Risk factor analysis: discussion and conclusions

Risk factor analysis was done for both lifetime and current experience of violence. The results show that there are slightly different risk factors predicting ever having experienced partner violence and currently experiencing partner violence, respectively.

All important risk factors for both lifetime violence and current partner violence against women are characteristics of the partner rather than of the woman: “fighting with other men” and “having extra-marital affairs” are both independently strongly associated with being violent against a wife or female partner. A woman whose partner fights with other men has 3.2 times increased odds to ever experiencing partner violence, and 1.9 times increased odds that she is currently experiencing partner violence, compared to women whose partners do not fight. If her partner has relationships with other women the odds ratio is 3.6 for ever violence and 2.1 for current violence.

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A man’s regular use of alcohol is a risk factor for him being currently violent against his wife (odds ratio = 2.3). There was no significant association between alcohol use and lifetime violence.

From all the risk factors from the woman’s side examined, only being young of age remained highly significantly related with the experience of current violence only.

A lower index of socio-economic status of the woman’s household increased only the risk for ever having experienced partner violence but, interestingly, not the risk for current partner violence.

The findings from the final models on risk factors for domestic violence against women are reflected in a slightly modified version of the ecological framework for explaining violence against women; see Figure 10.2 for lifetime violence and Figure 10.3 for current violence. Only the “protective factor” for lifetime violence - being physically abused since age 15 - has not been reflected (see discussion below) in Figure 10.2.

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This analysis indicates that for both lifetime and current violence, from a long list of potential risk factors, the majority of factors that remain independently associated (when accounting for all other factors) with intimate partner violence against women, are factors related to the male partner; in particular his fighting with other men and having parallel relationships with other women (extra-marital relationships), which are related with both lifetime and current violence.

Alcohol use (though measured in a way that is biased towards underestimating the effect) was significantly associated with current violence only. The fact that in the final model no association between alcohol use and lifetime violence was found (when controlling for other potential risk factors), can possibly be explained by the fact that current use of alcohol rather than lifetime use was measured, and the partner’s current use is not likely to predict violence in the past when he may or may not have been using alcohol. Moreover, alcohol use can probably be one of several manifestations of the same problem (such as aggressive behaviour) and when examined together with the other factors it does no longer show an independent effect.

What is interesting is that for the data from Tonga, the partner’s childhood experience with violence works differently in predicting whether he is currently violent or whether he has ever been violent against his wife or partner. If her partner’s mother had been beaten there is a higher risk that a woman will have ever experienced partner violence, but the same characteristic is not a predictor for current violence. This implies then that if the partner’s mother was beaten it is likely that the partner is violent against his wife in particular early on in the relationship. He may follow the example of his father but this may be only temporarily. However, if he himself has been beaten as a child, this may have a longer lasting effect because it is an independent predictor of him being currently violent.

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The analysis of the characteristics from the woman’s side is fascinating because it shows that when looking superficially and at a model with only women’s characteristics, it may seem that there are a number of factors on her side that put her at risk of partner violence. We refer in particular to model 1 for current violence, where her educational level and the nature of her first sexual intercourse seem to predict her as currently experiencing violence. However when combined in a model with men’s characteristics, these women’s factors no longer play a significant role. For the nature of her first intercourse, it could be hypothesized that a first sexual experience that is unwanted could have been caused by the very same partner that is currently abusing her. In this case these the first sexual experience is highly correlated with one or more of the male partner’s factors.

The most puzzling finding was that a woman’s experience of physical abuse by others seems to be a protective factor for lifetime partner violence. Thus if a woman has been beaten by another person she is more likely to not have ever experienced partner violence than a woman who has not been beaten. In the WHO multi-country study, having been a victim of physical non-partner violence was for women in many countries a strong risk factor for partner violence.55 In an attempt to explain this unusual finding for Tonga, we should consider that in Tonga more women have ever been beaten by a non-partner than by a partner (which in most other countries in the world is the other way around). We saw in Chapter 5 that the perpetrator is in almost all cases her father or her teacher, who beats her in an attempt to discipline her. Possibly this experience may cause some women to learn how to avoid being beaten, or may have resulted in some women’s learnt submissive behaviour making her no longer “disobedient”. To know if this is a valid explanation more analysis would need to be done. This finding is not very comfortable to be used for policy or campaigns as it may not give the appropriate signal. It is therefore purposely not included in Figure 10.2.

It should also be deliberated that while we modelled risk factors for both lifetime and current violence, the latter model (represented in Figure 10.3) could be considered the better conceptualized and more meaningful model among the two. This is because of the recent/on-going nature of the outcome variable and thus the risk-factors are more likely to precede the outcome. The risk factor model for current violence is more suitable to interpretation and also more practical for use for policy and programs as it better allows identification of risk factors that can be targeted by interventions and services.

All in all, the results described in this chapter shed a light on the complexity of factors that play a role in partner violence: individual factors of the woman and those of her partner, current factors and factors related to events early in their lives. While one limitation of our analysis is that we have only been able to look at possible risk factors at the individual and relationship level (the inner circles of the ecological framework), the analysis nevertheless reveals strong and consistent patterns, in particular for factors related to the woman’s partner.

55

Abramsky T, Watts CH, Garcia-Moreno C, Devries K, Kiss L, Ellsberg M, Jansen HA, Heise L. What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women's health and domestic violence. BMC Public Health 2011, 11:109 doi:10.1186/1471-2458-11- 109

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Another limitation of this analysis is that it is based on self-report by women only and may be biased when it comes to reporting on partner's characteristics. It has been mentioned that studies on violence against women are usually biased towards underreporting of violence, due to the taboos and stigma surrounding the topic, and an overestimation of the effect is not likely, due to the nature of the measured experience.56,57 The methodology developed for the WHO study, including the special training of the interviewers, was designed to maximise disclosure of violence.58

Because it was a cross-sectional study, there are limitations for establishing causal relationships, although the risk factors related to the partner’s childhood which remained significant in the final model, obviously dated from before the relationship.

Our findings on risk factors for violence, except for the finding of physical abuse by non- partners, are consistent with results from previous studies in other cultures, where men’s exposure to family violence in childhood predicted violent behaviour towards women later in life.59,60 Another commonly identified factor is alcohol abuse. 61,62,63

A striking finding from our study is that having extra-marital relationships (seeing one or more women concurrently while being in a relationship with the respondent) was highly correlated with partner violence.

The data suggests that violence is learned behaviour: a man’s experience of violence in his childhood is highly associated with him being violent against his wife. This can be either him having been beaten as a child or having seen his mother being beaten by his father. The importance of risk factor analysis for partner violence lies in the potential to use the findings for focusing violence prevention activities on particular aspects that have been shown to be associated with violent behaviour.

56

Ellsberg M, Heise L. Researching violence against women: a practical guide for researchers and

activists. Washington DC, United States: World Health Organization, PATH, 2005. 57

Ruiz-Perez I, Plazaola-Castano J, Vives-Cases C. Methodological issues in the study of violence against women. Journal of Epidemiology and Community Health 2007, 61:ii26-31.

58

Jansen HAFM, Watts C, Ellsberg M, et al. Interviewer training in the WHO Multi-country study on women's health and domestic violence. Violence Against Women 2004, 10:831-49.

59

Jewkes R, Levin J, Penn-Kekana L. Risk factors for domestic violence: findings from a South African cross-sectional study. Social Science and Medicine 2002, 55:1603-17.

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Gil-Gonzalez D, Vives-Cases C, Ruiz MT, et al. Childhood experiences of violence in perpetrators as a risk factor of intimate partner violence: a systematic review. Journal of Public Health 2008, 30:14-22.

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Walton-Moss B, Manganello J, Frye V, et al. Risk factors for intimate partner violence and associated injury among urban women. Journal of Community Health 2005, 30:377-89.

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Rodriguez E, Lasch KE, Chandra P, et al.Family violence, employment status, welfare benefits, and alcohol drinking in the United States: what is the relation? Journal of Epidemiology and Community

Health 2001, 55:172-8. 63

Gil-Gonzalez D, Vives-Cases C, Alvarez-Dardet C, et al.Alcohol and intimate partner violence: do we have enough information to act? European Journal of Public Health 2006, 16:278-84.

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