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City Research Online: http://openaccess.city.ac.uk/ [email protected] Uncertainties in gender violence epidemiology Neil Andersson Thesis submitted for the degree of Doctor of Philosophy (PhD) by prior publication City University London School of Health Sciences April 2013 TABLE OF CONTENTS List of Tables .................................................................................................................5 List of Figures................................................................................................................6 List of Appendices ........................................................................................................7 Abbreviations ................................................................................................................8 Glossary .........................................................................................................................9 Acknowledgements .....................................................................................................13 Declaration ...................................................................................................................14 ABSTRACT...................................................................................................................15 CHAPTER 1. INTRODUCTION ....................................................................................16 Summary ..................................................................................................................16 1.1 CIET and the research programme ....................................................................16 1.2 Defining terms ....................................................................................................18 1.2.1 Gender ........................................................................................................18 1.2.2 Violence ......................................................................................................19 1.2.3 Gender violence epidemiology ....................................................................21 1.3 The papers in this PhD by prior publication ........................................................24 1.3.1 Methods in gender violence epidemiology ..................................................26 1.3.2 Gender violence and HIV in southern Africa ...............................................27 1.3.3 Gender violence and maternal morbidity ....................................................31 1.4 Cumulative knowledge gained ............................................................................32 1.5 Research question ..............................................................................................34 1.5.1 Missing data ................................................................................................34 1.5.2 Clustering ....................................................................................................34 1.5.3 Unrecognised causality ...............................................................................35 2 CHAPTER 2. METHODS ..............................................................................................36 Summary ..................................................................................................................36 2.1 Critical review of the published papers ...............................................................36 2.2 Review of missing data in intimate partner violence studies .............................. 37 2.3 Qualitative research on missing data ..................................................................38 2.4 Correlated group data: incidental and informative clustering .............................. 40 2.5 Revisiting gender violence as a covariate ..........................................................41 CHAPTER 3. MISSING DATA ......................................................................................43 Summary ..................................................................................................................43 3.1 Ignorability of missing data .................................................................................43 3.2 Review of missing data in IPV studies ................................................................46 3.3 Focus group discussions ....................................................................................46 3.3.1 Gender roles and “indiscipline” ...................................................................47 3.3.2 Non-availability and violence ......................................................................48 3.3.3 Fear of violence ..........................................................................................48 3.3.4 Experience of violence among non-responders ..........................................50 3.4 Adjustments to estimates of rates of violence .....................................................50 3.5 An approach to minimise missing data and non-disclosure ................................51 3.6 Discussion ..........................................................................................................54 CHAPTER 4. CLUSTERING .........................................................................................57 Summary ..................................................................................................................57 4.1 Informative and incidental clustering ..................................................................57 4.2 Reanalysis of clustering for IPV ..........................................................................59 4.3 Discussion ..........................................................................................................63 CHAPTER 5. GENDER VIOLENCE AND UNRECOGNISED CAUSALITY .................66 Summary ..................................................................................................................66 3 5.1 Introduction .........................................................................................................66 5.2 Causes, confounders and colliders.....................................................................67 5.3 Revisiting gender violence as a covariate ..........................................................70 5.4 Discussion ..........................................................................................................74 CHAPTER 6. CONCLUSIONS .....................................................................................77 Summary ..................................................................................................................77 6.1 Less uncertainty in gender violence epidemiology .............................................77 6.1.1 Missing data ................................................................................................78 6.1.2 Clustering ....................................................................................................78 6.1.3 Unrecognised causality ...............................................................................79 6.2 Implications for future research ..........................................................................79 6.3 Endnote ..............................................................................................................82 Paper 1………………………………………….……………………………………………..85 Paper 2………………………………………….……………………………………………..99 Paper 3…………………………………………..………………………………………...…116 Paper 4…………………………………………..……………………………………..….…139 Paper 5…………………………………………..………………………………………...…146 Paper 6…………………………………………..………………………………………...…154 Paper 7…………………………………………..……………………………………..….…166 Paper 8…………………………………………...………………………………………..…181 Paper 9…………………………………………...………………………………………..…197 Paper 10………………………………………...……………………………………………202 Paper 11………………………………………...……………………………………………214 REFERENCES ............................................................................................................227 APPENDICES……………………………………………………………………………….234 4 List of Tables Table 1. Domestic violence in eight southern African countries, female p60 responses and male group variables as possible covariates of intimate partner violence (2002) Table 2. Domestic violence in Zambia, female responses and group variables p61 as covariates of intimate partner violence (2002) Table 3. The influence of gender violence history in HIV research p72 5 List of Figures Figure 1. Covariate relationships p68