Drought and intimate partner violence towards women in 19 countries in sub-Saharan Africa during 2011-2018: A population-based study
Drought and intimate partner violence towards women in 19 countries in sub-Saharan Africa during 2011-2018: A population-based study
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DOI：
10.1371/journal.pmed.1003064
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发表时间：
2020-03-01
期刊：
影响因子：
15.8
通讯作者：
Weiser, Sheri D.
中科院分区：
文献类型：
--
作者：
Epstein, Adrienne;Bendavid, Eran;Weiser, Sheri D.
干旱对人类健康有许多已知的有害影响，但对干旱与亲密伴侣暴力（IPV）之间的关系知之甚少。我们的目的是评估这种关系，并评估19个撒哈拉以南非洲国家妇女人口亚组之间的效应异质性。方法和发现我们使用了2011年至2018年19次人口与健康调查的数据，包括83990名15-49岁的有伴侣女性。调查日期前一年的降雨量偏差相对于前29年，使用气候危害组红外降水与台站数据进行测量，最近的干旱被分类为顺序分类变量（严重：第10个百分位到第30个百分位）。我们考虑了4个与IPV相关的结果：报告有一个控制伴侣（IPV的风险因素），并在调查前12个月内经历过情感暴力、身体暴力或性暴力。采用Logistic回归估计边际风险差异（RDs）。我们根据年龄组和就业状况评估了效应异质性的存在。在分析样本中的83990名女性中，10.7%（9019人）在调查前一年经历了严重干旱，23.4%（19639人）经历了轻度/中度干旱，各国之间存在很大的异质性。受访者的平均年龄为30.8岁（标准差8.2）。大多数妇女生活在农村地区（66.3%），已婚（73.3%），而识字的妇女不到一半（42.6%）。与没有经历过干旱的妇女相比，生活在严重干旱地区的妇女报告有控制伴侣的风险更高（边际风险比百分比= 3.0,95% CI 1.3, 4.6; p < 0.001），遭受身体暴力（边际风险比= 0.8,95% CI 0.1, 1.5; p = 0.019），以及遭受性暴力（边际风险比= 1.2,95% CI 0.4, 2.0; p = 0.001）。与没有生活在干旱地区的妇女相比，生活在轻度/中度干旱地区的妇女报告身体暴力（边际RD = 0.7, 95% CI 0.2, 1.1; p = 0.003）和性暴力（边际RD = 0.7, 95% CI 0.3, 1.2; p = 0.001）的风险更高。我们没有发现干旱和情感暴力之间存在关联的证据。在按国家分层的分析中，我们发现干旱对至少一种IPV测量具有保护作用的环境有3个：纳米比亚、坦桑尼亚和乌干达。我们发现了干旱与年轻年龄以及干旱与就业状况之间存在效应异质性（加性相互作用）的证据，在青春期女孩和失业妇女中，干旱与IPV之间存在更强的关联。这项研究是有限的，因为它缺乏测量假设的中介变量连接干旱和IPV，禁止正式的中介分析。其他限制包括由于残留混淆和结果测量的潜在非差异错误分类而导致观察到的关联衰减的潜在偏倚。结论研究结果表明，干旱与对妇女的IPV措施有关，其中青春期女孩和失业妇女的IPV与干旱有较大的正相关。这些关联在各国之间存在异质性。天气冲击可能加剧撒哈拉以南非洲地区妇女的脆弱性。未来的工作应该进一步评估驱动这些关系的潜在机制。
BackgroundDrought has many known deleterious impacts on human health, but little is known about the relationship between drought and intimate partner violence (IPV). We aimed to evaluate this relationship and to assess effect heterogeneity between population subgroups among women in 19 sub-Saharan African countries.Methods and findingsWe used data from 19 Demographic and Health Surveys from 2011 to 2018 including 83,990 partnered women aged 15-49 years. Deviations in rainfall in the year before the survey date were measured relative to the 29 previous years using Climate Hazards Group InfraRed Precipitation with Station data, with recent drought classified as ordinal categorical variable (severe: 10th percentile to 30th percentile). We considered 4 IPV-related outcomes: reporting a controlling partner (a risk factor for IPV) and experiencing emotional violence, physical violence, or sexual violence in the 12 months prior to survey. Logistic regression was used to estimate marginal risk differences (RDs). We evaluated the presence of effect heterogeneity by age group and employment status. Of the 83,990 women included in the analytic sample, 10.7% (9,019) experienced severe drought and 23.4% (19,639) experienced mild/moderate drought in the year prior to the survey, with substantial heterogeneity across countries. The mean age of respondents was 30.8 years (standard deviation 8.2). The majority of women lived in rural areas (66.3%) and were married (73.3%), while less than half (42.6%) were literate. Women living in severe drought had higher risk of reporting a controlling partner (marginal RD in percentage points = 3.0, 95% CI 1.3, 4.6; p < 0.001), experiencing physical violence (marginal RD = 0.8, 95% CI 0.1, 1.5; p = 0.019), and experiencing sexual violence (marginal RD = 1.2, 95% CI 0.4, 2.0; p = 0.001) compared with women not experiencing drought. Women living in mild/moderate drought had higher risk of reporting physical (marginal RD = 0.7, 95% CI 0.2, 1.1; p = 0.003) and sexual violence (marginal RD = 0.7, 95% CI 0.3, 1.2; p = 0.001) compared with those not living in drought. We did not find evidence for an association between drought and emotional violence. In analyses stratified by country, we found 3 settings where drought was protective for at least 1 measure of IPV: Namibia, Tanzania, and Uganda. We found evidence for effect heterogeneity (additive interaction) for the association between drought and younger age and between drought and employment status, with stronger associations between drought and IPV among adolescent girls and unemployed women. This study is limited by its lack of measured hypothesized mediating variables linking drought and IPV, prohibiting a formal mediation analysis. Additional limitations include the potential for bias due to residual confounding and potential non-differential misclassification of the outcome measures leading to an attenuation of observed associations.ConclusionsOur findings indicate that drought was associated with measures of IPV towards women, with larger positive associations among adolescent girls and unemployed women. There was heterogeneity in these associations across countries. Weather shocks may exacerbate vulnerabilities among women in sub-Saharan Africa. Future work should further evaluate potential mechanisms driving these relationships.