Factors associated with violence by a current ... - Wiley Online Library

Sociology of Health & Illness Vol. 33 No. 5 2011 ISSN 0141–9889, pp. 694–709 doi: 10.1111/j.1467-9566.2011.01319.x

Factors associated with violence by a current partner in a nationally representative sample of German women Heidi Sto¨ckl, Lori Heise and Charlotte Watts Department of Global Health and Development, London School of Hygiene and Tropical Medicine

Abstract

Partner violence is a serious human rights violation and public health issue. Although its pervasiveness is well documented, more research is needed on risk and protective factors to inform interventions. This study is based on a secondary analysis of the first national survey on violence against women in Germany. Women who reported partner violence by their current partner were compared to women who never reported partner violence. The prevalence of physical or sexual violence, or both, by current partners was 17 per cent. Women who experienced violence during their childhood had higher odds of experiencing partner violence. Partner violence was associated with women’s drug use in the last 5 years, physical disability or debilitating illness, having more than three children, experiencing violence by a non-partner and feeling socially excluded. The odds of violence also increased if both partners were unemployed or lacked vocational training or if only the woman had vocational skills. Relationships shorter than 5 years or where the man or both partners drank heavily were likewise associated with higher odds of violence. Partner violence interventions should focus on reducing children’s exposure to violence and preparing women and men for the job market as well as including interventions that tackle social isolation and substance use.

Keywords: domestic violence, risk and protective factors, gender, prevalence, Germany

Introduction Partner violence is a serious human rights violation and public health issue, significantly associated with homicide of women (McFarlane et al. 2002), social isolation (Jewkes 2002) and adverse physical and mental health outcomes, including injuries, chronic pain, depression and post-traumatic stress disorders (Campbell 2002, Eisenstat and Bancroft 1999, Kyriacou et al. 1999, Watts and Zimmerman 2002). Research over the last decade has shown that partner violence is common worldwide, although the fact that different measures and methodologies have been used makes it difficult to draw comparisons across settings except where a special effort has been made to enhance comparability. One study that focused on yielding comparable data was the World Health Organization (WHO) multi-country study on violence against women, which used standardised questionnaires and standardised training and procedures across sites to measure population prevalence of partner violence. 2011 The Authors. Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd. Published by Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA

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This study found that the lifetime prevalence for physical and sexual partner violence ranged from 15 per cent in a Japanese city to 71 per cent in an Ethiopian province (Garcia-Moreno et al. 2005). In Europe, several nationally representative surveys have been conducted but they all used different study designs and measures of partner violence. These studies estimate the lifetime prevalence of physical or sexual partner violence among women to be 32 per cent in Finland (Lundgren et al. 2002), 27 per cent in Norway (Nerøien and Schei 2008), 21 per cent in Switzerland (Gillioz et al. 1997) and 18 per cent in Portugal (Lourenco et al. 1997). The nationally representative survey of women in Germany, which is the foundation for this article’s secondary analysis, found that 25 per cent of German women had experienced physical or sexual partner violence, or both, in their lifetime (Mu¨ller and Schro¨ttle 2004). The high prevalence of partner violence combined with its established consequences for health raises the question of how violence in relationships can be prevented. Are there risk and protective factors that, if identified and understood, could help inform the design of interventions? Studies of risk and protective factors of partner violence, based on multivariate analyses of population-based surveys, have been conducted in Egypt (Akmatov et al. 2008), Peru (Flake 2005), eight southern African countries (Andersson et al. 2007), China (Parish et al. 2004), Vietnam (Dang Vung et al. 2008), Haiti (Gage 2005), Canada (Romans et al. 2007), the USA (Breiding et al. 2008) and four eastern states in India (Babu and Kar 2009). However, those coming from Europe suffer from serious limitations. Only two – one in Finland and one in the UK (Piispa 2004, Finney 2006) – are based on nationally representative surveys, while the remainder apply only to urban settings, including studies of partner violence in four Turkish cities (Kocacık et al. 2007), Tirana in Albania (Burazeri et al. 2005), Madrid in Spain (Zorrilla et al. 2010) and urban centres in Greece (Papadakaki et al. 2009). Moreover, most look only at individual and relationship-level factors and focus largely on factors related to the woman rather than her partner. By contrast, this article conceptualises partner violence as the product of an interplay of factors operating at different levels of the social ecology, including factors from the man and woman’s childhood such as prior experiences of abuse, factors relevant to the couples’ current relationship and household situation, factors related to the couples’ work and community environment and the social and economic drivers operating at the macro-social level. This ecological model of abuse has been widely applied to the study of partner violence (Dasgupta 2002, Heise 1998), including the WHO multi-country study on women’s health and domestic violence (Garcia-Moreno et al. 2006). In Germany the government published a descriptive analysis of factors associated with partner violence based on the nationally representative survey. However, this focused on describing bivariate associations and did not clearly define whether other factors were controlled for in the analysis (Schro¨ttle and Ansorge 2008). Moreover, it did not explore the strength of the associations or how different factors interact. The currect study therefore uses a multivariate analysis to establish the independent effect of different factors associated with abuse in the previously published German national survey.

Methods This article uses data drawn from the national survey ‘Health, well-being and personal safety of women in Germany’, the first nationally representative survey on violence against women in Germany. The Centre for Women’s Studies at the University of Bielefeld in cooperation with the Institute for Applied Social Sciences in Bonn conducted the survey from February to 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

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Heidi Sto¨ckl, Lori Heise and Charlotte Watts

October 2003 under a commission from the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth. Details of the study methods, sampling and response rate have been reported elsewhere (Mu¨ller and Schro¨ttle 2004). Briefly, the survey is based on a representative sample of 10,264 women between the age of 16 and 86, who were randomly selected from registration lists from 250 randomly chosen communities throughout Germany. The selected women received a personalised letter inviting them to participate and informing them about the study. The letter provided detailed information on participant selection, data privacy laws and the voluntary nature of participation. The study’s neutral title aimed to alert participants to the study’s theme without biasing participation by mentioning the word violence. The women received a free telephone calling card for their participation. All the interviewers were specially trained women who had had prior experience conducting surveys on sensitive matters. The research centres supervised the interviewers during the interviewing phase and established a hotline service to provide emotional support for participants or interviewers, or both, for the duration of the study. All the participants received information on regional domestic violence services. The survey was mainly conducted in the women’s homes. To assure privacy, 12 per cent of the interviews took place at a mutually agreed location outside the home. The national survey consisted of two components, a face-to-face interview and a written questionnaire that the participants filled out on their own. The face-to-face interview focused on experiences of violence by any perpetrator. The interviewers presented respondents with cards listing possible replies to sensitive questions and interviewees could use codes to respond. This allowed the interview to continue in the presence of others and encouraged honest answers (Mu¨ller and Schro¨ttle 2003). Other people were present at the home in 14 per cent of the interviews and in 4 per cent someone else was present in the same room or interrupted the interview, even if this was only for a short time. Although the interviewers were advised to ensure privacy and disrupt the interview when other people were present, the authors of the original study stated that this was not always possible, partly because the interview often lasted longer than expected (Mu¨ller and Schro¨ttle 2003).1 The written questionnaire focused on partner violence and included questions on psychological abuse and physical and sexual violence in intimate relationships and in women’s childhood. The national survey had a response rate of 52 per cent. The response rates were higher among younger women, with 57 per cent of all women under 24 years agreeing to be interviewed, compared with 39 per cent for women above 75. The reasons women gave for non-participation at the initial phone contact included their lack of interest (14%), a general refusal to participate in survey research (10%), a lack of time (7%), concerns about the survey topic (1%) and being prevented from doing so by a third person (1%) (Mu¨ller and Schro¨ttle 2003). Due to the study design women living in former East Germany are over-represented in this survey. A comparison with the Micro Census 2001, a survey with mandatory participation, showed that participation bias lead to an under-representation of younger women and women with low educational qualifications, an overrepresentation of women from urban areas and a regional variety in participation. The weighting according to the Micro Census corrected for these imbalances. Measurement of partner violence Women were considered to have experienced partner violence by a current partner if they reported physical and sexual violence ever in their current relationship in either the face-toface interview or in the written questionnaire. The disclosure rates were twice as high in the 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd


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written questionnaire. Physical and sexual violence was measured using a modified version of the revised conflict tactics scale (CTS) (Straus et al. 1996). The CTS inquires about specific acts ranging from being pushed away angrily and slapped in the face to being strangled and injured with a weapon. Modifications focused on adding phrases like ‘so that it hurt or I became frightened’ or ‘so that it could have injured me’ to exclude trivial acts that do not constitute physical assaults (Mu¨ller and Schro¨ttle 2004). The five questions on sexual violence reflect German criminal law and include acts from forced or attempted forced sexual intercourse to forced petting and the forced watching and re-enacting of pornographic material. Our analysis compared women who reported having experienced any act of physical or sexual violence, or both, by their current partner with partnered women who did not report experiencing any violent acts. Those who had experienced partner violence by a previous but not their current partner were excluded from the analysis to avoid diluting possible associations predicting violence in the current relationship. Conceptual framework To orient our analysis we used the ecological framework of partner violence first proposed by Heise (1998) and later promoted by the WHO (Krug et al. 2002). It examines potential risk factors for partner violence at the individual, couple, community and macro-social levels. Figure 1 displays the factors we included in the analysis from each level of the framework.

Woman’s childhood

Woman’s family of origin (Grew up with both parents/Grew up with single parent or others) Woman’s witnessing of parental violence (No/Mother initiated/ Father initiated/ Both initiated) Woman’s harsh physical punishment in childhood (No/Yes) Woman’s child sexual abuse (No/Yes)

Prior to relationship

Woman’s vulnerabilities

Woman’s disability status Physical disability or severe, chronic illness (Not disabled/Disabled) Woman’s drug use in the last five years (No/Yes) Woman’s physical/ sexual non-partner violence (> 15 years old) Perpetrator can be a stranger, family member, someone at work, friend, neighbour or others (No/Yes) Woman’s age (< 20, 20–35 and > 35)

Relationship and household characteristics

Age gap with partner (No gap/She is older/He is older) Relative income (Same/He earns more/She earns more) Relative education (Same/He has higher/She has higher) Relative vocational education and training (Both have/Only he has/Only she has/Both do not have) Relative employment (Both working/Only he is working/ Only she is working/Neither working) Relative nationality (Both German/Only he is/Only she is/Both not German) Children (No child/1–3 children/ > 3 children) Distribution of household chores (She does most/They share or he does) Heavy drinking in the last month (Neither/Her only/Him only/Both) Marital status (Married or widowed/ Single/Divorced) Relationship duration (> 5 years/ 3–5 years/< 3 years)

Social support and community

Woman's perception of her social network (Feels included/ Feels excluded) Woman's activities outside the home (Goes out/Does not go out) Woman's perception of having people close to her (People to talk to/No people to talk to) Woman gets visitors at home (Yes/No) Woman's perception of their neighbourhood (People know and help each other/ People do not know or help each other)

Wider surroundings

Woman live in East or West Germany (West/East) Woman lives in a rural or urban area (Rural/Urban)

Current situation

Figure 1 Ecological framework on confounders of partner violence in current relationships, outlining the measurement of factors analysed in this study 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

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We included factors from the respondent’s family of origin, including witnessing parental violence, growing up in a single parent family, experiencing harsh physical punishment or being sexually abused. Associations at the individual level focused on the women’s current behaviour and vulnerabilities, including substance use, their disability status and whether they had been physically or sexually assaulted, or both, by someone other than an intimate partner. At the household and relationships level we focused on status inconsistencies between the partners, including differences in education, income and employment. The factor ‘vocational education and training’ captures whether an individual has finished 2 to 3 years of vocational training for a job or has a university degree; a professional qualification necessary for getting decent, sustainable employment in Germany. At the community level we examined the degree to which women felt embedded in their community and had access to social support. At the macro social level we were limited to exploring the associations between urban versus rural settings and between the former East Germany versus West Germany. Statistical analysis Our analysis looks at a subset of 3866 women who were currently in a relationship and aged 16 to 49 at the time of the survey. We chose this age range to capture women of reproductive age, thus allowing comparisons with other international studies. Including only women with current partners allowed us to ensure that the data collected on women’s partners related to their current abuse status. This restriction, however, unfortunately excludes women who had left their abusive partners or who experienced partner violence during or after their separation. To analyse the data, we calculated descriptive statistics and explored possible associations between factors by conducting cross tabulations and chi square statistics. Next we estimated crude odds ratios (OR) using bivariate logistic regression. All associations with P-values below 0.05 were used in the multivariate logistic regressions to adjust for other significant factors operating at the same conceptual level or stage of the model (for example, childhood; women’s behaviour and vulnerability, relationship and household). Factors that remained significant at the (P < 0.05) level in each of the multivariate models were then combined in a staged manner into a multivariate logistic regression model. The variables from childhood were entered first, followed by those representing women’s current behaviour and vulnerability, household and relationship factors, social support and community and finally variables related to the surrounding macro environment. A variety of sensitivity analyses were conducted, which confirmed the fit of our model (data not shown). Because these data are cross-sectional, none of the associations except those from childhood (where the temporal sequencing of events is clear) can be interpreted as suggesting causality, because they might also reflect the consequences of the violence. All data were analysed using STATA 11.

Results Of the 3866 women in the analysis, 17 per cent reported physical or sexual violence by their current partner. Overall 15 per cent of women experienced only physical violence, 1 per cent only sexual violence and 1 per cent experienced both forms of violence. The women’s mean age was 35 years and most (91 per cent) were German nationals (Table 1). Most (96 per cent) had completed secondary education, with 26 per cent having finished their A-levels or with a university degree. Four per cent had no educational qualification. Two-thirds of respondents were employed at the time of the survey, 84 per cent 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd


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Table 1 Factors associated with physical or sexual partner violence, or both, in a current relationship. Frequencies and crude odds ratios (OR) with confidence intervals (CI) (weighted data)

Total sample

No violence Violence by current by current partner partner

N (%)

%

%

OR

90.3 9.7

83.6 16.4

1.83*** (1.31, 2.55)

86.8 7.8 2.0 3.4

68.1 19.0 2.8 10.1

3.12*** (2.37, 4.10) 1.78 (0.93, 3.43) 3.73*** (2.47, 5.62)

40.8 59.2

18.3 81.7

3.08*** (2.40, 3.94)

93.0 7.0

82.8 17.2

2.77*** (2.09, 3.65)

87.4 12.6

80.1 19.9

1.71*** (1.33, 2.20)

Woman’s childhood Family of origin Grew up with both parents (ref.) 3469 (89) Grew up with single parent or others 395 (11) Woman’s witnessing of parental violence No (ref.) 3263 (84) Father initiated 379 (10) Mother initiated 75 (2) Both parents initiated 149 (5) Woman’s physical punishment in childhood No (ref.) 1428 (37) Yes 2438 (63) Woman’s child sexual abuse No (ref.) 3528 (91) Yes 338 (9) Woman’s vulnerabilities Woman’s disability status Not disabled (ref.) 3307 (86) Disabled 559 (14) Woman’s drug use in the last 5 years No (ref.) 3689 (96) Yes 145 (5) Woman’s physical ⁄ sexual non-partner violence (> No (ref.) 3610 (93) Yes 256 (7) Woman’s age (time of the survey) 36–49 (ref.) 2196 (52) 20–35 1489 (44) < 20 181 (5) Relationship and household Relative income Same (ref.) 413 (9) He earns more 1602 (41) She earns more 344 (8) Missing 1507 (42) Age gap between partner No gap (ref.) 756 (19) He is older 2646 (70) She is older 441 (11) Relative education Same education (ref.) 2104 (53) He has higher 916 (28) She has higher 846 (19)

96.8 89.0 3.2 11.0 15 years old) 88.7 64.9 11.3 35.1

(CI)

3.74*** (2.35, 5.96)

4.24*** (3.33, 5.39)

52.4 43.1 4.6

48.1 45.9 6.0

1.16 1.44

(0.94, 1.43) (0.88, 2.34)

9.5 40.6 7.2 42.6

8.4 41.0 9.9 40.6

1.14 1.57* 1.08

(0.81, 1.60) (1.01, 2.45) (0.76, 1.53)

18.8 70.7 10.5

19.7 64.4 15.9

0.87 1.44

(0.68, 1.12) (0.99, 2.11)

53.3 28.4 18.3

49.0 28.3 22.8

1.09 1.35*

(0.84, 1.41) (1.07, 1.71)

2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

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Table 1 (Continued)

Total sample

No violence by current partner

Violence by current partner

N (%)

%

%

OR

(CI)

79.3 11.3 4.4 5.0

69.2 11.3 8.2 11.3

1.15 2.13*** 2.58***

(0.83, 1.59) (1.48, 3.07) (1.60, 4.16)

60.3 27.7 7.6 4.5

53.8 29.0 7.9 9.4

1.17 1.16 2.36***

(0.93, 1.48) (0.83, 1.63) (1.61, 3.47)

0.5 91.8 3.3 4.4

0.7 89.3 3.9 6.1

0.73 0.89 1.05

(0.23, 2.31) (0.24, 3.27) (0.31, 3.59)

28.0 68.0 4.0

29.2 63.2 7.5

0.89 1.79*

(0.70, 1.13) (1.14, 2.80)

50.6 12.4 37.0

55.9 9.4 34.7

0.69* 0.85

(0.50, 0.94) (0.68, 1.07)

78.9 2.9 13.3 4.9

58.2 3.3 28.5 10.0

1.56 2.90*** 2.73***

(0.87, 2.80) (2.29, 3.67) (1.71, 4.37)

72.2 23.9 3.9

65.4 28.5 6.1

1.32* 1.72*

(1.03, 1.68) (1.10, 2.71)

75.3 10.2 14.6

67.0 13.8 19.2

1.53** 1.48*

(1.13, 2.07) (1.08, 2.03)

94.0 6.0

84.0 16.0

1.43***

(1.30, 1.59)

95.1 4.9

91.1 8.9

1.88**

(1.26, 2.81)

Relative vocational education and training Both have (ref.) 3175 (78) Only he has 340 (11) Only she has 217 (5) Neither has 134 (6) Relative employment Both working (ref.) 2293 (59) Only he is working 964 (28) Only she is working 326 (8) Neither is working 204 (5) Relative nationality Both are German (ref.) 20 (1) Only she is 3452 (91) Only he is 103 (3) Neither is German 140 (5) Children No child (ref.) 1040 (28) 1–3 children 2671 (67) > 3 children 152 (5) Distribution of household chores She does most 2012 (52) They share or he does 536 (14) Missing 1318 (34) Heavy drinking in the last month Neither (ref.) 2932 (75) Her only 104 (3) Him only 613 (16) Both 205 (6) Relationship status Married or widowed (ref.) 2738 (71) Single 955 (25) Divorced ⁄ separated 170 (4) Relationship duration > 5 years (ref.) 2819 (74) 3–5 years 398 (11) < 3 years 543 (15) Social support and community Woman’s perception of her social network Feels included (ref.) 3497 (98) Feels excluded 62 (2) Woman’s activities outside her home Goes out (ref.) 3570 (92) Does not go out 273 (8)



701

Table 1 (Continued)

Total sample

No violence Violence by current by current partner partner

N (%)

%

%

OR

(CI)

81.7 18.3

79.6 20.4

1.14

(0.88, 1.47)

88.4 11.6

78.4 21.6

2.10*** (1.61, 2.74)

59.6 40.4

50.5 49.5

1.45*** (1.18, 1.78)

81.6 18.4

83.3 16.7

0.89

(0.70, 1.12)

66.9 33.1

71.4 28.6

0.81

(0.65, 1.01)

Woman’s perception of having people close to her People to talk to (ref.) 3648 (94) No people to talk to 195 (6) Woman gets visitors at home Yes (ref.) 3038 (81) No 671 (19) Woman’s perception of her neighbourhood People know and help each other (ref.) 3352 (87) People do not know or help each other 501 (13) Wider surroundings Woman lives in East or West Germany West (ref.) 2707 (82) East 1159 (18) Woman lives in a rural or urban area Urban 2596 (68) Rural 1270 (32) *

P < 0.05, **P < 0.01, ***P < 0.001 ref. indicates reference category

had finished their vocational education and training and 91 per cent were German nationals. The distribution of associated factors by percentage, according to partner violence status and the crude OR are also shown (Table 1). Of these, relative education, marital status, the women’s activities outside the home and their perception of their neighbourhood became insignificant when other factors at the same conceptual level were adjusted for. Marital status and relative education became insignificant probably because of their strong association with the relationship duration, their employment status and relative vocational training and education. Likewise, activities outside the home and perceptions of the neighbourhood were strongly associated with receiving visitors at home and feeling socially included. We excluded differences in the couples’ income and the distribution of household chores from further analysis due to the high amount of missing information. Table 2 displays the adjusted OR of the final, multi-stage logistic regression model and adjusted OR for factors operating at each conceptual level. Women who were exposed to violence during childhood, such as physical punishment, child sexual abuse or to witnessing marital violence initiated by the father or by both parents, have a higher risk of experiencing partner violence in their current relationship. Controlling for factors operating at other levels of the social ecology influences the strength of these associations only modestly. The women’s drug use in the previous 5 years, their experiences of violence by nonpartners and their disability or debilitating chronic illness all increased the women’s odds of experiencing violence by their current partner, even after controlling for the effect of all factors operating at the level of the relationship or household. The women’s odds of experiencing partner violence were also higher if they and their partners both lacked 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

Woman’s family of origin Grew up with both parents (ref.) Grew up with single parent or others 1.60* Woman’s witnessing of parental violence No (ref.) Father initiated 2.21*** Mother initiated 1.25 Both parents initiated 3.07*** Woman’s physical punishment in childhood No (ref.) Yes 2.40*** Woman’s child sexual abuse No (ref.) Yes 1.89*** Woman’s disability status Not disabled (ref.) Disabled Woman drug use in the last 5 years No (ref.) Yes Woman’s physical ⁄ sexual non-partner violence (> 15 No (ref.) Yes Relative vocational education and training Both have (ref.) Only he has Only she has Neither has

Model 1

(1.16, 2.18)

(1.50, 4.15)

(1.06, 1.81)

1.59**

2.50***

1.39*

(1.38, 2.57)

(2.36, 3.93)

(1.71, 2.88)

2.22***

(1.85, 3.11)

3.05***

(1.39, 2.57) (0.46, 2.14) (1.77, 4.42)

1.89*** 0.99 2.80***

(1.65, 2.96) (0.63, 2.46) (1.99, 4.74)

years old)

(0.96, 1.86)

1.34

(1.11, 2.30)

Model 2

(2.32, 3.80)

(0.75, 1.59) (1.17, 2.84) (1.97, 5.59)

1.10 1.82** 3.32***

(1.13, 1.95)

(1.28, 3.39)

(1.19, 2.22)

(1.72, 2.92)

(1.53, 2.79) (0.60, 2.63) (1.72, 4.19)

(0.84, 1.63)

2.97***

1.49**

2.08**

1.62**

2.24***

2.06*** 1.25 2.69***

1.17

Model 3

1.01 1.85** 2.62**

2.86***

1.44**

2.18**

1.56**

2.24***

2.01*** 1.20 2.59***

1.15

Model 4

(0.69, 1.46) (1.21, 2.84) (1.46, 4.70)

(2.23, 3.68)

(1.10, 1.89)

(1.35, 3.52)

(1.14, 2.14)

(1.71, 2.93)

(1.48, 2.72) (0.55, 2.65) (1.65, 4.07)

(0.83, 1.61)

Table 2 Factors associated with physical and sexual partner violence in a current relationship. Odds ratios (OR) and confidence intervals (CI) of the multivariate logistic regression model (weighted data)

702 Heidi Sto¨ckl, Lori Heise and Charlotte Watts


Model 1

* P < 0.05, ** P < 0.01, *** P < 0.001 Exponentiated coefficients; 95% confidence intervals in brackets ref. indicates reference category

Relative employment Both working (ref.) Only he is working Only she is working Neither is working Heavy drinking in the last month Neither (ref.) Her only Him only Both Children No child (ref.) 1–3 children > 3 children Relationship duration > 5 years (ref.) 3–5 years < 3 years Woman’s perception of her social network Feels included (ref.) Feels excluded Woman gets visitors at home Yes (ref.) No N (total used for each model) 3864

Table 2 (Continued)

3833

Model 2

(0.59, 2.33) (2.18, 3.62) (1.16, 2.85)

(0.94, 1.78) (1.35, 4.14)

(1.10, 2.25) (0.85, 1.81)

1.17 2.81*** 1.82**

1.29 2.36**

1.57* 1.24

3658

(0.86, 1.43) (0.64, 1.41) (1.03, 2.53)

1.11 0.95 1.62*

Model 3

(1.15, 2.35) (0.86, 1.82)

(1.12, 1.43)

(1.11, 2.07) 3632

1.27***

1.52**

(0.96, 1.81) (1.37, 4.15)

(0.62, 2.45) (2.20, 3.63) (1.17, 2.89)

(0.84, 1.40) (0.59, 1.32) (0.89, 2.12)

1.64** 1.25

1.31 2.38**

1.23 2.82*** 1.84**

1.08 0.88 1.37

Model 4

Factors associated with partner violence 703


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vocational education and training or if only the woman had vocational training and education but her partner did not. Having good social support appeared to mediate the effect of unemployment on women’s risk of violence, as evidenced by the reduction in the strength and statistical significance of the association between unemployment and risk of partner violence when social support is added. Social support did not have a similar effect on the odds of partner violence when only the woman had vocational training and education. Heavy drinking in the previous month was strongly associated with partner violence if the man alone or both partners drank heavily in the previous month, with lower odds if both drank than if only the man drank. The women’s odds of experiencing partner violence also increased if women had more than three children, had been in their relationship for between 3 to 5 years compared to more than 5 years, felt socially excluded and never received visitors at home.

Discussion The study shows that almost one in five women in Germany have experienced physical or sexual partner violence from a current partner (17 per cent). This is higher than that documented in Sweden (11 per cent) and lower than in Finland (22 per cent) (Heiskanen and Piispa 1998, Lundgren et al. 2002). However, caution is in order when making such comparisons, as these differences may reflect variations in study design as well as true differences in prevalence. Our findings add support for the known association between partner violence and drug and alcohol use. Heavy alcohol use can slowly destroy relationship quality, raise individual’s level of aggression, interfere with cognitive abilities and impulse control and increase marital conflict (DeMaris et al. 2003, Klostermann and Fals-Stewart 2006); all potential causes of partner violence. The women’s odds of partner violence were almost threefold if the man drank heavily in the previous month or both partners did so. The association between partner violence, unemployment and lack of vocational training and education can be interpreted through the lens of several theories. Family stress theory would argue that unemployment and lack of vocational and educational training can result in stress and anxiety about the future, thereby increasing the risk of aggression and partner violence (Fox et al. 2002, Tjaden and Thoennes, 1998). Relative resource theory and gender role theory suggest that unemployed men with poor vocational skills may feel inadequate if they are unable to fulfil socially prescribed expectations as family bread winner (Goode 1971, McCloskey 1996, Macmillan and Gartner 1999). In such situations they may compensate by exerting male authority in the one domain where they can still prevail – their marriage (Atkinson et al. 2005, Goode 1971). While most studies on the intergenerational transmission of violence focus on the perpetrator’s childhood experiences of violence (Capaldi and Clark 1998), our findings confirm that that a woman’s exposure to physical punishment, sexual abuse or to witnessing marital violence, or both the latter, can also predispose her to experiencing partner violence in adulthood (Ehrensaft et al. 2003, Renner and Slack 2006). Interestingly, only witnessing violence initiated by the father or both parents (but not the mother alone) was significantly associated with increased risk. The association we found between the number of children and partner violence may arise from increased stress or conflict over levels of discipline, bringing up and supervising the children, financial resources or reduced quality of the marital relationship (Hoffman et al. 1994). Children can also hamper the ability of women to leave violent marriages or threaten 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd


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divorce, particularly if they are economically dependent on their partner and place a priority on keeping the family together (DeMaris et al. 2003, Hoffman et al. 1994). Conversely, having many children could also be a result of partner violence if an abusive partner interferes with contraceptive use or women become pregnant in the belief that it might reduce the abuse (Heise et al. 2002). Two different explanations may account for the association between partner violence and non-partner violence. Gage (2005), who found a significant association between violence by family members after the age of 15 and partner violence in Haiti, argues that child sexual abuse, witnessing violence and experiencing violence by other family members negatively impact on women’s self-esteem, increase their emotional vulnerabilities and impede their selfprotective capacities in the face of later threats of assault. Gage’s explanation finds support in the wider literature (Breitenbecher 2001, Casey and Nurius 2005). Alternatively, non-partner violence might reflect being exposed to neighbourhood crime or deviant peer groups, both known to be associated with partner and non-partner violence (Capaldi et al. 2001, Lauritsen and Schaum 2004). This study also investigated several factors that have not received significant attention in the literature, most notably women’s disability status. Existing studies suggest that disabled women may be more vulnerable to partner violence because of their higher dependency and lower socioeconomic status and their partners’ increased substance abuse, especially when the partner is the woman’s primary carer (Curry et al. 2001, Martin et al. 2006). The fact that disability remained significant in our analysis after controlling for alcohol abuse and unemployment suggests that dependency and control may be a more plausible explanation than alcohol abuse or socioeconomic status in our study. Our analysis further showed that women who are socially embedded are less likely to experience partner violence and that social inclusion mediates the adverse effect of other associations with partner violence, such as employment. Social networks, community involvement and friends can provide comfort, support and help, help solve disputes between partners and promote a kind of surveillance that helps enforce socially approved behaviour (Almgren 2005, DeMaris et al. 2003). Social isolation, however, could also be a result of controlling, abusive relationships. Our study also has several limitations. Firstly, the participation rate was 52 per cent and refusal may have biased the sample, since this was linked to age and time constraints. Although this rate is low, it is above average for a representative survey in Germany. For example, the response rate to the 2009 German General Social Survey was 40 per cent and it was 42 per cent to the 1999 European Social Value Survey. All data on partner and relationship characteristics are based on women’s accounts alone and we were unable to explore some established risk factors because the survey did not measure them, such as men’s experiences of violence during childhood, societal acceptance of violence or laws and services available to abused women in different regions. In addition, our analysis looks only at partner violence by a women’s current partner, excluding violence by former partners which might still be occurring in the woman’s life, given the high rate of partner violence postseparation (Brownridge 2006). Finally, the cross-sectional design of the study limits the extent to which we can establish the order of effect and distinguish risk factors from consequences of abuse. Too few prospective longitudinal studies exist that can clarify the causality of factors associated with partner violence; a gap that needs to be addressed by the next generation of studies on partner violence. Nonetheless, the study’s findings overall – emphasising the role of early childhood exposure to violence, current drug and alcohol abuse, large family size and access to resources – are consistent with the emerging international literature on risk and protective factors for partner violence (Graham et al. 2008, Hindin 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

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et al. 2008, Jeyaseelan et al. 2004). The findings suggest that partner violence interventions should holistically address factors at multiple levels, including efforts to address heavy drinking and prepare women and men for the job market. Prevention measures should include efforts to curb physical and sexual abuse in childhood, including programmes to support disclosure, punish perpetrators, change social norms and intervene with children living in violent homes. While socioeconomic factors such as unemployment and lack of vocational skills are not resolved quickly, their impact on partner violence should be considered when designing programmes, especially supporting men and women without vocational training and education or women with disabilities. Likewise, tackling alcohol abuse and integrating violence awareness into alcohol programming could help reduce the knock-on effect of excessive drinking on violence in relationships (Klostermann and Fals-Stewart 2006). In short, the field of violence prevention and services must look beyond its traditional borders and make common cause with researchers, advocates and practitioners working to keep children safe, curb alcohol abuse and improve employment and vocational training and education options for disenfranchised youth. Address for correspondence: Heidi Sto¨ckl, Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Room 327, 15–17 Tavistock Place, London WC1H 9SH e-mail: [email protected]

Note 1 Of the 14 per cent of interviews where other people were at home at the same time as the interview took place, half of the other people were children and most of the rest were partners. Of the 4 per cent of interviews where other people were in the same room, half of the others were children, mostly below the age of 4, and approximately one quarter were the women’s partners. Given the importance of confidentiality and safety in conducting interviews on sensitive issues like partner violence, the presence of others in the same room is likely to have reduced the identification of violence among these women and might have put them at risk of further violence.

References Akmatov, M.K., Mikolajczyk, R.T., Labeeb, S., Dhaher, E., et al. (2008) Factors associated with wife beating in Egypt: analysis of two surveys (1995 and 2005), BMC Women’s Health, 8, 15. Almgren, G. (2005) The ecological context of interpersonal violence: from culture to collective efficacy, Journal of Interpersonal Violence, 20, 218–24. Andersson, N., Ho-Foster, A., Mitchell, S., Scheepers, E., et al. (2007) Risk factors for domestic physical violence: national cross-sectional household surveys in eight southern African countries, BMC Women’s Health, 7, 1. Atkinson, M.P., Greenstein, T.N. and Lang, M.M. (2005) For women, breadwinning can be dangerous: gendered resource theory and wife abuse, Journal of Marriage and the Family, 67, 1137–48. Babu, B.V. and Kar, S.K. (2009) Domestic violence against women in eastern India: a populationbased study on prevalence and related issues, BMC Public Health, 9, 129. Breiding, M.J., Black, M.C. and Ryan, G.W. (2008) Prevalence and risk factors of intimate partner violence in eighteen U.S. states ⁄ territories, 2005, American Journal of Preventive Medicine, 34, 112–18. 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd


707

Breitenbecher, K.H. (2001) Sexual revictimization among women: a review of the literature focusing on empirical investigations, Aggression and Violent Behavior, 6, 415–32. Brownridge, D.A. (2006) Violence against women post-separation, Aggression and Violent Behavior, 11, 514–30. Burazeri, G., Roshi, E., Jewkes, R., Jordan, S., et al. (2005) Factors associated with spousal physical violence in Albania: cross sectional study, British Medical Journal, 331, 197–201. Campbell, J.C. (2002) Health consequences of intimate partner violence, Lancet, 359, 1331–36. Capaldi, D.M. and Clark, S. (1998) Prospective family predictors of aggression toward female partners for at-risk young men, Developmental Psychology, 34, 1175–88. Capaldi, D.M., Dishion, T.J., Stoolmiller, M. and Yoerger, K. (2001) Aggression toward female partners by at-risk young men: the contribution of male adolescent friendships, Developmental Psychology, 37, 61–73. Casey, E.A. and Nurius, P.S. (2005) Trauma Exposure and sexual revictimization risk: comparisons across single, multiple incident and multiple perpetrator victimizations, Violence Against Women, 11, 505–30. Curry, M.A., Hassouneh-Phillips, D. and Johnston-Silverberg, A. (2001) Abuse of women with disabilities: an ecological model and review, Violence against Women, 7, 60–79. Dang Vung, N., Ostergren, P.O. and Krantz, G. (2008) Intimate partner violence against women in rural Vietnam – different socio-demographic factors are associated with different forms of violence: need for new intervention guidelines? BMC Public Health, 8, 55. Dasgupta, S.D. (2002) A framework for understanding women’s use of nonlethal violence in intimate heterosexual relationships, Violence Against Women, 8, 1364–89. DeMaris, AA., Benson, M.L., Fox, G.L., Hill, T., et al. (2003) Distal and proximal factors in domestic violence: a test of an integrated model, Journal of Marriage and the Family, 65, 652–67. Ehrensaft, M.K., Cohen, P., Brown, J., Smailes, E., et al. (2003) Intergenerational transmission of partner violence: a 20-year prospective study, Journal of Consulting and Clinical Psychology, 71, 741–53. Eisenstat, S. and Bancroft, L. (1999) Domestic violence, The New England Journal of Medicine, 341, 886–92. Finney, A. (2006) Domestic violence, sexual assault and stalking: findings from the 2004 ⁄ 05 British Crime Survey, Home Office Online Report 12 ⁄ 06. Flake, D.F. (2005) Individual, family and community risk markers for domestic violence in Peru, Violence Against Women, 11, 353–73. Fox, G.L., Benson, M.L., DeMaris, A.A. and Van Wyk, J. (2002) Economic distress and intimate violence: testing family stress and resources theories, Journal of Marriage and the Family, 64, 793–807. Gage, A.J. (2005) Women’s Experience of intimate partner violence in Haiti, Social Science and Medicine, 61, 342–64. Garcia-Moreno, C., Heise, L., Jansen, H.A., Ellsberg, M., et al. (2005) Violence against women, Science, 25, 1282–83. Garcia-Moreno, C., Jansen, H.A., Ellsberg, M., Heise, L., et al. (2006) Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence, Lancet, 368, 1260–69. Gillioz, L., De Puy, J. and Ducret, V. (1997) Domination et violence envers la femme dans le couple. Lausanne: Payot. Goode, W.J. (1971) Force and violence in the family, Journal of Marriage and the Family, 33, 624– 36. Graham, K., Bernards, S., Munne, M. and Wilsnack, S. (2008) Unhappy Hours: Alcohol and Partner Aggression in the Americas. Washington: Pan American Health Organization. Heise, L. (1998) Violence against women: an integrated, ecological framework, Violence Against Women, 4, 262–90. Heise, L., Ellsberg, M. and Gottmoeller, M. (2002) A global overview of gender-based violence, International Journal of Gynecology and Obstetrics, 78, 5–14. 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

708


Heiskanen, M. and Piispa, M. (1998) Faith, Hope, Battering – A Survey of Men’s Violence against Women in Finland. Yliopistopaino, Helsinki: Statistics Finland. Hindin, M.J., Kishor, S. and Ansara, D.L. (2008) Intimate Partner Violence among Couples in 10 DHS Countries: Predictors and Health Outcomes. Calverton: Macro International. Hoffman, K.L., Demo, D.H. and Edwards, J.N. (1994) Physical wife abuse in a non-western society: an integrated theoretical approach, Journal of Marriage and the Family, 56, 131–46. Jewkes, R. (2002) Intimate partner violence: causes and prevention, Lancet, 359, 1423–29. Jeyaseelan, L., Sadowski, L.S., Kumar, S., Hassan, F., et al. (2004) World studies of abuse in the family environment – risk factors for physical intimate partner violence, International Journal of Injury Control and Safety Promotion, 11, 117–24. Klostermann, K.C. and Fals-Stewart, W. (2006) Intimate partner violence and alcohol use: exploring the role of drinking in partner violence and its implications for intervention, Aggression and Violent Behavior, 11, 587–97. Kocacık, F., Kutlar, A. and Erselcan, F. (2007) Domestic violence against women: a field study in Turkey, The Social Science Journal, 44, 698–720. Krug, E.G., Dahlberg, L.L., Mercy, J.A., Zwi, A., et al. (2002) World Report on Violence and Health. Geneva: World Health Organization. Kyriacou, D.N., Anglin, D., Taliaferro, E., Stone, S., et al. (1999) Risk factors for injury to women from domestic violence against women, The New England Journal of Medicine, 341, 1892–98. Lauritsen, J.L. and Schaum, R.J. (2004) The social ecology of violence against women. Criminology, 42, 323–57. Lourenco, N., Lisboa, M. and Pais, E. (1997) Violeˆncia contra as mulheres. Lisboa: Comissaõ para a igualdade e para os direitos das mulheres. Lundgren, E., Heimer, G., Westerstrand, J. and Kalliokoski, A.M. (2002) Captured Queen: Men’s Violence Against Women in ‘Equal’ Sweden: a Prevalence Study. Stockholm: Offentliga Publikationer. McCloskey, L. (1996) Socioeconomic and coercive power within the family, Gender and Society, 10, 449–63. McFarlane, J., Campbell, J.C. and Watson, K. (2002) Intimate partner stalking and femicide: urgent implications for women’s safety, Behavioral Sciences and the Law, 20, 51–68. Macmillan, R. and Gartner, R. (1999) When she brings home the bacon: labor-force participation and the risk of spousal violence against women, Journal of Marriage and the Family, 61, 947–58. Martin, S.L., Ray, N., Sotres-Alvarez, D., Kupper, L.L., et al. (2006) Physical and sexual assault of women with disabilities, Violence Against Women, 12, 823–37. Mu¨ller, U. and Schro¨ttle, M. (2003) Lebenssituation, Sicherheit und Gesundheit von Frauen in Deutschland: Eine repra¨sentative Untersuchung zu Gewalt gegen Frauen in Deutschland. BadenBaden: Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, KoelblinFortuna-Druck. Mu¨ller, U. and Schro¨ttle, M. (2004) Health, well-being and personal safety of women in Germany: a representative study of violence against women in Germany. Baden-Baden: Federal Ministry for Family Affairs Senior Citizens Women and Youth. Nerøien, A.I. and Schei, B. (2008) Partner violence and health: results from the first national study on violence against women in Norway, Scandinavian Journal of Public Health, 36, 161–68. Papadakaki, M., Tzamalouka, G.S., Chatzifotiou, S. and Chliaoutakis, J. (2009) Seeking for risk factors of intimate partner violence (IPV) in a Greek national sample: the role of self-esteem, Journal of Interpersonal Violence, 24, 732–50. Parish, W.L., Wang, T., Laumann, E.O., Pan, S., et al. (2004) Intimate partner violence in China: national prevalence, risk factors and associated health problems, International Family Planning Perspectives, 30, 174–81. Piispa, M. (2004) Age and meanings of violence: women’s experiences of partner violence in Finland, Journal of Interpersonal Violence, 19, 30–48. 2011 The Authors Sociology of Health & Illness 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd


709

Renner, L.M. and Slack, K.S. (2006) Intimate partner violence and child maltreatment: understanding intra- and intergenerational connections, Child Abuse and Neglect, 30, 599–617. Romans, S., Forte, T., Cohen, M.M., Du Mont, J., et al. (2007) Who is most at risk for intimate partner violence? Journal of Interpersonal Violence, 22, 1495–514. Schro¨ttle, M. and Ansorge, N. (2008) Gewalt gegen Frauen in Paarbeziehungen – eine sekunda¨ranalytische Auswertung zur Differenzierung von Schweregraden, Mustern, Risikofaktoren und Unterstu¨tzung nach erlebter Gewalt. Bonn: Federal Ministry for Family Affairs Senior Citizens Women and Youth. Straus, M.A., Hamby, S.L., Boney-McCoy, S. and Sugarman, D.B. (1996) The revised conflict tactics scale (CTS-2): development and preliminary psychometric data, Journal of Family Issues, 17, 283–316. Tjaden, P. and Thoennes, N. (1998) Prevalence, Incidence and Consequences of Violence Against Women: Findings from the National Violence Against Women Survey. Washington: US Department of Justice. Watts, C. and Zimmerman, C. (2002) Violence against women: global scope and magnitude, Lancet, 359, 1232–37. Zorrilla, B., Pires, M., Lasheras, L., Morant, C., et al. (2010) Intimate partner violence: last year prevalence and association with socio-economic factors among women in Madrid, Spain, European Journal of Public Health, 20, 169–75.
