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      Disability status, intimate partner violence and perceived social support among married women in three districts of the Terai region of Nepal

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          Abstract

          Introduction

          Women living with disabilities are disproportionately vulnerable to intimate partner violence (IPV). Existing research on the topic largely takes place in high-income settings and treats disability as a dichotomous experience—an individual either has a disability or does not. Disability experiences, however, are diverse such that some individuals face minimal impairment, while for others impairment can be severe. With this spectrum in mind, this study sought to examine the associations between severity of disability impairment, past-year IPV, past-year in-law violence and perceived social support among married women in Nepal.

          Methods

          Baseline data (2016) from a randomised controlled trial aiming to reduce IPV among women aged 18–49 (n=1800) were analysed using generalised estimating equations logistic regressions to assess associations.

          Results

          Women with severe impairment reported higher levels of physical and/or sexual, emotional, economic and in-law violence than women without a disability (adjusted OR (AOR)=1.68, 95%  CI 1.04 to 2.72; AOR=1.65, 95%  CI 1.03 to 2.65; AOR=1.75, 95%  CI 1.02 to 3.02; AOR=2.80, 95%  CI 2.53 to 5.11, respectively). Differences in IPV between women reporting some impairment versus no disability were observed for economic (AOR=1.47, 95%  CI 1.11 to 1.94) and in-law violence (AOR=1.50, 95%  CI 1.07 to 2.10). Women with severe or some impairment versus no disability were less likely to perceive their in-laws as supportive.

          Conclusion

          Disability status was associated with increased vulnerability to IPV. A gradient was observed; the highest levels of IPV were experienced by women with severe impairment, followed by some impairment. Future research should examine the mechanisms driving such observations.

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          Most cited references24

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          Closing the gap in a generation: health equity through action on the social determinants of health.

          The Commission on Social Determinants of Health, created to marshal the evidence on what can be done to promote health equity and to foster a global movement to achieve it, is a global collaboration of policy makers, researchers, and civil society, led by commissioners with a unique blend of political, academic, and advocacy experience. The focus of attention is on countries at all levels of income and development. The commission launched its final report on August 28, 2008. This paper summarises the key findings and recommendations; the full list is in the final report.
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            Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence.

            Violence against women is a serious human rights abuse and public health issue. Despite growing evidence of the size of the problem, current evidence comes largely from industrialised settings, and methodological differences limit the extent to which comparisons can be made between studies. We aimed to estimate the extent of physical and sexual intimate partner violence against women in 15 sites in ten countries: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania. Standardised population-based household surveys were done between 2000 and 2003. Women aged 15-49 years were interviewed and those who had ever had a male partner were asked in private about their experiences of physically and sexually violent and emotionally abusive acts. 24,097 women completed interviews, with around 1500 interviews per site. The reported lifetime prevalence of physical or sexual partner violence, or both, varied from 15% to 71%, with two sites having a prevalence of less than 25%, seven between 25% and 50%, and six between 50% and 75%. Between 4% and 54% of respondents reported physical or sexual partner violence, or both, in the past year. Men who were more controlling were more likely to be violent against their partners. In all but one setting women were at far greater risk of physical or sexual violence by a partner than from violence by other people. The findings confirm that physical and sexual partner violence against women is widespread. The variation in prevalence within and between settings highlights that this violence in not inevitable, and must be addressed.
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              Social determinants of health inequalities

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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2018
                31 October 2018
                : 3
                : 5
                : e000934
                Affiliations
                [1 ] departmentDepartment of Global and Community Health, College of Health and Human Services , George Mason University , Fairfax, Virginia, USA
                [2 ] departmentSchool of Policy and Practice , University of Pennsylvania , Philadelphia, Pennsylvania, USA
                [3 ] Equal Access International , San Francisco, California, USA
                [4 ] departmentLeonard Cheshire Research Centre, Department of Epidemiology and Public Health , University College London , London, UK
                [5 ] departmentDepartment of Global Health , Rollins School of Public Health, Emory University, Atlanta , Georgia, USA
                Author notes
                [Correspondence to ] Professor Jhumka Gupta; jgupta4@ 123456gmu.edu
                Article
                bmjgh-2018-000934
                10.1136/bmjgh-2018-000934
                6231095
                ee222501-93fd-401b-b38f-3a68892d1165
                © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 04 May 2018
                : 06 September 2018
                : 14 September 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000278, Department for International Development;
                Award ID: P06254
                Categories
                Research
                1506
                Custom metadata
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                public health
                public health

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