Spousal violence against women is endemic and owes its genesis to deeply entrenched socio-cultural norms. In this study 2015 Demographic and Health Survey data for Afghanistan was used to calculate the provincial prevalence and two correlates of spousal violence, and their bivariate mapping. Large differences were present in the provincial prevalence of spousal violence, having witnessed their father ever beat their mother, and acceptance of spousal violence by the currently or ever married women aged 15-49 years. In general, bivariate maps showed strong associations between spousal violence against women, its acceptance by women, and having witnessed their father beat their mother by ever married women. In an easily comprehensible manner, these maps underscore ensuring better quality of life in marital settings, higher and more equal social stature of women, and protecting their basic human rights would entail legal, social, and cultural paradigm shift.
Keywords: Domestic Violence, Intimate Partner Violence, Afghanistan, Women, Abuse.
Violence against women, in the context of intimate relationships is endemic, cuts across all cultures, geographies, socio-economic strata and is a flagrant but preventable violation of human rights that has been declared as a major public health problem by the World Health Organization.1,2 Based on 2018 data, lifetime prevalence of ever married women who experienced physical and/or sexual violence perpetrated by either a current, former husband, or male partner was 27% globally and 31% in the WHO Eastern Mediterranean region.2 During and in the aftermath of complex humanitarian emergencies, disasters, and conflicts, tend to worsen intimate partner violence.1,3
Deeply entrenched gender-based inequities and norms against women coupled with manifest power imbalance promote intimate partner violence and impede its eradication.4-7 Afghanistan, located in Central and South Asia, conducted the first Demographic and Health Survey (DHS) in 2015 that included a module on domestic violence with questions on intimate partner/spousal violence. The data collection phase of Afghanistan DHS lasted from June 2015 to February 2016. Afghanistan DHS is the only survey that provides a nationally as well as provincially representative estimates of various demographic and health indices including spousal violence against women.8 Studies using DHS Afghanistan 2015 data have reported that in a sample of 21,324 women who were selected and interviewed for the domestic violence module, 15% were married before the age of 15, with 55.54% prevalence in 15-49 years old women who had experienced some form of physical, emotional, and/or sexual violence by their current or former husbands.9,10
Bivariate maps provide simultaneous graphic representation of two thematic variables depicting easily fathomable complex patterns and associations in administrative subdivisions/provinces. Bivariate maps have been used for studying and depicting cardiovascular mortality and economic development, opioid overdose and health services, and cancer epidemiology.11-13 However, bivariate maps have not been used for depicting associations of spousal violence and its correlates.
The prevalence of spousal violence against women and its correlates have been reported previously, using Afghanistan DHS 2015 data.10 However, in this study Afghanistan DHS 2015 data was used to determine the prevalence and two correlates of spousal violence against women for each province, and the mapping of provincial prevalence of spousal violence and its two correlates using bivariate maps.
Methods and Results
The Demographic and Health Survey of Afghanistan data, conducted in 2015 was used8. Permission to access and use data for this analysis was obtained from the DHS Programme. The domestic violence module was administered to a total of 21,324 either currently or ever married women aged 15-49 years. Questions in this module inquired about emotional, physical, and sexual violence committed by either current husband or former husband for currently or ever married women, respectively (Table-1).
Table-1 shows the questions asked, the answer options available to respondents, and coding of variables, using the same methodological approach previously reported using Afghanistan DHS 2015 data.10 Similarly, spousal violence against women variable was created in a two-step process: each of the three forms (physical, emotional, and sexual) of spousal violence were recoded as '1' if answer to any one of the questions within a spousal violence category was answered affirmatively by the respondent; in the second step having ever experienced any of the three types of spousal violence was recoded as '1'.10 While respondents who replied as having never experienced any type of spousal violence were recoded as '0'. Similarly, affirmative response to any of the spousal violence acceptance questions were deemed as being accepting of spousal violence by the respondent, as used in the previous study.10
Proportion (percent) of women reporting having ever experienced any form of spousal violence perpetrated by either their current/former husband, having witnessed their father beat their mother, and acceptance of spousal violence (attitudinal acceptance) variables were dichotomized and their proportions were calculated using Stata 16 survey procedures to incorporate the complex sample design, sampling weight, while accounting for the differential probability of selection of ever married women, as reported previously.10
Afghanistan has 34 provinces, and the polygon shapefile of all provinces was obtained from the DHS website. For security reasons, DHS Afghanistan 2015 could not be conducted in the south-central province of Zabul. Map-1 shows the provinces of Afghanistan. Two bivariate maps were created, showing by province, bivariate association of having ever experienced spousal violence and acceptance of spousal violence by the respondents; and acceptance of spousal violence by the respondents and having witnessed their father ever beat their mother. The bivariate maps were created using quantile classification for each variable in R version 4.0.2. The quantile mapping method creates relatively equal data groups, with a break created at the 33rd and 66th percentiles for a three-by-three map.
There were large differences in the prevalence of spousal violence, having ever witnessed father beat the mother, and acceptance of spousal violence in the provinces of Afghanistan in 2015. The prevalence of ever having experienced any type of spousal violence, having ever witnessed father beat the mother, and acceptance of spousal violence by the respondents ranged from 6.38% to 92.22%, 0.65% to 69.21%, and 33.25% to 96.84%, respectively.
The prevalence of spousal violence was highest in Herat (92.22%), followed by Ghor (91.84%), and Wardak (87.78%), and lowest in Helmand (6.38%), followed by Badakhshan (6.86%), and Daykundi (14.28%). A dissimilar pattern was found in the prevalence of having ever witnessed father beat the mother. Its prevalence was highest in Ghor (69.21%), followed by Ghazni (67.40%), and Nangarhar (64.98%), and lowest in Helmand (0.65%), followed by Khost (6.25%) and Kapisa (8.21%). Dissimilar pattern was also found in the prevalence of acceptance of spousal violence by the respondents. Its prevalence was highest in Paktya (96.84%), followed by Nangarhar (96.60%), and Kunarha (94.49%), and lowest in Kunduz (33.25%), followed by Urozgan (43.20%) and Khost (52.85%).
Map-2 shows the bivariate associations by province, between proportion (percent) of women reporting having ever experienced any form of spousal violence perpetrated by either their current/former husband, and proportion of acceptance of spousal violence by these women. Provinces in the central part from west to east (Herat, Ghor, Wardak, Logar, Paktya, Nangarhar, and Baghlan) fell into the group with high proportions of spousal violence reporting and its higher acceptance by ever married women. Four provinces i.e. Helmand, Bamyan, Samangan, Panjsher, and Badakhshan in the south, central-north and north were in the group with low proportions of spousal violence reporting and its lower acceptance by ever married women.
While the southern province of Nimroz, and northern provinces of Jawzjan, and Kapisa had low proportions of spousal violence but its higher acceptance. None of the provinces had higher proportion of spousal violence with lower proportion of its acceptance.
Map-3 shows the bivariate associations by province, between proportion (percent) of women reporting having ever witnessed their father beat their mother, and acceptance of spousal violence by women. Strikingly, almost similar pattern was observed in terms of having witnessed parental spousal violence and acceptance of spousal violence. Two provinces Urozgan and Sar-E-Pul stood out as having high proportions of having ever witnessed father beat the mother but low acceptance of spousal violence.
Afghanistan DHS 2015 provides the only nationally and provincially representative data on the prevalence of spousal violence in the country. For the first time, these maps demonstrate the statistically representative provincial prevalence of spousal violence against women in 15-49 years old, ever married women, and its bivariate association with its acceptance by these women using DHS data. In addition to the bivariate association of acceptance of spousal violence and daughters having witnessed their father perpetrating spousal violence against their mothers. In general, there were strong associations between spousal violence, its acceptance, and having witnessed spousal violence while growing up by the ever-married women.
These associations reflect deeply entrenched cultural attitudes and norms towards spousal violence.9,14,15 The fact that child marriages are not uncommon in Afghanistan and only women aged 15 to 49 women were interviewed in DHS Afghanistan 2015, limits the generalizability of result to the entire population of the country.9
Consequently, results underscore the dire need to change the status quo and improve the lot of women in Afghanistan. Hence, to ensure better quality of life in marital settings, higher and more equal social status of women, and protecting their basic human rights would entail legal, social and cultural paradigm shift.
The Afghanistan DHS report states that 'National Action Plan for Women of the Afghanistan' the Ministry of Public Health's five-year 'National Gender Strategy', as well as Article 14 of the 'Elimination of Violence against Women law' are cognizant and are some of the endeavors to address the public health problem of spousal violence.10 The bivariate maps presented here further underscore the gravity, and magnitude of this problem in an easily comprehensible manner.
Spousal violence prevalence varies by provinces in Afghanistan and shows strong associations with acceptance of this disturbing behaviour and women having witnessed such behaviour in their own families while growing up. Bivariate maps can be a powerful tool to depict such associations in a simple way, highlighting the plight of spousal violence victims.
Conflict of Interest: None.
Funding Disclosure: None.
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