1. International experience with data collection: 1. Results from the countries using WHO multi- country study methodology 2. Results from Serbia on factors associated with VAW Dr Henrica A. F. M. (Henriette) Jansen Sub-regional workshop Skopje, 15-17 February 2010

2. Countries that implemented the WHO multi-country study methodology Brazil Peru Samoa Namibia United Republic of Tanzania Bangladesh Thailand Japan Serbia New Zealand Ethiopia Countries in the WHO study Other countries (most with national surveys) 2 Kiribati Sol. Isl Vanuatu Tonga Turkey Viet Nam Maldives Equatorial Guinea

3. 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) Study objectives

4. Study Design (WHO) Formative qualitative research (focus groups, in depth interviews of survivors, key informants) Quantitative household survey of women (15-49 years of age) One or two sites per country: approx. 1500 women per site Standardized training and questionnaire Standardized quality control Ethical and safety recommendations: one woman per household, support for participants

5. Turkey

6. Women’s Health and Life Experiences Questionnaire outline 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 6

7. Types of violence measured Violence by current or former intimate partners: Physical violence Sexual violence Emotional abuse and controlling behaviours Economic abuse (Turkey) Violence by others (parents, neighbours, strangers, etc): Physical violence (after age 15 years) Sexual violence (after age 15 years) Childhood sexual abuse (prior to age 15 years) 7

8. How is physical partner violence measured? Slapped or threw something at you 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 Severe 8

9. How is sexual partner violence measured? 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? 9

10. Physical and sexual violence is extremely common in women’s lives 10

11. 11 How common is partner violence? ● In most sites, 4 out of 5 women who have been abused (by anybody: partners and others) reported being abused by a partner. ● 15-71% (between one in six and two out of three) of ever-partnered women experienced physical or sexual violence by an intimate partner

12. Pregnancy is not necessarily a protected time Pregnancy is not necessarily a protected time He hit me in the belly and made me miscarry two babies - identical or fraternal twins, I don’t know. I went to the hospital with heavy bleeding and they cleaned me up. Woman interviewed in Peru ● In most sites 4%-12% (note: Peru province 28%) of women who had been pregnant were beaten during a pregnancy ● In 90%-100% of cases the abuser was the father of the unborn child ● Between on-quarter to half of these women reported being punched or kicked in the stomach 12

13. Violence impacts on women’s health I suffered a long time and swallowed my pain. That is why I am constantly visiting doctors and using medicines. No one should have to do this. Woman interviewed in Serbia & Montenegro Women who have ever experienced violence by a partner have: ◦ Worse general health ◦ More symptoms of ill health such as pain, memory loss, dizziness in the past 4 weeks ◦ More signs of mental distress ◦ More suicidal thoughts and attempts ◦ More induced abortions and miscarriages 13

14. Partner violence increases risk of suicidal thoughts 14

15. Associations between physical partner violence and behavioural problems in children 5-12 years old. Behavioural problem in children 6-12 yrs Women reporting physical violence AOR95% CI Frequent nightmares1.51.4-1.7 Thumb sucking1.41.2-1.7 Bed wetting1.51.3-1.7 Extremely timid1.41.2-1.6 Aggressive1.61.4-1.8 Table shows odds ratios adjusted for number of children in same age group living in household, partnership status and educational level of respondent and site 15

16. 16 Outcomes related to violence For women: injuries own physical, mental and reproductive health financial status ability to work ability to function participate in society For children: low birth-weight emotional well-being behavioural difficulties problems at school leave home

17. 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 Many women internalize social norms justifying abuse 17

18. Violence is largely hidden One-fifth to two- thirds of women had never told anyone about their partner’s violence prior to the WHO interview If I protest I’ll be marked in the society and then my daughter wouldn’t be able to get married… If I voice my protest the community will blame me for not bearing it in silence. This helplessness is a torture in itself. Woman, 43 years old, interviewed in Bangladesh 18

19. An ecological framework for understanding violence Individual Relationship CommunitySociety

20. Findings from Belgrade, Serbia 20

21. Serbia – analysis of risk factors This analysis aimed to identify factors associated with intimate partner violence against women in women 15-49 living in Belgrade. 21

22. 22

23. Women's characteristics Age (3 groups) Education Proximity of women’ family Frequency of talking with family members Can count on support of the family members Child sexual abuse by others <15 Physical violence by others > 15 Sexual abuse by others > 15 Nature of first sexual intercourse (wanted/coerced/forced) Women’s mother was beaten

24. Partner's characteristics Age (3 groups) Education Employment status Alcohol consumption Drug consumption Fighting with the other men Having parallel relationship with other women Partner’s mother was beaten Partner was beaten by family member

25. Relationship characteristics 25 Socio economic status Cohabitation with partners family Cohabitation with woman’s family Discrepancy in education

26. Variables considered in logistic regression modelling Women’s characteristics Age Education Frequency of talking with her family members Experienced physical violence by non-partners Experienced sexual violence by non partners Nature of first sexual experience Women’s mother was beaten by mother’s partner 26 Partner’s characteristics Age Education Alcohol consumption Drug consumption Fighting with the other men Having parallel relationship with other women Partner’s mother was beaten by mother’s partner Partner was beaten as a child, by family member Relationship’ characteristics Socio-economic status (SES) Cohabitation with partner’s family Cohabitation with women’s family

27. Results in ecological framework: factors associated with intimate partner violence He was abused as a child His is mother was abused by partner He drinks alcohol every day He fights with other men He has less then highly education He is not faithful Societal – Community – Relationship – Individual level Her first sexual experience was unwanted or forced

28. Risk factors for IPV in Serbia Conclusion: Majority of risk factors for IPV are related to the male partner Long-term violence prevention programmes should target boys growing up in families where father is violent, as they were three times more frequently perpetrators of IPV in their adulthood.

29. 29 henriette.jansen@gmail.com (c) photos: Henriette Jansen THANK YOU!

30. References WHO Multi-country study on Women’s Health and Domestic Violence, C. Garcia-moreno, H. Jansen et al. WHO 2005 http://www.who.int/gender http://www.who.int/gender Factors associated with intimate partner violence against women in Serbia: a cross sectional study. B. Djikanovic, H. Jansen, S. Otasevic. JECH, 2009 Turkey study: http://ksgm.gov.tr/tdvaw/default.htm 30