Domestic Violence in Rural Uganda: Evidence from a Community-Based Study. (Policy and Practice)
Koenig, Michael A., Lutalo, Tom, Zhao, Feng, Nalugoda, Fred, Wabwire-Mangen, Fred, Kiwanuka, Noah, Wagman, Jennifer, Serwadda, David, Wawer, Maria, Gray, Ron, Bulletin of the World Health Organization
Voit page 59 le resume en francais. En la pagina 59 figura un resumen en espanol.
Over the past decade, recognition of the scope and significance of domestic violence globally has increased. Domestic violence has been defined as "the range of sexually, psychologically and physically coercive acts used against adult and adolescent women by current or former male intimate partners" (1). A growing body of evidence is highlighting the magnitude of the problem of domestic violence in developing countries (2-11). In sub-Saharan Africa, empirical evidence on the prevalence of domestic violence is limited and confined to a small number of population-based (12-15) or special-population studies (16). Recognition of the links between domestic violence and a range of adverse reproductive health outcomes--including non-use of contraception and unintended pregnancy (17, 18), poor outcomes of pregnancy and birth (19-24), gynaecological morbidity (25) and sexually transmitted diseases and human immunodeficiency virus (HIV) (18, 26, 27)--is also growing.
Our understanding of the underlying determinants of domestic violence in developing countries remains limited. A number of studies have found strong associations between socioeconomic status and domestic violence, with indicators of household wealth or education of the male partner significantly inversely associated with the risk of violence (6, 7, 11, 28, 29). Demographic characteristics are also significant risk factors for domestic violence, with several studies finding that higher age (6, 9) and higher numbers of children (9, 30) are associated with a reduced risk of violence. Other studies have found that women with a high status--as measured by their educational attainment, degree of autonomy or control over resources--are more protected from the risk of domestic violence. One consistent finding is an inverse association between women's educational attainment and the risk of domestic violence (3, 5, 9, 31). Studies have also reported that women with greater autonomy and control over resources are more protected from violence (7, 32, 33). However, some evidence shows that this association may be context-specific and that, in more conservative settings, women with high autonomy may actually be at increased risk of violence (33, 34).
Several studies in developing countries have also found a strong association between consumption of alcohol or drugs and the risk of violence (14, 15, 30, 31). A potential link between HIV status and domestic violence has also been recognized (26), with studies from Africa showing an increased risk of violence when the man is HIV positive (14) or when the woman perceives herself to be at high risk of acquiring HIV from the man (16). Finally, evidence highlights the role of intergenerational transmission of domestic violence; studies have shown that children who witness family violence are more likely to become perpetrators or victims of violence in adulthood (8, 31, 35). Thus, although some evidence does exist, the issue of domestic violence and its underlying determinants in developing countries remain inadequately understood.
Data from the Rakai Project in rural Uganda provide a unique opportunity to explore the issue of domestic violence from a community-based perspective. In the 2000-01 round of data collection, a special module of questions was fielded to assess the prevalence of domestic violence and its potential contribution to transmission of HIV in this population.
The primary study population reported in this paper consisted of 5109 sexually active women of reproductive age who lived in the 46 communities under surveillance in the Rakai Project at the time of the 2000-01 survey. This study investigates the prevalence of lifetime and recent domestic violence in this population, as well as the frequency of specific violent behaviours. We examined the specific sociodemographic and behavioural risk factors associated with recent domestic violence and the attitudes of male and female respondents toward the circumstances under which such violence is justifiable. …