Elsevier

The Lancet

Volume 371, Issue 9619, 5–11 April 2008, Pages 1165-1172
The Lancet

Articles
Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study

https://doi.org/10.1016/S0140-6736(08)60522-XGet rights and content

Summary

Background

This article summarises findings from ten countries from the WHO multi-country study on women's health and domestic violence against women.

Methods

Standardised population-based surveys were done between 2000 and 2003. Women aged 15–49 years were interviewed about their experiences of physically and sexually violent acts by a current or former intimate male partner, and about selected symptoms associated with physical and mental health. The women reporting physical violence by a partner were asked about injuries that resulted from this type of violence.

Findings

24 097 women completed interviews. Pooled analysis of all sites found significant associations between lifetime experiences of partner violence and self-reported poor health (odds ratio 1·6 [95% CI 1·5–1·8]), and with specific health problems in the previous 4 weeks: difficulty walking (1·6 [1·5–1·8]), difficulty with daily activities (1·6 [1·5–1·8]), pain (1·6 [1·5–1·7]), memory loss (1·8 [1·6–2·0]), dizziness (1·7 [1·6–1·8]), and vaginal discharge (1·8 [1·7–2·0]). For all settings combined, women who reported partner violence at least once in their life reported significantly more emotional distress, suicidal thoughts (2·9 [2·7–3·2]), and suicidal attempts (3·8 [3·3–4·5]), than non-abused women. These significant associations were maintained in almost all of the sites. Between 19% and 55% of women who had ever been physically abused by their partner were ever injured.

Interpretation

In addition to being a breach of human rights, intimate partner violence is associated with serious public-health consequences that should be addressed in national and global health policies and programmes.

Funding

WHO; Governments of the Netherlands, Norway, Sweden, Switzerland, and UK; Rockefeller Foundation; Urban Primary Health Care project of the Government of Bangladesh; Swedish Agency for Research Cooperation with Developing Countries (SAREC/Sida); United Nations Fund for Population Activities (UNFPA); and Trocaire.

Introduction

In the past decade, increasing attention has focused on the effects of male partner violence on women's physical and mental health. Studies of visits to emergency departments in the USA and elsewhere have suggested that physical abuse is a major cause of injury in women.1, 2, 3, 4 Population-based studies have suggested that 20–75% of women who are physically abused by a partner report injuries due to violence at some point in their lives.5, 6, 7 Nonetheless, injury is not the most common physical health outcome of abuse by male partners. Epidemiological and clinical studies have noted that physically and sexually violent acts by intimate partners are consistently associated with a broad array of negative health outcomes, including gynaecological disorders, adverse pregnancy outcomes, irritable bowel syndrome, gastrointestinal disorders, and various chronic-pain syndromes.8, 9, 10 Abused women have more physical symptoms of poor health, and more days in bed than do women who have not been abused.11, 12, 13, 14, 15, 16 Physical and sexual violence have also been associated with psychiatric problems, including depression, anxiety, phobias, post-traumatic stress disorder, suicidality, and alcohol and drug abuse.17, 18, 19, 20, 21, 22

Research on the health effects of partner violence has been constrained by several factors. Most studies have been undertaken on clinical rather than population-based samples, mainly in north America and Europe. Furthermore, many studies have had small sample sizes, and have not controlled analyses for potential confounders. Violence has not been defined or measured consistently in the studies, making comparisons difficult.23, 24

The aim of the WHO multi-country study was to explore the magnitude and characteristics of different forms of physical, sexual, and emotional violence against women, with particular emphasis on violence perpetrated by male intimate partners. The study attempted to overcome obstacles of comparability encountered in previous studies by use of population-based surveys that included a standardised questionnaire, and with standardised training and data-collection procedures across participating sites.25, 26, 27, 28 A further objective of the study was to assess the extent to which physical and sexual violence by intimate partners is associated with a range of health outcomes.

This report presents findings on partner violence and womens' self-reported physical and mental health. Details on study methods, sampling, response rates, and findings on the prevalence of different types of partner violence in these same study sites have been reported elsewhere.25, 26, 27, 28

Section snippets

Sample design

Population-based surveys were done in 15 sites, in ten study countries, between 2000 and 2003. Trained female interviewers completed interviews with women aged 15–49 years. Sites and countries were selected to enable comparisons between different regions and, when possible, between urban and rural settings within countries. In five countries (Bangladesh, Brazil, Peru, Thailand, and United Republic of Tanzania), surveys were done in the capital or a large city and one province or region, the

Results

24 097 eligible women completed the interview (ie, 97% of all eligible women), of which 19 568 women were ever-partnered.25 Only the ever-partnered women were included in the analysis. 15–71% of ever-partnered women reported that they had experienced physical or sexual violence, or both, at some point in their lives by a current or former partner. A description of the women interviewed and characteristics of violence is reported elsewhere.25 In most sites, women who reported violence by a

Discussion

This study has shown significant associations between lifetime experiences of physical or sexual violence, or both, by a male intimate partner, and a wide range of self-reported physical and mental health problems in women. These associations do not seem to be explained by differences in age, education, or marital status in any of the sites.

Because of the cross-sectional design of the study, we were unable to establish whether exposure to violence occurred before or after the onset of symptoms.

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