Risk factors for domestic violence: findings from a South African cross-sectional study
Introduction
Intimate partner violence, or domestic violence, is increasingly being recognised as a public health problem and associated with injuries and a wide range of other mental and physical health problems (Campbell et al., forthcoming; Heise, Ellsberg, & Gottemoeller, 1999). Its causes have preoccupied social scientists for several decades. Hypotheses that domestic violence might be biologically determined were significantly undermined by observations that its occurrence varies considerably between as well as within societies, and in some it has been reported to be exceptionally rare or even absent (Levinson, 1989; Counts, Brown, & Campbell, 1992). Understanding of social causation has been significantly hampered by the narrow geographical base of research (most work being from North America), a tendency of academics and activists to pursue single-factor theories and the reliance on data from small samples or women who had succeeded in accessing sources of help such as shelters (Hoffman, Demo, & Edwards, 1994; Heise, 1998). In the last decade there have been several papers from well-designed studies conducted in a range of countries which discuss risk factors and processes using survey (e.g. Hoffman et al., 1994; Ellsberg, Pena, Herreras, Liljestrand, & Winkvist, 1999; Martin, Tsui, Maitra, & Marinshaw, 1999; INCLEN, 2000) and ethnographic methods (e.g. Rao, 1997; Wood & Jewkes, 2001; Bourgois, 1996; Harvey & Gow, 1994). These have enabled hypotheses to be explored more critically and an understanding of the social plausibility of relationships. However the body of evidence available to date falls very far from the standards of epidemiologists for establishing disease causation (Hill, 1965).
Household research on violence against women is regarded as difficult. Many women are reluctant to disclose abuse1 because of perceptions of shame, fear of blame or reluctance to be ‘disloyal’ to their partner. Differences in question wording and the number of times questions asked can result in widely differing prevalences (Ellsberg, Heise, Pena, Agurto, & Winkvist, 2001). The research is difficult for field workers. Listening to a daily litany of abuse can provoke overwhelming feelings of powerlessness, as well as difficult memories and reflections on experiences of the field workers’ own intimate relationships. Without adequate support, and an ability to support women interviewees, field workers may burn out or learn to ask questions in a manner which discourages disclosure (Jewkes, Watts, Abrahams, Penn-Kekana, & Garcia-Moreno, 2000; Ellsberg et al., 2001). Interviewers also bring their own views on gender to the interview setting and this is also believed to influence levels of disclosure. Careful interviewer training, selection and support is essential, however interviewer effects may persist. Recent advances in statistical methodology have enabled adjustment for interviewer effects (O’Muircheartaigh & Campanelli, 1998); however these have not previously been used in violence against women research.
In understanding the origins of intimate partner violence (physical and sexual), Heise's (1998) ecological framework has recently assumed prominence. Based on review of the mainly, but not exclusively, North American literature, it premises that abuse results from an interplay of personal, situational and socio-cultural factors at different levels in the social environment. Heise seeks to present the factors which are predictive at each level of the social ecology. At an individual level, factors include being abused as a child or witnessing marital violence in the home, having an absent or rejecting father; at the level of the family or relationship factors include use of alcohol, male control of wealth and decision-making in the family and marital conflict; at a community level factors include poverty and unemployment, social isolation of the woman and male participation in delinquent peer associations; and at a societal level factors include male ownership of women, ideas of masculinity linked to aggression and dominance, rigid gender roles, acceptance of interpersonal violence and acceptance of physical chastisement. This model and other theories (e.g. of status inconsistency (Gelles, 1974)) were drawn on in the development of a questionnaire for cross-sectional study of violence against women in South Africa, and subsequently used to develop a list of candidate variables for the risk factor analysis. In this paper we present findings from the first representative study of violence against women in South Africa on risk factors for experiencing physical violence from an intimate partner and we conclude by discussing their implications for a broader theoretical understanding of the problem.
Section snippets
Background
South African society is very violent. Decades of apartheid State-sponsored violence and reactive community insurrection, meticulously described in the report of the Truth and Reconciliation Commission (1998), have contributed to a situation in which for many people physical violence is a first line strategy for resolving conflict and gaining ascendancy (Simpson, 1991). All forms of interpersonal violence are very common. Violence is used regularly, for example, in disputes between neighbours (
Methods
The objectives of the study were to describe the prevalence of physical, sexual, financial, and emotional abuse and aspects of the economic and service implications; and to identify risk factors, associated health problems and health service use. This paper focuses on risk factors for physical violence, a more detailed description of prevalence of all forms of violence by province can be found elsewhere (Jewkes et al., 2001). The authors recognise that domestic violence often has emotional,
Results
Of the 2 232 households selected for interview, 1447 had eligible women (the others were vacant or had no eligible woman). Forty women declined to be interviewed or only completed part of the interview and 101 women were uncontactable after three visits. Thus 1306 interviews were completed, a 90.3% response rate. Of the women interviewed, 1279 reported having ever had a husband or boyfriend, and were thus ‘at risk’ of domestic violence, the subsequent analysis is based on this group. In all,
Discussion
The study shows that domestic violence is experienced by many women in South Africa, in marital, co-habiting and dating relationships. The life time and one year prevalence reported here were in the middle of the range of those found in other countries (Heise, 1998). The high proportion of women abused in the past year who were injured raises the possibility that less severe forms of violence (e.g. slaps) have been under-reported. This problem has been reported from other areas with much
Acknowledgements
This study was funded by the Department of Arts, Culture, Science and Technology National Innovation Fund and the Medical Research Council. We would like to thank: Matsie Ratsaka for contributions towards study design and fieldwork supervision; Charlotte Watts for her technical advice; to all the staff of the Masisukumeni Women's Crisis Centre who assisted us with development, piloting and interviewing; the Northern Province Office for the Status of Women who assisted with fieldworker
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