A COMPARATIVE ASSESSMENT OF THE PREVALENCE,
DETERMINANTS, AND HEALTH CONSEQUENCES OF
INTIMATE PARTNER VIOLENCE AMONG WOMEN IN A
RURAL AND AN URBAN AREA IN LAGOS STATE
A DISSERTATION SUBMITTED
BY
DR UKATU, ELOCHUKWU EBUNOLUWA
TO
THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA
IN FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF THE
FELLOWSHIP OF THE MEDICAL COLLEGE IN PUBLIC HEALTH
JANUARY 2016
1
DECLARATION
I hereby declare that this work titled “A Comparative Assessment of the Prevalence,
Determinants, and Health Consequences of Intimate Partner Violence among Women in a Rural and an Urban Area of Lagos State” was conducted by me under supervision. I also declare that this work has not been presented to any other college for a fellowship nor has it been submitted elsewhere for publication.
------
DR UKATU, ELOCHUKWU EBUNOLUWA
Department of Community Health and Primary Health Care,
Lagos State University Teaching Hospital,
Ikeja - Lagos
2
DEDICATION
This work is dedicated to the Almighty God whose grace makes all the difference in my life.
3
CERTIFICATION BY SUPERVISOR
This is to certify that this dissertation titled “A Comparative Assessment of the Prevalence,
Determinants and Health Consequences of Intimate Partner Violence among Women in a Rural and an Urban Area of Lagos State” was conducted by Dr. Ukatu, Elochukwu Ebunoluwa of the
Department of Community Health and Primary Health Care, Lagos State University Teaching
Hospital Ikeja, under my supervision.
DR YETUNDE KUYINU (MBBS, MPH, FMCPH)
Department of Community Health and Primary Health Care,
Lagos State University Teaching Hospital,
Ikeja - Lagos.
4
ATTESTATION
This attestation declares that this study titled “A Comparative Assessment of the Prevalence,
Determinants, and Health Consequences of Intimate Partner Violence among Women in a Rural and an Urban Area of Lagos State” conducted by Dr. Ukatu, Elochukwu Ebunoluwa of the
Department of Community Health and Primary Health Care, Lagos State University Teaching
Hospital Ikeja, was presented to the department in January, 2016 as required by the Faculty of
Public Health of the National Postgraduate Medical College of Nigeria.
------
DR YETUNDE KUYINU (MBBS, MPH, FMCPH)
Ag. Head, Department of Community Health and Primary Health Care,
Lagos State University Teaching Hospital,
Ikeja - Lagos.
5
ACKNOWLEDGEMENTS
I hereby express my profound gratitude to my supervisor and "mummy" for all her patience and guidance throughout my training programme and particularly during my research work despite her busy schedule.
I must also thank all my consultants namely, Prof. Odusanya for being a mentor and a father through the years, Dr. Wright, Dr. Adeniran, Dr. Goodman, Dr. Akinyinka and Dr. Bakare for their input in putting my work together and also for their mentorship in the course of my training. I also want to thank all past and present residents particularly Dr. Odugbemi, Dr. Mohammed and all the medical officers and nurses in the department for all their support and encouragement in the course of my work.
I must acknowledge all the women that consented to participate in the study as well as my data collectors, Kemi and her team, not forgetting to mention Mr Yomi for all his patience during data analysis.
I also want to acknowledge my father, Prof. Uche Onwudiegwu, my star and mentor for building the foundation for all I have become. I am eternally grateful to my late mother for believing in me even when no one else would. To my mum who took on the baton afterwards, for your care, support and patience, I say a big thank you.
Finally, to my king, crown and glory, Mr Chimezie Ukatu for everything that you represent beyond what words can express, and to my children, Chiamaka, Somkene, Somebi and Somanna, thanks a million times for all your love, patience and support, and for enduring the deprivation that you had to go through while I put this work together.
May God richly bless you all.
6
TABLE OF CONTENTS PAGE
Title page i
Declaration ii
Dedication iii
Certification by supervisor iv
Attestation v
Acknowledgements vi
Table of Contents vii
Abstract x
CHAPTER ONE: INTRODUCTION
1.1 Background 1
1.2 Statement of the problem 2
1.3 Justification 4
1.4 Aim and objectives 6
CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction to IPV 7
2.2 History 8
2.3 Definitions 9
7
2.4 Prevalence of IPV 11
2.5 Determinants of intimate partner violence 17
2.6 Health consequences of intimate partner violence 21
2.7 Prevention of IPV 25
CHAPTER THREE: METHODOLOGY
3.1 Study location 26
3.2 Study design 28
3.3 Study population 28
3.4 Study duration 28
3.5 Sample size determination 29
3.6 Sampling technique 30
3.7 Data collection instruments 33
3.8 Data collection method 34
3.9 Data Analysis 36
3.10 Ethical considerations 44
3.11 Limitations 45
4.0 Results 47
8
4.1 FGD Results 108
5.0 Discussion 114
Conclusion 130
Recommendation 131
References 133
Appendices:
Consent Form 140
Questionnaire 142
Focus Group Discussion Guide 153
List of LGAs in Lagos State 158
List of wards in the selected LGAs 159
List of streets in the study communities 160
List of abbreviations 169
9
ABSTRACT
Introduction
Violence against women is a technical term which refers to brutal acts primarily and exclusively committed against women. It is a major public health problem occurring globally and a violation of human rights which adversely affects women, men and children though unnoticed and often undocumented because it is regarded as a taboo. There are several potential perpetrators of violence, however, women are more likely to be victimized by someone that they are intimate with, commonly called " Intimate Partner Violence". Intimate partner violence occurs across different age groups, socio-economic classes, and irrespective of marital status and could be physical, emotional or sexual. Identified risk factors for its occurrence include low education, witnessing or being a victim of violence as a child, drug or alcohol use, gender inequality and unemployment particularly of the male partner.
Globally, 1 in 3 women have experienced some form of gender-based abuse during her lifetime.
Similar findings have been documented in Africa as well as Nigeria and the practice even justified and condoned in certain cultures. IPV puts a heavy burden on health care services with women who have suffered violence being more likely to need health services and at higher costs, compared to women who have not suffered violence. Increased health problems are well documented by research on IPV in various settings with the health consequences long standing, even after the abuse has ended. Much of the work on IPV has focused on individual-level characteristics, there was therefore increasing need to consider the roles of relationship-level characteristics, community-level characteristics and of factors related to health more broadly.
10
Methodology
This was a comparative cross-sectional study to determine the prevalence of, identify determinants and report possible health consequences of IPV among women in an urban and a rural area of Lagos state. The study population were women aged 18-49 years in Oshodi/Isolo and Ikorodu local government areas who freely consented to participate in the study using a multi-staged sampling technique. Data was collected using pre-tested interviewer administered questionnaires as well as focus group discussions to complement quantitative findings. This study analysed data collected from four wards in Oshodi/Isolo local government area and six wards in Ikorodu local government area of Lagos state between April and June, 2015. Analysis of data was done using the Statistical Package for Social Sciences version 20.
Results
There was a statistically significant difference in socio-demographic characteristics such as age, tribe and marital status between the two groups (p<0.05). There was a slight although not statistically significant difference in the prevalence of violence experienced by women with 21.7 percent experiencing violence in the urban group and 27.2 percent in the rural group.
In the urban area, 16.5% of women experienced emotional, physical or sexual violence in the past 12 months, while 21% of women in the rural area experienced any form of violence.
Intimate partner violence in this study was related to a lack of family support or justifying partner violence for any reason in the urban area compared to determinants such as having increasing number of children, justifying partner abuse and having either no education or a tertiary education in the rural area(p=0.05). Residing in the rural area was also a determinant for intimate partner violence.
11
Common health problems found in this study were similar to those documented in other studies and include pelvic pain, physical injury, mental health problems, increased use of medications in both urban and rural areas as well as an increased overnight hospital stay in the past year in the urban area.
Conclusion
Findings in this study buttress the fact that the occurrence of violence is an interplay of different
factors and as such, variations may solely be due to differences in individuals, culture, and the
society. What therefore obtains in one setting though similar, may not apply in another.
Strategies to tackle IPV should be multidisciplinary and at various levels. Health workers also
have a role to play in not only detecting this problem but also in preventing it.
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND
Violence against women is a technical term which refers to violent acts primarily and exclusively committed against women. It is a violation of human rights and a major public health problem which adversely affects women, men and children.1 This practice has been associated with the historical perception of women as property, subservient and inferior to men.2 It is similar to a hate crime which targets a specific group with the victim’s gender being the primary motive.3, 4
Violence against women is a universal issue persisting globally and the perpetrators of violence are often well known to their victims.5-7 Potential perpetrators include spouses and partners, parents, neighbours, family members and men in positions of authority.8 However, women are more likely to be victimized by someone that they are intimate with, commonly called "Intimate
12
Partner Violence" (IPV). An intimate partner is a current or former spouse, boyfriend or girlfriend in a heterogenous or homogenous relationship.9, 10 Violence against women by an intimate partner is a major contributor to the ill-health of women though unnoticed and undocumented because it is regarded as a taboo.6
IPV otherwise called spousal abuse or domestic violence has been defined in various ways such as physical or sexual assault occurring in an intimate relationship. Others include the intention to physically harm one's partner even without actually doing so.11 IPV refers to behavior by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, and psychological abuse and controlling behaviors.1
Intimate partner violence occurs across different age groups irrespective of marital status.1
Several factors increase the likelihood of occurrence of IPV. Some of the identified risk factors include low education, witnessing or being a victim of violence as a child, drug or alcohol use, gender inequality and joblessness especially of the male partner.7, 12 Due to the sensitivity of the subject, this form of violence is almost universally under-reported, as instances of IPV tend not to be reported to the police.13 However, many experts believe that although the true magnitude of the problem is hard to estimate, millions of women are experiencing violence and living with its consequences.6 Domestic violence continues to be alarmingly common and acceptable in many societies and various patterns of this violence differ across countries, cultures and socio- economic class.6 The World Health Organization’s (WHO) report on Violence and Health challenged preconceived notions that acts of violence are simply matters of family privacy, individual choice, or inevitable facts of life.6
1.2 PROBLEM STATEMENT
13
Globally, the lifetime prevalence of IPV ranges between 11-74% while the yearly prevalence is between 20-60%.14 Worldwide, at least 1 in 3 women have experienced some form of gender- based abuse during her lifetime.6 Several studies have shown a link between poor treatment of women and violence. These studies show that one of the best predictors of inter- and intra- national violence is the maltreatment of women in the society.15 In the United States of America, about 4.8 million women are victims of intimate partner-related physical assaults and rapes while there are about 2.9 million intimate partner related physical assaults against men.16 In parts of the developing world and particularly in West Africa, domestic violence is prevalent and even justified and condoned in certain cultures.12, 17 Lifetime prevalence of IPV in developing countries is 11-25% with a yearly prevalence of 4-29%.18 In Nigeria, the lifetime prevalence of
IPV ranges between 11-52% while the yearly prevalence is 32%.6, 10, 19
IPV puts an undue burden on health care services with women who have suffered violence being more likely to need health services and at higher costs, compared to women who have not suffered violence.1 Studies have shown that victims of violence had higher negative health outcomes, gynecological symptoms, and risk factors for homicide.20, 21 In the US, IPV results in approximately two million injuries, more than five hundred and fifty thousand of which require medical attention. Also, IPV victims lose about eight million days of paid work which is approximately thirty-two thousand full-time jobs, and nearly 5.6 million days of household productivity as a result of violence.22 IPV health related costs are mostly unavailable for sub-
Saharan Africa; however, the United States spends approximately $8.3 billion yearly on IPV related concerns. This is spent on direct medical and mental health services, lost productivity from paid work and household chores.22 In 2002, direct medical costs of all forms of violence against women as estimated by Health Canada was 1.1 billion Canadian dollars while in Uganda,
14 the cost of domestic violence was approximately 2.5 million United States dollars in 2007.23-25
The social and economic costs of intimate partner and sexual violence are enormous and have ripple effects throughout the society. Women may suffer isolation, inability to work, loss of wages, lack of participation in regular activities, and limited ability to care for themselves and their children.1
Current statistics indicate that 40–70% of murders in women are committed by their husband or by an intimate partner.1 A study done in the United States showed that IPV resulted in about
1510 deaths in a year, 75% of these deaths were women, while 25% were men.26 Similarly, in England and Wales, about 100 women are killed by partners or former partners each year as opposed to 21 men showing that women are much more likely than men to be murdered by an intimate partner.27, 28
In less industrialized countries, prevalence of IPV deaths may be even higher, although data on murder of women is insufficient for meaningful comparisons. In Ghana, IPV tops the list of domestic violence, similar to findings in other African countries.29, 30 A high proportion has also been documented in Nigeria and Nigeria has not been spared cases of murder by intimate partners.31-33
Studies have shown that violence is not always perpetrated as a form of physical violence but can also be psychological, sexual, emotional and verbal.34 In the US alone, there are well over 2000 groups involved in sheltering abused women and their offspring. Children who grow up in families where there is violence may suffer a range of behavioral and emotional disturbances.
These can also be associated with perpetrating or experiencing violence later in life. IPV in pregnancy has been associated with varying degrees of maternal and fetal morbidity and mortality.35, 36
15
Intimate partner violence has also been associated with higher rates of infant and child morbidity and mortality (e.g. diarrheal disease, malnutrition).1
1.3 JUSTIFICATION FOR THE STUDY
In Africa, rural women are expected to exemplify socio-cultural values of traditional society.
These socio-cultural values typically promote an imbalance of power between ‘subordinate’ women and ‘superior’ men.2, 29, 37 Women in rural areas are underrepresented in IPV research, despite the fact that the majority of African populations reside in the rural areas. Available studies indicate high rates of IPV among rural women.29, 30, 38 39, 40 Those who reside in rural areas tend to be more accepting of IPV.38, 39 One study suggested the influence of social, religious, and cultural influences in the women’s attitudes towards IPV.41, 42 Women with low levels of education, low household wealth, limited or non-existent financial autonomy are more likely to tolerate IPV.43 These women reside predominantly in rural areas, whereas women who reside in urban areas mostly have higher levels of education as well as financial autonomy which are thought to be protective but may not actually be so.44
Researchers have found a direct relationship between positive attitude towards violence and the actual occurrence of violence.41 In addition, physical isolation in the rural environment may provide aggressors opportunities to engage in abusive behavior.41 The patriarchal attitude of rural law enforcement officers may also impede responses to domestic violence reports thereby fostering its perpetration.41
Two large case control studies of women in the US on the other hand identified male rather than female characteristics such as substance abuse, poor education, unemployment, and ex-partner status as risk factors for IPV.39, 45
16
Only recently were injuries due to violence recognized as a public health issue.6 Increased health problems such as injury, chronic pain, gastro-intestinal and gynaecological signs including sexually transmitted infections, depression and post-traumatic stress disorders are well documented by research on IPV in various settings.46 The health consequences are long standing, even after the abuse has ended.21
This study compared IPV in a rural and an urban setting and examined how attitudes to IPV differed in these subgroups and if these attitudes actually translated to a significant difference in prevalence in both settings. The comparison helped to identify factors specific to their locations that influence or determine IPV based on socio-cultural differences and examined differences across socio-economic groups. Few local studies have examined the health consequences of IPV.
This study aimed to determine the health consequences of IPV in Lagos state and how comparable these findings were to those documented in other countries. These findings would offer important implications for prevention, care and mitigation.
1.4 AIM AND OBJECTIVES
1.4.1 Aim
To determine and compare the prevalence and determinants of intimate partner violence
and its health consequences among women in a rural and an urban area of Lagos state.
1.4.2 Specific Objectives
To determine the prevalence of intimate partner violence among women in a rural and an
urban area of Lagos state.
To identify determinants of intimate partner violence among women in a rural and an
urban area of Lagos state.
17
To document the health related consequences of intimate partner violence on women in a
rural and an urban area of Lagos State.
To compare the prevalence, determinants, and health consequences of intimate partner
violence in a rural and an urban area of Lagos State.
CHAPTER TWO
LITERATURE REVIEW
2.1 BACKGROUND TO INTIMATE PARTNER VIOLENCE
Violence against women particularly intimate partner violence and sexual violence are preventable public health problems and violations of women's human rights.47 It affects millions of women regardless of age, race, culture, ethnicity, socio-economic status or educational background.48 In the past two decades, IPV was recognized as an important issue in the international arena, at the World Conference on Human Rights (1993), the United Nations
International Conference on Population and Development (1994) and the Fourth World
Conference on Women (1995), held in Beijing. The United Nations defines violence against women as any act of gender-based violence that results in, or is likely to result
18 in physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.1 Violence against women could be perpetrated by assailants of either gender, family members and even the
"State" itself and includes battering, sexual abuse of female children in the household, dowry- related violence, wife inheritance, marital rape, female genital mutilation and other traditional practices harmful to women.49, 50
Intimate partner violence has been defined as a pattern of assaultive and coercive behavior which includes physical injury, psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and reproductive coercion.51
Women of reproductive age are more vulnerable to abuse by intimate partners than by any other perpetrator and although both men and women experience IPV, women are victims of violence five times more than men.6, 10, 52-54 In a study of wife beating among civil servants in Ibadan,
Nigeria, Fawole et al found that being young, unmarried and having a history of parental violence in the partner were significantly associated with a woman being a victim of IPV.17
Across the world researches have provided increasing proof of the crisis of violence against women. It has been generally reported in developing countries where patriarchal family norms and gender relations are common and reinforced by traditional, cultural, legal, and possibly religious legacies. This is particularly so in Nigeria where reporting incidents of violence is quite challenging because doing so is viewed as dishonouring to the husband and being disrespectful of family members and elders who often arbitrate in such matters.40, 41, 55-57
2.2 HISTORY OF VIOLENCE AGAINST WOMEN
19
Violence against women has been tied to the history of women being viewed as property and a gender role assigned to be subservient to men and also other women.58, 59 The UN Declaration on the Elimination of Violence against Women (1993) states that "violence against women is a manifestation of historically unequal power relations between men and women, which have led to domination over and discrimination against women by men and to the prevention of the full advancement of women, and that violence against women is one of the crucial social mechanisms by which women are forced into a subordinate position compared with men.50, 60 In the 1870s courts in the United States stopped recognizing the common-law principle that a husband had the right to "physically chastise an errant wife".61 In the UK the traditional right of a husband to inflict moderate corporal punishment on his wife in order to keep her "within the bounds of duty" was removed in 1891.62
In Nigeria, as in several African countries, the beating of wives and children are generally sanctioned as a form of discipline. Therefore, husbands believe that in beating their wives who are regarded as children, they are instilling discipline in them. This is particularly so when the woman is economically dependent on a man. However, even when a woman is not economically dependent, domestic violence serves as a means of enforcing conformity with the subordinate role of a woman within customary society.12 Obi and Ozumba found that domestic violence was significantly associated with financial disparity in favour of the female; influential in-laws, educated women and couples within the same age group were less likely to be violated as compared to their counterparts.63
2.3 DEFINITIONS
A series of definitions are given for the different terminologies that are used in this book:
20
Domestic violence against women
Any act or omission by a family member (most often a current or former husband or
partner), regardless of the physical location where the act takes place, which negatively
affects the well-being, physical or psychological integrity, freedom or right to full
development of a woman.34
Intimate-partner violence
Any act or omission by a current or former intimate partner which negatively affects the
well-being, physical or psychological integrity, freedom or right to full development of a
woman.34
Physical violence
Physical violence is the intentional use of physical force with the potential for causing death, injury or harm. Physical violence includes, but is not limited to: scratching, pushing, shoving, throwing, grabbing, biting, choking, shaking, poking, hair pulling, slapping, punching, hitting, burning, the use of restraints or one’s body size or strength against another person, and the use or threat to use a weapon (gun, knife or object).34
Severe physical violence
Physical violence that is likely to lead to external or internal injuries.34
Abusive sexual contact
21
Abusive sexual contact is any act in which one person in a power relationship uses force,
coercion or psychological intimidation to force another to carry out a sexual act against her
or his will, or to participate in unwanted sexual relations from which the offender obtains
gratification. Abusive sexual contact occurs in a variety of situations, including within
marriage, on dates, at work and school, and in families (i.e. incest). Other manifestations
include undesired touching, oral, anal or vaginal penetration with the penis or objects, and
obligatory exposure to pornographic material.34
Forced sex
Forced sex will be taken to be where one person has used force, coercion or psychological
intimidation to force another to engage in a sex act against her or his will, whether or not the
act is completed.34
Sex act
Sex act is defined as contact between the penis and vulva, or the penis and the anus, involving penetration, however slight; contact between the mouth and the penis, vulva or anus; or penetration of the anal or genital opening of another person by a hand, finger or other object.34
Psychological abuse
Psychological abuse is any act or omission that damages the self-esteem, identity or development of the individual. It includes but is not limited to humiliation, threatening loss of custody of the children, forced isolation from family or friends, threatening to harm the individual or someone
22 they care about, repeated yelling or degradation, inducing fear through intimidating words or gestures, controlling behaviour, and the destruction of possessions.34
2.4 PREVALENCE OF IPV
It is quite difficult to accurately estimate the prevalence of different forms of violence against women in families. Violence is a highly sensitive area that touches on fundamental issues of power, gender and sexuality. As violence is commonly perpetrated by a woman’s partner, often within her home, it is often considered as "private", lying outside the realm of public debate or exploration.34 Such factors have, until recently, helped violence against women to remain largely hidden and undocumented, particularly in developing countries.54 Worldwide research indicates that the most common type of violence against women is domestic violence. Among the most prevalent are those forms of violence perpetrated against women by intimate partners and ex- partners.34
Prevalence studies done in the past indicate that between 15% and 52% of women who have ever been married report experiencing some form of physical violence by their partners.54 Domestic violence is a pressing issue even in America where the National Coalition against Domestic
Violence reports that 1.3 million women are assaulted by their partner every year and 85% of domestic violence reported is against women.64 Studies have found that between 15% of women aged 15-49 years in Japan and 71% in Ethiopia reported physical and/or sexual violence by an intimate partner at some point in their lives whereas between 0.3% to 11.5% of women reported experiencing sexual violence by a non-partner since the age of 15 years.1, 65 A study done in the
United States reported a higher prevalence of IPV (22.5%) among women in small rural areas compared to 15.5% for urban women.66 A systematic review of 63 studies also reported that
23 certain groups of rural women may be at increased risk for IPV compared to similar groups of urban women although the rates of IPV was generally similar across rural, urban and suburban residents.67
Intimate partner violence is well documented in several African countries.68 Physical violence against women by an intimate partner was put at a prevalence of 25% in Dakar and Kaolack in
Senegal and very few reportedly admitted being beaten. A study done in South Africa among people aged 13-23 years found that 42% of females and 38% of males reported being victims of physical dating violence indicating that IPV cuts across different age groups.1
A clinic-based survey of 300 women in eastern Nigeria reported that 40% had experienced violence in the previous year.69 Studies done among pregnant women in Jos and Zaria showed
63.2% and 28% of respondents respectively experiencing one form of abuse.70, 71 Another clinic- based study in Lagos, south western Nigeria put the prevalence at 29% with considerable proportions reporting psychological(23%), physical (9%) and sexual (8%) abuse.72 A similar prevalence pattern was found in a study conducted in Ibadan, Nigeria with emotional violence having the highest prevalence followed by physical violence and then sexual violence.73 The aforementioned studies were clinic-based and might therefore be subject to some bias; a community based survey will therefore be more representative. A comparative study conducted in south western Nigeria put the lifetime prevalence in a rural community at 64% and the lifetime prevalence in an urban community at 70%.31 A prevalence as high as 87% has also been reported in a migrant community in southwestern Nigeria.32 Yearly prevalence from the National
Demographic Health Survey (NDHS) in Nigeria is 32% with a lifetime prevalence of 11-52%.
Also, about a third to two thirds of women are believed to have been victims of violence carried out primarily by husbands, partners and fathers.6, 12 Most women who experience intimate
24 partner violence are not willing to report due to the possible repercussions that may follow.69 In
Nigeria, there are no functioning means of identifying these women.
Most common forms of violence are physical, psychological and sexual violence against women.
Physical violence includes beating, stabbing, burning, and the intentional deprivation of food.
Psychological or emotional violence includes the enforcement of strict isolation, constant denigration and public humiliation. Sexual abuse includes sexual harassment, coerced sex and forced pregnancy. Although either men or women can be victimized by an intimate partner, women are at a significantly higher risk of experiencing IPV, of sustaining serious injuries, and being killed by an intimate partner.27, 28 Situations of conflict, post conflict and displacement may exacerbate existing violence and present new forms of violence against women.
2.4.1 Prevalence by types of Intimate Partner Violence
Physical violence
In surveys from around the world, 10-69% of women reported being physically assaulted by an intimate male partner at some point in their lives while a review by WHO of over 50 population- based studies performed in 35 countries prior to 1999 indicated that between 10% and 52% of women around the world report that they have been physically abused by an intimate partner at some point in their lives.6
From around the world in the United Kingdom 25% of women from a random sample of women from a district had been punched or slapped by a partner or ex-partner in their lifetime. In the
United States, the prevalence of physical abuse in a current relationship is approximately 8.4%
25 for cohabiting women aged 18 to 65 years. National studies done in Canada between 1991-1992 showed that 21% of women had been physically assaulted by an intimate partner; in South
Africa in 1998 this was found to be 13% while in the United States between 1995 -1996 it was found to be 22%.1, 74
In sub-Saharan Africa, 13-49% of women have been reported to have been hit or otherwise physically assaulted by an intimate male partner, with 5-29% reporting physical violence in the year before the survey.5 In rural Ethiopia and Tanzania, 49% and 47% respectively of ever- partnered women experienced physical violence by an intimate partner while in Malawi 20% reported being pushed, shaken, slapped or punched; 3% reported experiencing severe violence, such as being strangled or burned, threatened with a knife, gun or with another weapon.75-77
In a study conducted in Ile-Ife, southwest Nigeria by Fatusi et al, a prevalence of physical abuse was 7.3% while a similar study in Lagos found a prevalence of 9%.72, 74 Other studies among women working in the market, other places of work and young women and girls in secondary schools and universities, in Lagos state, Nigeria reported the following; 56.6% of 48 interviewed market women and 64.4% of 45 women interviewed in the work place reported been beaten by a partner (boyfriend or husband).12 The higher prevalence in the latter studies mentioned above could be due to the fact that the women were interviewed away from their homes. A study among low income earners in Nigeria found a lifetime prevalence of physical abuse by an intimate partner among ever-partnered women of 28.2%.32 A Nigerian multi-regional study found a 26.9% prevalence of physical abuse, while a study in eastern Nigeria by Obi and
Ozumba found an 83% prevalence of physical abuse.63, 78 In a comparative study in south western Nigeria, more rural women experienced physical violence (28%) compared to urban women (14%).31
26
Emotional violence
The WHO multi-country study on women’s health and domestic violence findings showed that the percentage of women experiencing one or more forms of controlling behaviours by their intimate partner varied from 21% in Japan city to about 90% in the United Republic of
Tanzania. This suggests varying degrees of male control over female behaviour in the various settings included in the study. The study also found that there were more significant acts of controlling behaviours by their partners than other forms of violence.54
In a systematic review of African studies on intimate partner violence, emotional violence was recorded in three studies with varying prevalence of 24.8%; 41% and 49%. A study in Malawi showed a prevalence of 13% among the respondents.75
A study carried out in Jos northern Nigeria among pregnant women showed psychological violence as being the most prevalent form of violence (38.0%), while studies in Lagos and Ile-
Ife had a prevalence of 68.6% and 61.1% respectively with psychological violence also being the commonest form.71, 74, 79 Pregnant women have also been victims of verbal intimate partner violence, a form of psychological abuse as demonstrated by several studies. A study carried out in Delta State, Nigeria showed that majority (58%) of victims of domestic violence were verbally abused while a study in Zaria showed that 36% of respondent were also abused verbally.80
Sexual violence
A community based study in rural Ethiopia showed a higher prevalence of sexual violence(59%) than physical violence(49%). Conversely, in a similar study in Tanzania, sexual violence(31%) was less prevalent than physical violence(47%).76, 77
27
Population-based studies performed in 35 countries indicated that between 10% and 30% of the women experienced sexual violence by an intimate partner.81 In another study that assessed the prevalence of different types of intimate partner violence among 600 women aged 15 to 49 years in selected rural and urban communities in south western Nigeria, sexual violence was the least common in both rural and urban areas howbeit more prevalent in urban areas.82 A study in Ile-
Ife showed that 19.9% of the women were abused sexually while in a study in the eastern part of
Nigeria on wife rape among married couples, 27.8% of the total respondents reported any level of sexual abuse and those who were uneducated experienced more abuse compared to those who were educated.74, 82
2.5 DETERMINANTS OF INTIMATE PARTNER VIOLENCE
An entire picture of the risk factors for violence has yet to surface and as such, there is no one single factor that has been suggested to be responsible for violence perpetrated against women. It has therefore been suggested that violence against women arises from a union of a range of inter- related factors that are within different social and cultural factors that have kept women vulnerable to the violence directed at them.
The social-Ecological Model: A Framework for Prevention of Violence
28
The socio-ecological model for violence prevention helps us understand determinants of IPV, coping methods and consequences at different levels as well as the effect of potential prevention strategies.83 This theoretical model of risk factors and protective factors for family violence considers an interplay between individual, relationship, community and societal factors that put people at risk for violence or protect them from experiencing or perpetrating violence. It identifies characteristics of the larger society (societal level), the immediate social context
(community level), the immediate family context (relationship or inter-personal level) and finally the personal history and characteristics of the individuals involved (individual or intra-personal level).34, 83 Besides identifying these factors, the model also suggests the necessity to act across multiple levels of the model at the same time in order to sustain prevention efforts over time than any single intervention.
Characteristics within the larger society that possibly contribute to violence in families include national laws and statutes, inadequate sanction mechanisms regarding abuse and societal norms such as masculinity linked to dominance or toughness, male entitlement and ownership of women, and approval of the physical chastisement of women.59, 84, 85 Within the immediate social context, community characteristics, which include the low social status of women, high levels of societal tolerance of domestic violence against women, a lack of supportive services, high levels of unemployment, crime and male on male violence come to play.59, 84, 85 A study by Pallito and
O'Campo found that community gender inequality (women's status, women's autonomy, male
29 patriarchal control) was associated with women's experience of IPV and unintended pregnancy.86
Also, Koenig et al showed that higher levels of crime in the community as well as community level attitudes towards domestic violence were associated with women experiencing violence.87
Studies on factors associated with IPV found that individual factors such as a higher level of women’s education and, sometimes, husbands’/partners’ education, higher household economic status was associated with less physical violence in marriage.88 A meta-analysis of 63 studies on
IPV found that IPV perpetrator and victim characteristics in rural areas are generally similar to
IPV perpetrator and victim characteristics in urban areas. A meta-analysis of studies on IPV in
China found that low educational status or low socioeconomic status of either partner was related to a higher level of IPV, as was a longer duration of the relationship.88 A study in Nigeria found that majority of respondents who reported ever experiencing violence in an intimate relationship either had no formal education or only primary education.89
A study on Prevalence and Correlates of Spousal Violence in Southwest Nigeria found that women who were unemployed were significantly more likely to experience spousal violence than women who were employed. In the study, about half of the respondents that were unemployed had been victims of spousal violence sometime in the past, while only 16.9% of those employed had ever experienced spousal violence.89 Obi and Ozumba found that domestic violence was significantly associated with financial disparity in favour of the female, influential in-laws, educated women and couples within the same age group.63 Also associated with the risk of spousal violence is the number of living children. Women who had more than two children alive were more likely to experience violence from their partners than women who had fewer children. Also, women who had no children were more likely to experience spousal violence than women who had one child.90
30
A Systematic Review of African Studies on Intimate Partner Violence examined possible protective factors within the immediate social context which may include community characteristics such as women being involved in groups or supporting each other, owning land and mobilizing resources, or being able to maintain custody of their children following separation from their partner while also showing strong positive associations between a woman's low level of education and experiencing IPV.44
Within the immediate family context, contributing factors to violence may include male dominance in the family, male control of wealth, marital conflict, and isolation of the woman in the family.91-93 Possible risk factors for being a perpetrator related to personal history include low education, past exposure to child maltreatment or witnessing violence in the family, excessive use of alcohol or other substances, the ownership of weapons, loss of status, associations with delinquent peers, attitudes accepting of violence and gender inequality.41, 91
Alcohol consumption has been associated with increased risk of all forms of interpersonal violence. Heavy alcohol consumption by men, and often women, is associated with intimate partner violence. Alcoholic intoxication triggers violent behavior and this may explain to a degree the differences in the experience of spousal violence among women whose husbands/partners drink and those whose husbands/partners do not.90 Several studies that examined the relationship between alcohol use and IPV found that alcohol use by a woman and/or partner whether heavily or occasionally is significantly associated with pregnancy-related abuse. Studies have also found that women whose partners consumed alcohol frequently were at greater risk of physical IPV than their counterparts whose husbands did not consume alcohol.94
A comparative study in southwestern Nigeria showed that alcohol consumption by partners was significantly associated with reporting physical violence in both urban and rural communities.
31
Also, among rural women, younger partners were more likely to perpetrate emotional violence.31
Another study in Nigeria also strongly associated IPV with partner's alcohol use with respondents being significantly more likely to experience spousal violence, if their husbands/partners often got drunk (71.1%) than if they did not drink alcohol at all or never got drunk (28.9%).90
The relationship between domestic violence and alcohol use is however controversial although the role of alcohol as a risk factor for violence is commonly documented. Some researchers have argued that it may be that both alcohol use and violence are behaviors adopted in response to other difficulties. It has also been argued that some men use alcohol or drugs as an excuse for violence, or as a mechanism to gain sufficient courage to be violent to their partner.34
Risk factors for being a victim of intimate partner and sexual violence include low education, witnessing violence between parents, exposure to abuse during childhood and attitudes accepting violence and gender inequality.41, 91, 95
The socio-ecological model emphasizes that it is a combination of factors, acting at different levels, which may increase the likelihood that violence will occur in one family, and not another.
Presently, many analyses focus on assessing the role of individual risk factors. Greater insights into the situations and contexts in which violence does and does not occur could however be obtained through a multivariate and multilevel analysis of the possible combinations of factors acting at different levels.59 Evidence has shown that levels of violence vary substantially both within and between countries.34 Comparative analysis could be used to find out whether there are identifiable factors within the immediate and larger community that could possibly be reduced
32 through community prevention activities. The identification of potentially modifiable risk factors would have important implications for the development of preventive interventions.
2.6 HEALTH CONSEQUENCES OF INTIMATE PARTNER VIOLENCE
In many countries, violence against women is predominantly perceived as an issue of women’s rights. Yet, such violence has far reaching physical, mental and reproductive health consequences.1 Although most national data are scarce, several community-based and small- scale studies have shown that violence against women is an important cause of morbidity and mortality.46, 96 Consequences may be immediate and direct such as injury or death, longer term and direct such as disability, indirect or psychosomatic such as gastro-intestinal disorders or all three.97 The physical and mental health consequences are numerous, with both fatal and non-fatal outcomes.46
2.6.1 Physical health consequences
Intimate partner violence is one of the common causes of injury in women.98 These include injuries, pelvic inflammatory diseases, unwanted pregnancy, miscarriage, chronic pelvic pain, headaches and alcohol abuse.86 Victims of violence may however not present with obvious trauma, even in accident and emergency departments. Studies by JC Campbell reported injuries which include bruises, cuts, black eyes, burns, concussion and broken bones, cuts from knives and other objects, which may lead to lasting physical impairment.46
Injuries, fear and stress associated with IPV can also lead to chronic health problems such as chronic pain (such as headaches or back pain) or recurring central nervous system symptoms like fainting and seizures.46 Postulated mechanisms of such effects include recurrent injury or stress, alterations in neurophysiology or both. Ten to forty-four percent of abused women often report
33 choking, incomplete strangulation and blows to the head resulting in loss of consciousness both of which could lead to neurological sequelae. Physical abuse has also been linked with higher rates of psychiatric treatment, attempted suicide and alcohol dependence.34 It has also been suggested that IPV victims in rural areas may have worse psychosocial and physical outcomes due to lack of availability, accessibility and quality of services to tackle such violence.67
2.6.2 Mental health sequelae
Depression and post-traumatic stress disorder with substantial co-morbidity are the most prevalent mental health sequelae of IPV.46, 99 A US based study reported that the risk of depression and post-traumatic stress disorder associated with IPV was even higher than that associated with childhood sexual assault. Depression in abused women has also been associated with other stressors that often accompany IPV such as childhood abuse, daily stressors, many children and forced sex. Some abused women might have chronic depression that is aggravated by the stress of a violent relationship. However, evidence has shown that first episodes of depression can be triggered by such violence with longitudinal evidence of depression lessening with decreasing intimate partner violence. Other mental health sequelae include fear, anxiety, fatigue, depression and post-traumatic stress disorder. Long term reactions include sleeping and eating disturbances.34, 46 A comparative qualitative study done in Nigeria reported similar health consequences among urban and rural to include depression, hypertension and damage to the reproductive tract.100
2.6.3 Reproductive health consequences
Threatened or actual violence is used by many men to maintain control over women’s reproduction and sexuality. Women may be vulnerable to violence if they are perceived to
34 question or not be adequately fulfilling their reproductive role within marriage, during conflicts associated with pregnancy or childbirth, or because of suspected infidelity. Violence may also have a direct impact on a woman’s reproductive and sexual health. Several studies in industrialized countries have documented women’s increased vulnerability to violence during pregnancy, with blows commonly being directed towards a woman’s abdomen. IPV has been noted in about 3-13% of pregnancies in many studies from around the world.46, 101 Voluntary termination of pregnancy has been related to IPV in studies in developed countries. Moreover, physical abuse has been found to be associated with delayed entry into prenatal care. Pregnant women who experience domestic violence are at increased risk of adverse outcomes in addition to the risks to themselves. Inadequate prenatal care, direct physical trauma, stress, higher incidences of high risk behaviours, and neglect are postulated mechanisms.102 Clearly, such violence can have a significant impact on the child’s subsequent health. Studies in the United
States indicate that women battered during pregnancy run twice the risk of miscarriage, and have a four times higher risk of having a low-birth-weight baby than women who are not beaten.34 The
US Department of Health and Human Services has recommended that IPV screening and counseling should be a core part of women’s preventive health visits. Physicians should screen all women for IPV at periodic intervals, (including during the first prenatal visit, at least once every trimester, and at the post-partum check-up), offer on-going support, and review available prevention and referral options.34, 97, 103
Sexual assault causes physical and psychological damage, and has serious sexual and reproductive health consequences. Survivors of rape face a real risk of contracting a sexually transmitted disease, including HIV.104 The risk of unwanted pregnancy is also substantial. In countries where legal termination services are inaccessible or expensive, many women are faced
35 with the choice of either having to bear the rapist’s child, or having an illegal abortion.34 Rape survivors may exhibit a variety of trauma-induced symptoms including nightmares, depression, inability to concentrate, sleep and eating disorders, and feelings of anger, humiliation and self- blame. Rape is also associated with severe sexual problems and mental health disorders, including severe depression, obsessive compulsive disorder and post-traumatic stress disorder.34
Gynaecological problems are the most consistent, longest lasting and largest physical health difference between abused and non-abused women.46 Common symptoms include sexually transmitted diseases, vaginal bleeding or infection, fibroids, decreased sexual desire, genital irritation, pain on intercourse, chronic pelvic pain and urinary tract infections.46 In one of the best sampled US population based study of self reported data, the odds of having a gynaecological problem were three times greater than average for victims of spouse abuse. Evidence of a dose- response effect with severity of physical assault has also been reported. A combination of physical and sexual abuse which accounts for about 40% to 45% of victims of IPV furthermore increases the risk for health problems than women who are only physically assaulted.46
Finally, violence against women in families may be fatal. Data from several countries indicate that the majority of women who are murdered are killed by present or former partners. Also, women may commit suicide as a last resort to escape a violent situation.34, 105
2.7 Prevention of IPV
Worldwide, governments and organizations actively work to combat violence against women through a variety of programs such as the "domestic violence prevention enhancement and leadership through alliances" (DELTA), the "Bridge project", amongst others.26, 106 In May 2013, the Violence against Persons (Prohibition) Bill was passed in Nigeria.106 It is a law which aims to
36 eliminate and reduce to a minimum the cases of gender based violence. In fact, the United
Nations designated the 25th of November every year as the International Day for the Elimination of Violence against Women.107 The date of November 25 was chosen to commemorate the
Mirabal sisters, three political activists the Dominican ruler Rafael Trujillo (1930-1961) ordered to be brutally assassinated in 1960.107
In high-income settings, school-based programmes to prevent relationship violence among young people (or dating violence) are supported by some evidence of effectiveness. In low- income settings, other primary prevention strategies, such as microfinance combined with gender equality training and community-based initiatives that address gender inequality and communication and relationship skills; that reduce access to and harmful use of alcohol; and that change cultural gender norms hold promise.1
37
CHAPTER THREE
METHODOLOGY
3.1 STUDY LOCATION
The study was carried out in Lagos State which is located in the South western part of Nigeria. It lies approximately on longitude 200 420E and 300 220E and between latitude 600 220N and 600
420N respectively. Lagos State was created on May 27, 1967 and although it is the smallest state geographically, it has the highest population and can be considered the commercial capital of the country. Presently, it has a population of over 21 million and has been designated the second fastest growing city in Africa and the seventh in the world. Lagos state was projected to be the third megacity in the world by 2015 at the present annual population growth rate of 600,000.108,
109
Lagos State covers an area of approximately 3,568 square kilometers with 75 square kilometers being wetlands. It shares boundaries with Ogun State both in the North and East and is bounded on the west by the Republic of Benin. In the South, it stretches for about 180 kilometres along the coast of the Atlantic Ocean. It is divided into twenty local government areas (LGAs) and is further subdivided into thirty-seven local council development areas (LCDAs) for administrative purposes. Presently, sixteen of the LGAs are designated urban while four are rural.108, 110
Although the indigenous inhabitants are of the Yoruba ethnic group, it is a socio-cultural melting point attracting Nigerians of other tribes such as the Hausas and Igbos as well as foreigners.
Religions practiced include Islam, Christianity and traditional religion.110
There are two hundred and seventy-six primary health care centres, twenty five state general hospitals, one state tertiary hospital distributed across the twenty LGAs in Lagos. In addition,
38 there are three federal tertiary centres, one federal medical centre and several privately owned health facilities in the state. This study was conducted in two LGAs in Lagos State, one urban and one rural namely Oshodi/Isolo and Ikorodu respectively.
Oshodi/Isolo LGA was created in 1980. It has a land mass of 50 square km. It is bounded by
Ikeja LGA in the north, in the south by Surulere LGA, on the north eastern part by Mushin LGA, and by Alimosho LGA in the West. It is in the Lagos West senatorial district. The two major religions practiced are Islam and Christianity while majority of the inhabitants are traders.
Majority of the inhabitants are Yoruba, although all ethnic groups are duly represented.
Presently, the estimated population is 1,414 428 based on the 2013 projections from the 2006
National Population census. Oshodi/Isolo LGA has twenty wards. There are nine public primary health centres and one secondary health facility in Oshodi/Isolo LGA .109
The history of Ikorodu LGA dates back to the period of British colonial administration in
Nigeria and has evolved through various reforms. Ikorodu is an LGA in Lagos State located along the Lagos Lagoon. It is the second largest of the twenty LGAs in Lagos state. It is one of the four designated rural LGAs. It is bounded on the north by Ogun State; on the south by the
Lagos lagoon; Epe LGA on the east while on the west by Kosofe LGA. As of the 2006 census,
Ikorodu had a population of 535, 619 and it occupies an area of 394 square km. The original settlers are the Yorubas particularly the Ijebu, a Yoruba sub-group, however, a few non indigenes reside in Ikorodu LGA namely: the Fulanis who are nomadic herdsmen; People from the middle belt and south-south Nigeria who are mostly wine-tappers and the Ghanaians who are also into fishing like the indigenes. Majority of residents are of medium to low socio-economic status. In the 19th Century, Ikorodu was an important trading zone for the Remo Kingdom; this was achieved due to its location along the trade route between Lagos and Ibadan. In addition to
39 trading, its current dwellers also engage in fishing, hunting and farming. Religions practiced include Islam, Christianity and traditional religion. There are thirty wards and twenty-three public health centres which include two secondary health facilities within Ikorodu LGA.111
3.2 STUDY DESIGN
The study was a community-based comparative cross-sectional descriptive study with both qualitative and quantitative components comparing the prevalence, determinants and health effects of IPV among women in urban and rural areas of Lagos state.
3.3 STUDY POPULATION
The study population consisted of women aged 18-49 years in a rural and an urban LGA in
Lagos State.
3.3.1 Inclusion criteria
Women aged 18-49 years who have been in an intimate relationship; i.e. single, married,
co-habiting or who have ever been married
Women residing in the selected urban and rural areas
3.3.2 Exclusion criteria
Visitors or temporary residents ( i.e residents of less than six months) of the study area.
3.4 STUDY DURATION
The study lasted for six months; data collection was completed in three months (between April and June, 2015), and three months was used for data analysis and report preparation.
40
3.5 SAMPLE SIZE DETERMINATION
Sample size formula for comparison of two independent proportions was used to calculate the minimum sample size.112
2 n per group = (Zα + Zβ) × [p1(1 – p1) + (p2 (1−p2)]
2 (p1 – p2)
Where, n= the minimum sample size
Zα = standard normal deviate of α at 95% confidence level, (i.e. probability of making a type 1 error) =1.96
Zβ = standard normal deviate of β corresponding to power at 90% confidence level (i.e. probability of making a type 2 error) =1.28
P1 – P2 = the difference between the two groups: forty-four percent(44%) as an estimate of the prevalence of IPV in an urban setting in Nigeria and 30% as an estimate of the IPV prevalence in a rural setting were used.113, 114
Hence, p1 – p2 = 44 -30 = 14
2 n per group = (1.96+1.28) x [0.44(0.56)+0.3(0.7) = 244
(0.14)2
Correction for non-response, N = n/100%−10%
N = 244/ 0.9 =271
41
The sample size per group would be rounded up to 272 making a total of 544 respondents.
3.6 SAMPLING TECHNIQUE
The respondents were selected through a multistage sampling technique.
Stage One: selection of an urban and a rural LGA
One urban and one rural local government area (LGA) each was randomly selected from the list of sixteen urban and four rural LGAs already in existence in Lagos State by balloting(Appendix
4).115 Oshodi/Isolo LGA and Ikorodu LGA were selected as the urban and rural local government areas respectively.
Stage Two: selection of wards
Oshodi/Isolo LGA has twenty wards whereas Ikorodu LGA has thirty wards within it giving a ratio of 2:3. The list of wards in the selected LGAs was obtained from the selected local government secretariats (Appendix 5).
From the list of wards in each selected LGA, four and six wards were selected in Oshodi/Isolo and Ikorodu LGAs respectively by simple random sampling method using a table of random numbers. Proportionate sampling was done for a wider spread of respondents and therefore better representation within the selected LGAs. Mafoluku, Afariogun, Ajao estate and Ewutuntun wards were selected in Oshodi/Isolo LGA while Abosan, Itunmokun, Ajaguro, Bayeku, Ipakodo and Maya wards were selected in Ikorodu LGA.
Stage Three: selection of streets
42
Urban area: Ten streets were selected using a table of random numbers from a list of streets in each selected ward in Oshodi/Isolo LGA which was obtained from the local government secretariats(Appendix 6). The starting street in each ward was selected by simple random sampling method by balloting from the selected streets. If a selected street was non-residential, another street was selected using a table of random numbers to replace it.
Rural area: Ten streets were selected using a table of random numbers from a list of streets in each selected ward in Ikorodu LGA. The starting street in each ward was selected by simple random sampling method by balloting from the selected streets. If a selected street was non- residential, another street was selected using a table of random numbers to replace it.
Stage Four: Selection of houses
In order to select houses for the study, the following steps were followed:
The sample size per group was divided by the number of selected wards in each group to obtain an equal number of respondents per group. Therefore, in the urban (Oshodi/Isolo) LGA, 272/4≈
68 respondents were required in each ward whereas, in the rural (Ikorodu) LGA, 272/6≈ 46 respondents were required in each ward.
The required number of respondents per ward was also divided by the number of selected streets to obtain an equal number of respondents from each street. Thus, in Oshodi/Isolo LGA, 68/10≈ 7 houses/respondents were required from each street while in Ikorodu LGA, 46/10≈ 5 houses/respondents were required from each street.
Urban area: Houses were then selected by a systematic random sampling method as follows:
43
Sampling interval = Sample frame (average number of houses on each street) Required number of houses for that street
Oshodi/Isolo LGA has an average of thirty-five houses on each street, therefore;
Sampling interval = 35/7=5. Every 5th house was therefore visited in Oshodi/Isolo LGA.
Using a table of random numbers, the first house on each street was randomly selected between one and the value of the sampling interval. Subsequent houses were selected systematically by adding the value of the sampling interval to the serial number of the previously selected house till the allotted sample size for that street was reached.
Rural area: Houses were selected by systematic random sampling method as follows:
Sampling interval = Sample frame (total number of houses) on each street Required number of houses for that street Ikorodu LGA has an average of forty houses on each street, therefore; Sampling interval = 40/5 = 8. Every 8th house was therefore visited in Ikorodu LGA. Using a table of random numbers, the first house on each street was randomly selected between one and the value of the sampling interval. Subsequent houses were selected systematically by adding the value of the sampling interval to the serial number of the previously selected house till the allotted sample size for that street was reached.
Stage Five: Selection of households
One household was selected in each selected house. If there was more than one household in a house, the households were numbered and one household was selected by ballot.
Stage Six: Selection of respondents
44
An eligible respondent willing to participate in the study was chosen in each selected household.
The selection of a single participant per house was to ensure confidentiality and also a wider spread and thus, representativeness. If there was more than one eligible woman in a household, one of them was randomly selected by balloting. If there was no eligible woman in a house, the next house was visited.
Selection of FGD participants
Selection of the FGD participants was by purposive sampling in the rural and urban communities. Participation was solicited for while administering questionnaires and willing participants in the selected communities were recruited for the FGDs. Participants were stratified into two groups: women with primary education or less, and women with a minimum of secondary education. Interviewed participants were excluded from the FGDs.
3.7 DATA COLLECTION INSTRUMENTS
Data collection consisted of both quantitative (questionnaire) and qualitative (focus group discussion) methods.
3.7.1 Quantitative Data
The questionnaire used for the WHO Multi-Country Study on Women’s Health and Domestic
Violence was used to collect the data for this study.116 In cases where privacy could not be assured, interviews were rescheduled for a different time or place. If someone entered the room during an interview, the interviewer switched the conversation to a dummy question for instance on breastfeeding.
45
The questionnaire included the individual consent form and 8 sections as follows: Socio demographic characteristics; Respondent and her community; General health; Reproductive health; Current or most recent partner; Attitudes towards gender roles; Respondent and her partner; and Injuries.1 TOPICS INCLUDED
3.7.2 Qualitative Data
A focus group discussion guide guided by the study objectives was used (Appendix 3).
3.8 DATA COLLECTION METHOD
3.8.1 Interviewer Selection and Training
The collection of information on IPV is challenging because women may not disclose these experiences due to fear or shame. Collection of such sensitive information requires the establishment of rapport between the interviewer and the respondent. Female interviewers were therefore used. The interviewers were recruited based on a minimum qualification of senior secondary certificate, previous experience in data collection and fluency in Yoruba.
The interviewers were trained by the principal investigator. The trainings were done over three days in sessions of three hours each, two weeks prior to commencement of the data collection.
The WHO guideline for interviewer training in the WHO Multi-Country Study on Women’s
Health and Domestic Violence as well as the WHO practical guide for researching violence against women were used for the trainings. Copies of the questionnaire were also used for the training. In preparation for data collection the interviewers were given an overview of gender- based violence, focusing on intimate partner violence (IPV), as well as aims and overview of the study and questionnaire, including a detailed question-by-question explanation of the questionnaire. Practice interviews using the different sections and how answers should be
46 recorded were also done. Interviewers were instructed that interviews should only proceed when maximum privacy had been secured. If privacy was not assured, the interview should not go on.
3.8.1.1 Quantitative data collection
Quantitative data was collected from women in the 18-45 year age group using interviewer - administered questionnaires. The questionnaires were administered to respondents on week days, each interview lasted about thirty minutes. If an eligible respondent was not at home, the visit was rescheduled for a later date.
3.8.2 Pre-Test
The questionnaire was pre-tested in Ikeja LGA, ten percent of the sample size (50 questionnaires) was used as well as trained interviewers as this formed part of the training.
Following analysis of the questionnaires, interviewers were re-trained in collecting data to remove any ambiguity.
3.8.3 Qualitative Data
Focus Group Discussion (FGD)
The FGDs were conducted to complement the information from the quantitative data. The discussions were used to explore women’s attitudes and beliefs about IPV and capture certain areas that the quantitative area did not capture. It did not seek to make inference about the larger population but rather to gain comprehensive data from a small number of participants.
Two FGDs were conducted in each of the selected LGAs using an FGD guide prepared in
English language and guided by the study objectives. Each focus group comprised of eight
47 women that were grouped homogenously based on their age, place of residence and educational level. The focus group discussion was conducted by the principal researcher who served as the facilitator and one research assistant who recorded key information through jottings and audio recording. It was carried out using the FGD guide. The groups were structured as follows:
URBAN
FGD 1: Women with a minimum of secondary education, 18-49years
FGD 2: Women with primary education or less, 18-49years
RURAL
FGD 1: Literate women (minimum of secondary education) 18-49years
FGD 2: Illiterate women (primary education or less) 18-49years
Participants were recruited by convenience sampling from the community during the course of administering questionnaires. All involvement was voluntary. Permission was sought from all participants before recording was done. Each of the discussions conducted lasted between 40-55 minutes. Interviewed participants were excluded from the FGDs.
3.9 DATA ANALYSIS
3.9.1 Quantitative Data
Data was cleaned, entered into and analysed using (SPSS) version 20.0. Analysis of data started with description of data using mean and standard deviation for quantitative variables
(respondents’ age, partners age, mean age difference between partner and respondent),counts and
48 frequencies for qualitative variables (marital status, tribe, and educational status etc.) and also presented using graphs and tables for frequencies and percentage of variables and cross tabulations for comparison.
Bivariate analysis
Independent t test was used to compare means of respondents’ age and partner’s age in rural and urban groups respectively.
Chi square test was used to compare the socio-demographic variables (age group, marital status, educational status, tribal distribution etc.) in both groups and also to compare respondents and their partner’s background characteristics with current and lifetime experience of violence.
Multivariate analysis
To identify the factors that significantly increase the risk of experiencing partner violence,
Binary logistic regression analyses were performed. Factors considered included all the characteristics discussed in the bivariate analysis that were found to have a statistically significant association with partner violence. The dependent variables analyzed were lifetime experience and experience of intimate partner violence in the past 12months (current experience).
All statistical tests were carried out as 2 tailed test with level of significance (α) set at 0.05
49
(i.e. p ≤ 0.05 (95% confidence interval).
3.9.2 Measurement of Variables
3.9.2.1 Outcome / Dependent Variables
Prevalence of IPV was the proportion of ever-partnered women reporting at least one act of IPV in the preceding 12 months.78
Lifetime prevalence of IPV was defined as the proportion of ever-partnered women who report having experienced one or more acts of IPV by a current or former male partner at any point in their lives.78
Prevalence estimates of IPV were obtained by asking direct, clearly coded questions about the respondent’s experience of specific acts. The WHO Multi-country Study definitions were adopted for defining the types of IPV.
Physical Violence
A woman was considered to have experienced physical violence if she answered “yes” when asked if a current or past partner had ever abused her in any of the following ways:
Slapped her, or thrown something at her that could hurt her;
Pushed or shoved her;
Hit her with a fist or something else that could hurt;
Kicked, dragged or beaten her up;
Choked or burnt her on purpose;
50
Threatened her with, or actually used a gun, knife or other weapon against her.78
Physical abuse was classified as moderate if the respondent answered “yes” to any of the first two questions listed above while severe physical abuse will be indicated by an affirmative answer to any of the other four questions.
Emotional abuse
Implied saying yes to the any of the following:
Being insulted or made to feel bad about oneself;
Being humiliated or belittled in front of others;
Being intimidated or scared on purpose (for example by a partner yelling and smashing things);
Being threatened with harm either directly or to someone one cared about.78
Sexual violence
Sexual violence implied saying yes to any of the following:
Being physically forced to have sexual intercourse against her will;
Having sexual intercourse because she was afraid of what her partner might do;
Being forced to do something sexual she found degrading or humiliating.78
Determinants of IPV
Determinants of IPV refer to factors influencing IPV which could be risk factors or protective factors.
51
3.9.2.2 Independent variables
These were categorized into four factors namely:
Community factors – community connectedness (relationship with family of birth and other community members) and level of crime in the community.
Relationship factors –type of relationship (monogamous/polygamous) and spousal communication.
Male factor- such as level of education, employment status and occupation, alcohol use and frequency, substance abuse, involvement in fights with other men, extra-marital affairs, witnessing IPV between parents in childhood, being a victim of violence in childhood, etc
Female factors – respondent’s age, level of education, employment status, whether properly married or co-habiting, religion, ethnicity, residence, attitude towards IPV, witnessing IPV between parents at childhood.
Alcohol consumption
This refers to the frequency of alcohol consumption by the respondent’s partner. It has been classified as never, rarely (less than 3-4 times in a week) and often (more than 3-4 times per week).
Controlling behavior
It was defined as any behaviour exhibited by a woman’s partner on question 62 such as restricting contact with her friends and family, extreme jealousy or controlling her access to health care. A positive answer to one or more of these options was classified as controlling
52 behaviour while controlling behaviour was absent in anyone who gave a negative answer to all options.
Attitudes towards IPV
This composite variable was created from responses to six options on question 58 about whether the women would justify a partner hitting his wife for any of these six reasons: not completing her household work to his satisfaction, disobeying him, refusing to have sexual relations with him, questioning his fidelity, his suspicion or discovery that she has been unfaithful, her not taking care of the children.
Responses were transformed into a dichotomous "yes" or "no" variable. Women who responded
"yes" to one or several of the six attitude questions formed one group of the dichotomy and were said to be tolerant whereas women who responded "no" to all the attitude questions formed the other group and were said to be non tolerant of IPV.
Spousal communication
This was determined from responses to question 60. Responses were transformed into a single dichotomous "yes" or "no" variable. Women who responded "yes" to all formed one group of the dichotomy and were said to have “mutual” spousal communication while women who responded
"no" to any or all of the questions formed the other group and were said to have a “non mutual” communication.
Socio-economic disparity
This was defined by comparing the respondent’s level of education and occupation to her partner’s. It was categorized into two:
a. Wife earning less than husband
53
b. Wife earning same or more than husband
Community connectedness
This was defined by a yes answer to any of the questions such as if neighbours in the community knew each other well, if people would generally do something to stop a street fight in the community, or if neighbours would offer to help if someone in a family suddenly fell ill or had an accident.
Answering no to all of the three questions was classified as no community connectedness.
Community level of crime
This was assessed based on one question. Answering a ‘yes’ to this question connoted a moderate to high level of crime and a negative response to the question implied a low level of crime. The question was:
In the past four weeks, has someone in your household been the victim of a crime in your
community, such as robbery or assault?
Family support
This was assessed based on two questions (questions 13 and 14). Answering a ‘yes’ to one or two of the questions connoted a moderate to high level of family support and a negative response to both questions implied a low level of family support.
54
Health consequences
This was determined by answers to a series of questions which were analyzed accordingly.
Questions on physical health included if the respondent frequently had;
Problems with performing usual activities like work, study, household, family or social activities
Pain or discomfort
Dizziness or vaginal discharge
Injuries
Others included whether the respondent frequently took medication to help calm down or sleep; relieve pain; help not feel sad or depressed. Questions were also asked about headaches, poor appetite among others.
Mental health was assessed by questions such as those concerning difficulty in thinking clearly, unhappiness, inability to concentrate, excessive crying, and difficulty in making decisions, suicidal ideation or actual attempt.
Responses were transformed into dichotomous “yes” and “no” variables.
Reproductive health was assessed by questions on contraceptive use, partner’s awareness about contraceptive use and if partner had ever refused a method or prevented respondent from using a method. The respondent was also asked if she had ever asked her partner to use a condom and if her partner had ever refused.
Socio-economic status was classified using the Oyedeji classification as follows:117
55
For Occupation
Class
I Senior Public Servants, Professionals, Managers, large scale traders, businessmen and
contractors.
II Intermediate grade public servants and Secondary school teachers.
III Skilled workers – Primary school teachers, professional drivers, artisans, business women
IV Unskilled workers - Petty traders, laborers, messengers
V Unemployed - Unemployed, full-time housewife, students and Subsistence farmers.
Education was classified into having none, primary, secondary and tertiary.
Qualitative data- at the end of each FGD session, a debrief meeting was held between the facilitator and the note-taker to examine the FGD activities and the results. The recordings were transcribed and reconciled with the notes. An excel spreadsheet was used to analyse transcribed data. A separate excel data base spreadsheet was used for each group, and within each spreadsheet, a sheet was used per question. When all comments were entered, similar responses were coded for themes or categories. A number was assigned to each category and the excel sort function was used to group entries by the categories. The findings from each category was summarized noting similarities and differences across groups.
3.10 Ethical Considerations
Ethical clearance was obtained from the Health Research and Ethics Committee of the Lagos
State University Teaching Hospital (HREC approval reference number: LREC/10/06/423), prior to commencement of the study. Permission to conduct the study was also obtained from the
Chairmen and Medical Officers of Health of the local government areas in which the study was conducted. Written informed consent was also obtained from each of the eligible respondents
56 before the interview. Confidentiality was assured to all respondents by non use of identifiers or personal information and the selection of one respondent per household.
3.10.1 Community agreement
Permission was sought from the community leaders to explain the overall objectives of the research. For safety reasons, the study was framed in general terms, i.e. a study on women’s health and life experiences. Disclosing the real intent of the study could not only undermine the study objectives but also potentially jeopardize the safety of respondents.
3.10.2 Referrals for care and support
Based on ethical considerations, victims of IPV detected during the study were provided with relevant information for support and referred to relevant service institutions and NGOs with focus and competencies in IPV issues.
3.11 Limitations
Due to the sensitivity of the topic and the possible fear and stigma that are associated with it, respondents might not have appropriately disclosed IPV thereby not giving a true picture of the prevalence. To deal with this, interviewers were strictly female and were adequately trained.
There was also a possibility of recall bias depending on the time of occurrence of IPV; however, the study aimed to also capture those who might have ended past relationships as a result of violence. In addition, the health outcomes that were documented may not be adequately representative as they were self reported. Also, certain male factor determinants of IPV such as witnessing IPV in childhood may have been difficult to establish because the respondents were women .Finally, this study being a cross-sectional study could not demonstrate the patterns of
57 causality between IPV and specific events; however, the health findings documented were used to explore possible forms of association, and the extent to which different associations were found in each area. As such, this study stimulates further research. Test of associations were carried out during bivariate statistical analysis while possible confounders were taken care of during logistic regression analysis.
58
CHAPTER FOUR
4.0 RESULTS
A total of 544 questionnaires were administered to the respondents in the urban and rural areas.
All questionnaires in the urban and rural areas were completely filled, returned and analysed after validation, giving a response rate of 100% for urban and rural areas.
Table 1: Socio-Demographic Characteristics of Respondents
Variables Urban n=272 Rural n=272 Test Statistic p-value n (%) n (%) Age (years) 18-24 53(19.5) 69(25.4) χ2=19.5 0.001* 25-34 106(39.0) 138(50.7) 35-44 94(34.5) 56(20.6) 45-49 19 (7.0) 9 (3.3) Mean age ± SD 31.98±8.07 29.29±7.39 t=4.061 0.001* Religion Christianity 165(60.7) 179(65.8) χ2= 4.24 0.237 Islam 100(36.8) 90(33.1) Traditional 4 (1.5) 3 (1.1) Others 3 (1.0) 0 (0.0) Ethnicity Hausa 21 (7.7) 12 (4.4) χ2=14.84 0.002* Ibo 26 (9.6) 54(19.9) Yoruba 207(76.0) 196(72.0) Others 18 (6.6) 10 (3.7) Highest level of education None 17 (6.3) 12 (4.4) χ2=26.48 0.090 Primary 59(21.7) 84(30.9) Secondary 120(44.1) 104(38.2) Tertiary 76(27.9) 72(26.5) Occupation Professionals/Senior 17 (6.2) 29(10.7) χ2= 4.72 0.377 Public Servants Junior Public Servants 28(10.3) 23 (8.4) Skilled workers 70(25.7) 68(25.0) Unskilled workers 95(35.0) 86(31.6) Unemployed 62(22.8) 66(24.3) * Statistically significant
59
There was a statistically significant difference between the mean age (p=0.001) and ethnicity
(p=0.002) of respondents in the urban and rural communities.
One hundred and six (39%) and 138(50.7%) of respondents in the urban and rural communities respectively were between 25-34 years of age. The mean age was 31.98±8.07 and 29.29±7.39 in urban and rural communities respectively. About two-thirds of respondents in both groups were
Christians 165(60.7%) and 179 (65.8%) (p=0.237)
Most of the respondents were Yoruba 207(76.0%) and 196(72.0%) in both groups ( p=0.002).
About two-fifths of the women had secondary education, 120(44.1%) and 104(38.2%) in urban and rural areas respectively.
Seventy-six (27.9%) and 72 (26.5%) in both groups had tertiary education while 6.3% and 4.4% of respondents in urban and rural areas respectively had no education (p=0.090).
In both groups, most of the women (35% urban and 31.6% rural) were unskilled workers. About a quarter of respondents in urban and rural groups 70(25.7%) and 68(25%) respectively were skilled workers. Very few 17(6.2%) and 29(10.3%) in urban and rural areas respectively were senior public servants or professionals (p=0.377).
60
Table 2: Respondents' marital status and number of children
Variables Urban Rural Test Statistic p-value
n (%) n (%) χ2
Type of n=272 n=272 Relationship Single 65(23.9) 82(30.2) 12.434 0.014* Currently married 158(58.1) 153(56.1) Co-habiting 4 (1.5) 5 (1.9) Separated 33(12.1) 13 (4.8) Divorced 12 (4.4) 19 (7.0)
Type of Marriage n=203** n=185** Monogamy 149(73.4) 146(78.9) 1.618 0.203 Polygamy 54(26.6) 39(21.1)
Number of living n=272 n=272 children 0 82(30.1) 97(35.7) 7.744 0.052 1-2 88(32.4) 93(34.2) 3-4 100(36.8) 75(27.6) ≥5 2 (0.7) 7 (2.6) Mean number of 1.86 ± 1.48 1.64 ± 1.51 t = 1.67 0.096 children ± SD * Statistically significant ** Currently married, separated and divorced women
About two thirds of respondents in the urban and rural community were currently married. There was a statistically significant difference between respondents in urban and rural groups 58.1% and 56.1% respectively (p=0.014). However, there was a statistically significant difference between the type of marriage among the two groups (p=0.203).
Over a third of the respondents in the urban area (36.8%) had between three to four children alive compared to 27.6% of respondents in the rural area. 32.4% and 34.2% of women in both areas had between one to two children (p=0.052).
61
Table 3: Socio- demographic characteristics of the respondents partners and age difference
between respondents and their partners
Variables Urban n=272 Rural n=272 Test Statistic p-value
n (%) n (%)
Age (years) 20-29 55(20.2) 72(26.5) 0.006 30-39 98(36.0) 123(45.2) 40-49 100(36.8) 69(25.4) ≥50 19(7.0) 8(3.0) Mean age ± SD 37.49+8.749 34.28+8.401 t=4.359 0.001
Highest level of education None 0(0.0) 6(2.2) 0.021** Primary 11(4.0) 8(2.9) Secondary 164(60.3) 167(61.4) Tertiary 97(35.7) 91(33.5)
Employment status Working 236(86.8) 214(78.7) 0.081** Unemployed 12(4.4) 29(10.7) Retired 4(1.5) 3(1.1) Student 19(7.0) 25(9.2) Disabled/Long term sick 1(0.4) 1(0.4)
Occupation Senior public servant 60(22.1) 48(17.6) χ2 = 8.175 0.085 Junior public servant 29(10.7) 21 (7.7) Skilled 111(40.8) 114(41.9) Unskilled 36(13.2) 31(11.4) Unemployed 36(13.2) 58(21.3)
Age difference (years) ≤ 4 112(41.2) 146(53.7) χ2=6.572 0.010 5-9 127(46.7) 102(37.5) ≥10 33(12.1) 24(8.8) Mean age difference ± SD 5.51+3.173 5.00+4.321 t=1.572 0.117 Statistically significant in bold ** Fisher's exact P-value
62
The respondent's partners in the urban areas were older (37.49±8.749) than those in the rural areas (34.28±8.401) p=0.001.
Those who had completed secondary education formed the highest proportion(60.3% and 61.4%) in urban and rural areas respectively. About a third (35.7% and 33.5%) of partners in both areas had tertiary education. The difference between urban and rural groups was statistically significant (p=0.021).
More than three quarters of respondents' partners (80.9% and 76.1%) in urban and rural areas respectively were working, consisting majorly of skilled workers(40.8% and 41.9% ). In urban and rural areas respectively, 13.2% and 21.3% were unemployed. There was no significant difference between the groups (0.085).
Almost half of the respondents (46.7%) and their partners in the urban area had an age difference of 5-9 years compared to 37.5% in the rural area (p=0.0104). Few women (12.1% and 8.8%) in both areas had an age difference of ≥10 years. The mean age difference was 5.51±3.173 and
5.00±4.321 in urban and rural areas respectively (p=0.117).
63
Table 4: Respondents' family support, community level of crime and community connectedness
Variable Urban n=272 Rural n=272 Test statistic p-value n (%) n (%) χ2 Family support Yes 258(94.8) 252(92.6) 1.129 0.288 No 14 (5.2) 20 (7.4)
Community level of crime Moderate to high level 190(69.9) 183(67.3) 0.418 0.518 Low level 82(30.1) 89(32.7)
Community connectedness Yes 258(94.9) 234(86.0) 12.248 0.001 No 14 (5.1) 38(14.0) Statistically significant in bold
The majority of respondents in the urban and rural areas had the support of their family (94.8% and 92.6%) respectively(p = 0.288).
Over two-thirds of respondents reported a moderate to high level of crime in the urban and rural communities 69.9% and 67.3% respectively. Community level of crime was not significantly associated with location (p = 0.518).
Although the majority of respondents in both groups had a level of connectedness with their communities, respondents in the urban area (94.9%) were more connected with their communities than those in the rural area (86%), (p = 0.001). There was a statistically significant difference in the level of community connectedness between the two groups.
64
Table 5: Respondent's choice of spouse, witness of violence in childhood and attitude towards violence
Variables Urban Rural Test statistic p-value n (%) n (%) χ2 Current/most recent partner was chosen by: n=203** n=185** Both chose 165(81.3) 149(80.5) χ2=9.008 0.009* Respondent chose 5 (2.5) 17 (9.2) Partner chose 26(12.3) 9 (4.9) Others chose 7 (3.4) 10(5.40)
Father ever hit mother n=272 n=272
Yes 19 (7.0) 25 (9.2) χ2=0.618 0.432 No 253(93.0) 247(90.8)
Witnessed father hit mother n=19 n=25 Yes 13(68.4) 22(88.0) 1.482*** 0.223 No 6(31.6) 3(12.0)
IPV tolerant(justified at least n=272 n=272 one reason for IPV) Yes 108(39.7) 79(29.0) χ2=6.389 0.012* No 164(60.3) 193(71.0) Others include respondent or partner's family members *Statistically significant
** Married or ever married
The majority of women who had been married or were co-habiting took part in choosing their spouses in the urban and rural communities (83.8% and 89.7%) respectively. However, significantly more women in the rural area took part in choosing their spouses (p=0.009).
Most women in the urban and rural communities had not experienced inter-parental violence during childhood (93% and 90.8%) respectively, only 7% of women in the urban and 9.2% of those in the rural groups had such experience (p=0.432).
65
More women in the urban area(39.7%) justified IPV compared with the rural area (29%). There was a statistically significant association between justifying IPV and respondents' location
(p=0.012).
66
Table 6: Spousal communication, marital discord and controlling behaviour
Variables Urban Rural Test statistic p-value n (%) n (%) χ2 Mutual spousal n=162* n=158* communication Yes 131(80.9) 126(79.7) 0.063 0.802 No 31(19.1) 32(20.3)
Socio-economic n=207** n=190** disparity Wife's socio-economic 79(38.2) 83(43.7) 1.250 0.264 class less than husband Wife's socio-economic 128(61.8) 107(56.3) class same or higher than husband
Controlling behaviour n=272 n= 272 Yes 175(64.3) 192(70.6) 2.420 0.120 No 97(35.7) 80(29.4) *Ever married or cohabiting women only **All women excluding singles
A similar proportion of respondents (80.9% and 79.7%) in the urban and rural groups communicated mutually with their spouses (p=0.802).
Over half to two-thirds of women in both groups (61.8% urban, 56.3% rural) were of the same socio-economic class as or higher than their partners. There was no statistically significant difference between the urban and rural groups (p=0.264).
More partners of women in the rural area exercised controlling behaviour over them (70.6%) compared to the urban area (64.3%), p=0.120.
67
Table 7a: Partner's alcohol/drug intake
Variables Urban n (%) Rural n (%) Test p-value statistic Husband/partner drink alcohol n=272 n=272
Yes 29(10.7) 41(15.1) χ2=1.984 0.159 No 243(89.3) 231(84.9)
Partner's alcohol intake n=29 n=41 1-3 times in a month 2 (6.9) 6(14.6) 0.599* Every day or nearly every day 3(10.3) 1 (2.4) Less than once a month 0 (0.0) 3 (7.3) Once or twice a week 24(82.8) 31(75.6)
Frequency of partner's n=29 n=41 drunkenness in the past 12 months Most days 2 (6.9) 3 (7.3) 0.860* Weekly 2 (6.9) 0 (0.0) Once a month 4(13.8) 5(12.2) < once a month 0 (0.0) 2 (4.9) Never 21(72.4) 31(75.6)
Partner ever smoked cigarettes or n=272 n=272 used drugs Daily 0 (0.0) 2 (0.7) 0.581* 1-2 times/week 11 (4.0) 6 (2.2) 1-3 times/month 4 (1.5) 1 (0.4) < once a month 2 (0.7) 0 (0.0) Never 249(91.5) 258(94.9) * Fisher's exact P-value
Although a small proportion of respondents' partners drank alcohol, more respondents partners
41 (15.1%) in the rural area drank alcohol compared with the urban area 29 (10.7%) with no significant difference between the two groups (p= 0.159). About a third of those who took alcohol, 8 (27.6%) had ever been drunk in the urban area compared to 10 (24.4%) in the rural area (p=0.860).
Very few respondents partners (6.2% and 3.3%) smoked cigarettes or used drugs in the urban and rural areas respectively (p=0.581)
68
Table 7b: Partner's history of violence, relationship issues and experience of violence in childhood
Variables Urban Rural Test p-value n (%) n (%) statistic
Partner's involvement in physical n=272 n=272 fight with another man Yes 21 (7.7) 27 (9.9) χ2=0.840 0.656 No 238(87.5) 233(85.6) Don't know 13(4.7) 12(4.4)
Physical fight in the past 12 months n=21 n=27 Never 11(52.4) 13(48.2) χ2=7.06 0.029 Once or twice 10(47.6) 7(25.9) Don't know 0 (0.0) 7(25.9)
Partner in relationship with any n=162 n=158 other women while with respondent Yes 20(12.3) 20(12.7) χ2=1.19 0.550 No 123(76.0) 113(71.5) Don't know 19(11.7) 25(15.8)
Partner had children with any other n=162 n=158 woman while with respondent Yes 3 (1.9) 7 (4.4) χ2=2.10 0.350 No 150(92.6) 140(88.6) Don't know 9 (5.6) 11(70.0)
Partner's mother hit or beaten by n=162 n=158 his father Yes 9 (5.6) 7 (4.4) χ2=0.42 0.809 No 142(88.0) 140(88.6) Don't know 4 (2.4) 11 (7.0)
Partner himself hit or beaten n=162 n=158 regularly by a family member Yes 6 (3.7) 7 (4.4) χ2=0.14 0.932 No 106(65.4) 104(66.0) Don't know 50(30.9) 47(29.7)
69
Only 7.7% and 9.9% of respondents' partners in urban and rural groups had ever been involved in physical fights with another man (p=0.656).
About 12.3% and 12.7% of respondents partners had had extra marital affairs with other women
(p=0.550) and even fewer (1.9% and 4.4%) in urban and rural areas respectively had children with other women while being with respondent (p=0.350).
Most respondents partners (88% and 88.6%) in the urban and rural groups respectively did not experience inter-parental violence in childhood (p=0.809) and were not victims of violence in childhood themselves (65.4% urban, 66% rural, p=0.932).
70
Table 8: Respondents' physical and mental health
Variables Urban n=272 Rural n=272 Test statistic p-value n (%) n (%) χ2
General Health Vaginal discharge 86(31.6) 70(25.7) 2.3 0.129 Vaginal bleeding 16 (5.9) 34(12.5) 5.44 0.020 Pelvic pain 51(18.8) 26 (9.6) 9.46 0.002 Genital irritation 41(15.1) 39(14.3) 0.057 0.809 Feel tired 8 (3.0) 14 (5.1) 1.71 0.192 Poor appetite 57(21.0) 61(22.4) 0.000 1.000 Abdominal 6 (2.2) 14 (5.1) 3.32 0.068 discomfort
Mental Health/CNS Dizziness 81(29.8) 92(33.8) 1.03 0.311 Headaches 72(26.5) 97(35.7) 1.60 0.205 Poor sleep 39(14.3) 64(23.5) 1.27 0.260 Easily frightened 26 (9.6) 44(16.2) 3.04 0.081 Hands shake 11 (4.0) 8 (2.9) 0.491 0.484 Nervous or 30(11.0) 38(14.0) 1.08 0.300 worried Poor digestion 15 (5.5) 32(14.0) 6.73 0.205 Trouble thinking 19 (7.0) 62(22.8) 26.8 0.260 clearly Unhappy 23 (8.5) 25 (9.2) 0.091 0.762 Cry often 13 (4.8) 37(13.6) 12.7 0.000 Not enjoying 20 (7.4) 41(15.1) 8.14 0.004 daily activities Difficulty making 29(10.7) 64(23.5) 15.9 0.000 decisions Work suffers 20 (7.4) 13 (4.8) 1.58 0.209 Unable to play 11 (4.1) 10 (3.7) 0.050 0.824 useful part in life Lost interest in 9 (3.3) 6 (2.2) 0.617 0.432 things once enjoyed Worthless 19 (7.0) 20 (7.4) 0.028 0.868 Suicidal attempt 4 (1.5) 3 (1.1) 0.145 0.704 Statistically significant in bold
71
A significantly (p= 0.020) higher proportion of women in the rural area reported frequent vaginal bleeding(12.5% vs 6.6%) while more women in the urban area reported pelvic pain than in the rural area(18.8% and 9.6%) respectively p=0.002.
A significantly higher proportion of women in the rural area reported crying often(p=0.000), did not enjoy daily activities(p=0.004) and had difficulty making decisions(p=0.000).
72
Table 9: Respondents' use of medication and health visits
Variables Urban n=272 Rural n=272 Test statistic p-value n (%) n (%) χ2 Frequent use of medication in the past one month: To help calm down or sleep No 172(63.2) 198(72.8) 0.000 Once or twice 60(22.1) 71(26.1) A few times 22 (8.1) 3 (1.1) Many times 18 (6.6) 0 (0.0)
To relieve pain No 189(69.5) 155(57.0) 0.005 Once or twice 63(23.2) 87(32.0) A few times 11 (4.0) 24(8.8) Many times 9 (3.3) 6(2.2)
For sadness/depression No 219(80.5) 232(85.3) 0.023 Once or twice 48(17.6) 28(10.3) A few times 4 (1.5) 10 (3.7) Many times 1 (0.4) 2 (0.7)
Health personnel frequently consulted when sick Doctor 129(47.4) 119(43.8) 0.004 Nurse 31(11.4) 10 (3.7) Midwife(auxillary) 7 (2.6) 0 (0.0) Counsellor 2 (0.7) 1 (0.4) Pharmacist 53(19.5) 46(16.9) Traditional healer 3 (1.1) 0 (0.0) Traditional birth attendant 2 (0.7) 2 (0.7)
Has had to spend nights in the hospital other than to give birth Yes 69(25.4) 61(22.4) 0.647 0.421 No 203(74.6) 211(77.6) Statistically significant in bold (Fisher's P-value)
73
A significantly greater proportion 100 (36.8%) of women in the urban areas took medication to enable them calm down compared to 74 (27.2%) who do so in the rural areas (p=0.000).
Respondents in the rural communities 117 (43%) more frequently took medication to relieve pain compared to 83(30.5%) in the urban communities (p=0.005). However, more respondents in the urban areas took medication for sadness or depression than in the rural areas (19.5% and
14.7%) respectively (p=0.023). These differences were however not statistically significant.
More than two-fifths of women (47.4% and 43.8%) in the urban and rural areas respectively frequently consulted a doctor rather than other health care givers for illnesses although more women did so in urban communities (p=0.004).
74
Table 10: Respondents' reproductive health
Variables Urban Rural Test statistics n (%) n (%) χ2 P-value Ever been pregnant n=272 n=272 Yes 182(66.9) 175(64.3) 0.399 0.527 No 90(33.1) 97(35.7)
Ever tried to delay or avoid n=272 n=272 getting pregnant? Yes 75(27.6) 86(31.6) 1.067 0.302 No 197(72.4) 186(68.4)
Main method of n=75 n=86 contraceptive currently on Pill/tablets 23(46.0) 12(17.4) 1.692 0.193 Injectables 11(22.0) 7(10.1) 0.000 0.991 Implants 0 (0.0) 4 (5.8) IUCD 0 (0.0) 2 (2.9) Calendar/Mucus method 0 (0.0) 10 (0.0) Female sterilization 2 (4.0) 0 (0.0) Condoms 4 (8.0) 6 (8.7) 1.262 0.261 Male sterilization 0 (0.0) 0 (0.0) Withdrawal 5(10.0) 26(37.7) 0.470 0.493 Herbs 5(10.0) 2 (2.9) 1.516 0.218
About two-thirds of women 182 (66.9%) and 175 (64.3%) in the urban and rural areas respectively had ever been pregnant (p=0.527).
Few women in both groups (27.6% urban, 31.6% rural) had ever used anything to delay pregnancy (p=0.302).
The pill was the most commonly used method of contraception among women in the urban area
(46% urban and 17.4% rural, p=0.1934) compared to the rural area where withdrawal method was the most predominantly used method of contraception (10% urban and 37.7% rural, p=0.4928).
75
Table 11: Respondents' partner's involvement in their reproductive health
Variables Urban Rural Test P-value n (%) n (%) statistics χ2
Partner aware of respondent's n=75 n=86 use of contraceptive Yes 35(46.7) 59(68.6) 7.058 0.008 No 40(53.3) 27(31.4)
Partner ever refused to use a method or tried to stop n=75 n=86 respondent from using a method Yes 22(29.3) 10(11.6) 6.813 0.009 No 53(70.6) 76(88.4)
Partner's interest in respondent's antenatal care n=162 n=158 (ANC) for last pregnancy Stop 18(11.1) 5 (3.2) 14.297 0.006 Encourage 106(65.4) 117(74.1) No interest 35(21.6) 25(15.8) Don't know/remember 1 (0.6) 2 (1.3) Refused/No answer 2 (1.2) 9 (5.7)
Partner's preference or indifference towards gender for n=162 n=158 last pregnancy Son 40(24.7) 33(20.9) 10.566 0.032 Daughter 12 (7.4) 11 (7.0) Did not matter 68(42.0) 89(56.3) Don't know/remember 32(19.8) 14 (8.9) Refused/No answer 10 (6.2) 11 (7.0)
Married respondents only
*Statistically significant in bold
76
Out of the women who were currently on contraception, 35 (46.7%) and 59 (68.6%) of respondents' partners in the urban and rural areas respectively were aware of their use of contraception(p=0.008).
More respondents partners in the urban areas (29.3%) either refused to use a method or tried to stop them from using a method of contraception compared to 11.6% in the rural area. The difference between the groups was statistically significant (p=0.009).
Most respondents partners in both groups(65.4% urban, 74.1% rural) encouraged them to receive antenatal care for their last pregnancy. Thirty- five (21.6%) and 25 (15.8%) of respondents partners in urban and rural groups respectively had no interest in whether they received antenatal care whereas, 18(11.1%) and 5(3.2%) of respondents partners in both groups actually stopped them from receiving antenatal care during their last pregnancy. The difference between groups was statistically significant (p=0.006).
Also, for their last pregnancy, the gender of the child did not matter to 68(42%) and 89(56.3%) of respondents partners, however, 40(24.7%) and 33(20.9%) of respondents partners preferred to have a son while 12(7.4%) and 11(7%) preferred to have a daughter in urban and rural groups respectively (p=0.032). The difference between the groups was statistically significant.
77
Table 12: Lifetime prevalence of intimate partner violence among respondents
Variable Urban n=272 Rural n=272 Test Statistic P-value n (%) n (%) χ2
Emotional 42(15.4) 60(22.1) 3.910 0.048 Physical 23 (8.5) 34(12.5) 2.371 0.124 Sexual 21 (7.7) 28(10.3) 1.099 0.295 Lifetime 59(21.7) 74(27.2) 1.738 0.187 prevalence Note: positive responses only
The lifetime prevalence of at least one act of IPV among the respondents was 21.7% and 27.2% in urban and rural areas respectively. There was no statistically significant difference (p =0.187) between the urban and rural groups.
Emotional violence was the most prevalent form of violence in both groups (15.4% urban,
22.1% rural), p = 0.048.
More rural women experienced physical violence (12.5%) compared to 8.5% of urban women (p
= 0.124). Sexual violence was also more predominant among rural women (10.3%) compared to
7.7% urban women (p = 0.295). These findings were not statistically significant.
78
Table 13: Prevalence of intimate partner violence within the last 12 months (current IPV)
Variable Urban n=272 Rural n=272 Test Statistic P-value n (%) n (%) χ2
Emotional 35(12.9) 48(17.6) 2.403 0.121 Physical 21 (7.7) 26 (9.6) 0.582 0.445 Sexual 15 (5.5) 17 (6.3) 0.133 0.716 Prevalence 45(16.5) 57(21.0) 0.582 0.445
The one-year prevalence of at least one act of violence in the urban group (16.5%) was less than the rural group (21.0%). The difference between the two groups was however not statistically significant (p= 0.445).
Among women currently experiencing violence, emotional violence was still the most prevalent form of violence (12.9% and 17.6% ), followed by physical violence (7.7% and 9.6%) and then sexual violence (5.5% and 6.3%) in the urban and rural areas respectively. These findings were not statistically significant (p = 0.121, p = 0.445 and p = 0.716).
79
Determinants of IPV:
Table 14a: Association between age, age difference between respondents and their partners and experience of IPV
Variables Experienced violence Experienced violence in the past (Lifetime) 12 months (current) Urban n= 59 Rural n =74 Urban n=45 Rural n =57 n (%) n (%) n (%) n (%)
Age in years ≤24 11(20.8) 17(24.6) 7(13.2) 14(20.3) 25-34 25(23.5) 34(24.6) 21(19.8) 28(20.3) 35-44 21(22.3) 18(32.1) 16(17.0) 12(21.4) ≥45 2(10.5) 5(55.6) 1 (2.2) 3(33.3) Test statistics & P = 0.698 χ2= 4.993 Fisher's Fisher's P-value P = 0.172 P = 0.000 P = 0.771
Age difference 0-4 27(24.1) 36(24.7) 20(17.9) 31(21.2) 5-9 27(21.3) 33(32.4) 21(16.5) 21(20.6) ≥10 5(15.1) 5(20.8) 4(12.1) 5(20.8) Test statistics and χ2= 1.230 χ2= 2.335 Fisher's χ2 = 0.015 P- value P = 0.541 P = 0.311 P = 0.804 P = 0.992
The highest proportion of women who experienced lifetime abuse in the urban area (23.5%) were those in the 25-34 year age group whereas, the highest proportion of ever abused women in the rural group (55.6%) were above 45 years. Age was not associated with the lifetime experience of IPV in both urban and rural groups (p = 0.698 and p = 0.172) respectively. Age was however significantly associated with the experience of IPV in the preceding twelve months in the urban area (P=0.000).
80
The highest proportion of women who had experienced lifetime abuse in the urban area (24.1%) had partners who were older than them with 0-4 years whereas in the rural area, the highest proportion of ever abused women had a spousal age difference of 5-9 years.
Spousal age difference was neither associated with the experience of IPV in the urban area nor in the rural area ( p = 0.541 urban, p = 0.311 rural).
81
Table 14b: Association between socio-demographic characteristics of respondents and experience of IPV
Variables Experienced violence Experienced violence in the past (Lifetime) 12 months (current) Urban n= 59 Rural n =74 Urban n Rural n =57 n (%) n (%) =45 n (%) n (%)
Tribe Yoruba 41(19.8) 52(26.5) 29 (14) 37(18.9) Ibo 3(11.5) 14 (26) 3(11.5) 13(24.1) Hausa 12 (57) 3 (25) 12 (57) 3 (25) Others 3(16.7) 5 (50) 1 (5.5) 4 (40) Test statistics & Fisher's Fisher's Fisher's Fisher's P-value P = 0.002 P = 0.432 P = 0.000 P = 0.229
Religion Christianity 34(20.6) 53(29.6) 24(14.5) 42(23.5) Islam 23 (23) 19(21.1) 19 (19) 14(15.5) Traditional 0 (0.0) 2(66.7) 0 (0.0) 1(33.3) Others 2(66.7) 0 (0.0) 2(66.7) 0 (0.0) Test statistics & Fisher's Fisher's Fisher's Fisher's P-value P = 0.196 P = 0.078 P = 0.098 P = 0.213
Highest level of education None 8(47.1) 3 (25) 8(47.1) 3 (25) Primary 10(16.9) 15(17.9) 5 (8.5) 10(11.9) Secondary 25(20.8) 28(26.9) 23(19.2) 22(21.2) Tertiary 16(21.1) 28(38.9) 9(11.8) 22(30.6) Test statistics & χ2 = 6.244 Fisher's χ2 = 13.713 Fisher's P-value P = 0.100 P = 0.033 P = 0.003 P = 0.033 Statistically significant in bold
The highest proportion of respondents who ever experienced violence in the urban area were of the Hausa ethnic group whereas other tribes constituted the highest proportion in the rural area.
Tribe was significantly associated with lifetime and current experience of violence (p = 0.002 and p = 0.000) respectively in the urban area.
82
The majority of women who experienced IPV in both urban and rural areas were christians although religion was not statistically significantly associated with IPV experience in either of the groups.
Women who had no education constituted the highest proportion of those who experienced IPV in the urban area compared to the rural area where women with tertiary education constituted the highest proportion to experience IPV in the rural area. The level of education was statistically significantly associated with experiencing lifetime IPV in the rural area (0.033) as well as with currently experiencing IPV (0.003 and 0.033) in urban and rural areas respectively.
83
Table 14c: Association between respondents' marital status, number of children and experience of IPV
Variables Experienced violence Experienced violence in the past (Lifetime) 12 months (current) Urban Rural Urban Rural n (%) n (%) n (%) n (%)
Marital status n= 59 n =74 n =45 n =57
Currently married 32(20.3) 44(28.7) 27(17.1) 35(22.9) Divorced 2(16.7) 4(21.1) 0 (0.0) 1 (5.2) Separated 9(27.3) 6(46.2) 6(18.2) 6(46.2) Single 16(24.6) 20(24.4) 12(18.5) 15(18.3) Test statistics & χ2= 0.886 χ2= 0.625 χ2= 0.511 χ2= 0.504 P-value P = 0.642 P = 0.731 P = 0.775 P = 0.777
Type of marriage n =32 n =44 n =27 n =35 Monogamous 25(16.8) 34(23.3) 20(13.4) 28(19.2) Polygamous 7(13.0) 10(25.6) 7(13.0) 7(18.0) Test statistics & χ2 =0.129 χ2 =0.094 χ2 =0.007 χ2 =0.030 P-value P = 0.719 P = 0.759 P = 0.933 P = 0.862
Number of n= 59 n =74 n =45 n =57 children 0 15(18.3) 18(18.6) 11(13.4) 12(12.4) 1-2 11(12.5) 25(26.9) 9(10.2) 20(21.5) 3-4 32(32.0) 26(34.7) 25(25.0) 21(28.0) ≥5 1(50.0) 5(71.4) 0 (0.0) 4(57.1) Test statistics & Fisher's Fisher's Fisher's Fisher's P = 0.007 P-value P = 0.004 P = 0.006 P = 0.039
84
The proportion of those who experienced lifetime IPV was highest among women who were seperated from their spouses in urban and rural groups (27.3% and 46.2%) respectively although more in the rural group compared to the urban group. A similar proportion of single women
(24.6% vs 24.4%) had ever experienced partner violence in urban and rural groups respectively.
Statistically, marital status was not significantly associated with IPV experience in either urban
(p = 0.642) or rural groups (p = 0.731).
The proportion of women who currently or ever experienced violence was highest among those who had more than five children in the urban and rural areas although greater in the rural area.
Respondents' number of children was significantly associated with the experience of IPV in both groups and in all instances.
85
Table 14d: Association between witnessing childhood violence and experience of IPV
Variables Experienced violence Experienced violence in the past (Lifetime) 12 months (current) Urban Rural Urban Rural n (%) n (%) n (%) n (%)
Respondent's father hit n = 59 n = 74 n = 45 n = 57 mother Yes 5(26.3) 12(48.0) 5(26.3) 10(40.0) No 54(21.3) 62(25.1) 40(15.8) 47(19.0) Test statistics & P-value χ2 =0.257 χ2 =6.011 χ2 =1.413 χ2 =6.028 P = 0.612 P = 0.014 P = 0.235 P = 0.014
Respondent witnessed n = 5 n = 12 n = 5 n = 10 father hit mother Yes 2(15.4) 11(50.0) 1 (7.6) 8(36.4) No 3(50.0) 1(33.3) 4(66.7) 2(66.7) Test statistics & P-value Fisher's Fisher's Fisher's Fisher's P = 0.262 P = 1.000 P = 0.017 P = 0.544
Statistically significant in bold
A higher proportion of respondents that ever experienced violence (26.3% vs 21.3% and 48% vs
25.1%) in the urban and rural area respectively experienced inter-parental violence in childhood compared to those who did not. The experience of violence in childhood was significantly associated with a lifetime IPV experience in the rural area (p=0.014) but not in the urban area
(p=0.612).
86
Table 15: Association between partner’s characteristics and women's experience of IPV Variables Experienced violence (Lifetime) Experienced violence in the past 12 months (current) Urban n= 59 Rural n =74 Urban n =45 Rural n =57 n (%) n (%) n (%) n (%) Partner's age 20-29 11(20.0) 13(18.1) 6(10.9) 12(16.7) 30-39 29(29.6) 39(31.7) 27(27.6) 30(24.4) 40-49 17(17.0) 19(27.5) 11(11.0) 14(20.3) 50-59 2(10.5) 3(37.5) 1 (5.3) 1(12.5) Test statistics & p-value Fisher's Fisher's Fisher's Fisher's P = 0.123 P = 0.131 P = 0.005 P = 0.639
Highest level of education Primary 3(27.3) 3(37.5) 3(27.3) 2(25.0) Secondary 36(22.0) 43(25.7) 29(17.7) 35(21.0) Tertiary 20(20.6) 28(30.8) 13(13.4) 20(22.0) Test statistics & P-value Fisher's Fisher's Fisher's Fisher's P = 0.836 P = 0.480 P = 0.375 P = 0.883
Occupation Class I 15(25.0) 21(43.8) 13(21.7) 17(35.4) Class II 3 (10.3) 5 (23.8) 2 (6.9) 3 (14.3) Class III 30(27.0) 35(30.7) 21(18.9) 28(24.6) Class IV 8(22.2) 6 (19.4) 7(19.4) 5(16.1) Class V 3 (8.3) 7 (12.1) 2 (5.6) 4 (7.0) Test statistics & P-value Fisher's χ2=15.135 Fisher's Fisher's P = 0.075 P = 0.004 P = 0.125 P = 0.004
Partner drinks alcohol Yes 10(34.5) 14(34.1) 8(27.6) 11(26.8) No 49(20.2) 60(26.0) 37(15.2) 46(20.0) Test statistics & P-value χ2=2.354 χ2=0.798 χ2=2.041 χ2= 0.631 P = 0.126 P = 0.372 P = 0.153 P = 0.427
Ever noticed drunk n=10 n=14 n=8 n=11 Yes 3(37.5) 7(70.0) 3(37.5) 2(20.0) No 7(33.3) 7(22.6) 5(23.8) 9(29.0) Test statistics & p-value χ2= 0.051 χ2=5.599 χ2 = 0.074 χ2 = 0.023 P = 0.821 P= 0.018 P=0.785 P=0.881
Partner's mother ever hit n=59 n=74 n=45 n=57 by father Yes 3(33.3) 7(100.0) 3(33.3) 6(85.7) No/Don't know 56(36.6) 67 (44.4) 42(27.5) 51(33.8) Test statistics & p-value Fisher's Fisher's Fisher's Fisher's P = 1.000 P = 0.004 P = 709 P = 0.009
87
Statistically significant in bold
88
The highest proportion of women who ever experienced IPV (29.6%) in the urban group had partners who were between the ages of 30-39 years compared to partners who were between 50-
59 years in the rural area. Among women who experienced current abuse however, the highest proportion of respondents' partners were between the ages os 30-39 years in both urban and rural areas. Respondents partners' age was statistically significant among those who experienced current abuse in the urban area ( p= 0.005). The difference between the two groups was not statistically significant.
The highest proportion of respondents that ever or currently experienced violence had partners with a primary education (27.3% and 27.3%) in urban and (37.5% and 25%) in rural groups.
Respondents' partners education was not statistically significant in either of the groups. The urban and rural groups did not vary significantly.
Skilled workers (Social class III) constituted the highest proportion of women who ever experienced IPV (27%) in the urban area compared to professionals (Social class I) in the rural area. The occupational class of respondents' partners was significant for IPV experience among women in the rural area (p=0.004).
A higher proportion of respondents' partners who drank alcohol perpetrated violence compared to those who did not (34.5% vs 20.2% and 34.1% vs 26%) in urban and rural areas respectively.
A similar proportion of partners who ever perpetrated violence in the urban area had been drunk compared with those who had never been. However, a higher proportion of partners who ever perpetrated violence in the rural group had ever been drunk (70%) compared to those who had never been drunk (22.6%). Drunkenness was statistically significant for ever perpetrating violence in the rural area (p=0.018).
89
A higher proportion of perpetrators of IPV in the urban area did not experience inter-parental violence in childhood (39.4% vs 33.3%) whereas, a higher proportion of IPV perpetrators in the rural area did (100% vs 47.9%). The findings were significant among women who ever experienced IPV (p= 0.004) or currently experienced IPV (p= 0.009) in the rural area.
90
Table 16: Association between family support, community characteristics and experience of IPV
Variables Experienced violence Experienced violence in the past (Lifetime) 12 months (current) Urban n= 59 Rural n =74 Urban n Rural n =57 n (%) n (%) =45 n (%) n (%)
Family support Yes 54(20.9) 68(27.0) 40(15.5) 53(21.0) No 5(35.7) 6(30.0) 5(35.7) 4(20.0) Test statistics & χ2=0.949 χ2=0.000 χ2 =2.601 Fisher's p-value P =0.329 P =0.970 P = 0.107 P = 1.000
Community level of crime High level 14 (7.4) 14 (7.6) 13 (6.8) 12 (6.6) Low level 45(54.9) 60(67.4) 32(39.0) 45(50.6) Test statistics & χ2=73.34 χ2=42.73 χ2=40.67 χ2=67.37 p-value P =0.000 P =0.000 P =0.000 P =0.000
Community connectedness Yes 56(21.7) 63(27.0) 43(16.7) 49(21.0) No 3(21.4) 11(29.0) 2(14.3) 8(21.0) Test statistics & Fisher's χ2=0.004 Fisher's χ2=0.039 p-value P =1.000 P =0.949 P =1.000 P =0.842
Statistically significant in bold
A higher proportion of women who had experienced violence in their lifetime had no support from their families in both groups (35.7% urban, 30% rural). Lack of family support was however not significantly associated with lifetime IPV experience in both groups (p = 0.329 urban, p = 0.970 rural).
Also, more women who ever experienced spousal violence (54.9% urban, 67.4% rural) reported a low level of crime compared to those reporting a high level of crime (7.4%, 7.6% rural). A low
91 level of crime in the community was significantly associated with IPV experience in both urban
(p<0.000) and rural areas (p<0.000).
Although a higher proportion of women who had ever experienced IPV in the rural areas were connected with their communities compared to the urban area, community connectedness was however not statistically significant for IPV experience in any of the groups.
92
Table 17: Association between spousal socio-economic disparity, attitude towards IPV, spousal communication and experience of IPV
Variables Experienced violence Experienced violence in the past (Lifetime) 12 months (current) Urban Rural Urban Rural n (%) n (%) n (%) n (%)
Socio-economic disparity n=43 n= 54 n= 33 n= 42 Wife of less occupational 20(25.3) 19(23.0) 16(20.3) 12(14.5) class than husband Wife of same or higher 23(18.0) 35(32.7) 17(13.3) 30(28.0) occupational class than husband Test statistics & P-value χ2= 1.187 χ2 = 1.759 χ2=1.290 χ2 = 4.248 P = 0.276 P = 0.185 P = 0.256 P = 0.039
Attitude towards IPV n= 59 n =74 n =45 n =57
Justified at least one reason 39(36.1) 33(41.8) 33(30.6) 32(40.5) for a husband/partner maltreating his partner
Justified no reason for 20(12.2) 41(21.2) 12 (7.3) 25(13.0) husband / partner maltreating his partner
Test statistics & P-value χ2= 20.542 χ2= 10.914 χ2= 26.291 χ2= 24.054 P < 0.000 P = 0.001 P < 0.000 P < 0.000
Mutual spousal n=32 n=44 n=37 n=32 communication Yes 28(21.4) 38(30.2) 23(17.6) 30(23.8) No 4(12.9) 6(18.8) 4 (12.9) 5 (15.6) Test Statistic & P-value Fisher's χ2= 1.134 Fisher's χ2= 0.573 P = 0.451 P = 0.287 P = 0.789 P = 0.449
Significant in bold
93
A higher proportion of women who experienced lifetime abuse were of less occupational class than their partners (25.3% vs 18%) in the urban area as compared with those in the rural area
(23% vs 32.7%) who were mostly of the same or higher occupational class than their husbands/partners. Socio-economic disparity was statistically significant for current abuse in the rural area (p=0.039).
A significantly higher proportion of ever abused women justified violence for at least one reason compared to those who did not (36.1% vs 12.2% and 41.8% vs 21.2%) in the urban and rural groups respectively. The attitude of respondents towards IPV was significantly associated with
IPV experience in both urban and rural groups.
The majority of abused women had mutual spousal communication in both groups and in all instances. This finding was however not statistically significant.
94
Table 18: Health consequences of IPV: Physical injuries due to IPV Variables Urban Rural Test P-value n (%) n (%) statistics χ2 Injury due to any violent act by n=272 n=272 husbands/ partners Yes 26 (9.6) 19 (7.0) 0.872 0.350 No 246(90.4) 253(93.0) Number of times injured by any n=26 n=19 husbands /partners 1-2 times 12(46.2) 16(84.2) 7.525 0.023 3-5 times 14(53.8) 3(15.8) Injury in the past 12 months n=26 n=19 Yes 18(69.2) 4(21.1) 10.387 0.006 No 8(30.8) 15(78.9)
Type of injury n=26 n=19 Cuts, punctures, bites 13(50.0) 12(63.2) Scratches, abrasions, bruises 2 (7.7) 3(15.8) Penetrating injury, deep cuts, gashes 0 (0.0) 1 (5.3) Fractures, broken bones 1 (3.8) 0 (0.0) Lost consciousness due to physical IPV n=26 n=19 Yes 14(53.8) 9(47.4) 0.016 0.899 No 12(46.2) 10(52.6)
Lost consciousness in the past 12 n=14 n=9 months Yes 14 (100) 8(88.9) 0.030 0.030 No 0 (0.0) 1(11.1)
Hurt badly enough to need health n=26 n=19 care Needed health care 16(61.5) 7(36.8) 1.782 0.182 Not needed 10(38.5) 12(63.2)
Hurt badly in the last 12 months n=16 n=7 Yes 16(100.0) 7(100.0) No 0 (0.0) 0 (0.0)
Ever received healthcare for this n=26 n=19 injury/injuries Yes, sometimes 8 (30.8) 9(47.4) 6.167 0.046 Yes, always 7 (26.9) 0 (0.0) No, never 11(42.3) 10(52.6) Ever had to spend any nights in a n=26 n=19 hospital due to the injury/injuries Yes 6(23.1) 4(21.1) 0.041 0.840 No 20(76.9) 15(78.9) Statistically significant in bold
95
Twenty-six(9.6%) and 19(7%) of women in the urban and rural area respectively had been injured as a result of physical abuse by their partners (p=0.3504).
Significantly more respondents in the urban area 14(53.8%) had been injured about 3-5 times than in the rural area 3(15.8%); whereas more respondents in the rural area 16(84.2%) had been injured about 1-2 times (p=0.0232).
Out of those injured, 18(69.2%) of women in the urban and 4(21.2%) of women in the rural areas had been injured in the preceding twelve months.
The most predominant types of injuryin the urban and rural areas respectively were cuts, punctures and bites (50% and 63.2%).
In the urban and rural groups respectively, 14(53.8%) and 9(47.4%) were said to have ever lost consciousness as a result of physical abuse at some time in their lives and all of such women except one in the rural area had lost consciousness in the preceding twelve months(p=0.030).
Sixteen(61.5%) and 7(36.8%) of women injured had ever been hurt badly enough to receive health care and also within the preceding twelve months (p=0.1819).
Fifteen(57.7%) of women in the urban and 9(47.4%) of women in the rural area had actually ever received health care for these injuries (p=0.0458). Out of these, 6(23.1%) of women in the urban area and 4(21.1%) of those in the rural area ever had to spend nights in the hospital due to the injuries(p=0.8402).
96
Table 19: Respondents' reporting of physical injury
Variables Urban Rural Test statistic P-value n (%) n (%) χ2
If ever received health care for n=26 n=19 injuries, told a health worker the real cause of injury Yes 7(26.9) 4(21.1) 0.017 0.017 No 19(73.1) 15(78.9)
Ever reported being maltreated n=26 n=19 Yes 17(65.4) 11(57.9) 0.040 0.841 No 9(34.6) 8(42.1)
Who reported to n=17 n=11
Family 10(58.8) 5(45.5) 0.004 0.950 Police 12(70.6) 8(72.7) 0.163 0.687 Hospital/health centre 11(64.7) 6(54.5) 0.012 0.914 Social services 14(82.4) 8(72.7) 0.001 0.995
Reason for going for help n=17 n=11
Encouraged by friends/family 3(17.6) 6(54.5) 0.116 0.733 Could not endure anymore 9(52.9) 6(54.5) 0.219 0.640 Badly injured 8(47.1) 5(45.5) 0.265 0.606 He threatened or tried to kill me 1 (5.9) 1 (9.1) 6.753 0.009 He threatened or hit the children 2(11.8) 1 (9.1) 3.588 0.058 Saw the children suffering 6(35.3) 6(54.5) 0.008 0.930 Afraid he would kill me 3(17.6) 0 (0.0)
Reasons for not reporting n=9 n=8
Don't know/No answer 7(77.8) 1(25.5) 0.189 0.664 Fear of threats/Consequences 0 (0.0) 2(25.0) More violence 0 (0.0) 1(12.5) Violence not serious 1(11.1) 1(12.5) 2.450* 0.118 Ashamed/Afraid would not be 0 (0.0) 1(12.5) believed or would be blamed Believed not helped/Know other 0 (0.0) 1(25.5) women not helped Afraid would end relationship 0 (0.0) 1(25.5) Afraid would lose children 0 (0.0) 1(25.5) Bring bad name to family 1(11.1) 7(87.5) 0.189* 0.664 Others 0 (0.0) 2(25.0) Statistically significant in bold
97
Of those who received healthcare for their injuries, 6(23.1%) and 4(21.1%) of those in the urban and rural areas respectively told a health worker the real cause of their injury (p=0.017).
Seventeen(65.4%) and 11(57.9%) of injured women in the urban and rural areas respectively ever reported being maltreated(p=0.8410), respondents in both groups reported to either family members, the police, a healthcare facility or the social welfare services. However, the highest proportion reported to the social services (82.4% and 72.7%) in the urban and rural areas respectively (p=0.9946). This was not statistically significant.
The main reason for reporting was not being able to endure anymore 52.9% in the urban area which was similar to 54.5% in the rural area (p=0.6401).
The commonest reason respondents in the rural area did not report to anyone was because they felt that it will bring a bad name to the family 7(87.5%), p=0.6639. Approximately 77.8% and
25.5% of women in the urban and rural groups could not give reasons why they would not report while respondents that were afraid of any consequences or being maltreated more if they talked about it made up 37.5% of the rural groups. 11.1% and 12.5% felt violence was not serious (p=
0.1175).
98
Table 20: Comparison between reported health symptoms among currently abused and non-abused women in the urban area
Variables Abused Not abused Test P-value n = 45 n = 227 Statistic (χ2) General health Vaginal discharge 12(26.6) 74(32.6) 0.611 0.435 Vaginal bleeding 2 (4.4) 14 (6.1) 0.181 0.654 Pelvic pain 13(28.9) 38(16.7) 2.330 0.047 Genital irritation 11(24.4) 30(13.2) 2.566 0.055 Feel tired 9 (20) 13 (5.7) 8.059 0.001 Poor appetite 17(37.7) 40(17.6) 5.435 0.002 Abdominal discomfort 9 (20) 2 (0.8) 9.174 0.000
Mental Health Dizziness 11(24.4) 70(30.8) 0.411 0.392 Headaches 39(86.6) 33(14.5) 3.662 0.000 Poor sleep 24(53.3) 15 (6.6) 3.999 0.000 Easily frightened 10(22.2) 16 (7.0) 7.575 0.002 Hands shake 6(13.3) 5 (2.2) 10.334 0.001 Nervous or worried 9(20.0) 21 (9.3) 3.332 0.036 Poor digestion 4 (8.9) 11 (4.8) 1.029 0.279 Trouble thinking clearly 9(20.0) 10 (4.4) 11.165 0.000 Unhappy 10(22.2) 13 (5.7) 10.143 0.000 Cry often 7(15.5) 6 (2.6) 11.573 0.000 Not enjoy daily activities 7(15.5) 13 (5.7) 4.335 0.021 Difficulty making decisions 15(33.3) 14 (6.2) 20.322 0.000 Work suffers 12(26.7) 8 (3.5) 9.709 0.000 Unable to play useful part in 6(13.3) 5 (2.2) 10.334 0.003 life Lost interest in things once 9 (20.0) 0 (0.0) enjoyed Feel worthless 9(20.0) 10(44.1) 11.165 0.000 Suicidal thought 4 (8.9) 4 (1.7) 6.025 0.009 Suicidal attempt 1 (2.2) 3 (1.3) 0.203 1.000
Medication use& hospital stay Frequent medications for 18(40.0) 82(36.1) 0.11 0.622 sleep Frequent use of pain 20(44.4) 63(27.8) 2.425 0.027 relievers Antidepressants 8(17.7) 45(19.8) 0.068 0.752 Overnight hospital stay in 19(42.2) 42(18.5) 6.844 past 12 months 0.000 Statistically significant in bold
99
A significantly higher proportion of abused women as compared with non-abused women in the urban area reported pelvic pain (28.9% vs 16.7%, p=0.047)feeling tired (20% vs 5.7%, p=0.001); poor appetite (37.7% vs 17.6%, p=0.002); abdominal discomfort (20% vs 0.8%, p=0.000).
Also, a statistically significant proportion of abused women compared to non- abused women reported frequent headaches (p=0.000); poor sleep (0.000); were easily frightened (0.002); hands shook (0.001); nervousness or anxiety (0.036); having trouble thinking clearly (p=0.000); being unhappy (p=0.000); crying often (p=0.000); not enjoying daily activities (p=0.021); having difficulty making decisions (p=0.000); work suffering (p=0.000), being unable to play a useful part in life (p=0.003); feeling worthless (p=0.000) and having suicidal thoughts (p=0.009).
A significant proportion also reported frequently taking pain relievers (44.4%, p= 0.027); and
42.2% had stayed overnight in the hospital in the preceding twelve months, (p=0.000).
100
Table 21: Comparison between reported health symptoms among currently abused and non-abused women in the rural area
Variables Abused Not abused Test P-value n = 57 n = 215 Statistic(χ2) General health Vaginal discharge 17(29.8) 53(24.7) 12.49 0.438 Vaginal bleeding 8(14.0) 26(12.1) 5.337 0.643 Pelvic pain 10(17.5) 16 (7.4) 0.554 0.021 Genital irritation 9(15.8) 30(14.0) 6.558 0.725 Feel tired 6(10.5) 13 (6.0) 1.014 0.239 Poor appetite 11(19.3) 50(23.3) 2.812 0.525 Stomach discomfort 4 (7.0) 10 (4.7) 0.757 0.473
Mental Health Dizziness 32(56.1) 65(30.2) 8.719 0.000 Headaches 24(42.1) 40(18.6) 8.719 0.000 Poor sleep 9(15.8) 35(16.3) 8.820 0.929 Easily frightened 3 (5.3) 5 (2.3) 0.002 0.244 Hands shake 6(10.5) 32(14.9) 8.858 0.399 Nervous or worried 5 (8.8) 27(12.6) 4.988 0.431 Poor digestion 3 (5.3) 59(27.4) 18.201 0.000 Trouble thinking clearly 13(22.8) 12(55.8) 0.040 0.000 Unhappy 11(19.3) 26(12.1) 3.702 0.159 Cry often 7(12.3) 34(15.8) 9.349 0.508 Not enjoy daily activities 8(14.0) 56(26.0) 18.860 0.057 Difficulty making decisions 15(26.3) 49(22.8) 11.912 0.577 Work suffers 5 (8.8) 5 (2.3) 0.010 0.021 Unable to play useful part in 3 (5.3) 3 (1.4) 0.010 life 0.077 Lost interest in things once 3 (5.3) 17 (7.9) 3.409 enjoyed 0.497 Feel worthless 7(12.3) 7 (3.3) 0.010 0.006 Suicidal thought 2 (3.5) 1 (0.4) 0.467 1.000 Suicidal attempt 18(31.6) 56(26.1) 13.342 0.405
Medication use& hospital stay Frequent medications for sleep 21(36.8) 96(44.7) 31.178 0.291 Frequent use of pain relievers 12(21.1) 28(13.0) 3.997 0.128 Antidepressants 19(33.3) 42(19.5) 6.167 0.027 Overnight hospital stay in past 14(24.6) 55(25.6) 15.37 0.875 12 months Statistically significant in bold
101
A significantly higher proprtion of abused women in the rural area reported pelvic pain as compared to non-abused women(17.5% vs 7.4%, p=0.021). Also, significantly more women who were abused compared with those who were not abused reported the following symptoms in the preceding twelve months:
Dizziness (56.1% vs 30.2%, p=0.000); Headaches (42.1% vs 18.6%, p=0.000); their work suffers (8.8% vs 2.3%, p=0.006). Significantly more abused women also reported the frequent use of antidepressants (33.3% vs 19.5%, p=0.027).
On the other hand, significantly more women who were not abused (27.4%) reported poor digestion compared to abused women (5.3%, p=0.000). Also, more non-abused women (55.8%) reported having trouble thinking clearly compared to abused women (22.8%, p=0.000).
102
Table 22: Comparison of respondents' reproductive health among currently abused and non-abused women in the urban area
Variables Abused Not abused Test Statistic P-value n = 45 n = 227 χ2 Tried to delay or 19(42.2) 56(24.7) 12.69 0.000 avoid getting pregnant
Main method of contraception used Calendar/Mucus 0 (0.0) 0 (0.0) Method Condoms 0 (0.0) 4 (1.8) Diaphragm/Foam/Jelly 0 (0.0) 0 (0.0) Female Sterilization 0 (0.0) 2 (0.8) Herbs 2 (4.4) 3 (1.3) 0.226 0.635 Implants (norplant) 0 (0.0) 0 (0.0) Injectables 6(13.3) 5 (45.5) 0.095 0.758 IUD 0 (0.0) 0 (0.0) Pill/Tablet 11(24.4) 12 (5.3) 0.043 0.836 Withdrawal 0 (0.0) 0 (0.0) Partner aware of 12(26.7) 23(10.1) 2.000 0.157 contraceptive use Partner refused 5(11.1) 17 (7.5) 2.943 0.086 contraceptive use or stopped respondent's contraceptive use Partner stopped or had 6(13.3) 12 (5.3) 0.708 0.400 no interest in ANC for last pregnancy Partner had preference 4 (8.9) 48(21.1) 15.29 0.000 for a particular gender for last pregnancy Statistically significant in bold
A significantly higher proportion of currently abused women (42.2%) had tried to delay or avoid getting pregnant compared to non-abused women (24.7%, p=0.000).
103
A lesser proportion of partners of currently abused women (8.9%) in the urban area preferred a particular gender for their last pregnancy compared to partners of non-abused women (21.1%).
This finding was statistically significant (p=0.000).
104
Table 23: Comparison of respondents' reproductive health among currently abused and non-abused women in the rural area
Variables Abused Not abused Test Statistic P-value n = 57 n = 215 χ2
Tried to delay or avoid 14 (24.6) 72(33.5) 23.554 0.000 getting pregnant
Main method of contraception used Calendar/Mucus 1 (1.8) 9 (4.2) 0.364 0.546 Method Condoms 2 (3.5) 4 (1.9) 0.009 0.924 Diaphragm/Foam/Jelly 0 (0.0) 0 (0.0) Female Sterilization 0 (0.0) 0 (0.0) Herbs 2 (3.5) 0 (0.0) Implants (norplant) 1 (1.8) 3 (1.4) 0.089 0.766 Injectables 2 (3.5) 15 (7.0) 2.476 0.116 IUD 0 (0.0) 2 (1.0) Pill/Tablet 5 (8.8) 7 (3.2) 0.000 0.985 Withdrawal 0 (0.0) 0 (0.0) Partner aware of 9(15.8) 50(23.3) 15.701 0.000 contraceptive use Partner refused 2 (3.5) 8 (3.7) 0.608 0.436 contraceptive use or stopped respondent's contraceptive use Partner stopped or had 4 (7.0) 1 (0.5) 0.002 0.962 no interest in ANC for last pregnancy Partner had preference 16(28.0) 28(13.0) 2.035 0.154 for a particular gender Statistically significant in bold
A significantly higher proportion of non-abused women in the rural area (33.5%) tried to delay or avoid getting pregnant compared to currently abused women (24.6%, p= 0.000).
105
A significantly higher proportion of partners of non-abused women were aware that they used any method of contraceptive (23.3%) compared to partners of currently abused women (15.8%, p= 0.000).
106
Table 24: Comparison of health related symptoms among ever abused women in the urban and rural areas
Variables Urban n= 59 Rural n =74 Test Statistic P-value n (%) n (%) χ2
General Health Vaginal discharge 18(30.5) 22(29.7) 0.010 0.922 Vaginal bleeding 3 (5.1) 11(14.9) 2.380 0.123 Pelvic pain 16(27.1) 12(16.2) 2.350 0.125 Genital irritation 12(20.3) 13(17.6) 0.170 0.684 Feel tired 11(18.6) 7 (9.5) 2.370 0.124 Poor appetite 19(32.2) 12(16.2) 4.690 0.030 Stomach discomfort 10(16.9) 6 (8.1) 2.420 0.119 Mental Health Dizziness 17(28.8) 27(36.5) 0.870 0.350 Headaches 43(72.9) 34(45.9) 9.770 0.001 Poor sleep 26(44.1) 25(33.8) 1.470 0.226 Easily frightened 11(18.6) 10(13.5) 0.650 0.420 Hands shake 7(11.9) 3 (4.1) 2.000 0.089 Nervous or worried 11(18.6) 7 (9.5) 2.370 0.124 Poor digestion 5 (8.5) 6 (8.1) 0.010 0.993 Trouble thinking clearly 10(16.9) 3 (4.1) 6.190 0.012 Unhappy 12(20.3) 14(18.9) 0.040 0.837 Cry often 8(13.6) 11(14.9) 0.050 0.831 Not enjoy daily activities 7(11.9) 8(10.8) 0.040 0.849 Difficulty making decisions 16(27.1) 9(12.2) 4.810 0.028 Work suffers 12(20.3) 16(21.6) 0.030 0.856 Unable to play useful part in life 6(10.2) 6 (8.1) 0.170 0.680 Lost interest in things once 11(18.6) 3 (4.1) 7.420 0.006 enjoyed Feel worthless 10(16.9) 3 (4.1) 0.060 0.813 Suicidal thought 4 (6.8) 8(10.8) 0.650 0.420 Suicidal attempt 1 (1.7) 3 (4.1) 0.080 0.629 Medication use& hospital stay Frequent medications for sleep 24(40.7) 25(33.8) 0.670 0.413 Frequent use of pain relievers 28(47.5) 28(37.8) 1.250 0.264 Antidepressants 11(18.6) 18(24.3) 0.620 0.430 Overnight hospital stay in past 12 15(25.4) 19(25.7) 0.001 0.974 months
A greater proportion of respondents in the urban area reported poor appetite (0.0300); headaches
(0.001); trouble thinking clearly (p=0.012); having difficulty making decisions (0.028); and losing interest in things once enjoyed (p=0.006). There was a statistically significant association
107 between the proportion of the aforementioned reported sypmtoms among ever abused respondents and respondents' location.
108
Table 25: Comparison of health related symptoms among currently abused women in the urban and rural areas
Variables Urban n= 45 Rural n =57 Test Statistic P-value n (%) n (%) χ2
General Health Vaginal discharge 12(26.7) 17(29.8) 0.120 0.726 Vaginal bleeding 2 (4.4) 8(14.0) 2.620 0.179 Pelvic pain 13(28.9) 10(17.5) 1.850 0.173 Genital irritation 11(24.4) 9(15.8) 1.200 0.274 Feel tired 9(20.0) 6(10.5) 1.800 0.180 Poor appetite 17(37.8) 11(19.3) 4.310 0.037 Abdominal discomfort 9(20.0) 4(7.0) 6.580 0.014 Mental Health Dizziness 11(24.4) 21(36.8) 1.800 0.180 Headaches 39(86.7) 32(56.1) 11.08 0.001 Poor sleep 24(53.3) 24(42.1) 1.270 0.259 Easily frightened 10(22.2) 9(15.8) 0.690 0.407 Hands shake 6(13.3) 3 (5.3) 2.040 0.154 Nervous or worried 9(20.0) 6(10.5) 1.800 0.179 Poor digestion 4 (8.9) 5 (8.8) 0.110 0.624 Trouble thinking clearly 9(20.0) 3 (5.3) 5.260 0.022 Unhappy 10(22.2) 13(22.8) 0.011 0.944 Cry often 7(15.6) 11(19.3) 0.240 0.622 Not enjoy daily activities 7(15.6) 7(12.3) 0.230 0.633 Difficulty making decisions 15(33.3) 8(14.0) 4.300 0.038 Work suffers 12(26.7) 15(26.3) 0.030 0.852 Unable to play useful part in 6(13.3) 5 (8.8) 0.540 0.460 life Lost interest in things once 9(20.0) 3 (5.3) 5.260 0.022 enjoyed Feel worthless 9(20.0) 3 (5.3) 5.260 0.022 Suicidal thought 4 (8.9) 7(12.3) 0.300 0.583 Suicidal attempt 1 (2.2) 2(3.5) 0.150 0.703 Medication use& hospital stay Frequent medications for 18(40.0) 18(31.6) 0.780 0.377 sleep Frequent use of pain relievers 20(44.4) 21(36.8) 0.600 0.436 Antidepressants 8(17.8) 12(21.1) 0.170 0.679 Overnight hospital stay in 14(31.1) 19(33.3) 0.060 0.812 past 12 months
109
A greater proportion of respondents in the urban area reported poor appetite (0.037); abdominal discomfort (p=0.014); headaches (p=0.001); trouble thinking clearly (p=0.022); having difficulty making decisions (0.038); losing interest in things once enjoyed (p=0.022); and feeling worthless
(p=0.022). There was a statistically significant difference between the proportion of these health sypmtoms among currently abused respondents in the urban and rural areas.
110
Table 26: Comparison of reproductive health among abused women in the urban and rural areas
Variables Experienced violence (Lifetime) Experienced violence in the past 12 months (current) Urban n= Rural χ2 and Urban Rural χ2 and 59 n =74 P-value n =45 n =57 P- n (%) n (%) n (%) n (%) value
Tried to delay or avoid 23(39.0) 23(31.1) χ2=0.91 19(42.2) 14(24.6) χ2=3.58 getting pregnant p=0.341 p=0.058
Main method of contraception used Calendar/Mucus 0 (0.0) 4 (5.4) 0(0.0) 1(1.8) Method Condoms 0 (0.0) 3 (4.1) 0(0.0) 2(3.5) Herbs 3 (5.1) 2 (2.7) χ2=0.510 2(4.4) 2(3.5) χ2=0.07 p=0.654 p=1.000 Implants (norplant) 0 (0.0) 1 (1.4) 0(0.0) 1(1.8) Injectables 6(10.2) 3 (4.1) χ2=1.95 6(13.3) 2(3.5) χ2=3.36 p=0.163 p=0.134 Pill/Tablet 14(23.7) 9(12.2) χ2=3.07 11(24.4) 5(8.8) χ2=4.67 p=0.079 p=0.030 Partner aware of 14(23.7) 14(18.9) χ2=0.46 12(26.7) 9(15.8) χ2=1.82 contraceptive use p=0.499 p=0.177 Partner refused 7(11.9) 3 (4.1) χ2=0.88 5(11.1) 2(3.5) χ2=1.82 contraceptive use or p=0.349 p=0.177 stopped respondent's contraceptive use Partner stopped or had 7(11.9) 6 (8.1) χ2=0.53 6(13.3) 4(7.0) χ2=2.27 no interest in ANC for p=0.468 p=0.131 last pregnancy Partner had preference 10(16.9) 20(27.0) χ2=1.91 4(8.9) 16(28.1) χ2=5.87 for a particular gender p=0.167 p=0.015
111
Out of those who ever experienced abuse, a total of 23(39%) and 23(31.1%), p=0.3411 tried to avoid or delay getting pregnant in the urban and rural area respectively. Among those who experienced current abuse, 19(42.2%) and 14(24.6%) tried to avoid or delay getting pregnant in the urban and rural area respectively.
Although the main method of contraception used among ever abused women was the pill, a higher proportion of women in the urban area (23.7%) used the pill compared to the rural area
(12.2%). There was a statistically significant difference in the use of the pills among currently abused urban and rural respondents (p=0.030). None of the women in the urban group and very few (4.1%) in the rural group used condoms.
A significantly higher proportion of women who currently experienced IPV in the rural area had partners who had preference for a particular gender (28.1%) than in the urban area (8.9%), p=0.015.
112
Table 27: Multi-variate analysis of determinants of lifetime IPV among urban respondents
95% C.I. P-value Odd ratio Lower Upper Tribe Hausa 0.054 Ibo 0.996 0.995 0.169 5.848 Yoruba 0.180 0.122 0.006 2.636 Others 0.112 8.618 0.605 122.807 Education None 0.416 Primary 0.294 0.271 0.024 3.110 Secondary 0.492 0.651 0.191 2.216 Tertiary 0.556 1.346 0.501 3.612 No. of children 0 0.131 1-2 0.111 0.080 0.004 1.781 3-4 0.072 0.060 0.003 1.287 ≥5 0.197 0.138 0.007 2.794 Family Support 0.019 6.574 1.356 31.875 Level Crime 0.442 1.472 0.549 3.950 IPV tolerant attitude 0.062 0.456 0.200 1.040 Statistically significant in bold
After controlling for all significant variables in the bivariate analysis, multivariable logistic regression appeared as though having family support was associated with a lifetime experience of violence in the urban area (p=0.019) with those who had some support from their families being over six times more likely to experience violence than those who did not (OR= 6.574, CI:
1.356-31.875).
113
Table 28: Multi-variate analysis of determinants of IPV in the past 12 months among urban respondents
95% C.I. P-value Odd ratio Lower Upper Education None 0.067 Primary 0.641 1.532 0.255 9.212 Secondary 0.248 0.368 0.067 2.009 Tertiary 0.105 2.525 0.825 7.730 No. of children 0 0.076 1-2 0.999 1.382E008 0.000 . 3-4 0.999 5.971E7 0.000 . ≥5 0.999 2.517E8 0.000 . Father Hit Mother 0.085 4.933 0.805 30.249 Partners socio economic status I 0.948 II 0.999 9.470E7 0.000 . III 0.999 2.868E8 0.000 . IV 1.000 0.193 0.000 . V 1.000 0.831 0.000 . Family support 0.069 4.906 0.883 27.248 Low level of crime 0.900 1.069 0.378 3.024 IPV tolerant attitude 0.004 .246 .095 0.640 Statistically significant in bold
After controlling for confounders, there is a significant association between a tolerant attitude towards IPV and the actual experience of violence (p= 0.004) with women who justified IPV for at least one reason (IPV tolerant) in the urban area being slightly more likely to have experienced violence in the last twelve months (OR-0.256; CI:0.095-0.640).
114
Table 29: Multi-variate analysis of determinants of lifetime IPV among rural respondents
95% C.I. Variable P-value Odds ratio Lower Upper
Tribe Hausa 0.536 Ibo 0.140 0.184 0.019 1.741 Yoruba 0.188 0.199 0.018 2.196 Others 0.999 0.000 0.000 . Education None 0.240 Primary 0.169 6.606 0.448 97.473 Secondary 0.740 1.211 0.390 3.757 Tertiary 0.265 0.551 0.193 1.572 No of children 0 0.006 1-2 0.005 0.022 0.002 0.311 3-4 0.009 0.035 0.003 0.432 ≥5 0.076 0.108 0.009 1.267 Father Hit Mother 0.069 3.223 0.913 11.372 Partner’s age 20-29 0.385 30-39 1.000 1.118E8 0.000 . 40-49 1.000 1.333E9 0.000 . 50-59 1.000 9.294E8 0.000 . 60-69 1.000 9.811E8 0.000 . Family Support 0.097 3.406 0.801 14.476 Low level of crime 0.016 3.552 1.270 9.933 Attitude 0.099 0.462 0.185 1.157 Statistically significant in bold
115
After adjusting for all significant variables, the number of children was significantly associated with ever experiencing violence among rural respondents. Having no children, between 1-2 children significantly reduced the likelihood for violence (p= 0.005) (OR=0.022, CI:0.002-0.311)
Women who had between 3-4 children (p= 0.009)were also less likely to experience violence
(OR= 0.035, CI: 0.003-0.432) than those who had five or more children.
116
Table 30: Multi-variate analysis of determinants of current IPV (Rural)
95% C.I. Variable P-value Odd ratio Lower Upper Education None 0.028 0.637 .639 0.100 4.102 Primary Secondary 0.092 0.333 0.093 1.197 Tertiary 0.003 0.176 0.055 0.561 No of children 0 0.062 1-2 0.007 0.016 0.001 0.329 3-4 0.015 0.039 0.003 0.539 ≥5 0.020 0.040 0.003 0.603 Father hit mother 0.004 8.088 1.980 33.042 Partner's socio economic status I 1.000 II 0.999 8.260E9 0.000 . III 0.999 6.356E9 0.000 . IV 1.000 145.112 0.000 . V 1.000 61.445 0.000 . Level of crime 0.604 1.343 0.441 4.095 IPV tolerant attitude 0.001 0.152 0.052 0.446 Wife's socio-economic 0.999 4.758E8 0.000 . status same as husband Statistically significant in bold
117
Level of education was statistically signifiant for current IPV experience. Those who had tertiary education were least likely to experience spousal violence (OR= 0.176) as compared with those who had primary (OR= 0.639) or secondary level of education (OR= 0.333). The number of children respondents had was also significantly associated with the experience of current IPV in the rural area with women having between 1-2 children being less likely to experience IPV(p=
0.007:OR= 0.016) than those who had 3-4 children or over five children (p= 0.020: OR=0.040).
A tolerant attitude towards IPV was also significantly associated with current experience of IPV in the rural area.
118
Table 31: Logistic regression of locational determinant of IPV
95% C.I. Variable P-value Odd ratio Lower Upper Location Urban Rural 0.009 1.609 1.126 2.299
The table shows that women who reside in the rural areas were 1.6 times more likely to be victims of IPV compared to those residing in urban areas (p=0.009, OR-1.609, CI-1.126-2.299).
119
Table 32: Multi-variate analysis of health consequences of current IPV among urban respondents
95% C.I. Variable P-value Odd ratio Lower Upper
Feels tired 0.994 5.756E28 .000 . Poor appetite 0.117 .363 .102 1.289 Abdominal 0.994 .000 .000 . discomfort Headaches 0.195 .570 .244 1.334 Poor sleep 0.217 .469 .141 1.560 Easily frightened 0.443 .383 .033 4.456 Hands shake 0.994 3.221E27 .000 . Trouble thinking 0.179 .231 .027 1.963 Unhappy 0.994 9.268E20 .000 . Cry often 0.995 .000 .000 . Not enjoy activities 0.995 1.320E30 .000 . Difficulty making 0.994 .000 .000 . decisions Work suffers 0.908 1.074 .322 3.582 Unable to play useful 0.007 .098 .018 .529 part in life Feels worthless 0.994 .000 .000 . Suicidal thought 0.036 10.907 1.174 101.318 Frequent use of pain 0.820 1.079 .561 2.076 relievers Overnight hospital 0.035 .465 .228 .949 stay in past 12 months
Statistically significant in bold
Women who experienced current IPV in the urban area were slightly more unable to play a useful part in life compared to those who did not experience IPV (p=0.007). Also, current victims of IPV were about eleven times more likely to have suicidal thoughts than those who did not experience IPV (p=0.036;OR-10.907;CI-1.174-101.318) and were also slightly more likely to have stayed overnight in the hospital in the past year (p=0.035).
120
Table 33: Multi-variate analysis of health consequences of current IPV among rural respondents
95% C.I. Variable P-value Odd Ratio Lower Upper Pelvic pain 0.317 0.709 0.362 1.390 Headaches 0.191 0.648 0.338 1.242 Poor digestion 0.861 0.895 0.258 3.101 Trouble thinking 0.004 9.445 2.009 44.403 Work suffers 0.000 0.118 0.054 0.258 Feel worthless 0.515 0.530 0.078 3.583 Frequent 0.004 0.325 0.152 0.693 antidepressants
Statistically significant in bold
Women who experienced violence in the last twelve months were nine times more likely to have trouble thinking clearly than those who did not experience violence in the rural area (p=0.004;
OR-9.445; CI-2.009-44.403). Victims of IPV were also slightly more likely to have their work suffer (p=0.000; OR-0.118) and to use antidepressants slightly more frequently than those who were not IPV victims (p=0.004; OR-0.325).
121
4.1 RESULTS OF THE FOCUS GROUP DISCUSSION.
The main findings that emerged from the focus group discussions were centered on five major themes which include:
1. Prevalence of IPV
2. What respondents perceived constitutes violence in their communities
3. Determinants/factors contributing to violence in their community
4. Perceived consequences of IPV to women's health
5. Support system for violence and what they should do when they experience violence
Prevalence of IPV
Participants in both urban and rural settings thought that IPV was very common. However, women in the urban area were of the opinion that IPV was still largely undisclosed.
"Yes it is common, it has been occurring from the beginning of time, that is how we met it" (FGD 1, rural)
"I am a victim, I have a sister who is haemoglobin SS and was a victim" (FGD 2, urban)
" It might be common but people are not willing to speak up about it so you cannot really tell and when they do speak, it is only physical violence that will be reported" (FGD 2, urban)
122
Perception of what violence constitutes in their communities
Most participants in both settings had similar views about what constitutes violence among women and their husbands/partners. They unanimously agreed that men beating their wives was a serious form of violence.
Most of the participants felt that violence included men beating their wives, running a woman down, sending his relations to deal with her as well as sexual violence. Sexual violence however was not readily volunteered.
Participants in the urban area stated that abusing your partner, excessive restriction, getting jealous or suspicious at all times were forms of violence while those in the rural area agreed that abusing your partner and denying your partner sex were forms of violence.
Rural participants also felt it involved being unfaithful, not providing necessary things
(economic violence) and not caring for your partner.
“Some men would not let you work and yet would not provide for you “(FGD 2, rural)
Most urban as well as rural participants felt that a man could not be said to rape his wife even though some rural women agreed that sometimes women are forced into having sexual relations against their will.
"Can a man rape his wife?" (FGD, rural)
" In our own environment, you really cannot say that a man raped his wife" (FGD, urban)
"Even the bible says that a wife's body belongs to her husband" (FGD 1, urban).
123
“A man that does not sleep with his wife is wicked, when he is now finally ready, I will also refuse and then he will beat me and still force me to sleep with him” (FGD 1, rural)
Factors contributing to violence in the community
Regarding determinants of violence and factors that make it common or uncommon in their communities, participants agreed that some religions and cultures permit women being put down.
Both urban and rural women believed male dominance or entitlement to be a major determinant of IPV.
"Men are more respected and favoured and sometimes they take it too far"(FGD 1, rural)
"Some men believe that females are under them" (FGD 1, urban)
" I have a friend whose fiancé told her that a man can rape his wife because she is his property"
(FGD 2, urban)
More urban women however felt that financial hardship played a major role because lack of money in the home causes a lot problem such that little things stir up fights and a man with no money is not respected by his partner.
" Especially when men don't have money, they are aggressive" (FGD 1, urban)
" Men that do not have money could be violent" (FGD 2, urban)
A few urban participants however felt that having money could actually promote violence.
" Sometimes money makes men more arrogant because they think they can get as many women as they want so they misbehave" (FGD 2, urban)
124
Participants unanimously agreed that unemployment on the part of the male promotes intimate partner violence as well as financial disparity where the woman earns more money than the man.
Both urban and rural participants were of the opinion that education(male) helps protect against violence, however, a few felt that education does not make any difference.
Other factors identified by participants in both urban and rural locations include upbringing where the man witnesses violence as a child; alcohol use or substance abuse particularly in those who get drunk by reducing their inhibition; male dominance or entitlement and; the ownership of weapons.
"When he takes alcohol, it is worse" (FGD 2, urban).
"Upbringing is very important because you become what you see" (FGD 1, rural)
Circumstances women deserved to be maltreated
Participants were asked if there were circumstances where partner violence was justifiable.
Although most of the participants in both urban and rural groups found partner violence unjustifiable, a good number agreed that women sometimes bring it upon themselves as some are said to lack home training and marriage training.
"We women don't control our mouth and don't know when to stop; men will want to tell her shut up and subject her".(FGD 2: formal education, urban)
" A real man should control himself when he is angry and leave the place" (FGD 2: formal education, urban).
125
A woman being employed was thought to be protective. "Working will make her busy and therefore less probing, her husband will also respect her better" (FGD 2: formal education, urban).
"No man wants a dependent woman" (FGD 2: formal education, rural).
Perceived consequences to women's health
Responses were similar in both urban and rural areas and ranged from reduced self esteem to anxiety, loss of interest in life, depression, emotional trauma, physical injuries, mental imbalance and suicide.
"Yes it affects a woman's health; it can cause mental imbalance or injuries from the beating"
(FGD 1, rural).
"It makes you traumatized and you transfer the aggression to people around you including your children" (FGD 2, urban)
"It affects your general well being" (FGD 2, urban).
Support system for violence and what they should do when they experience violence
Participants were asked where they thought victims of violence should go for help.
Although responses were similar in both groups, more rural women said they should turn to God, religious bodies, support groups or their family members. However some participants believed that families could either make the violent situation better or worse and that it could more likely be worsened by the woman's family following their reaction to the man. "Families make things better; my family told me to come out alive". (FGD 1: formal education, rural).
126
Women in the rural areas mostly did not support reporting to the police as compared with the urban women even though some participants in the urban area were of the same opinion; "The police is out of it, they won't help you. You end up giving them money for nothing" (FGD 1: formal education, rural).
Most women in the urban area agreed that victims should report to the police so that the offender can be arrested. However, they also unanimously agreed that most women would see that option as a last resort due to the stigma associated with it. They thought that most people would not even want people to see the police go into their houses nor really want their husbands to be arrested.
Some urban women who knew women who had reported IPV to the police felt it was an exercise in futility. "My friend that went to the police was told," see the way you are dressed, why won't your husband beat you? Her husband raped her" (FGD 1: formal education, urban).
127
CHAPTER FIVE
DISCUSSION
Intimate partner violence is a public health problem that affects people from all walks of life.
Gender based violence including IPV targets a woman's gender as the primary motive and is an aspect of reproductive health that cannot be ignored if the fifth sustainable development goal
(SDG) of gender equality is to be achieved. It is rapidly increasing worldwide and remains a problem of public health importance. This study was carried out among a total of 544 women aged between 18-49 years in Oshodi/Isolo and Ikorodu LGAs.
In this study, respondents between 25-34 years of age formed the highest proportion in both urban and rural communities, which was similar to studies in Imo state of Nigeria.104 This study explored the experiences of twenty-two purposively selected married women aged 22 to 40 years from two sheltlers for abused women who were victims of IPV. In studies carried out in
Bangladesh and Kenya, which were part of the ten countries included in the demographic and health survey (DHS ) on intimate partner violence, majority of the respondents were between 25 to 34.118, 119 Findings however contrast with findings from NDHS 2013 as well as a study in
Ibadan, in which most of the respondents were less than 24.76, 94
The high percentage of Yorubas in the study is a reflection of the study area which predominantly comprises of people of Yoruba ethnicity. The educational achievement was also quite high in both groups although slightly higher in the urban group with over two thirds of respondents completing their secondary education. This offers implications for IPV as a higher level of education is thought to reduce the likelihood of experiencing IPV.88 In the rural area,
4.4% had no formal education whereas 6.2% had no formal education in the urban group. This
128 again is indicative of the high literacy level in Lagos State.120 The findings on educational level were comparable to studies carried out in Kaduna, Benue, and Delta states of Nigeria and
Bangladesh but contrasted with findings from studies in Zimbabwe where most of the women had completed tertiary education.12, 90, 118, 121, 122
The majority of respondents also belonged to social class IV (35.0% and 31.6%)in both groups which consists of mainly unskilled workers. This possibly again reflects a low literacy level or their inability to find "blue collar jobs".
In both areas, a greater proportion of the respondents were married in a monogamous setting; however, more women in the urban group were in a polygamous relationship (26.6%) compared to the rural group (21.1%). Also, a higher proportion of urban women (16.5%) were either separated or divorced compared to rural women (11.8%). This could be due to the fact that rural women are generally thought to uphold socio-cultural values and as such tend to stay married as culturally expected irrespective of what goes on in the marriage. Studies carried out in Zaria and
Ibadan also had majority of the respondents married but findings in Brazil contrasted this, where an equal proportion of women studied were living with a man without being married.76, 118, 121, 123
Respondents' partners in the urban communities (37.49±8.749) were significantly older than partners of respondents in the rural communities (34.28±8.401) . This could be due to a rural- urban migration to find work.
The age difference between respondents and their partners significantly varied in the urban and the rural area (p=0.010). Approximately 59% of the partners in urban area compared to 46.3% in the rural area were older than the respondents with over five years. A higher proportion of respondents and their partners (53.7%) in the rural area had an age difference of less than four
129 years which was probably due to the fact that the rural women were younger and as such possibly got married more recently in which dispensation a narrower age difference is more preferable. Also, 12.1% of partners in the urban area compared to 8.8% in the rural area were older than the respondents with over a decade. These findings contrast with studies in Delta and
Imo, which showed that most men preferably marry women they are quite older than to ensure respect and some form of control over them.12, 124
All of the respondents’ partners in the urban group had some form of formal education as did
97.8% in the rural group. This differed from findings in Imo, Nigeria where the proportion of respondents partners in the rural areas with formal education were much less.124 This could be due to the high literacy rate in Lagos State that was recently put at 92%.120
The majority of respondents partners were skilled workers in both the urban (44.9%) and the rural areas(44.8%). This could indicate an inability to find formal jobs.
About a third of women in both urban and rural communities were said to have good family support system. There was a significantly higher level of crime reported in the urban communities (94.9%) than in the rural communities (86%). This is quite expected as the level of crime is generally thought to be influenced by rapid urban growth due to the decline of traditional values and the breakdown of family cohesiveness.125
The lifetime prevalence of intimate partner violence was generally low in both groups. However, a higher proportion of women in the rural group (27.2%) reported exposure to at least one act of violence compared to the urban group (21.7%)(Table 4). Women in rural areas have been thought to be more tolerant of IPV as they more typically exemplify socio-cultural traditions, and tolerance for spousal violence has been linked with actual experience of violence. The difference
130 between the groups was however not statistically significant. What obtained in this study was similar to studies from Uganda and other parts of southwest Nigeria on spousal abuse and well within the global lifetime prevalence of 15%- 71% and also the national average of 11% -52%.1,
38, 94 More recently, however, a study on controlling behavior, sexual and physical abuse in
Nigeria from the 2013 NDHS had a lifetime prevalence of 63%.94 This study obtained low rates possibly because it did not include controlling behaviour as part of emotional violence as in most studies with high prevalence rates.31 The low prevalence could also be due to the existing law in
Lagos state to protect against domestic violence.126
The prevalence of current abuse in both groups was 16.5% and 21% in urban and rural areas respectively. This contrasted with a 40% prevalence from a survey in eastern Nigeria, a 29% prevalence from a study in Lagos, Nigeria as well as the 32% yearly prevalence from the NDHS in Nigeria.69, 72, 94 These two studies were clinic based and may therefore not be representative of the community because the health issues that made such women present at the clinics could be from underlying IPV. The NDHS prevalence also reflects a national figure; however, the NDHS prevalence of physical and sexual violence for Lagos State was 12.9% which is quite similar to findings in this study particularly since emotional violence was not included.
Emotional violence was the most prevalent form of violence ever experienced and also within the past 12 months before the study in both groups with a lifetime prevalence of 15.4% and
22.1% among women in the urban and rural groups respectively. This trend was comparable and consistent with findings from the WHO multi-country study on women’s health and domestic violence. The WHO study found emotional violence to be the commonest form of violence experienced with between 20% and 75% of the women ever experiencing one or more of the
131 emotionally abusive acts they were asked about, and between 12% and 58% of the women experiencing so within the 12 months prior to the interview. Similarly, in Cyprus, 54.8% of the women experienced emotional violence which was higher than other forms experienced. Studies in Nigeria also reflect a similar pattern. 12, 118, 127 However, the prevalence of emotional violence recorded in this study was much lower than the aforementioned studies. This reflects the low overall prevalence of violence in this study.
The prevalence of physical violence within the past 12months before the study was 7.7% in the urban area and 9.6% in the rural area, the difference was not statistically significant (Table 5).
The rates were similar to a 9% prevalence rate from a previous study carried out in Lagos.72 The rates were higher than estimates of 4% for current experience (within the last twelve months) of spousal violence in Japan but were lower than the NDHS 2013 findings and estimates of 54% for
Ethiopia.94, 118
Sexual violence was reportedly low compared to physical and emotional violence, which may not be unrelated to the fact that issues of sex are still regarded as forbidden and matters of family privacy.128 In this study, more women in the rural area (10.3%) compared to the urban area
(7.7%) experienced sexual abuse. Findings in the rural group were similar to the WHO multi- country study where the lifetime prevalence of sexual violence by an intimate partner in most sites studied was between 10% and 50% and was more in rural areas compared to what was obtained in the city in all sites except in Thailand.118
Generally more women in the rural areas experienced different forms of violence compared to the urban areas and the reason for this could be connected with the fact that in urban areas, a higher proportion have at least a secondary school education and therefore are possibly more
132 empowered which could limit the financial stressors that may trigger violence. More women in the rural area are unemployed and therefore depend more on their partners for means of livelihood which could encourage some level of controlling behaviour and consequently, violence. Also, urban women might be more aware of IPV as well as their rights, existing support groups and places they can report to for related matters which could be protective.
The experience of violence was highest among women aged between 25-34 years in the urban area and lowest among women above 45 years. Similar findings were recorded in a qualitative study in eastern Nigeria where 50% of IPV victims were 28 years. This may be because younger women may be less assertive in the early years of marriage because they have not yet established themselves or possibly because they are just building up a career path and so are mostly dependent on their partners. Findings differed from studies carried out in Kano and Delta, where women younger than 25 years experienced more violence compared to the older women.12, 127
However, the experience of IPV was highest among women older than 35 years in the rural area where age was statistically significantly associated with current IPV experience. This was similar to findings in Osun and Bangladesh where women older than 35years were more likely to experience violence.94, 123 This might be due in part to the fact that lifetime experience of violence increases with age as older women have been exposed to the risk of violence for longer. The older age associated with a lower likelihood of violence in the urban area fits with literature on how a woman’s position in the household changes as she ages such that it can be reasonably assumed that the longer couples stay or live together, the more they understand themselves and the lower the risk of spousal violence.129
There was a low level of IPV with age difference between respondent and her partner 10 years and above compared to ages between 0-9 years in both urban and rural areas. This was similar to
133 findings in Zambia from the DHS where there was a higher risk of violence for women whose husbands/partners were less than ten years older.123 This contrasted with findings in Osun where the likelihood for IPV was increased with increased spousal age difference.123, 130 The findings in this study could be explained by the fact that men who are much older than their partners are usually more mature and may therefore find it easier to overlook their wives' shortcomings.
Hausas constituted the highest proportion of abused women in the urban area (57%) compared to other minority tribes in the rural area (50%). A higher proportion of Hausas were victims of abuse in the urban area as compared with 25% in the rural area. Also, the highest proportion of ever abused women in the urban area were Muslims (23%) as compared with Christians in the rural area (29.6%). IPV was most predominant among women with no education (47.1%) in the urban area, as compared to women with a tertiary education in the rural area (38.9%). There was a statistically significant association between the level of education and the current experience of violence (p= 0.003 and p=0.033) in urban and rural areas respectively (Table 14b). Findings in this study differed from findings in southwest Nigeria and in Ethiopia where those with formal education formed a larger proportion of those experiencing abuse in the urban area as well as from other studies in Benue and Osun state where violence occurred more among women with no formal education in the rural area.31, 74, 127, 129 This variation shows that violence cuts across all groups as there are other individual and possibly relational factors that contribute to women’s risk of intimate partner violence beyond their level of education or location.
Lifetime partner violence was highest among women who were separated from their husbands/partners in both groups although not statistically significant. This is logical, as IPV might have been responsible for the separation. This contrasted with a study conducted in Benue where IPV was predominant among currently married women, however, studies done in Oyo,
134
Enugu and in Osun which found that IPV was more common among divorced and separated couples supported findings from this study.90, 127
Violence was highest among those who had more than three children in both study groups,
(p<0.05, Table 14c). This was quite similar to what was found in a WHO study in all the sites studied and three sites from the DHS on IPV (Bangladesh, Bolivia, and Haiti) where women who experienced violence were significantly more likely to have more children than non-abused women.118 123 These studies suggest that parity might just be a consequence of abuse making it appear that those with more children are prone to abuse.
Witnessing inter-parental violence in childhood has been linked to experiencing violence later in life. IPV in this study was more predominant among women who experienced inter-parental violence in childhood in both groups but particularly so in the rural area where it was statistically significant (p=0.014, Table 14d). This agrees with studies carried out in Odisha and Utar Pradesh in India where a greater proportion of women who witnessed violence in childhood reported experiencing violence in the last 12 months.131
Most perpetrators of partner violence were between 30-39 years which gives more information for planning intervention (Table 15). This somewhat contrasts with findings in India that men who are over 34 years of age are less likely to perpetrate violence compared to younger men and also contrasts with findings in studies carried out in Malawi, Oyo, Enugu and Kaduna where older men perpetrated violence.78, 129, 131 In the urban area, most perpetrators had a primary education with an inverse relationship between IPV perpetration and partners' level of education.
This agrees with findings in India where perpetration of violence decreased as the men's education increased beyond secondary schooling as well as a study in eastern Nigeria where 58%
135 of perpetrators had no formal education while 8% had a secondary education.104, 131 Similarly, most perpetrators in the rural area had a primary level of education, however, beyond secondary education, the likelihood for perpetration of IPV begins to increase again.
Findings in this study suggest that unlike other studies, men who are gainfully employed tend to perpetrate violence possibly because most of the employed men are in low paying jobs and there is still a huge financial strain which could trigger violence. Some other studies found that women with unemployed partners were more likely to experience violence.123, 129 In the urban area, most perpetrators were skilled workers compared to the rural area where they were mostly professionals. Drinking alcohol particularly drunkenness was more common among perpetrators of violence in both urban and rural areas, although this finding was not statistically significant.
Studies carried out in Kaduna, Enugu and Ibadan also found that violence was more prevalent among those whose partners drank alcohol and often got drunk.78 Similarly, in a comparative study in western Nigeria, history of alcohol consumption by partners was significantly associated with reporting violence in both urban and rural locations. The relationship between alcohol intake and violence however has been controversial as some men are thought to use alcohol as an excuse for violence or to gain sufficient courage to be violent to their partner. A history of interparental violence in childhood was also significantly associated with ever or currently perpetrating violence in the rural area (p<0.005, Table 15).
Having family support was protective for women ever experiencing IPV in both urban and rural areas as a smaller proportion of women who had some level of support from their families experienced violence in their lifetime compared to those who did not have family support in both groups. This finding was statistically significant (p<0.05, Table 16). This agreed with findings in
Haiti where lack of supportive services for women were thought to promote domestic violence.85
136
The level of community connectedness was very high in both urban (94.9%) and rural groups
(86%). However, community factors such as the level of crime in the community and connectedness within the community was not protective of violence but instead, a low level of crime was associated with an increased likelihood of ever experiencing violence in the urban and rural areas (p<0.05, Table 16). A higher proportion of women who reported a low level of crime
(54.9% urban, 67.4% rural) experienced spousal violence compared to those reporting a moderate to high level of crime (7.4%, 7.6% rural) in both groups. This also contrasted with findings in Vietnam and Haiti where crime and male on male violence were thought to promote
IPV.84, 85 This implies that measures to combat IPV in Nigeria must go beyond community level interventions to include and strenghten family support systems.
As regards relationship factors, good communication, in contrast to other studies, was not protective of violence as a higher proportion of those who had ever been abused in both urban and rural areas had mutual communication with their husbands/partners. Also, having a lower occupational class than their husbands/partners increased the experience of violence than having the same or higher occupational class in urban (45.6% vs 18%) and rural groups (47% vs
32.7%). This finding was however only significant among those who currently experienced IPV in the rural area (p=0.039) but not in the urban area. This contrasted with findings from a study in Kenya where having a higher socio-economic status than their partners increased women's vulnerability to IPV.132 This could possibly be because under such circumstances, the men feel rather insecure and in order to compensate, try to exercise control over such women which could lead to violence. Findings in this study however could be explained by the fact that most of the women of lower occupational class are more dependent upon their partners and as such are more
137 vulnerable to being controlled and abused; such women are also more likely to be of lower educational status.
A higher proporion of women who justified IPV in the rural area (41.8%) experienced IPV compared to 36.1% in the urban area (p= 0.032). This agrees with findings in a study in rural
Nigeria where 42% of the respondents justified IPV.41 Although most of the women felt that being maltreated is not deserved as expressed in the FGDs, the fact that some women felt it can be excused under certain conditions or always is quite disconcerting and needs to be addressed.
A tolerant attitude was associated with a higher likelihood of experiencing violence in both groups howbeit more in the rural group (p<0.05, Table 17). This agrees with a study on attitudes of women towards intimate partner violence as well as other studies.41, 84
In this study, 9.6% and 7% of women in urban and rural areas sustained injuries as a result of physical abuse by their partners. Those in the urban area were injured more frequently than those in the rural area (p<0.05) out of whom 69.2% and 21.2% in the urban and rural areas respectively were injured in the preceding twelve months. These findings are not quite far from a study which found that physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; and developing a chronic disease, chronic mental illness, and injury.99 The most predominant types of injury noted were cuts, punctures and bites. About half of the injured women were said to have lost consciousness at some point in their lives as a result of physical abuse, most of which also occurred within the preceding twelve months. Out of the injured women hurt badly enough to require health care, only about a third to half in the urban and rural areas respectively actually received health care for these injuries.
138
Currently abused women in the urban area recorded more significant health problems than those in the rural area( Tables 20 and 21). Pelvic pain was the only gynaecological symptom associated with IPV in the urban area (28.9%, p=0.047) as well as in the rural area (17.5%, p=0.021).
General health symptoms associated with current abuse in the urban area include feeling tired, poor appetite and frequent abdominal discomfort while poor digestion was associated with current abuse in the rural area (p<0.05).
Common mental health problems associated with the current experience of IPV in both urban and rural areas include headaches, trouble thinking clearly, work suffering and feeling worthless.
However, certain mental health symptoms were associated with current abuse in the urban area alone and include poor sleep, being easily frightened, hand tremors, nervousness, anxiety, being unhappy, crying often, not enjoying daily activities, having difficulty making decisions, being unable to play a useful part in life and having suicidal thoughts (p=0.000) while dizziness was associated with current abuse in the rural area. This is quite similar to findings from a study where common health consequences of IPV recorded were headaches, fainting, back pain, seizures, vaginal infections and pelvic pain.46 This also agrees with studies which found that victims of IPV had higher risk factors for suicide.96, 105 Also, a significantly higher proportion of currently abused women in the urban area frequently used pain relievers compared to non- abused women (p=0.027) while more of those in the rural area frequently used antidepressants
(p=0.027). There was no statistically significant difference between any of the health related symptoms reported in the urban and rural areas (Tables 24 and 25). A higher proportion of women who currently experienced IPV in the urban area (42.2%) had to stay overnight in the hospital in the preceding twelve months compared to those who had not experienced IPV
(18.5%, p=0.000). In the rural area however, a similar proportion of women who experienced
139
IPV had stayed overnight in the hospital in the past year compared to those who did not experience IPV (24.6% vs 25.6%). Findings in the urban area agree with WHO studies which found that IPV puts an undue burden on health care services with women who have suffered violence being more likely to need health services and at higher costs, compared to women who have not suffered violence.1
About two fifths of women who currently experienced IPV in the urban area compared to one third of those in the rural area had ever tried to delay getting pregnant, the pill being the most commonly used method of contraception in both groups. Although very few abused respondents' partners were aware of their contraceptive use, more partners were aware in the urban group
(26.7%) compared to the rural group (15.8%). Similarly, a higher proportion of partners of currently abused women in the urban group(11.9%) refused contraceptive use or tried to stop them from using contraceptives compared to 3.5% in the rural area. Very few respondents partners perpetrating violence had no interest in antenatal care for their last pregnancy in both groups. This contrasts with findings by Shah linking adverse outcomes in pregnancy among domestic violence victims to inadequate prenatal care.102
About two-thirds of those who had injuries from physical violence reported to someone in both urban (65.4%) and rural (57.9%) areas. Surprisingly, a high proportion of them reported to the police(70.6%, 72.7%), health facility(64.7%, 54.5%) or social services(82.4%,72.7%). This contrasts with findings from a study carried out in Georgia where most women disclosed violence to their parents, partner’s parents or friends and very few told the authorities. Studies in
Benue and Lagos also reported similar findings to those in Georgia. 90, 94, 133 The pattern of reporting found in this study could be due to the political will in Lagos State in enforcing the law to protect against domestic violence. This law guarantees the right to speak, free legal services,
140 protection in a shelter and compels the perpetrating partner to pay for the upkeep of the woman and her children as well as their schooling. This would possibly make its citizens more confident in reporting and could possibly also inhibit perpetrators of IPV.
Most of the women who reported in the urban group (52.9%) did so because they could not endure anymore while majority of those who reported in the rural group did so either because they were encouraged by family members (54.5%), they could not endure anymore (54.5%) or they could not just bear to see the children suffer (54.5%). By contrast, the majority of women who participated in the FGDs in both urban and rural locations felt that family members were the best people to report to, particularly the woman's family and not her partner's nor friends or even the police. The majority were of the opinion that the police would either not do much or only make things worse and even collect money from the woman. Unfortunately in most cases as echoed in the FGDs, all that was done was either advising the perpetrator, asking them to settle at home or even blaming the woman. In some instances, it led to separation or divorce, women are often encouraged to stay in abusive relationships without disclosing their experiences to anyone due to cultural beliefs that a woman's place is with her husband and because divorced and separated women are not held in high social esteem compared to women who remain in marriage. This could well be the reasons why most felt reporting was unnecessary and couples should handle their own issues as culture and religion advocates , learning to endure and be patient in all circumstances, more so if they are married, particularly in Christianity where divorce is not encouraged.
Logistic regression demonstrated that after controlling for other covariates, in the urban area
(Table 27), having no family support was associated with an increased likelihood of ever
141 experiencing violence (p<0.05). Also, women who justified IPV for any reason were more likely to have experienced violence in the last twelve months (p<0.05) (Table 30).
In the rural area however, an increasing number of children and a low level of crime was significantly associated with ever experiencing violence (Table 31) while either having no formal education or a tertiary level of education, an increasing number of children and a tolerant attitude towards IPV was significantly associated with currently experiencing violence (p<0.05) (Table
32). Women who had less children were less likely to experience violence than those with a greater number of children. Surprisingly, women who reported a low level of crime in their communities were more likely to have experienced spousal violence than those who reported a high level of crime. Also, the lower the level of education, the higher the likelihood of experiencing violence. Residing in the rural area (Table 33) was associated with a 1.6 times increased risk of experiencing IPV than residing in the urban area.
Significant health symptoms associated with current IPV experience in the urban area include inability to play a useful part in life (p=0.007), suicidal thoughts (p=0.036) and having an overnight hospital stay in the preceding twelve months (p=0.035) compared to trouble thinking
(p=0.004), work suffering (p=0.000) and the frequent use of anti-depressants (p=0.004) in the rural area. Currently abused women in the rural area were nine times more likely to have trouble thinking clearly than never abused women. Other frequently reported but not significant problems in both groups were sexually transmitted infections, vaginal bleeding, headache, pelvic pain, dizziness and digestive problems (p>0.05).
142
Conclusion
The findings from this study show a relatively low prevalence of intimate partner violence in
Lagos. At the aggregate level, more than one-fifth of the women (21.7%) and more than a quarter of the women (27.2%) studied in the urban and rural areas respectively reported experiencing any form of violence during their lifetime. There was no statistically significant difference between the urban and ruralgroups. The prevalence of different forms of violence also varies in both groups, however, the trend was similar. Emotional violence was most prevalent, followed by physical violence, and least of all sexual violence.
Intimate partner violence in this study was not related to most socio-economic and demographic indicators, such as age, employment and marital status of women. However, an increasing number of children, a low level of crime in the community, having no formal education or a tertiary education as well as a tolerant attitude towards IPV increased the likelihood of experiencing spousal violence in the rural area whereas lack of family support and a tolerant attitude towards IPV were identified determinants of IPV in the urban area. Findings in this study buttress the fact that the occurrence of violence is an interplay of different factors as such variations may solely be due to differences in individuals, culture, and the society; what obtains in one setting though with similarities may not apply in another.
Common health problems found in this study were similar to those documented in other studies and include gynaecological problems, mental health problems as well as physical injury. In the urban area, IPV was associated with the inability to play a useful part in life, frequent suicidal thoughts, frequent use of pain relievers and an increased hospital stay in the preceding twelve months as opposed to having trouble thinking clearly, work suffering and the frequent use of
143 anti-depressants in the rural area. Self reported health consequences suggest that IPV may play a role in the poor state of health of Nigerian women.
Recommendations
In view of the observed findings, the following recommendations are suggested:
Government:
1. The government needs to strengthen and expand national laws defining violence within marriage. In addition, education programmes should also be conducted for important target groups such as the law enforcement agencies about partner violence and improve their application of existing laws. Perpetrators of violence should be severely punished to act as deterrents to others. Prepetrators should also be made to undergo rehabilitation.
2. The economy should be strengthened such that even the not so highly educated can get steady and fairly well paid jobs to meet their financial obligations which could in turn limit triggers for spousal violence.
3. Education, particularly of the girl child should be made a priority. Measures to prevent school drop-out rates such as school fee subsidies should also be put in place to ensure that these girls attain a high level of education up to the tertiary level. Girls who attend school are also able to use more effective methods of family planning and therefore have fewer and healthier babies as having fewer children also reduces the risk of experiencing IPV.
4. Efforts at combatting IPV should more in the rural areas.
Communities:
1. There is the need for community based intervention programmes involving religious leaders emphasizing on their role in raising awareness regarding this social ill as well as its effects. This
144 is particularly so because victims of abuse usually go to them to seek help and possible intervention.
2. Families and communities should also educate children adequately on gender roles; male children should be particularly educated on the concept of manhood as well as their supportive and protective roles.
Health workers:
1. Health workers should also engage in active surveillance for domestic violence. Since most women will visit a health worker at some point during their reproductive years, questions concerning domestic violence should be routinely asked as part of social history because this might be the underlying cause of whatever symptoms the women might be presenting with.
Researchers:
1. Subsequent research on IPV in rural areas should be carried out in areas outside Lagos State that would possibly more typically depict a difference in urban and rural locations.
145
REFERENCES
1. WHO. Factsheet on Violence against women: World Health Organization [updated October 201315/10/2013]. Available from: www.who.int/medidcentre/factsheets/.../e... 2. Okeke G. Christian marriage in Nigeria in the 21st century: problems and challenges. Bigard Theological Studies. 2002;2:19-35. 3. Gerstenfeld, Phyllis B. Hate Crimes: Causes, Controls, and Controversies 2013. 4. McPhail B, DiNitto D. Prosecutional Perspectives on Gender-bias Hate Crimes. SAGE journals. 2005;11:9. 5. Krug E, Mercy J, Dahlberg L, Zwi A. The world's report on violence and health. Lancet. 2002;360:1083-8. 6. Garcia-Moreno C, Jansen H, Ellsberg M, Heise L, Watts C. Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence. Lancet. 2007;368(9543):1260-9. 7. Shamu S, Abrahams N, Temmerman M, Musekiwa A. A systematic review of African studies on intimate partner violence against pregnant women: prevalence and risk factors. PLOS one. 2011;6:3. 8. Watts C, Zimmerman C. Violence against women: global scope and magnitude The Lancet. 2002;359(9313):1232-7. 9. Sprague S, Kaloty R, Madden K, Dosanjh S, Mathews DJ, Bhandari M, et al. Perceptions of Intimate Partner Violence: a cross-sectional survey of surgical residents and medical students. JIVR. 2011;5(1):147. 10. Laisser R, Nyström L, Lugina H, Emmelin M. Community perception of intimate partner violence- a qualitative study from urban Tanzania BMC Women's Health. 2011;11:13. 11. Rothman E, Butchart A, Cerda’ M, editors. Intervening with perpertrators of intimate partner violence ; a global perspective Geneva, Switzerland: WHO; 2003. 12. Aihie O. Prevalence of domestic violence in Nigeria: Implications for counselling. African Journals Online. 2009;2:1. 13. AfrolNews. Half of Nigeria’s Women experience domestic violence 2007 [cited 2013 20/10/2013]. Available from: http://www.afro.com/articles/16471. 14. Ellsberg M, Heise L. Researching violence against women: a practical guide for researchers and activists Washington, DC and Geneva: PATH/World Health
Organization. 15. Maffly B. "BYU study links women's safety, nation's peace". The Salt Lake Tribune 2009. 16. CDC. "Intimate Partner Violence: Overview": Centre for Disease Control and Prevention; 2006. Available from: http://www.cdc.gov/violenceprevention/pdf/IPV. 17. Fawole O, Aderonmu A, Fawole A. Intimate partner abuse: wife beating among civil servants in Ibadan, Nigeria. African Journal of Reproductive Health. 2005;9:2. 18. Ellsberg M, Heise L. Researching violence against women: a practical guide for researchers and activists. Washington, DC and Geneva: PATH/World Health
Organization. 19. John A. Screening of intimate partner violence in health in Kano Nigeria: Barriers and challenges for health care professionals Karolinska Institute; 2010.
146
20. Bacchus L, Mezey G, Bewley S. Domestic violence: prevalence in pregnant women and association with physical and psychological health. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2004;113:6-11. 21. Campbell J, Soeken K. Forced Sex and Intimate Partner Violence. Effects on Women's Risk and Women's Health. SAGE journals. 1999;5(9):1017-35. 22. National Centre for Injury Prevention and Control. Costs of intimate partner violence against women in the United States. . Atlanta (GA): Centre for Disease Control and Prevention, 2003. 23. Garcia M, Watts C. Violence against women: an urgent public health priority World Health Bulletin. 2011;89:2. 24. Economic Policy Research Centre. Kampala Intimate Partner Violence Estimating its cost and effect in Uganda. In: Intimate partner violence: high costs to households and communities. New York: International Center for Research on Women (ICRW) and
United Nations Population Fund (UNFPA), 2009. 25. Violence against women: impact of violence on women’s health. Ottawa: Health
Canada: 2002 Contract No.: 6 December 2015. 26. CDC. Consequences/Intimate Partner Violence/Violence Prevention/Injury 2013. Available from: www.cdc.gov/violenceprevention/intimat... 27. Karch D, Lubell K, Friday J, Patel N, Williams D. Surveillance for Violent Deaths, Violent Death Reporting System, 16 States, 2006. Centre for Disease Control and Prevention, 2009. 28. Breiding M, Black M, Ryan G. Prevalence and risk factors of intimate partner violence in eighteen U.S. States/Territories, 2005. American Journal of Preventive Medicine. 2008;34:112-8. 29. Karamagi C, Tumwine J, Tylleskar T, Heggenhougen K. Intimate partner violence against women in eastern Uganda: implications for HIV prevention. BMC Public Health. 2006;6:284. 30. Lawoko S. Factors associated with attitudes towards intimate partner violence: a study of women in Zambia. Violence and Victims. 2006;21:645-55. 31. Balogun M, Owoaje E, Fawole O. Intimate partner violence in south western Nigeria: are there rural-urban differences? . Women's Health 2012;52(7):627-45. 32. Owoaje E, Olaolorun F. Intimate partner violence among women in a migrant community in southwest Nigeria. International Quarterly of Community Health Education. 2005;25(4):337-49. 33. Village Square. Cases of Domestic Violence in Nigeria
2013 [08/02/2014]. Available from: http://naija-infohotspot.blogspot.co...-to-death.html http://www.tribune.com.ng/news2013/i...-of-snake.html. 34. WHO. Multi-Country Study on Women’s Health and Domestic Violence- Study Protocol
2006. 35. Keeling S. Stop! Silent screams. Pract Midwife. 2012;15:28-30. 36. Sarkar N. The impact of intimate partner violence on women's reproductive health and pregnancy outcome. Journal of Obstetrics and Gynaecology. 2008;28:266-71. 37. Uchem R. Overcoming women's subordination, an Igbo African and Christian perspective. Enugu: Snapp Press; 2001. 38. Koenig M, Lutalo T, Zhao F, Nalugoda F, Wabwire-Mangen F, Kiwanuka Nea. Domestic violence in rural Uganda: evidence from a community-based study Bulletin of the World Health Organization. 2003;81:53-60.
147
39. Hindin M. Understanding women's attitudes towards wife abuse in a non-western society Bulletin of the World Health Organization. 2003;81:501-8. 40. Ilika A. Women's perceptions of partner violence in a rural Igbo community. Afr J Reprod Health. 2005;9(3):77-88. 41. Antai D, Antai J. Attitudes of women toward intimate partner violence: a study of rural women in Nigeria. Rural and Remote Health. 2008;8:996. 42. Oladeji D, Adegoke T. Personal, situational and socio-cultural factors as correlates of intimates partner abuse in Nigeria. J Soc Sci. 2008;16:57-62. 43. Uthman O, Moradi T, Lawoko S. 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. Social Science & Medicine 2009;68(10):1801-9. 44. Vyas S, Watts C. How does economic empowerment affect women's risk of intimate partner violence in low and middle income countries? A systematic review of published evidence. Journal of International Development. 2009;21(5):577-602. 45. Rani M, Bonu S, Diop-Sidibe N. An empirical investigation of attitudes towards wife-beating among men and women in seven sub-Saharan African countries. African Journal of Reproductive Health. 2004;8:116-36. 46. Campbell J. Health consequences of intimate partner violence. The Lancet. 2002;359(9314):1331-6. 47. Stockl H, Filippi V, Watts C, Mbwambo J. Induced abortion, pregnancy loss and intimate partner violence in Tanzania: a population based study. BMC Pregnancy Childbirth. 2012;12:12. 48. Indu P, Remadevi S, Vidhukumar K, Anikumar T, Subha N. Development and validation of the domestic violence questionnaire in married women aged 18-25 years. Indian J Psychiatry. 2011;53:218- 23. 49. Watts C, Zimmerman C. Violence against women: global scope and magnitude. . The Lancet. 2002;359(9313):1232-7. 50. Declaration on the Elimination of Violence against Women., (1993). 51. FVPF. Reproductive health and partner violence guidelines: an integrated response to intimate partner violence and reproductive coersion. San Francisco: Family Violence Prevention Fund; 2010. 52. Callie MR, Sarah W. Intimate partner violence: BJS Statisticians 2000. 53. Johnson M, Leonne J. The differential effects of intimate terrorism and situational couple violence: findings from the national violence against women survey. Family Issues. 2005;26:322– 49. 54. Garcia M, Jansen H, Ellsberg M, Heise L, Watts C. WHO Multi-Country Study on
Women’s Health and Domestic Violence Against Women: Initial Results on
Prevalence, Health Outcomes, and Women’s Responses. Geneva, Switzerland: World Health Organization
2005. 55. Emenike E, Lawoko S, Dalal K. Intimate partner violence and reproductive health of women in Kenya. Int Nurs Rev. 2008;55(1):97-102. 56. Girmatsion F, Abebe G, Mulusew G. Intimate partner physical violence among
148 women in Shimelba refugee camp, northern Ethiopia BMC Public Health 2012;12:125. 57. Narayan D. Voices of the poor: Crying out for change. New York: Oxford University
Press 2000. 58. Penelope H, Peter G. Sex and violence : issues in representation and experience. In: Routledge, editor. 1994. p. 36. 59. Antai D. Controlling behavior, power relations within intimate relationships and intimate partner physical and sexual violence against women in Nigeria. BMC Public Health. 2011;11:511. 60. UNFPA. Addressing Gender-based Violence: Advancing Human Rights. 61. Calvert R. Criminal and civil liability in husband-wife assaults. . In: Steinmetz S SM, editor. Violence in the family. New York: Harper & Row; 1974. p. 88–91. 62. Article Corporal punishment. Britannica. Eleventh ed1891. 63. Obi S, Ozumba B. Factors associated with domestic violence in South-East Nigeria. Journal of obstetrics and gynaecology. 2007;27(1):75-8. 64. Men R. The Overlooked Victims of Domestic Violence. 2012 May 16, 2012. Report No. 65. Dibaba Y. Prevalence and correlates of intimate partner physical violence against women in Kafale district Ethiopia. Trop Doct 2008;38:11-5. 66. Peek-Asa C, Wallis A, Harland K, Beyer K, Dickey P, Saftlas A. Rural Disparity in Domestic Violence Prevalence and Access to Resources. Journal of Women's Health. 2011;20(11):1743-9. 67. KM E. Intimate Partner Violence and the Rural-Urban -Suburban Divide: Myth or Reality? A Critical Review of the Literature. Trauma Violence Abuse. 2015;15(3):359-73. 68. Anderson N, Ho-foster A, Mitchell S, Scheepers E, Goldstein S. Risk factors for domestic physical violence: national cross-sectional household surveys in eight southern African countries. BMC Women's Health. 2007;7:1. 69. Ilika A, Okonkwo P, Adogu P. Intimate Partner Violence Among Women of Childbearing age in a Primary Health Care Centre in Nigeria. Afr J Reprod Health. 2002;6(3):53-8. 70. Ameh N, Abdul M. Prevalence of Domestic Violence Amongst Pregnant Women in Zaria. Nigeria Annals of African Medicine. 2004;3(1):4-6. 71. Gyuse A, Ushie A. Pattern of domestic violence among pregnant women in Jos, Nigeria SA Fam Pract 2009;51(4):343-5. 72. Okenwa L, Lawoko S, Janson B. Exposure to Intimate Partner Violence Amongst Women of Reproductive Age in Lagos, Nigeria: Prevalence and Predictors. Journal of Family Violence 2009;24(7):517-30. 73. Sogbekun O, Fawole O, Ogunniyan T. Experienceof Intimate Partner Violence as a Predictor of Sexually Transmitted Infections Among Married Women in Nigeria. Annals of Ibadan Postgraduate Medicine
2015;13(1):6-16. 74. Fatusi AO, Alatise O, . Intimate partner violence in Ile-Ife, Nigeria: Women’s experiences and men’s perspectives. Gender Behav. 2006;4(2):764-81. 75. Hejazia S, Medeirosc S, Mohammadi R, Line J, Dalal K. Patterns of Intimate Partner Violence: a study of female victims in Malawi J Inj Violence Res 2013;5(1):38-50. 76. Venis S, Horton R. Violence against women: a global burden. Lancet. 2002;357:1172. 77. Lary H, Maman S, Katebalila M, Mbwambo J. Exploring the Association between HIV and Violence: Young People’s Experiences with Infidelity, Violence and
Forced Sex in Dar es Salaam, Tanzania. International Family Planning Perspectives
149
2004;30(4):200-20. 78. Yusuf O, Arulogun O, Oladepo O, Olowokeere F. Physical violence among intimate partners in Nigeria: A multi level analysis Journal of Public Health and Epidemiology 2011;3(5):240-7 79. Odujinrin O. Wife battering in Nigeria. Int J Gyn Obst. 1993;41:159-64. 80. Awusi V, Okeleke V, Ayanwu B. Prevalence of Domestic Violence During
Pregnancy in Oleh, a Suburban Isoko Community, Delta state, Nigeria Benin Journal of Postgraduate Medicine. 2009;11. 81. Heise L, Garcia-Moreno C. Violence by intimate partners. Geneva: World Health Organization, 2002. 82. Uwaoma N, Njoku A, Madukwe A. Prevalence Of Wife’s Rape Among Married
Couples In Imo State. Nigeria Australian Journal of Basic and Applied Sciences. 2011;5(9):1865-71. 83. Bandura A. Social learning theory. Englewood Cliffs, NJ: Prentice Hall; 1977. 84. Krantz G, Vung N. The role of controlling behavior in intimate partner violence and its health effects: a population based study from rural Vietnam. BMC Public Health. 2009;9:143. 85. Gage S, Hutchinson P, . Power, control and intimate partner sexual violence in Haiti. Arch Sex Behav. 2006;35:11-26. 86. Pallito C, O'campo P. The relationship between intimate partner violence and unintended pregnancy: analysis of a national sample from Colombia
International Family Planning Perspectives
2005;30(4). 87. Koenig M, Stephenson R, Ahmed S, Jejeebhoy S, Campbell J. Individual and contextual determinants of domestic violence in North India. Am J Public Health. 2006;96:132-8. 88. Tang C, Lai B. A review of empirical literature on the prevalence and risk markers of male-on-female intimate partner violence in contemporary China,1987-2006
Aggression and Violent Behavior 2008;13(1):10-28. 89. Alo O, Odusina E, Babatunde G. Spousal Violence in Southwest Nigeria:
Prevalence and Correlates. Women’s Health Care. 2012;1:110. 90. Luke N, Schuler B, Mai PVT, Minh T. Exploring couple attributes and attitudes and marital violence in Vietnam.
. Violence Against Woman. 2007;13(1):5-27. 91. Nguyen D, Ostergren P, Krantz G. Intimate partner violence against women in rural Vietnam- different forms of violence: need for new intervention guidelines? . BMC Public Health. 2008;8:55. 92. Negussie D, Berhane Y, Ellsberg M, Emmelin M, Kullgren G, Hugberg U. Violence against women in relation to literacy and area of residence in Ethiopia. Global Health Action. 2010;3:2070. 93. Ackerson L, Kawachi I, Barbeau E, Subramanian S. Effects of individual and proximate educational context on intimate partner violence: a population- based study of women in India Am J Public Health. 2008;98:507-14. 94. National Population Commission. Nigerian Demographic and Health Survey 2013. Federal Republic of Nigeria, Abuja,Nigeria: 2013.
150
95. Antai D. Traumatic physical health consequences of intimate partner violence against women: what is the role of community-level factors?
. BMC Women's Health. 2011;11:56. 96. Ellsberg M, Jansen H, Heise L, Watts C, Garcia-Moreno C. Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study. Lancet. 2008;371:1165–72. 97. Plichta S. Intimate Partner Violence and Physical Health Consequences: Policy and Practice Implications. J Interpers Violence 2004;19:1296-323. 98. Parish W, Wang T, Laumann E, Pan S, Luo Y. Intimate partner violence in China: national prevalence, risk factors and associated health problems. Int Fam Plan Perspect 2004;30:174-81. 99. Coker A, Davis K, Arias I, Desai S, Sanderson M, Brandt H, et al. Physical and mental health effects of intimate partner violence for men and women
American journal of preventive medicine. 2002 23(4):260-8. 100. Balogun M, John-Akinola Y. A Qualitative Study of IPV Among Women in Nigeria Journal of Interpersonal Violence. 2015;30(14). 101. Watts C, Mayhew S. Reproductive Health Services and Intimate Partner Violence: Shaping a Pragmatic Response in Sub-Saharan Africa International Family Planning Perspectives. 2004;30(4). 102. Shah P, Shah J. Maternal exposure to domestic violence and pregnancy and birth outcomes: a systematic review and meta analysis. J Women's Health (Larchmt). 2010;19:207-13. 103. O'Reilly R, Beale B, Gillies D. Screening and intervention for domestic violence during pregnancy care: a systematic review. Trauma Violence Abuse. 2010;11:190-201. 104. Esere M, Idowu A, Durosaro I, Omotoso J. Causes and consequences of intimate partner rape and violence: Experience of victims in Lagos, Nigeria. Journal of AIDS and HIV Research 2009;1(1):001-7. 105. Naved R, Akhtar N. “Spousal violence against women and suicidal ideation in Bangladesh” Women's Health Issues. 2008;18(6):442-52. 106. History is made as Nigeria passes domestic violence law: Jackie Repila; 2013 [February 5, 2014]. Available from: policy-practice.oxfam.org.uk. 107. UN Resolution 54/134-''International Day for the Elimination of Violence against Women''. Un.org.
[cited 2014 05/02/2014]. 108. National Population Commission. Report of the final 2006 census results. 2006. 109. Lagos State Bureau of Statistics. Population [cited 2014 02/12/2014]. Available from: http://www.lagosstate.gov.ng/pagelinks.php. 110. Lagos State Government. Welcome to Lagos State, centre of excellence: an authoritative guide book on Lagos State of Nigeria 1ed1998. 111. Ikorodu Local Government. Brief History of Ikorodu local government. 2008. 112. Taylor D. The calculation of sample size and power in biostatistics. Ontario, Canada: Mc Master University, Hamilton; May Revision 1983. 113. Fawole O, Salawu T, Olarinoye E. Intimate partner violence: prevalence and perceptions of married men in Ibadan, Nigeria. Int Q Community Health Education. 2009;30(4):349-64. 114. Speizer I. Intimate Partner violence Attitudes and Experience Among Women and Men in Uganda. J Interpers Violence. 2010;25(7):1224-41. 115. List of Local Government Area In Lagos- Nigeria Zip Codes. Available from: http://nigeriazipcodes.com/4003/local-government-area-in-lagos/. 116. Jansen H, Watts C. WHO Multi-country Study on Women’s Health and Life Experiences Questionnaire World Health Organization
151
2005. 117. Oyedeji G. Socio-economic and Cultural Background of Hospitalized Children in Ilesha. Nigerian Journal of Paediatrics. 1985;12(4):111-7. 118. Heise L. Violence against women: global organizing for change
Thousand Oaks, CA: Sage Publications; 1996. 119. Ochai E. Knowledge and Attitude of Women Toward Intimate Partner Violence a
Study in Tudun Wada Community Jos. Injection Prevention 2010 16(229). 120. The National Literacy Survey. National Bureau of Statistics, June, 2010. 121. United Nations Children's Fund. Domestic Violence Against Women And Girls
June 2000. 122. Alhabib S, Nur U, Jones R. Domestic Violence Against Women: Systematic Review of Prevalence Studies Journal of Family Violence 2009;25:369–82 123. Hindin M, Kishor S, Donna L. Intimate partner violence among couples in 10 DHS countries : predictors and health outcomes: Macro International Inc.; 2008. 124. Okemgbo C, Omideyi A, Odimegwu C. Prevalence, patterns and correlates of domestic violence in selected Igbo communities of Imo State African journal of reproductive health. 2002;6(2):101-14. 125. Onibokun A, Faniran A. Urbanisation and Urban Problems in Nigeria: IFRA Nigeria. 126. Women Empowerment and Legal Aid. A Law To Provide Protection Against Domestic Violence And For Connected Purposes Falana F, editor. Ikeja-Lagos: Lagos State Government,
Ministry of Women's Affairs & Poverty Alleviation
2013. 127. Salaudeen A, Akande T, Musa O, Bamidele J, Oluwole F. Assessment of violence against women in Kano metropolis, Nigeria Niger Postgrad Med J 2010;17(3):218-22. 128. Robson E. Wife seclusion and the spatial praxis of gender ideology in Nigerian Hausaland Place and Culture. 2008;7:179-99. 129. Secretariat of the Pacific Community PHD. Kiribati family health and support study : a study on violence against women and chidren Noumea, New Caledonia: Secretariat of the Pacific Community, 2010. 130. Adebayo O, Uche I. Sexual Violence against Women in Marital dyads, Prevalence and Reproductive Health Consequences: A Situation Among The Ijesa of South-Western Nigeria Union of African Population Studies. Arusha,Tanzania: Fifth African population conference, 13/12/2007. 131. UNFPA, ICRW. Masculinity, Intimate Partner Violence and Son Preference in India- A study. United Nations Population Fund, 2014. 132. Lawoko S, Dalal K, Jiayou L, Jansson B. Social inequalities in intimate partner violence: a study of women in Kenya. Violence and Victims. 2007;22(6):773-84. 133. Okenwa L, Eberechukwu E, Lawoko S, Janson B. Factors associated with disclosure of intimate partner violence among women in Lagos, Nigeria J Inj Violence Res Journal of Injury and Violence Research. 2009;1(1):37-47.
152
APPENDIX 1:
QUESTIONNAIRE ON WOMEN’S HEALTH AND LIFE EXPERIENCES INDIVIDUAL CONSENT FORM Name of principal investigator: Dr Ukatu, Elochukwu Department: Community Health and Primary Health Care, LASUTH, Ikeja. e-mail: [email protected] Phone number: 08034936868 Title: Women’s health and life experiences among women in Oshodi/Isolo and Ikorodu local government areas of Lagos State. Study purpose: To determine the factors that influence some of the life experiences women face and note the health consequences of these experiences. Procedure: Your street has been chosen by chance (as in a lottery/raffle) and you have been chosen to participate in the study because you are above 18 years of age and live on this street. Study Duration: The interview takes approximately 30 minutes to complete. Risks: For those who have had unpleasant life experiences, recollection might be discomforting. Participants will however be provided with contact information for women’s health organizations where they can get help within the state. Costs: Your participation in this research will not cost you anything. Benefits: Some of the topics may be difficult to discuss, but many women have found it useful to have the opportunity to talk. Confidentiality: All of your answers will be kept strictly secret. No records will be kept of your name, address or any other self identifying information. Voluntariness: You have the right to stop the interview at any time or to skip any questions that you don’t want to answer. There is no right or wrong answer. Your participation is completely voluntary but your experiences could be very helpful to other women in your community and the country at large as it will help determine how common these experiences are and how it affects women’s health so as to provide information that will guide policy on how to prevent these experiences and design better interventions for those with such experiences. Alternatives to Participation: If you choose not to participate in this study there will be no consequences. Due Inducement: You will not be paid any fees for participating in this research.
153
What happens to research participants and communities when the research is over: Results will be disseminated to Local Government offices and health care centres, and the State Ministry of Health for appropriate public health program planning. Any apparent or potential conflict of interest: There is no conflict of interest to report.
Statement of Person obtaining informed consent I have fully explained this research to And have given sufficient information, including about risks and benefits, to make an informed decision.
DATE: SIGNATURE: NAME: Statement of person giving consent: I have read the description of the research or have had it translated into a language I understand. I have also talked it over with the doctor to my satisfaction. I understand that my participation is voluntary. I know enough about the purpose, methods, methods, risks and benefits of the research study to judge that I want to take part in it. I understand that I may freely stop being part of this study at any time. I have received a copy of this consent form and additional information sheet to keep for myself. DATE: SIGNATURE: NAME: WITNESS NAME AND SIGNATURE:
154
APPENDIX 2:
QUESTIONNAIRE ON WOMEN’S HEALTH AND LIFE EXPERIENCES
A STUDY BY
DR UKATU, E.E.
LAGOS STATE UNIVERSITY TEACHING HOSPITAL
IKEJA
155
SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS 1. Age at last birthday 2. Religion CHRISTIANITY...... 1 ISLAM...... 2 TRADITIONAL...... 3 OTHERS...... 4 3. Marital Status SINGLE...... 1 CURRENTLY MARRIED...... 2 CO-HABITING...... 3 SEPERATED...... 4 DIVORCED...... 5
4. Highest level of education NONE...... 1 PRIMARY...... 2 SECONDARY...... 3 TERTIARY...... 4 DON’T KNOW...... 98 REFUSED/NO ANSWER...... 99 5. Ethnicity HAUSA...... 1 IBO...... 2 YORUBA...... 3 OTHERS...... 4 6. Occupation
SECTION 2: RESPONDENT AND HER COMMUNITY 7. In the past 4 weeks, has someone from this household been the victim of a YES...... 1 crime in this neighbourhood, such as a robbery or assault? NO...... 2 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 8. Do neighbours in this community generally tend to know each other well? YES...... 1 NO...... 2 DON’T KNOW...... 8 REFUSED/NO ANSWER...... 9 9. How long have you been living continuously in this community? NUMBER OF YEARS ...... [ ][ ] LESS THAN 1 YEAR...... 00 LIVED ALL HER LIFE ...... 95 VISITOR (AT LEAST 4 WEEKS IN HOUSEHOLD) .... 96 DON’T KNOW/DON’T REMEMBER ...... 98 REFUSED/NO ANSWER…………………………………..99 10. If there were a street fight in this community would people generally do YES...... 1 something to stop it? NO...... 2 DON’T KNOW...... 8 REFUSED/NO ANSWER...... 9 11. If someone in your family suddenly fell ill or had an accident, would your YES...... 1 neighbours offer to help? NO...... 2 DON’T KNOW...... 8 REFUSED/NO ANSWER...... 9 12. Do any of your family of birth live close enough by that you can easily see/visit YES...... 1 them? NO...... 2 LIVING WITH FAMILY OF BIRTH...... 3 DON’T KNOW/DON’T REMEMBER...... 4 13. How often do you see or talk to a member of your family of birth? Would you AT LEAST ONCE A WEEK...... 1 say at least once a week, once a month, once a year, or never? AT LEAST ONCE A MONTH...... 2 AT LEAST ONCE A YEAR...... 3 NEVER/(HARDLY EVER)...... 4 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 14. When you need help or have a problem, can you usually count on members of YES...... 1 your family of birth for support? NO...... 2 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9
156
15. Have you ever had a husband before your current *husband? YES...... 1 NO...... 2 REFUSED/NO ANSWER...... 3 16. Did the last partnership with a man end in divorce or seperation or did your last DIVORCED...... 1 husband/partner die? SEPARATED/BROKEN UP...... 2 WIDOWED/PARTNER DIED...... 3 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 17. How many times in your life have you been married and/or lived together with a NUMBER OF TIMES MARRIED/ man? LIVED TOGETHER...... [ ][ ] (INCLUDE CURRENT PARTNER IF LIVING TOGETHER) DON’TKNOW/DON’T REMEMBER...... 98 REFUSED/NO ANSWER...... 99 The next few questions are about your current or most recent partnership. 18. Do/did you live with your husband/partner’s parents or any of his relatives? YES...... 1 If no,→20 NO...... 2 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 19. IF CURRENTLY WITH PARTNER: Do you currently live with your parents or any of YES...... 1 your relatives? NO...... 2 IF NOT CURRENTLY WITH PARTNER: Were you living with your parents or DON’T KNOW/DON’T REMEMBER...... 8 relatives during your last relationship? REFUSED/NO ANSWER...... 9 20. How many wives does/did he have (including yourself)? NUMBER OF WIVES ...... [ ][ ] DON’T KNOW...... 98 REFUSED/NO ANSWER...... 99 21. Are/were you the first, second..... wife? NUMBER /POSITION...... [ ][ ] DON’T KNOW/DON’T REMEMBER...... 98 REFUSED/NO ANSWER...... 99 22. Did you have any kind of marriage ceremony to formalize the union? What type NONE...... A of ceremony did you have? CIVIL MARRIAGE...... B MARK ALL THAT APPLY RELIGIOUS MARRIAGE...... C CUSTOMARY MARRIAGE...... D OTHER: ______23. Did you yourself choose your current/most recent husband, did someone else BOTH CHOSE ………………………………….1 choose him for you, or did he choose you? RESPONDENT CHOSE………………………...2 RESPONDENT’S FAMILY CHOSE ……...... 3 PARTNER CHOSE...... 4 IF SHE DID NOT CHOOSE HERSELF, PROBE: PARTNER’S FAMILY CHOSE...... 5 Who chose your current/most recent husband for you? OTHER: ______...... 6 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 SECTION 3: GENERAL HEALTH 24. Do you frequently have: YES NO DK a) DIZZINESS 1 2 8 a) Dizziness b) VAGINAL DISCHARGE 1 2 8 b) Vaginal discharge c) VAGINAL BLEEDING 1 2 8 d) PELVIC PAIN 1 2 8 e) GENITAL IRRITATION 1 2 8 25. Do you frequently take medication: NO ONCE OR A FEW MANY TWICE TIMES TIMES a) To help you calm down or sleep? a)FOR SLEEP 1 2 3 4 b) To relieve pain? b)FOR PAIN 1 2 3 4 c) To help you not feel sad or depressed? c)FOR SADNESS 1 2 3 4
26. Do you frequently consult a doctor or other NO ONE CONSULTED...... A
professional or traditional health worker because DOCTOR...... B you yourself are sick? NURSE (AUXILIARY)...... C MIDWIFE ...... D COUNSELLOR...... E IF YES: Whom do you consult? PHARMACIST...... F
157
TRADITIONAL HEALER...... G TRADITIONAL BIRTH ATTENDANT...... H PROBE: Do you also see anyone else?
OTHER: ______X 27. The next questions are related to other common problems that may have been bothering you. If you frequently have the YES NO problem, answer yes. If you do not frequently have the a) HEADACHES 1 2 problem, answer no. b) APPETITE 1 2 c) SLEEP BADLY 1 2 a) Do you often have headaches? d) FRIGHTENED 1 2 b) Is your appetite poor? c) Do you sleep badly? a) HANDS SHAKE 1 2 d) Are you easily frightened? b) NERVOUS 1 2 c) DIGESTION 1 2 a) Do your hands shake? d) THINKING 1 2 b) Do you feel nervous, tense or worried? c) Is your digestion poor? a) UNHAPPY 1 2 d) Do you have trouble thinking clearly? b) CRY MORE 1 2 c) NOT ENJOY 1 2 a) Do you feel unhappy? d) DECISIONS 1 2 b) Do you cry more than usual? c) Do you find it difficult to enjoy your daily activities? a) WORK SUFFERS 1 2 d) Do you find it difficult to make decisions? b) USEFUL PART 1 2 c) LOST INTEREST 1 2 a) Is your daily work suffering? d) WORTHLESS 1 2 b) Are you unable to play a useful part in life? e) FEEL TIRED 1 2 c) Have you lost interest in things that you used to enjoy? f) STOMACH 1 2 d) Do you feel that you are a worthless person?
e) Do you feel tired all the time? f) Do you have uncomfortable feelings in your stomach?
28. Just now we talked about problems that may have been YES...... 1 bothering you in the past. I would like to ask you now: In your NO ...... 2 life, have you ever thought about ending your life? DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 29. Have you ever tried to take your life? YES...... 1 NO...... 2 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 30. In the past 12 months, did you have to spend any nights in a NIGHTS IN HOSPITAL...... [ ][ ] hospital because you were sick (other than to give birth)? NONE...... 00 IF YES: How many nights in the past 12 months? DON’T KNOW/DON’T REMEMBER...... 98 REFUSED/NO ANSWER...... 99 SECTION 4: REPRODUCTIVE HEALTH 31. Have you ever been pregnant? YES...... 1 NO...... 2 MAYBE/NOT SURE...... 3 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 32. How many children do you have, who are alive CHILDREN...... [ ][ ] now? NONE ...... 00 RECORD NUMBER 33. Have you ever used anything, or tried in any way, to delay or YES...... 1 If no, skip to 37 avoid getting pregnant? NO ...... 2 NEVER HAD INTERCOURSE...... 3 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 34. What (main) method are you currently using? PILL/TABLETS...... 01 INJECTABLES...... 02 IF MORE THAN ONE, ONLY MARK MAIN METHOD IMPLANTS (NORPLANT)...... 03 IUD...... 04 DIAPHRAGM/FOAM/JELLY...... 05 CALENDAR/MUCUS METHOD...... 06
158
FEMALE STERILIZATION...... 07
CONDOMS...... 08 MALE STERILIZATION...... 09 WITHDRAWAL...... 10
HERBS...... 11 OTHER:______...... 96
DON’T KNOW/DON’T REMEMBER...... 98 REFUSED/NO ANSWER...... 99 35. Does your current husband/partner know that you are using a YES...... 1 method of family planning? NO...... 2 N/A: NO CURRENT PARTNER...... 7 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 36. Has/did your current/most recent husband/partner ever YES...... 1 refused to use a method or tried to stop you from using a NO...... 2 method to avoid getting pregnant? DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 37. Did your husband/partner stop you, encourage you, or have STOP...... 1 no interest in whether you received antenatal care for your ENCOURAGE...... 2 last pregnancy? NO INTEREST...... 3 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 38. When you were pregnant with this child, did your SON...... 1 husband/partner have preference for a son, a daughter or did DAUGHTER...... 2 it not matter to him whether it was a boy or a girl? DID NOT MATTER...... 3 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 SECTION 5: CURRENT OR MOST RECENT PARTNER 39. I would now like you to tell me a little about your AGE (YEARS) ...... [ ][ ] current/most recent husband/partner. How old was your husband/partner on his last birthday? PROBE: MORE OR LESS IF MOST RECENT PARTNER DIED: How old would he be now if he were alive? 40. What is the highest level of education that he achieved? PRIMARY...... 1 MARK HIGHEST LEVEL. SECONDARY...... 2 HIGHER...... 3 DON’T KNOW...... 8 DON’T KNOW/DON’T REMEMBER...... 98 REFUSED/NO ANSWER...... 99 41. IF CURRENTLY WITH PARTNER: Is he currently WORKING ...... 1 working, looking for work or unemployed, retired or LOOKING FOR WORK/UNEMPLOYED...... 2 RETIRED...... 3 studying? STUDENT...... 4 IF NOT CURRENTLY WITH PARTNER: Towards the end of your DISABLED/LONG TERM SICK...... 5 relationship was he working, looking for work or unemployed, DON’T KNOW/DON’T REMEMBER...... 8 retired or studying? REFUSED/NO ANSWER...... 9 42. What kind of work does/did he normally do? SPECIFY KIND OF WORK 43. Does your husband/partner drink alcohol? YES……………………………………….1 NO…………………………………………2 DON’T KNOW /DON’T REMEMBER..…8 REFUSED/NO ANSWER...... 9 44. How often does/did your husband/partner drink alcohol? EVERY DAY OR NEARLY EVERY DAY...... 1 ONCE OR TWICE A WEEK...... 2 1–3 TIMES IN A MONTH...... 3 LESS THAN ONCE A MONTH...... 4 NEVER...... 5
159
DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 45. In the past 12 months (In the last 12 months of your last MOST DAYS...... 1 relationship), how often have you seen (did you see) your WEEKLY...... 2 husband/partner drunk? Would you say most days, weekly, ONCE A MONTH...... 3 once a month, less than once a month, or never? LESS THAN ONCE A MONTH...... 4 NEVER ...... 5 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 46. In the past 12 months (In the last 12 months of your relationship), have you experienced any of the following YES NO problems, related to your husband/partner’s drinking? a) MONEY PROBLEMS 1 2
b) FAMILY PROBLEMS 1 2 a) Money problems b) Family problems Any other problems, specify.
x) OTHER: 1 2 47. Does/did your husband/partner ever smoke EVERY DAY OR NEARLY EVERY DAY...... 1 ONCE OR TWICE A WEEK...... 2 cigarettes or use drugs? 1 – 3 TIMES IN A MONTH...... 3 LESS THAN ONCE A MONTH...... 4 NEVER...... 5 IN THE PAST, NOT NOW...... 6
DON’T KNOW /DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 48. Since you have known him, has he ever been involved in a YES...... 1 physical fight with another man? NO...... 2 DON’T KNOW /DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 49. In the past 12 months (In the last 12 months of the NEVER...... 1 relationship), has this happened? ONCE OR TWICE...... 2 A FEW (3-5) TIMES...... 3 MANY (MORE THAN 5) TIMES...... 4 DON’T KNOW /DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 50. Has your current/most recent husband/partner had a YES...... 1 relationship with any other women while being with you? NO...... 2 MAY HAVE...... 3 DON’T KNOW /DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 52. Has your current/most recent husband/partner had children YES...... 1 with any other woman while being with you? NO...... 2 MAY HAVE...... 3 DON’T KNOW /DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 53. When you were a child, was your mother hit by your father (or YES...... 1 her husband or boyfriend)? NO...... 2 PARENTS DID NOT LIVE TOGETHER...... 3 DON’T KNOW...... 8 REFUSED/NO ANSWER ...... 9 54. As a child, did you see or hear this violence? YES...... 1 NO...... 2 DON’T KNOW...... 8 REFUSED/NO ANSWER...... 9
55. As far as you know, was your (most recent) partner’s mother YES...... 1 hit or beaten by her husband? NO...... 2 PARENTS DID NOT LIVE TOGETHER...... 3
160
DON’T KNOW ...... 8 REFUSED/NO ANSWER...... 9 56. Did your (most recent) husband/partner see or hear this YES...... 1 violence? NO...... 2 DON’T KNOW...... 8 REFUSED/NO ANSWER...... 9 57. As far as you know, was your (most recent) husband/partner YES...... 1 himself hit or beaten regularly by someone in his family? NO...... 2 DON’T KNOW...... 8 REFUSED/NO ANSWER...... 9 SECTION 6:ATTITUDES In this community and elsewhere, people have different ideas about families and what is acceptable behaviour for men and women in the home. I am going to read you a list of statements, and I would like you to tell me whether you generally agree or disagree with the statement. There are no right or wrong answers. 58. In your opinion, does a man have a good reason to YES NO DK
hit his wife if: a) HOUSEHOLD 1 2 8 a) She does not complete her household work to his b) DISOBEYS 1 2 8 satisfaction c) NO SEX 1 2 8 b) She disobeys him d) GIRLFRIENDS 1 2 8 c) She refuses to have sexual relations with him e) SUSPECTS 1 2 8 d) She asks him whether he has other girlfriends f) UNFAITHFUL 1 2 8 e) He suspects that she is unfaithful f) He finds out that she has been unfaithful 59. In your opinion, can a married woman refuse to have sex with YES NO DK her husband if: a) She doesn’t want to a) NOT WANT 1 2 8 b) He is drunk b) DRUNK 1 2 8 c) She is sick c) SICK 1 2 8 d) He mistreats her d) MISTREAT 1 2 8 SECTION 7: RESPONDENT AND HER PARTNER When two people marry or live together, they usually share both good and bad moments. I would now like to ask you some questions about your current and past relationships and how your husband/partner treats (treated) you. If anyone interrupts us I will change the topic of conversation. I would again like to assure you that your answers will be kept secret, and that you do not have to answer any questions that you do not want to. May I continue? 60. In general, do (did) you and your (current or most YES NO DK
recent) husband/partner discuss the following a) HIS DAY 1 2 8 topics together: b) YOUR DAY 1 2 8 a) Things that have happened to him in the day c) YOUR WORRIES 1 2 8 b) Things that happen to you during the day d) HIS WORRIES 1 2 8 c) Your worries or feelings d) His worries or feelings 61. In your relationship with your (current or most recent) RARELY ...... 1 husband/partner, how often would you say that you SOMETIMES...... 2 quarrelled? Would you say rarely, sometimes or often? OFTEN...... 3 DON’T KNOW/DON’T REMEMBER...... 8 REFUSED/NO ANSWER...... 9 62. I am now going to ask you about some situations that are true for many women. Thinking about your (current or most recent) husband/partner, would you say it is generally true that he: YES NO DK a) Tries to keep you from seeing your friends a) SEEING FRIENDS 1 2 8 b) Tries to restrict contact with your family of birth b) CONTACT FAMILY 1 2 8 c) Insists on knowing where you are at all times d) Ignores you and treats you indifferently a) WANTS TO KNOW 1 2 8 e) Gets angry if you speak with another man b) IGNORES YOU 1 2 8 f) Is often suspicious that you are unfaithful c) GETS ANGRY 1 2 8 g) Expects you to ask his permission before seeking health d) SUSPICIOUS 1 2 8 care for yourself e) HEALTH CENTRE 1 2 8
161
63. The next questions are A) B) C) D) about things that happen (If YES continue Has this happened in the past 12 In the past 12 Before the past to many women, and that with B. months? months would 12 months your current partner, or If NO skip to any other partner may next item) (If YES ask C only. If NO ask D only) you say that this would you say
have done to you. has happened that this has
once, a few times happened once,
Has your current or many times? a few times or husband/partner, or any
other partner ever…. (after answering many times? YES NO C, go to next
item)
One Few Many
YES NO One Few Many a) Insulted you or made 2 2 1 2 3 1 2 3 you feel bad about yourself? b) Belittled or 1 2 2 1 2 3 1 2 3 humiliated you in front of other people? 1 2 2 1 2 3 1 2 3 c) Done things to scare or intimidate you on purpose (e.g. by the way he looked at you, by yelling and smashing things)? 1 2 1 2 1 2 3 1 2 3 d) Threatened to hurt you or someone you care about?
64. A) B) C) D) (If YES continue Has this In the past 12 Before the with B. happened in months would past 12 If NO skip to next Has he or any other partner ever…. item) the past 12 you say that months months? this has would you
(If YES ask C only. happened say that this If NO ask D only) once, a few has
times or many happened times? (after once, a few
answering C, times or
go to next many times?
item)
One Few Many
One Few YES NO YES NO Many a) Slapped you or thrown something at you that 1 2 1 2 1 2 3 1 2 3 could hurt you?
b) Pushed you or shoved you or pulled your hair? 2 2 1 2 3 1 2 3 c) Hit you with his fist or with something else that 2 2 1 2 3 1 2 3 could hurt you?
d) Kicked you, dragged you or beaten you up? 2 2 1 2 3 1 2 3 e) Choked or burnt you on purpose? 2 2 1 2 3 1 2 3 f) Threatened to use or actually used a gun, knife or 1 2 1 2 1 2 3 1 2 3
162
other weapon against you?
65. A) B) C) D) (If YES continue Has this In the past 12 Before the with B. happened in months would past 12 If NO skip to next item) the past 12 you say that months months? this has would you
(If YES ask C only. happened say that this If NO ask D only) once, a few has
times or many happened YES NO a) Did your current husband/partner or any other times? (after once, a few partner ever physically force you to have sexual answering C, times or intercourse when you did not want to? YES NO b) Did you ever have sexual intercourse you did not go to next many times? want to because you were afraid of what your item) partner or any other partner might do?
c) Did your partner or any other partner ever forced
you to do something sexual that you found degrading One Few Many or humiliating? One Few Many
2 1 2 1 2 3 1 2 3
2 1 2 1 2 3 1 2 3
1 2 1 2 1 2 3 1 2 3
66. You said that you have been pregnant TOTAL times. YES ...... 1 Was there ever a time when you were slapped, hit or NO ...... 2 beaten by (any of) your partner(s) while you were DON’T KNOW/DON’T REMEMBER ...... 8 pregnant? REFUSED/NO ANSWER 9 SECTION 8: INJURIES 67. Have you ever been injured as a result of these acts by YES ...... 1 (any of) your husband/partner(s). Please think of the NO ...... 2 acts that we talked about before DON’T KNOW/DON’T REMEMBER ...... 8 REFUSED/NO ANSWER 9 68a. In your life, how many times were you injured by (any ONCE/TWICE...... 1 of) your husband(s)/partner(s)? SEVERAL (3-5) TIMES ...... 2 Would you say once or twice, several times or many MANY (MORE THAN 5) TIMES ...... 3 times? DON’T KNOW/DON’T REMEMBER ...... 8 REFUSED/NO ANSWER 9 68b. Has this happened in the past 12 months? YES ...... 1 NO ...... 2 DON’T KNOW/DON’T REMEMBER ...... 8 REFUSED/NO ANSWER 9
163
b) ONLY ASK FOR RESPONSES MARKED IN 69a. What type of injury did 70a: you have? Please Has this happened in the past 12 months? mention any injury due YES NO DK to (any of) your CUTS, PUNCTURES, BITES ...... A 1 2 8 husband/partners acts, SCRATCH, ABRASION, BRUISES ...... B 1 2 8 no matter how long ago SPRAINS, DISLOCATIONS ...... C 1 2 8 it happened. BURNS ...... D 1 2 8 PENETRATING INJURY, DEEP CUTS, GASHES ...... E 1 2 8 MARK ALL BROKEN EARDRUM, EYE INJURIES ...... F 1 2 8 FRACTURES, BROKEN BONES ...... G 1 2 8 PROBE: BROKEN TEETH...... H 1 2 8 Any other injury? INTERNAL INJURIES ...... I 1 2 8 OTHER (specify): ______...... X 70a. In your life, did you ever lose consciousness YES 1 1 2 NO ...... 3 1 2 because of what (any of your) your 1 2 husband/partner(s) did to you? DON’T KNOW/DON’T REMEMBER ...... 8 1 2 REFUSED/NO ANSWER ...... 9 1 2 1 2 1 2 1 2
1 2 70b. Has this happened in the past 12 months? YES ...... 1 NO ...... 2 DON’T KNOW/DON’T REMEMBER ...... 8 REFUSED/NO ANSWER ...... 9 71a. In your life, were you ever hurt badly enough TIMES NEEDED HEALTH CARE ...... [ ][ ]
by (any of ) your husband/partner(s) that you REFUSED/NO ANSWER ...... 99 needed health care (even if you did not receive it)? NOT NEEDED ...... 00 IF YES: How many times? IF NOT SURE: More or less? 71b. Has this happened in the past 12 months? YES ...... 1 NO ...... 2 DON’T KNOW/DON’T REMEMBER ...... 8 REFUSED/NO ANSWER ...... 9 72. In your life, did you ever receive health care YES, SOMETIMES ...... 1 YES, ALWAYS ...... 2 for this injury (these injuries)? Would you say, NO, NEVER ...... 3 sometimes or always or never? DON’T KNOW/DON’T REMEMBER ...... 8 REFUSED/NO ANSWER ...... 9
73a. In your life, have you ever had to spend any nights in a NUMBER OF NIGHTS IN HOSPITAL ...... [ ][ ] hospital due to the injury/injuries? IF NONE ENTER ‘00’ IF YES: How many nights? (MORE OR LESS) DON’T KNOW/DON’T REMEMBER ...... 98 REFUSED/NO ANSWER ...... 99 73b. Did you tell a health worker the real cause of your YES ...... 1 injury? NO ...... 2 DON’T KNOW/DON’T REMEMBER ...... 8 REFUSED/NO ANSWER ...... 9 74. Did you ever go to any of the following for help? READ If marked yes in 75a EACH ONE Were you satisfied with the help given?
164
YES NO a) Police YES NO b) Hospital or health centre a) POLICE 1 2 2 c) Social services b) HOSPITAL/ HEALTH CENTRE 1 2 2 d) Legal advice centre c) SOCIAL SERVICES 1 2 2 d) LEGAL ADVICE CENTRE 1 2 2 a) Court b) Shelter a) COURT 1 2 2 c) Local leader b) SHELTER 1 2 2 d) Women’s organization (Use name) c) LOCAL LEADER 1 2 2 d) WOMEN’S ORGANIZATION: 1 2 2 j) Priest/Religious leader e) PRIEST, RELIGIOUS LEADER 1 2 1 2
x) Anywhere else? Where? x) ELSEWHERE (specify) :
75. What were the reasons that made you go for help? ENCOURAGED BY FRIENDS/FAMILY ...... A COULD NOT ENDURE MORE ...... B BADLY INJURED ...... C Mark if answered yes to any on 74 HE THREATENED OR TRIED TO KILL HER ...... D HE THREATENED OR HIT CHILDREN ...... E Can answer more than one SAW THAT CHILDREN SUFFERING ...... F THROWN OUT OF THE HOME ...... G AFRAID SHE WOULD KILL HIM ...... H AFRAID HE WOULD KILL HER ...... I
76. What were the reasons that you did not go to any of DON’T KNOW/NO ANSWER ...... A these? FEAR OF THREATS/CONSEQUENCES/ If answered no to 74 MARK ALL MENTIONED MORE VIOLENCE ...... B VIOLENCE NORMAL/NOT SERIOUS ...... C EMBARRASSED/ASHAMED/AFRAID WOULD NOT BE BELIEVED OR WOULD BE BLAMED ...... D BELIEVED NOT HELP/KNOW OTHER WOMEN NOT HELPED ...... E AFRAID WOULD END RELATIONSHIP ...... F AFRAID WOULD LOSE CHILDREN ...... G BRING BAD NAME TO FAMILY ...... H
OTHER (specify): ______...... X
165
APPENDIX 3:
FOCUS GROUP DISCUSSION GUIDE
Number of participants: ______Marital status: Married/Single
Age range of participants: 15–20, 20–35, 35–49 years
Introduction
Thank you for coming. We are from LASUTH, Ikeja. We are conducting a research on family problems and their possible solutions. We have invited you here today to discuss this issue with you. Your responses will be used to help develop materials and services to assist women experiencing violence.
All of our discussions will be kept strictly secret. We will be producing a report on our findings, but will not reveal your name if we quote anything you say.
If you don’t mind, we would like to tape record our discussion. This is to help us record what has been said. The tape will not be played to anyone. Once notes have been taken from the tape, it will be destroyed.
Is everyone happy to participate in this discussion? Record response Yes/No
Is there anyone who would like to leave now? Record if someone leaves
Thank you.
166
We hope that you will all feel free to discuss your opinions openly. There are no right or wrong answers and we would like to hear your honest opinions about the issue. All of your responses will remain confidential.
Notes on background of participants and comments on discussion
To be completed after interview
Focus group discussion guide
1. Warm-up
Tell me something about yourself, your family, your work and the things you like to do.
What worries you these days?
S/N TOPIC QUESTIONS
1. General questions What are the biggest problems facing women today? about IPV Do male partners contribute to these problems? Do they scare
or hurt (abuse) their female partners and in what ways do they
do so in this community?
Probe for physical, sexual and emotional abuse
167
2. Prevalence of IPV In this community, is it common for males to abuse their
female partners? Why?
3. Determinants of IPV What do you think are the causes of women being abused in
this community?
Probe for:
Community level of crime
Societal norms: male dominance or toughness; male
entitlement and ownership of women; approval of the physical
chastisement of women.
Spousal behaviours such as alcohol abuse, substance abuse,
poor education, unemployment, ex-partner status, witnessing
violence as a child, ownership of weapons.
Do you think women sometimes bring it upon themselves? In
what ways?
Probe for socio-economic status, unemployment and financial
independence, marital conflict.
High level of tolerance: what kind of situations would make
168
IPV justifiable?
Is IPV acceptable in your community? Why?
4. Health consequences Do you think IPV can affect a woman’s health? In what
ways?
Probe for injuries, fear, stress.
Gastro-intestinal symptoms e.g. loss of appetite, eating
disorders.
Chronic health problems such as headache, back pain.
STIs, unwanted pregnancy, pregnancy termination.
Depression, suicide.
5. Support system Where do you think victims of IPV should turn to for help?
What role do you think families have to play in IPV? Do they
make things better or worse?
Do you think they should report to the police? Why?
Probe for what could encourage or discourage her?
How many of you know someone who has had contact with
the police because her partner was hurting or abusing her?
169
What did the officer do that was helpful?
What kind of help should be available but is not?
170
APPENDIX 4:
List of Local Government Areas In Lagos
Urban Rural
1. Agege 17. Badagry 2. Ajeromi-Ifelodun 18. Epe 3. Alimosho 19. Ibeju-Lekki 4. Amuwo-Odofin 20. Ikorodu 5. Apapa 6. Eti-Osa 7. Ifako-Ijaye 8. Ikeja 9. Kosofe 10. Lagos Island 11. Lagos Mainland 12. Mushin 13. Ojo 14. Oshodi-Isolo 15. Shomolu 16. Surulere
171
APPENDIX 5: LIST OF WARDS IN THE SELECTED LOCAL GOVERNMENTS
OSHODI- ISOLO L.G IKORODU LG 1. Oluyeye 1. Abosan 2. Ogunoloko 2. Aga ijomu 3. Igbehinadu 3.Agbala/Lasuwon 4. Afariogun 4. Agura 5. Mafoluku 5. Aige splomade 6. Shogunle 6. Ajaguro 7. Ewu 7. Atere 8. Agbaka 8. Ayegbami 9. Alagbeji 9. Bayeku 10. Akingbaye 10. Egbin 11. Ilasamaja 11. Elepe 12. Okota 12. Erikorodo 13. Apena 13. Ibeshe 14. Isaaga / 14. Igbookuta ire-akari 15. Ipakodo 15. Ajao estate 16. Isawo 16. Adu 17. Isele 17. Ifosai 18. Isiu 18. Ilamosai 19. Itunmokun 19. Ailegun 20. Itunpate 20. Oke-afa 21. Maja 22. Majidun 23. Odogunyan 24. Okeeletu 25. Okeoyinbo 26. Olori eyita 27. Olorunda 28. Owutu 29. Sholafun 30. Tolabun
172
APPENDIX 6: LIST OF STREETS IN THE STUDY COMMUNITIES OSHODI/ISOLO LGA: 27. Lateef Salami 55. Akinola Sholanke Ajao estate 28. Raji Aliu 56. Omowumi Abudu 1. Ome close 29. Fatai Irawo 57. Baale Shekoni 2. Canal close 30. Richfield avenue 58. Chivita avenue 3. Ibiyemi close 31. Stella Sholanke 59. Alao street 4. Seriki Abass 32. Olutosin Ajayi 60. Robinson Gbagi 5. Bola Jegede close 33. Adewale street 61. Eyitayo Omotashe 6. Innua Mohammed 34. Betty pride 62. Ugo Nnabuife 7. Asa Afariogun 35. Chief Vincent Eze 8. Joy Avenue 54. Sanni Adele 9. Gani Dabiri 36. New world 63. Church close 10. Gogo Hassan 37. Anthony Dabiri 64. Omolara Anibabi 11. Awoniyi Elemo 38. Chief Mike close 65. Ajibade Oke 12. Chimade okafor 39. Peace and Faith 66. Osolo way 13. Don-linus 40. Kaara 67. Rasmon 14. Daniel Ekwanga 41. Seriki Abass 68. Olabode 15. Jay Momoh 42. Agbor close 69. Inwelle 16. Nurudeen Ganiyu 43. Church street 70. Alao 17. Monilola Oyeyinka 44. Aanuoluwapo 71. Oketoki close 18. Okpofe street 45. Rasmond 72. Canal view 19. Modua Ofuani 46. Olakunle Selesi 73. Dr Ogbewi close 20. Vitrus Opara 47. Adekunle Alaka 74. Gani William 21. Leo Ikeagwu 48. Jaiyeola Ajata 75. Adewumi close 22. Flabora 49. Oredola Olojo 23. Halbadeen 50. Olateju Oluwole 24. Maurice Okafor 51. Banana close
173
25. Benson Avenue 52. Kolawole Shonibare 26. Niyi Ogunbameru 53. Kolex avenue
Afariogun ward 1. Adebayo street 16. Afariogun street 32.Jubril street 2. Ishola Daniel street 17. Akin Lawanson street 33. Adedeji street 3. Adewale crescent 18. Akanji Odutolu 34. Sadiku street 4. Agbalaya street 19. Yusuf street 35. Akinode street 5. Abdul-Razak street 20.Folorunsho street 36. Salami street 6. Ewenla street 21.Oluwole street 37. Okeleye street 7. Ishola Anigbajumo 22. Aduke Thomas street 38. Adeogun street street 23. Odunbaku street 39. Akinosho street 8. Osho street 24. Olusoji street 40. Adejumobi street 9. Ago Ijaiye street 25. Kunle Akinosi street 10. Seinde-Calistro street 26.Gani Kale street 11. Boladale street 27. Iretioluwa street 12. Suwebatu street 28. Adeyinka street 13. Ajenifuja street 29. Odulola street 14. Apapa-Oshodi expressway 30. Arugbajumo street 15. Sabielegbe close 31. Aimabibo street
174
Mafoluku ward 1.Rasheed Abayomi street 27. Airport road 2.Ariyo close 28. Okanlawon close 3.Olalubi street 29. Oduwusi street 4.Salako street 30. Makinde street 5.Oshundeyi street 31. Fasasi Ayinde street 6.Ijaiye street 32. Bada street 7.Arewa street 33. Eyinogun street 8.Summonu street 34. Omilade street 9. Temidire street 35. Alh Rafiu street 10. Ajibulu street 36. Airport close 11. Dosunmu street 37. Musa Oyinbo street 12. Ilare close 38. Jenrola street 13. Yisa close 39. Apakun lane street 14. Iyemoja street 40. Owolabi street 15. Ayinde street 41. Fadeyi street 16. Olatunbosun street 42. Obisanya street 17. Muriaka street 43. Branco street 18. Aluprom avenue 45. Raji street 19. Bello street 46. Ariori street 20. St. Paul street 47. Amusa street 21. Old Ewu road street 22. Adeola Ajayi crescent 23. Oludegun street 24. Mafoluku street 25. Ijaiye street 26. Agboola street
175
Ewutuntun ward
1. Adewunmi Ogefon 24. Aluko close 2. African church 25. Dele Obilade close 3. Wuraola street 26. Winsala close 4. Sadiku street 27. Assoland close 5. Atanda street 28. Osemene close 6. Okeji street 29. Ogundele close 7. Ileshomi street 30. Adeoso close 8. Bode Onifade street 31. Oluniyi Jaji street 9. Sunkanmi Awoyungbo 32. Subairu street street 33. Sule close 10. Baba Ode street 34. Yinusa close 11. Oluwasanmi street 35. Adebisi Oluwole street 12. Diran Alake street 36. Dolapo street 13. Ayinke street 37. Aina street 14. Shokoya street 38. Oyewunmi street 15. Hassan street 39. Abidun street 16. Adelani street 40. Jacob Taiwo street 17. Babayanju street 41. Aberuagba street 18. Lewis street 42. Alhaji Ajani street 19. Saka street 43. Adeyanju street 20. Olusoji street 44. Oyewunmi Ojo street 21. Anthony Obe street 45. Olaleye street 22. Dele Araoye street 46. Akinsoji street 23. Osunyemi close 47. Deji Adeoye street
176
Itunmokun ward:
1. Oba Omolaja road Baiyeku ward: 2. Basorun road 1. Alli Sandra street 3. Kosebinu Orepekan 2. Omidina street 4. Paul Palmer 3. Akindina street 5. Faniyi close 4. Itungodo street 6. Igbe road 5. Oseni street 7. Kolapo Ogunyemi 6. Babs Ogunlewe street 8. Selewu street 7. Skidam street 9. Agunfoye village 8. Olafenwa street 10. Oluwoamoju 9. Abosan street 11. Awolowo way
12. Solawon street
13. Otugbuwa street
14. Stadium road
15. Bola Ahmed Tinubu street 16. Owolabi street 17. Okusile street 18. Olusileru street 19. Tipper garage street 20. Demeke street 21. Awotunde lane 22. Meri road 23. Jimohogunlewe street 24. Olisah street
177
Ipakodo ward
1. Pirera lane 25. Junaid Owokodo street 49. Yomi Oshikoya
2. Alagba GRA 26. Ogbesanya close 50. Sabitu Olokunola
3. Dosunmu Ayodeji 27. Itasin Zion road 51. Odufeko street
4. Palapo town 28. Owode Ibeshe road 52. Dauda street
5. Sola Mongaji 29. Olufemi crescent 53. Abiola Kosoko
6. Justice Eniola 30. Samuel Adebayo 54. Aliyu Musa street
7. Otunba Olukoga 31. Afolabi Ekiyoyo 55. Bello Solebo street
8. Dauda street 32. Abike Jokogbola 56. Jokodola street
9. Alhaja Wosilat street 33. Faniyi street 57. Towobola street
10. Sandfilled 34. Araromi compound 58. Awawu Lambo
11. First Baptist road 35. Banjo close
12. Alhaji Sanni Alashe 36. Adeyemo close
13. Paul Kolawole 37. Akinatoloye street
14. Onayemi Erinkintola 38. Risikat Ogunleye
15. Odusoga street 39. Badiru Kassim
16. Ebute Iga 40. Yekinni Showole
17. Liberty road 41. Baale street
18. Ojediran street 42. Ibuowo street
19. Fagbamila street 43. Tanimola street
20. Jarinatu street 44. Olabode Akinyemi
21. Kayode Anifowoshe 45. Alhaji Odusanwo
22. Sholaja Alapapo 46. Abraham Oke
23. Haju Olorunfunmi 47. Muba Abiru
24. Shopitan street 48. Ikot Ekan street
178
Abosan ward:
1. Odofin lane 2. Odofin street 3. Adeboruwa street 4. Obafemi Awolowo 5. Oba-Omolaja 6. Oguntuase 7. Olubi street 8. Iyewa road 9. Ebute road 10. Orefuwa lane 11. Orejoko lane 12. Rasaq Banjoko 13. Aro lane 14. Ogundipe street 15. Bode Elewure 16. James Udoka 17. Awobo estate 18. 1st container 19. 2nd container 20. Baale's house 21. Redeemed street 22. Igbina settlement 23. Oludo village 24. Adeyoruwa street
179
Ajaguro ward:
1. Kayode Shokunbi 20. Amu street 41. Marvellous street street 21. Olanrewaju 42. Olowu street 2. Obafemi street Hammed close 43. Adekite street 3. Sakiru Oyekanmi 22. Okiki street 44. Olarewaju street street 23. Egunsola street 45. Sobowale street 4. Yemi Oduwole 24. Adebimpe street 46. Rabiu street 25. Igbeti street 47. Olafinroye street 5. Grace Ibiyemi 26. Salvation crescent 48. Asimiu Alami 6. Temi Oduwole 27. Olalekan Ojo street street 7. Akingbile crescent 28. Isokan estate 49. Unity street 8. Aderemi-Adedigba 29. Modupe Oguneye 50. Alhaji Mutari street street street 51. Celestial street 9. Idowu-Omolayo 30. Ebumare avenue 52. Akinpelu street street 31. Owolabi 53. Olorunsogo street 10. Jomo-Olusipe Onafowokan 54. Alli Oluwafiniyi street 32. Adeniyi Adebanjo street 11. Oluwaseun street street 55. Odoarewa street 12. Adisalalohinpe 33. Abeke Bello street 56. Francis Onajinmi street 34. Dayo Abiona street 13. Aborowa street 35. Imodiyasi street 57. Omotayo street 14. Tolalolubi avenue 36. Omotayo Ibrahim 58. Deko street 15. Igbeti street street 16. Adekunle Olatunji 37. Akinpelu street 59. Akiniyi street 17. Odusote Rafiu 38. Adewale Odebanke 60. Omodisu street street street 18. Oluwaseyi 39. Sanusi Adegoke 61. Segun Ilori Onafowakan street avenue crescent 19. Ademola Olubisi 40. Kenneth Home
Benson street street
180
Settlements in Maya ward 1. Aiye 27. Orenuga 2. Orekokomaya 28. Odunuga 3. Eluku 29. Fadayin village 4. Oke-odo 30. Amugbase 5. Anibaba 31. Abule Ijaro 6. Oregunwa 7. Itunmaje 8. Awobajo 9. Lilroru 10. Bada Onayele 11. Redeem street 12. Mosafejo 13. Oyefolu 14. Cemetery 15. Farm settlement 16. Tanimola 17. Bimowu 18. Kajola 19. Awobanjo 20. Awotungashe 21. Odusote 22. Oriokuta 23. Adaranijo 24. Ogunowo 25. Oyefolu 26. Aiyegbami
181
APPENDIX 7:
LIST OF ABBREVIATIONS
IPV- Intimate Partner Violence
WHO- World Health Organization
US- United States
UN- United Nations
UK- United Kingdom
DELTA- Domestic violence prevention enhancement and leadership through alliances
HIV- Human immunodeficiency virus
LGA-Local government area
LCDA- Local council development area
NDHS- National Demographic Health Survey
NPC- National Population Commission
FGD- Focus group discussion
SPSS- Sstatistical package for social sciences
182