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Understanding Domestic Violence and Its Consequences: Contributions of the Demographic and Health Surveys
Breaking the Cycle of Violence Against Women:Understanding the Impact of Violence Against Womenon DevelopmentNovember 25 through December 10, 2006 ~ Washington, DC
Kiersten Johnson, PhDORC Macro/Demographic & Health Surveys
Overview
What is violence against women? Historical context Data Creation of survey instrument Logistical/ethical challenges and sensitivities Extent, correlates and consequences Use of findings Continuing evolution
What is violence against women?
Any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivations of liberty, whether occurring in public or private life
Article 1, United Nations Declaration for the Elimination of Violence against Women
Gender-Based Violence Over the Life Cycle:
(adapted from Watts and Zimmerman, 2002)
Oth
ers
Intim
ate
par
tner
Fam
ily
mem
bers
Prebirth/Infancy
Adolescence Reproductive Elderly age
Violence by states (e.g. rape in war)TraffickingAcid throwing
Non-partner rape/harassment/violence
Dowry deaths/honor killingsDifferential access to food/medical care Psychological abuse; Coerced sex/rape/harassment; Physical violence; Violence during pregnancy
Female infanticide; FGMSex-selective abortion
Differential access to food/medical careViolence in pregnancyPhysical and sexual violencePsychological abuse
Setting the context:
Within the past 30 years: developing awareness of the importance of women’s social status in
relation to key outcomes violence against women (VAW) as an indicator of status
Early research: demonstrated a relationship between VAW and reproductive health raised awareness of the problem, health consequences
1995 Beijing World Conference on Women Platform of Action: explicitly recognizes that VAW:
• creates an obstacle to the achievement of the objectives of equality, development and peace at the national level
• violates the human rights of women at the individual level. recognized that the lack of data and statistics on the incidence of
violence against women is an impediment
Problem: Lack of data and statistics
Solution: Demographic and Health Surveys (DHS) - Nationally-representative household surveys with large samples
- Provide data in the areas of population, health, and nutrition
- Comparable across countries and over time
History of violence measurement in the DHS
Earliest efforts: Country-specific questions (Colombia 1990 & 1995) Questions developed and implemented as part of topic-specific studies
• 1993 Philippines Safe Motherhood Study • 1995/96 Uganda Negotiating Reproductive Outcomes Study.
In 1993, DHS hired a WID specialist to introduce and measure women’s status in the DHS on a pilot basis.
WS module developed in 94-95, implemented in 1995 Egypt DHS Included questions that measured freedom from violence
Special efforts were made in the 1998 Nicaragua DHS develop a set of questions that increased the validity of the DV measure provide related information such as help seeking
The current module result of the lessons learned from the Egypt and Nicaragua exercises accompanied by guidelines (adapted from WHO guidelines) on its ethical
implementation
Defining ‘what’ violence you want to measure
Ensuring safety and ethical standards
Ensuring validity of the measures
Analysis concerns
Treading carefully
Challenges
What to Measure...
Types of violence Economic Emotional/Psychological Physical Sexual During pregnancy
Issues of severity: Act vs. Outcome
Which perpetrators to include?
Which women are in the denominator?
Safety and Ethical Concerns
Confidentiality
Respondent and interviewer safety
Emotional burden of such research
The Do Good vs. Do No Harm principles
A need to balance concerns with information A need to balance concerns with information needsneeds
Validity of Data
No catch-all term to capture violenceRecommendation: Ask about different types of violent acts separately, specifically
Risk of underreporting of violence Recommendations: Build rapport, ensure privacy, provide multiple opportunities to reveal abuse
Spousal violence
Physical and sexual violence Does/Did your (last) husband ever:
• Push you, shake you, or throw something at you?
• Slap you or twist your arm?
• Punch you with his fist or with something that could hurt you?
• Kick you or drag you?
• Try to strangle you or burn you?
• Threaten you with a knife, gun, or other type of weapon?
• Attack you with a knife, gun, or other type of weapon?
• Physically force you to have sexual intercourse with him even when you did not want to?
• Force you to perform other sexual acts you did not want to?
Spousal violence (contd.)
Additional questions: Give additional opportunities for disclosure
and provide a measure of health consequences
Did the following ever happen because of something your (last)
husband did to you:
• You had bruises and aches?
• You had an injury or a broken bone?
• You went to the doctor or health center as a result of something you
husband did to you?
Spousal violence (contd.)
Emotional violence
Does your husband ever:
• Say or do something to humiliate you in front of others?
• Threaten you or someone close to you with harm?
Violence by others
From the time you were 15 years old has anyone (other than your current/last husband) hit, slapped, kicked, or done anything to hurt you physically? Can include ex-husbands of women married more than once
Violence during pregnancy also uses similar question Can include current husbands
At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?
How old were you the first first time you were forced to have sexual intercourse or perform any other sexual acts?
Other questions
Marital control Now I am going to ask you about some situations which happen to
some women. Please tell me if these apply to your relationship with your (last) husband/partner?
• He is jealous or angry if you talk to other men?• He frequently accuses you of being unfaithful?• He does not permit you to meet your female friends?• He tries to limit your contact with your family?• He insists on knowing where you are?• He does not trust you with any money?
Violence by women against their spouse Have you ever hit, slapped, kicked or done anything else to
physically hurt your (last) husband when he was not beating or physically hurting you?
Help seeking
Domestic violence data in the DHS
Africa Cameroon 2004 Egypt 1995 & 2005 Kenya 2003 Liberia 2006/07* Malawi 2004 Mali 2006* Namibia 2006* Rwanda 2005 South Africa 1998 Uganda 2006* Zambia 2001/02 Zimbabwe 2005/06*
Asia/South Asia Bangladesh 2004 Cambodia 2000 & 2005* India 1998/99 & 2005/06*
Latin America/Caribbean Bolivia 2003 Colombia 1990, 1995, 2000,
2005 Dominican Republic 2002 Haiti 2000 & 2005* Honduras 2005* Nicaragua1997/98 Peru 2000 & 2004
Eurasia Azerbaijan 2006* Moldova 2005* Turkmenistan 2001* Ukraine 2007*
* Data not yet available.
Prevalence of domestic violence in DHS countries (ever experienced)
IA19
KE47
RW34
MW27
ZM48
CM42
NC30
DR22
CO44
HT29
PE42
BO53
EG34
KH18
Specific acts of physical violencePercentage of women who have ever experienced specific acts by their spouse
0
5
10
15
20
25
30
35
40
Cambodia Colombia Dom Rep Haiti Nicaragua
Push, shake,throw
Slap, twist
Punch
Bite
Kick, drag
Strangle,burn
Weapon-threat
Weapon-attack
Specific acts of sexual violencePercentage of women who have ever experienced specific acts by their spouse
3.4
11.0
6.0
16.7
8.7
5.1
1.4
3.4
6.0
5.7
Cambodia
Colombia
Dom Rep
Haiti
Nicaragua
Zambia Force other
Force sex
Specific acts of emotional violencePercentage of women who have ever experienced specific acts by their spouse
7.9
11.5
15.1
11.9
27.7
9.3
9.9
6.9
16.5
Cambodia
Colombia
Dom Rep
Haiti
NicaraguaThreatenedloved ones
Publiclyhumiliated
Violence during pregnancy
2.5
12.8
6.2
11.1
6.5
1.3
10.6
5.1
5.4
11.1
Cambodia
Colombia
Dom Rep
Egypt
Haiti
Nicaragua
Husband
Anyone
Consequences of husband’s actPercentage of women who have ever experienced specific consequences of violence
6.3
27.5
20.7
9.2
4.9
6.5
10.2
12.9
7.7
4.9
36.5
53.3
47.5
15.5
22.7
Cambodia
Colombia
Dom Rep
Haiti
NicaraguaBruises, aches
Injury, brokenbone
Had to go tohealth facility
Role of husband’s drinking habitsAdjusted odds of women reporting violence in the past yearReference category: Husband does not drink
0.82
0.76
1.43
1.07
1.62
2.37
2.14
6.07
7.39
4.08
4.80
Cambodia
Dom Rep
Haiti
Nicaragua
Comes homedrunk frequently
Comes homedrunk sometimes
Never comeshome drunk
(ns)
Baseline risk (1.0)
(ns)
(ns)
Intergenerational aspects of violenceAdjusted odds of women reporting violence everReference category: Respondent’s mother not hit by respondent’s father
2.26
2.16
2.00
1.96
1.61
1.63
Cambodia
Colombia
Dom Rep
Haiti
Nicaragua
Peru
Baseline risk (1.0)
Health outcomes: pregnancy terminationAdjusted odds of ever-experience of pregnancy termination Reference category: Never experienced domestic violence
1.91
1.53
1.29
Dom Rep
Cambodia
Haiti
Baseline risk (1.0)
Health outcomes: experience of STIsAdjusted odds of experience of STI/symptom of STI in past 12 monthsReference category: Never experienced domestic violence
2.59
1.92
1.78
Dom Rep
Haiti
Cambodia
Baseline risk (1.0)
Health outcomes: unwanted birthAdjusted odds of experience of unwanted birth in the past 5 yearsReference category: Never experienced domestic violence
1.70
1.16
1.43
Dom Rep
Haiti
Cambodia
Baseline risk (1.0)
(ns)
Use of findings
Advocacy
Demonstrate health consequences
Estimate DALYs, economic costs
Legislation
Doing more to minimize under-reporting
Recognize the limitations of large scale surveys Doing more in-depth and longitudinal studies to fill in gaps
Going beyond the measurement of prevalence Analysis, dissemination, action
Measurement of men’s experience of violence from women
Remaining Gaps and Challenges
measuredhs.com
Photo credits: Photos courtesy of M/MC Photoshare at jhuccp.org/mmc
For specific questions:
