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Dr Henrica A. F. M. (Henriette) Jansen

International experience with data collection: 1. Results from the countries using WHO multi-country 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.

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Dr Henrica A. F. M. (Henriette) Jansen

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  1. International experience with data collection:1. Results from the countries using WHO multi-country study methodology2. Results from Serbia on factors associated with VAW Dr Henrica A. F. M. (Henriette) Jansen Sub-regional workshop Skopje, 15-17 February 2010

  2. Countries that implemented the WHO multi-country study methodology Serbia Japan Turkey Thailand Viet Nam Bangladesh Kiribati Equatorial Guinea Sol. Isl Maldives Samoa Peru Vanuatu Ethiopia Namibia United Republic of Tanzania Brazil Tonga New Zealand Countries in the WHO study Other countries (most with national surveys)

  3. 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)

  4. Study Design (WHO) • 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

  5. Turkey

  6. 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 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 Women’s Health and LifeExperiencesQuestionnaire outline

  7. 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)

  8. How is physical partner violence measured? • Slapped or threw something at you 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? Moderate Severe

  9. 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?

  10. Physical and sexual violence is extremely common in women’s lives

  11. 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

  12. Pregnancy is not necessarily a protected time • 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 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. Woman interviewed in Peru

  13. 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 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 Violence impacts on women’s health

  14. Partner violence increases risk of suicidal thoughts

  15. Associations between physical partner violence and behavioural problems in children 5-12 years old. 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

  16. For women: 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 Outcomes related to violence

  17. 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

  18. One-fifth to two-thirds 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 Violence is largely hidden

  19. An ecological framework for understanding violence Society Community Relationship Individual

  20. Findings from Belgrade, Serbia

  21. 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.

  22. 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

  23. 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

  24. Relationship characteristics • Socio economic status • Cohabitation with partners family • Cohabitation with woman’s family • Discrepancy in education

  25. Variables considered in logistic regression modelling • Partner’s characteristics • Age • Education • Alcohol consumption • Drug consumption • Fighting with the other men • Having parallel relationship with other women • Partner’s mother was beaten by mother’s partner • Partner was beaten as a child, by family member • Relationship’ characteristics • Socio-economic status (SES) • Cohabitation with partner’s family • Cohabitation with women’s family Women’s characteristics • Age • Education • Frequency of talking with her family members • Experienced physical violence by non-partners • Experienced sexual violence by non partners • Nature of first sexual experience • Women’s mother was beaten by mother’s partner

  26. 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 Her first sexual experience was unwanted or forced He is not faithful

  27. 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.

  28. THANK YOU! henriette.jansen@gmail.com (c) photos: Henriette Jansen

  29. 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 • Factors associated with intimate partner violence against women in Serbia: a cross sectional study. B. Djikanovic, H. Jansen, S. Otasevic. JECH, 2009 • Turkey study: http://ksgm.gov.tr/tdvaw/default.htm

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