research paper of domestic violence

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PASK FINDINGS

61-Page Author Overview

Domestic Violence Facts and Statistics at-a-Glance

PASK Researchers

PASK Video Summary by John Hamel, LCSW

• Introduction
• Implications for Policy and Treatment
• Domestic Violence Politics

17 Full PASK Manuscripts and tables of Summarized Studies

INTERNATIONAL RESEARCH

THE PARTNER ABUSE STATE OF KNOWLEDGE PROJECT

The world's largest domestic violence research data base, 2,657 pages, with summaries of 1700 peer-reviewed studies.

Courtesy of the scholarly journal, Partner Abuse www.springerpub.com/pa and the Association of Domestic Violence Intervention Providers www.domesticviolenceintervention.net

MAJOR UPDATE COMING, JANUARY, 2025!

Over the years, research on partner abuse has become unnecessarily fragmented and politicized. The purpose of The Partner Abuse State of Knowledge Project (PASK) is to bring together in a rigorously evidence-based, transparent and methodical manner existing knowledge about partner abuse with reliable, up-to-date research that can easily be accessed both by researchers and the general public.

Family violence scholars from the United States, Canada and the U.K. were invited to conduct an extensive and thorough review of the empirical literature, in 17 broad topic areas. They were asked to conduct a formal search for published, peer-reviewed studies through standard, widely used search programs, and then catalogue and summarize all known research studies relevant to each major topic and its sub-topics. In the interest of thoroughness and transparency, the researchers agreed to summarize all quantitative studies published in peer-reviewed journals after 1990, as well as any major studies published prior to that time, and to clearly specify exclusion criteria. Included studies are organized in extended tables, each table containing summaries of studies relevant to its particular sub-topic.

In this unprecedented undertaking, a total of 42 scholars and 70 research assistants at 20 universities and research institutions spent two years or more researching their topics and writing the results. Approximately 12,000 studies were considered and more than 1,700 were summarized and organized into tables. The 17 manuscripts, which provide a review of findings on each of the topics, for a total of 2,657 pages, appear in 5 consecutive special issues of the peer-reviewed journal Partner Abuse . All conclusions, including the extent to which the research evidence supports or undermines current theories, are based strictly on the data collected.

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NISVS: The National Intimate Partner and Sexual Violence Survey

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CLASSIC VIDEO PRESENTATIONS Murray Straus, Ph.D. *  Erin Pizzey  *  Don Dutton, Ph.D. Click Here

Video: the uncomfortable facts on ipv, tonia nicholls, ph.d., video: batterer intervention groups:  moving forward with evidence-based practice, john hamel, ph.d., additional research.

From Other Renowned Scholars and Clinicians.  Click on any name below for research, trainings and expert witness/consultation services

PREVALENCE RATES

Arthur Cantos, Ph.D. University of Texas

Denise Hines, Ph.D. Clark University

Zeev Winstok, Ph.D. University of Haifa (Israel)

CONTEXT OF ABUSE

Don Dutton, Ph.D University of British Columbia (Canada)

K. Daniel O'Leary State University of New York at Stony Brook

Jennifer Langhinrichsen-Rohling, Ph.D. University of South Alabama

ABUSE WORLDWIDE ETHNIC/LGBT GROUPS

Fred Buttell, Ph.D. Tulane University

Clare Cannon, Ph.D. University of California, Davis

Vallerie Coleman, Ph.D. Private Practice, Santa Monica, CA

Chiara Sabina, Ph.D. Penn State Harrisburg

Esteban Eugenio Santovena, Ph.D. Universidad Autonoma de Ciudad Juarez, Mexico

Christauria Welland, Ph.D. Private Practice, San Diego, CA

RISK FACTORS

Louise Dixon, Ph.D. University of Birmingham (U.K.)

Sandra Stith, Ph.D. Kansas State University

Gregory Stuart, Ph.D. University of Tennessee Knoxville

IMPACT ON VICTIMS AND FAMILIES

Deborah Capaldi, Ph.D. Oregon Social Learning Center

Patrick Davies, Ph.D. University of Rochester

Miriam Ehrensaft, Ph.D. Columbia University Medical Ctr.

Amy Slep, Ph.D. State University of New York at Stony Brook

VICTIM ISSUES

Carol Crabsen, MSW Valley Oasis, Lancaster, CA

Emily Douglas, Ph.D. Bridgewater State University

Leila Dutton, Ph.D. University of New Haven

Margaux Helm WEAVE, Sacramento, CA

Linda Mills, Ph.D. New York University

Brenda Russell, Ph.D. Penn State Berks

CRIMINAL JUSTICE RESPONSES

Ken Corvo, Ph.D. Syracuse University

Jeffrey Fagan, Ph.D. Columbia University

Brenda Russell, Ph.D, Penn State Berks

Stan Shernock, Ph.D. Norwich University

PREVENTION AND TREATMENT

Julia Babcock, Ph.D. University of Houston

Fred Buttell, Ph.D.Tulane University

Michelle Carney, Ph.D. University of Georgia

Christopher Eckhardt, Ph.D. Purdue Univerity

Kimberly Flemke, Ph.D. Drexel University

Nicola Graham-Kevan, Ph.D. Univ. Central Lancashire (U.K.)

Peter Lehmann, Ph.D. University of Texas at Arlingon

Penny Leisring, Ph.D. Quinnipiac University

Christopher Murphy, Ph.D. University of Maryland

Ronald Potter-Efron, Ph.D. Private Practice, Eleva, WI

Daniel Sonkin, Ph.D. Private Practice, Sausalito, CA.

Lynn Stewart, Ph.D. Correctional Service, Canada

Casey Taft, Ph.D Boston University School of Medicine

Jeff Temple, Ph.D. University of Texas Medical Branch

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Open Access

Peer-reviewed

Research Article

A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Resources, Software, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation International Centre for Reproductive Health, Ghent University, Ghent, Belgium

Roles Data curation, Formal analysis, Methodology, Writing – review & editing

Affiliation Georgia State University Alumna, Atlanta, Georgia, United States of America

Roles Validation, Writing – review & editing

Affiliation Médecins Sans Frontières-Operational Centre Brussels, Brussels, Belgium

Roles Methodology, Supervision, Writing – review & editing

• Emilomo Ogbe, 
• Stacy Harmon, 
• Rafael Van den Bergh, 
• Olivier Degomme

• Published: June 25, 2020
• https://doi.org/10.1371/journal.pone.0235177
• Reader Comments

Intimate partner violence (IPV) is a key public health issue, with a myriad of physical, sexual and emotional consequences for the survivors of violence. Social support has been found to be an important factor in mitigating and moderating the consequences of IPV and improving health outcomes. This study’s objective was to identify and assess network oriented and support mediated IPV interventions, focused on improving mental health outcomes among IPV survivors.

A systematic scoping review of the literature was done adhering to PRISMA guidelines. The search covered a period of 1980 to 2017 with no language restrictions across the following databases, Medline, Embase, Web of Science, PROQUEST, and Cochrane. Studies were included if they were primary studies of IPV interventions targeted at survivors focused on improving access to social support, mental health outcomes and access to resources for survivors.

337 articles were subjected to full text screening, of which 27 articles met screening criteria. The review included both quantitative and qualitative articles. As the focus of the review was on social support, we identified interventions that were i) focused on individual IPV survivors and improving their access to resources and coping strategies, and ii) interventions focused on both individual IPV survivors as well as their communities and networks. We categorized social support interventions identified by the review as Survivor focused , advocate/case management interventions (15 studies) , survivor focused, advocate/case management interventions with a psychotherapy component (3 studies), community-focused , social support interventions (6 studies) , community-focused , social support interventions with a psychotherapy component (3 studies) . Most of the studies, resulted in improvements in social support and/or mental health outcomes of survivors, with little evidence of their effect on IPV reduction or increase in healthcare utilization.

There is good evidence of the effect of IPV interventions focused on improving access to social support through the use of advocates with strong linkages with community based structures and networks, on better mental health outcomes of survivors, there is a need for more robust/ high quality research to assess in what contexts and for whom, these interventions work better compared to other forms of IPV interventions.

Citation: Ogbe E, Harmon S, Van den Bergh R, Degomme O (2020) A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors. PLoS ONE 15(6): e0235177. https://doi.org/10.1371/journal.pone.0235177

Editor: Nihaya Daoud, Ben-Gurion University of the Negev Faculty of Health Sciences, ISRAEL

Received: March 7, 2019; Accepted: June 9, 2020; Published: June 25, 2020

Copyright: © 2020 Ogbe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: E.O- University of Gent BOF startkrediet (BOF.STA.2016.0031.01) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The global prevalence of intimate partner violence (IPV) has been estimated at about 30% for women aged 15 and over [ 1 ]. We define IPV within this paper as ‘any acts of physical violence, sexual violence, stalking and psychological aggression (including coercive tactics) by a current or former intimate partner’ [ 2 ]. IPV affects men and women, and men or women can be perpetrators or survivors of violence. However, women are the most affected by IPV, and men tend to perpetrate violence more than women [ 3 ]. Survivors of violence are likely to first disclose experiences of intimate partner violence and expect informal support from a friend, family member, neighbour or other members of their social network, prior to seeking support from formal sources like health institutions and legal officers, however, the extent of disclosure differed with age, nature, ethnicity and gender [ 4 ].

IPV has been found to be associated with an increased risk of poor health, depressive symptoms, substance use, chronic disease, chronic mental illness and injury for both men and women [ 5 ]. Social support has been found to be an important factor for mediating, buffering and improving the outcomes of survivors of violence and improving mental health outcomes[ 6 ]. Conversely, social isolation and lack of social support have been found to be linked with poor health outcomes for survivors of violence. Liang et al [ 6 ] discussed the importance, perception of the abuse by the IPV survivor plays on their decision to ask for help and support. They mentioned how cultural factors including stigma and shame around disclosing IPV, perception of the incident as a personal problem and awareness of resources available, play a determining factor on types of resources accessed, especially for IPV survivors with a migrant background or of a low socioeconomic status. IPV survivors who perceive the abuse to be a personal problem were more likely to use placating and avoidant strategies before seeking external support [ 6 ].

In this study, we make use of Shumaker and Brownell’s definition of social support, and define it as any provision of assistance, which may be financial or emotional, that is recognized by both the beneficiary and provider as advantageous to the beneficiary’s welfare. ‘[ 7 ]. IPV interventions that involve the use of social support, have the potential to improve the health seeking behaviour, access to resources and mental health outcomes of IPV survivors. Commonly cited types of social support interventions include but are not limited to the use of peer support, family support and the use of ‘remote interventions like the use of internet or telephones as sources of social support from trained counsellors, as well as information about resources’ [ 8 ]. Goodman and Smyth [ 9 ] discussed the importance of using a ‘network oriented’ approach to provision of domestic violence services that takes into account the value of informal support, from social network members of IPV survivors, as this would promote the well-being of the survivor and sustain some of the benefits of the intervention over time. Given the existing gap in evidence on the effect of different IPV interventions on social support and/ mental health outcomes of IPV survivors, this study aimed to address the evidence gap, by assessing the effects of these different IPV interventions, and network oriented approaches on improving access to social support and improved mental health outcomes for IPV survivors. This is of added benefit, as access to social support improves the mental health outcome of survivors of violence. More evidence of different types of social support interventions targeted at different groups of people, that are effective in addressing mental health outcomes of survivors, are needed.

The systematic review was developed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. The methods used to screen the studies and define eligibility are described below:

Eligibility criteria

Studies meeting the following criteria were included: Primary research (original articles excluding systematic reviews), targeted at IPV survivors, describing interventions focused on improving access to resources and mental health outcomes for IPV survivors. The interventions had to use a social support or network-oriented approach. There were no restrictions on gender, but most of the studies identified focused on female survivors of violence (See Table 1 ). We defined ‘IPV as physical, sexual and psychological abuse directed against a person, by a current or ex-partner’ [ 10 ].

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https://doi.org/10.1371/journal.pone.0235177.t001

Studies had to address the following outcomes: intimate partner violence, social support, mental health outcomes and quality of life. Other outcomes that were also included were those associated with access to resources, utilisation of health services, and safety-promoting behaviours, if they were assessed in addition to the outcomes mentioned earlier. No restrictions were placed on study design or language, to allow for inclusion of all relevant studies.

Information sources

Between May and July 2017, we conducted a search across 5 databases: Medline, Embase, Web of Science, Cochrane and PROQUEST, for studies published between 1980 and 2017. We decided to include studies from the 1980’s because some of the pioneering publications on the use of advocacy and social support, for example, Sullivan et al’s work were published in the late 80’s and early 1990’s and we wanted our review to include some of these publications. Even though the review eventually included only primary studies, we included studies from COCHRANE to allow us to identify additional articles. We did not conduct a separate search for grey literature, as the PROQUEST database also included scholarly journals, newspapers, reports, working papers, and datasets along with e-books. Retrieved references were imported to Endnote and Mendeley and were then transferred to a systematic review software called Co-evidence [ 11 ]. In January 2019, another search was done to update and ensure new articles or information could be included in the review. Table 1 provides an overview and summary of the studies selected, as well as the evidence ranking of the studies.

Search strategy

The search strategy was developed in collaboration with a librarian, as well as a review of other existing systematic reviews on IPV or social support interventions. Search terms combined MeSH terms, and specific terms related to IPV and were adapted to each of the databases searched. This is presented in Table 2 .

https://doi.org/10.1371/journal.pone.0235177.t002

Study selection

Inclusion of retrieved studies and their eligibility were independently assessed by two reviewers, EO and SH, in a two-step process. First, the authors independently screened all study titles and abstracts using Co-evidence (the systematic review software), which notified each author of conflicts. When a conflict was identified, articles were again independently reviewed, and discordance was resolved through discussion, using the systematic review protocol as a guide. The same process was also used for the full text-screening phase of the study. While this process lengthened the screening process, it allowed for transparency and made it possible for both reviewers to continually reference the study protocol and ensure that the study objectives were adhered to, through the review process.

Data extraction

A standardized data collection form was developed by EO and SH, adapted from the Cochrane data collection grid. EO extracted all the data from the studies, SH and RB reviewed the data and it was agreed that OD would provide input if there was any disagreement about the data extracted.

Risk of bias

The quality and risk of bias in the studies were independently assessed by EO and SH, using the appropriate quality assessment tool. As the studies selected included quantitative and qualitative studies, there was an agreement to assess quantitative and qualitative studies separately. Quantitative studies were assessed using the Quality Assessment Tool for quantitative studies developed by the Effective Public Health Practice Project, see Table 3 for an overview of the components of this tool [ 12 ]. This tool had been used in another systematic review focused on interventions [ 13 ]. Qualitative studies were assessed, using the Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist [ 14 ], the main components focused on assessing the methodological limitations, coherence, adequacy of data and relevance of research. See Table 4 for an overview.

https://doi.org/10.1371/journal.pone.0235177.t003

https://doi.org/10.1371/journal.pone.0235177.t004

Information about studies selected

The initial search across the different databases retrieved 3712 articles, of which 3364 articles were irrelevant based on the screening criteria. 337 articles were assessed at the full text screening stage, and 27 articles selected to be part of the systematic review, the overview is presented in Fig 1

From : Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi: 10.1371/journal.pmed1000097 For more information, visit www.prisma-statement.org .

https://doi.org/10.1371/journal.pone.0235177.g001

Results/Key findings from the systematic review

The interventions were classified based on the methodology or type of social support provided to the survivors of violence. Most of the studies identified involved the use of an ‘advocate/ case manager’ or ‘interventionist’ (which referred to a nurse, psychologist or volunteer trained to administer the IPV intervention). The advocate was often responsible for offering the survivor information on resources and helping them identify safety strategies. The interventions usually consisted of weekly sessions or phone calls for a certain period of time. These interventions were mostly in the United States and from other countries like China, Canada, Denmark, Netherlands, Uganda and the United Kingdom. Other interventions involved the use of advocacy with an added psychotherapy component, and interventions that focused on community education, as well as empowerment of the IPV survivors. One of such community focused interventions used an empowerment model and encouraged survivors of violence to take photos of their safety strategies. These photos were used to educate the community about the consequences of intimate partner violence and advocate for community support to prevent intimate partner violence and encourage access to services. In our paper, the term ‘community focused’ included interventions targeted at the community which used participatory and non-participatory methods in the design and implementation of the programmes. The interventions identified in this systematic review had different target groups, pregnant women, survivors of violence resident in shelters, community members and IPV survivors, substance abusing women, and women with small children.

Types of social support interventions for intimate partner violence survivor

Survivor- focused social support interventions..

The interventions described below were all focused on providing social support and improving mental health outcomes for the survivors of violence, all of them involved the use of advocacy/case management approaches, through remote or ‘face to face’ methods. We also identified advocacy interventions with a strong therapeutic component, which we have discussed separately.

Advocacy/ Case management interventions

These interventions involved the use of community-based advocacy interventions focused on individuals that were survivors of violence, these interventions were focused on assisting the survivors identify and access resources, supportive relationships and cope with the effects of intimate partner violence. Fifteen of the studies reviewed (11 RCTs, 2 pre-post evaluation, 1 retrospective study, 1 quasi-experimental study with randomization) described experiences with social support interventions that provided some sort of advocacy service in combination with community support for survivors of violence, on an individual level [ 15 – 29 ].

Advocacy interventions may include ‘helping abused women to access services, guiding them through the process of safety planning, and improving abused women’s physical or psychological health’ [ 30 ]. For the review, interventions grouped under this category included mentor-mother interventions (these interventions involved the training of IPV survivors who were mothers as counsellors and mentors, for other IPV survivors), and use of home-based or in-clinic advocates. Most of the studies reported a decrease in depression, fear, post-traumatic stress disorder, and increased access to social support for the IPV survivors included in the study.

In Tiwari et al’s study, where an advocacy intervention was compared to the usual community services, the reduction in depression and other mental outcomes, was not significant but the reduction in ‘partner aggression’ and increase in access to social support in the intervention arm was significant [ 15 ]. Two of the studies, an in-clinic advocacy intervention by Coker et al [ 23 ] and a home-based advocate intervention by Sharps et al [ 20 ] resulted in a significant reduction in the experience of intimate partner violence by the survivors (decrease in experience of IPV in the intervention arm compared to the control group). The two mentor mothers’ studies included in this review, showed an increase in uptake of support services and mental health services. Prosman et al’s study [ 18 ] specifically showed evidence that the mentor mother intervention led to a decrease of in experience of IPV (decreased Composite Abuse Scale (CAS) mean score by 37.7 (SD 25.7) after 16 weeks), as well as in depression scores. This study had a component that focused on uptake of therapy, which may have influenced the outcomes. Four of these studies compared ‘face to face’ case management/ advocacy services to remote modes of care and assessed the impact on social support and IPV. Gilbert et al’s study [ 24 ] compared online and case manager implemented screening, assessment, and referral to treatment intervention for IPV survivors who were substance abusing, the intervention was guided by social cognitive theory, and focused on short screening, an intervention and referral to treatment (SBIRT) model. There were no significant differences between both groups in terms of impact of the interventions, the study found both groups has an increase in access to social support, IPV self-efficacy (ability to protect themselves from IPV) and abstinence from substance use, irrespective of the type of intervention they received. McFarlane et al [ 26 ] assessed the differences between nurse case management and a referral card on reduction of violence and use of community resources among IPV survivors, and found no differences in outcome between both groups, but found compared to baseline, participants who received either intervention (nurse case management or referral card) had a significant reduction in experiences of violence (threats of abuse, assaults, risks of homicide and work harassment) between baseline and 24 months post-intervention. There were no significant differences in outcome for participants who were in the referral card or case management intervention arm. Other outcomes like improved safety behaviors and a reduction in the utilization of community resources were also found across both groups. Stevens et al’s [ 27 ] study focused on using telephone based support/referral services for IPV survivors compared to enhanced usual care (, the intervention was based on a social support and empowerment model. The study found no significant difference in outcomes between the intervention arm (telephone-based arm) and the control arm (enhanced usual care- community services provided by the community center including health, social, educational, and recreational services). Research participants reported a decrease in experiences of IPV across both groups, associated with ‘higher levels of social support’ at baseline and at 3 months post-intervention. However, the reduced levels of violence did not influence the capacity to obtain or utilize community resources among the research participants. Constantino et al’s [ 29 ] study compared an advocacy based intervention across different methods (online and face to face) and found the intervention reduced depression, anxiety and increased personal and social support among the online group compared to the control group. The intervention included a module that addressed interpersonal relationships, thoughts and emotions as well as access to referral services like legal aid. Another study by Constantino [ 28 ] involved a nurse led intervention focused on providing information on resources and services for IPV survivors living in a domestic violence shelter. The intervention was compared to usual care in the shelter. The intervention group had reduced psychological distress, increased levels of social support and reduced reporting of health care issues. Most of the studies we found in this category showed moderate levels of quality of evidence.

Advocacy/Case management interventions with a psychotherapy component

3 of the studies (3 RCTs) [ 31 – 33 ] were focused on interventions that included specific types of psychotherapy, sometimes delivered remotely or through individual or group sessions. Zlotnick et al [ 31 ] described the use of interpersonal psychotherapy among pregnant women focused at improving social support among the survivors of violence during individual psychotherapy sessions. Though there was a moderate change in depression and PTSD scores (reduction) between the control and intervention groups at post-intake (5–6 weeks), this difference was not sustained at the post-partum period. Hansen et al [ 33 ] describes the use of psychotherapy using either the ‘Trauma Recovery Group’ (TRG) method developed by ‘a private Danish organization called ‘‘The Mothers’ Aid”‘ or regular trauma therapy for individual or groups of women who were survivors of IPV. The study reported significant changes in PTSD, depression and anxiety symptoms and increased levels of social support (high effect sizes); however, our assessment with the EPHPP grading revealed that the study design was weak. Miller et al’s [ 32 ] study shows the effect of a ‘mom empowerment programme’ focused on improving mental health outcomes and ability to access resources among IPV survivors participating in the programme, with resulting improvement in PTSD, depression and anxiety symptoms.

Community-focused/ network social support interventions

These group of studies, distinct from the ones described above focused on community education and change, so the focus of the studies was not just the individual survivor of violence, but the community as a whole. 9 (3 RCTs, 3 pre-post evaluations, 3 qualitative research) of the studies we reviewed consisted of interventions described as being community-based [ 34 – 42 ]. The definitions of community-focused interventions used for classifying the studies followed the typology by McLeroy et al [ 43 ], which refers to interventions where:

• The setting of the intervention is the community
• The target population of the intervention is the community
• The intervention uses community members as a resource
• The community serves as an agent for the intervention (i.e. interventions working with already existing structures within the community)

We have focused on interventions in this category where the focus of the intervention is the community. The interventions described include community participatory research, like those described by Ragavan et al’s systematic review on community participatory research on domestic violence [ 44 ], as well as interventions that are ‘community placed’, where the community is a target of the intervention, and might not have been involved in the design of the intervention, in a participatory way.

All the interventions were focused on IPV reduction and improving social support and mental health outcomes for survivors of violence. Interventions like SASA [ 34 , 39 ], used community members as a resource for the intervention. In the SASA intervention, community activists in the intervention sites were trained on GBV prevention, power inequalities and gender norms. After training, they carried out advocacy activities, engaging different stakeholders and members of their social networks to address harmful social norms around GBV. At the end of the intervention, there were reported lower rates of IPV among the intervention community. Other interventions like the ‘Framing Safety project’ [ 35 ], which focused on promoting agency and self-empowerment among survivors of violence, found that by providing means through which survivors of violence could tell their own stories and take ownership of this process, there was a resulting feeling of empowerment among the women. Other interventions used group therapy sessions that were community-based and culturally tailored to the specific target population. Wuest et al [ 41 ] described a collaborative partnership with different stakeholders (academic, NGOs and community members) to develop a comprehensive intervention to IPV, ‘Intervention for Health Enhancement After Leaving (iHEAL), a primary health care intervention for women recently separated from violent/abusive partners’. The post evaluation revealed significant reduction in depression and PTSD from baseline to 6 months post-intervention, these improvements in mental health outcomes, were present at 12 months post-intervention. Other outcomes, like social support, showed some initial improvement from baseline to 6 months post-intervention but these changes were not sustained till 12 months post-intervention.

Community focused/ network interventions with a psychotherapy component

Three of the nine studies (1 RCT and 2 pre-post study) by Kelly et al [ 36 ], McWhirter et al [ 37 ], and Nicolaidis et al [ 38 ] described group therapy interventions that were designed in collaboration with the target population in a participatory way. These studies reported significant reductions in severity of mental health conditions like depression and PTSD, as well as an increase in social support and self-efficacy for the women who were involved in the study.

The focus of this systematic review was to assess the existing evidence available on IPV interventions focused on improving social support and/or mental health outcomes. To ensure that we included all relevant studies, we included both quantitative and qualitative articles. 27 articles were included in the systematic review out of 337 full text articles assessed. The following interventions were identified via the review: Survivor focused interventions (18 studies: 15 of these studies were focused on advocacy/case management services; 3 of these on advocacy/case management services with a psychotherapy component), community-based social support interventions (9 studies:4 out of these were community coordinated interventions with a psychotherapy component). The heterogeneity of the studies made it difficult to conduct a meta-analysis because of the variability in outcome measures, study design and processes and duration of interventions implemented. Survivor focused advocacy/case management IPV interventions made up most of the interventions identified (18 out of 27). The studies showed good to moderate evidence of the positive impact of these interventions on mental health outcomes and also access to social support for the IPV survivors included in the study, and in a few studies, a reduction in partner aggression or experience of IPV (IPV scores) [ 15 – 23 ]. In one study, by De Prince et al [ 42 ], where a community-based advocacy intervention was compared to an advocacy intervention that was focused on referral, both groups showed improvement in mental health outcomes, but the community-based advocacy intervention group (outreach) had slightly better mental health outcomes. A specific approach of the intervention was that it was community-led/ coordinated, the community based organisation reached out directly to the survivors of violence based on information from the systems based advocate, hence removing the need for survivors to seek out services themselves based on the referrals received from the system based advocate. This study might have important lessons for future advocacy interventions, as just provision of referrals might not ensure uptake of services, and a community coordinated follow up of IPV survivors might be more effective in ensuring uptake. However, it must be noted that only few of the advocate-based studies and 1 of the community-focused interventions reported an impact on IPV, with good level of evidence [ 15 , 20 – 23 , 34 ], similar to what has been found in other reviews of advocate-based interventions on intimate partner violence [ 45 ]. Tiwari et al’s study, which focused on the use of an empowerment, social support and advocacy-focused telephone intervention, found improved mental health outcomes among the intervention group. In comparison, Cripe et al’s [ 46 ] study also compared the effect of an empowerment-based intervention in comparison to usual care among abused pregnant women and found higher scores of improved safety behaviours among the intervention group compared to the control group but ‘no statistically significant difference in health-related quality of life, adoption of safety behaviours, and use of community resources between women in the intervention and control groups’. These differences we attribute to the study design, context and characteristics of the study participant. Goodman et al has described the importance of integrating a ‘social network’ approach into IPV interventions, and linking interventions with social networks of IPV survivors to ensure sustained access to social support for the survivors [ 9 , 47 ]. Many of the advocacy/case management interventions described above have created these linkages by assisting IPV survivors identify sources of support within their existing networks and also engage in forming new social relationships [ 16 , 18 , 48 ]. However, more IPV interventions should integrate this approach in a coordinated systemic manner, as engaging with social network members of the IPV survivors ensures sustainability of the programme’s effects over time [ 9 ].

Several of the studies focused on psychotherapy interventions, which were individual, or group based. We classified these interventions separately as these interventions combined community-based advocacy with a therapeutic component, as opposed to advocacy/case management alone or community focused interventions. These interventions either used interpersonal therapy [ 31 ], traumatic treatment therapy [ 33 ], empowerment based group therapy [ 32 ], and a multicomponent intervention that combined therapeutic education sessions with information on resources and legal help remotely or ‘face to face’ [ 29 ]. All the interventions showed some impact on mental health outcomes and social support, with a weaker level of evidence of an impact on IPV. Although Zlotnick et al’s study[ 31 ] on a therapeutic intervention for pregnant IPV survivors, described an improvement of mental health outcomes (moderate effect on PTSD and depression), this finding was not sustained in the postpartum period, drawing attention to the need to assess the efficacy of interventions in this particular group, taking into account time dependent factors and participant attributes. A review done by Trabold et al [ 49 ], found that clinically focused interventions and group-based cognitive or cognitive behavioural interventions had a significant effect on depression and PTSD, as well as the uses of Interpersonal therapy (time dependent). However, as our review focused on therapies focused on improving social support and mental health outcomes, we included fewer studies. Although we found a similar trend as described by Trabold et al, among community-based interventions (including those that were psychotherapy focused), we could not assign the effect specifically to the type of psychotherapy method, but rather to the length, associated support services and context of the intervention. Sullivan et al [ 50 ] discussed the positive effect of trauma informed practice on mental health outcomes of IPV survivors in Shelters, showing evidence of the importance of IPV interventions to include a comprehensive ‘therapeutic or mental health component’. They also discussed the six components of what ‘trauma informed practice’ which includes: (a) reflecting and understanding of trauma and its many impacts on health and behaviour, (b) addressing both physical and psychological safety concerns, (c) using a culturally informed strengths-based approach, (d) helping to illuminate the nature and impact of trauma on survivors’ everyday experience, and (e) providing opportunities for clients to regain control over their lives’. These components were useful for advocacy/case management interventions for IPV survivors, to ensure a focus on improving mental health outcomes, intersectional collaboration between stakeholders, and that the intervention is survivor-centred and addresses cultural factors.

Interventions that compared remote and ‘face to face’ methods of support and advocacy mostly resulted in a reduction in IPV victimization and increased access to social support. In cases where different modes of intervention delivery were tested, for example a comparison between remotely delivered interventions (telephone or online) and ‘face to face’ interventions, no difference was noted between both modes of intervention. Krasnoff and Moscati’s study [ 51 ] discussed a multi-component referral, support and case management intervention that reported similar reduction in perceived IPV victimization as seen in studies included in our review. There were some differences in the telephone support interventions included, Stevens et al’s study [ 27 ] reported no difference in mental health outcomes compared to Tiwari et al’s study[ 15 ] which found an improvement in mental health outcomes among the intervention group. We postulate differences in outcome could be attributable to the fact that Tiwari’s intervention was more advocacy, empowerment and support focused than the intervention described in Stevens et al study, which was more information and referral focused.

Summary of key findings and recommendations

• Most of the interventions that used advocacy with strong community linkages and a focus on community networks showed significant effects on mental health outcomes and access to social support, we assume a reason for this could be that because these interventions were rooted in the community, there were more sources of support that allowed the survivors of violence to develop better coping strategies, for example in the SASA study that included a strong community engagement component, community responses to cases of IPV were supportive of the survivor, and this had an effect on incidence of IPV. Future research and interventions on IPV should focus on ensuring stronger community linkages and outreach programmes to enhance the impact of the interventions on IPV survivors.
• This review found that when remote modes of intervention delivery were compared to ‘in person’ delivery of an intervention, there were no significant differences in outcome. This finding is of specific importance to hard-to-reach and vulnerable populations whom might be unwilling to access care at hospitals and registered clinics. More research focused on the use of remote support interventions among vulnerable populations (specifically IPV survivors), should be encouraged.
• There was a lot of heterogeneity in outcome measurements, especially measures of social support, drawing attention to the need for research and discussions around standardization and synthesis of evidence-based research on social support and IPV.
• In some of the studies, the ‘dosage of the intervention’, as well as some participant characteristics like age or ethnicity are often cited as potential moderators of some of the outcomes, more research on IPV intervention should examine the time dependent nature of interventions and their effect on outcomes similar to what was done by Bybee et al[ 16 ].

Limitations

Although there were no language restrictions included in our search strategy, most of the studies retrieved and subsequently reviewed were in English, which could have influenced some of our conclusions.

Conclusions

This systematic review presented the findings from IPV interventions focused on social support and mental health outcomes for IPV survivors. Advocacy/case management interventions that had strong linkages with communities, and were community focused seemed to have significant effects on mental health outcomes and access to resources for IPV survivors. However, all IPV survivors are not the same, and culture, socioeconomic background and the perception of abuse by the IPV survivor, have a mediating effect on their decision to access social support and utilize referral services. ‘An intersectional trauma informed practice’[ 50 ] [ 52 ] that addresses psychological and physical effects of IPV, is culturally appropriate and is empowering for the survivor, in addition to a ‘social network oriented approach’ might provide a way to ensure that IPV interventions are responsive to the needs of the IPV survivor[ 47 ]. This will ensure the interventions are targeted at ensuring survivors are able to access social support from their existing networks or new social relationships, and might also promote community education about IPV and promote community support for IPV prevention and mitigation. Future studies on IPV interventions should assess how these approaches impact the incidence of IPV, social and mental health outcomes across different populations’ of IPV survivors.

Supporting information

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https://doi.org/10.1371/journal.pone.0235177.s001

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EDITORIAL article

Editorial: new perspectives on domestic violence: from research to intervention.

• 1 Department of Psychology, University of Turin, Turin, Italy
• 2 School of Health and Social Work, University of Hertfordshire, Hertfordshire, United Kingdom

Editorial on the Research Topic New Perspectives on Domestic Violence: from Research to Intervention

In a document dated June 16th 2017, the United States Department of Justice stated that Domestic Violence (DV) has a significant impact not only on those abused, but also on family members, friends, and on the people within the social networks of both the abuser and the victim. In this sense, children who witness DV while growing up can be severely emotionally damaged. The European Commission (DG Justice) remarked in the Daphne III Program that 1 in 4 women in EU member states have been impacted by DV, and that the impact of DV on victims includes many critical consequences: lack of self-esteem, feeling shame and guilt, difficulties in expressing negative feelings, hopelessness and helplessness, which, in turn, lead to difficulties in using good coping strategies, self-management, and mutual support networks. In 2015 the EU Agency for Fundamental Rights affirmed that violence against women can be considered as a violation of human rights and dignity. Violence against women exists in each society and it can be related to any social, economic and cultural status and impact at the economic level. It includes physical, sexual, economic, religious, and psychological abuse.

Although men experience domestic violence by women, the rate of DV among women is much higher than that of men, especially in the category of being killed due to DV.

Recent studies have shown that between 13 and 61% of women (15–49 years old) report to have been physically abused at least once by an intimate partner. Domestic Violence takes place across different age groups, genders, sexual orientations, economic, or cultural statuses. However, DV remains largely under-reported due to fear of reprisal by the perpetrator, hope that DV will stop, shame, loss of social prestige due to negative media coverage, and the sense of being trapped with nowhere to go:

Hence, it is estimated that 90% of cases of DV continue to be identified as a non-denounced violence.

The aim of this Special Issue of Frontiers of Psychology is to gather updated scientific and multidisciplinary contributions about issues linked to domestic violence, including intimate partner violence (IPV). We encouraged contributions from a variety of areas including original qualitative and quantitative articles, reviews, meta-analyses, theories, and clinical case studies on biological, psycho-social and cultural correlates, risk and protective factors, and the associated factors related to the etiology, assessment, and treatment of both victims and perpetrators of DV.

We hope that this Special Issue will stimulate a better informed debate on Domestic Violence, in relation to its psychosocial impact (in and outside home, in school, and workplace), to DV prevention and intervention strategies (within the family and in society at large), in addition to specific types of DV, and to controversial issues in this field as well.

The Special Issue comprises both theoretical reviews and original research papers. 7 research papers, 6 reviews (policy and practice review, systematic review, review and mini-review) and 1 methodological paper are included.

The first section comprises 2 systematic review and 3 original research papers focused on factors associated with Domestic Violence/Intimate Partner Violence/feminicide. Velotti et al. conducted a systematic review focused on the role of the attachment style on IPV victimization and perpetration. Several studies included failed to identify significant associations. The authors suggest to consider other variables (e.g., socioeconomic condition) that in interaction with attachment styles could explain the differences found between the studies. Considering the clinical contribution that these findings can provide to the treatment of IPV victims and perpetrators, future studies are needed. From a systematic review conducted by Gerino et al. focused on IPV in the “golden age” (old age), economic and educational conditions, younger age (55–69), membership in ethnic minorities, cognitive and physical impairment, substance abuse, cultural and social values, sexism and racism, were found as risk factors; depression emerged as risk factor and consequence of IPV. However, social support was identified as main protective factor. Also help-seeking behaviors and local/national services had a positively impact the phenomenon. Furthermore, the role of the parental communication was highlighted ( Rios-González et al. ) In that mothers encourage daughters to engage in relationship with ethical men, while removing from their representation attractive features and enhancing the double standard of viewing ethical man as unattractive vs. violent and attractive man. Fathers' communication directed toward young boys supports the dominant traditional masculinity, objectifying girls and emphasizing chauvinist values. These communicative dynamics impact males' behavior and females' choice of the partner while increasing the attraction toward violent men, and thus influencing the risk to be involved in IPV episodes.

Furthermore, factors associated with multiple IPV victimization by different partners were identified. From the study of Herrero et al. , experiencing child abuse emerged as a main predictor (“conditional partner selection process”). Similarly, adult victimization perpetrated by other than the intimate partner influences multiple IPV episodes. Moreover, this phenomenon is more frequent among younger women and those with lower income satisfaction. Length of relationship and greater psychological consequences to previous IPV are positively associated with multiple IPV episodes, while previous physical abuse is negatively related with subsequent victimization. The risk of multiple IPV episodes is reduced in countries with greater human development, suggesting the role of structural factors.

Regarding reasons of feminicide, passion motives assume the main role, followed by family problems, antisocial reasons, predatory crimes that comprise sexual component, impulsivity and mental disorders. The risk of overkilling episodes is higher when the perpetrator is known by the victim and when the murder is committed for passion reasons ( Zara and Gino ).

The second section includes papers focused on IPV/DV in particular contexts (one research paper, two reviews). Within separated couples, where conflicts are common, both men and women experience psychological aggression. However, some particularities emerged: women started to suffer of several kinds of psychological violence that was aimed to control (complicating the separation process), dehumanize and criticize them. Men report only few forms of violence experienced (likely due to the men's social position that narrows their disclosure opportunity), which mainly concern the limitation of the possibility to meet children ( Cardinali et al. ). Regarding same-sex couples ( Rollè et al. ), both similarities and differences in comparison with heterosexual couples emerged. IPV among LGB people is comparable or even higher than heterosexual episodes. Unique features present in same-sex IPV concern identification and treatment aspects, mainly due to the absence of solutions useful in addressing obstacles to help-seeking behaviors (related to fear of discrimination within LGB community), and the limitation of treatment programs tailored to the particularities of the LGB experience. Similarly, within First Nation's communities in Canada, IPV is a widespread phenomenon. However, the lack of preventing programs and the presence of intervention solutions that fail to address its cultural origins, limit the reduction of the problem and the recovery of victims. Klingspohn suggests the development of interventions capable to guarantee cultural safety and consequently to reduce discrimination and marginalization that Aboriginal people experience with mainstream health care system and which limit help-seeking behaviors.

The third section comprises two reviews and one research paper concerned with the impact of Intimate Partner and Domestic Violence. The systematic review conducted by Onwumere et al. highlighted the financial and emotional burden that violence perpetrated by psychotic patients entails for their informal carers (mainly close family relatives). Moreover, the authors identified within the studies included positive association between victimization and trauma symptoms, fear, and feeling of powerless and frustration.

Among people who suffered of Domestic Violence with a romantic or non-romantic partner who became their stalker, stalking victimization entails physical and emotive consequences for both male and female victims. Females suffered more than males of depressive and anxiety symptoms (although for both genders symptoms were minimal), while males experienced more anger. Furthermore, both genders adopted at least one “moving away” strategy in coping with stalking episodes, and the increasing of stalking behaviors determined a reduction in coping strategies use. This latter finding is likely to be due to the distress experienced ( Acquadro Maran and Varetto ).

Children abuse—which occurs often in Domestic Violence—results in emotional trauma as well as physical and psychological consequences that can negatively impact the learning opportunities. The school staff's ability to identify abuse signals and to refer to professionals constitute their main role. However, lack of skills and confidence among teachers regarding this function emerged, and further training for the school staff to increase support provided to abused children is needed ( Lloyd ).

Lastly, the fourth section includes two papers (one review and one methodological paper) that provide information on intervention and prevention programs and one research paper which contributes to the development and validation of the Willingness to Intervene in Cases of Intimate Partner Violence Against Women (WI-IPVAW) Scale. Gracia et al. The instrument demonstrated—both in the long and in its short form—high reliability and construct validity. The development of WI-IPVAW can contribute to the evaluation of the t role that can be played by people who are aware of the violence and understand attitudes toward IPV that can influence perpetrator's behavior and victim disclosure. The origin of violence within intimate relationship during adolescence calls for the development of preventive programs able to limit the phenomenon. The mini-review conducted by Santoro et al. highlighted the necessity to consider the relational structure where women are involved (history of poly-victimization re-victimization), and the domination suffered according to the gender model structured by the patriarchal context. Moreover, considering that violence can occur after separation or divorce, requires in child custody cases the evaluation of parenting and co-parenting relationship. This process can provide an opportunity to assess and treat some kind of violent behavior (Conflict-Instigated Violence, Violent Resistance, Separation-Instigated Violence). According to these consideration, Gennari et al. elaborated a model for clinical intervention (relational-intergenerational model) useful to address these issues during child custody evaluation. The model is composed of three levels aimed at understanding intergenerational exchange and identify factors that contribute to safeguard family relationship. This assessment process allows parents to reflect on information emerged during the evaluation process and activate resources useful to promote a constructive change of conflict dynamics and violent behaviors.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thanks all the authors and the reviewers who contributed to the present article collection, for their dedication to our topics and to their readiness to share their knowledge, and thus to increase the research in this field; KathWoodward, Specialty Chief Editor of Gender, Sex, and Sexuality Studies that believed in our project, and to Dr. Tommaso Trombetta for his collaboration during last year.

Keywords: domestic violence, intimate partner abuse, intimate partner violence (IPV), gender violence against women, same sex intimate partner violence, systematic review, perpetrator and victim of violence, perpetrator

Citation: Rollè L, Ramon S and Brustia P (2019) Editorial: New Perspectives on Domestic Violence: From Research to Intervention. Front. Psychol. 10:641. doi: 10.3389/fpsyg.2019.00641

Received: 25 February 2019; Accepted: 07 March 2019; Published: 28 March 2019.

Edited and reviewed by: Kath Woodward , The Open University, United Kingdom

Copyright © 2019 Rollè, Ramon and Brustia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Luca Rollè, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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NRCDV works to strengthen researcher/practitioner collaborations that advance the field’s knowledge of, access to, and input in research that informs policy and practice at all levels. We also identify and develop guidance and tools to help domestic violence programs and coalitions better evaluate their work, including by using participatory action research approaches that directly tap the diverse expertise of a community to frame and guide evaluation efforts.

Safety & Privacy in a Digital World

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Policing Domestic Violence Special Edition Editorial: Seven years on—Reflections on progress in domestic abuse research and practice

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Jacqueline Sebire, Jesenia M Pizarro, Policing Domestic Violence Special Edition Editorial: Seven years on—Reflections on progress in domestic abuse research and practice, Policing: A Journal of Policy and Practice , Volume 18, 2024, paae082, https://doi.org/10.1093/police/paae082

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The last Special Edition of Policing, dedicated to Domestic Abuse, was published in 2016. This edition presented research centred on the practicalities of police and law enforcement agencies when dealing with domestic abuse. The issue included papers on risk assessment, the use of technology to improve investigations, perpetrator profiling, and police culture. In the issue’s editorial the guest editors’ note that, ‘Despite a great deal of research over the last 30 years, we still have major gaps in understanding the most effective strategies, in developing and implementing the best risk assessments and delivering the best victim and offender approaches’ ( Baldry and Sebire, 2016). There was a call for researchers and practitioners to support an evidence base for understanding ‘what works’ when policing domestic abuse.

Since there is still no comprehensive global database, we are unable to measure the number of lives lost to domestic abuse over the 8 years since that last Special Edition. A conservative and somewhat sobering estimate is approximately 376,000 women ( United Nations Office on Drugs and Crime, 2021). However, public awareness, researcher understanding, and practitioner expertise have continued to develop at pace in the interim, adding to the evidence base of what works. Seismic global events have also impacted the research and policing of domestic abuse. Coronavirus disease 2019 and its associated lockdowns, restrictions on movements, and service provision have developed our understanding of domestic abuse within the context of a global pandemic ( Kourti et al. , 2023). The #MeTo movement opened up public debate and awareness of gender-based violence ( Wilcox et al. , 2021). However, despite these new insights, the perennial challenges associated with policing domestic abuse, such as risk assessment, best use of technology, and what works recognized in the 2016 issue, remain very much on the research agenda.

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Domestic violence against women

A hidden and deeply rooted health issue in india.

Bhattacharya, Abantika 1 ; Yasmin, Shamima 1, ; Bhattacharya, Amiya 2 ; Baur, Baijayanti 1 ; Madhwani, Kishore P 3

1 Deparment of Community Medicine, Midnapore Medical College, West Bengal, India

2 Medical Officer (G&O) Jalpaiguri DH, West Bengal, India

3 Occupational Health Consultant, Mumbai, Maharashtra, India

Address for correspondence: Dr. Shamima Yasmin, Department of Community Medicine, Midnapore Medical College, Midnapore – 721 101, West Bengal, India. E-mail: [email protected]

Received March 30, 2020

Received in revised form April 25, 2020

Accepted July 02, 2020

Background: 

Domestic violence was identified as a major contributor to the global burden of ill health in terms of female morbidity leading to psychological trauma and depression, injuries, sexually transmitted diseases, suicide, and murder.

Aims: 

The study was conducted to find out the prevalence of different types of lifetime domestic violence against women, factors associated with it, and care-seeking behavior.

Settings and Design: 

An observational cross-sectional study conducted at a slum of Burdwan district of West Bengal, India.

Methods and Material: 

Study was done among 320 ever-married women of 15–49 years of age using a predesigned pretested proforma from March 2019 to December 2019 by face-to-face interview.

Statistical Analysis Used: 

Data were compiled and analyzed by EpiInfo 6 and SPSS 20 version.

Results and Conclusions: 

The overall prevalence of any form of violence during the lifetime among the study population was 35.63%. Verbal/psychological violence was the most common form of domestic violence (91.23%) followed by physical (82.46%) and sexual violence (64.91%). Slapping and/or beating, kicking, and object throwing were the major forms of physical violence; humiliation (88.46%) was the commonest form of psychological violence and most common form of sexual violence was forced sexual intercourse (51.35%). About 20% of the study population faced violence every day. Older age, lower age at marriage, longer duration of marriage, lower education of husband and wife, lower family income, unemployment of the husband, and alcohol consumption of husband were associated with the occurrence of domestic violence. We have found that the prevalence of domestic violence in this group of population is high. The alarming issue is that approximately one-third of women (32.46%) who faced violence in their lifetime had never sought any help. The findings indicate to develop appropriate and culturally relevant public health interventions to increase awareness.

Introduction

The Fourth United Nations World Conference on Women 1995 in Beijing stated that violence against women (VAW) is a manifestation of the historically unequal power relations between men and women.[ 1 ] United Nations declaration on the elimination of Violence against Women (VAW), in 1993, defined VAW as “any act of gender-based violence that results in, or is likely to result in physical, sexual, or psychological harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or private life.”[ 2 ]

The WHO Multi-country Study on “Women's Health and Domestic Violence Against Women” indicated that the range of lifetime physical violence by a male, intimate partner, ranged from 13% in Japan to 61% in Peru with most sites falling between 23% and 49%; range of lifetime prevalence of sexual violence by an intimate partner was between 6% (Japan) and 59% (Ethiopia) with most sites falling between 10% and 50%; range of lifetime prevalence of physical or sexual violence, or both, by an intimate partner, was 15% to 71% with most sites ranged from 30% to 60%.[ 3 ] Likewise, regarding current violence acts of physical or sexual violence in the year prior to being interviewed—the range was between 3% and 54%, with most sites falling between 20% and 33%.[ 3 ] Commonly mentioned perpetrators included fathers, other family members, and teachers. The highest levels of sexual violence by nonpartners ranged between 10% and 12% in Peru, Samoa, and Tanzania city to 1% in Bangladesh and Ethiopia.[ 3 ]

Only one in four abused women have ever sought help to end the violence they have experienced. Only two percent of abused women have sought help from police.[ 4 ]

Domestic violence is an underreported phenomenon in India including West Bengal, although West Bengal stands in the 8 th position according to the burden of domestic violence among all Indian states.[ 4 ] A need was, therefore, felt for a community-based study focusing on domestic violence against women (DVAW) to gather data that would improve our understanding of this “sleeping giant.”[ 5 ]

In this background, the present study was conducted with the objective of to find out the prevalence of different types of “lifetime” domestic violence against ever-married women in reproductive age group (15–49 years) in an urban area of a district of West Bengal, to identify the factors associated with it and also to estimate their care-seeking behavior.

Materials and Methods

A cross-sectional, community-based descriptive, and observational epidemiological study was carried out among all ever-married women of 15–49 years of age residing at a slum of Burdwan district of West Bengal, India from March 2019 to December 2019.

Inclusion criteria were all ever-married women of 15–49 years of age, permanent residents of the studied slum, and willing to participate. Exclusion criteria were women below 15 years and above 49 years, mothers-in-law, unmarried, divorced and separated women, widows, noncooperative women who refused to furnish necessary information, women who were seriously physically or mentally ill, and visitors to that locality. Considering the prevalence of domestic violence as 41.8%,[ 4 ] confidence level of 95%, 15% relative precision, and 10% nonresponse rate, the sample size was computed to be 357.

A sampling frame of the above population was prepared with the help of urban health post. Sampling technique was census population. The study tool was a predesigned pretested semistructured interview schedule. The schedule was prepared in the local language (Bengali) with the help of three experts of community medicine. The new tool was validated by three public health specialists. The pretesting was done among the married women of the adjacent slum area and the women were not included in the sampling frame and minor modifications were done in the tool. Then, the final tool was applied in data collection. Study variables were age in years, age at marriage, duration of marriage, religion, literacy status of study population, husband's education, occupation of study population, employment status of the husband, socioeconomic status (as per Modified Kuppuswamy's Scale 2019),[ 6 ] prevalence, type and frequency of domestic violence, addiction of husbands to alcohol, and their care-seeking behavior.

Procedure for data collection

Home visits were carried out, and face-to-face interview with these women was done in the absence of their guardian/husband by Principal Investigator (PI) and/or Co PIs. The purpose of the study was explained to the participants, informed consent was obtained, and initial rapport was built with the help of female Community Leader. They were also assured that anonymity and strict confidentiality would be maintained. In case the sampled woman was not at home at the time of visit, the next visit was scheduled after prior appointment. Information was gathered about the sociodemographic profile of the participants and whether they were subjected to any domestic violence or not.

The interview lasted for 30–45 min depending on the women's experiences. The reference period considered was any time preceding the survey.

Ethical permission was obtained from the Institutional Review Board of Burdwan Medical College, West Bengal, India.

Data were compiled and analyzed by Epi Info 6 version and SPSS 20 version. Proportions and Chi-square tests were used for analysis of data.

The present study was conducted among ever-married women of reproductive age group (15–49 years) in an urban area of Burdwan District. Out of 357 women, 320 participated while 27 (10.36%) refused because of feelings of shame and fear; thus, the response rate was 89.64%.

Mean age of the participants was 28 ± 5.34 years and majority of the women were in the age group of 25–35 years (33.94%). All were Hindu and were currently in monogamous relationship during the time frame of preceding 12 months of the study. Regarding educational status, 151 (47.19%) were illiterate, and only 4.68% had studied up to higher secondary and above. Majority (92.31%) of the respondents were homemakers and rest 7.69% were unskilled laborers. With regard to socioeconomic status (according to modified Kuppuswamy's Classification 2019),[ 6 ] a majority of the participants (36.56%) belonged to the lower middle class. So far as the occupation of husband was concerned, 277 (86.56%) were employed; 36.54% were unskilled laborers, 33.07% were skilled laborers, 4.61% were doing service, and 13.47% were self- employed. About 60.94% of the husbands of the study population were addicted to alcohol. A considerable number of husbands of participants 102 (31.88%) were illiterate and only 15 (4.69%) passed higher secondary and above. Majority 198 (61.88%) of the study population married after 18 years of age and 86 (26.88%) had married life for more than 10 years.

The overall prevalence of any form of violence during the lifetime among the study population was found to be 35.63% and husband was the main perpetrator followed by other family members.

Verbal/psychological violence was the most common form of domestic violence (91.23%) followed by physical (82.46%) and sexual violence (64.91%) among the subjects.

Slapping and or beating, kicking, and throwing objects were the major forms of physical violence experienced by these women. Humiliation 92 (88.46%) was the commonest form of psychological violence. Most common sexual violence was the use of physical force to have sexual intercourse (51.35%) [ Table 1 ].

In response to the frequency of domestic violence, the response of the participants was: every day 23 (20.18%), weekly 25 (21.93%), once in 15 days 29 (25.44%), monthly 21 (18.42%), and occasionally 16 (14.04%) [ Table 2 ].

Prevalence of all forms of violence increased along with the age of the respondents. Women aged 25–35 years 99 (47.47%) and 35–45 years 42 (51.85%) reported higher. Prevalence of violence in women aged less than 25 years was 22 (28.21%) and this difference was statistically significant ( P < 0.05) [ Table 3 ].

Though no significant difference was found so far as literacy of both partners was concerned, the data revealed that education had an impact on the prevalence of domestic violence. The prevalence of violence decreased as educational levels of women and their husbands increased. Sixty-five women (43.05%) with no education had experienced physical or sexual violence, as compared with two women (26.67%) with 12 or more completed years of education. Similarly the women whose husbands were illiterate 48 (47.06%) faced more violence than women whose husbands had higher secondary and above 3 (20%). Study population with unemployed husbands reported more violence 32 (74.42%) than their counterparts with employed husbands 103 (37.18%) and the difference was statistically significant ( P < 0.05) [ Table 3 ].

It was seen [ Table 3 ] that as the age at marriage of the participants was increased (69.67% for those who married before 18 years), the prevalence of domestic violence decreased (48.48% for those who married at 18 years and more). It was also reported that as the duration of married life increased prevalence of domestic violence decreased; those who married for less than 5 years had experienced higher prevalence (47.69%) of domestic violence than those married for more than 10 years (32.56%) ( P < 0.05). Women whose husbands addicted to alcohol (56.41%) experienced more violence than those without alcoholic husbands (20%), which was again statistically significant ( P < 0.05).

About one-third (32.46%) of women who faced violence in their lifetime had never sought any help. More than 23.68% women sought help from their parents, followed by 20.18% from neighbors and only 9.68% had reported to police [ Table 4 ].

Prevalence of domestic violence

The present study identified that 35.63% had faced domestic violence in any form or in combination in their lifetime. India's National Family Health Survey-III, carried out in 29 states during 2005-06, found that nation-wide, 37.2% of women experienced violence after marriage.[ 4 ] A similar study conducted in a slum of Kolkata revealed that the prevalence of domestic violence was 54%.[ 7 ] Another study in Delhi showed that the prevalence of psychological, physical, sexual, physical, or sexual violence and any form of violence was very high. Domestic violence against women is inversely associated with their mental health. A multisectoral approach is needed to address this problem.[ 8 ] A study on the same topic done by Sarkar[ 9 ] in rural setting of West Bengal showed that the prevalence of domestic violence was 23.4%. Babu and Kar[ 10 ] reported the prevalence of domestic violence of 56.3% in eastern India; 60.7% in Orissa, 51.8% in West Bengal, and 58.9% in Jharkhand. A study by Jeyaseelan et al .[ 11 ] in India showed 26% spousal physical violence during the lifetime of their marriage. The proportion of women who reported physical violence by their spouse was 26.6% in Goa,[ 12 ] 39% in six zones of India,[ 13 ] a total of 69% among nurses in AIIMS of Delhi,[ 14 ] 42.8% in a colony of Delhi,[ 15 ] and 29.57% in Bangalore.[ 16 ]

Prevalence of different types of domestic violence

In a study conducted in Uttar Pradesh by Koenig et al .,[ 17 ] the prevalence of lifetime physical and sexual violence was found to be 25.1% and 30.1%, respectively, which was found to be higher (71.4% and 57.1%, respectively) in our study. The corresponding figures were 35.5% and 10.0% in NFHS III,[ 4 ] 35.9% and 54.1% in Kolkata,[ 7 ] 52.1% and 52.5% in Orissa, 14.6% and 50.6% in West Bengal, 21.2% and 54.5% in Jharkhand, 16.1% and 52.3% in eastern India,[ 10 ] 43.3% and 30% among nurses in AIIMS,[ 14 ] 14% and 14% in six zones,[ 15 ] 31.6% and 10.5% in Bangalore,[ 16 ] and 84% and 90% in a study on five adjoining states of Andhra Pradesh, Chhattisgarh, Gujarat, Madhya Pradesh, and Maharashtra.[ 18 ]

In the present study, women also suffered from more than one type of violence. This was similar with the findings of other studies[ 4 14 18 ] where the reported violence was multiple in nature and most of the women were subjected to more than one type of violence.

Different forms of physical, psychological, and sexual violence

The most common form of lifetime physical violence was slapping and/beating (80.85%), kicking (68.09%), object throwing (43.62%), and choking and punching the women (29.79%), which was consistent with the findings of other studies.[ 4 8 9 10 12 14 18 ] According to NFHS III, the most common physical violence was slapping (34%) followed by twisting of arms or pulling of hairs (15.4%), throwing something (14%), kicking (12%), and choking (2%).[ 4 ] Humiliation was the most common form of emotional violence in this study and other studies.[ 4 9 12 ] The most common form of sexual violence was physically forced her to have sexual intercourse (58.3%).[ 4 9 ]

Frequency of domestic violence

In the present study response to frequency of domestic violence, the response of the participants was: every day 23 (20.18%), weekly 25 (21.93%), once in 15 days 29 (25.44%), monthly 21 (18.42%), and occasionally 16 (14.04%). In a study in five states,[ 18 ] about 16% of women reported that they were facing domestic violence once or twice in a week, or once or twice in a month and the percentage of respondents against whom domestic violence was committed practically every day was 15%; which was similar to the present study. In Singur, the study also found that 9.1% faced violence few times in a week or few times in a month, whereas 81.8% faced it in a year.[ 9 ] In Bangalore study, the frequency of violence was at least once in a week in 34.21% women, once in 15 days in 31.58% women, once in a month in 26.32%, and once in 1–3 months in 7.89% women.[ 16 ]

Relation of domestic violence with sociodemographic variables

Age had a profound association with the prevalence of domestic violence. Prevalence of all forms of violence was increased along with the increasing age of the women in the present study and other studies also[ 4 9 10 12 13 15 ] but Bangalore study[ 16 ] did not reveal this association where it was observed that as age of the women increased, the prevalence of domestic violence decreased.

Education had impact on the prevalence of domestic violence which was inversely associated with education levels of the women and their husbands and it was corroborative with the findings of some other studies.[ 4 9 10 11 12 13 14 18 ] In this study, families with low-income level showed a higher rate of violence and the rate of domestic violence decreased as the socioeconomic level increased; some other studies also supported this finding.[ 4 9 11 12 13 ]

Alcohol addiction of the husband was found to be strongly related to the presence of domestic violence in this study and other studies.[ 4 7 11 12 13 14 16 ] NFHS III reported that women whose husbands drink alcohol had significantly higher rates of violence than women whose husbands did not drink at all; emotional violence was three times as high, physical violence was more than two times as high, and sexual violence was four times as high.[ 4 ]

Majority of the victimized women preferred to be silent sufferers. The help-seeking behavior was found in one-third (31.5%) of women who had faced violence in their lifetime. These women had never sought any help, even from their relatives and close friends, and preferred to rely upon their own strategies to deal with the situation. This was corroborative to some other studies where 32.7% and 74.4% did not report the abusive situations in which they were living.[ 12 13 ] In urban and rural areas of Haryana, 37% of the married females had ever experienced domestic violence.[ 14 ]

In our study, 23.68% women sought help from their parents, followed by 20.18% from friends/neighbors while only 9.65% had reported to police which represented the tip of the iceberg. Notably few women seek help from any institutional sources such as the police, medical personnel, or social service organizations.[ 4 ] In a study in five states, among the respondents who sought help, 26.3% abused women had approached their parents, 15.6% to relatives, and 57.9% to friends.[ 18 ] Goa study revealed that 31.1% talked to relatives or close friends and only 4.4% took legal help.[ 12 ] In the Bangalore study, nobody informed the police.[ 16 ] The present study and some other studies highlighted the factors which had positive influence for domestic violence like young age at marriage,[ 12 16 18 ] duration of marriage,[ 4 14 ] as well as husband's employment status.[ 14 ]

Factors associated with an increased risk of perpetrating violence include low education, child maltreatment, exposure to violence in the family, use of alcohol, attitudes accepting of violence, and gender inequality.[ 19 ]

Emotional and verbal type of violence is the most common type. Caste, religion, literacy status of study subjects, and occupational status of spouses of study subjects were reported as significant correlates affecting the causation of domestic violence among the subjects.[ 20 ]

The effects of violence on a victim's health are severe. Domestic violence can lead to serious short- and long-term physical, mental, sexual, and reproductive health problems for women and lead to high social and economic costs.[ 21 22 ] Domestic violence is associated with mental health problems such as anxiety, post-traumatic stress disorder, and depression. Intimate partner violence in pregnancy also increases the likelihood of unplanned or early pregnancies and sexually transmitted diseases, miscarriage, stillbirth, preterm delivery, and low birth weight babies.[ 21 22 ]

Limitations of the Study

The sensitivity and stigma associated with violence, as well as fear of reprisal, may lead to under-reporting of violence. A small sample size has limited the generalizability of the present study. Investigation of the effects of violence on health would provide a clearer picture of short- and long-term suffering of the victims.

The present study found that the overall prevalence of physical, psychological, sexual and any forms of violence among women were 69.63%, 77.04%, and 54.81% respectively. The study revealed the high prevalence of all forms of violence against women in an urban area of Burdwan, India. Older age, lower age at marriage, longer duration of marriage, lower education of husband and wife, lower family income, unemployment of the husband, and alcohol consumption of husband were associated with the occurrence of domestic violence.

Ending violence against women needs to be addressed at various levels. The coordinated efforts of various sectors such as social, legal, educational, medical, etc., are essential to address the various economic and sociocultural factors that foster a culture of violence against women in India by strengthening women's human and economic rights and reducing gender gaps in relation to employment and education.

Ethical approval

Ethical and institutional clearance obtained from the Institutional Review Board of Burdwan Medical College, West Bengal, India 04.02.2019.

Declaration of patient consent

The authors certify that they have obtained all appropriate participant consent forms. In the form, the participants have given their consent for their images and other clinical information to be reported in the journal. The participants understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Conflicts of interest.

There is no conflicts of interest.

Care-seeking behavior; domestic violence; socioeconomic status; women

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• Published: 07 August 2024

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• MD Rafid Abrar Miah 1 &
• Ridwan Islam Sifat   ORCID: orcid.org/0000-0001-9897-0870 2  

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Violence against women is a common phenomenon in all societies, and in countries where gender inequality persists, such as Bangladesh, this issue is even more pronounced. Violence against any entity often stems from subordination, and it is generally accepted that empowering women can help prevent violence against them. The objective of the study is to unmask how different the role of economic performance of both men and women is impacting types of violence against women. With numerical data from the World Bank and Ain o Salish Kendra (ASK), we used Pearson correlation and OLS regression to extract the results from the raw data collected. The study finds that male unemployment is positively correlated with violence against women (including domestic violence, dowry-induced violence, and rape), while female unemployment shows an inverse relationship with the severity of violence. The findings emphasize the urgent need for policy interventions to address the underlying factors, effectively mitigate violence against women, inform policymakers and contribute to the development of effective strategies to promote a more equitable society.

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Introduction

Violence against women (VAW) is one of the most common global health concerns that significantly affect women’s health and wellness (Sardinha et al. 2022 ). VAW refers to cases of physical, emotional, or psychological violence that is directed against female-bodied individuals, leading to their abuse and oppression. As a result, it affects their mental and physical welfare (Cepeda et al. 2022 ). Due to this devastating phenomenon, VAW is considered a severe global human rights violation that protects individuals from such incidents (Sifat 2020a , b ). It is critical to analyze the rates of VAW in countries in transition or developing countries, such as Bangladesh, to see the background of the issue covered in the study.

Chowdhury et al. ( 2021 ), in their study in the urban slums of Bangladesh with 87 respondents, reported that 57.5% suffered from domestic violence by their husbands. The study revealed that age at marriage had a significant association with domestic violence. Compared with women from nuclear families, the odds of domestic violence for women from families with four members or more were 4.1 times higher. Akhter et al. ( 2022 ) investigated coping strategies of economically empowered Bangladeshi women who experience intimate partner violence. The results of the study demonstrate that financially stable victims either remain with offenders due to a divorce-linked stigma or lack of child custody and property rights or do not even consider marriage and cohabitation with their family members and close relatives in avoidance of challenges divorcees face.

The question arises whether economic abuse significantly affects violence in the form of physical, emotional, and sexual abuse (Alkan et al. 2021 ). Numerous studies have found a substantial relationship between economic abuse and both body and psychological injury. The misuse under discussion may frequently overlap with additional forms of violence and maintaining behavior. Women who suffer from economic abuse are significantly more likely to be afflicted by additional types of violence in addition to consequential psychological, physical, or sexual mistreatment (Stubbs & Szoeke 2022 ; Adams and Beeble 2019 ).

Bangladesh is about to achieve least developed country (LDC) graduation (Rahman and Strutt 2024 ). Amid such positive dimensions, one of the main questions about its development is shared prosperity between the genders. Indeed, inequality is among those few hurdles that restrict inclusivity in development to a great extent. Different datasets show that women's employment has dramatically increased in Bangladesh, yet VAW has not decreased. This employment–empowerment paradox is persistently evident from several studies (Khisa et al. 2020a ). According to Khisa et al. ( 2020a ), domestic violence reached a 30% rate in Bangladesh during the pandemic, which is a sixfold increase over the reports from the previous five years. The number of husband-committed murders was increased by 19%, the number of in-law murders rose by 20%, the number of in-law torture incidents was increased by 200%, and the number of suicides was increased by 54% as compared to 2019. Considering this pattern as problematic, Khisa et al. ( 2020b ) aimed to understand the paradox from a general view. Various organizations and researchers have developed and analyzed data and knowledge about various instances and events of VAW in Bangladesh over the years, based on data found from media reports, court cases, and recorded incidents by the police. However, most of these reports are inconsistent, uneven, selective, and sometimes overlap due to a lack of standard reporting practices.

This study unveils the role of economic performance in different types of VAW. There is a lack of data surrounding this topic, and this study thus has enough potential to understand the pattern that can contribute to policy reformation. As such, we consider this study significant for the policymakers' target audience.

Violence against women and development: the nexus

Oxfam introduced a critical perspective in this context, which examines development with the indicators of the United Nations Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) (Haylock et al. 2016 ). Oxfam recognizes that gender inequality is the root cause of domestic violence against women (DVAW). There is a linear, inverse relationship between the two, and an actual reduction in gender inequality will result in a lower volume of DVAW. Thus, the volume or growth of DVAW can be an indicator of measuring gender inequality. Ensuring gender equality is one of the significant concerns of the SDGs and MDGs. Therefore, an increase in DVAW can be considered a threat (if not a partial failure of the interventions of SDGs and MDGs) in this regard (Haylock et al. 2016 ).

Eswaran and Malhotra ( 2011 ) argued that although feminist theory has the ineptitude to invoke evolutionary arguments, evolutionary theory competently supports feminist theory with the evolutionary underpinnings of patriarchy. Several authors worked to reveal the aspects and multivariate dimensions of DVAW in third-world country contexts. Most of them looked for the correlation, and their sampling ranged from an area to the country. In this section, the authors try to identify the reviewed papers as per their point of analysis. Indeed, over the past two decades, many authors have worked on the above-mentioned factors, with particular reference to, if not all, third-world countries, at least South Asian countries.

Among those scholars, Koenig et al. ( 2006 ) tried to find a correlation between various socio-demographic aspects, i.e., education of spouses, marital duration, economic pressure, place of residence (rural or urban), childlessness, husband’s extramarital relationship, societal norms, and DVAW. Their field of study was North India. Another two scholars, Eswaran and Malhotra ( 2011 ), similarly studied demographics in India, trying to reveal the correlation of some factors, including wives’ height, economic participation, work status, signaling to in-laws/being judged by their in-laws, the distinction between job and self-employment, residing in a joint family or a nuclear one, religious beliefs and adherence, and the magnitude of the standard of living index with DVAW. They further evaluated the role of policy formulation in curving the DVAW graph flattening.

In 2016, one such study conducted by Haylock et al. ( 2016 ) tried to find the role of social norms and a means of changing social norms to reduce DVAW. In a broader perspective, along with the societal norm aspects, Bangladeshi author Khan ( 2015 ) analyzed influencing factors for DVAW, i.e., education, higher socioeconomic status, non-Muslim religion, dowry arrangement, women's empowerment, microcredit, and extended family residence. A decade earlier, a similar study was conducted by Bates et al. ( 2004 ) in the same region, who analyzed the factors of income, dowry, and education.

Economic participation, women empowerment, and VAW

Microcredit programs are driven by non-governmental organizations (NGOs), which have accelerated female participation in the economy and income-generating activities. Several studies have shown the impact of such credit programs on GBV. Cash transfer programs alone did not reduce domestic violence in Bangladesh; their combination with nutrition-specific and maternal–child health programs was beneficial. Cash transfers, severe malnutrition, and targeted maternal–child health programs decreased violence. This further supports the idea that while women have gained increased access to economic resources and become more responsible for the household’s finances, patriarchy has experienced no change or has worsened its power relations by encouraging violence (Roy et al. 2022 ).

Schuler et al. ( 1998 ) conducted an ethnographic study in which they supported the previous findings to some extent but also rejected some of them. According to Schuler et al. ( 1998 ), participation in credit programs can both lessen and increase VAW in the family. Since in-laws believe that wives violate traditional patriarchal norms by engaging in economic activity in public domains, microcredit has been proven to have some influence on stress. This aspect of society was further revealed and justified by Bates et al. ( 2004 ) in a later study, where they reported that normative factors and context are pivotal in shaping the effects of individual-level factors, regardless of what these factors are. Despite accepting the factors by Schular et al. (1998), the findings of Bates et al. ( 2004 ) are similar to those of Khan et al. ( 1998 ), which to some extent rejects the report given by Schular et al. ( 1998 ).

As per Bates et al. ( 2004 ), because women's participation in microcredit programs is becoming more widespread, there is no correlation between them and domestic violence. As a result, it is not regarded as offensive and does not raise the probability of violence against women. In this study, 4,195 women were surveyed, and it was discovered that those who received microcredit experienced much more physical domestic violence (Koenig et al. 2006 ). However, the deviation between the percentages is minimal but still higher.

Instead of focusing on the role of microcredit, a few groups of scholars explored the role of women's participation in the economy, their perceived autonomy, and their empowerment over DVAW and GBV. Menon and Johnson ( 2007 ) analyzed data from the Indian National Family Health Survey (NFHS) to establish that none of the earlier findings was accurate. This is a somewhat perplexing finding, given that women who have greater autonomy experience more spousal abuse. Eswaran and Malhotra ( 2011 ) and Rahman et al. ( 2011 ) both demonstrated that women's empowerment does not necessarily equate to a reduction in the risk of domestic violence, such as intimate partner violence (IPV). The findings showed that as the wife made more decisions, her husband began to physically and sexually harass her more frequently. We can also use evolutionary theory to support this thinking.

Data source

The main point of this study is secondary information gathered from the Ain O Salish Kendra (ASK) database (Ain o Salish Kendra 2023 ). One of the Bangladesh's top human rights organizations, ASK, regularly maintains a database on the various forms of violence that exist in contemporary society. They gather information from daily newspapers and TV networks. For VAW, ASK contains datasets from 2013 to 2020. Since no alternative datasets relevant to this context are publicly available online, and it is hard to acquire primary data in a pandemic situation, the authors decided to use this dataset for their analysis. Therefore, the authors believe it is possible to modify this dataset for this research instead of using any other survey methodology.

Data collection

All the data on VAW (domestic violence, dowry-induced domestic violence, and rape) we collected are available on the website of ASK in the form of PDF files for the period 2013–2020. They maintain a data bank for different types of violence that occur against women in Bangladesh. We sourced the data from the reports titled “Violence against women – Domestic Violence,” “Violence Against Women -Rape,” and “Violence Against Women – Dowry” for the years 2013–2020. We sorted the data using the Microsoft Excel 2019 version via manual input. We first formed the table per ASK format and then eliminated all the subcategories ASK considered. As such, we required no effort to segregate or form these categories. When we found all these data segregated, they then aimed at organizing this research by keeping them as they are, intending to get an inclusive and more in-depth analysis of the context. ASK segregates data based on the age of the victims, but here, we opted for the total number of the victims, not the ages of them. As such, we ignored the age-based subcategories in the data.

While working with the independent variables, we first took a handful of variables to see whether the regression analysis showed any results. At first, we took 26 variables from the World Bank Databank. Data from the years between 2013 and 2020 were considered for each of the variables. These 26 indicators can be divided into three categories: (a) labor force participation, (b) the ratio of female to male labor, and (c) the unemployment rate. For category a, we had 14 indicators; for b, it was only 02; and for c, we had 10 indicators (Sifat 2021 ). Unfortunately, in the databank, continuous data for 17 indicators were missing. Thus, we removed all these indicators in the first place. For the rest, we went for OLS regression and Pearson Correlation simultaneously. Then, they only found 04 indicators fitting in this study, i.e., unemployment for both males and females (ILO estimates), labor force participation by females as a percentage of the total labor force, and the ratio of female to male participation in the labor force from the World Bank. Eight reports from ASK were consulted for VAW data, and four datasets from a single source, the World Bank's databank, were consulted for unemployment data. No bias analysis was performed as it was not deemed a requirement for this study.

Key concepts

•Violence against women (VAW): In its broadest sense, this refers to any kind of abuse (physical, mental, sexual) faced by women when any other members of society perpetrate such abuses. It has certain tiers: (a) domestic violence, (b) dowry-induced domestic violence, (c) rape, and (d) sexual harassment. This paper examines three VAW tiers listed below and their impact on women’s economic activities. The tier of sexual harassment was omitted from the study due to the unavailability of data for the years investigated.

DVAW: If violence is perpetrated by any of the family members for any reason, either parental or marital, it is denoted as domestic violence.

Dowry-induced DVAW: If violence is perpetrated by any of the in-laws for dowry reasons, it can be denoted as dowry-induced domestic violence.

Rape: A man commits rape who, “except in the case hereinafter excepted, has sexual intercourse with a woman under any of the five following circumstances”:

“Firstly, against her will.”

“Secondly, without her consent.”

Thirdly, with her consent, when her consent has been obtained by putting her in fear of death, injury or under duress.

“Fourthly, with her consent, when the man knows that he is not her husband, and that her consent is given because she believes that he is another man to whom she is or believes herself to be lawfully married.”

“Fifthly, with or without her consent when she is under fourteen years of age.”

“Explanation: penetration is sufficient to constitute the sexual intercourse necessary to the offence of rape. Exception: sexual intercourse by a man with his own wife, the wife not being under thirteen years of age, is not rape.”

Economic performance : Economic performance refers to any kind of income-generating activities by any of the member of labor force, either by formal or informal activities.

Operationalization of the concepts

In this paper, the we have considered three particular types of physical violence to avoid complexity. These are (a) domestic violence, (b) dowry-induced domestic violence, and (c) rape. We perceive that (a) and (b), unlike the others, are highly influenced by economic factors, at the least in contemporary Bangladeshi society (Bates et al. 2004 ).

DVAW : In this paper, the term DVAW indicates only the physical violence faced by women. DVAW here comprises of seven types of physical abuses such as (a) torture by husband, (b) torture by in-laws, (c) murdered by husband, (d) murdered by in-laws, (e) murdered by own family, (f) torture by own family, and (g) suicide.

Dowry-induced DVAW : In this paper, the term dowry-induced domestic violence against women indicates only the physical violence faced by women for monetary reasons. It comprises four types of physical abuses such as (a) physical torture, (b) absconded by husband's family, (c) suicide after physical torture, and (d) murdered after physical torture.

Rape: In this paper, the term rape indicates only the physical and sexual torture faced by women. It comprises of several types such as (a) rape, (b) gang rape, (c) suicide after rape, and (d) murder after rape.

In this study, we also consider economic performance and how it affects VAW. Economic performance refers to any income-generating activity by any member of the labor force, whether formal or informal.

Indicators and measurements

This exploratory study is a mixed-methods research. A detailed quantitative analysis backs the qualitative discussion. For the quantitative part, all the data are collected from “Ain O Salish Kendra (ASK)” (see “Data source” section). ASK has data available from 2013 to 2021, which limited this study to 2013–2020, which provided complete calendar year data. The 2021 data were excluded as it included year-to-date data. From the ASK data, the total number of cases included in this study was 12,619, of which 3,468 of variable domestic violence, 2000 cases of dowry-induced violence, and 7151 cases of rape were considered in this study. These are the cumulative numbers of total violence in this country between 2013 and 2020. No data for sexual harassment are available as detailed in the methods, and thus, this subcategory is not considered a key concept in this paper. All of these data can be found on the ASK website per year, as shown in the “Data source” section.

All the collected data are first sorted in Excel on a year-by-year basis. Three separate sorting processes were run for each type of violence, i.e., domestic violence, dowry-induced domestic violence, and rape. Only the total values were taken from the ASK datasets of each form of violence of each year as monthly reports were not included in the study; subcategories of all included data (age-based segregation and different subtypes of violence) were removed in the data sorting phase as outlined in the “Data source” section. We then applied a simple growth model and year-over-year (YOY) growth model by using the following formula to identify the growth pattern on the sorted datasets. The formulas are as follows:

When we identified the growth pattern, we also wanted to explore the impact of this pattern for which regression and correlation were studied, considering each of the three strata (DVAW, dowry-induced DVAW, and rape) as dependent and different economic performance indicators, i.e., unemployment rate of men, unemployment rate of women, ratio of female to male participation in labor force, and labor force participation by women as a percentage of total labor force as independent variables. At this point, not all variables are examined mutually in the same pattern but rather by following some distinct patterns in each variable.

Dependent and independent variables

Table 1 denotes the classification of the independent variables and operations followed in this study.

Initially, we have planned to run OLS regression for all the variables listed in Table  1 to understand the causal relationship. Later, it was found that OLS does not fit in some cases, and dowry is an exception. Thus, in the dowry section, two separate operations are performed. Before moving to the “Results” section, we consider it essential to clarify that we completely understand that correlation and regression are two different techniques and tell other stories. Because of the nature of the data, OLS could not be used for every variable considered, though it was our primary aim. Since causal relationships for all the variables could not be identified, we tried to unveil the interrelations or correlations among the variables to the least. We do not perform correlation as an alternative technique to regression. Correlation is applied here to produce “some insights” rather than “no insight.” While running the correlation, we checked normality. All the data used in this study was interval data with an interval period of one year.

Table 2 contains the results of the Pearson correlation among different variables. This study performed five correlation analyses. With DVAW, the authors performed two correlation analyses: the first with the unemployment male variable and the second with the unemployment female variable. The result for the unemployment male variable is weakly positive, which means DVAW increases if the male counterpart of any family remains unemployed (Table  2 ).

On the other hand, the authors get an altered scenario; that is, if female employment increases, domestic violence increases simultaneously, in a proportional and non-singular, monolithic, weak manner. Regarding dowry-induced cases, the authors performed three correlation analyses: the first with the unemployment male variable, the second with the unemployment female variable, and the third with labor force participation by women as a percentage of the total labor force. The result with the unemployment male variable is a strong positive, which means that when men are unemployed, they demand a dowry.

Again, we see the result of the unemployment female variable is moderately negative, which means that when women are employed, men do the same thing, i.e., demanding a dowry. Finally, the result for women's labor force participation as a percentage of the total labor force is strongly positive, indicating that when women enter the workforce, men are more likely to strongly demand a dowry.

The analysis in Table  3 shows the relationship between an increase or decrease in employment and an increase or decrease in VAW. Among these two variables, employment and economic factors are considered independent, and violence-related factors are considered dependent. In terms of the dependent variable, we considered two types of violence: dowry-induced domestic violence and rape. For the independent variables, we considered the unemployment rate among men and the ratio of female to male participation in the labor force. The β coefficient depicts a proportionate relationship between these two variables.

The analysis shows that for every unit, i.e., a 1 unit increase in unemployment among male members, dowry-induced domestic violence increases by up to 5.28 units. In the case of rape, a one-unit (1 unit) increase in female labor force participation over males raises the bar to 5.24 units. Likewise, a per unit (1 unit) rise in unemployed males increases cases of rape to 3.69 units. Notably, all of the variables have a direct relationship with each other; an increase in the independent variables causes an increase in the dependent variables. The answer is the deeply rooted subordinate position of the women in the society for which, despite earning, they remain victims of violence caused by their intimate partners.

The study aims to determine whether the participation in economic activities by both males and females is connected with the ever-existing VAW in Bangladeshi society. If it does, what is the nature of the influence, and to what magnitude? The publicly available ASK data analysis indicates that male and female involvement or lack of participation in any activity that generates income directly relates to how the female is treated in their surroundings. Since the ASK data are not categorized based on social status, i.e., education and household income, the findings are general, and it is difficult to draw any inference where the existence or trend of VAW can be identified for different household categories. However, the findings suggest that the unemployment of men in Bangladeshi society increases violence toward women. On the other hand, female employment is seen to increase VAW. The opposing results from the activities of male and female employment and their consequences raise questions regarding men's and women's positions in this society. The following discussion comprises four issues, consequently: female employment increasing domestic violence, female employment increasing dowry-induced violence, male unemployment increasing domestic violence, and male unemployment increasing dowry-induced violence.

The tendency of VAW has, at its core, the subordinate position of women in this society. In societies, men are commonly viewed as breadwinners and women as child-carers. Men bring money to the household, and women care for the home. This division of labor can make men think of themselves as being in a superior position of power, as it is supposed to be acceptable that women run the house and men run the world. However, in the current modern and mobilized world, women are coming out of the house and working alongside men. They are contributing to the earnings of their households as well as the national economy, which is, in fact, necessary to make a nation reach the core of development. But on the other side of the coin, the picture is darker. Women stepping out of the house and showcasing their ability is seen as threatening the masculinity of men. This makes the men insecure about their superiority to women. For this reason, often, as a gesture of marking their territory and demolishing the contributions of women, men tend to abuse their position of power through VAW. When a woman becomes self-employed, she is likely to become independent; therefore, she is expected to have opinions on how her earned money will be spent, which leads to women's gaining the opportunity to make decisions on household expenditures. This participation by women is often unacceptable to the alpha male ego in this society, and as a medium to make women docile and subservient, men use violence against them (Agu et al. 2020 ).

Moreover, the author discovered that women working outside the home tended to suffer from domestic violence with the utmost probability by the prior history of jealousy and paternity doubt and argued that as for the high-income groups, there was an adverse correlation between women’s income and domestic assault when husbands’ wages were higher the wives are ups and over the contrary type of correlation developed when males were down (Roy et al. 2024 ). When a woman is a housewife, her acquaintances are limited and mainly familiar to her husband. On the other hand, a working woman needs to communicate with and deal with many people in her workplace due to her job. As such, the husband of a working woman is not very familiar with his wife’s network. This raises an issue in the insecurity of men, causing jealousy and doubt among spouses, which can lead to different types of DVAW.

In the case of dowry, this has been a custom of men enforcing their superiority over women as their subordinates in Bangladesh. As mentioned before, when a woman participates in income-generating activities, she has a hand in the household's decisions, which men with superiority issues do not want to let women have, as the decision-making power is typically handed over to the men in this traditional society. As they cannot manage their wives' earnings directly, the husbands try to enforce their power on the wives through dowry. They put pressure on their wives to bring possessions from their in-laws. An independent woman would never want to put this pressure on her family members. Thus, it often leads to conflict, which can lead to psychological, physical, and sexual abuse for the wives (Khisa et al. 2020b ).

This study’s findings show that men’s unemployment status increases the DVAW slightly. As mentioned before, men are generally the primary earners of a family. Hence, unemployment for a man brings financial crisis not only to the man but also to the whole household. This economic crisis can drive a man to frustration, which can then be directed upon his wife in the form of violence. Changing the man’s relative income might defy gender stereotypes and provide the impression that domestic violence is the result of “male backlash” (Meyer et al. 2024 ). According to a 2020 study done in India, the likelihood that a man will commit violence rises by almost 30% when he loses his employment (Bhalotra et al. 2020 ). Additionally, the husband’s inability to work forces him to stay at home more frequently, which increases their “exposure” to one another and their potential for violence (Miedema et al. 2021 ). As a result, unemployment among men leads to the shock of lost money, negotiation, and exposure, all of which help overcome men’s propensity for using violence toward women as a coping mechanism. Unemployment of men also contributes significantly to dowry-induced violence, much higher than domestic violence, according to the author’s analysis. Inevitably, a man who loses his job will often go through an economic crisis, and to find a way out of this, he demands a dowry from his in-laws. However, depending on their circumstances, no married woman can put financial pressure on her parents, and if her spouse asks them, they will undoubtedly protest (Khisa et al. 2020b ).

Based on the literature, a male is likely at his most vulnerable when he interprets his wife's alternative viewpoint as a critique of his masculinity. As a result, he begins using violence against her to demonstrate his masculinity, force her to obey him, and force his in-laws to agree to his demands. Thus, we can see that the impact of the job loss of the man fuels the financial crisis of the family, which can directly fall on the woman of the house in the form of violence (Bhalotra et al. 2020 ).

Prevailing picture of the context

Regarding the overall analysis of dowry-related domestic violence in recent years, both the simple growth model and the year-to-year model present a very unpredictable tendency. The two models' different methodologies result in changes in magnitude, although the patterns are otherwise very similar. With the exception of 2018, domestic violence in Bangladesh related to dowries has been trending upward. However, this environment has declined over the past two years, which appears to have changed in light of the COVID-19 pandemic in 2020. Four categories further separate domestic violence related to dowries. The subcategorized sections are (a) physical torture, (b) absconded by the husband's family, (c) suicide after physical torture, and (d) murder after physical torture.

In contrast to the totality, the increased rate of occurrences in this study is more stable, according to an analysis of the total number of dowry-related domestic violence incidents. Both models depict events other than a singular, extraordinary incident in 2016. However, there has been a downward trend in the last few "pre-pandemic" years (prior to 2020) as a significant increase occurred amid COVID-19. An exception is seen in one particular case.

The impact of COVID-19 on the physical growth of one of the subcategories, “absconded from husband’s house,” differs from the others. Surprisingly, the COVID-19 pandemic had no impact on this type of violence. However, the results of a simple growth model and a year-over-year growth model have remarkable differences in magnitude. Compared to 2013 (portrayed by the simple growth model), 2017 had a significant rise, and the subsequent two years had a sudden and significant fall, which has gone to zero amid the pandemic. On the contrary, the year-over-year model illustrates a reduced “rise and fall” trend. As such, it can be argued that, over the years, the occurrences have been reduced, and amid the pandemic, the context remains unchanged in Bangladesh.

Apart from domestic violence and dowry-induced violence inside the house, women are vulnerable to violence outside the house even more. In particular, employed women face various types of violence almost every day. A study conducted on 180 working women showed that 84.4% of women faced violence in their workplace, starting from monetary penalization and unfair discrimination to psychological, physical, and even sexual assault (Rahman 2019 ).

Even cases of doctors or nurses being raped while on duty at night frequently make headlines (Karim 2019 ). This is not limited to just the workplace, as women also fall victim to brutal violence in the transport system and on the roads, often on their way back home from their workplace. This violence mainly includes rape, attempted rape, and murder after rape. As soon as crimes like these are reported, a large proportion of society, majorly comprised of men, throws blame at the women for being victims because of their staying outside at night or, sometimes, simply being willing to have a job and earn money (Banarjee 2020 ).

It can also be addressed as words and actions resulting from threatened masculinity. The idea of women roaming around the workplace side-by-side with men, proving their ability, is not acceptable to these men, and they attempt to restrict the freedom of women by using violence against them. As can be seen previously, most of the longitudinal studies on domestic violence conducted in Bangladesh to date have been thoroughly reviewed. Domestic violence in contemporary Bangladesh, according to the report (Sifat 2020b ), is a subtle, multifaceted problem that causes trauma to women from several dimensions. In the respective studies reviewed in this paper, numerous scholars have captured several significant dimensions of this problem, and we now have some unambiguous knowledge of certain facets of this issue because of their scholarly efforts. Many problems of domestic abuse against women, however, have yet to be discussed.

For instance, when a woman refuses to have sexual intercourse with her husband, she faces physical and emotional hardships (Banarjee 2020 ). Moreover, she remains deprived of financial support from her husband, and even her own income is taken away. The existing studies on this issue do not expose the dimensions underlying this problem. The lack of research on women's perceptions of economic exploitation is also noteworthy. Important international documents have also distinguished between different forms of violence, including economic violence. An in-depth study report, for example, has already identified this kind of domestic violence (Sardinha et al. 2022 ; Sardinha and Catalán, 2018 ). The Government of Bangladesh's main policy action, the 2010 Domestic Violence (Prevention & Protection) Act (Banarjee 2020 ), has specified the various practices of economic violence. Examining this specific kind of domestic abuse within the contemporary Bangladeshi context is necessary to have a meaningful understanding of its prevalence and scope (Haque et al. 2022 ).

Studies conducted in Bangladesh have compared psychological and emotional abuse (Sifat 2020b ). The group experiencing emotional violence would benefit more from some of the psychological abuse techniques utilized in this study. Therefore, readers may become perplexed about the distinction between psychological and emotional abuse in these situations. For instance, Mannan ( 2011 ) defined psychological abuse as excessive control, verbal abuse or scolding, curtailing or disrupting routine activities, social relationships, and access to money. Khan and Aeron ( 2014 ) included insulting women and their parents, criticizing, limiting movement, and shaming as forms of emotional violence. There may be some overlap between the practices listed.

The existing policies of the Domestic Violence Act of 2010, also known as the “Prevention and Protection Act,” were enacted in Bangladesh to offer legal redress and protection to the victims (Khan & Ratele 2020 ). This Act defines domestic violence to encompass incidents involving a family member, including physical, psychological, sexual, and economic abuse. The legislation allows victims to file for a protection order, which the court can grant to prevent the perpetrator from harming the victims (Banarjee 2024 ). Also, the Dowry Prohibition Act of 1980, made more stringent in 2018, is intended to eliminate dowry, which is deeply ingrained in Bangladeshi society and has long been a widely recognized cause of violence against women. Punishing demand for or acceptance of any dowry is the focus of the Act (Akram and Pervin 2021 ). The 2018 amendment complemented the law by adopting a more substantial punishment for dowry-related offenses. It has been, in a reasonable sense, the intent of the government to make the Act more efficient, adapting it against the practical difficulties encountered with its execution and enhancing the Act’s deterring aspect. The reformation aims to create a basis for the law to be sustained and to change societal attitudes (Naznin 2021 ; Jahan 2017 ).

However, enforcement and implementation have remained some of the most significant challenges in Bangladesh. Factors such as established societal norms and culture, lack of access to justice and awareness on the path of victims, inadequate resources, and the court’s eventual delay have persistently affected the independence of these laws (Naznin 2021 ; Banarjee 2020 ). In this regard, activists and legal scholars have called for a more active form of implementation, support systems for those affected, training, and sensitization for the members of the society to attain the intended purpose. Some of the most immediate steps to protect women from domestic violence and rituals such as dowry are through supporting the legal provisions and putting more effort into enforcement and implementation. Therefore, a clear demarcation between these two types of violence is needed, and this study contributes to filling this gap. This study empirically proves that domestic violence, dowry-induced domestic violence, and rape are very different in terms of causal factors, at the very least, in Bangladesh. Violence against women is not a single concept, and there is no single panacea. Each type of violence asks for different types of intervention prior to understanding the causal factors and driving forces. This study seeks further studies against each type of violence to unveil the root causes and, however, pivotal to make readers understand that VAW is a multidimensional concept comprising diverse aspects. Each component under VAW has its nature and causal factors. However, we acknowledge that the results found here will vary for different other countries and hypothesize that it will remarkably vary depending upon the socioeconomic context of these countries. Since these studies are rare to find to the author’s knowledge, this study will be one of the most contributory studies in this kind of macro-level policy-oriented research to counter VAW in transitional economies like Bangladesh.

Limitations of study

The study also has some drawbacks. Due to time constraints, we had to compromise with the quality of the study in terms of the literature review, data collection, and analysis, though to a very small extent. Besides, the lack of availability of data was a limitation to integrating more dimensions and more samples than those included in this study, such as sexual harassment, as outlined in the “Data source” section. Primary data could not be collected due to movement restrictions during the COVID-19 pandemic, and the authors could not access several data sources due to a lack of resources, especially financial resources, limiting the study to secondary publicly available data.

This study highlights the critical need for more in-depth, multifaceted research to gain a comprehensive and nuanced understanding of women's coping mechanisms, help-seeking behaviors, and lived experiences with both formal and informal help-seeking strategies in response to the diverse forms of violence they may face. Our findings particularly underline the pivotal role that the economic performance and financial security of both men and women can play in influencing the prevalence and dynamics of the different forms of violence perpetrated against women within various social and cultural contexts. Empowering women and reducing the scourge of violence in Bangladesh necessitate a multipronged approach that combines immediate deterrents and substantial, long-term policy reforms. A rigorous examination of the complex social, cultural, and economic factors that contribute to and perpetuate the pervasive issue of violence against women is essential if meaningful and lasting progress is to be achieved. Addressing this critical problem and designing effective policies to protect and empower women cannot be accomplished without a comprehensive, evidence-based understanding of the scale, patterns, and root causes of domestic violence in Bangladesh.

Data availability

The data that support the findings of this study are openly available in figshare at https://doi.org/ https://doi.org/10.6084/m9.figshare.15156885.v1

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Miah, M.R.A., Sifat, R.I. Economic dimensions of violence against women: policy interventions needed. J. Soc. Econ. Dev. (2024). https://doi.org/10.1007/s40847-024-00368-y

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Accepted : 26 July 2024

Published : 07 August 2024

DOI : https://doi.org/10.1007/s40847-024-00368-y

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Domestic Violence Victims Reported Abuse. Caseworkers Watched Them Too.

New York parents who report abuse to protect themselves and their families often become the targets of child welfare investigators. A lawsuit is trying to change that.

By Andy Newman

“You’re not accused of anything,” the judge told the mother of an infant in family court in Brooklyn last summer.

The woman was the victim of domestic violence. She was in family court because she had told her therapist that her ex-boyfriend beat and slapped her and yanked her dreadlocks out in front of their 9-month-old daughter. The judge issued an order of protection barring him from the home.

But despite the mother’s blamelessness, the judge also pronounced a sort of sentence on her: She and her daughter would receive “announced and unannounced visits” from the city’s child welfare agency, the Administration for Children’s Services, during which investigators could search their apartment, interrogate the mother and physically examine the child for signs of abuse.

Thousands of times a year across New York State, advocates for families say, parents — usually women — who have been abused by their partners are then subjected to surveillance from child welfare authorities.

It is considered child neglect for one parent to abuse the other in the presence of their children. Often, after a victim reports abuse, A.C.S. files a child neglect case against the accused parent and a judge bars that person from the home and grants the agency “supervision” over the parent who was abused.

An appeal filed on behalf of the Brooklyn woman in state appellate court in December seeks to change that. Oral arguments in the case are expected to be heard within a few months.

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Perth mother given bravery award for helping friend survive domestic violence assault

In January last year, Ebony Jones was at home when she received a call from a friend's daughter, saying she was being attacked by her partner. 

Ms Jones got straight in her car and drove to her friend's house, and stayed there until police arrived. 

She has now been honoured with a commendation for brave conduct.

One night in January last year, Ebony Jones received a phone call she would never forget.

"It was my friend's daughters crying and saying, 'Can you please come? I need help. My dad's bashing my mum,'" Ms Jones said.

Without hesitation, Ms Jones got in her car and drove to her friend's house, while continuing to reassure the young girl on the phone that everything was going to be okay.

That 20-minute drive felt like a lifetime for the 30-year-old.

"I felt like I couldn't get there quick enough," she said.

"The fear in this little girl's voice was just heartbreaking [and] I just kept on having these thoughts of, 'What if I don't get there in time?'"

When Ms Jones finally arrived at the home, she walked in to find her friend being assaulted by her husband with her young baby still in her arms.

She attempted to stop the offender and protected her friend and the two children until police arrived.

Now looking back, the single mother acknowledges she put her life at risk, but says she would do it again in a heartbeat.

"Honestly, I had no fear, no second thoughts about going there," she said.

"I just knew that I had one job and that was to get there and to make sure that those kids were safe and my girlfriend was OK."

Bravery honoured

This week, Ms Jones was awarded a commendation for brave conduct for her actions that night.

She is one of 46 people from around the country who have been recognised for their courage by Governor-General Sam Mostyn.

"Australian bravery decorations honour those Australians who put themselves in danger to protect the lives or property of others," Ms Mostyn said.

"Recipients come from different parts of our country and diverse backgrounds. 

"They are connected by their selfless, courageous, resilient and determined response in extraordinary circumstances. 

"Each is inspiring. I am delighted that these exceptional people will forever know they have earned the gratitude of every Australian."

While she was grateful for the recognition, Ms Jones said she had initially struggled to accept the award.

"Obviously I did a lot, and I helped a lot, but I just feel like it was something so natural for me to do that I don't feel like it's that big of a deal," she said.

"If anything, if I could have gotten there quicker, I would have."

The single mother, who is a domestic violence survivor herself, said she often downplayed her achievements and rarely gave herself credit for the things she did for people.

"I feel like this award is putting me in a position now to really look back at the things that I've done and allow myself to be proud of what I've done," she said.

"This is probably a huge thing that I've achieved, apart from having my son and being a single mum and all that kind of stuff … having a lot of people recognise what I've done, it is a nice feeling."

Call for more help

However, Ms Jones said the real reward would be seeing more support and funding invested in family and domestic violence services.

She said the incident last year trigged memories of her experiences in two abusive relationships and she wished she could have had someone to help and support her during those times.

"I think domestic violence has risen so much over the last few years, and there's so many more women who are finding the courage to speak up and to ask for help, but there's so many women who don't, and they sit there and suffer in silence," she said.

"But then it does hit you sometimes and it does get you a little bit emotional because it is a lot.

"I feel emotional for people that have to go through domestic violence, I feel emotional for their children that they have to grow up with that.

"I never want my son to be around that kind of stuff, and at some point we need to start breaking that cycle in families and children."

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Pima County deputy shot while responding to domestic violence incident

A deputy with the Pima County's Sheriff's Office was injured during a shooting after responding to a domestic violence call midday Tuesday the agency said.

Pima County Sheriff Chris Nanos held a brief press conference outside Banner Main Hospital in Tucson, where he said the deputy was being treated for non-life-threatening injuries. Nanos said the deputy was responding to a 911 call regarding domestic violence at a home near Jeffrey Road and Camino De Oeste at around 11:50 a.m. when an armed man ambushed him and shot him at least once during the confrontation.

The agency said in an updated news release that the deputies who arrived at the scene of the domestic violence call spotted two men fleeing from the area in a vehicle, which the two men abandoned, starting a short foot pursuit with deputies in which the shooting occurred.

Nanos said the deputy was able to get away and immediately call for backup. It was not immediately clear how many rounds the deputy fired.

Responding deputies arrested one man but said another remains outstanding and is believed to be armed and dangerous. Nanos added that the area where the shooting occurred remained locked down and that law enforcement were going door-to-door searching for him. Nanos advised any residents who received a knock at their door to check who it was before opening it.

The agency issued a community alert describing a bearded man in his twenties in his late 30s, approximately 5 foot 9 inches tall with an average build, wearing a dark shirt and either tan shorts or pants and urged anyone matching this description to not approach him and instead call 911.

Nanos said he didn't know if the man in custody was the one who shot the deputy. He urged anyone in the area who noticed anything suspicious to report it to law enforcement immediately.

It was not immediately clear where the deputy was struck or the exact nature of his injuries, though Nanos said he was relieved to report the deputy was doing well and would survive.

The updated news release stated the deputy sustained non-life-threatening injuries. No one else was injured as a result of the shooting.

The Tucson Police Department will conduct an investigation into the officer involved shooting, as per the PCSD's participation in the Pima Regional Critical Incident Team, which conducted shootings involving a law enforcement.

Anyone with information regarding the suspect was asked to call 911 or 88-CRIME.

Recommended

‘proud’ blake lively addresses the domestic violence in ‘it ends with us’ amid press tour backlash.

Blake Lively subtly hit back at backlash surrounding her “It Ends With Us” press tour.

Amid claims the actress has not focused on the film’s serious themes — namely its depiction of domestic violence — she reshared a clip Tuesday on her Instagram Story from an interview with BBC News .

“She is not just a survivor, and she’s not just a victim, and while those are huge things to be, they are not her identity,” Lively, 36, said Friday of her character, Lily Bloom.

View this post on Instagram A post shared by BBC News (@bbcnews)

She added that Lily “is not defined by something someone else did to her or an event that happened to her, even if it’s multiple events.”

The “Gossip Girl” alum noted, “She defines herself, and I think that’s deeply empowering. … No one else can define you. No experience can define you. You define you.”

Lively wrote a lengthy message over the footage, beginning by thanking “everyone who came out to show that people WANT to see films about women and the multitudes we hold.”

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She continued, “‘It Ends With Us’ is the story of the female experience. All the highest highs and the lowest lows. And we are so proud of it.

“We have been in celebration of this film and of getting a message so important out there to the masses,” Lively concluded. “Thank you all for embracing @itendswithusmovie with the same pain, love and joy we had sharing it with you all.”

In the subsequent slide, she shared stats on intimate partner violence as well as a link for the hotline and access to “immediate help.”

Prior to the upload, Lively had been called out by social media users for focusing on floral fashion , her Blake Brown haircare line and her husband Ryan Reynolds’ “Deadpool & Wolverine” movie while promoting “It Ends With Us.”

One X user wrote , “Blake Lively spending the entire press run for her new film, which is about domestic violence and abuse, acting like it’s a fun gals night out like seeing ‘Mamma Mia’ and promoting her businesses at the same time is INSANE behavior.”

Others slammed an “out of touch” video of Lively cracking jokes when asked what she would say to people who “relate” to the movie’s heavy themes.

Many, however, have praised the film’s director — and Lively’s co-star — Justin Baldoni for addressing the movie’s message in numerous interviews.

Notably, the “Jane the Virgin” alum has not done press with the rest of the cast.

An industry source claimed Friday to Page Six that Baldoni, 40, was “extremely difficult” and “none of the cast enjoyed working with him,” adding that he made Lively feel “uncomfortable” about her postpartum body following the birth of her son, Odin .

Throwback footage has since surfaced on social media of Baldoni and Lively appearing to argue on set earlier this year.

The filmmaker has reportedly hired veteran PR crisis manager Melissa Nathan for help amid the drama.

Baldoni’s and Lively’s reps have yet to respond to Page Six’s requests for comment.

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Blake Lively Shares Domestic Violence Hotline to Social Media Followers Amid ‘It Ends With Us’ Success

By Jack Dunn

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Blake Lively , star of the breakout summer hit “It Ends With Us, ” took to Instagram Tuesday morning to discuss the film’s domestic violence narrative.

Accompanied by a video of a BBC red carpet interview, Lively wrote in a story post, “Thank you to everyone who came to show that people WANT to see films about women, and the multitudes we hold. ‘ It Ends With Us ‘ is a story of the female experience. All the highest highs, and the lowest lows. And we are so proud of it. We have been in celebration of this film and of getting a message so important out there to the masses.”

Popular on Variety

Related stories, ai content licensing deals with publishers: complete updated index, 'road house' director doug liman says '50 million people' streamed the film, but 'i didn’t get a cent. jake gyllenhaal didn’t get a cent ... that’s wrong.'.

This post comes after a handful of vocal internet critics expressed concern surrounding the film’s “grab your friends and wear your florals” marketing. While on the press tour for “It Ends With Us,” Lively and other members of the production encouraged fans to “wear your florals” while seeing the film, in reference to her character Bloom, who is a florist. Social media critics have chastised the campaign, saying that the focus on the fun, lighthearted flower motif is completely inappropriate for a film about domestic violence.

“It Ends With Us” is based on Colleen Hoover’s 2016 bestseller of the same name. The story is centered around Lily Bloom (Lively) who falls in love with Ryle Kincaid (Justin Baldoni) and gets married. Over time, their relationship evolves into something more and more violent, and Ryle eventually assaults her. Hoover wrote the book based on her own experiences growing up and witnessing the challenges her mother faced with in her relationship with her father.

Rumors kicked up when Baldoni arrived to the film’s premiere with his wife Emily Baldoni, who appears in the film. While the director posted pictures in a pink suit solo, Lively posted with the film’s secondary love interest Sklenar, Slate and Hoover.

Regardless of the conversation surrounding the film, “It Ends With Us” has been an unexpected box office sensation, opening to the tune of $50 million in a traditionally sluggish late summer release window.

Plus, there have been many positive reviews about the film, including Variety’s Owen Gleiberman, who praised Lively’s acting writing, “She fills the screen with her acutely aware and slightly tremulous radiance.”

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Domestic violence against women in India: A systematic review of a decade of quantitative studies

Ameeta kalokhe.

a Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

b Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA

Carlos del Rio

Kristin dunkle.

c Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA

Rob Stephenson

d Center for Sexuality and Health Disparities, University of Michigan School of Public Health and School of Nursing, Ann Arbor, MI, USA

Nicholas Metheny

Anuradha paranjape.

e General Internal Medicine, Temple University School of Medicine, Philadelphia, PA, USA

Seema Sahay

f Department of Social and Behavioral Sciences, National AIDS Research Institute, Pune, India

Associated Data

Domestic violence (DV) is prevalent among women in India and has been associated with poor mental and physical health. We performed a systematic review of 137 quantitative studies published in the prior decade that directly evaluated the DV experiences of Indian women to summarise the breadth of recent work and identify gaps in the literature. Among studies surveying at least two forms of abuse, a median 41% of women reported experiencing DV during their lifetime and 30% in the past year. We noted substantial inter-study variance in DV prevalence estimates, attributable in part to different study populations and settings, but also to a lack of standardisation, validation, and cultural adaptation of DV survey instruments. There was paucity of studies evaluating the DV experiences of women over age 50, residing in live-in relationships, same-sex relationships, tribal villages, and of women from the northern regions of India. Additionally, our review highlighted a gap in research evaluating the impact of DV on physical health. We conclude with a research agenda calling for additional qualitative and longitudinal quantitative studies to explore the DV correlates proposed by this quantitative literature to inform the development of a culturally tailored DV scale and prevention strategies.

Introduction

Domestic violence (DV), defined by the Protection of Women from Domestic Violence Act 2005 as physical, sexual, verbal, emotional, and economic abuse against women by a partner or family member residing in a joint family, plagues the lives of many women in India. National statistics that utilise a modified version of the Conflict Tactics Scale (CTS) to measure the prevalence of lifetime physical, sexual, and/or emotional DV estimate that 40% of women experience abuse at the hands of a partner ( Yoshikawa, Agrawal, Poudel, & Jimba, 2012 ). Data from a recent systematic review by the World Health Organization (WHO) provides similar regional estimates and suggests that women in South-East Asia (defined as India, Maldives, Sri Lanka, Thailand, Bangladesh, and Timor-Leste) are at a higher likelihood for experiencing partner abuse during their lifetime than women from Europe, the Western Pacific, and potentially the Americas ( WHO, 2013 ).

Among the different proposed causes for the high DV frequency in India are deep-rooted male patriarchal roles ( Visaria, 2000 ) and long-standing cultural norms that propagate the view of women as subordinates throughout their lifespan ( Fernandez, 1997 ; Gundappa & Rathod, 2012 ). Even before a child is born, many families have a clear preference for male children, which may result in their preferential care, and worse, sex-selective abortions, female infanticide and abandonment of the girl-child ( Gundappa & Rathod, 2012 ). During childhood, less importance is given to the education of female children; further, early marriage as occurs in 45% of young, married women, according to 2005–2006 National Family Health Survey (NFHS-3) data ( Raj, Saggurti, Balaiah, & Silverman, 2009 ), may also heighten susceptibility to DV ( Ackerson, Kawachi, Barbeau, & Subramanian, 2008 ; Raj, Saggurti, Lawrence, Balaiah, & Silverman, 2010 ; Santhya et al., 2010 ; Speizer & Pearson, 2011 ). In reproductive years, mothers pregnant with and/or those who give birth to only female children may be more susceptible to abuse ( Mahapatro, Gupta, Gupta, & Kundu, 2011 ) and financial, medical, and nutritional neglect. Later in life, culturally bred views of dishonour associated with widowhood may also influence susceptibility to DV by other family members ( Saravanan, 2000 ).

In addition to being prevalent in India, DV has also been linked to numerous deleterious health behaviours and poor mental and physical health. These includes tobacco use ( Ackerson, Kawachi, Barbeau, & Subramanian, 2007 ), lack of contraceptive and condom use ( Stephenson, Koenig, Acharya, & Roy, 2008 ), diminished utilisation of health care ( Sudha & Morrison, 2011 ; Sudha, Morrison, & Zhu, 2007 ), higher frequencies of depression, post-traumatic stress disorder (PTSD), and attempted suicide ( Chandra, Satyanarayana, & Carey, 2009 ; Chowdhury, Brahma, Banerjee, & Biswas, 2009 ; Maselko & Patel, 2008 ; Shahmanesh, Wayal, Cowan, et al., 2009 ; Shidhaye & Patel, 2010 ; Verma et al., 2006 ), sexually transmitted infections (STI) ( Chowdhary & Patel, 2008 ; Sudha & Morrison, 2011 ; Weiss et al., 2008 ), HIV( Gupta et al., 2008 ; Silverman, Decker, Saggurti, Balaiah, & Raj, 2008 ), asthma ( Subramanian, Ackerson, Subramanyam, & Wright, 2007 ), anaemia ( Ackerson & Subramanian, 2008 ), and chronic fatigue ( Patel et al., 2005 ). Furthermore, maternal intimate partner violence (IPV) experiences have been associated with more terminated, unintended pregnancies ( Begum, Dwivedi, Pandey, & Mittal, 2010 ; Yoshikawa et al., 2012 ), less breastfeeding ( Shroff et al., 2011 ), perinatal care ( Koski, Stephenson, & Koenig, 2011 ), and poor child outcomes ( Ackerson & Subramanian, 2009 ). These negative health repercussions and high DV frequency speak to the need for the development of effective DV prevention and management strategies. And, the development of effective DV interventions first requires valid measures of occurrence and an in-depth understanding of its epidemiology.

While many aspects of DV are similar across cultures, recent qualitative studies describe how some aspects of the DV experienced by women in India may be unique. These studies highlight the role of non-partner DV perpetrators for those living in both nuclear and joint-families ( Fernandez, 1997 ; Kaur & Garg, 2010 ; Raj et al., 2011 ). (These families are patrilineal where male descendants live with their wives, offspring, parents, and unmarried sisters.) They discuss the high frequency and near normalisation of control, psychological abuse, neglect, and isolation, the occurrence of DV to women at both extremes of age (young and old), dowry harassments, control over reproductive choices and family planning, and demonstrate the use of different tools to inflict abuse (i.e. kerosene burning, stones, and broomsticks as opposed to gun and knife violence more commonly seen in industrialised nations) ( Bunting, 2005 ; Go et al., 2003 ; Hampton, 2010 ; Jutla & Heimbach, 2004 ; Kaur & Garg, 2010 ; Kermode et al., 2007 ; Kumar & Kanth, 2004 ; Peck, 2012 ; Rastogi & Therly, 2006 ; Sharma, Harish, Gupta, & Singh, 2005 ; Stephenson et al., 2008 ; Wilson-Williams, Stephenson, Juvekar, & Andes, 2008 ).

This paper presents a systematic review of the quantitative studies conducted over the past decade that estimate and assess DV experienced by women in India, and evaluates their scope and capacity to measure the DV themes highlighted by recent qualitative studies. It aims to examine the distribution of the prevalence estimates provided by the recent literature of DV occurrence in India, improve understanding of the factors that may affect these prevalence estimates, and identify gaps in current studies. This enhanced knowledge will help inform future research including new interventions for the prevention and management of DV in India.

We utilised PubMed, OVID, Cochrane Reviews, PsycINFO, and CINAHL as search engines to identify articles published between 1 April 2004 and 1 January 2015 that focused on the DV experiences of women in India ( Figure 1 ). Our specific search terms included ‘domestic violence’, ‘intimate partner violence’, ‘spouse abuse’, ‘partner violence’, ‘gender-based violence’, ‘sexual violence’, ‘physical violence’, ‘wife battering’, ‘wife beating’, ‘domestic abuse’, ‘violence’, and ‘India’. We first removed duplicate articles and then filtered the articles based on our inclusion criteria: quantitative studies evaluating original data that had been published in English and directly surveyed the DV experiences of women. While we recognise that in cultures where DV is commonplace the reporting of DV perpetration by men may be as high as the frequency of experiencing DV reported by women ( Koenig, Stephenson, Ahmed, Jejeebhoy, & Campbell, 2006 ), we restricted our eligibility criteria to studies directly surveying women about their DV experiences to reduce further inter-study variation and allow for more accurate cross-study comparisons. We excluded reviews, case reports, meta-analyses, and qualitative studies. A single author (ASK or NM) reviewed each individual article to determine whether it met inclusion criteria. If questions arose regarding its inclusion into the review, they were discussed with a second author (SS) until concordance was reached regarding whether or not the paper was to be included.

Adapted PRISMA Flow Diagram demonstrating study selection methodologies and filter results.

Note: An initial PubMed search of articles published between 1 April 2004 and 1 January 2015 focusing on the DV experiences of women in India is depicted. This figure illustrates the search terms, search engines, applied inclusion and exclusion filters, the process by which articles were chosen to be included in the study, and the results of the selection process.

We collected data from each study regarding study population; study setting; use of a validated scale; forms of, perpetrators of, and time frame during which DV was measured; whether an attempt was made to measure severity of DV; whether potential DV correlates were evaluated; and whether DV prevalence was estimated. We subcategorised the forms of violence into physical, sexual, psychological, control, and neglect based on descriptions of questions provided in the studies. Emotional and verbal forms of abuse were classified as psychological abuse and deprivation was classified as neglect. If the study asked participants about agency or autonomy, this was noted in the summary tables. In publications where information about the DV assessment tool and its validation was not provided, we contacted the authors for more information. If authors reported having conducted formative fieldwork to generate questions, pre-tested the items, and/or conducted some assessment of the measurement tool’s expert or face validity, we reported the validation as ‘limited’. If we did not hear back from the authors, we stated the data were ‘not reported’.

Article yield of systematic search

Our initial search of DV articles published in PubMed, OVID, Cochrane Reviews, PsycINFO, and CINAHL between 1 April 2004 and 1 January 2015 yielded 3843 articles ( Figure 1 ). We identified 628 articles using search terms ‘domestic violence’ and ‘India’, 283 articles using ‘intimate partner violence’ and ‘India’, 98 articles using ‘spouse abuse’ and ‘India’, 221 articles using ‘partner violence and India’, 54 articles using ‘gender-based violence’ and ‘India’, 199 articles using ‘sexual violence’ and ‘India’, 120 articles using ‘physical violence’ and ‘India’, 1 article using ‘wife battering’ and ‘India’, 51 articles using ‘wife beating’ and ‘India’, 10 articles using ‘domestic abuse’ and ‘India’, and 2022 articles using ‘violence’ and ‘India’. Of the 3843 articles, 3705 articles were removed because they (1) were duplicated in the search, (2) focused on extraneous topics, (3) lacked Indian context, (4) were not based on original quantitative data, or (5) were based on study data that were not directly obtained through surveying women about their personal DV experiences. Thus, the selection criteria yielded a total of 137 studies examining the DV experiences of women in India: 14 international studies (see Table 1 in supplementary material ), 50 multi-state India studies (see Table 2 in supplementary material ), and 73 single-state India studies (see Table 3 in supplementary material ).

The scope and breadth of recent studies: study populations

Collectively, the reviewed studies provide information on the DV experienced by young and middle-aged women in traditional heterosexual marriages from both urban and rural environments, joint and nuclear families, across Indian states ( Figure 2 ). Among the studies specifying age limits, the vast majority (88% or 92/104) evaluated DV experienced by women age 15–50, with only 11% (11/104) of studies surveying DV suffered by women above age 50 and 1% (1/104) evaluating DV experienced by young adolescents (wed before age 15). Only one study assessed DV experienced by women in HIV discordant. No studies surveyed DV in non-traditional relationships, such as same-sex relationships or live-in relationships. Less than one-third (29% or 40/137) collected data differentiating DV experienced by women in joint versus nuclear families. Thirty-seven per cent (51/137) evaluated domestic abuse suffered by women living in urban settings, 18% (24/137) in rural, and the remainder (44% or 60/137) in both rural and urban environments. Only one examined DV experienced by women residing in tribes. Twenty-three per cent (32/137) and 3% (4/137) utilised a nationally representative and sub-nationally representative study population, respectively. Southern Indian states were by far the most surveyed in the literature (Maharashtra 66 studies, Tamil Nadu 59 studies, and Karnataka 51 studies) and Northern Indian states the least (Uttaranchal, Sikkim, Punjab, Haryana, Chhattisgarh, and Assam each with 33 studies).

A summary of the distribution of recent Indian DV literature by region, state, surveyed perpetrator, and family type.

Note: (a) demonstrates the distribution of studies by rural versus urban region, (b) by state, (c) by the perpetrator surveyed, and (d) whether the survey collected data differentiating DV in joint versus nuclear family households.

Prevalence of DV in India

Collectively, the reviewed studies demonstrate that DV occurs among Indian women with high frequency but there is substantial variation in the reported prevalence estimates across all forms of DV ( Figure 3 ). For example, the median and range of lifetime estimates of psychological abuse was 22% (range 2–99%), physical abuse was 29% (2–99%), sexual abuse was 12% (0–75%), and multiple forms of DV was 41% (18–75%). The outliers at the upper extremes were contributed by a study of in low-income slum communities with high prevalence of substance abuse( Solomon et al., 2009 ) and a second study conducted in a tertiary care centre where surveys were self-administered and thus participants may have felt increased comfort in reporting DV( Sharma & Vatsa, 2011 ). The median and range of past-year estimates of psychological abuse was 22% (11–48%), physical abuse was 22% (9–90%), sexual abuse was 7% (0–50%), and multiple forms of DV was 30% (4–56%). The outlier of 90% for physical abuse was contributed by a study of women whose husbands were alcoholics in treatment ( Stanley, 2012 ). As expected, higher DV prevalence was noted when multiple forms of DV were assessed. Of all forms of DV, physical abuse was measured most frequently, with psychological abuse, sexual abuse, and control or neglect receiving substantially less attention. Further statistical analysis beyond these descriptive statistics was not conducted due to the large inter-study heterogeneity of designs and populations limiting comparability across studies.

A summary of the lifetime and past 12-month prevalence estimates of the various forms of DV as documented by each individual study.

Note: Circles, squares, upright triangles, and inverted triangles represent prevalence estimates of psychological, physical, sexual, and multiple forms of DV, respectively, as provided by each individual study. While medians and ranges are provided, further analysis was not carried out due to the limited homogeneity between studies impeding accurate comparison.

The scope and breadth of recent studies: study design

The past decade of quantitative India DV research has included a breadth of large regional and international studies as well as smaller scale, single-state studies. However, the capacity to draw causal inferences from this literature has been limited by the nearly exclusive use of cross-sectional design. The country and regional-level studies utilised larger, often nationally or sub-nationally representative samples (average sample size: 25,857 women, range: 111–124,385), to provide inter-country or regional epidemiologic comparisons. The single-state studies tended to use smaller sample sizes (average: 1109 women, range: 30–9639) to provide a more in-depth evaluation of DV experienced in a particular population of women.

The vast majority of all reviewed studies utilised cross-sectional design, with only 12% (17/137) using a prospective design to draw causal inferences. Six of these 13 utilised the NFHS-2 and four-year follow-up data from the rural regions of four states to evaluate the effect of DV on mental health disorders ( Shidhaye & Patel, 2010 ), a woman’s adoption of contraception, occurrence of unwanted pregnancy ( Stephenson et al., 2008 ), uptake of prenatal care ( Koski et al., 2011 ), early childhood mortality ( Koenig et al., 2010 ), functional autonomy and reproduction ( Bourey, Stephenson, & Hindin, 2013 ), and contraceptive adoption ( Stephenson, Jadhav, & Hindin, 2013 ), while one used the data to evaluate the effect of autonomy on experience of physical violence ( Nongrum, Thomas, Lionel, & Jacob, 2014 ; Sabarwal, Santhya, & Jejeebhoy, 2014 ). Only one study employed a case-control study to evaluate the link between DV and child mortality ( Varghese, Prasad, & Jacob, 2013 ) and another utilised a randomised control design to evaluate the effect of a mixed individual and group women’s behavioural intervention in reducing DV and marital conflict over time ( Saggurti et al., 2014 ). The remainder of prospective studies evaluated the causal association between DV and incident STIs and/or attempted suicide ( Chowdhary & Patel, 2008 ; Maselko & Patel, 2008 ; Weiss et al., 2008 ), DV and maternal and neonatal health outcomes ( Nongrum et al., 2014 ), the effect of the type of interviewing (face-to-face versus audio computer-assisted self-interviews) on DV reporting ( Rathod, Minnis, Subbiah, & Krishnan, 2011 ), trends in DV occurrence over time ( Simister & Mehta, 2010 ), and the effect of change in a woman or her spouse’s employment status on her experience of DV ( Krishnan et al., 2010 ).

The scope and breadth of recent studies: DV measures

Only 61% (84/137) of studies reported use of a validated scale or made attempts to validate the instrument they ultimately used. When use of a validated instrument was reported, most (82% or 69/84) had been developed for the cultural context of North America and Europe (i.e. modified CTS, Abuse Assessment Screen, Index of Spouse Abuse, Woman Abuse Screening Tool, Partner Violence Screen, Composite Abuse Scale, and Sexual Experience Scale). In fact, only 15 of the studies reporting use of a validated questionnaire adapted or developed their instrument to the Indian context by surveying themes raised by the prior qualitative literature (i.e. use of belts, sticks, and burning to inflict physical abuse, restricting return to natal family home, not allowing natal family to visit marital home). As expected, these studies reported higher frequencies of DV. In personal communication, some authors who chose not to use validated, widely used DV scales (i.e. CTS) stated they did so because of space limitations and inadequacy of existing tools for measuring DV in the Indian cultural context.

Two-thirds of studies (64% or 87/137) assessed two or fewer forms of DV. Of all forms of DV, physical abuse was evaluated most frequently (96% or 131/137), followed by sexual abuse (58% or 79/137), psychological abuse (44% or 60/137), neglect and control (4% or 7/137). Only 11% (15/137) of studies evaluated DV perpetrated by non-partner family members. For these studies evaluating DV perpetrated by partners and non-partner family members, available estimates of lifetime sexual and psychological abuse were always higher than the median prevalence estimates of reviewed studies; available estimates of lifetime physical abuse were often, but not universally, higher. Only 20% (109/137) attempted to evaluate different levels of DV severity. While many (43% or 59/137) studies evaluated lifetime violence, a considerable number assessed recent DV (42% or 58/137 past-12 month DV, 5% or 7/137 past-6 month DV, 4% or 5/137 past-3 month DV, and 4% or 6/137 the time period of current or research partnerships). Additionally, 10% (14/137) evaluated DV occurrence during pregnancy or the peri-partum period.

The scope and breadth of recent studies: measured outcomes

Figure 4 provides a framework for synthesising the potential DV correlates measured to date. It demonstrates that the focus of the quantitative literature has largely been on the mental health and gynecologic consequences of DV but has only begun to evaluate repercussions on physical health and health behaviour. Twelve per cent (16/137) of the studies evaluated one or multiple mental health disorder as outcomes of DV, including PTSD, depression, and suicide, but not anxiety. The literature provided a comprehensive evaluation of the association between DV and gynaecologic health including sexual (15% or 21/137) and maternal health (8% or 11/137). However, only six studies were dedicated to evaluating physical health outcomes (oral health, nutrition, chronic fatigue, asthma, direct injury, and blindness during pregnancy). And while 17 studies were dedicated to evaluating the association between DV and uptake of health behaviours, 11 of the 15 were focused on behaviours related to sexual and maternal health. Thus, the association between health behaviours like the woman’s substance abuse and adherence to medical and clinical care remains largely understudied, as does the link between DV and physical health outcomes such as cardiovascular and gastrointestinal disease, chronic pain syndromes (including migraines), and urinary tract infections.

A framework for conceptualising the reviewed studies.

Note: The proposed framework provides structure for interpreting and synthesising the prior decade’s quantitative research evaluating the domestic violence experienced by women in India.

The past 10 years have been an incredible period of growth in DV research in India and South Asia. Our systematic review contributes to the growing body of evidence by providing an important summary of the epidemiologic studies during this critical period and draws attention to the magnitude and severity of the ongoing epidemic in India. Comprehensively, the reviewed literature estimates that 4 in 10 Indian women (when surveyed about multiple forms of abuse) report experiencing DV in their lifetime and 3 in 10 report experiencing DV in the past year. This is concordant with the WHO lifetime estimate of 37.7% (95% CI: 30.9%43.1%) in South-East Asia (defined as India, Maldives, Sri Lanka, Thailand, Bangladesh, and Timor-Leste) and is higher than the regional estimates provided by the WHO for the Europe, the Western Pacific, and potentially the Americas. In addition to highlighting the high frequency of occurrence, the studies in this review emphasise the toll DV takes on the lives of many Indian women through its impact on mental, physical, sexual, and reproductive health.

Perhaps the most striking finding of our review was the large inter-study variance in DV prevalence estimates ( Figure 3 ). While this variability speaks to the capacity of the India literature to capture the breadth of DV experiences in different populations and settings, it also underscores the need for standardising aspects of study design in the investigator’s control to make effective inter-study and cross-population comparisons. Standardisation of the instruments used to measure DV should be a priority. To optimise the yield of such an instrument in capturing the DV experiences of Indian women, it should build upon currently available, well-validated instruments, but also be culturally tailored. Thus, it should account for the culturally prominent forms of DV identified by the Indian qualitative literature and social media, survey abuse inflicted by non-partner perpetrators, survey multiple forms abuse (i.e. physical, sexual, psychological, and control), and ideally, include a measure of DV severity (i.e. based on frequency of affirmative responses, frequency of abuse, or resultant injury). Our review demonstrates that current studies fall short, with only 61% reporting use of validated questions (rarely developed or adapted to Indian culture), 11% surveying DV perpetrated by non-partner family members, 64% assessing more than two different forms of abuse, and 20% evaluating level of DV severity. Our review also suggests that when questions assessing DV are culturally adapted and validated, evaluate multiple forms of abuse, and survey abusive behaviours by non-partner family members in addition to partners, reporting of DV increases.

While our search yielded many well-designed cross-sectional studies providing insight into the epidemiology of DV in India (i.e. patterns of occurrence, socio-demographic, and health correlates), it also revealed many gaps and thus, a potential research agenda. Future qualitative studies are needed to examine the link between DV and correlates identified by the cross-sectional literature, to inform the development of future prevention strategies, and to enhance delivery of DV supportive services by examining survivor preferences and needs. Additional longitudinal quantitative studies are also needed to better understand predictors of DV and to explore the direction of causality between DV and the physical health associations identified in the reviewed studies. They are also needed to assess the link between DV and other physical health outcomes like injury, cardiovascular disease, irritable bowel syndrome, immune effects, and psychosomatic syndromes as well as non-sexual health behaviours such as substance abuse and medication adherence. This is particularly paramount in India, where physical injury and cardiovascular disease together account for over a quarter of disability-adjusted life years lost ( National Commission on Macroeconomics and Health, 2005 ).

Additionally, our review also exposed gaps in the current understanding of DV in some populations and regions of India. For example, most studies focused on women of age 15–50. Only 11 reported on the DV experiences of women over 50, a stage where frailty, financial and physical dependence, and culturally engendered shame and disgrace associated with widowhood may heighten their risk of experiencing DV, neglect, and control by various family members ( Solotaroff & Pande, 2014 ). And, while 43% of Indian women aged 20–24 marry before the age of 18, we encountered few studies evaluating DV experienced by pre-adolescents or young adolescents married as children ( UNICEF, 2014 ). An additional gap is in evaluating the DV experiences of women engaging in live-in relationships as opposed to marital relationships, divorced or widowed women, women involved in same-sex relationships, and in HIV serodiscordant and concordant relationships, settings in which social and family support systems are already weakened ( Kohli et al., 2012 ). Next, beyond the national and multi-state data sets, there is little representation of the northern states of India (i.e. Uttaranchal, Sikkim, Punjab, Haryana, Chhattisgarh, and Assam) and of women residing in tribal villages ( Sethuraman, Lansdown, & Sullivan, 2006 ). The vast cultural, religious, and socio-economic inter-regional differences in India highlight the need for more in-depth study of the DV experiences of women in these areas.

The high prevalence of DV and its association with deleterious behaviours and poor health outcomes further speak to the need for multi-faceted, culturally tailored preventive strategies that target potential victims and perpetrators of violence. The recent Five Year Strategic Plan (2011–2016) released by the Ministry of Women and Child Development discusses a plan to pilot ‘one-stop crisis centres for women’ survivors of violence, which would include medical, legal, law enforcement, counselling, and shelter support for themselves and their children. The significant differences in women’s empowerment and DV experience by region and population within India ( Kishor & Gupta, 2004 ) underscore the need to culturally- and regionally tailor the screening and support services provided at such centres. For example, in resource-limited states where sexual forms of DV predominate, priority should be given to the allocation of health-care providers to evaluate, document, and treat associated injuries and/or transmitted diseases. In settings where financial control and neglect are common, legal, financial, and educational empowerment may need to be given precedence.

Our review is not without limitations. First, our analysis relied solely on data directly provided in the publications. We did not further contact the authors if information was not provided. Second, a single author (ASK or NM) reviewed the individual papers for inclusion into the review, which may have introduced a selection bias. We tried to limit this bias through discussion of the papers in which eligibility was not clear-cut with a second author (SS) until agreement about the inclusion status was reached. Next, we included studies whose main intent was to evaluate the DV experiences of Indian women as well as studies whose main aim may not have been related to DV at all, but included DV as a covariate in the analysis. Thus, many of the studies that solely included DV as a covariate may not have had the intent or resources to fully examine the DV experience. While this may be viewed as a limitation, our goal was not to critically evaluate each individual study, but to comprehensively review the information currently provided in the Indian DV literature. Lastly, inclusion of multiple studies that utilise the same data set (e.g. NFHS) may have skewed the overall median estimate of DV prevalence and the remainder of our analysis. We felt, however, that the substantial differences in DV assessment (e.g. measurement time frames, forms of DV assessed, whether DV severity was assessed, and measured health correlates) between these studies legitimised their need to be included as separate entities in the review.

In conclusion, our literature review underscores the need for further studies within India evaluating the DV experiences of older women, women in same-sex relationships, and live-in relationships, extending the assessment of DV perpetrated by individuals besides intimate partners and spouses, and assessing the multiple forms and levels of abuse. It further stresses the necessity for the development and validation (in multiple regions and study populations within India) of a culturally tailored DV scale and interventions geared towards the prevention and management of DV.

Supplementary Material

Tables and table references, acknowledgments.

This work was supported by the US Department of Health and Human Services, National Institutes of Health, Fogarty International Center [grant number 1 R25 TW009337-01 K01 TW009664].

Supplemental data for this article can be accessed at http://dx.doi.org/10.1080/17441692.2015.1119293

Disclosure statement

No potential conflict of interest was reported by the authors.

Ameeta Kalokhe , http://orcid.org/0000-0002-3556-1786

Seema Sahay , http://orcid.org/0000-0001-6064-827X

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Browns’ mike hall jr. accused of threatening woman with gun in domestic violence arrest.

Browns defensive lineman Mike Hall Jr. was arrested in Ohio on Monday after he was accused of pressing a gun against a woman’s head and threatening to kill her.

During an argument, Hall allegedly pressed a gun up against the side of the woman’s head, and said, “I will f–king end it all. I don’t care,” according to a police report cited by ESPN .

The accuser told police that she is Hall’s fiancée, that the two share an 11-month-old baby together and that the argument arose from discussing the finances of her daughter from a previous relationship.

Hall, 21, was charged with domestic violence, and pleaded not guilty.

He faced a $10,000 bond and there is a hearing set for Sept. 10.

The woman told police that Hall ordered her to leave the house but then grabbed her by her feet and pulled her back to the house down the driveway.

The woman’s mother provided a written statement to police that alleged Hall struck the accuser with a baby bottle and choked her.

Hall left the home before police arrived but was arrested in Avon, Ohio on Monday night.

Police said that they observed two guns on a mattress and also saw “several indicators of a physical altercation”, according to ESPN.

The Browns issued a statement about the arrest on Tuesday.

“We are aware of the incident involving Mike Hall, Jr. last night,” the statement said. “Mike and his representatives have been in touch with the appropriate authorities. We are in the process of gathering more information and will have no further comment at the time.”

Hall starred at Ohio State and the Browns selected him in the second round of this year’s NFL Draft.

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