Transcript International experience with data collection: 1. Results from the countries using WHO multicountry study methodology 2.

International experience with data collection:
1. Results from the countries using WHO multicountry study methodology
2. Results from Serbia on factors associated with
VAW
Dr Henrica A. F. M. (Henriette) Jansen
Sub-regional workshop
Skopje, 15-17 February 2010
Countries that implemented the
WHO multi-country study methodology
Serbia
Japan
Turkey
Thailand
Bangladesh
Equatorial
Guinea
Samoa
Peru
Namibia
Tonga
Brazil
Viet Nam
Kiribati
Sol. Isl
Maldives
Vanuatu
Ethiopia
United Republic
of Tanzania
New Zealand
Countries in the WHO study
Other countries (most with national surveys)
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Study objectives
Estimates of prevalence of violence against
women
 Associations between partner violence and
health outcomes
 Risk and protective factors for partner
violence
 Strategies used by women who experience
partner violence (who do they talk to, where
do they seek help, what response do they get)
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Study Design (WHO)
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Formative qualitative research (focus
groups, in depth interviews of survivors,
key informants)
Quantitative household survey of women
(15-49 years of age)
One or two sites per country: approx.
1500 women per site
Standardized training and questionnaire
Standardized quality control
Ethical and safety recommendations: one
woman per household, support for
participants
Turkey
Women’s Health and Life Experiences
Questionnaire outline
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Section 1: Respondent and her
community
Section 2: General Health
Section 3: Reproductive health
Section 4: Children
Section 5: Current or most
recent partner
Section 6: Attitudes toward
gender roles
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Section 7: Respondent and
her partner
Section 8: Injuries
Section 9: Impact and coping
Section 10: Other
experiences
Section 11: Financial
autonomy
Section 12: Completion of the
interview
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Types of violence measured
Violence by current or former intimate partners:
 Physical violence
 Sexual violence
 Emotional abuse and controlling behaviours
 Economic abuse (Turkey)
Violence by others (parents, neighbours, strangers,
etc):
 Physical violence (after age 15 years)
 Sexual violence (after age 15 years)
 Childhood sexual abuse (prior to age 15 years)
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How is physical partner violence
measured?
Slapped or threw something at you that could hurt you?
 Pushed or shoved you or pulled your hair?
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Hit with his fist or with something else that could hurt
you?
 Kicked, dragged or beat you up?
 Choked or burnt you on purpose?
 Threatened to use or actually used a gun, knife or other
weapon against you?

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How is sexual partner violence
measured?
Were you ever physically forced to have
sexual intercourse when you did not want
to?
 Did you ever have sexual intercourse you
did not want because you were afraid of
what he might do?
 Ever force you to do something sexual
that you found degrading or humiliating?

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Physical and sexual violence is
extremely common in women’s lives
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How common is partner violence?
● In most sites, 4 out of 5 women who have been abused
(by anybody: partners and others) reported being abused
by a partner.
● 15-71% (between one in six and two out of three) of
ever-partnered women experienced physical or sexual
violence by an intimate partner
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Pregnancy is not necessarily a
protected time
He hit me in
the belly and made
me miscarry two
babies - identical
or fraternal twins, I
don’t know. I went
to the hospital with
heavy bleeding
and they cleaned
me up.
● In most sites 4%-12% (note: Peru
province 28%) of women who had been
pregnant were beaten during a pregnancy
● In 90%-100% of cases the abuser was the
father of the unborn child
● Between on-quarter to half of these
women reported being punched or kicked
in the stomach
Woman interviewed
in Peru
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Violence impacts on women’s health
I suffered a long
time and swallowed
my pain. That is why I
am constantly visiting
doctors and using
medicines. No one
should have to do
this.
Woman interviewed in
Serbia & Montenegro
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Women who have ever experienced violence by
a partner have:
◦ Worse general health
◦ More symptoms of ill health such as pain,
memory loss, dizziness in the past 4 weeks
◦ More signs of mental distress
◦ More suicidal thoughts and attempts
◦ More induced abortions and miscarriages
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Partner violence increases risk of
suicidal thoughts
%
60
never experienced violence
ever experienced physical or sexual violence, or both
50
47
42
40
38
35
33
32
30
26
24
24
22
21
20
20
16
16
14
15
15
11
11
10
8
7
8
7
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Associations between physical partner violence and
behavioural problems in children 5-12 years old.
Behavioural
problem in children
6-12 yrs
Women reporting
physical violence
AOR
95% CI
Frequent nightmares
1.5
1.4-1.7
Thumb sucking
1.4
1.2-1.7
Bed wetting
1.5
1.3-1.7
Extremely timid
1.4
1.2-1.6
Aggressive
1.6
1.4-1.8
Table shows odds ratios adjusted for number of children in same
age group living in household, partnership status and educational
level of respondent and site
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Outcomes related to violence
For women:
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injuries
own physical, mental and
reproductive health
financial status
ability to work
ability to function
participate in society
For children:
low birth-weight
 emotional well-being
 behavioural difficulties
 problems at school
 leave home

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Many women internalize social
norms justifying abuse
My husband slaps me, has
sex with me against my will and
I have to conform. Before being
interviewed I didn't really think
about this. I thought this is only
natural. This is the way a
husband behaves.
Woman interviewed in Bangladesh
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Violence is largely hidden
One-fifth to twothirds of women
had never told
anyone about their
partner’s violence
prior to the WHO
interview
If I protest I’ll be marked in
the society and then my
daughter wouldn’t be able to get
married…
If I voice my protest the
community will blame me for
not bearing it in silence. This
helplessness is a torture in itself.
Woman, 43 years old, interviewed in
Bangladesh
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An ecological framework for
understanding violence
Society
Community
Relationship
Individual
Findings from Belgrade, Serbia
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Serbia – analysis of risk factors
This analysis aimed to identify factors
associated with intimate partner violence
against women in women 15-49 living in
Belgrade.
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Women's characteristics
Age (3 groups)
Education
Proximity of women’ family
Frequency of talking with family members
Can count on support of the family members
Child sexual abuse by others <15
Physical violence by others > 15
Sexual abuse by others > 15
Nature of first sexual intercourse
(wanted/coerced/forced)
 Women’s mother was beaten
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Partner's characteristics
Age (3 groups)
Education
Employment status
Alcohol consumption
Drug consumption
Fighting with the other men
Having parallel relationship with other
women
 Partner’s mother was beaten
 Partner was beaten by family member
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Relationship characteristics
 Socio economic status
 Cohabitation with partners family
 Cohabitation with woman’s family
 Discrepancy in education
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Variables considered in logistic
regression modelling
Women’s characteristics
Partner’s characteristics
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Age
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Age
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Education
Education
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Frequency of talking with her
family members
Alcohol consumption
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Drug consumption
Experienced physical violence by
non-partners
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Fighting with the other men
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Experienced sexual violence by
non partners
Having parallel relationship with other
women
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Nature of first sexual
experience
Partner’s mother was beaten by
mother’s partner
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Women’s mother was beaten by
mother’s partner
Partner was beaten as a child, by family
member
Relationship’ characteristics
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Socio-economic status (SES)
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Cohabitation with partner’s family
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Cohabitation with women’s family
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Results in ecological framework:
factors associated with intimate partner violence
Societal – Community – Relationship – Individual
level
He was abused as a child
His is mother was abused by partner
He drinks alcohol every day
He fights with other men
He has less then highly education
He is not faithful
Her first sexual
experience was
unwanted or forced
Risk factors for IPV in Serbia
Conclusion:
Majority of risk factors for IPV are related to the
male partner
Long-term violence prevention programmes should
target boys growing up in families where father is
violent, as they were three times more frequently
perpetrators of IPV in their adulthood.
THANK YOU!
[email protected]
(c) photos: Henriette Jansen
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References

WHO Multi-country study on Women’s Health
and Domestic Violence,
C. Garcia-moreno, H. Jansen et al. WHO 2005
http://www.who.int/gender
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Factors associated with intimate partner
violence against women in Serbia: a cross
sectional study.
B. Djikanovic, H. Jansen, S. Otasevic. JECH, 2009
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Turkey study:
http://ksgm.gov.tr/tdvaw/default.htm
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