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

1. 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 Paulo Faculdade de Medicina Departamento de Medicina Preventiva

2. Research partners Gender, Violence & Health Centre, LSHTM UK • Launched in 2006 • Multi- disciplinary cross-faculty research group at LSHTM • Strong quantitative expertise, including social epidemiology, economics, intervention evaluation • Works 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 Brazil • Launched in 2000 • Part of Medical School, University of Sao Paulo • Strong social-science expertise • Part of extensive network of activists & governmental agencies in many regions of Brazil.

3. 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

4. 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 daPenha) 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

5. Overall project objectives • 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 • 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;

6. 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?

7. Data analysis: theoretical framework CONTEXT Socioeconomic characteristics of the neighbourhood Community levels of violence Availability of services assisting IPV Traditional gender norms WOMAN SES Financial autonomy Age Family 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 RESPONSES Fights back Tells family or friends Seeks formal help (legal, health, other) Leaves the partner

8. Steps in data analysis • 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 • Analysis of individual level factors • Multi-level analysis, with women at level 1 and census tracts at level 2 • Complementary review of existing qualitative data from each setting on abused women’s experience of services

9. 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?

10. Prevalence of physical and/or sexual violence in Sao Paulo and Pernambuco (n=2,128)

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

12. 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

13. 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

14. 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