Identifying the women most vulnerable to intimate partner violence: A decision tree analysis from 48 low and middle-income countries

Abstract

Background: Primary prevention strategies are needed to reduce high rates of intimate partner violence (IPV) in low-and middle-income countries (LMICs). The effectiveness of population-based approaches may be improved by adding initiatives targeted at the most vulnerable groups and tailored to context-specificities. Methods: We applied a decision-tree approach to identify subgroups of women at higher risk of IPV in 48 LMICs and in all countries combined. Data from the most recent Demographic and Health Survey carried out between 2010 and 2019 with available information on IPV and sociodemographic indicators was used. To create the trees, we selected 15 recognized risk factors for IPV in the literature which had a potential for targeting interventions. Exposure to IPV was defined as having experienced physical and/or sexual IPV in the past 12 months. Findings: In the pooled decision tree, witnessing IPV during childhood, a low or medium empowerment level and alcohol use by the partner were the strongest markers of IPV vulnerability. IPV prevalence amongst the most vulnerable women was 43% compared to 21% in the overall sample. This high-risk group included women who witnessed IPV during childhood and had lower empowerment levels. These were 12% of the population and 1 in 4 women who experienced IPV in the selected LMICs. Across the individual national trees, subnational regions emerged as the most frequent markers of IPV occurrence. Interpretation: Starting with well-known predictors of IPV, the decision-tree approach provides important insights about subpopulations of women where IPV prevalence is high. This information can help designing targeted interventions. For a large proportion of women who experienced IPV, however, no particular risk factors were identified, emphasizing the need for population wide approaches conducted in parallel, including changing social norms, strengthening laws and policies supporting gender equality and womens rights as well as guaranteeing womens access to justice systems and comprehensive health services.

Partner Alcohol Use and Attitudes Toward Intimate Partner Violence: Independent and Synergistic Effects on Intimate Partner Violence Across 19 Low- and Middle-Income Countries

“…In this analysis, we sought to jointly analyze two well-known risk factors for IPVAW: partner alcohol use and attitudes toward IPVAW (Coll et al, 2021). We aimed to examine these risk factors’ independent and joint influence on IPVAW across levels of the social ecology.…”

“…Multiple risk factors have shown consistent associations with IPVAW. These include diverse factors related to women (e.g., age, witnessing IPV in childhood, and polygyny), partners (e.g., current alcohol use), and households (e.g., wealth) (Coll et al, 2021). In a recent analysis, fifteen risk factors were evaluated using a decision tree analysis.…”

“…In a recent analysis, fifteen risk factors were evaluated using a decision tree analysis. Witnessing IPV during childhood, partner alcohol use, and empowerment (of which attitudes toward IPVAW is one component) emerged as the three most important risk factors (Coll et al, 2021). Partner alcohol use and attitudes toward IPVAW have overlapping risk factors and pathways occurring at multiple levels of the social ecology; yet, they historically have been addressed by different investigators, disciplines, and interventions, and therefore, their intersections are underexplored.…”

A Systematic Review of Public Stigmatization Toward Women Victims of Intimate Partner Violence in Low- and Middle-Income Countries

“…They explained that patriarchal hegemony was present in many LAMIC and that this influenced education, legislation, and the criminal justice system in a way that facilitated those attitudes. The incidence of IPV in the past 12 months is also higher in LAMIC (WHO, 2022) and previous research indicates trends in predictors and risk factors of IPV for women living in these countries (Coll et al, 2021). Furthermore, the victim's autonomy and financial status influence public stigma and help-seeking (McDougal et al, 2019), which may differ between highincome countries and LAMIC.…”

Public stigma toward women victims of intimate partner violence: A systematic review

“…It also follows conventions of other global studies on IPV which classify results similarly in large income groups for analytical purposes (WHO, 2021). Further to these pragmatic reasons, we focus on studies from high-income countries because prior research indicates trends in predictors and risks of IPV for women living in low-and middle-income countries to high-income countries (Coll et al, 2021). McDougal et al (2019) suggest that women's financial status and autonomy may influence experiences of IPV, public stigma, and helpseeking pathways.…”