Elsevier

Social Science & Medicine

Volume 69, Issue 5, September 2009, Pages 691-697
Social Science & Medicine

Community influences on intimate partner violence in India: Women's education, attitudes towards mistreatment and standards of living

https://doi.org/10.1016/j.socscimed.2009.06.039Get rights and content

Abstract

Intimate partner violence (IPV) directed towards women is a serious public health problem. Women's education may offer protection against IPV, but uncertainty exists over how it might reduce risk for IPV at the community and individual levels. The objectives of this study are to: (1) disentangle community from individual-level influences of women's education on risk for IPV; (2) quantify the moderating influence of communities on individual-level associations between women's education and IPV; (3) determine if women's attitudes towards mistreatment and living standards at the community and individual levels account for the protective influence of women's education; and (4) determine if the protective influence of education against IPV is muted among women living in communities exhibiting attitudes more accepting of mistreatment.

Study information came from 68,466 married female participants in the National Family Health Survey conducted throughout India in 1998–1999. Multilevel logistic regression was used to address the study objectives. IPV showed substantial clustering at both the state (10.2%) and community levels (11.5%). At the individual level, there was a strong non-linear association between women's education and IPV, partially accounted for by household living standards. The strength of association between women's education and IPV varied from one community to the next with evidence that the acceptance of mistreatment at the community level mutes the protective influence of higher education. Furthermore, women's attitudes towards mistreatment and their standards of living accounted for community-level associations between women's education and IPV.

Place of residence accounted for substantial variation in risk of IPV and also modified individual-level associations between IPV and women's education. At the community level, women's education appeared to exert much of its protective influence by altering population attitudes towards the acceptability of mistreatment. However, there was no residual association between women's education and IPV at the community level once living standards are taken into account. While women's education provides strong, independent leverage for reducing the risk of IPV, planners must keep in mind important community factors that modify its protective influence.

Section snippets

Women's education in India and risk for IPV

The second National Family Health Survey (NFHS-2) conducted throughout India in 1998–1999 (International Institute for Population Sciences (IIPS) and ORC Macro, 2000) reported a strong negative gradient between educational attainment for married women and their reports of being beaten or physically mistreated in the past 12 months (recent IPV): illiterate, 14.1%; <middle school, 8.8%; middle school complete, 7.0%; and high school complete and above 3.6%. In a recent study of the same data set,

Methods

In the NFHS-2, female interviewers used standard survey questionnaires administered face-to-face to collect health-related information from a nationally representative probability sample of women aged 15–49 years living in household dwellings. The survey used a stratified, multi-stage, cluster design based on the 1991 Census. Each state was divided into urban and rural areas. In urban areas, wards listed in the 1991 Census were stratified by district and female literacy, and a sample of wards

Intimate Partner Violence (IPV)

Three questions taken from the Status of Women module were used to classify IPV in the last 12 months. The stem question read, ‘Since you completed 15 years of age, have you been beaten or mistreated physically by any person?’ Women responding yes were asked to identify their relationship to all persons responsible for such acts and then to report the aggregate frequency of occurrence in the last 12 months in three categories: once, a few times and many times. Women answering yes to the stem

Results

Table 1 presents summary information on the total sample. There are 26 states, 3118 areas (clusters) and 68,466 women. There is substantial variation in the prevalence of IPV between states (1.5 to 19.0%) and between clusters (0.0 to 61.5%). About 31.3% of women live in urban areas and 51.4% live in nuclear families. On average, women have 3.90 years of education and 9.7% of the sample reported exposure to IPV in the last 12 months.

Correlations among the study variables are shown in Table 2. At

Discussion

In this study, clustering of IPV was extensive, accounting for about 21.5% of its variability and evenly divided between large states and communities. This contrasts with other studies in which the clustering of health-related phenomena is much less evident in larger administrative areas than smaller communities in the same country (Boyle & Willms, 1999). States in India are relatively autonomous and quite diverse in language, culture and economic standing. Across states and communities in

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    Michael Boyle is supported by a Canada Research Chair in the Social Determinants of Child Health. Katholiki Georgiades is supported by an Ontario Mental Health Foundation New Investigator Fellowship. The authors thank Jon Rasbash for his helpful comments on the manuscript.

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