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

2. 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

3. What is the DHS?
Nationally-representative household surveys with large samples (typically ; 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.

4. 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

5. 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).

6. 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

7. 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

8. 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

9. 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)

10. 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

11. 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.

12. 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.

13. 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

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

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

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

17. Injuries Due to Spousal Violence
Percent of women who have experienced spousal violence who had:
India

18. 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

19. 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?

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

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

22. 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?

23. 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

24. For Specific Questions:
Photo credits: Photos courtesy of M/MC Photoshare at jhuccp.org/mmc

25. measuredhs.com