1. Data collection on Violence against Women at national level:
Data collection on Violence against Women at national level: The first steps
Dr Henrica A. F. M. Jansen
UNECE Workshop on Gender Statistics
Geneva, 9 October 2008

2. To whom do woman talk about physical partner violence?%
Many women never tell anyone about partner violence
Very few women talk to a formal agency or person in authority.
With the following results from the WHO study I would like to illustrate some of the challenges for collecting data on violence.
In this study women who had experienced physical violence by an intimate partner were asked whom they had told about the violence.
Results will be presented for 5 of the countries: Bangladesh, Thailand, Peru, Tanzania and Serbia (with in the first 4 countries a city and a rural province).
Just think for a moment what kind of results you are expecting to see.
In each site a large proportion of women had not told anyone about the violence prior to the interview -- no matter where in the world a woman lives and if she is from a city or a rural province: this ranges from less than 30% in some sites to 66% in Bangladesh.
If women talked about the violence, this was in most cases to family members or friends, neighbours, their close social network.
Only a very small percentage of women mentioned they had told services, authorities (including police, health personnel and religious leaders) .
Points to take home from these data:
Many women have not talked with any one. This has implications for the interviewer who is often the first recipient of this women's story. This brings a hug responsibility and can have much impact on the interviewer as a "vessel for the unheard stories", like one of the interviewers described it.
Secondly we see that services are mentioned very rarely, this shows immediately the drawbacks/weakness of the use of service statistics, such as police or health service reports for a sensitive subject as violence against women, if you want to find out what the magnitude of the problem is (prevalence and characteristics of violence), they say something on access, use, effectiveness, quality, but NOT on magnitude of the problem.

3. % physically assaulted by partner
Many countries doing domestic Violence surveys
Country
Year of field work
Coverage
Sample size
Age (years)
Mode of data collection
% physically assaulted by partner
Albania
2002
National
4049
15-44 8
Azerbaijan
2001
5533 20
Finland
4464
18-74
Postal survey 30
France
5908
18+
Telephone survey 9
Germany
2003
10264
16-85
Face to face and self-administered 23
Lithuania
1999
1010 42
Republic of Moldova
2000
333 15
Romania
5322 29
Russia
Three provinces
5482 22
Serbia
Capital
1189
15-49
Sweden
5868
18-64 18
Switzerland
1500
20-60 21
United Kingdom
12226
16-59
British crime survey, face to face, CASI 19
Since then many countries have taken up doing research on violence against women. This slide is not to be studied but to give a general idea about domestic violence studies in Europe. We see prevalence rates of physical violence between say 10 and 50% but also that age groups and ways of data collection differ so they are not strictly comparable.

4. Countries part of WHO multi-country or that used WHO methodology
TURKEY
Serbia
Japan
Vanuatu
Solomon Isl
Kiribati
Tonga
Thailand
Bangladesh
Vietnam
Ethiopia
Equatorial Guinea
Samoa
United Republic
of Tanzania
To overcome methodological challenges and to get data that was as comparable as possible WHO started some 10 years ago, together with partners to develop the WHO Multi-Country Study on Women’s Health and Domestic Violence against Women. We claim that it represents the first global study to yield truly comparable data on domestic violence and other forms of violence against women.
At the time that our report was published (2005) In this study, over 24,000 women in 10 countries, representing regional and cultural diversity, were interviewed, yielding rich and compelling data on the rates and health consequences of abuse. Since then quite a few other countries have implemented the methods
In most countries, the study include two separate sites: the capital or other major city, and a representative more rural province. The total number of sites included in our report was 15.
Significantly, the study used state of the art techniques to enhance disclosure and protect women’s safety during the research.
Women were asked the same questions, by interviewers all who received the same extensive 2-3 week training.
Peru
Namibia
Chili
Brazil
Maldives
New Zealand
Countries with two study sites
Countries with one study site

5. Where do you start?? No expertise No money Hidden agendas Competition
Other work priorities
Importance of data quality!!

6. Suggestions on how to Look at existing sources of data
Find allies, interested parties (national, international)
Find out about existing methods and expertise
Get your objectives clear
Explore funding
Set up advisory committee of interested parties
Work on proposal
Get ethical approval

7. Other decisions Qualitative research?? How about men?
Sample size? Regional or national sample?
What types of violence?
Long/short questionnaire, module ?
Who trains the interviewers?
Ethics!!!!!!
Develop a very good proposal
Do a thorough pre-test of methods: feasibility, confidence, issues, respondents reactions

8. Possible sources of fundingEU
Bilateral funders CIDA, SIDA, DFID…
Funder with interest in women ??

9. Example of existing methods
WHO (20+ languages, including Arab)
IVAWS
National surveys other countries
DHS, CDC (short modules)
DRAW ON EXISTING EXPERTISE!!!
Work is currently ongoing on developing a common short module

10. REALIZE that this is different from other routine surveys
Ethical and safety issues
Selection and training of interviewers: very important!!
Psychological support for interviewers and respondents
Survey as awareness building among respondents
Survey as transforming for interviewers and researchers
It is an intervention in itself

11. Many women start thinking about what is happening to them…
My husband slaps me, has sex with me against my will and I have to conform. Before being interviewed I didn't really think about this. I thought this is only natural. This is the way a husband behaves.
Woman interviewed in Bangladesh
Participating in the study was creating awareness in respondents:
This comes through strongly in the words of this woman interviewed in Bangladesh. She notes:
[Read Slide]

12. "Somehow it made me feel good, because it was something that I had never told anyone before. Now I’ve told someone".
--Respondent, Brazil
Talking about it has consequences for the women, therefor interviewers need to have the right attitudes and training to make the women talk. And women talk, often for the first time. We also found if interviews that are conducted in the proper way women find it beneficial. They feel better afterwards.

13. “I learned a lot from the beginning of the training, till the end of the survey. The survey opened wounds, but I had to learn to face it and cope with it. The respondents really needed and enjoyed this experience… My career path changed, … because I could do something which can make a difference…”
Interviewer from Namibia
For interviewers and researchers participating in this intensive study has been a transforming experience with many going to work to address the violence they have been documenting. Here is how an interviewer in Namibia phrased it

14. Points to take home
A population based survey on violence against women should be and can be done ethically and safely
Women are willing to share experiences with trained and empathetic interviewers
Some points to take home are:
The experience has shown that a population based survey on violence against women can be done ethically and safely if appropriate conditions are ensured
and that
Women are willing to share experiences with trained and empathetic interviewers, often for the first time. (we are convinced that training is key)
It was essential that the study design built in mechanisms to ensure findings are owned by a wide range of stakeholders and used for policy change
Even before results are known, there have been many direct impacts of the study in all countries where implemented, in the areas of collaboration, local capacity building, increased awareness and sensitivity to violence among researchers, policy makers and health providers, knowledge translated into action at the local level.
Thus Research can be an intervention at many levels.

15. And do not forget during your preparations...
If you have a good proposal and the right people, it can be done
Ensure buy-in from stake-holders, build partnerships from the beginning
Get technical advice, tools, manuals, support
There should be a first time!!

16. Methodological and ethical aspects

17. Estimates of prevalence of violence against women
WHO multi-country study objectives
Estimates of prevalence of violence against women
Associations between partner violence and health outcomes
Risk and protective factors for partner violence
Strategies used by women who experience partner violence (who do they talk to, where do they seek help, what response do they get)
This population-based, cross sectional study aimed to ….
Obtain valid estimates of prevalence of violence against women in several countries – different types: focus on partner, physical, violence, severity, frequency – also non-partner violence
Document the associations between Intimate Partner Violence (IPV) and health variables – for us as WHO important – Mental, Reproductive, General, - entry point to show why violence is important for the health sector,
Identify risk and protective factors for domestic violence against women, and compare them within and between settings
Explore and compare the strategies used by women who experience domestic violence – To whom women talk, where they seek help, if they leave and why,…etc.
-----

18. Additional Objectives
Develop and test new instruments for measuring violence cross-culturally
Increase national capacity amongst researchers and women’s organizations working on violence
Increase sensitivity to violence among researchers, policy-makers and health providers
Promote ethically sound research
Besides the main objectives just mentioned, we are also committed to achieving other more process and action oriented objectives, which are:
the development and testing of new instruments for measuring violence cross-culturally
increasing national capacity and collaboration among researchers and women's organizations working on violence against women,
increasing sensitivity and responsiveness to violence among researchers, policy makers and health providers.
And we want to promote a model of participatory research that is ethically sound, fully addressing safety issues and safe-guarding women’s well being
[The Study therefore has been designed to achieve also these more “process-oriented” objectives. This has on one hand increased the richness of the Study and on the other the difficulties which are already inherent in any multi-country study.
Staying true to this more participatory approach to research has been perhaps the biggest methodological and administrative challenge of the Study.]

19. Factors that affect disclosure
How the questions are phrased
Number of opportunities to disclose
Context in which questions are asked
Characteristics and skill of interviewers
Social stigma attached to issue
WHO study building on experience from other studies done in the 90sFurther Experience from international research indicates that some methods are more effective than others in encouraging women to talk about violence. The following series of issues may affect women’s willingness to discuss experiences of violence.
How the questions are phrased, and also which method was used to ask, e.g. face to face, telephone interview, self administered questionnaire
How many times you ask a woman about violence. Numerous studies have shown the importance of giving women more than one opportunity to disclose violence during and interview, as they may not feel comfortable talking about something so intimate the first time it is mentioned
The context of the interview and the context of the question. E.g. Are there many questions before you ask about violence – this may make her tired of the interview, less likely to disclose, on the other hand it has given the opportunity to build up rapport. Another issue around the context is confidentiality, privacy, one woman per household
Type of interviewer, her attitudes and training play a role,
As does the social stigma attached to the issue, many women may have never talked about violence

20. WHO Multi-country Study - design
Formative qualitative research, consultations, etc
Quantitative household survey women 15-49y
1 or 2 sites per country: appr women/site
Standardized questionnaire
Standardized 3 week training
All respondents provided with information about sources of support; follow up support offered
One data entry system, double entry
Standardized quality control measures
To ensure comparability between countries and settings the following methods we adopted; 1. Formative, qualitative research (focus groups, indepth interviews with survivors, key informants) to uncover norms and attitudes, with the aim to inform quantitative survey development (helping to identify key questions and appropriate wording) and to interpret quantitative methods.
2. The quantitative hh survey: face to face interviews with randomly selected women 15-49
3. the hh survey in most countries is implemented in 2 sites
(4. Sampling)
Standard questionnaire, developed in collaboration with the countries
5. An important aspect is that all respondents are provided with information about sources of support and where necessary follow up support is being offered.
6. All countries in the study are using the same data entry system with interactive error checking, double entry
7. And a number of other standardized and rigorous quality control measure, to ensure that the collected data are as comparable as possible, such as ways of supervision, checking of questionnaires, data editing,
one core questionnaire, ,developed in collaboration with countries, experts, based on existing experience (back translation)
standardized 3 week training for supervisors and interviewers
annual research team meeting sharing and learning
technical support to countries (visits during training, pilot, intensive support during data processing)
same manuals
same data entry (interactive checking of errors, inconsistencies, compulsory double entry)
other quality control methods at all levels:
questionnaire checking and editing in the field
supervision procedures
monitoring of work
multiple visits
debriefings

21. Types of domestic violence in WHO study
Partner violence: physical, sexual, emotional, controlling behaviours
Violence in pregnancy
Violence resulting in injuries
By others
Physical violence by others (>15)
Sexual violence by others (>15)
Childhood sexual abuse (<15)
Forced first sex
The WHO study on women's health and domestic violence was particularly interested on measuring partner violence; physical, sexual and emotional as well as controlling behaviours. The study also looked at violence in pregnancy, violence resulting in injuries,
Moreover it looked at violence by others than-partners; physical and sexual violence by others (since age 15) and childhood sexual abuse, and whether the first sexual experience was forced.

22. Women’s Health and Life Experiences - Questionnaire
Section 1: Respondent and her community
Section 2: General Health
Section 3: Reproductive health
Section 4: Children
Section 5: Current or most recent partner
Section 6: Attitudes toward gender roles
Section 7: Respondent and her partner
Section 8: Injuries
Section 9: Impact and coping
Section 10: Other experiences
Section 11: Financial autonomy
Section 12: Completion of the interview
The questionnaire for the survey has been developed for use in different cultural settings with a minimum of adaptation.
It is the result of extensive discussion, consultations and field-testing.
It builds among others on the collective experiences of the International Research Network of VAW and formative research in the first 5 countries.
It was reviewed by specialists in specific areas and members of the Expert Steering Committee
Refer to title of slide: The study is introduced in the community by a different title - as one of the safety measures
On this slide are listed the 12 sections or modules.
The order of the questionnaire is such that it ensures a careful built up, with the initial sections dealing with less sensitive subjects like information about herself, her community, health, children, then asking about general partner characteristics and attitude questions.
By the time the interviewer gets to the section with violence questions, section 7, she has already spent a considerable time with the respondent an atmosphere of good rapport and confidence should have been created.
Following up on the violence questions, the woman gets questions on injuries and response strategies.
Towards the end of the questionnaire, in the section “other experiences” the respondent is asked among others about childhood sexual abuse.

23. Study population in WHO VAW study
Country
Study population
Bangladesh
Women ever married
Peru
Women ever married/cohabiting, ever dating
Serbia and Montenegro
Women ever married/cohabiting, currently dating
And this is what happened in the WHO study. Even if you standardize the final choice of definition is context specific
Even if most countries use the same age groups (some countries used for legal reasons) the partnership definition was context specific. While we recommend using the broadest criteria possible to define the study population of ever-partnered women (the at risk population), it should be recognized that this will be different in different contexts (e.g. in Bangladesh is was not feasible to ask unmarried women about their partners, but then, an unmarried woman in Bangladesh cohabiting with a partner would in most instances would have identified herself as being married and in this way still be included in the study population).
In serbia also cohabitating women were included as well as those currently dating. In Peru single mothers had never lived together with the man who fathered their children and it was essential to also include past dating relationship to not loose out on the voices and experiences of these women.
It is recommended to define your population at risk as wide as possible. .

24. Measurement of physical violence by partner
Has your partner ever.....
Slapped or threw something at that could hurt you?
Pushed or shoved you or pulled your hair?
Hit with his fist or with something else that could hurt you?
Kicked, dragged or beat you up?
Choked or burnt you on purpose?
Threatened to use or actually used a gun, knife or other weapon against you?
Moderate
I am using here the physical violence question of the WHO study as an examples of a way to measure researcher defined violence.
The respondent was asked about specific acts. These are the acts that are asked about, one by one, to measure physical violence by current partner or any other partner (refer to slide). They are very similar to what is done in other studies that you will hear about today.
For each of the acts she is also asked whether it happened in the past 12 months or before the past 12 months (time frame) and how often this has happened (frequency).
In the analysis and presentation we make a classification in Moderate and severe as follows. This classification is justified also because of the much stronger association with injuries. Although we should remember that this classification does not take into consideration the subjective suffering and impact on the woman.
Severe
(in the last 12 months; has this happened once, a few times, many times?)

25. Measurement of sexual violence by partner
Were you ever physically forced to have sexual intercourse when you did not want to?
Did you ever have sexual intercourse you did not want because you were afraid of what he might do?
Ever force you to do something sexual that you found degrading or humiliating?
In the WHO study for the measurement of sexual violence the respondent is being asked about the following acts:
Has your current or any other partner ever physically…..(see slide).
Most other studies use only the first or the first two questions. We have added the third following much testing and consultation and it appeared important to have this more subjective question to capture situations that in some cultures and contexts would not be caught by the first two.
Along the same lines we have questions for controlling behaviours and emotional abuse

26. Measurement of emotional abuse:
Has your partner ever….
Insulted you or made you feel bad about yourself?
Belittled or humiliated you in front of other people?
Done things to scare or intimidate you on purpose (e.g. by the way he looked at you, by yelling and smashing things)?
Threatened to hurt you or someone you care about?

27. Measurement of child sexual abuse
Before the age of 15, do you remember if any one in your family ever touched you sexually or made you do something sexual that you didn’t want to?
If yes, who did this to you?
How old were you when it happened for the first time?
How old was this person?
How many times did this happen? Once/twice; few, many?
Probes: school, friend or family, neighbor; stranger or anyone else?
This was the way the study measured CSA

28. Anonymous reporting of sexual abuse before age 15
It is of interest to mention is that at the end of the interview women are given a second opportunity to report CSA, in an anonymous way whether they have suffered sexual abuse as a child.
For this she is given a card with two faces. She has to mark the smiling face if she has not been abused and she has to mark the sad face if she has been abused as a child. With this method we initially expected to get a sense of the degree of underreporting.
Mention card, also mention this did not work in Bgd. Card also inciting women to talk, after the interview has finished.

29. Comparison of methods of measuring sexual abuse before age 15
Disclosure during the interview and using the card was different. In this graph for Peru we see that women in rural Peru reported much less CSA than the women in urban Peru, the capital. The anonymous reporting for the capital was about the same, whereas in the rural area of Peru, where sexual violence has an enormous stigma, the anonymous reporting showed more than double prevalence.
Deviation: For the early country such as Peru the anonymous reports of sexual abuse under fifteen were not linked to the individual questionnaires, and so the individual patterns of disclosure between the face to face reporting and anonymous disclosure cannot be explored. Because women have different reasons to report one way or the other, we have now developed a method to link the results from the cards with those from the questionnaire so that we can report a figure based on both methods combined

30. Putting women’s safety first
1. Safety of respondents and research team
2. Studies need to be methodologically sound
3. Confidentiality for safety and data quality
4. Selection and training of team members
5. Actions to reducing distress to respondents
6. Possibilities of referral, support mechanisms
7. Proper interpretation and use of study results
8. Violence questions in other surveys
When conducting surveys to measure VAW, special attention needs to be give to ethical and safety issues. This is much more essential than in other "ordinary" surveys, other areas of research, because of the sensitivity of the subject. It is important for the safety of the women and the researchers, and further more it is crucial for data quality.
The World Health Organization ash developed a set of ethical and safety commendations for research on domestic violence against women. These build on the collective experiences of the International Research Network on Violence against Women, They have been reviewed and approved by the Expert Steering committee for the MC study and also reviewed by members of the Scientific and Ethical Review Group of the Special Programme of Research and Training on Human Reproductions. The emerged from those prepared for the WHO MCs but are applicable to other research on this issue and are currently widely used as standard.
This slides summarizes the main headings
1. Safety of respondents and research team – eg Interviews only in a private setting, participant should feel free to reschedule or relocate. Frame the study not in terms of violence (but further information should be give as part of consent procedure). Only one woman per household interviewed, train interviewers about interruptions
2. Studies need to be methodologically sound -Ethically it is unacceptable to conduct a poorly designed study that cannot address the aims. Practically too: too low estimates can be used to question the importance of violence. Avoid loaded terms as abuse, rape, violence
.3. Confidentiality is central, crucial for safety and data quality. This should be addressed in training of interviewers; no interviewers working in their own community, Confidentiality procedures, consent process, Handling of names, photographs
4. Crucial is the selection and training of interviewers. Will say a few more words on this in the next slides.
5. Minimize distress to participants by asking questions in a supportive and non-judgemental manner, training interviewers to deal with distress (referrals, information, no counselling) and end all interviews positively.
6. A next set of recommendations is around referral and support of respondents who need it. If possible meet prior to field work with potential providers of support. Develop list of resources and offer to all respondents – either small enough to be hidden or include a range of other services. Where few resources exist, consider having a trained counsellor or women's advocate accompany the teams
7. Researchers need to be proactive in ensuring that research findings are interpreted appropriately by public and media- Research findings should be fed into ongoing advocacy, policy-making and intervention activities ' Involve advocacy and service groups etc from the beginning as part of research team or advisory committee. Also in use and advocacy
8. Adding violence to other surveys, should be done only of research team is willing and able to address basic ethical and methodological guidelines, in particular training, confidentiality support

31. Interviewer training
Training should include introduction on gender and violence
Training as opportunity for researchers and interviewers to come to terms with own experiences
Addressing emotional needs of team members
Role of interviewers: Not counselling, not trying to "save" respondents
With the experience with the WHO study we found the interviewer selection and training was key for data quality and women's safety.
We had developed a 3 week training schedule, with as essential components training (sensitization) on gender and vioelnce issues (to develop a basic understanding of gender based violence, its characteristics, causes and impact on the health of women and children).
-- an opportunity for trainers and interviewers to address their own biases and stereotypes or own experiences of abuse. In terms of supporting the research team, recommendations include: (giving interviewers the chance to withdraw without prejudice – thus train more than needed), having regular briefing and councelling sessions with the team (also during field work). And make clear that their role is not to save the respondents, but they should know how to deal with distress and how to refer when needed.

32. Evidence of the value of training
Serbia 2003
13 inexperienced, carefully selected interviewers, trained during 3 weeks
21 professional interviewers, selected because of their interest in the topic, trained during one day
In Serbia and Montenegro where they replicated the WHO study methodology 13 inexperienced, carefully selected interviewers were trained during 3 weeks. Half way the field work it appeared they were not able to finish the field work within the time set for it and 21 professional interviewers were hired, selected because of their interest in the topic. They got a much shorter training of one day, including some background on violence and gender issues.

33. Special training vs professional interviewers
Inexperienced,
3 week training
Professional,
1 day training
Response rate
93%
86%
Disclosure rate
26%
21%
Respondent satisfaction – with violence
46%
29%
Respondent satisfaction – without violence
38%
We found that the inexperienced women, who got the full training achieved a significantly higher response rate, a higher disclosure rate and, very important a higher respondent satisfaction with the interview, whether she had experienced partner violence or not. Respondent satisfaction was measured at the end of the interview with a question about if the interview made her feel good or better, the same or worse.

34. Thank you!