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IN LATIN AMERICA AND THE CARIBBEAN: A comparative analysis of population-based data from 12 countries IN LATIN AMERICA AND THE CARIBBEAN: A comparative analysis of population-based data from 12 countries SARAH BOTT ALESSANDRA GUEDES MARY GOODWIN JENNIFER ADAMS MENDOZA A collaboration between the Pan American Health Organization and the Centers for Disease Control and Prevention, with technical input from MEASURE DHS, ICF International PAHO HQ Library Cataloguing-in-Publication Data ****************************************************************************** Pan American Health Organization; Centers for Disease Control and Prevention. Violence Against Women in Latin America and the Caribbean: A comparative analysis of population-based data from 12 countries. Washington, DC: PAHO, 2012. 1. Violence Against Women. 2. Domestic Violence. 3. Sexual Violence. 4. Gender and Health. 5. Human Rights Abuses. 6. Epidemiologic Studies. I. Title. II. Centers for Disease Control and Prevention. ISBN 978-92-75-11718-7 (NLM classification: WA309 DA1) The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to Editorial Services, Area of Knowledge Management and Communications (KMC), Pan American Health Organization, Washington, DC, U.S.A. The Area for Sustainable Development and Environmental Health/Intra-Family Violence - Alessandra Guedes, Regional Advisor on Intra-Family Violence: guedesal@ paho.org/[email protected] will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pan American Health Organization, 2012. All rights reserved. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the Pan American Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Pan American Health Organization be liable for damages arising from its use. This publication is a joint production of PAHO and CDC. CDC makes no endorsement of any other PAHO product, service, or enterprise. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention. Suggested citation: Bott S, Guedes A, Goodwin M, Mendoza JA (2012) Violence Against Women in Latin America and the Caribbean: A comparative analysis of population-based data from 12 countries. Washington, DC: Pan American Health Organization. TABLE OF CONTENTS PREFACE . vii ACKNOWLEDGEMENTS . ix ACRONYMS . xi GLOSSARY OF KEY TERMS . xiii EXECUTIVE SUMMARY . xv LIST OF TABLES AND FIGURES . xxi CHAPTER 1 . INTRODUCTION AND RATIONALE . 1 1.1 Violence against women as a public health problem and a violation of human rights .....................1 1.2 International and regional evidence about violence against women ....................................1 1.3 Rationale and purpose of this comparative analysis . 2 CHAPTER 2 . METHODS . 5 2.1 Surveys in this report: which surveys were selected and why? ........................................5 2.2 Survey designs ..................................................................................5 2.3 Sample design and procedures . 7 2.4 Ethical and safety considerations . 9 2.5 History of the DHS and RHS violence modules . 10 2.6 Constructing standardized indicators for this comparative analysis.................................. 10 2.7 Measures and definitions of intimate partner violence...............................................12 2.8 Measures and definitions of other experiences of violence ..........................................15 2.9 Data analysis tools and techniques................................................................15 2.10 Presentation of results: managing limits to comparability ...........................................17 CHAPTER 3 . PREVALENCE OF PHYSICAL AND SEXUAL VIOLENCE BY INTIMATE PARTNERS . 19 3.1 Physical violence by intimate partners . .19 3.2 Physical violence by intimate partners by severity and act..........................................20 3.3 Sexual violence by intimate partners . 21 3.4 Physical or sexual violence by intimate partners...................................................24 CHAPTER 4 . FACTORS ASSOCIATED WITH PHYSICAL AND SEXUAL INTIMATE PARTNER VIOLENCE . 29 4.1 Prevalence of intimate partner violence by women’s background characteristics......................29 4.2 Intimate partner violence according to ethnicity...................................................36 4.3 Factors associated with intimate partner violence: multivariate logistic regression....................38 VIOLENCE AGAINST WOMEN IN LATIN AMERICA AND THE CARIBBEAN iii TABLE OF CONTENTS CHAPTER 5 . VIOLENCE AGAINST WOMEN AND REPRODUCTIVE HEALTH . 45 5.1 Intimate partner violence and unintended pregnancy...............................................45 5.2 Violence against women and reproductive health . 47 CHAPTER 6 . TRIGGERS, CONSEQUENCES, AND HELP-SEEKING . 51 6.1 Situations that triggered intimate partner violence ..................................................51 6.2 Physical consequences of intimate partner violence . 53 6.3 Mental health, emotional, and work-related consequences . 55 6.4 Help-seeking by women who experienced violence................................................57 6.5 Reasons why women did not seek help for intimate partner violence................................62 CHAPTER 7 . EMOTIONAL ABUSE AND CONTROLLING BEHAVIORS BY INTIMATE PARTNERS . 65 7.1 Emotional abuse by intimate partners .............................................................65 7.2 Controlling behaviors by the current or most recent partner ........................................68 CHAPTER 8 . SEXUAL VIOLENCE BY ANY PERPETRATOR . 73 8.1 Circumstances of sexual debut . 73 8.2 Lifetime prevalence of sexual violence by any perpetrator..........................................75 8.3 Perpetrators of lifetime sexual violence...........................................................79 CHAPTER 9 . HISTORY OF PHYSICAL AND SEXUAL VIOLENCE IN CHILDHOOD . 81 9.1 History of sexual abuse in childhood . 81 9.2 History of physical abuse in childhood............................................................83 9.3 History of their father (or stepfather) beating their mother (or stepmother) . 85 9.4 Punishment of children in the current home . 85 CHAPTER 10 . GENDER NORMS AND VIOLENCE . 89 10.1 Acceptability of wife-beating....................................................................89 10.2 Agreement that a wife has the right to refuse sex with her husband ................................94 10.3 Agreement with other gender norms and attitudes ...............................................94 CHAPTER 11 . OTHER SOURCES OF DATA ON VIOLENCE AGAINST WOMEN IN THE REGION . 99 11.1 Other sources of data on violence against women in the Region . 99 11.2 Men’s perspectives on violence ..................................................................101 CHAPTER 12 . DISCUSSION OF FINDINGS . 105 12.1 Discussion of findings..........................................................................105 12.2 Limitations of this comparative analysis..........................................................115 CHAPTER 13 . RECOMMENDATIONS FOR FUTURE RESEARCH, POLICIES, AND PROGRAMS . 119 13.1 Recommendations for future research............................................................119 13.2 Policy and program implications . 120 13.3 Promising strategies for preventing and responding to violence against women ....................120 iv VIOLENCE AGAINST WOMEN IN LATIN AMERICA AND THE CARIBBEAN TABLE OF CONTENTS REFERENCES . 123 List of individual survey country final reports ........................................................ 123 References cited in the text........................................................................ 124 APPENDIX . 139 VIOLENCE AGAINST WOMEN IN LATIN AMERICA AND THE CARIBBEAN v PREFACE Violence against women is a human rights violation with important public health ramifications. Evidence from across the globe documents that such violence is widespread and that women and girls bear the overwhelming burden of violence by intimate partners and sexual violence by any perpetrator. The consequences of such violence can be long-lasting and extensive, making violence against women an important cause of morbidity and

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