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MAKING THE INVISIBLE VISIBLE : Measuring Domestic Violence and Its Consequences

MAKING THE INVISIBLE VISIBLE : Measuring Domestic Violence and Its Consequences. Sunita Kishor (Ph.D.) Senior Gender Advisor Demographic and Health Research Macro International, Inc. Maryland, USA. Overview. Gender and gender-based violence (GBV)

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MAKING THE INVISIBLE VISIBLE : Measuring Domestic Violence and Its Consequences

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  1. MAKING THE INVISIBLEVISIBLE:Measuring Domestic Violence and Its Consequences Sunita Kishor (Ph.D.) Senior Gender Advisor Demographic and Health Research Macro International, Inc. Maryland, USA

  2. Overview • Gender and gender-based violence (GBV) • The role of the Demographic and Health Surveys in making theinvisibleVISIBLE • The nitty-gritty of measurement: substantive and ethical challenges • What we now know: prevalence, correlates, and consequences • Continuing challenges

  3. A digression: What is gender? ...the different roles, rights, and obligations that culture and society attach to individuals according to whether they are born with male or female sex characteristics Not just different, but UNEQUAL… Not just UNEQUAL, but SUBORDINATE GBV an inherent part, an expression, an outgrowth, of this gender inequality

  4. What is gender-based violence? Gender-based violence is violence involving men and women, in which the female is usually the victim; and which is derived from unequal power relationships between men and women. Violence is directed specifically against a woman because she is a woman, or affects women disproportionately.  United Nations Population Fund (UNFPA) Gender Theme Group

  5. Gender-Based Violence Over the Life Cycle • Violence by states (e.g. rape in war) • Trafficking • Acid throwing • Non-partner rape/harassment/violence • Dowry deaths/honor killings • Differential access to food/medical care Psychological abuse; Coerced sex/rape/harassment; Physical violence; Violence during pregnancy • Female infanticide; FGC/M • Sex-selective abortion • Differential access to food/medical care • Violence in pregnancy • Physical and sexual violence • Psychological abuse Others Family members Intimate partner Prebirth/ Infancy Adolescence Reproductive Older ages (adapted from Watts and Zimmerman, 2002)

  6. Sources of Domestic Violence Data • Institutional sources: Police, hospital, court records; data from shelters • Incomplete coverage; provide data on only very severe cases • Qualitative, ethnographic studies: • Cannot be generalized; good for in-depth study • Survey sources: • Surveys on GBV: Rare and costly e.g., WHO Multi-Country Study of Domestic Violence • Surveys on other topics with questions on GBV e.g., Demographic and Health Surveys (DHS)

  7. What is the DHS? • A demographic, nutrition, and health survey program for the developing world since1984, primarily funded by USAID • Nationally-representative household surveys with large samples (typically 6000 +; India-100,000+) • Usually repeated every 5-7 years • Provide indicators for monitoring at the national and sometimes, sub-national level • Comparable across countries and over time • More recently include biomarkers, e.g., syphilis and HIV, and domestic violence DHS surveys considered the ‘gold standard’ by countries and development partners

  8. Africa Cameroon 2004 DRC 2007 Egypt 1995 & 2005 Ghana 2008* Kenya 2003 Liberia 2006/07 Malawi 2004 Mali 2006 Rwanda 2005 South Africa 1998 Uganda 2006, 2009* Zambia 2001/02; 2007* Zimbabwe 2005/06 Asia/South Asia Bangladesh 2004, 2007* Cambodia 2000 & 2005 India 1998/99 & 2005/06 Jordan 2007* Latin America/Caribbean Bolivia 2003 Colombia 1990, 1995, 2000, 2005 Dominican Republic 2002 & 2007 Haiti 2000 & 2005 Honduras 2005 Nicaragua1997/98 Peru 2000 & 2004 Eurasia Azerbaijan 2006 Moldova 2005 Turkmenistan 2001 Ukraine 2007* DHS Countries with Domestic Violence Data * Data not yet available.

  9. Measurement Challenges • Defining ‘what’ violence to measure • Ensuring validity of the measures: the ‘how’ • Ensuring safety and ethical standards • Determining what else to measure other than prevalence

  10. Validity of Data • No catch-all term to capture violence Recommendation:Ask about different types of violent acts separately, eg: have you been slapped NOT have you experienced any violence or have you been beaten? • Risk of underreporting of violence Recommendations: Build rapport, ensure privacy, provide multiple opportunities to reveal abuse

  11. Measures of Spousal Violence • Physical violenceAny of the following acts perpetrated by her husband: • Pushed her, shook her, or threw something at her • Slapped her • Twisted her arm or pulled her hair • Punched her • Kicked her, dragged her, or beat her up • Tried to choke her or burn her on purpose • Threatened her or attacked her with a weapon • Sexual violenceAny of the following any of the following acts: • Forced her to have sexual intercourse when she did not want it • Forced her to perform sexual acts she did not want to • Emotional violence

  12. Selected Domestic Violence Indicators in the DHS • Prevalence of spousal violence: ever and 12 months • Timing of initiation of spousal violence • Injuries related to spousal violence • Wives initiating spousal violence • Violence by others (ex-spouse, boyfriend, family, others) • Forced first sexual intercourse* • Violence during pregnancy * • Lifetime prevalence of sexual violence by anyone • Help seeking by abused women

  13. Safety and Ethical Concerns • Confidentiality and informed consent • Only one woman per household receives the DV questions • Men not asked DV questions in the same household • Informed consent obtained • Translators not used for this section • Interview discontinued if privacy not assured • Respondent and interviewer safety • DHS guidelines are modeled on WHO’s Guidelines for the Ethical Conduct of Domestic Violence research (WHO, 2002) • DHS has sought to strike the right balance between ethical concerns and information needs

  14. Prevalence of Spousal Physical or Sexual Violence: Selected Countries Percent of ever-married women age 15-49 Only 1-7% of married women have ever initiated violence against their husbands.

  15. Correlates of Spousal Violence India 2005-06 Percent of ever-married women age 15-49

  16. Correlates: Husband’s Drinking of AlcoholAdjusted odds of experiencing violence among ever-married women age 15-49 Odds of experiencing violence = 1 if husband does not drink;then odds of experiencing violence if husband: are: (ns) Kishor and Johnson, 2004

  17. Intergenerational Aspects of ViolenceAdjusted odds of women (ever-married, 15-49) reporting violence ever Odds of experiencing violence if father did not beat mother =1; Adjusted odds of experiencing violence if father beat mother = Kishor and Johnson, 2004

  18. SelectedAdverseHealth Outcomes Never experienced spousal violence, odds = 1; If experienced violence, adjusted odds = Had an STI Discontinued modern contraceptive Base line risk: 1.0 Base line risk: 1.0

  19. MORE AdverseHealth Outcomes Never experienced spousal violence, odds = 1; If experienced violence adjusted odds = Pregnancy termination Unwanted birth Base line risk: 1.0 Base line risk: 1.0 Kishor and Johnson, 2006

  20. What we do know… • Spousal violence varies from about 14% in Cambodia to 59% in Uganda • Typically, half or more of the women who have ever experienced spousal violence have experienced it in the past 12 months • Spousal sexual violence is reported by 5-20 percent of women • Physical violence is the most common type of violence • Violence begins early in the marriage • Violence results in injuries • Women rarely seek help • Further analysis shows that there are strong links to health outcomes for mothers and their children

  21. What Perpetuates GBV? • Gender norms that • Rigidly define gender roles and what a ‘good’ woman is • Tolerate and accept male aggression and risky sexual behavior as part of being a man • Give men the right to discipline and control wives • Cultural norms that treat domestic violence as a private matter • Women’s lower status in society that results in: • Limited access to and control over resources • Less education and skill development • Dependency on men, on sons

  22. DHS Question on Norm Socialization • Is a husband justified in hitting or beating his wife if she… • Neglects the children • Answers back/argues with him • Goes out without telling him • Refuses sex with him • Burns the food

  23. Evidence of Norm Socialization One of the most common reasons: Neglects the children

  24. Solution: Multifaceted Interventions A Health-Sector Example Communication for social & behavior change programs HEALTH SERVICE DELIVERY PROGRAMS • Correct diagnosis • Appropriate care • No harm to patient • Care attuned to physical +psychological needs Effectiveness of health provision Community mobilization programs Health policy programs Women’s RH Women’s experience of GBV Norms Laws Institutions Funding Policy discourse

  25. Gaps and Continuing Challenges • Measurement of • men’s experience of violence from women • other types of intimate partner violence • 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

  26. www. measuredhs.com

  27. For Specific Questions: sunita.kishor@macrointernational.com Photo credits: Photos courtesy of M/MC Photoshare at jhuccp.org/mmc References Kishor S. and K. Johnson. 2006. Reproductive Health and Domestic Violence: Are the Poorest Women Uniquely Disadvantaged? Demography Vol. 43(2 ): 293-307 --. 2004. Profiling domestic violence: A multi-country study. ORC Macro, Calverton, Maryland Watts. C. and C. Zimmerman. 2002. Violence against women: global scope and magnitude Lancet Vol. 359( 9313):1232 – 1237 World Health Organization. 2001. Putting women first: Ethical and safety recommendations for research on domestic violence against women. Department of Gender and Women's Health, Geneva, Switzerland

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