Vanke School of Public Health, Tsinghua University, Beijing, China.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Chan Zuckerberg Biohub- San Francisco, San Francisco, CA, USA.
Lancet Glob Health. 2023 Dec;11(12):e1863-e1873. doi: 10.1016/S2214-109X(23)00417-5.
In low-income and middle-income countries (LMICs), intimate partner violence poses a substantial barrier to accomplishing target 5.2 of the Sustainable Development Goals: to eliminate all forms of violence against women and girls. Our study aimed to assess the prevalence and changes of intimate partner violence against women in LMICs. We also explored the association between women's empowerment and intimate partner violence.
In this secondary analysis of population-based surveys, we obtained data from the nationally representative Demographic and Health Surveys conducted in LMICs between 2000 and 2021. We selected countries with available data on the domestic violence module, and women aged 15 to 49 years who currently or formerly had a husband or partner, and who had provided information about intimate partner violence, were included in the analysis. We first estimated the weighted prevalence of intimate partner violence in LMICs with available data, and then we assessed the average annual rate of change using Poisson regression with robust error variance in a subset of countries with at least two surveys. We used multilevel analysis to investigate the association between intimate partner violence and women's empowerment measured at both the country and individual levels. Country-level empowerment was measured by gender inequality index, while individual-level empowerment considered social independence, decision making, and attitude to violence.
A total of 359 479 women aged 15 to 49 years were included from 53 LMICs. 336 811 women from 21 countries with two surveys provided data for assessing the trends of intimate partner violence. The weighted prevalence of any type of intimate partner violence was 37·2% (95% CI 36·6 to 37·8). A significant overall decline in the prevalence of any type of intimate partner violence was observed with an average annual rate of change of -0·2% (95% CI -0·4 to -0·03); however six countries showed significant increasing trends, with average annual rates of change ranging from 1·2% (95% CI 0·7 to 1·7) in Nigeria to 6·6% (5·3 to 7·8) in Sierra Leone. Notably, the prevalence of psychological intimate partner violence has risen (average annual rate of change, 2·3% [95% CI 2·1 to 2·6]), reflected in increased rates across eight countries. Higher levels of country-level women's empowerment were associated with a lower risk of intimate partner violence: women from countries with the highest tertile of gender inequality index had an increased odds of any type of intimate partner violence (odds ratio 1·58 [95% CI 1·12 to 2·23]). Similarly, better individual-level women's empowerment also showed significant associations with a lower risk of intimate partner violence.
The prevalence of intimate partner violence remains high, and some countries have shown an increasing trend. The strong relationship between both country-level and individual-level women's empowerment and the prevalence of intimate partner violence suggests that accelerating women's empowerment could be one strategy to further reduce intimate partner violence against women.
National Natural Science Foundation; Vanke School of Public Health, Tsinghua University; and Sanming Project of Medicine in Shenzhen.
在低收入和中等收入国家（LMICs），亲密伴侣暴力是实现可持续发展目标 5.2 的重大障碍：消除针对妇女和女童的一切形式暴力。我们的研究旨在评估 LMICs 中针对妇女的亲密伴侣暴力的流行率和变化情况。我们还探讨了妇女赋权与亲密伴侣暴力之间的关系。
在这项对基于人群的调查进行的二次分析中，我们从 2000 年至 2021 年在 LMICs 进行的具有代表性的人口与健康调查中获取数据。我们选择了具有家庭暴力模块数据的国家，并纳入了目前或曾经有丈夫或伴侣、且提供了关于亲密伴侣暴力信息的 15 至 49 岁的妇女。我们首先估计了具有可用数据的 LMICs 中亲密伴侣暴力的加权流行率，然后在至少有两个调查的国家亚组中使用泊松回归和稳健误差方差评估了平均年变化率。我们使用多水平分析来研究国家和个人层面的亲密伴侣暴力与妇女赋权之间的关联。国家层面的赋权通过性别不平等指数衡量，而个人层面的赋权则考虑社会独立性、决策和对暴力的态度。
来自 53 个 LMICs 的 359479 名 15 至 49 岁的妇女被纳入研究。来自 21 个具有两次调查的国家的 336811 名妇女提供了数据，用于评估亲密伴侣暴力的趋势。任何类型的亲密伴侣暴力的加权流行率为 37.2%（95%CI 36.6 至 37.8）。观察到任何类型的亲密伴侣暴力的流行率呈显著总体下降趋势，平均年变化率为-0.2%（95%CI -0.4 至 -0.03）；然而，六个国家显示出显著的上升趋势，平均年变化率范围从尼日利亚的 1.2%（95%CI 0.7 至 1.7）到塞拉利昂的 6.6%（5.3 至 7.8）。值得注意的是，心理亲密伴侣暴力的流行率有所上升（平均年变化率，2.3%[95%CI 2.1 至 2.6]），这反映在八个国家的比率上升。较高的国家层面妇女赋权水平与较低的亲密伴侣暴力风险相关：来自性别不平等指数最高三分位的国家的妇女发生任何类型亲密伴侣暴力的几率增加（比值比 1.58[95%CI 1.12 至 2.23]）。同样，更好的个人层面妇女赋权也与较低的亲密伴侣暴力风险显著相关。
亲密伴侣暴力的流行率仍然很高，一些国家呈上升趋势。亲密伴侣暴力的流行率与国家和个人层面的妇女赋权之间的强烈关系表明，加速妇女赋权可能是进一步减少针对妇女的亲密伴侣暴力的一种策略。
国家自然科学基金；清华大学万科公共卫生学院；深圳三明明医学。
