Domestic violence against women in sub-saharan Africa: Associations with maternal health

Transcription

1 Domestic violence against women in sub-saharan Africa: Associations with maternal health Holley Stewart, A. Elisabeth Sommerfelt, Reena Borwankar, Doyin Oluwole, Karen Fogg, Stella Goings In Commemoration of 16 Days of Activism against Gender Violence 2010 PATH, Tuesday, December 7, 2010

2 Africa s Health in 2010 project Technical support project funded by USAID Bureau for Africa To provide strategic, analytical, communications and advocacy, and monitoring and evaluation technical assistance to African institutions and networks, and USAID regional and bilateral programs to improve the health status of Africans.

3 Influencing policies and programs

4 Gender-based Violence Violence involving men and women, in which the female is usually the victim; and which is derived from unequal power relationships between men and women. Violence is directed specifically against a woman because she is a woman, or affects women disproportionately. It includes, but is not limited to physical, sexual, and psychological harm (including intimidation, suffering, coercion, and/or deprivation of liberty within the family, or within the general community). It includes violence which is perpetrated or condoned by the state. United Nations Population Fund (UNFPA) Gender Theme Group, 1998

5 Rationale for the Analysis Centrality of women to the health of their families and communities value of investing in girls and women Widespread and persistent inequalities between women and men Violence affects women's health across life cycle

6 Purpose of the Analysis Describe the magnitude of domestic violence against women in selected sub-saharan African countries Explore associations between domestic violence and maternal health

7 Global evidence for linkages between violence and women s health DHS 2004 multi-country study profiling domestic violence IGWG 2004 literature review and analysis Addressing GBV from the RH/HIV Sector WHO 2005 multi-country study on women s health and domestic violence WHO World Health Report 2005:Make Every Mother and Child Count. USAID/Africa s Health in 2010 project regional review of DHS findings on GBV and their use in national planning WHO/LSHTM 2010 Preventing IPSV against women: taking action and generating evidence. HEALTH SECTOR IS AN IMPORTANT POINT OF CONTACT FOR WOMEN WHO EXPERIENCE VIOLENCE

8 Data Source Demographic and Health Surveys (DHS) Nationally representative, population based information related to fertility, mortality, maternal & child health, STI/HIV/AIDS, family planning Cross-sectional household survey with domestic violence module (2006 to 2008) Study sample: Women ages 15 to 49 Sample sizes for women who answered questions about violence from husband/partner ranged from ~ Comparable questions allowing comparisons across countries

9 Analysis of Violence against Women Physical violence inflicted by anyone Since age 15 During pregnancy Physical/+ sexual violence inflicted by husband/partner Types of violence (physical, sexual, emotional) Violence by different characteristics (woman s education level, husband s controlling behavior and his alcohol use) Association between violence and selected aspects of maternal health Pregnancy loss Self-reported STI symptoms Use of ANC, SBA, facility delivery

10 Woman s experience of physical and sexual violence (Zambia 2007) Does your husband ever do any of the following : slap you? twist your arm or pull your hair? push you, shake you, or throw something at you? punch you w/ his fist or with something that could hurt you? kick you, drag you, or beat you up? try to choke you or burn you on purpose? threaten/attack you with a knife, gun or any other weapon? physically force you to have sexual intercourse with him even when you did not want to? force you to perform any sexual acts you did not want to?

11 Findings on Domestic Violence and Selected Aspects of Maternal Health Countries of Analysis DRC 2007 Ghana 2008 Liberia 2007 Mali 2006 Nigeria 2008 Zambia 2007

12 Physical violence inflicted by anyone among ever-married women 70% 60% 50% 40% 30% 20% 10% 0% DRC 2007 Ghana 2008 Liberia 2007 Mali 2006 Nigeria 2008 Zambia 2007 Source: Africa s Health in 2010 Project, analysis of DHS data files

13 Physical/sexual violence inflicted by husband among ever-married women Source: Africa s Health in 2010 Project, analysis of DHS data files

14 Women experience physical violence during pregnancy Physical violence by anyone during pregnancy among ever married, ever pregnant women Source: Africa s Health in 2010 Project, analysis of DHS data files

15 Types of violence - Zambia DHS 2007 (among women who experienced violence from husband) Sexual not physical 6% Emotional only 8% Sexual and physical 26% Physical not sexual 61% Source: Africa s Health in 2010 Project, analysis of DHS data files

16 Types of violence DRC DHS 2007 among women who had experienced violence from husband Sexual not physical 10% Emotional only 10% Physical not sexual 40% Sexual and physical 40% Source: Africa s Health in 2010 Project, analysis of DHS data files

17 Physical and/or sexual violence from husband by woman s education (among ever married women) 70% No education Primary Secondary+ 60% 50% 40% 30% 20% 10% 0% DRC 2007 Ghana 2008 Liberia 2007 Mali 2006 Nigeria 2008 Zambia 2007 Source: Africa s Health in 2010 Project, analysis of DHS data files

18 Physical and/or sexual violence from husband by husband s controlling behavior (among ever married women) 100% 0 (minimum) 1-2 points 3-4 points 5+ points 75% 50% 25% 0% Ghana 2008 Liberia 2007 Mali 2006 Nigeria 2008 Zambia 2007 Source: Africa s Health in 2010 Project, analysis of DHS data files

19 Physical and/or sexual violence from husband by husband s use of alcohol (among ever married women) 100% Does not drink Is drunk sometimes Drinks, never gets drunk Is drunk often 75% 50% 25% 0% DRC 2007 Ghana 2008 Liberia 2007 Mali 2006 Source: Africa s Health in 2010 Project, analysis of DHS data files Nigeria 2008 Zambia 2007

20 Pregnancy loss is greater among women who have experienced violence DRC 2007 Ghana 2008 * Liberia 2007 Mali 2006 * Never violence Ever violence Nigeria 2008 * Zambia 2007 * 0% 25% 50% Note: * P < Pregnancy loss among ever married ever pregnant women by physical/sexual violence from husband Source: Africa s Health in 2010 Project, analysis of DHS data files

21 Self-reporting of STI symptoms is greater among women who have experienced violence DRC 2007 * Ghana 2008 * Liberia 2007 * Mali 2006 * Never violence Ever violence Nigeria 2008 * Zambia 2007 * 0% 25% 50% Note: * P < Self-reported STI symptoms among ever married women by physical/sexual violence from husband Source: Africa s Health in 2010 Project, analysis of DHS data files

22 Antenatal care from skilled provider among ever-married women Zambia 2007 EDUCATION * Higher Secondary Primary No education RESIDENCE* Rural Urban VIOLENCE Ever violence Never violence Zambia % 25% 50% 75% 100% ANC from skilled provider Source: Africa s Health in 2010 Project, analysis of DHS data files Notes: Findings are among women with at least one live birth. ANC from skilled provider for at least one live birth in the past 5 years before the survey. Physical and/or sexual violence refers to violence from the woman s husband. * = p < 0.001

23 Delivery by skilled birth provider among ever-married women Zambia 2007 EDUCATION * Higher Secondary Primary No education RESIDENCE* Rural Urban VIOLENCE Ever violence Never violence Zambia % 25% 50% 75% 100% SBA delivery Source: Africa s Health in 2010 Project, analysis of DHS data files Notes: Findings are among women with at least one live birth. Delivery by skilled provider for at least one live birth in the past 5 years before the survey. Physical and/or sexual violence refers to violence from the woman s husband. * = p < 0.001

24 Delivery in a facility among ever-married women Zambia 2007 EDUCATION * Higher Secondary Primary No education RESIDENCE* Rural Urban VIOLENCE Ever violence Never violence Zambia % 25% 50% 75% 100% Delivery in facility Source: Africa s Health in 2010 Project, analysis of DHS data files Notes: Findings are among women with at least one live birth. Delivery in facility for at least one live birth in the past 5 years before the survey. Physical and/or sexual violence refers to violence from the woman s husband. * = p < 0.001

25 Conclusion Women in SSA experience high levels of physical and sexual violence from their husbands. Levels are higher among those whose husbands are drunk often and controlling. Violence occurs during pregnancy.

26 Conclusion (2) Ever experience of physical/sexual violence from husband is associated with: pregnancy loss in 4 of 6 countries self-reported STI symptoms in all 6 countries not associated with use of ANC, SBA delivery and delivery in a facility in Zambia.

27 Program Implications & Opportunities for Health Sector Response Awareness raising and continued advocacy Target policymakers, civil society, community leaders Power balance between men and women to improve status of women Capacity building for health care providers Recognize the magnitude of domestic violence Identify and manage cases Development of country specific health sector responses Evidenced-based, context-specific, multisectoral Woman-centered country specific approach (GHI)