DOMESTIC VIOLENCE: THE MEASURED AND THE TO BE MEASURED Sunita Kishor (Ph.D.) Demographic and Health Research Macro International, Inc. Maryland, USA

Overview What we know Lessons learned What we do not know ….and the data with which we know it (DHS examples) Lessons learned ….and the questions raised What we do not know

What is the DHS? Nationally-representative household surveys with large samples (typically 6000 +; India-100,000+) Usually done every 5-7 years Provide indicators for monitoring at the national and sometimes, sub-national level Comparable across countries and over time Includes information in selected countries on domestic violence (27) and violence against men Violence measurement in the DHS yields information on: prevalence, risk factors, and consequences of violence.

Measurement Challenges Defining ‘what’ violence to measure Ensuring validity of the measures: the ‘how’ Ensuring safety and ethical standards Determining what else to measure other than prevalence

History of violence measurement in the DHS Earliest efforts: Country-specific questions (Colombia 1990 & 1995) Questions developed and implemented as part of topic-specific studies 1993 Philippines Safe Motherhood Study 1995/96 Uganda Negotiating Reproductive Outcomes Study. 1995 Egypt DHS as part of the women’s status module Special efforts were made in the 1998 Nicaragua DHS develop questions that increased the validity of the DV measure The current module incorporates lessons from the Egypt and Nicaragua exercises accompanied by guidelines adapted from WHO guidelines on its ethical implementation There were several, mostly unrelated efforts before the final formulation and subsequent standardization and implementation of the DHS DV module in about 2000. a)     Country specific questions developed by the implementing agency and implemented with no real input from DHS in Colombia as early as 1990 and repeated in the next DHS there. b)     Questions developed and implemented as part of topic specific studies, namely the 1993 Philippines Safe Motherhood Study and the 1995/96 Uganda Negotiating Reproductive Outcomes Study. These efforts were ad hoc and not aimed at getting estimates of violence but to understand if violence was associated with or was an outcome of what was being studied. Approaches taken to document the experience of violence in these studies were obviously affected by the context of the study. For example, the Uganda one asked about violence in the context of conflicts arising during disagreements about having sex and reproductive decisionmaking.   c)    In 1998, with special input from Mary Ellsberg (who lived in Nicaragua at that time and was hired using SIDA (Swedish development agency) funding for just the violence portion), special efforts were made in the 1998 Nicaragua DHS to develop a set of questions which increased the validity of the DV measure and provided related information such as help  seeking .   The current module is a result of the lessons learned from the Egypt and Nicaragua exercises. The current DHS domestic violence module is accompanied by guidelines on its ethical implementation. These guidelines have been adapted from the corresponding World Health Organization guidelines (WHO, 2001).

Validity of Data No catch-all term to capture violence Recommendation: Ask about different types of violent acts separately, specifically, as in the Conflict Tactics Scale (CTS) Risk of underreporting of violence Recommendations: Build rapport, ensure privacy, provide multiple opportunities to reveal abuse Some surveys ask only a threshold question, such as, “Has your husband ever hit, slapped, or kicked you?” However, more valid data may be obtained by using an approach like the Conflict Tactics Scale, which asks about different discrete acts of violence, specifically. The CTS approach has several advantages over a single question threshold type approach, particularly in the context of cross-cultural research. By asking separately about specific acts of violence, the violence measure is not affected by different understandings between women of what constitutes violence. All women would probably agree on what constitutes a slap, but what constitutes a violent act or what is understood as violence, may vary across women, as also across cultures. This also gives women more than one opportunity to disclose abuse. Risk of underreporting of violence: Fear of reprisals, embarrassment, shame, reluctance to recall traumatic events

Forms of Spousal Violence: Definitions Physical violence Any of the following acts of violence perpetrated by her husband: Pushed her, shook her, or threw something at her Slapped her Twisted her arm or pulled her hair Punched her Kicked her, dragged her, or beat her up Tried to choke her or burn her on purpose Threatened her or attacked her with a weapon

Forms of Spousal Violence: Definitions Sexual violence: Any of the following: Forced her to have sexual intercourse when she did not want to Forced her to perform sexual acts she did not want to Emotional violence: Any of the following: Said or did something to humiliate her in front of others Threatened to hurt or harm her or someone close to her Insulted her to made her feel bad about herself

Violence by Others Physical violence by others From the time you were 15 years old has anyone (other than your current/last husband) hit, slapped, kicked, or done anything to hurt you physically? (Who?) Can include ex-husbands Violence during pregnancy also uses similar question (Who?) Can include current husbands Sexual violence at any time in life At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts? (Who and Age at first occurrence determined)

Other Issues Examined Timing of initiation of spousal violence Injuries related to spousal violence Wives initiating spousal violence Data on known or potential correlates Help seeking by abused women

DHS domestic violence data in 27 countries Africa Cameroon 2004 DRC 2007* Egypt 1995 & 2005 Kenya 2003 Liberia 2006/07* Malawi 2004 Mali 2006* Namibia 2006* Rwanda 2005 South Africa 1998 Uganda 2006 Zambia 2001/02 Zimbabwe 2005/06* Asia/South Asia Bangladesh 2004 Cambodia 2000 & 2005 India 1998/99 & 2005/06 Latin America/Caribbean Bolivia 2003 Colombia 1990, 1995, 2000, 2005 Dominican Republic 2002 & 2007* Haiti 2000 & 2005 Honduras 2005 Nicaragua1997/98 Peru 2000 & 2004 Eurasia Azerbaijan 2006* Moldova 2005 Turkmenistan 2001* Ukraine 2007* - 26 countries * Data not yet available.

Spousal Violence: India 2005-06 Percent of ever-married women age 15-49 Only 1% of married women have ever initiated violence against their husbands.

At what marital duration does spousal violence first occur? Percent 87% of spousal violence initiated within 5 years of marriage 87% of spousal violence initiated within 5 years of marriage 87% of spousal violence initiated within 5 years of marriage India 2005-06

Education and Spousal Violence: India 2005-06 Percent of ever-married women

What other factors are strongly associated with the likelihood of spousal violence? Percent of ever-married women India 2005-06

What other factors are strongly associated with the likelihood of spousal violence? Percent of ever-married women India 2005-06

Injuries Due to Spousal Violence Percent of women who have experienced spousal violence who had: India 2005-06

What we do know… Spousal violence varies from about 14% in Cambodia to 59% in Uganda Typically, half or more of the women who have ever experienced spousal violence have experienced it in the past 12 months Spousal sexual violence experienced by 5-20% Physical violence most common form of violence Violence begins early in marriage Violence results in injuries Violence varies by education and wealth and has intergenerational effects However, not explained by alcohol or parental effects Further analysis of the data show that there are strong links to health outcomes for mothers and their children

Questions Arising from Lessons Learned How do we measure trends? Men, the CTS, and measurement of violence against women Should we be moving from measuring prevalence to measuring incidence?

Prevalence of Spousal Violence: Uganda 2006 Percent age 15-49

Consequences and Help Seeking: Uganda 2006 Percent of ever-married women/men who have experienced violence: who report injuries who sought help

Men, the CTS, and measures of VAW Question raised: Are the instruments not able to distinguish the ‘syndrome’ of violence against women from ‘common couple violence? Answering this question is a challenge and in turn raises the following questions about measuring and defining violence: Is it important who initiates the violence? Should factors such as ‘helplessness’ and ‘fear’ be considered? Should the ‘violent acts’ be made more specific? Should frequency be taken into account? Should the definition of violence be any act from the list or a clustering of acts?

For M &E: Prevalence or Incidence? Advantages Disadvantages Prevalence Def: Old + New cases ever or in a time period Already have measures Known to affect health Provides larger #s of cases for analysis Can measure change over longer periods of time Great for national level monitoring Easy to understand Tends to be static over the short period Largely descriptive Not good for evaluation and impact assessment Not useful for criminalizing violence Incidence Def: New cases in a time period Good for criminalizing violence Good for impact assessment May distinguish better between VAW and common couple violence Not used much in surveys May not be useful for long term monitoring May not yield enough cases for analysis Not likely to be stable across surveys and hence difficult to compare

For Specific Questions: sunita.kishor@macrointernational.com Photo credits: Photos courtesy of M/MC Photoshare at jhuccp.org/mmc

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