Alcohol use and intimate partner violence among women and their partners in sub-Saharan Africa.

W A Tol,J C Kane,M C Greene

doi:10.1017/gmh.2017.9

Abstract

Alcohol use is a well-documented risk factor for intimate partner violence (IPV); however, the majority of research comes from high-income countries. Using nationally representative data from 86 024 women that participated in the Demographic and Health Surveys, we evaluated the relationship between male partner alcohol use and experiencing IPV in 14 countries in sub-Saharan Africa (SSA). Using multilevel mixed-effects models, we calculated the within-country, between-country, and contextual effects of alcohol use on IPV. Prevalence of partner alcohol use and IPV ranged substantially across countries (3-62 and 11-60%, respectively). Partner alcohol use was associated with a significant increase in the odds of reporting IPV for all 14 countries included in this analysis. Furthermore, the relationship between alcohol use and IPV, although largely explained by partner alcohol use, was also attributable to overall prevalence of alcohol use in a given country. The partner alcohol use-IPV relationship was moderated by socioeconomic status (SES): among women with a partner who used alcohol those with lower SES had higher odds of experiencing IPV than women with higher SES. Results of this study suggest that partner alcohol use is a robust correlate of IPV in SSA; however, drinking norms may independently relate to IPV and confound the relationship between partner alcohol use and IPV. These findings motivate future research employing experimental and longitudinal designs to examine alcohol use as a modifiable risk factor of IPV and as a novel target for treatment and prevention research to reduce IPV in SSA.

Highlights

Intimate partner violence (IPV), defined as any behavior within an intimate relationship that causes physical, psychological, or sexual harm, is one of the leading risk factors for mental disorder (Trevillion et al 2012), physical disorder (Durevall & Lindskog, 2015), and health-related disability among women of reproductive age worldwide (Krug et al 2002; Shield & Rehm, 2015)
The prevalence of IPV is generally higher in low- and middle-income countries (LMICs) relative to high-income countries (HICs), with some of the highest prevalence estimates identified in sub-Saharan Africa (SSA) (Garcia-Moreno et al 2013), yet far less research attention is paid to IPV in these settings
Prevalence estimates ranged from 2.6% in Comoros to 62.4% in Gabon

Summary

Introduction

Intimate partner violence (IPV), defined as any behavior within an intimate relationship that causes physical, psychological, or sexual harm, is one of the leading risk factors for mental disorder (e.g. depression, anxiety) (Trevillion et al 2012), physical disorder (e.g. sexually transmitted infections, injury) (Durevall & Lindskog, 2015), and health-related disability among women of reproductive age worldwide (Krug et al 2002; Shield & Rehm, 2015). The spurious effects model suggests that the association between alcohol use and IPV may be explained by confounding through another factor (e.g. age, general male deviance) (Osgood et al 1988; Leonard & Quigley, 1999). This model has received limited support in empirical investigations, which have failed to identify confounders that fully account for the relationship between alcohol use and IPV (Leonard, 2005). Alcohol use is a well-documented risk factor for intimate partner violence (IPV); the majority of research comes from high-income countries

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