MAKING THE INVISIBLE VISIBLE:
Measuring Domestic Violence and Its
Consequences
Sunita Kishor (Ph.D.)
Senior Gender Advisor
Demographic and Health Research
Macro International, Inc.
Maryland, USA
Overview
• Gender and gender-based violence (GBV)
• The role of the Demographic and Health
Surveys in making the invisible VISIBLE
• The nitty-gritty of measurement: substantive
and ethical challenges
• What we now know: prevalence, correlates,
and consequences
• Continuing challenges
A digression:
What is gender?
...the different roles, rights, and obligations
that culture and society attach to individuals
according to whether they are born with male
or female sex characteristics
Not just different, but UNEQUAL…
Not just UNEQUAL,
but SUBORDINATE
GBV an inherent part, an expression, an
outgrowth, of this gender inequality
What is gender-based violence?
Gender-based violence is violence involving
men and women, in which the female is
usually the victim; and which is derived
from unequal power relationships
between men and women. Violence is
directed specifically against a woman
because she is a woman, or affects
women disproportionately.
United Nations Population Fund (UNFPA)
Gender Theme Group
Gender-Based Violence Over the
Life Cycle
Dowry deaths/honor killings
Differential access to food/medical care Psychological
abuse; Coerced sex/rape/harassment; Physical violence; Violence
during pregnancy
Female infanticide; FGC/M
Sex-selective abortion
Differential access to food/medical care
Violence in pregnancy
Physical and sexual violence
Psychological abuse
Intimate
partner
Family
members
Violence by states (e.g. rape in war)
Trafficking
Acid throwing
Non-partner rape/harassment/violence
Prebirth/
Infancy
Adolescence
Reproductive
Older
ages
(adapted from Watts and Zimmerman, 2002)
Sources of Domestic Violence Data
• Institutional sources:
Police, hospital, court records; data from shelters
• Incomplete coverage; provide data on only very
severe cases
• Qualitative, ethnographic studies:
• Cannot be generalized; good for in-depth study
• Survey sources:
– Surveys on GBV: Rare and costly
e.g., WHO Multi-Country Study of Domestic Violence
– Surveys on other topics with questions on GBV
e.g., Demographic and Health Surveys (DHS)
What is the DHS?
A demographic, nutrition, and health survey program for the
developing world since1984, primarily funded by USAID
 Nationally-representative household surveys with large
samples (typically 6000 +; India-100,000+)
 Usually repeated every 5-7 years
 Provide indicators for monitoring at the national and
sometimes, sub-national level
 Comparable across countries and over time
 More recently include biomarkers, e.g., syphilis and HIV, and
domestic violence
DHS surveys considered the ‘gold
standard’ by countries and development
partners
DHS Countries with Domestic Violence
Data
•
Africa
–
–
–
–
–
–
–
–
–
–
–
–
–
•
Cameroon 2004
DRC 2007
Egypt 1995 & 2005
Ghana 2008*
Kenya 2003
Liberia 2006/07
Malawi 2004
Mali 2006
Rwanda 2005
South Africa 1998
Uganda 2006, 2009*
Zambia 2001/02; 2007*
Zimbabwe 2005/06
Asia/South Asia
–
–
–
–
Bangladesh 2004, 2007*
Cambodia 2000 & 2005
India 1998/99 & 2005/06
Jordan 2007*
* Data not yet available.
•
Latin America/Caribbean
–
–
–
–
–
–
–
•
Bolivia 2003
Colombia 1990, 1995, 2000, 2005
Dominican Republic 2002 & 2007
Haiti 2000 & 2005
Honduras 2005
Nicaragua1997/98
Peru 2000 & 2004
Eurasia
–
–
–
–
Azerbaijan 2006
Moldova 2005
Turkmenistan 2001
Ukraine 2007*
Measurement Challenges
 Defining ‘what’ violence to measure
 Ensuring validity of the measures: the
‘how’
 Ensuring safety and ethical standards
 Determining what else to measure other
than prevalence
Validity of Data
 No catch-all term to capture violence
Recommendation: Ask about different types of violent
acts separately, eg: have you been slapped NOT have
you experienced any violence or have you been
beaten?
 Risk of underreporting of violence
Recommendations: Build rapport, ensure privacy,
provide multiple opportunities to reveal abuse
Measures of Spousal Violence
 Physical violence Any of the following acts perpetrated by her
husband:







Pushed her, shook her, or threw something at her
Slapped her
Twisted her arm or pulled her hair
Punched her
Kicked her, dragged her, or beat her up
Tried to choke her or burn her on purpose
Threatened her or attacked her with a weapon
 Sexual violence Any of the following any of the following acts:
 Forced her to have sexual intercourse when she did not want it
 Forced her to perform sexual acts she did not want to
 Emotional violence
Selected Domestic Violence Indicators in
the DHS
 Prevalence of spousal violence: ever and 12 months
 Timing of initiation of spousal violence
 Injuries related to spousal violence
 Wives initiating spousal violence
 Violence by others (ex-spouse, boyfriend, family,
others)
 Forced first sexual intercourse*
 Violence during pregnancy *
 Lifetime prevalence of sexual violence by anyone
 Help seeking by abused women
Safety and Ethical Concerns
• Confidentiality and informed consent
–
–
–
–
–
Only one woman per household receives the DV questions
Men not asked DV questions in the same household
Informed consent obtained
Translators not used for this section
Interview discontinued if privacy not assured
• Respondent and interviewer safety
– DHS guidelines are modeled on WHO’s Guidelines for the Ethical
Conduct of Domestic Violence research (WHO, 2002)
DHS has sought to strike the right balance
between ethical concerns and information
needs
Prevalence of Spousal Physical or
Sexual Violence: Selected Countries
Percent of ever-married women age 15-49
Ever
In the past 12 months
59
48
34
25
28
27
24
27
Only 1-7% of married women
have ever initiated violence
against their husbands.
nd
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31
18
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M
27
25
24
38
37
45
43
42
Correlates of Spousal Violence
India 2005-06
Percent of ever-married women age 15-49
46
47
69
47
49
21
30
12
No education
12+ years of
education
Woman's education
Husband's education
Does not Does not
drink
get drunk
Drunk
sometimes
Drunk
often
Husband's drinking habits
Correlates: Husband’s Drinking of Alcohol
Adjusted odds of experiencing violence among ever-married women age 15-49
Odds of experiencing violence = 1 if husband does not
drink; then odds of experiencing violence
if husband:
Comes home
drunk frequently
4.80
Nicaragua
2.14
Comes home
drunk sometimes
4.08
Haiti
2.37
are:
Dom Rep
Cambodia
7.39
1.62
6.07
1.07 (ns)
Kishor and Johnson, 2004
Intergenerational Aspects of Violence
Adjusted odds of women (ever-married, 15-49) reporting violence ever
Odds of experiencing violence if father did not beat mother =1;
Adjusted odds of experiencing violence if father beat
mother =
Peru
1.63
Nicaragua
1.61
Haiti
Dom Rep
Colombia
Cambodia
1.96
2.00
2.16
2.26
Kishor and Johnson, 2004
Selected Adverse Health Outcomes
Never experienced spousal violence, odds = 1;
If experienced violence, adjusted odds =
Had an STI
Discontinued modern
contraceptive
1.78
1.77
C
am
bo
di
a
Cambodia
1.92
1.41
H
ai
ti
Haiti
R
ep
2.59
1.14
D
om
Dom Rep
Base line risk: 1.0
Base line risk: 1.0
MORE Adverse Health Outcomes
Never experienced spousal violence, odds = 1;
If experienced violence adjusted odds =
Pregnancy termination
Unwanted birth
1.29
1.43
H
ai
ti
Cambodia
1.53
1.16
C
am
bo
di
a
Haiti
R
ep
1.91
1.70
D
om
Dom Rep
Base line risk: 1.0
Base line risk: 1.0
Kishor and Johnson, 2006
What we do know…
 Spousal violence varies from about 14% in Cambodia
to 59% in Uganda
 Typically, half or more of the women who have ever
experienced spousal violence have experienced it in
the past 12 months
 Spousal sexual violence is reported by 5-20 percent of
women
 Physical violence is the most common type of violence
 Violence begins early in the marriage
 Violence results in injuries
 Women rarely seek help
 Further analysis shows that there are strong links to
health outcomes for mothers and their children
What Perpetuates GBV?
• Gender norms that
 Rigidly define gender roles and what a ‘good’
woman is
 Tolerate and accept male aggression and
risky sexual behavior as part of being a man
 Give men the right to discipline and control
wives
• Cultural norms that treat domestic violence as a
private matter
• Women’s lower status in society that results in:
 Limited access to and control over resources
 Less education and skill development
 Dependency on men, on sons
DHS Question on Norm Socialization
Is a husband justified in hitting or
beating his wife if she…
•
•
•
•
•
Neglects the children
Answers back/argues with him
Goes out without telling him
Refuses sex with him
Burns the food
Evidence of Norm Socialization
Percentage who agree with any reason
for wife beating
Country
Women
Men
Moldova
21
22
Malawi
28
16
Zimbabwe
48
37
India
54
51
Kenya
68
63
Uganda
70
60
Zambia
85
69
One of the most common reasons: Neglects the children
Solution: Multifaceted Interventions
A Health-Sector Example
Communication
for social &
behavior change
programs
Community
mobilization
programs
Health
policy
programs
HEALTH SERVICE DELIVERY PROGRAMS
•Correct diagnosis
•Appropriate care
•No harm to patient
•Care attuned to physical
+psychological needs
Norms
Laws
Institutions
Funding
Policy discourse
Women’s
experience
of GBV
Effectiveness
of health
provision
Women’s
RH
Gaps and Continuing Challenges

Measurement of
 men’s experience of violence from women
 other types of intimate partner violence

Doing more to minimize under-reporting

Recognize the limitations of large scale surveys
• Doing more in-depth and longitudinal studies
to fill in gaps

Going beyond the measurement of prevalence
• Analysis, dissemination, action
www. measuredhs.com
For Specific Questions:
sunita.kishor@macrointernational.com
Photo credits: Photos courtesy of M/MC Photoshare at jhuccp.org/mmc
References
Kishor S. and K. Johnson. 2006. Reproductive Health and Domestic Violence: Are the Poorest
Women Uniquely Disadvantaged? Demography Vol. 43(2 ): 293-307
--. 2004. Profiling domestic violence: A multi-country study. ORC Macro, Calverton, Maryland
Watts. C. and C. Zimmerman. 2002. Violence against women: global scope and magnitude Lancet
Vol. 359( 9313):1232 – 1237
World Health Organization. 2001. Putting women first: Ethical and safety recommendations for
research on domestic violence against women. Department of Gender and Women's Health,
Geneva, Switzerland