Physical and sexual intimate partner violence may have lasting effects on a woman's health, according to a recent multicountry study by the World Health Organization.¹ Compared with women who had never been abused, those who had suffered intimate partner violence had 60% greater odds of being in poor or very poor health, and about twice the odds of having had various health problems, such as memory loss and difficulty walking, in the past four weeks.

Unlike previous research on the health effects of intimate partner violence, which has mostly focused on small clinical samples of women in developed countries, the new analysis used a population-based sample of 19,568 ever-partnered women aged 15–49 at 15 sites in 10 countries. In most of the countries, the study was conducted in a rural province (Ethiopia), a large city (Japan, Namibia, Serbia and Montenegro) or both (Bangladesh, Brazil, Peru, Thailand and Tanzania); in Samoa, the whole country was sampled. Between 2000 and 2003, the researchers interviewed women about their health and their experience with physical and sexual intimate partner violence. Women were asked to rate their health as either excellent, good, fair, poor or very poor, and to note whether in the past month they had had various physical symptoms, such as memory loss or difficulties with daily activities, and symptoms of emotional distress, such as crying and inability to enjoy life. In addition, women were asked if they had ever attempted suicide or had suicidal thoughts. The researchers assessed women's experiences of physical and sexual violence in the past 12 months and in their lifetime; they used a composite variable that encompassed both physical and sexual abuse because a previous analysis had shown that 20–50% of women had suffered both kinds of abuse, making it difficult for the investigators to determine the effects of either type alone. The investigators conducted regression analyses to examine the relationship between abuse and health outcomes, adjusting for women's location, age, marital status and level of education.

Across sites, 15–71% of women reported that a current or former partner had abused them physically, sexually, or both during their lifetime. In every country but Samoa, women who had been abused were more likely than those who had not to report being in poor or very poor health (odds ratio, 1.6). Moreover, the odds of having had pain (1.6), difficulty walking (1.6), memory loss (1.8), dizziness (1.7), vaginal discharge (1.8) or difficulties with daily activities (1.6) in the past month were elevated among abused women.

In addition to suffering recent physical problems, significant proportions of abused women (ranging from 19% in Ethiopia to 55% in Peru's provincial site) said that they had been injured at some point in their lives during a partner's assault. The majority of these women reported having been injured once or twice, but at seven study sites at least 20% had been injured six or more times. Although most of the injuries had been minor, such as bruises or bites, some women reported more serious consequences; for example, one-half of injured women in Bangladesh and the Peruvian province, and 8–34% of injured women elsewhere, had lost consciousness. Between 23% and 80% of injured women indicated that they had needed medical treatment as a result of a partner's assault.

Symptoms of emotional ill health were also associated with intimate partner violence: Abused women were more likely than other women to have ever had suicidal thoughts (odds ratio, 2.9) or to have ever attempted suicide (3.8). Suicidal thoughts were associated with intimate partner violence in every country but Ethiopia. More generally, abused women in all sites had higher levels of emotional distress than did women who had not been abused.

The researchers note that because the study was cross-sectional, they could not determine if abuse had caused the physical and mental health problems that women reported; it is possible, the investigators acknowledge, that women in ill health might have an elevated risk of experiencing intimate partner violence. However, they noted in a previous report on this sample that in every study country except Ethiopia, one-third of abused women had not been assaulted in the previous year, which suggests that abuse frequently preceded and may have caused the health problems. Moreover, the consistent association between poor health and lifetime experience of abuse among women of such varied backgrounds and circumstances is "striking," according to the researchers. Given that intimate partner violence not only violates the rights of the abused partner but results in increased "health expenditures and human suffering," they recommend greater policy and programmatic attention to partner violence. —S. Ramashwar

REFERENCE

1. Ellsberg M et al., Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study, Lancet, 2008, 371(9619):1165–1172.