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Intimate Partner Violence Against Women: Is Women Empowerment a Reducing Factor? A Study from a National Bangladeshi Sample Mosfequr Rahman, Md. Aminul Hoque & Satoru Makinoda

Journal of Family Violence ISSN 0885-7482 Volume 26 Number 5 J Fam Viol (2011) 26:411-420 DOI 10.1007/ s10896-011-9375-3

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Author's personal copy J Fam Viol (2011) 26:411–420 DOI 10.1007/s10896-011-9375-3

ORIGINAL ARTICLE

Intimate Partner Violence Against Women: Is Women Empowerment a Reducing Factor? A Study from a National Bangladeshi Sample Mosfequr Rahman & Md. Aminul Hoque & Satoru Makinoda

Published online: 13 May 2011 # Springer Science+Business Media, LLC 2011

Abstract This article explores how women empowerment affects Intimate Partner Violence (IPV) in Bangladesh using a cross-sectional investigation of currently married women (n=4,181) sampled via the Bangladesh Demographic Health Survey (BDHS), 2007. About one-fourth (24%) of currently married Bangladeshi women experienced both physical and/or sexual IPV in the past year. Prevalence of physical and sexual violence was 19.4% and 10.5%, respectively. Younger generation (age 15–24), illiterate, rural, and the poorest household wealth categorized women were much victimized. Current employment status predicted intimate partner violence. Household decision-making pattern also emerged as a predictor of IPV. Likelihood of all forms of IPV increases with increase of number of participation in household decision-making. Promoting women empowerment in the household without men’s support may put women at more risk of IPV. Keywords Intimate Partner Violence (IPV) . Women empowerment . Decision-making . Empowerment indicators . Bangladesh

M. Rahman (*) : S. Makinoda Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan e-mail: [email protected] M. A. Hoque Department of Medical Informatics, Niigata University of Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, Niigata-shi 951-8520, Japan

Introduction IPV against women is a pervasive public health concern and human rights violation of worldwide significance (Krantz 2002; Krantz and Garcia-Moreno 2005; Oyediran and Isiugo-Abanihe 2005; UNICEF 2000). It is as serious cause of death and incapacity as cancer and malaria combined (World Bank 1993). IPV has been shown to adversely affect women’s health, with evidence of an increased risk of HIV/AIDS, peri-natal and neonatal mortality, and a range of reproductive, mental and physical outcomes (Dunkle et al. 2004; Jejeebhoy 1998; Patel et al. 2006; Sidibe et al. 2006; Silverman et al. 2008; Stephenson et al. 2006). It is theoretically plausible that women’s economic empowerment through the process of development may be linked to IPV. On the one hand, women who earn an income and help themselves and their families have means to get out of bad marriages or not to marry at all. When women have more options, this should decrease likelihood of their being in an abusive relationship. Kabeer (1999) suggested that poor women are often most vulnerable to violence. On the other hand, women’s economic empowerment may promote male insecurity and feelings of economic inadequacy, leading to more violence in relationships. In support of the idea that economic empowerment can decrease IPV, Blumberg (1991) provides evidence that having their own income improves women’s ability to have say over fertility preferences, input into household decision-making, and self-esteem. Accordingly, when women feel empowered, they are better able to take action at the household level to improve their own and their children’s well-being. In India, study finds that even after controlling for total household income, the greater the wife’s income, the lower the likelihood that she will be beaten (Rao 1991). In contrast to the inverse association

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between women’s economic empowerment and domestic violence, Blumberg (1991) also points to evidence that as women gain more domestic power due to earned income, they may also face resistance and violence from their spouses (see Roldan 1988, for evidence of violence in households where husbands are unemployed and women are employed). Pattern of household decision-making characterize the interpersonal dynamics between husband and wife. Interdisciplinary research has focused on the reasons why one spouse may dominate decision-making (Blood and Wolfe 1965; Blumberg 1991) and how within families, when one individual decides for others, they may not consider the well-being of all family members (Dwyer and Bruce 1988; Sen 1990; Thomas 1990). Several studies have looked at the impact of spousal domination of decision making on the well-being and reproductive health of women (Ansara and Hindin 2009; Castro et al. 2008; Hindin 2000; Lawoko 2008) and some measures of women’s status are being explored in connection with IPV (Gelaye et al. 2010; Heise et al. 1999; Jejeebhoy and Cook 1997; Mann and Takyi 2009). In addition, a literature on IPV suggests that understanding the “origins and dynamics of different kinds of control in relationships will lead to progress in understanding domestic violence…” (Johnson and Ferraro 2000, p. 955). In this study, we assess the factors of women empowerment, including domination of household decision-making with past year IPV. The aim is to determine how and to what extent individual and economic empowerment of women is related to past year IPV in Bangladesh.

Methods Sample The study utilized the 2007 Bangladesh Demographic Health Survey (BDHS), conducted by the National Institute for Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare of Bangladesh from March to August 2007 (NIPORT et al. 2009). The survey used a sample drawn from the total population of Bangladesh residing in private dwellings. A stratified, multistage cluster sample of 361 primary sampling units, 227 in rural areas and 134 in urban areas, was conducted. A total of 11,178 eligible women age 15–49 was identified to participate in the survey, 10,996 were interviewed, for a response rate of 98.4%. Eligible men in every second household were selected to yield 4,074 potential male respondents, of whom 92.6% or 3,771 were successfully interviewed. The members of the survey team (which consisted of educated men and women) were trained by

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the experts for 4 weeks on how to collect the data properly. Five, well-designed, pre-tested, questionnaires were used during this survey. Fieldwork was supervised by the expert quality control teams. Questionnaire were drafted in English and then translated into Bangla, the national language of Bangladesh. The questions on domestic violence in the Women’s and Men’s Questionnaires were administered to only one eligible respondent per household, whether female or male. Selecting only one person to receive the domestic violence questions protects privacy of that person and helps to ensure that other respondents in the household are not aware of the types of questions that the selected respondent was asked. If there was more than one eligible female or male respondent in the household, the respondent was selected randomly through a specially designed simple selection procedure based on the Kish Grid (Kish 1965), which was built into the Household Questionnaire. Informed consent was obtained from survey respondents at the beginning of the interview. Data collection procedures for the BDHS were approved by the ORC Macro Institutional Review Board. Details of data collection and management procedure are described elsewhere (NIPORT et al. 2009). In this study, 4,181 currently married women were included for analyses. Measures All variables were assessed via self-report. A single item assessed demographics including age, education, and place of residence. A relative index of household wealth was calculated based on interviewer-observed assets (e.g., ownership of consumer items, dwelling characteristics). To create the wealth index, each asset was assigned a weight (factor score) generated through principal component analysis, and the resulting asset scores were standardized in relation to a normal distribution with a mean of zero and standard deviation of one (Gwatkin et al. 2000). Each household was then assigned a score for each asset, and the scores were summed for each household; individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles with 1 = poorest and 5 = wealthiest 20% of household. The questionnaire included six violence related questions. Each married woman was asked ‘(Does/did) your (last) husband ever do any of the things to you: (a) push you, shake you, or throw something at you; (b) slap you; (c) twist your arm or pull your hair; (d) punch you with his fist or with something that could hurt you; (e) kick you, drag you, or beat you up; (f) try to choke you or burn you on purpose; (g) threaten or attack you with a knife, gun, or any other weapon; (h) physically force you to have sexual intercourse with him even when you did not want to?’ A

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positive answer of these questions ((a)–(g)) indicated physical perpetration and positive to question (h) indicated sexual IPV perpetration. After each positive response, currently married women were asked about frequency of the act in the 12 months preceding the survey. We use the experience of past year IPV among currently married women in our study. The 2007 BDHS explores women’s empowerment in terms of employment, type of earnings, and control over cash and earnings, and freedom of movement. In order to examine how domestic violence varies by women’s empowerment, information on women’s participation in household decision-making and their attitudes towards wife beating are summarized in two separate indices. These indices are based only on women’s responses to the survey. The first index is the number of household decisions in which women participate alone or jointly with their husband. The items included in this index are: woman’s own health care; major household purchases; purchases of daily household needs; visits to family or relatives; and child’s health care. This index ranges in value from 0 to 5 and is positively related to women’s empowerment. This reflects the degree of control that women are able to exercise through making decisions in areas that affect their own lives and environments. The second index, which also ranges in value from 0 to 5, is the total number of reasons that a woman believes justifies a husband beating his wife. The items included to form this index are: she doesn’t obey elders; argues with husband; goes out without telling husband; neglects the children; and refuses to have sexual intercourse with husband. A higher score on this indicator may interpret as the women’s supportive attitudes towards wife beating. It also indicates, a woman who believes that a husband is justified in hitting or beating his wife for all of these reasons may consider herself to be of low status, both absolutely and relative to men.

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statistical analyses were conducted using SPSS 15.0 for windows (SPSS Inc., Chicago, IL) to accommodate the complex sampling design of the BDHS.

Results Nearly one in every four (24%) currently married Bangladeshi women experienced both physical and/or sexual violence in the 12 months preceding the survey: 10.5% experienced sexual violence in the absence of physical violence, 19.4% experienced physical violence in the absence of sexual violence by husbands (Fig. 1). Among different forms of IPV, the most common act of physical violence was slapping (Fig. 2). Eighteen percent of currently married women reported that they were being slapped by their current husband past year. Age was negatively associated with physical (p