1. World Health Organization Gender and Women’s Health Challenges of a short module in surveys on other topics vs a specialized survey Henrica A.F.M. Jansen UNECE Work Session on Gender Statistics, Geneva, 18-20 October 2004

2. World Health Organization Gender and Women’s Health What this talk is about Comparison of the two ways of measuring violence Examples highlighting some (remaining) challenges for measuring violence Conditions that need to be in place when using a short module Importance of interviewer training

3. World Health Organization Gender and Women’s Health Two trends in international violence research Addition of violence questions to studies designed for other purposes Focused specialized studies (national and regional)

4. World Health Organization Gender and Women’s Health Strengths and weaknesses of the two approaches Short module in survey: Official statistics Includes other variables Less detailed information on violence Less attention to safety Lower prevalence Specialized survey: Often smaller scale More attention to safety issues Measures to enhance disclosure More in-depth information on violence Higher prevalence estimates

5. World Health Organization Gender and Women’s Health What is your objective? To raise awareness about the problem To influence policy To monitor trends To contribute to indicators at global level To compare between countries To understand more about violence, the associations, risk and protective factors Short module Special survey

6. World Health Organization Gender and Women’s Health Challenges to developing a common set of indicators on violence against women 1. Enhancing comparability –How violence is defined –How is violence measured 2. Enhancing disclosure –Opportunities to disclose, context, skill of interviewers 3. Enhancing safety –privacy, special training for field staff, support for respondents and interviewers Discussed already

7. World Health Organization Gender and Women’s Health Factors that affect disclosure How the questions are phrased Number of opportunities to disclose Context in which questions are asked Characteristics and skill of interviewers Social stigma attached to issue

8. World Health Organization Gender and Women’s Health Single versus multiple questions to measure abuse, Nicaragua Since you were 15, has anyone ever hit or physically mistreated you? Who? 14% of women reported abuse by partner Using a more detailed instrument that asked about occurrence and frequency of acts... 29% of women reported physical abuse by a partner

9. World Health Organization Gender and Women’s Health “…In the first question, they would say that he didn’t beat them, but when we got to the other questions, then they would say yes, sometime he beats me and kicks me or uses a gun, or whatever.” (interviewer, Nicaraguan DHS)

10. World Health Organization Gender and Women’s Health Measurement of Child Sexual Abuse WHO Study Before the age of 15, do you remember if any one in your family ever touched you sexually or made you do something sexual that you didn’t want to? –If yes, who did this to you? –How old were you when it happened for the first time? –How old was this person? –How many times did this happen? Once/twice; few, many? Probes: school, friend or family, neighbor; stranger or anyone else?

11. World Health Organization Gender and Women’s Health Anonymous reporting of sexual abuse before age 15

12. World Health Organization Gender and Women’s Health Comparison of methods of measuring sexual abuse before age 15

13. World Health Organization Gender and Women’s Health Percentage reporting sexual abuse before age 15, Tanzania

14. World Health Organization Gender and Women’s Health More ways to enhance disclosure (context) Establishing trust and credibility in community Letters from proper authorities to households One woman per household - Visible process of randomization Sensitivity and engagement of interviewers Privacy – creative strategies needed Uniform, IDs.

15. World Health Organization Gender and Women’s Health Importance of interviewer selection and training Thus far, we saw the mode, question wording, order, context, privacy etc has effect on disclosure But…. Even if all this is the same, the type and skills of interviewer still makes a difference.

16. World Health Organization Gender and Women’s Health Evidence of the value of training Serbia and Montenegro 2003 13 inexperienced, carefully selected interviewers, trained during 3 weeks 21 professional interviewers, selected because of their interest in the topic, trained during one day

17. World Health Organization Gender and Women’s Health Special training vs professional interviewers Inexperienced, 3 week training Professional, 1 day training Response rate 93% 86% Disclosure rate 26% 21% Respondent satisfaction – with violence 46% 29% Respondent satisfaction – without violence 46% 38%

18. World Health Organization Gender and Women’s Health "Somehow it made me feel good, because it was something that I had never told anyone before. Now I’ve told someone". --Respondent, Brazil

19. World Health Organization Gender and Women’s Health Examples of short modules DHS violence module CDC violence module in reproductive health surveys IVAWS subset of questions WHO violence against women instrument –(partner violence and non-partner violence)

20. World Health Organization Gender and Women’s Health Minimum conditions for using a short module Measures to protect safety of respondents and interviewers Crisis intervention and referrals to specialized services for respondents who need this Special training and emotional support and follow-up for interviewers

21. World Health Organization Gender and Women’s Health Minimizing risk to the respondents: Total privacy and confidentiality One woman interviewed per household Study is not presented to household as asking questions on violence

22. World Health Organization Gender and Women’s Health These minimal set of conditions are crucial for Doing research safely for all involved Enhancing disclosure Data quality – scientific rigour Political importance, to be able to do fieldwork in future research

23. World Health Organization Gender and Women’s Health Thank you! jansenh@who.int http://www.who.int/gender/