Intimate Partner Violence and Depressive Symptoms Among Married Women of Reproductive Age in Rural Bangladesh
Stake, Stephen Bradley
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Problem Statement: Intimate partner violence (IPV) is ubiquitous and its prevalence varies between and within countries, ranging between 15 and 71%. In Bangladesh, women experience high levels of physical, sexual, and verbal abuse, with substantial variation by region. IPV has been associated with adverse physical and mental health outcomes for victims. Little research exists concerning IPV in northeast Bangladesh and no studies to date explore IPV typology in the context of Bangladesh. Community specific research on prevalence, risk factors, associations with depressive symptoms, and typology is vital for understanding IPV and future intervention. Methods: This cross-sectional study uses data from a household survey of married women of reproductive age in the Sylhet District of Bangladesh conducted in 2014 as part of an endline of a quasi-experiment. The original study, known as the Healthy Fertility Study, was a clustered trial designed to measure the effect of a community-based postpartum family planning program on the primary outcome of healthy birth spacing. 4,430 married women were recruited during pregnancy at baseline and 3,966 of these women were available for the endline survey. A revised version of the Conflict Tactics Scale was used to assess exposure to specific acts violence and the Edinburgh Postpartum Depression Scale – Bangladesh Version (EPDS-B) was used to assess depressive symptoms. Factors associated with IPV were determined through use of mixed effects logistic regression. Hierarchical (Ward’s Method) and nonhierarchical (K-means) cluster analysis was used to explore IPV typology. Results: Among women included in the study sample, 28.8% of women had ever experienced physical or sexual IPV by their spouse and 13.2% had experienced a form of physical or sexual IPV in the past year. The odds of having experienced physical or sexual IPV in the past year were greater among less educated women (AOR = 2.42, 95% CI: 1.86-3.14), for women whose husbands were less educated (AOR = 1.64, 95% CI: 1.23-2.18), and younger women (AOR = 1.50, 95% CI: 1.01-2.25). The prevalence and forms of IPV varied by Union (community). Using a clinical cutoff of 9/10 for the EPDS-B, 30.8% (95% CI: 29.4% - 32.3%) of women were at risk for depressive symptoms. The odds of being at risk for depressive symptoms were more likely (AOR = 2.47, 95% CI: 2.11-2.89) among women exposed to at least one form of abuse in the past year. Physical, sexual and verbal abuses were each independently associated with being at risk for depressive symptoms and those who experienced multiple forms or more severe abuses were most likely to demonstrate depressive symptoms. Cluster analysis results were compatible with Johnson’s proposed typology of “situational couple violence” and “intimate terrorism.” Conclusions: In rural northeast Bangladesh, a high number of married women experience IPV. Seldom do victims of IPV share their experiences with others and women almost never pursue formal avenues for assistance. IPV and being at risk for depressive symptoms often go hand in hand. Study findings indicate the need to address all forms of abuse, whether physical, sexual, or verbal. Moreover, there is a great need to address associated mental health burdens among victims. Based on clustering results and typology theory, violent relationships in rural Bangladesh are not all alike and treating them as such in future intervention efforts could be erroneous, even dangerous. Research is needed to better understand the context of IPV and to further validate typology theory in the context of rural Bangladesh.