I have read the journal's policy and the authors of this manuscript have the following competing interests: RJ is a member of the Editorial Board of
¶ Membership of the UN Multi-country Study on Men and Violence Study Team is provided in the Acknowledgements.
Understanding the past-year prevalence of male-perpetrated intimate partner violence (IPV) and risk factors is essential for building evidence-based prevention and monitoring progress to Sustainable Development Goal (SDG) 5.2, but so far, population-based research on this remains very limited. The objective of this study is to compare the population prevalence rates of past-year male-perpetrated IPV and nonpartner rape from women’s and men’s reports across 4 countries in Asia and the Pacific. A further objective is to describe the risk factors associated with women’s experience of past-year physical or sexual IPV from women’s reports and factors driving women’s past-year experience of partner violence.
This paper presents findings from the United Nations Multi-country Study on Men and Violence in Asia and the Pacific. In the course of this study, in population-based cross-sectional surveys, 5,206 men and 3,106 women aged 18–49 years were interviewed from 4 countries: Cambodia, China, Papua New Guinea (PNG), and Sri Lanka. To measure risk factors, we use logistic regression and structural equation modelling to show pathways and mediators. The analysis was not based on a written plan, and following a reviewer’s comments, some material was moved to supplementary files and the regression was performed without variable elimination. Men reported more lifetime perpetration of IPV (physical or sexual IPV range 32.5%–80%) than women did experience (physical or sexual IPV range 27.5%–67.4%), but women’s reports of past-year experience (physical or sexual IPV range 8.2%–32.1%) were not very clearly different from men’s (physical or sexual IPV range 10.1%–34.0%). Women reported much more emotional/economic abuse (past-year ranges 1.4%–5.7% for men and 4.1%–27.7% for women). Reports of nonpartner rape were similar for men (range 0.8%–1.9% in the past year) and women (range 0.4%–2.3% in past year), except in Bougainville, where they were higher for men (11.7% versus 5.7%). The risk factor modelling shows 4 groups of variables to be important in experience of past-year sexual and/or physical IPV: (1) poverty, (2) all childhood trauma, (3) quarrelling and women’s limited control in relationships, and (4) partner factors (substance abuse, unemployment, and infidelity). The population attributable fraction (PAF) was largest for quarrelling often, but the second greatest PAF was for the group related to exposure to violence in childhood. The relationship control variable group had the third highest PAF, followed by other partner factors. Currently married women were also more at risk. In the structural model, a resilience pathway showed less poverty, higher education, and more gender-equitable ideas were connected and conveyed protection from IPV. These are all amenable risk factors. This research was cross-sectional, so we cannot be sure of the temporal sequence of exposure, but the outcome being a past-year measure to some extent mitigates this problem.
Past-year IPV indicators based on women’s reported experience that were developed to track SDG 5 are probably reasonably reliable but will not always give the same prevalence as may be reported by men. Report validity requires further research. Interviews with men to track past-year nonpartner rape perpetration are feasible and important. The findings suggest a range of factors are associated with past-year physical and/or sexual IPV exposure; of particular interest is the resilience pathway suggested by the structural model, which is highly amenable to intervention and explains why combining economic empowerment of women and gender empowerment/relationship skills training has been successful. This study provides additional rationale for scaling up violence prevention interventions that combine economic and gender empowerment/relationship skills building of women, as well as the value of investing in girls’ education with a view to long-term violence reduction.
In a cross-sectional analysis of survey data from Cambodia, China, Papua New Guinea, and Sri Lanka, Rachel Jewkes and colleagues compare women's and men's reports of past-year prevalence of intimate partner violence and rape.
Understanding the past-year prevalence of physical and or sexual intimate partner violence (IPV) and risk factors is essential for building evidence-based prevention.
Previous studies have not compared men’s and women’s past-year prevalence reports and have been limited by a predominant focus on risk factors for lifetime exposure to IPV.
Monitoring SDG 5.2 and building evidence-based prevention require a relative understanding of the measures of past-year prevalence and the drivers of this violence.
We use data from 4 countries of the UN Multi-country Study on Men and Violence in Asia and the Pacific to compare the population prevalence rates of past-year IPV and nonpartner rape from women’s and men’s reports and present an analysis of drivers of women’s experience of past-year physical or sexual IPV.
Women’s reports of past-year male-perpetrated IPV were similar to those from men.
Four groups of variables are important drivers of IPV: poverty, all childhood trauma, quarrelling and women’s limited control in the relationship, and partner factors (substance abuse, unemployment, and infidelity).
Past-year IPV indicators based on women’s reported experience that were developed to track SDG 5 are probably reasonably reliable.
Women appear to gain resilience to violence through combined economic power and understanding gender empowerment/relationship skills, as well as education; this is an important foundation for intervention.
Further research is needed on the validity of men’s and women’s reports of IPV, which could not be determined from these data.
In 2015, eliminating all forms of violence against women and girls (VAWG) was adopted as a target for the Sustainable Development Goal (SDG) 5 on gender equality and empowerment of women. To achieve this, we must develop and roll out effective measures to prevent male-perpetrated violence and show their effect. The indicators of progress towards this target are not finalized but will be a measure of women’s experience of intimate partner violence (IPV) and of nonpartner sexual violence in the past 12 months. According to most recent estimates, 30% of women aged 15 years and over have experienced male-perpetrated physical and/or sexual IPV, and 7% nonpartner sexual violence, in their lifetime [
In low- and middle-income countries, the World Health Organization instrument that was developed for its Multi-country Study on Women’s Health and Domestic Violence against Women is generally seen as the gold standard measure for women. Parallel research with men has developed a methodology for measuring perpetration, but the 2 measures of violence in heterosexual relationships have not been compared. Given that widely used indicators will most likely focus on reports of just 1 gender for reasons of resource constraints, it is important that there be an understanding of the comparability of men’s and women’s reports. Without this, we have uncertainty about the validity of women’s reports of experiences of IPV and nonpartner sexual violence. There is particular concern that sexual violence may be under-reported by women because rape is highly stigmatized, which may result in minimization of events, but it is also possible men might under-report perpetration of violence so as not to incriminate themselves [
Prevention of VAWG needs to be built on evidence of drivers among women currently at risk (as well as those of perpetration). There is a reasonably large amount of literature on risk factors for experience of IPV (for example, summarized in the World Health Organization’s 2010 review [
The UN Multi-country Study on Men and Violence was designed to address many of the gaps in previous data sources [
Ethical approval was provided by the Medical Research Council of South Africa; the College of Humanities, Beijing Forestry University; National Ethics Committee for Health Research of Cambodia; and the Faculty of Medicine at the University of Colombo, Sri Lanka.
The survey was developed by Partners for Prevention in collaboration with the Medical Research Council of South Africa and the country research teams. Research was conducted in 2011–2012. Of the 6 country surveys, only 4 had male and female interviews: China, Cambodia, Bougainville in Papua New Guinea, and Sri Lanka. The present study is intended to contrast women's reported experience of IPV and nonpartner rape with men's reported perpetration of IPV and nonpartner rape; therefore, our analysis focuses on these 4 surveys. The sample from Cambodia and the sample from Papua New Guinea were representative, respectively, of Cambodia and the island of Bougainville. The Chinese site was a county with a town and rural area, and in Sri Lanka, Colombo and 3 contrasting districts were surveyed. Further details of the research can be found elsewhere [
In each setting, we selected census enumeration areas, with a probability proportionate to size, and systematically selected households within these areas. In households, we invited a man or woman (depending on the cluster) aged 18–49 years (where necessary, randomly selected) for interview, with a trained sex-matched interviewer. Most interviews were face to face, but for men, answers to most sensitive questions were self-completed on audio-enhanced personal digital assistants (APDAs). In China, a household list of individuals in each cluster by age and sex was available and used for sampling within selected clusters, and the entire questionnaire was self-completed. Full details of the methods, sampling, and response rates are presented elsewhere [
Construct | Indicator | Definition |
---|---|---|
Physical IPV | The score was based on 5 behaviourally specific items asked about the actions of a current or former partner in the last year and 5 before the past year: was slapped or had something thrown at her that could hurt her; was pushed or shoved; was hit with a fist or something else that could hurt her; was kicked, dragged, or beaten up; or current/former partner threatened to use or actually used a gun, knife, or other weapon against her. These items were developed from Garcia-Moreno et al. (2005), and each had ‘never’, ‘once’, ‘a few times’, or ‘often’ response options. | |
Sexual IPV (men) | 2 items: He forced partner to have sex when she did not want to; he had sex with partner when he knew she did not want to, but he believed she should agree because she was his wife/partner. | |
Sexual IPV (women) | 2 items: He physically forced her to have sex when she did not want to; she had sex with a current/former partner when she did not want to because she was afraid of what he might do to her. | |
Emotional IPV | 5 items: Current/former partner ever insulted or deliberately made her feel bad about herself; belittled or humiliated her in front of other people; did things to scare or intimidate her on purpose (e.g., by yelling or smashing things); threatened to hurt her; or hurt people she cares about as way of hurting her or damaged things that were important to her. | |
Economic IPV | 2 items: Current/former partner prohibited her from getting a job, going to work, trading, or earning money; current/former partner took her earnings against her will. | |
Physical IPV only | Respondent experienced/perpetrated at least 1 act of physical IPV or experienced/perpetrated at least 1 act of physical IPV and emotional/economic abuse but did not experience/perpetrate any acts of sexual IPV. | |
Sexual IPV only | Respondent experienced/perpetrated at least 1 act of sexual IPV or experienced/perpetrated at least 1 act of sexual IPV or emotional/economic abuse but did not experience/perpetrate any acts of physical IPV. | |
Both sexual and physical IPV | Experienced/perpetrated at least 1 act of sexual IPV and at least 1 act of physical IPV, with or without emotional/economic abuse. | |
Multiple emotional/economic only | Respondent experienced/perpetrated more than 1 act of emotional or economic abuse, or 1 act several times, from/on intimate partner but never experienced/perpetrated sexual or physical IPV. | |
Nonpartner rape (men) | 2 items: asked about having forced a woman who was not his wife or girlfriend at the time to have sex; having had sex with a woman who was too drunk or drugged to indicate whether she consented. 2 further items were asked using the same structure but with the formulation ‘with other men’. | |
Nonpartner rape (women) | 3 items: forced or persuaded to have sex against her will by a man who was not her husband or boyfriend; forced to have sex with a man who was not a husband or boyfriend when too drunk or drugged to refuse; or forced or persuaded to have sex against her will with more than 1 man at the same time. | |
Hunger | The respondent was asked the following: ‘Would you say that the people in your home often, sometimes, seldom, or never go without food?’ | |
Resource mobilisation | The respondent was asked the following: ‘If a person became ill in your home and [about US$10] was needed for treatment or medicines, would you say it would be very easy, easy, quite difficult, or very difficult to find the money?’ | |
Wealth score | (Exogenous in structural model) | Sum of the hunger and emergency resource mobilisation variables. 8-point scale. |
Childhood trauma | Childhood emotional abuse or neglect | Based on a modified version of the Childhood Trauma Questionnaire: Before age 18 years, the respondent had at least 1 of the following experiences sometimes, often, or very often: lived in different households at different times; was told she was lazy or stupid or weak by someone in her family; was insulted or humiliated by someone in her family in front of other people; both of her parents were too drunk or drugged to take care of her; or spent time outside the home and none of the adults at home knew where she was. |
Physical abuse | Before age 18 years, the respondent had at least 1 of the following experiences sometimes, often, or very often: was beaten at home with a belt, stick, whip, or something else that was hard; was beaten so hard at home that it left a mark or bruise. | |
Sexual abuse | Before age 18 years, the respondent had at least 1 of the following experiences sometimes, often, or very often: someone touched her buttocks or genitals or made her touch them when she did not want to; or she had sex with someone because she was threatened, frightened, or forced. | |
Childhood trauma overall score | Childhood trauma score derived from the sum of the about 3 subscales (Cronbach’s Alpha was 0.74). | |
Witnessing abuse of mother | Before age 18, the respondent saw or heard her mother being beaten by her husband or boyfriend | |
Partner drug use | Single item asking about how often the partner uses drugs. | |
Partner alcohol use | Single item asking about how often the partner drinks. | |
Gender-equitable attitudes | A scale was created from 8 items scored on a 4-point scale from strongly agree to strongly disagree: |
|
Partner faithfulness | The respondent was asked the following: ‘How likely do you think it is that your |
|
Controlling behaviour | Partner is moderately or highly controlling over female partner compared with least controlling, based on 8 items scored on a 4-point scale from strongly agree to strongly disagree: ‘When I want sex, I expect my partner to agree’; ‘If my partner asked me to use a condom, I would get angry’; ‘I won’t let my partner wear certain things’; ‘I have more to say than she does about important decisions that affect us’; ‘I tell my partner who she can spend time with’; ‘When my partner wears things to make her look beautiful, I think she may be trying to attract other men’; ‘I want to know where my partner is all of the time’; and ‘I like to let her know she isn’t the only partner I could have.’ | |
Quarrelling | Respondent quarrels with current or most recent intimate partner rarely, sometimes, or often. |
IPV, intimate partner violence.
The data analysis was largely planned at the point of commencement of the work on the paper. Authors EF and RJ were involved in the research from its inception and had planned the questionnaire so that it would be possible to undertake an analysis of prevalence of violence and risk factors. They ensured as much as possible that the main variables previously described in the literature [
We combined the datasets and analysed the data using Stata, version 13. All procedures took into account the multistage structure of the dataset, with stratification by site within a country and enumeration areas as clusters. The sample was self-weighting. Women’s experiences of violence and male partner violence perpetration, as well as the independent variables, were summarized as percentages (or means), with 95% confidence limits calculated using standard methods (Taylor linearization).
We categorised the type of violence exposure according to the most severe type experienced, where greatest severity was considered as exposure to physical and/or sexual IPV, as this is the category that has been the basis of most health consequences research [
The multiple emotional/economic abuse category consisted of women who had experienced more than 1 act of economic or emotional abuse but never experienced sexual or physical abuse. All ever-partnered women and men were classified into 5 violence exposure categories: none, emotional/economic without sexual or physical (henceforth referred to as ‘emotional/economic’), sexual without physical and with or without emotional/economic (henceforth referred to as ‘sexual’), physical without sexual and with or without emotional/economic (henceforth referred to as ‘physical’), or sexual and physical with or without emotional/economic (henceforth referred to as ‘physical/sexual’).
We also evaluated the relationship between the outcome (IPV) and nonresponse (missing data) in putative risk factors. No association was found between a woman’s IPV status and her nonresponse to any of the possible risk factors. However, to increase the sample of women with responses to scale measurements (e.g., gender attitudes and relationship control), women with partial responses to scale items were also included. Three methods for imputing for missing data were initially compared. These involved imputing for missing scale items using either (1) a woman’s responses to other items in the scale (individual respondent mean) or (2) the average for each item adjusted for IPV status, or (3) the average of the overall score adjusted for IPV status. There were no significant differences in the 3 methods for both gender attitudes and relationship control scores. We used ‘the average of the overall score (adjusted for IPV status)’ to impute for missing scores.
The exercise of testing variables and building model drew on current theories about risk factors and drivers of violence against women. The selection of variables as putative risk factors was informed by the state of knowledge in the field. Drawing on a life-course modified ecological model of violence risk [
To show associations between independent variables that were putative risk factors, we first conducted a bivariable analysis with a (by type) lifetime IPV exposure measure and a multinomial regression with no physical, sexual, or severe economic/financial violence as the comparison group. A maximum likelihood multinomial logit model, which adjusted for the survey design, was used to compare factors associated with different types of IPV experienced with the no-violence reference category. We initially fitted bivariable models and then included all factors that were significantly associated with IPV experience in the bivariate models into an overall model, which was adjusted for the country and age group of the woman.
We examined factors associated with past-year experience of IPV considering the same independent variables, but with a past-year exposure to any physical and/or sexual IPV as the outcome, due to sample size considerations, we did not perform multinomial modelling. We sought to model 19 covariates in the logistic regression model, which, according to generally accepted rules of thumb [
Multivariable logistic regression was used to determine risk factors associated with past-year physical and/or sexual IPV experience in women, with those not experiencing this as the reference group. To enable the use of a variable on frequency of quarrelling, which was not measured in Cambodia, a dummy level for Cambodia was created for the quarrelling variable for use in the logistic regression model. All variables were included in the multivariate analysis. We focus the discussion on variables with
The population attributable fractions (PAFs) for each category of IPV were calculated using the formula PAF = ((RRR − 1) / RRR) * Pe, where RRR is the adjusted relative risk ratio from the adjusted model and Pe is the proportion of women who had experienced that particular IPV type and who had the exposure.
Structural equation modelling (SEM) was conducted using Stata 13.0 to assess the interrelationship between variables associated with physical and/or sexual IPV in the multinomial regression model. The model outcome was a past-year IPV variable that had 4 levels drawn from the physical and sexual IPV questions: no exposure, sexual IPV, physical IPV, and physical or sexual IPV. The correlation between each hypothesized variable and the IPV variable was then tested by building variable pairs. All associations were tested by running a full-information maximum likelihood method to deal with missing values. This method was chosen over multiple imputations because it has been shown to yield superior results in structural equation modelling [
We fitted a path model using full information maximum likelihood (FIML) estimation to model all available data. The final model was built based on theory and statistically meaningful modifications using backwards elimination to exclude endogenous variables that did not mediate any path (with significance set at the
In total, 3,106 women aged between 18 and 49 years were interviewed in the 4 countries, among whom 2,855 (91.9%) were ever-partnered. Of the ever-partnered women, 90 (3.3%) did not respond to any of the questions related to IPV experience and were thus excluded from analysis. In total, 5,206 men were interviewed in the 4 countries, and 4,360 (83.8%) had ever been partnered. Four thousand and fifteen men completed the IPV questions, and 5,062 completed the non-partner rape questions.
Comparing lifetime reports of women’s experiences and men’s reports of IPV by type from the 4 countries (
Total number of partnered women/men sampled | No violence |
Sexual violence only |
Physical violence only |
Both physical and sexual violence |
Multiple emotional/economic violence |
|
---|---|---|---|---|---|---|
CAMBODIA | ||||||
Women | 410 | 43.4% (38.2%–48.8%) | 3.2% (2.0%–4.9%) | 16.2% (12.1%–21.3%) | 5.9% (3.7%–9.4%) | 31.4% (27.4%–35.6%) |
Men‡ | 1,390 | 42.6% (39.6%–45.7%) | 16.5% (14.6%–18.7%) | 12.1% (10.2%–14.2%) | 4.5% (3.6%–5.7%) | 24.2% (22.0%–26.7%) |
Women | 410 | 64.2% (59.2%–68.9%) | 2.0% (1.0%–3.7%) | 4.4% (2.3%–8.3%) | 1.7% (1.0%–3.7%) | 27.7% (23.4%–32.5%) |
Men | 1,395 | 87.5% (85.5%–89.3%) | 3.9% (2.9%–5.2%) | 2.6% (1.9%–3.5%) | 0.4% (0.2%–0.8%) | 5.7% (4.5%–7.1%) |
CHINA | ||||||
Women | 1,033 | 56.4% (53.1%–59.7%) | 3.5% (2.5%–4.8%) | 30.3% (27.4%–33.3%) | 4.8% (3.6%–6.3%) | 5.1% (3.8%–6.7%) |
Men‡ | 930 | 44.2% (40.7%–47.8%) | 6.8% (5.5%–8.4%) | 32.2% (28.9%–35.6%) | 12.6% (10.7%–14.8%) | 4.3% (3.3%–5.6%) |
Women | 1,033 | 82.6% (80.2%–84.8%) | 2.3% (1.6%–3.4%) | 4.9% (3.8%–6.5%) | 1.0% (0.3%–1.4%) | 9.4% (7.8%–11.3%) |
Men | 931 | 78.5% (76.1%–80.7%) | 5.6% (4.4%–7.1%) | 12.6% (10.6%–14.8%) | 1.7% (1.1%–2.6%) | 1.6% (1.0%–2.6%) |
BOUGAINVILLE | ||||||
Women | 787 | 25.9% (22.3%–29.9%) | 16.0% (13.1%–19.4%) | 11.1% (8.9%–13.7%) | 40.3% (35.8%–45.0%) | 6.7% (4.9%–9.2%) |
Men‡ | 714 | 12.7% (9.7%–16.5%) | 18.2% (15.5%–21.3%) | 20.6% (17.4%–24.2%) | 41.2% (36.8%–45.7%) | 7.3% (5.4%–9.7%) |
Women | 787 | 57.1% (52.3%–61.7%) | 10.8% (8.6%–13.4%) | 9.0% (7.1%–11.5%) | 12.3% (9.9%–15.2%) | 10.8% (8.7%–13.3%) |
Men | 678 | 60.5% (55.9%–64.8%) | 15.6% (12.8%–19.0%) | 12.2% (10.2%–14.6%) | 6.2% (4.7%–9.2%) | 5.5% (4.0%–7.3%) |
SRI LANKA | ||||||
Women | 535 | 66.2% (61.4%–70.6%) | 6.9% (4.9%–9.7%) | 12.2% (9.5%–15.4%) | 8.4% (5.7%–12.3%) | 6.4% (3.9%–10.1%) |
Men‡ | 1,040 | 60.6% (57.1%–63.9%) | 9.5% (7.7%–11.8%) | 16.3% (14.1%–18.9%) | 6.7% (5.0%–9.1%) | 6.8% (5.4%–8.6%) |
Women | 535 | 78.6% (73.7%–82.8%) | 12.5% (8.9%–17.2%) | 2.2% (1.2%–4.0%) | 2.6% (1.5%–4.5%) | 4.1% (2.8%–6.0%) |
Men | 1,011 | 88.5% (85.8%–90.8%) | 4.9% (3.7%–6.6%) | 4.3% (3.3%–5.5%) | 0.9% (0.4%–1.8%) | 1.4% (0.8%–2.3%) |
Combined sample (women) (lifetime) | 2,765 | 47.7% (44.9%–50.5%) | 7.7% (6.5%–9.1%) | 19.2% (17.5%–21.0%) | 15.8% (13.5%–18.3%) | 9.7% (8.2%–11.4%) |
Combined sample (women) (past year) | 2,765 | 71.8% (69.5%–74.1%) | 6.7% (5.5%–8.0%) | 5.5% (4.6%–6.5%) | 4.5% (3.6%–5.6%) | 11.5% (10.1%–13.1%) |
Data are
# The violence categories are mutually exclusive. No violence = never experienced sexual or physical violence or multiple incidents of emotional or economic violence. Sexual violence only = experienced sexual violence with or without emotional or economic violence but did not experience physical violence. Physical violence only = experienced physical violence with or without emotional/economic violence but did not experience sexual violence. Both physical and sexual violence = experienced both physical and sexual violence with or without emotional/economic violence. Multiple emotional/economic violence only = experienced repeated incidents of emotional/economic violence but never experienced sexual or physical violence.
In Cambodia, 0.4% (95% CI 0.1%–1.73%) of women had experienced nonpartner rape in the past year, and 1.9% (95% CI 1.12%–2.70%) of men disclosed perpetration. In China, 2.3% (95% CI 1.49%–3.43%) of women had experienced nonpartner rape in the past year, and 1.7% (95% CI 0.94%–2.52%) of men disclosed perpetration. In Bougainville, 5.7% (95% CI 4.21%–7.75%) of women had experienced nonpartner rape in the past year, and 11.7% (95% CI 9.02%–14.30%) of men disclosed perpetration. In Sri Lanka, 0.5% (95% CI 0.15%–1.40%) of women had experienced nonpartner rape in the past year, and 0.8% (95% CI 0.22%–1.43%) of men disclosed perpetration.
The prevalence of past-year physical and/or sexual IPV experience increased with age (
Total |
Risk factor prevalence | Risk factor prevalence | Crude OR (95% CI) | aOR (95% CI) | ||
---|---|---|---|---|---|---|
Age | 2,763 | |||||
18–24 years | 450 | 16.8 | 13.9 | |||
25–34 years | 1,002 | 36.3 | 36 | 1.20 (0.87–1.66) | 1.00 (0.66–1.50) | |
35–49 years | 1,311 | 46.9 | 50.1 | 1.29 (0.93–1.78) | 1.26 (0.83–1.90) | |
Education | 2,762 | |||||
None | 195 | 6.9 | 8.0 | |||
Incomplete primary | 404 | 13.6 | 19.5 | 1.22 (0.78–1.91) | 0.97 (0.57–1.66) | |
Complete primary | 482 | 16.7 | 21.3 | 1.09 (0.69–1.73) | 0.99 (0.59–1.68) | |
Incomplete secondary | 1,079 | 41.1 | 28.9 | 0.60 (0.38–0.95) | 0.99 (0.57–1.71) | |
Complete secondary/higher | 602 | 21.7 | 22.3 | 0.88 (0.55–1.42) | 0.84 (0.44–1.58) | |
Present food insecurity | 2,713 | 941 | 31.3 | 51.4 | 2.32 (1.80–3.00) | |
Resource mobilisation problems | 2,717 | 1,519 | 54.1 | 64.8 | 1.56 (1.24–1.98) | |
Overall wealth score (mean [SD]) | 2,722 | 6.0 (1.5) | 5.5 (1.5) | 0.82 (0.76–0.88) | 0.88 (0.80–0.97) | |
Currently married | 2,763 | 2,432 | 87.4 | 90.9 | 1.43 (1.01–2.03) | 2.45 (1.37–4.38) |
Source of income | 2,759 | |||||
Woman | 293 | 9.7 | 15.3 | |||
Her partner | 1,109 | 40.7 | 37.5 | 0.58 (0.41–0.83) | 0.83 (0.49–1.41) | |
Both equally | 1,013 | 36.4 | 38.3 | 0.67 (0.49–0.92) | 1.11 (0.69–1.78) | |
Parents/others | 344 | 13.2 | 8.9 | 0.43 (0.27–0.69) | 0.74 (0.39–1.40) | |
Sexually abused as child | 2,728 | 208 | 5.9 | 16.1 | 3.06 (2.23–4.21) | 2.18 (1.46–3.26) |
Physically abused as child | 2,733 | 830 | 26.3 | 50.4 | 2.85 (2.25–3.62) | 1.48 (1.11–1.97) |
Emotionally abused as child | 2,714 | 1,531 | 52.4 | 76 | 2.87 (2.26–3.64) | 1.88 (1.41–2.51) |
Witnessed abuse of mother | 2,728 | 775 | 24.6 | 47 | 2.71 (2.14–3.42) | 1.24 (0.96–1.60) |
Earning disparity | 2,093 | |||||
Same | 680 | 32.4 | 32.8 | |||
Man earns more | 710 | 35.9 | 25.1 | 0.69 (0.52–0.92) | ||
Woman earns more | 703 | 31.7 | 42.1 | 1.31 (0.98–1.76) | ||
Partner alcohol use | 2,594 | |||||
Never | 971 | 39.6 | 26.8 | |||
Occasional | 1,029 | 39.1 | 42.7 | 1.62 (1.24–2.11) | 1.50 (1.10–2.03) | |
Daily or weekly | 594 | 21.4 | 30.5 | 2.11 (1.63–2.73) | 1.53 (1.12–2.08) | |
Partner drug use | 2,735 | |||||
None | 2,467 | 91.8 | 82.4 | |||
Prior | 110 | 3.6 | 6.1 | 1.88 (1.21–2.92) | 0.85 (0.49–1.45) | |
Past year | 158 | 4.6 | 11.5 | 2.78 (1.83–4.23) | 1.67 (1.06–2.62) | |
Not confident in partner fidelity | 2,702 | 1,014 | 35.1 | 49.5 | 1.81 (1.47–2.23) | 1.36 (1.05–1.77) |
Partner unemployed | 2,717 | 701 | 22.8 | 40.4 | 2.30 (1.82–2.89) | 1.18 (0.85–1.62) |
Woman’s control in the relationship | 2,739 | |||||
High | 596 | 22.0 | 20.6 | |||
Medium | 1,786 | 67.1 | 55.7 | 0.89 (0.67–1.17) | 0.92 (0.67–1.28) | |
Low | 357 | 10.9 | 23.6 | 2.32 (1.64–3.27) | 1.76 (1.15–2.69) | |
Frequency of quarrelling | 2,715 | |||||
Rarely | 998 | 44.7 | 36.9 | |||
Sometimes | 1,143 | 51.1 | 42.5 | 1.01 (0.78–1.31) | 1.36 (1.01–1.83) | |
Often | 166 | 4.1 | 20.7 | 6.04 (4.28–8.54) | 5.03 (3.17–7.99) | |
Cambodia |
408 | – | – | – | ||
Gender equity | 2,763 | |||||
High | 416 | 16 | 10.4 | |||
Medium | 1,632 | 58.8 | 60.5 | 1.58 (1.13–2.21) | 0.77 (0.49–1.21) | |
Low | 715 | 25.2 | 29.1 | 1.77 (1.50–2.60) | 0.71 (0.41–1.23) |
aOR, adjusted odds ratio.
‡ Item not asked in Cambodia;
* not included in the adjusted model due to high level of missing data;
** not included in the adjusted model, used ‘overall wealth score.’
All 3 forms of childhood abuse (sexual, physical, and emotional) and witnessing abuse of mother were more common among women with past-year physical or sexual IPV experience. Women whose partners earned more than them had a lower past-year IPV prevalence than those earning the same as their partners or women who earned more. Partner characteristics associated with women’s past-year IPV experience were the male partner’s regular alcohol use, ever or past-year drug use, lack of fidelity, and unemployment. Women who were highly controlled by their partner were more likely to have experienced past-year IPV, as were those who quarrelled more often and those holding less gender-inequitable views.
Results for the structural equation model are presented in
Parameter | Standardized coefficients | SE | z | (95% confidence interval) | ||
---|---|---|---|---|---|---|
Direct effects | ||||||
Wealth score → Childhood trauma | −0.257 | 0.058 | −4.44 | <0.001 | −0.371 | −0.144 |
Childhood trauma → Educational attainment | −0.056 | 0.045 | −0.125 | 0.212 | −0.145 | 0.032 |
Wealth score → Educational attainment | 0.311 | 0.085 | 3.65 | <0.001 | 0.144 | 0.478 |
Gender equity → Lower partner alcohol use | 0.081 | 0.044 | 1.83 | 0.068 | −0.006 | 0.167 |
Childhood trauma → Lower partner alcohol use | −0.117 | 0.014 | −8.1 | <0.001 | −0.145 | −0.089 |
Childhood trauma → Witness abuse | 0.588 | 0.037 | 15.76 | <0.001 | 0.515 | 0.661 |
Educational attainment → Partner fidelity | −0.038 | 0.045 | −0.86 | 0.391 | −0.126 | 0.049 |
Gender equity → Partner fidelity | 0.029 | 0.038 | 0.76 | 0.447 | −0.045 | 0.102 |
Childhood trauma → Partner fidelity | −0.194 | 0.038 | −5.06 | <0.001 | −0.285 | −0.119 |
Gender equity → Quarrelling | 0.241 | 0.055 | 4.34 | <.001 | 0.132 | 0.349 |
Lower partner alcohol use → Quarrelling | −0.174 | 0.063 | −2.78 | 0.005 | −0.296 | −0.051 |
Educational attainment → Gender equity | 0.187 | 0.071 | 2.63 | 0.009 | 0.047 | 0.326 |
Childhood trauma → Gender equity | −0.226 | 0.034 | −6.61 | <0.001 | −0.293 | −0.159 |
Witness abuse → Gender equity | −0.054 | 0.041 | −1.33 | 0.185 | −0.134 | 0.026 |
Wealth score → Gender equity | 0.213 | 0.120 | 1.77 | 0.076 | −0.022 | 0.448 |
Gender equity → IPV | −0.188 | 0.014 | −4.53 | <0.001 | −0.269 | −0.107 |
Childhood trauma → IPV | 0.154 | 0.029 | 5.4 | <0.001 | 0.098 | 0.210 |
Partner fidelity → IPV | −0.076 | 0.019 | −4 | <0.001 | −0.113 | −0.038 |
Quarrelling → IPV | 0.223 | 0.016 | 13.56 | <0.001 | 0.171 | 0.251 |
Witness abuse → IPV | 0.064 | 0.037 | 1.75 | 0.08 | −0.008 | 0.137 |
Disturbance variances | Estimate | SE | (95% confidence interval) | |||
Educational attainment | 0.891 | 0.056 | 0.788 | 1.008 | ||
Gender equity | 0.784 | 0.102 | 0.608 | 1.012 | ||
Childhood trauma | 0.934 | 0.030 | 0.877 | 0.994 | ||
Partner fidelity | 0.959 | 0.019 | 0.923 | 0.996 | ||
IPV | 0.860 | 0.025 | 0.813 | 0.910 | ||
Lower partner alcohol use | 0.974 | 0.008 | 0.957 | 0.990 | ||
Quarrelling | 0.922 | 0.018 | 0.887 | 0.958 | ||
Witness abuse | 0.655 | 0.044 | 0.574 | 0.746 | ||
Equation-level goodness of fit | r-squared | |||||
Educational attainment | 0.1087 | |||||
Gender equity | 0.2156 | |||||
Childhood trauma | 0.0662 | |||||
Partner fidelity | 0.0408 | |||||
IPV | 0.1397 | |||||
Lower partner alcohol use | 0.0265 | |||||
Quarrelling | 0.0781 | |||||
Witness abuse | 0.3453 |
Note: mc2 is the Bentler-Raykov squared multiple correlation coefficient. IPV, intimate partner violence.
Between a quarter and two-thirds of women in the 4 countries studied had experienced IPV, and 1.7% and 15.9% had experienced nonpartner rape. There was very great diversity in the prevalence of IPV between countries, as previously reported in Asia and the Pacific [
We would not necessarily expect men’s and women’s reports of nonpartner sexual violence to concur, and some women are at much higher risk than others in the population and may experience multiple rapes [
We saw 4 important groups of risk factors for IPV experience. First, our results confirm that past-year IPV victimisation is more common in a context of poverty [
Witnessing abuse of one’s mother has been found to be associated with both experience of and perpetration of IPV in many studies [
The third variable group consists of partner characteristics: his drinking, past-year drug use, controlling behaviour, unemployment, and fidelity. Generally, these are previously well-established risk factors, although research with men has not confirmed associations with drug use in Asia and the Pacific, except in relation to perpetration of multiple perpetrator rape [
The frequency of quarrelling was very strongly associated with IPV, as it was in the models of men’s perpetration in the 4 countries [
One of the most important findings of the structural model was a pathway that can be interpreted as indicating variables that build women’s resilience to violence. This linked higher wealth, higher educational attainment, and having more gender-equitable attitudes. This is very important because all of these factors are amenable to intervention, and it highlights the role of poverty reduction and interventions to enhance girls’ schooling, which may be supported for many reasons related to development and the general upliftment of women, in IPV prevention. In this study, the Gender Equitable Men (GEM) scale was used to measure women’s gender attitudes. This is a broad measure that includes attitudes towards the use of violence against women. The latter alone have been shown to be very strongly associated with risk of violence [
Economic empowerment has been shown to be a fruitful area of intervention with women [
Reducing childhood trauma exposure is ultimately critical to reducing women’s experience of violence and is strongly related to poverty. Whilst there is much work on early interventions in childhood to reduce the experience of trauma and IPV in the next generation, it is possible that poverty reduction will have the greatest impact.
The study findings reflect the sampled sites; generalizability beyond this is unclear, and the combined dataset analysed here does not reflect the whole region. Since the research was cross-sectional, temporality may be questioned, but since this was recent violence, this is not likely to be a great problem. All the prevalence estimates for violence were compared with estimates weighted for the number of eligible men and women per household. The latter were not significantly different in any site, and thus, we have used unweighted estimates. The main analysis was on past-year IPV exposure, and because this is less common than lifetime exposure, the power of the analysis was inevitably impacted. However, the focus has strengthened the interpretability of the results for programming, as it is the goal of IPV prevention to reduce exposure of women at risk in the future and recent abuse is the best measure of this. A study limitation is that we do not have a comparison of men’s and women's reports from the same relationship. In accordance with WHO ethics and safety guidelines, we did not interview men and women in the same location, much less in couples. The motivation is to avoid the (to our knowledge small) possibility of retaliatory violence associated with partners learning of the interview content. This risk is not justified in cross-sectional research but prevents comparison of couples’ reports.
Our findings suggest that newly emphasised past-year IPV indicators that were developed to track SDG 5 would be reasonably reliable if based on women’s interviews. Interviews with men to track past-year nonpartner rape perpetration are important. We have shown an important IPV resilience pathway. This helps us to understand why interventions that combine women’s economic empowerment and building gender-equitable attitudes (and communication skills), such as Pronyk and colleagues’ Image [
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Checklist of items that should be included in reports of cross-sectional studies.
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The UN Multi-country Study on Men and Violence was a collaborative effort and only made possible by the commitment, dedication, and hard work of all of the organizations and individuals involved, both internationally and in each of the study countries. First and foremost, we would like to acknowledge and give gratitude to the women and men who gave their time to participate in our study and generously shared their life experiences with us. We wish to express our profound thanks to our partner institutions and organizations in each of the study countries, as well as all of the interviewers and supervisors who worked tirelessly, and often under difficult circumstances, to collect the data for this study. We would like to thank the studies’ technical advisors, members of the steering committee, and members of the national working groups. We would like to thank all the members of the Partner for Prevention Technical Advisory Group and Regional Steering Committee who guided the overall study.
adjusted odds ratio
audio-enhanced personal digital assistant
adjusted relative risk ratio
Gender Equitable Men
intimate partner violence
population attributable fraction
Papua New Guinea
relative risk ratio
Sustainable Development Goal
Strengthening the Reporting of Observational Studies in Epidemiology
UN Multi-country Study on Men and Violence
violence against women and girls