International Institute for Population Sciences, Mumbai, India.
Department of Public Health and Mortality Studies, Mumbai, India; Center of Demography of Gender, Mumbai, India.
Lancet Glob Health. 2023 Oct;11(10):e1587-e1597. doi: 10.1016/S2214-109X(23)00377-7.
Although intimate partner violence (IPV) against women is a substantial challenge in India, response is limited by little evidence on substate prevalence. District-level IPV estimates are essential in targeted response and prevention efforts, but cannot be directly calculated from the National Family Health Surveys (NFHS), which is the main source of nationally representative IPV estimates in India. We aimed to use small-area estimation techniques to derive reliable estimates of physical, emotional, and sexual IPV for the 640 districts of India.
For this secondary analysis of a cross-sectional, population-based survey, we used model-based small-area estimation techniques linking data from the 2015-16 NFHS-4 and the 2011 Indian Population and Housing Census (2011 Indian Census) to derive district-level estimates of physical, emotional, and sexual IPV for the 640 districts of India in the previous 12 months. Only women who had ever been married aged 15-49 years, who were interviewed in NFHS-4, and who were included in the domestic violence module were eligible for inclusion in this analysis. Data collection occurred between Jan 20, 2015, and Dec 4, 2016. The 2011 Indian Census was conducted in all 640 districts from Feb 9 to Feb 28, 2011. It collected information on a range of data including sociodemographic data and housing characteristics. The primary outcomes of this analysis were the district-level mean proportions of women who experienced physical IPV, emotional IPV, and sexual IPV in the previous 12 months. This outcome was estimated for all women aged 15-49 years who had ever been married in the 640 districts of India that were included in the 2011 Indian Census.
699 686 women aged 15-49 years were interviewed in NFHS-4. One woman per household in a randomly selected 15% of households was chosen for participation in the domestic violence module, resulting in 83 397 (11·9%) of 699 686 women included. Of these 83 397 women, 14 377 (17·2%) were excluded as they had never been married and 3007 (3·6%) were excluded due to privacy limitations. The mean prevalence of physical IPV in the previous 12 months was 22·5% (95% CI 21·9-23·2), of emotional IPV in the previous 12 months was 11·4% (11·0-11·9), and of sexual IPV in the previous 12 months was 5·2% (4·9-5·5). Model-based estimates revealed intrastate and interstate IPV variations. In Bihar, which had the highest state-level physical IPV prevalence (35·1%, 33·3-37·0), district-level estimates varied from 23·5% (23·0-23·9) in Siwan to 42·7% (42·3-43·1) in Purbi Champaran. In Tamil Nadu, which had the highest state-level emotional IPV prevalence (19·0%, 17·4-20·8), district estimates ranged between 13·7% (13·2-14·1) in Kanniyakumari and 30·2% (29·5-30·8) in Sivaganga. Bihar also had the highest state-level sexual IPV prevalence (11·1%, 9·9-12·4), with estimates ranging between 6·3% (6·1-6·6) in Siwan and 18·1% (17·6-18·6) in Saharsa. Across districts, there was substantial spatial clustering of IPV prevalence.
This reliable district-level estimation of IPV prevalence in the 640 districts of India has important policy implications. The ability to track substate levels of IPV over time enables the identification of progress in reducing IPV; recognises the heterogeneity of culture and context in India; and informs the targeting of resources, interventions, and prevention programmes to districts with the greatest need.
Bill & Melinda Gates Foundation.
尽管亲密伴侣暴力（IPV）在印度是一个严重的挑战，但由于缺乏州级流行率的证据，应对措施受到限制。地区一级的 IPV 估计对于有针对性的应对和预防工作至关重要，但不能直接从全国家庭健康调查（NFHS）中计算得出，NFHS 是印度全国代表性 IPV 估计的主要来源。我们旨在使用小区域估计技术，为印度的 640 个地区提供身体、情感和性 IPV 的可靠估计。
这是一项基于横断面、基于人群的调查的二次分析，我们使用基于模型的小区域估计技术，将来自 2015-16 年 NFHS-4 和 2011 年印度人口和住房普查（2011 年印度人口普查）的数据联系起来，以得出印度的 640 个地区在前 12 个月内的身体、情感和性 IPV 的地区一级估计。只有曾经结过婚、年龄在 15-49 岁之间、在 NFHS-4 中接受过采访并包括在家庭暴力模块中的妇女才有资格纳入这项分析。数据收集于 2015 年 1 月 20 日至 2016 年 12 月 4 日进行。2011 年印度人口普查于 2011 年 2 月 9 日至 2 月 28 日在所有 640 个地区进行。它收集了一系列数据的信息，包括社会人口数据和住房特征。本分析的主要结果是前 12 个月内经历身体 IPV、情感 IPV 和性 IPV 的妇女的地区一级平均比例。这一结果是为所有 640 个印度地区中曾经结过婚的 15-49 岁的妇女估计的，这些妇女都包括在 2011 年印度人口普查中。
在 NFHS-4 中采访了 699686 名年龄在 15-49 岁的妇女。每个家庭随机选择 15%的家庭中的一名妇女参加家庭暴力模块，结果有 83397（11.9%）名 699686 名妇女被纳入。在这 83397 名妇女中，有 14377 名（17.2%）因从未结婚而被排除在外，有 3007 名（3.6%）因隐私限制而被排除在外。前 12 个月身体 IPV 的平均流行率为 22.5%（95%CI 21.9-23.2），前 12 个月情感 IPV 的平均流行率为 11.4%（11.0-11.9），前 12 个月性 IPV 的平均流行率为 5.2%（4.9-5.5）。基于模型的估计显示了州内和州际的 IPV 差异。在比哈尔邦，身体 IPV 的州一级流行率最高（35.1%，33.3-37.0），地区一级的估计从 Siwan 的 23.5%（23.0-23.9）到 Purbi Champaran 的 42.7%（42.3-43.1）不等。在泰米尔纳德邦，情感 IPV 的州一级流行率最高（19.0%，17.4-20.8），地区估计在 Kanniyakumari 为 13.7%（13.2-14.1），在 Sivaganga 为 30.2%（29.5-30.8）。比哈尔邦也是性 IPV 流行率最高的州（11.1%，9.9-12.4），其估计范围在 Siwan 的 6.3%（6.1-6.6）和 Saharsa 的 18.1%（17.6-18.6）之间。在各地区，IPV 流行率存在显著的空间聚类。
这项对印度 640 个地区 IPV 流行率的可靠地区一级估计具有重要的政策意义。能够跟踪州一级 IPV 的时间变化，使我们能够识别减少 IPV 的进展；认识到印度文化和背景的异质性；并为需要的地区提供资源、干预措施和预防方案的目标定位。
比尔和梅琳达·盖茨基金会。
