Jewkes Rachel, Fulu Emma, Tabassam Naved Ruchira, Chirwa Esnat, Dunkle Kristin, Haardörfer Regine, Garcia-Moreno Claudia
Gender & Health Research Unit, Medical Research Council and School of Public Health, University of the Witwatersrand, Pretoria, South Africa.
The Equality Institute, Melbourne, Australia.
PLoS Med. 2017 Sep 5;14(9):e1002381. doi: 10.1371/journal.pmed.1002381. eCollection 2017 Sep.
Understanding the past-year prevalence of male-perpetrated intimate partner violence (IPV) and risk factors is essential for building evidence-based prevention and monitoring progress to Sustainable Development Goal (SDG) 5.2, but so far, population-based research on this remains very limited. The objective of this study is to compare the population prevalence rates of past-year male-perpetrated IPV and nonpartner rape from women's and men's reports across 4 countries in Asia and the Pacific. A further objective is to describe the risk factors associated with women's experience of past-year physical or sexual IPV from women's reports and factors driving women's past-year experience of partner violence.
This paper presents findings from the United Nations Multi-country Study on Men and Violence in Asia and the Pacific. In the course of this study, in population-based cross-sectional surveys, 5,206 men and 3,106 women aged 18-49 years were interviewed from 4 countries: Cambodia, China, Papua New Guinea (PNG), and Sri Lanka. To measure risk factors, we use logistic regression and structural equation modelling to show pathways and mediators. The analysis was not based on a written plan, and following a reviewer's comments, some material was moved to supplementary files and the regression was performed without variable elimination. Men reported more lifetime perpetration of IPV (physical or sexual IPV range 32.5%-80%) than women did experience (physical or sexual IPV range 27.5%-67.4%), but women's reports of past-year experience (physical or sexual IPV range 8.2%-32.1%) were not very clearly different from men's (physical or sexual IPV range 10.1%-34.0%). Women reported much more emotional/economic abuse (past-year ranges 1.4%-5.7% for men and 4.1%-27.7% for women). Reports of nonpartner rape were similar for men (range 0.8%-1.9% in the past year) and women (range 0.4%-2.3% in past year), except in Bougainville, where they were higher for men (11.7% versus 5.7%). The risk factor modelling shows 4 groups of variables to be important in experience of past-year sexual and/or physical IPV: (1) poverty, (2) all childhood trauma, (3) quarrelling and women's limited control in relationships, and (4) partner factors (substance abuse, unemployment, and infidelity). The population attributable fraction (PAF) was largest for quarrelling often, but the second greatest PAF was for the group related to exposure to violence in childhood. The relationship control variable group had the third highest PAF, followed by other partner factors. Currently married women were also more at risk. In the structural model, a resilience pathway showed less poverty, higher education, and more gender-equitable ideas were connected and conveyed protection from IPV. These are all amenable risk factors. This research was cross-sectional, so we cannot be sure of the temporal sequence of exposure, but the outcome being a past-year measure to some extent mitigates this problem.
Past-year IPV indicators based on women's reported experience that were developed to track SDG 5 are probably reasonably reliable but will not always give the same prevalence as may be reported by men. Report validity requires further research. Interviews with men to track past-year nonpartner rape perpetration are feasible and important. The findings suggest a range of factors are associated with past-year physical and/or sexual IPV exposure; of particular interest is the resilience pathway suggested by the structural model, which is highly amenable to intervention and explains why combining economic empowerment of women and gender empowerment/relationship skills training has been successful. This study provides additional rationale for scaling up violence prevention interventions that combine economic and gender empowerment/relationship skills building of women, as well as the value of investing in girls' education with a view to long-term violence reduction.
了解过去一年中男性实施的亲密伴侣暴力（IPV）的患病率及其风险因素，对于建立基于证据的预防措施和监测实现可持续发展目标（SDG）5.2的进展情况至关重要，但迄今为止，基于人群的相关研究仍然非常有限。本研究的目的是比较亚洲及太平洋地区4个国家中女性和男性报告的过去一年男性实施的IPV及非伴侣强奸的人群患病率。另一个目的是描述女性报告中与过去一年身体或性IPV经历相关的风险因素，以及促使女性过去一年遭受伴侣暴力的因素。
本文展示了联合国在亚洲及太平洋地区开展的多国男性与暴力问题研究的结果。在这项研究过程中，通过基于人群的横断面调查，对来自柬埔寨、中国、巴布亚新几内亚（PNG）和斯里兰卡4个国家的5206名18至49岁男性和3106名女性进行了访谈。为了衡量风险因素，我们使用逻辑回归和结构方程模型来展示路径和中介因素。分析并非基于书面计划，根据审稿人的意见，一些材料被移至补充文件，且回归分析未进行变量剔除。男性报告的一生中实施IPV行为（身体或性IPV范围为32.5% - 80%）多于女性所经历的（身体或性IPV范围为27.5% - 67.4%），但女性报告的过去一年经历（身体或性IPV范围为8.2% - 32.1%）与男性报告的（身体或性IPV范围为10.1% - 34.0%）差异并不十分明显。女性报告的情感/经济虐待情况更多（男性过去一年的范围为1.4% - 5.7%，女性为4.1% - 27.7%）。男性和女性报告的非伴侣强奸情况相似（男性过去一年的范围为0.8% - 1.9%，女性为0.4% - 2.3%），但在布干维尔地区除外，该地区男性的报告率更高（11.7%对5.7%）。风险因素模型显示，有4组变量在过去一年的性和/或身体IPV经历中很重要：（1）贫困，（2）所有童年创伤，（3）争吵以及女性在关系中的控制权有限，（4）伴侣因素（药物滥用、失业和不忠）。人群归因分数（PAF）在经常争吵方面最大，但第二大PAF与童年时期遭受暴力暴露的组相关。关系控制变量组的PAF排第三，其次是其他伴侣因素。目前已婚女性也面临更高风险。在结构模型中，一条复原力路径显示，较少的贫困、更高的教育水平以及更具性别平等观念相互关联，并传递了对IPV的防护。这些都是可调节的风险因素。本研究为横断面研究，因此我们无法确定暴露的时间顺序，但在某种程度上，以过去一年为衡量结果可减轻这一问题。
为跟踪可持续发展目标5而制定的基于女性报告经历的过去一年IPV指标可能相当可靠，但并不总是能给出与男性报告相同的患病率。报告的有效性需要进一步研究。对男性进行访谈以跟踪过去一年非伴侣强奸行为的实施情况是可行且重要的。研究结果表明，一系列因素与过去一年的身体和/或性IPV暴露相关；特别值得关注的是结构模型所暗示的复原力路径，它非常适合进行干预，并解释了为何将增强女性经济权能与性别赋权/关系技能培训相结合取得了成功。本研究为扩大结合增强女性经济权能和性别赋权/关系技能建设的暴力预防干预措施提供了额外的理论依据，以及投资女童教育以实现长期减少暴力的价值。
