Olalekan A. Uthman. Thesis for doctoral degree (Ph.D.) 2011

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1 Thesis for doctoral degree (Ph.D.) 2011 Thesis for doctoral degree (Ph.D.) 2011 Attitudes Towards and Exposure to Intimate Partner Violence Against Women in Sub-Saharan Africa Olalekan A. Uthman Attitudes Towards and Exposure to Intimate Partner Violence Against Women in Sub-Saharan Africa: Contextual Effects, Neighbourhood Variations and Individual Risk Factors Olalekan A. Uthman

2 ATTITUDES TOWARDS AND EXPOSURE TO INTIMATE PARTNER VIOLENCE AGAINST WOMEN IN SUB-SAHARAN AFRICA: CONTEXTUAL EFFECTS, NEIGHBOURHOOD VARIATIONS AND INDIVIDUAL RISK FACTORS

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4 There is little difference in people, but that little difference makes a big difference. That little difference is attitude. The big difference is whether it is positive or negative. -

5 ABSTRACT Background: Aims: Methods: Results:

6 Conclusions:

7 LIST OF PUBLICATIONS BMC Int Health Hum Rights BMC Public Health Soc Sci Med

8 CONTENTS

9 LIST OF ABBREVIATIONS

10 AN OVERVIEW OF THE FIVE STUDIES Study Short title Data source Study design Outcome Statistical method Level of analysis

11 1 INTRODUCTION

12 2 BACKGROUND

13 2.1 THE CONSEQUENCES OF INTIMATE PARTNER VIOLENCE IPVAW operates through multiple pathways to affect women's sexual and reproductive health (see directly

14 Figure 1: Reproductive health complications associated IPVAW (Adapted from Heise 83 ) Figure 2: Health outcomes of IPVAW

15 2.2 THEORETICAL MODELS / CONCEPTUAL FRAMEWORK Ecological model Figure 3: Ecological model (Adapted from Heise (1998) 85 )

16 2.2.2 Bandura's social learning theory Theory of planned behaviour Figure 4: Theory of planned behaviour (Ajzen )

17 BIW ABbeW SNnmW PBCcp where BI= = Behavioral intention; AB = Attitude toward behavior;(b) = the strength of each belief; (e) = the evaluation of the outcome or attribute ; SN = social norm; (n) = the strength of each normative belief; (m) = the motivation to comply with the referent; PBC = Perceived Behavioral Control; (c) = the strength of each control belief; (p) = the perceived power of the control factor; W = empirically derived weight/coefficient Social disorganization Imbalance theory of resources and power 2.3 RATIONALE FOR CONTEXTUAL AND CROSS-COUNTRY

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19 3 AIMS AND HYPOTHESIS 3.1 OVERALL AIM 3.2 SPECIFIC OBJECTIVES: 3.3 HYPOTHESES

20 4 MATERIALS AND METHODS 4.1 DATA SOURCES Individual-level data Figure 5: Study countries

21 4.1.2 Community-level data Country-level data 4.2 ETHICAL CONSIDERATIONS 4.3 OUTCOME VARIABLES Intimate Partner Violence Against Women (IPVAW)

22 4.3.2 Attitudes towards IPVAW 4.4 DETERMINANT VARIABLES Individual-level factors Demographic /social position Media access Decision making power

23 4.4.2 Community-level Country-level

24 4.5 STATISTICAL ANALYSIS Study I I 2 I 2 I 2

25 4.5.2 Study II Meta-analysis: I I I Meta-regression analysis: p Study III y, i jk π ijk y ijk π ijk X π = π π = β + β X + β X + β X + u + v ijk ijk ijk ijk jk k jk k β + β X + β X + β X ijk jk k u jk v k Modelling:

26 Fixed effects (measures of association) Random effects (measures of variation) = π = π + + =

27 ( ) = ( β ) ( β ) = ( β + ) ( β + ) = τ

28 4.5.4 Study IV Study V

29 Figure 6: Alternative hypotheses for the association between tolerant attitudes towards IPVAW, witnessing IPVAW and experience of IPVAW

30 5 RESULTS 5.1 COMPARATIVE ANALYSES Factors associated with attitudes towards intimate partner violence against women: a comparative analysis of 17 sub-saharan countries (STUDY I) Description of included countries Table 1: Selected social, economic, and demographic characteristics of 17 countries in Sub-Saharan Africa by year of survey. Country Year Sample size Polygamy (%) GDP (US$ 2005) Adult literacy rate GDI HDI

31 5.1.2 Justification of IPVAW by gender norm transgressed Figure 7: Percentage of women who believe that IPVAW is justified, by different scenarios

32 Figure 8: Percentage of men who believe that IPVAW is justified, by different scenarios Figure 9: Sex-difference in attitudes towards IPVAW of 17 sub-saharan countries

33 5.1.3 Factors associated with attitudes towards IPVAW

34 Table 2 * Benin Burkina Faso Ethiopia Ghana Kenya Lesotho Liberia Madagascar Malawi Mozambiqu e Namibia Nigeria Rwanda Swaziland Tanzania Uganda Zimbabwe Variable OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR Sex Age Education Occupation Marital Wealth Type of residence Decision making indices

35 Zimbabwe Uganda Tanzania Swaziland Rwanda Nigeria Namibia Mozambiqu e Malawi Madagascar Liberia Lesotho Kenya Ghana Ethiopia Burkina Faso Benin Variable OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR Media access

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37 Figure 10: Forest plot showing pooled odds ratio and 99% confidence interval for socio-demographic factors 5.2 GENDER DISPARITIES IN ATTITUDES TOWARDS IPVAW Sex disparities in attitudes towards intimate partner violence against women in sub-saharan Africa: a socio-ecological analysis (STUDY II)

38 Figure 11: Forest plot of weighted gender-difference in attitude toward intimate partner violence against women of 17 countries in sub-saharan Africa. p I

39 Figure 12: Plot indicating the influence of each country on the overall pooled result- "leave-one-country-out" sensitivity analysis.

40 Table 3: Univariable meta-regression of attitudes towards intimate partner violence using study and country-specific characteristics as explanatory factors Variable Study characteristics Country-covariates Ratio of OR (95% CI)

41 5.3 INDIVIDUAL AND CONTEXTUAL SOCIOECONOMIC POSITION The independent contribution of individual-, neighbourhood-, and country-level socioeconomic position on attitudes towards intimate partner violence against women in sub-saharan Africa: a multilevel model of direct and moderating effects (STUDY III) Sample characteristics Table 4: Descriptive statistics of positive attitudes towards intimate partner violence against women and selected socioeconomic variables Variable Total Number (%) Yes (%) No (%) Level 1: Individuals

42 Variable Total Number (%) Yes (%) No (%) Level 2: Communities Level 3: Countries Measures of variations (random-effects) τ τ

43 Table 5: Results from random intercept model measures of variation Model 1 a Model 2 b Model 3 c Model 4 d Measures of variation a b c d

44 Table 6: Interval odds ratio (IOR), neighbourhood and country slope variance from Model 5 for individual, neighbourhood, and country variables regarding attitudes toward IPV against women among men and women residing in 17 countries from sub-saharan Africa

45 5.3.3 Measures of associations (fixed effects) Table 7: Individual compositional, community-, and country-level socio-economic position associated with attitudes toward IPV against women and their interaction with sex of respondent identified by multivariable multilevel logistic regression and estimated by Odds Ratios (OR) and 95% confidence intervals (95% CI), sub- Saharan Africa

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47 5.4 ROLES OF GENDER INEQUALITIES IN FORMING ATTITUDES The role of individual, community, and societal gender inequality in forming women s attitudes towards intimate partner violence against women: a multilevel analysis (STUDY IV) Sample Characteristics Error! Reference source not found Measures of Variations (Random Effects) τpτp Table 8: Individual-, community- and country-level gender inequality associated with attitudes toward intimate-partner violence against women (IPVAW) identified by multivariable multilevel logistic regression, sub-saharan Africa Variable Empty Model a Full model b OR (95% CI) Level 1: Individuals

48 Variable Empty Model a Full model b OR (95% CI) Level 2: Communities Level 3: Countries Measures of variation ppp a b Measures of Associations (Fixed Effects)

49 5.5 LINKING ATTITUDES TO OCCURRENCE OF PARTNER ABUSE Are individual and community acceptance and witnessing of intimate partner violence against women related to its occurrence? A multilevel structural equation model (STUDY V) Characteristics of the couples Measurement model

50 Figure 13: Item analysis, goodness-of-fit, reliability and validity assessment of the experience of IPVAW measurement model Figure 14: Item analysis, goodness-of-fit, reliability and validity assessment of the couple s tolerant attitudes towards IPVAW measurement model

51 5.5.3 Model selection Final model Figure 15: Final model

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53 6 DISCUSSION 6.1 MAIN FINDINGS

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57 6.2 STUDY LIMITATIONS AND METHODOLOGICAL CONSIDERATIONS

58 6.3 STUDY STRENGTHS

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60 P- 6.4 STUDY IMPLICATIONS AND RECOMMENDATIONS

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62 6.5 FUTURE RESEARCHES

63 7 CONCLUSIONS

64 8 ACKNOWLEDGEMENTS

65 9 REFERENCES Columbia J Gend Law African journal of reproductive health AIDS Captions Gend Dev African journal of reproductive health Safaids News Arch Intern Med Fam Plann Perspect Clin Psychol Rev Journal of Family Violence Lancet Int Nurs Rev Violence Vict Int Q Community Health Educ BMC Public Health Violence Vict Int Fam Plan Perspect Int Fam Plan Perspect African journal of reproductive health J Interpers Violence Ethiop Med J BJOG

66 CMAJ J Interpers Violence Sex Transm Infect Econ Pol Wkly Lancet European journal of obstetrics, gynecology, and reproductive biology Violence Vict Arch Sex Behav J Epidemiol Community Health Am Psychol J Epidemiol Community Health Soc Sci Med African journal of reproductive health Violence Vict J Interpers Violence Bull World Health Organ Violence Vict A user's guide to MLwiN. Version 2.10 Preventing intimate partner and sexual violence against women: taking action and generating evidence WHO Multi-Country study on women s health and domestic violence against women World report on violence and health Lancet Int Fam Plan Perspect

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