The independent contribution of individual-, neighbourhood-, and country-level socioeconomic position on attitudes towards intimate partner violence against women in sub-Saharan Africa: A multilevel model of direct and moderating effects

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Abstract

We examined associations between country, neighbourhood, and individual socioeconomic position (SEP) and attitudes towards intimate partner violence against women (IPVAW). We applied multivariable multilevel logistic regression analysis on Demographic and Health Survey data for 165,983 women and 68,501 men nested within 7465 communities from 17 countries in sub-Saharan Africa collected between 2003 and 2007. Contrary to expectation women were 34% more likely to justify IPVAW than men. We found that sex moderates associations of individual-, neighbourhood-, and country-level SEP with attitudes towards IPVAW. There was a significant positive interaction effect between sex and education attainment; women with no education were more likely to justify IPVAW than men with no education. Negative sex interaction with household wealth status indicates that differences in attitude are less pronounced among women. Unemployed men were more likely to justify IPVAW. Interaction effects indicate that the association of neighbourhood socioeconomic disadvantage with attitudes was more pronounced among women than among men. The association of country-level SEP with attitudes towards IPVWA was inconclusive. There was some evidence that neighbourhood modified the association between individual SEP and attitudes towards IPV. Also, there was cross-level interaction between country and neighbourhood SEP. Neighbourhood and individual SEP were independently associated with attitudes towards IPVAW. The relationship with country-level SEP was inconclusive. The findings underscore the need to implement public health prevention/intervention strategies not only at the level of individual SEP but also at the neighbourhood level.

Section snippets

Background

Studies from Africa and rest of the world document intimate partner violence against women (IPVAW) as a serious public health issue, conferring immediate and long-term threats to women's health (Afifi et al., 2008, Cleary et al., 2008, Dunkle et al., 2006, Fonck et al., 2005, Jewkes et al., 2006, Krishnan et al., 2008, Sarkar, 2008, Shuman et al., 2008, Silverman et al., 2008). Researchers and policy makers have increasingly cited gender-based violence as essential determinants of women's

Conceptual framework

Family violence researchers often draw upon an ecological perspective to understand partner abuse (Belsky, 1980, Heise, 1998). This framework conceptualizes violence as a multifaceted phenomenon grounded in an interplay of individual, family, community, and societal factors (Heise, 1998). The framework takes into account the different levels of societal organization and their role in influencing attitudes towards IPVAW. An individual resides in a household unit, which in turn is situated within

Data

This study used data from 17 Demographic and Health Surveys (DHS) conducted between 2003 and 2007 in sub-Saharan Africa (Benin, Burkina Faso, Ethiopia, Ghana, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Namibia, Nigeria, Rwanda, Swaziland, Tanzania, Uganda and Zimbabwe) available as of November 2008. Methods and data collection procedures have been published elsewhere (DHS, 2008). Briefly, DHS surveys are implemented by respective national institutions and Macro International Inc.,

Sample characteristics

The countries, year of data collection, final sample and number of communities sampled per country, and average number of respondents per communities are listed in Table 1. The median number of communities sampled was 405 ranging from 275 in Swaziland to 750 in Benin. The median number of respondents per community varied from 24 in Lesotho to 44 in Liberia. The percentage of respondents endorsing IPVAW in at least one situation varied across countries and sex. Women were more likely to justify

Discussion

Drawing upon multilevel perspectives, in this paper we have offered an alternative to more traditional ways of thinking about the factors associated with attitudes towards IPVAW at the population level. In particular, we have demonstrated that individual and neighbourhood context in which people live is associated with the attitude of individuals even after taking into account individual-level SEP. As hypothesized, we found that sex moderates associations of individual-, community-, and

Acknowledgements

The authors are grateful to Measure DHS for providing them with the DHS data. The authors thank the two anonymous reviewers for critical review of an earlier version of this manuscript.

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