico. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP10594-NP10618. [PMID: 31535920 PMCID: PMC10976363 DOI: 10.1177/0886260519876016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Female labor force participation is important for women, children, and societies, but also may have unintended impacts including an increased risk of intimate partner violence (IPV). IPV is a global health, human rights, and development problem with far-reaching economic and societal consequences. Mexico has a very high prevalence of IPV: 43.9% of Mexican women have reported experiencing IPV at the hands of their current partner. The literature on women's economic participation reveals mixed evidence on whether women's employment is associated with higher levels of IPV or whether it is protective against IPV. As the effect of women's work operates differently across contexts, we aim to estimate the effect of women's employment on their risk of experiencing IPV in rural and urban Mexico. Utilizing the nationally representative 2016 Mexican National Survey on the Dynamics of Household Relationships (ENDIREH), we employ propensity score matching (PSM) to address the potential selection bias between women who are employed and/or receiving a cash transfer with women who are not. We additionally implement inverse probability weighted regression adjustment (IPWRA) to explore this relationship and compare the results with the PSM findings. Three different measures of women's economic participation are analyzed: whether they had engaged in any productive work outside of the home in the past year, whether they received conditional cash transfers through Mexico's Prospera program, and whether they received Prospera and worked. Given the high levels of IPV in Mexico and the greater levels of economic participation borne of an increased number of women in the workforce, our results have important potential implications for targeting support to survivors of violence who receive cash transfers and undertake employment in both urban and rural areas.
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Greene MC, Heise L, Musci RJ, Wirtz AL, Johnson R, Leoutsakos JM, Wainberg ML, Tol WA. Improving estimation of the association between alcohol use and intimate partner violence in low-income and middle-income countries. Inj Prev 2020; 27:injuryprev-2019-043433. [PMID: 32371469 PMCID: PMC9121334 DOI: 10.1136/injuryprev-2019-043433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/04/2020] [Accepted: 04/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Alcohol 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). METHODS In 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. RESULTS Partner 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. CONCLUSION Partner 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.
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Affiliation(s)
- M Claire Greene
- Psychiatry, Columbia University, New York, New York, USA
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rashelle J Musci
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Renee Johnson
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | | | - Wietse A Tol
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, New York, USA
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Gender Based Violence against Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030903. [PMID: 32024080 PMCID: PMC7037605 DOI: 10.3390/ijerph17030903] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to systematically review studies that examined the prevalence of gender based violence (GBV) that included intimate partner violence (IPV) and non-IPV among women in sub-Saharan Africa (SSA). This evidence is an important aspect to work towards achieving the Sustainable Development Goals (SDG’s) target of eliminating all forms of violence in SSA. The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines were followed. Ovid Medline, CINAHL, Cochrane Central, Embase, Scopus and Web of Science were used to source articles with stringent eligibility criteria. Studies on GBV in SSA countries that were published in English from 2008 to 2019 were included. A random effect meta-analysis was used. Fifty-eight studies met the inclusion criteria. The pooled prevalence of IPV among women was 44%, the past year-pooled prevalence of IPV was 35.5% and non-IPV pooled prevalence was 14%. The highest prevalence rates of IPV that were reported included emotional (29.40%), physical (25.87%) and sexual (18.75%) violence. The sub-regional analysis found that women residing in Western (30%) and Eastern (25%) African regions experienced higher levels of emotional violence. Integrated mitigation measures to reduce GBV in SSA should focus mainly on IPV in order to achieve the SDG’s that will lead to sustainable changes in women’s health.
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Choi HM, Kim D, Lee W, Kim H. Estimating causal associations of atopic dermatitis with depression using the propensity score method: an analysis of Korea Community Health Survey data, 2010-2013. Epidemiol Health 2018; 40:e2018059. [PMID: 30650301 PMCID: PMC6335500 DOI: 10.4178/epih.e2018059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Numerous studies have reported associations between atopic dermatitis (AD) and depression, but the causal relationship between the 2 diseases has not been established. Therefore, this study used the propensity score method to investigate whether there was a positive causal effect of AD on depression in 16 regions (cities and provinces) in Korea. METHODS The study analyzed 16 regions (cities and provinces) in Korea, using data obtained from the Korea Community Health Survey for the years 2010-2013. Propensity score matching was used to estimate the causal influence of AD on depression in Korea. RESULTS After propensity score matching, the standardized difference for each covariate among the 16 regions (cities and provinces) was less than 1, indicating a balance between the case and control groups. At the national level, those diagnosed with AD had a 2.31 times higher risk for being diagnosed with depression than those who had not been diagnosed with AD. In particular, the risk was highest in North Jeolla Province (odds ratio [OR], 4.87; 95% confidence interval [CI], 2.28 to 10.43) and lowest in Gwangju (OR, 1.82; 95% CI, 0.87 to 3.79), and the OR for Seoul was 2.23 (95% CI, 1.66 to 2.99). CONCLUSIONS This study provides insights into how causal inferences can be derived from observational studies, through an analysis of Korea Community Health Survey data. Furthermore, the study results have implications for region-specific guidelines for preventive health policies targeting depression.
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Affiliation(s)
| | - Dahye Kim
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Whanhee Lee
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Korea
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Gupta J, Willie TC, Harris C, Campos PA, Falb KL, Garcia Moreno C, Diaz Olavarrieta C, Okechukwu CA. Intimate partner violence against low-income women in Mexico City and associations with work-related disruptions: a latent class analysis using cross-sectional data. J Epidemiol Community Health 2018. [PMID: 29514921 PMCID: PMC6031258 DOI: 10.1136/jech-2017-209681] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Disrupting women’s employment is a strategy that abusive partners could use to prevent women from maintaining economic independence and stability. Yet, few studies have investigated disruptions in employment among victims of intimate partner violence (IPV) in low-income and middle-income countries. Moreover, even fewer have sought to identify which female victims of IPV are most vulnerable to such disruptions. Methods Using baseline data from 947 women in Mexico City enrolled in a randomised controlled trial, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Furthermore, multilevel logistic regression analyses were performed on a subsample of women reporting current work (n=572) to investigate associations between LCA membership and IPV-related employment disruptions. Results Overall, 40.6% of women who were working at the time of the survey reported some form of work-related disruption due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); High Sexual and Low Physical Violence class (9.6%); High Physical and Low Sexual Violence and Injuries (36.5%); High Physical and Sexual Violence and Injuries (14.8%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of work disruption (adjusted relative risk (ARR) 2.44, 95% CI 1.80 to 3.29; ARR 2.05, 95% CI 1.56 to 2.70, respectively). No other statistically significant associations emerged. Conclusion IPV, and specific patterns of IPV experiences, must be considered both in work settings and, more broadly, by economic development programmes. Trial registration number NCT01661504.
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Affiliation(s)
- Jhumka Gupta
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Tiara C Willie
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Courtney Harris
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Paola Abril Campos
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kathryn L Falb
- International Rescue Committee, New York City, New York, USA
| | - Claudia Garcia Moreno
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Cassandra A Okechukwu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Vyas S, Heise L. How do area-level socioeconomic status and gender norms affect partner violence against women? Evidence from Tanzania. Int J Public Health 2016; 61:971-980. [PMID: 27557746 DOI: 10.1007/s00038-016-0876-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/16/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To explore how area-level socioeconomic status and gender-related norms influence partner violence against women in Tanzania. METHODS We analysed data from the 2010 Tanzania Demographic and Health Survey and used multilevel logistic regression to estimate individual and community-level effects on women's risk of current partner violence. RESULTS Prevalence of current partner violence was 36.1 %; however, variation in prevalence exists across communities. Twenty-nine percent of the variation in the logodds of partner violence is due to community-level influences. When adjusting for individual-level characteristics, this variation falls to 10 % and falls further to 8 % when adjusting for additional community-level factors. Higher levels of women's acceptance towards wife beating, male unemployment, and years of schooling among men were associated with higher risk of partner violence; however, higher levels of women in paid work were associated with lower risk. CONCLUSIONS Area-level poverty and inequitable gender norms were associated with higher risk of partner violence. Empowerment strategies along with addressing social attitudes are likely to achieve reductions in rates of partner violence against women in Tanzania and in other similar low-income country settings.
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Affiliation(s)
- Seema Vyas
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Lori Heise
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Vyas S, Jansen HA, Heise L, Mbwambo J. Exploring the association between women's access to economic resources and intimate partner violence in Dar es Salaam and Mbeya, Tanzania. Soc Sci Med 2015; 146:307-15. [PMID: 26494417 DOI: 10.1016/j.socscimed.2015.10.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 11/27/2022]
Abstract
The relationship between women's access to economic resources, e.g. employment or access to micro-credit, and experience of intimate partner violence is complex. Empirical evidence documents that in some settings women's employment is associated with higher risk of partner violence but in other settings with lower risk. Evidence also shows that these conflicting associations exist not only between countries but also within different country settings. Using two population-based data sets gathered in 2002 in contrasting Tanzania settings-Dar es Salaam and Mbeya-, we used multivariate logistic regression to examine the relationship between women's access to economic resources and partner violence. Two indicators of economic resources were examined: whether women earned money and whether women owned a business either with someone or exclusively. In Dar es Salaam we found evidence of a higher risk association among women who earned money and who owned a business exclusively by themselves and a lower risk association among women who owned a business with someone. We found no relationship between either indicator of economic resources and partner violence in Mbeya. Other factors were similarly associated with partner violence in both settings and the strongest associations found were related to the respondents' partners: refusal to give money; alcohol use and relationships with other women. The findings support the assertion that women's access to economic resources operate differently in different country settings, thus highlighting the need for targeted prevention efforts that are relevant for the context.
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Affiliation(s)
- Seema Vyas
- Kilimanjaro Christian Medical University College, Department of Epidemiology and Biostatistics, PO BOX 2240, Moshi Kilimanjaro Region, Tanzania.
| | - Henrica Afm Jansen
- UNFPA Asia and the Pacific Regional Office (APRO), 4th Floor UN Service Building, Rajadamnoen Nok Avenue, Bangkok 10200, Thailand.
| | - Lori Heise
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Jessie Mbwambo
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, Dar es Salaam, Tanzania.
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