Abstract
BackgroundRelations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, gender (in)equitable decision-making, and intimate partner violence (IPV) represent serious global health concerns. Our objective was to determine extent of exposure to these variables and test pathways between these indicators of interest.MethodsWe surveyed 605 women aged 13 to 49 who were randomly selected via multistage sampling across three districts in Northeastern Uganda in 2016. We used Mplus 7.4 to estimate a moderated structural equation model of indirect pathways between armed conflict and intimate partner violence for currently partnered women (n = 558) to evaluate the strength of the relationships between the latent factors and determine the goodness-of-fit of the proposed model with the population data.ResultsMost respondents (88.8%) experienced conflict-related violence. The lifetime/ past 12 month prevalence of experiencing intimate partner violence was 65.3%/ 50.9% (psychological) and 59.9%/ 43.8% (physical). One-third (30.7%) of women’s partners reportedly consumed alcohol daily. The relative fit of the structural model was superior (CFI = 0.989; TLI = 0.989). The absolute fit (RMSEA = 0.029) closely matched the population data. The partner and joint decision-making groups significantly differed on the indirect effect through partner alcohol use (a1b1 = 0.209 [0.017: 0.467]).ConclusionsThis study demonstrates that male partner alcohol misuse is associated with exposure to armed conflict and intimate partner violence—a relationship moderated by healthcare decision-making. These findings encourage the extension of integrated alcohol misuse and intimate partner violence policy and emergency humanitarian programming to include exposure to armed conflict and gendered decision-making practices.
Highlights
Relations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, genderequitable decision-making, and intimate partner violence (IPV) represent serious global health concerns
All are of serious global public health concern because of their scope and impact presently and because of their enduring and intergenerational effects
It could be that the psychopharmacologic effects of alcohol interact with relational negotiation of resources where decision-making is inequitable in either direction
Summary
Relations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, gender (in)equitable decision-making, and intimate partner violence (IPV) represent serious global health concerns. In 2013, the World Health Organization, United Nations Development Programme, and partners joined to address the intersections of alcohol misuse, gender-based violence, and infectious diseases, seminally acknowledging the interrelatedness of these problems at a policy level [1] This policy momentum has not explicitly addressed exposure to armed conflict, and there remains a paucity of research that examines these problems beyond bivariate relations and as conceptually interrelated, signifying a policy-to-research gap. Relations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, gender (in)equitable decision-making, and intimate partner violence (IPV) represent such problems. Armed conflict exposure has protractedly negatively affected development and progress on the United Nation’s Millennium Development Goals by increasing rates of malnutrition and infant deaths and reducing access to clean drinking water [13]
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