Social Inequality and Women's Response to Domestic Violence: A UK-Brazil research partnership

Charlotte Watts, Ligia Kiss, Ana Flavia d’Olivieira, Lori Heise, Lilia Blima Schraiber

Universidade de São PauloFACULDADE DE MEDICINADEPARTAMENTO DE MEDICINA PREVENTIVA

Research partners

Gender, Violence & Health Centre, LSHTM UKLaunched in 2006Multi- disciplinary cross-faculty research group at LSHTM Strong quantitative expertise, including social epidemiology, economics, intervention evaluationWorks with UN agencies & partners around the world to conduct action-oriented, research on gender-based violence and health

Gender, Violence and Health Research Group, USP BrazilLaunched in 2000Part of Medical School, University of Sao PauloStrong social-science expertisePart of extensive network of activists & governmental agencies in many regions of Brazil.

10 year history of collaboration

Starting with the WHO multi-country study on women’s health and domestic violence

Brazil one of 10 countries involved in the WHO study

Large, representative household surveys conducted in 2 contrasting sites: Sao Paulo - a large city, located in the Southeast of

Brazil, with high levels of social and economic inequality.

Pernambuco in the Northeast of Brazil, and largely a poor rural setting.

Careful design & implementation of study, high response rates

Poverty, social inequality & intimate partner violence

Violence in intimate relationships most common form of violence against women

IPV both a cause and consequence of poverty & social inequality

IPV and gender-inequality have important health, social and economic consequences

Limited evidence about how to effectively respond In Brazil recent Law (Maria da Penha) criminalizes domestic

violence & requires establishment of an inter-sectoral network, including health services, and the comprehensive provision of assistance for women and men.

Lack of data on how women from different socio-economic contexts, in urban and rural settings, respond to IPV & implications for service planning

Overall project objectives

1. Strengthen the links between UK and Brazil partners Facilitate future joint research on violence, gender and

health Support the exchange of students, knowledge, skills and

disciplinary expertise

1. Support the joint analysis of Brazilian micro data on women’s responses to intimate partner violence in Sao Paulo & Pernambuco Support the merging of Brazilian micro-data sets and

analysis of how socio-economic factors and the availability of services influence women’s responses to violence;

Build capacity and share experience in quantitative data analysis;

Data analysis: research questions

How do neighbourhood characteristics influence women’s responses to violence?

What individual & relationship factors are associated with different responses to violence? How does the severity of violence influence women’s responses?

Is service availability a key predictor of service use? How do different responses to violence affect current

levels and severity of violence? How does this differ by socio-economic contexts?

What kinds of formal help is more associated with reported non-violence in the past year?

Data analysis: theoretical framework

CONTEXT Socioeconomic characteristics of the

neighbourhood Community levels of violence

Availability of services assisting IPV Traditional gender norms

RESPONSES Fights back

Tells family or friends Seeks formal help (legal, health, other)

Leaves the partner

WOMAN SES Financial autonomy

AgeFamily support Acceptability of

violence

RELATIONSHIP Partner’s controlling

behaviour Communication

Characteristics of violence, including

severity

PARTNER Problematic alcohol use

Unemployment Fights with other men Relationship with other

women

Steps in data analysis

1) Merge 3 datasets: Population data from the WHO multi-country study on

domestic violence and health from Sao Paulo and Zona da Mata de Pernambuco

data from the Brazilian national census (IBGE) Data from mapping of the availability of services offering

assistance to women experiencing IPV in each study setting

2) Analysis of individual level factors

3) Multi-level analysis, with women at level 1 and census tracts at level 2

4) Complementary review of existing qualitative data from each setting on abused women’s experience of services

Direct questions used to ask women about experiences of physical and sexual intimate partner violence

Physical violence Slapped or threw something at that could hurt you? Pushed or shoved you or pulled your hair? 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?

Sexual Violence Physically forced to have sexual intercourse even when you did not

want to? Have sexual intercourse did not want because afraid of what he

might do? Forced to do something sexual that found degrading or humiliating?

Prevalence of physical and/or sexual violence in Sao Paulo and Pernambuco

SITES Physical Violence

Sexual Violence Physical and/or sexual violence

Ever (%)

Current (%)

Ever (%)

Current (%)

Ever(%)

Current (%)

Sao Paulo (urban)

27.2 8.3 10.1 2.8 28.9 9.3

Pernambuco (rural)

33.8 12.9 14.3 5.6 36.9 14.8

(n=2,128)

Frequency of responses by women who have ever experienced physical intimate partner violence (n=657)

Sao Paulo

(urban)

Pernambuco

(rural)

Total P-values

% % %

Fought back Never 21.1% 37.0% 30.8% <0.001

At least once 78.9% 63.0% 69.2%

Told family/ friends

No 27.7% 27.4% 27.6% 0.932

Yes 72.3% 72.6% 72.5%

Sought formal help

No 55.5% 78.1% 69.3% <0.001

Yes 44.5% 22.0% 30.8%

Left home Never 58.9% 48.3% 52.3% 0.035

Temporarily 21.1% 26.8% 24.5%

Permanently 20.3% 25.0% 23.2%

Women’s strategies in response to intimate partner violence (IPV)

Of 657 women who experienced physical violence, only 6% did not use any of the studied strategies

Preliminary individual level analysis suggests that most important associated factors associated with seeking help or leaving are: severity of violence disruption of work by violence child witnessed violence

Strategies for dissemination

Dissemination of the results within the inter-sectoral networks in Brazil & UK

Distribution of information through primary care settings to vulnerable women in Brazil

Closed-doors meetings with decision-makers and donors on services and resource planning in Brazil & internationally

Workshop with agencies, NGOs, providers, police, academics and government representatives

The development and dissemination of briefing papers via internet

Academic publications

Current progress & next steps

Finalise individual level analysis using WHO data-set & publication (Brazil lead)

Finalise merging of data sets & circulate analysis plan for multi-level analysis (joint)

UK visits by Brazilian partner / training for Ph.D. students Multi-level analysis, publication & policy brief (UK lead) Joint analysis of qualitative data Revision of conceptual framework & publication Meeting Brazil to support joint writing, share research

portfolios, plan final dissemination & future research Dissemination activities