Association between exposure to political violence and intimate-partner violence in the occupied Palestinian territory: a cross-sectional study

Summary

Background

Intimate-partner violence might increase during and after exposure to collective violence. We assessed whether political violence was associated with male-to-female intimate-partner violence in the occupied Palestinian territory.

Methods

A nationally representative, cross-sectional survey was done between Dec 18, 2005, and Jan 18, 2006, by the Palestinian Central Bureau of Statistics. 4156 households were randomly selected with a multistage random cluster design, from which 3815 ever-married women aged 15–64 years were identified. We restricted our analysis to presently married women (n=3510, 92% participation rate), who completed a short version of the revised conflict tactics scales and exposure to political violence inventory. Exposure to political violence was characterised as the husband's direct exposure, his indirect exposure via his family's experiences, and economic effects of exposure on the household. We used adjusted multinomial logistic regression models to estimate odds ratios (ORs) for association between political violence and intimate-partner violence.

Findings

Political violence was significantly related to higher odds of intimate-partner violence. ORs were 1·89 (95% CI 1·29–2·76) for physical and 2·23 (1·49–3·35) for sexual intimate-partner violence in respondents whose husbands were directly exposed to political violence compared with those whose husbands were not directly exposed. For women whose husbands were indirectly exposed, ORs were 1·61 (1·25–2·07) for physical and 1·97 (1·49–2–60) for sexual violence, compared with those whose husbands were not indirectly exposed. Economic effects of exposure were associated with increased odds of intimate-partner violence in the Gaza Strip only.

Interpretation

Because exposure to political violence is associated with increased odds of intimate-partner violence, and exposure to many traumas is associated with poor health, a range of violent exposures should be assessed when establishing the need for psychosocial interventions in conflict settings.

Funding

Palestinian National Authority, Core Funding Group, Program in Health Disparities Research at the University of Minnesota.

Introduction

Collective violence, such as war, state repression, torture, and violent political conflicts,¹ increases risk of various forms of gender-based violence.2, 3 UN Security Council Resolution 1325⁴ calls for protection of women and girls from such violence in conflict settings. Humanitarian guidelines⁵ have been developed to address this issue; however, such guidelines frequently focus on gender-based violence perpetrated by individuals outside the family, often with a particular emphasis on sexual violence. This focus neglects the potentially heightened risk of other forms of gender-based violence to which women might be more exposed, such as intimate-partner violence. Anecdotal evidence² suggests that perpetration of intimate-partner violence might increase during episodes of collective violence and its aftermath. Collective and intimate-partner violence have well documented mental and physical health consequences,1, 6 and exposure to both might raise the risk of deleterious health consequences attributable to cumulative effects of exposure to many traumas.⁷ Hence, further examination of the relation between these types of violence is warranted.

Empirical research about the association between collective violence and intimate-partner violence has mainly been of military personnel. Prevalence estimates for perpetration of physical intimate-partner violence are up to three times higher for veterans and active-duty servicemen than for the general population.⁸ For military personnel, exposure to war-zone stressors has been associated with perpetration of intimate-partner violence, a relation that is largely mediated by presence of post-traumatic stress disorder.⁸ Few studies have investigated the link between intimate-partner violence and forms of collective violence in civilian populations, but evidence mostly supports this association.

Results of studies9, 10, 11, 12, 13, 14 undertaken in Sri Lanka, Afghanistan, Lebanon, and the West Bank showed that exposure to violent conflict was associated with intimate-partner violence and other forms of domestic violence. In a recent study¹⁵ of immigrant men attending health clinics in Boston, MA, USA, men who reported exposure to preimmigration political violence had much higher rates of past-year perpetration for both physical and sexual intimate-partner violence than did those who were not exposed to such violence. By contrast, results of a multicountry study16, 17 of women affected by violent conflict showed no association between collective and intimate-partner violence, or an inverse association,¹⁸ dependent on the setting. Limitations of these studies were the study methods used, including an inability to ascertain temporality, non-representative or immigrant population samples; poor response rates; or an absence of adjustment for potential confounding factors. Our analysis attempted to overcome many of these shortcomings.

2005 was a time of political turmoil, instability, and continuing violence in the occupied Palestinian territory. Although Israeli settlements in the Gaza Strip ceased with Israeli disengagement, the West Bank continued to host several hundred thousand settlers.¹⁹ Occupation policies restricting movement of Palestinian people and goods were a defining factor of everyday life,²⁰ and negatively affected the Palestinian economy.²¹ The economic situation in the occupied territory was characterised by widespread poverty and increasing need for development assistance.²² Exposures to these factors represent forms of political violence that directly (eg, injury and death) and indirectly (eg, economic ramification of policies restricting movement of goods and people) affect human security.²³ Within this context of sustained insecurity, we assessed whether exposure to political violence was associated with increased risk of male-to-female intimate-partner violence on the basis of reports of presently married women.