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Correlates of intimate partner violence against women during a time of rapid social transition in Rwanda: analysis of the 2005 and 2010 demographic and health surveys

  • Dana R. Thomson1, 2,
  • Assiatou B. Bah2,
  • Wilson G. Rubanzana1, 3 and
  • Leon Mutesa4Email author
BMC Women's Health201515:96

https://doi.org/10.1186/s12905-015-0257-3

Received: 19 February 2015

Accepted: 19 October 2015

Published: 28 October 2015

Abstract

Background

In Rwanda, women who self-reported in household surveys ever experiencing intimate partner violence (IPV) increased from 34 % in 2005 to 56 % in 2010. This coincided with a new constitution and majority-female elected parliament in 2003, and 2008 legislation protecting against gender-based violence. The increase in self-reported IPV may reflect improved social power for women, and/or disruptions to traditional gender roles that increased actual IPV.

Methods

This is a cross-sectional study of IPV in 4338 couples interviewed in the 2005 and 2010 Rwanda Demographic and Health Surveys (RDHSs). Factors associated with physical or sexual IPV in the last 12 months were modeled using manual backward stepwise logistic regression. Analyses were conducted in Stata v13 adjusting for complex survey design.

Results

Risk factors for IPV in 2005 (p < 0.05) were: experiencing emotional IPV (OR = 18.1), beating husband/partner unprovoked (OR = 12.3), witnessing IPV against mother (OR = 1.82), husband/partner consumes alcohol often (OR = 3.13), and polygynous marriage (OR = 1.51), whereas having a husband/partner with secondary education (OR = 0.43) was protective. Factors associated with increased IPV in 2010 (p < 0.05) were husband/partner (OR = 1.30) or woman (OR = 1.36) believes IPV is justified, husband/partner has sex with non-marital partners (OR = 2.52), bottom wealth quintile (OR = 1.25), polygynous marriage (OR = 2.29), having a son (OR = 2.05) or only daughters (OR = 2.58) versus no children, and having a husband/partner employed with in-kind versus cash compensation (OR = 1.58). In 2010, woman being involved with her own health (OR = 0.79) or earnings (OR = 0.57) decision-making was protective against IPV. Several variables were not available in the 2010 RDHS.

Conclusions

Our results may provide evidence of both increased self-reporting of IPV and social power disruption. Rwanda’s Isange One Stop Center project, with medical, legal, and psychosocial services for domestic violence victims, is currently scaling to all 44 district hospitals, and police station gender desks reduce barriers to legal reporting of IPV. Additional support to Abunzi mediators to hear IPV cases in communities, and involvement of men in grassroots efforts to redefine masculinity in Rwanda are suggested. Additional research is needed to understand why self-reported IPV has increased in Rwanda, and to evaluate effectiveness of IPV interventions.

Keywords

Violence against women Gender based violence Domestic violence IPV GBV DHS Africa Physical Sexual

Background

Intimate partner violence (IPV) describes physical, sexual, or psychological harm by a current or past partner. Not only does IPV compromise survivors’ basic human rights, physical and sexual assault can result in direct physical harm, sexually transmitted infections, or pregnancy, and all IPV can result in long-term mental and physical health problems [1, 2]. While IPV occurs in heterosexual and same-sex couples and is perpetrated by both women and men, the majority of cases are perpetrated by male partners against female partners worldwide [3]. A World Health Organization (WHO) analysis combining data from 77 studies across 56 countries estimated that, in Africa, 37 % of women have ever experienced physical or sexual IPV [3]. These rates were similar to the Eastern Mediterranean (37 %) and South-East Asia (38 %), and higher than the Americas (30 %), Europe (25 %), and Western Pacific (25 %) [3].

Within region and country, however, experiences of IPV vary widely, underscoring differences in national histories, institutional policies, cultural identities, resources, and other factors. When comparable measures and methods are used to measure lifetime prevalence of physical and sexual violence across national surveys [47], they show that lifetime prevalence of physical or sexual violence ranges from 64 % in Democratic Republic of Congo and Bolivia, to 6 % in Canada [3]. In national surveys, physical violence includes such actions as being beat, hit, kicked, choked, burned, or threatened with a weapon. Sexual violence is defined as being physically forced or threatened to have sex or to do something sexually degrading. Two such national surveys in Rwanda found that a woman’s experience of physical or sexual IPV in her lifetime almost doubled from 34 % in 2005 [8] to 56 % in 2010 [9] placing Rwanda among the countries with the high rates of IPV against women in the world.

Rwanda is a small, densely populated country that has undergone rapid demographic, social, and economic transition in the last 20 years since the Tutsi Genocide that killed around 1 million people. In the period between 2005 and 2010, fertility rates fell from 6.1 to 4.6 children per woman, child mortality was halved from 152 to 76 deaths per 1000 live births, and the percent of women completing secondary school increased from 1.6 to 4.3 % [8, 9]. Meanwhile, representation of women in parliament has increased dramatically from 18 % before the Genocide, to 26 % during the post-genocidal transitional government (1994–2003), to 56 % in the 2008 elections when Rwanda became the first and only country in the world with a majority woman parliament.

Women’s political representation and legal protection is an important step toward gender equity. Several factors may contribute to women’s political representation in Rwanda; foremost, Rwanda’s government has prioritized women’s political inclusion. In 2003, new legislation reserved 24 of 80 parliamentary seats for women-only parliamentarians to be filled by women-only voters [10]. While the evidence is mixed about whether more women representation changes policy outcomes overall [10], key pieces of legislation in Rwanda have certainly been shaped and shepherded by women parliamentarians including the 2008 law (No. 59/2008) on Prevention and Punishment of Gender-Based Violence (GBV). Some have suggested that Rwanda’s population, which is currently comprised of more women than men as a result of men being targeted during the genocide, has contributed to women’s political representation [10], as well as additional leadership roles by women within households [11]. Many assume that these gains in women’s representation and protections reflect women’s empowerment, which makes the dramatic rise in self-reported IPV against women between 2005 and 2010 particularly striking.

Violence in intimate partnerships is a common phenomenon worldwide, and is partially attributed to couples spending lots of time with each other [12]. Time exposure, however, does not explain why women and not men are most often the target of IPV. Feminist and socio-culture explanations provide frameworks to understand IPV against women. Power theory explains increases in IPV that coincide with women’s empowerment as a result of disruptions in traditional gendered roles [13]. Social learning theory adds that violence against women is learned through witness of IPV against women in childhood, and early experiences that cement these ‘lessons’ [14]. Background/situation modeling builds on this by adding that historical and socio-cultural context further normalizes violence in relationships [14].

In Africa, systematic gender inequality is often reinforced by cultural traditions of men in roles of head of household in charge of family finances and decisions [12], as well as colonial and post-colonial histories of slavery and labor migration that resulted in the absence of adult men and the feminization of poverty within households [13]. Until discussion of the new Inheritance Law began 1998, Rwandan land ownership and inheritance law treated women like minors; a spouse or father could appropriate a woman-owned business, and it was not acceptable for a woman to speak and share her own views in public (only on behalf of her family) [14]. The near universal exposure of adults to community violence during the genocide may exacerbate any existing ideas of normalized IPV. Finally, Rwanda faces the same male–female power differentials in the media as other countries [15]. Popular media worldwide portrays sexism, devaluation of women, and direct violence against women [16], which is reinforced locally by dominant community perceptions of gender differences [15, 17]. Adding household-level triggers for violence such as financial stress or alcohol abuse can further increase risk of IPV [14, 15].

Gender roles in Rwanda are in the midst of rapid transition, and the implications for IPV are not well understood. In a qualitative study in Rwanda after 2003, women described experiencing greater respect by family and community members, new confidence to speak in public forums, more autonomy and opportunities, as well as increased friction with their brothers and husbands, perceptions that men were withdrawing from politics, and feelings that the institution of marriage had been disrupted due to rapid changes in conventional gender roles [18]. A 2010 qualitative study on the same topic found that laws protecting women’s rights were perceived by women and men as having led to loss of women’s values and respect for men, thus provoking husbands to resort to violence to re-establish order in their households; this type of violence is believed by many woman and men as normal and even necessary [19, 20]. The large increase in self-reported IPV between 2005 and 2010 may reflect greater empowerment of women to speak about a high level of violence that already existed, or it could reflect a real increase in experiences of IPV. The present paper identifies factors associated with physical or sexual IPV in Rwanda in 2005 and 2010 that might inform hypotheses and further research about IPV against women in Rwanda.

Methods

Data

This analysis is based to the 2005 and 2010 Rwanda Demographic and Health Surveys (DHSs), which are nationally and sub-nationally representative two-stage cluster samples, conducted every 5 years to monitor demographic, socioeconomic, and health indicators [8]. In both surveys, primary sampling units (PSUs) were randomly selected from a recent census listing, and urban PSUs were oversampled to increase precision of urban estimates. Questionnaires were translated into Kinyarwanda, back translated into English, and field tested before implementation. Women aged 15 to 49 were the primary respondents, answering detailed questions about themselves, their households, and their children. Men aged 15 to 59 were secondary respondents, selected from every 3rd household in 2005, and every 2nd household in 2010. Both surveys were implemented by the National Institute of Statistics-Rwanda with technical support from Macro International, Inc. and funding from USAID, and in both surveys the all-female interviewing teams received the same standardized training [8, 9].

Of the 11,321 and 13,671 women interviewed in 2005 and 2010, respectively, 4066 and 5008 were randomly selected and agreed to complete a special module about domestic violence. Only one woman per household was selected for the domestic violence module to ensure that no one else in the household knew about sensitive questions that could compromise her safety, and to minimize the total number of women asked to describe traumatic events. Female interviewers received special training to conduct secure, confidential interviews in respondents’ homes and administered the domestic violence module in face-to-face interviews; they were supposed to skip the module if a confidential interviewing environment was not possible. According to the DHS datasets, 100 % of women in 2005 and more than 99 % of women in 2010 who were selected for the domestic violence module completed it. Of the 9074 women interviewed across the two surveys, 4338 had husbands/partners who were interviewed in the men’s survey. In this analysis of 4338 couples (2005: 1888; 2010: 2450), we link women’s self-reports of intimate partner violence in the last 12 months with husband/partner’s survey responses based on wife-ID in the men’s questionnaire.

In the domestic violence module, women were asked directly about their experiences of physical and sexual violence in the last 12 months and this outcome was modeled as a binary variable. In the 2005 survey only, women reported emotional IPV, physical violence perpetrated against her husband/partner when he was not already physically hurting her, history of her father beating her mother, and frequency of husband/partner’s alcohol usage, all of which are key risk factors for IPV against women [14, 2125]. In both years, men and women were asked about their own demographic, education, and employment characteristics, as well as their perceptions of violence against women, and who makes decisions about their own health care and earnings. An adult in the household answered an additional questionnaire about household assets, and demographics of each household member including their age, sex, and household membership.

Ethics

Both the 2005 and 2010 DHSs were reviewed and approved by the Macro International Internal Review Board, Rwanda’s National Institute of Statistics, and the National Ethics Committee of Rwanda. We were granted permission by Macro International, Inc. to use these de-identified data for this analysis.

Data analysis

We used multivariable regression to identify belief or behavioral and socio-demographic factors associated with sexual or physical IPV against women in Rwanda in 2005 and 2010. We used percentages and Chi-square tests to compare (p < 0.05) socio-demographic characteristics of women in this study with married/partnered women not in the study (because their partner was not interviewed) and divorced or separated women. Then we defined 25 potential covariates and tested bivariate Chi-square distributions among women who had, and had not, experienced physical or sexual IPV in the last 12 months. Non-collinear (Pearson correlation r < 0.5) variables associated with IPV (at p < 0.1) were retained for multivariable model building. Finally, we used manual backward stepwise logistic regression, first removing variables that were least associated with IPV and retaining those variables that were associated with IPV (p < 0.05). Separate models were fit for 2005, for 2005 using the reduced set of variables available in 2010, and for 2010. The analysis was carried out in Stata version 13 using survey commands to apply sampling probability weights, account for clustering and stratification in the sample design, and perform subpopulation analysis in couples only. We presented final models as odds ratios (ORs) with 95 % confidence intervals.

Results

Self-reported IPV in the last 12 months among married/partnered women doubled from 24.1 % to 49.5 % between 2005 and 2010. In 2005 and 2010, the married/partnered women in our study were slightly younger, less educated, and less likely to work than women whose husbands/partners were not interviewed or who were divorced or separated (p < 0.05 for all) (Table 1). There was a sizable increase in the percent of women who say a man is justified to beat his wife for at least one reason from 46.5 % in 2005 to 57.0 % in 2010 (Table 1).
Table 1

Distribution of key women socioeconomic characteristics and beliefs by marital status and inclusion criteria

 

Interviewed about domestic violence

   
 

Included

     
 

% In union, partner interviewed

% In union, partner not interviewed

% Divorced, separated

X2p-value

% Widowed

% Never in union

2005

      

Woman’s age

   

<0.001

  

  15–19

1.1

0.1

0.7

 

0.0

60.0

  20–29

39.9

30.9

30.5

 

3.0

33.7

  30–39

35.4

38.1

32.5

 

27.4

4.6

  40–49

23.5

30.9

36.4

 

69.5

1.6

Woman’s education

   

0.014

  

  No school

28.3

34.1

34.1

 

40.6

8.6

  Primary

64.0

55.5

60.0

 

46.3

78.7

  Secondary or higher

7.7

10.4

5.9

 

13.1

12.7

Woman’s employment

   

0.033

  

  Employed, for cash

17.0

18.0

24.7

 

24.9

19.6

  Employed, in - kind

50.0

51.4

46.2

 

42.9

26.2

  Not working

33.0

30.7

29.1

 

32.2

54.2

Household wealth

   

0.103

  

  Top 4 quintiles

79.6

76.2

74.5

 

71.2

80.9

  Bottom quintile

20.4

23.8

25.5

 

28.8

19.1

Household residence

   

0.013

  

  Urban

12.0

14.6

17.6

 

19.9

21.6

  Rural

88.0

85.4

82.4

 

80.1

78.4

Woman believes a man can beat his wife

   

0.822

  

  0 reasons

53.5

51.7

52.2

 

57.2

52.9

  1+ reasons

46.5

48.3

47.8

 

42.8

47.1

  Total

100.0

100.0

100.0

 

100.0

100.0

  N (unweighted)

1888

448

378

 

157

1195

2010

      

Woman’s age

   

<0.001

  

  15–19

1.4

1.4

3.0

 

0.0

54.5

  20–29

42.5

30.0

30.4

 

5.2

39.7

  30–39

36.0

38.5

35.8

 

21.0

4.5

  40–49

20.1

30.1

30.8

 

73.8

1.3

Woman’s education

   

0.054

  

  No school

19.4

19.4

27.3

 

36.4

6.1

  Primary

71.2

68.6

64.4

 

53.3

66.4

  Secondary or higher

9.4

12.1

8.4

 

10.3

27.5

Woman’s employment

   

0.005

  

  Employed, for cash

56.9

52.8

65.9

 

60.5

34.6

  Employed, in - kind

22.7

28.3

16.2

 

18.8

23.6

  Not working

20.4

18.9

18.0

 

20.8

41.8

Household wealth

   

<0.001

  

  Top 4 quintiles

82.5

74.3

68.7

 

74.2

86.2

  Bottom quintile

17.5

25.7

31.3

 

25.8

13.8

Household residence

   

0.697

  

  Urban

12.7

13.7

14.4

 

17.7

18.3

  Rural

87.3

86.3

85.6

 

82.3

81.7

Woman believes a man can beat his wife

   

0.165

  

  0 reasons

43.0

43.8

36.7

 

43.4

47.7

  1+ reasons

57.0

56.2

63.3

 

56.6

52.3

  Total

100.0

100.0

100.0

 

100.0

100.0

  N (unweighted)

2450

493

269

 

264

1532

In bivariate analysis in 2005, sexual or physical IPV was associated with emotional IPV (84.7 %), witnessing physical violence by father against mother as a child (31.5 %), and having a partner who consumes alcohol often (54.3 %) (p < 0.001 for all) (Table 2). IPV was also high in relationships where the wife reported beating her husband/partner when he was not already hurting her (82.4 %, p < 0.001), though only nine women (<1 %) reported this behavior. No other beliefs or behaviors were associated with IPV in 2005. A number of socio-demographic factors were associated with IPV in 2005 (p < 0.1) including rural residence, polygynous marriage, having any children, there being no adults other than the couple in the household, having a husband/partner with less than secondary education, and the woman having less than secondary education.
Table 2

Bivariate associations of physical or sexual IPV in the last 12 months with behavioral and socio-demographic characteristics

 

2005

2010

Source Questionnaire

 

N (weighted)

% IPV

95 % CI

X2

N (weighted)

% IPV

95 % CI

X2

p-value

p-value

Beliefs and behaviors

         

Emotional violence by partner last 12 months

   

<0.001

    

Women

  No

1432

19.4

[17.4,21.5]

 

Not

    

  Yes

105

84.7

[76.4,90.5]

 

available

    

Woman beat partner unprovoked last 12 months

   

<0.001

    

Women

  No

1535

23.7

[21.6,25.9]

 

Not

    

  Yes

9

82.4

[49.0,95.8]

 

available

    

Woman’s father beat mother

   

<0.001

    

Women

  No

1028

20.4

[18.1,23.0]

 

Not

    

  Yes

507

31.5

[27.4,35.8]

 

available

    

Partner consumes alcohol very often

   

<0.001

    

Women

  Never or sometimes

1358

19.8

[17.8,21.9]

 

Not

    

  Very often

184

54.3

[46.5,61.8]

 

available

    

Partner believes a man can beat his wife

   

0.188

   

0.003

Men

  0 reasons

1196

23.2

[21.0,25.7]

 

1638

47.9

[45.2,50.5]

  

  1+ reasons

347

26.9

[22.2,32.3]

 

407

56.1

[51.5,60.6]

  

Woman believes a man can beat his wife

   

0.108

   

<0.001

Women

  0 reasons

828

22.5

[19.8,25.4]

 

879

43.7

[40.4,47.0]

  

  1+ reasons

718

25.9

[22.9,29.2]

 

1165

54.0

[50.9,57.0]

  

Woman involved in her own health decisions

   

0.134

   

<0.001

Women

  Partner only, other

654

26.1

[22.8,29.7]

 

553

56.6

[52.0,61.0]

  

  Woman involved

892

22.6

[19.9,25.6]

 

1494

46.9

[44.4,49.5]

  

Woman involved with decisions about her earnings

   

0.249

   

<0.001

Women

  Partner only, other

65

32.5

[23.5,43.0]

 

224

64.8

[58.0,71.1]

  

  Woman involved

217

26.1

[20.3,32.8]

 

1079

48.3

[45.2,51.3]

  

  No earnings

913

22.7

[20.0,25.6]

 

534

45.0

[40.7,49.4]

  

  Not working

347

24.8

[20.4,29.7]

 

206

51.4

[44.9,57.9]

  

Partner had sex with non-wife last 12 months

   

0.552

   

<0.001

Men

  No

1468

24.0

[21.8,26.2]

 

1971

48.7

[46.4,51.1]

  

  Yes

78

26.7

[18.5,36.8]

 

75

71.0

[60.9,79.3]

  

Woman says it is okay to refuse sex

   

0.709

   

0.008

Women

  No

485

24.7

[21.2,28.5]

 

445

55.4

[50.3,60.3]

  

  Yes

1059

23.8

[21.2,26.6]

 

1600

47.9

[45.4,50.4]

  

Woman says it is okay to request use of condom

   

0.927

   

0.008

Women

  No

848

24.0

[21.1,27.2]

 

445

55.4

[50.3,60.3]

  

  Yes

695

24.2

[21.1,27.6]

 

1600

47.9

[45.4,50.4]

  

  Socio-demographics

         

Woman’s age

   

0.739

   

0.091

Women

  15–19

18

18.7

[7.5,39.7]

 

29

29.9

[17.3,46.4]

  

  20–29

620

25.4

[22.3,28.8]

 

870

48.0

[45.0,51.0]

  

  30–39

547

23.4

[20.3,26.7]

 

737

51.3

[47.6,54.9]

  

 40–49

361

23.2

[18.5,28.8]

 

411

51.0

[45.1,57.0]

  

Difference in partner and woman age

   

0.706

   

0.638

Women & Men

  Woman older

238

25.4

[20.5,30.9]

 

360

50.2

[45.2,55.2]

  

  Same age, partner 0–4 years older

691

24.8

[21.7,28.3]

 

945

49.2

[46.0,52.5]

  

  Partner 5–9 years older

369

22.0

[18.1,26.4]

 

477

51.3

[46.6,55.9]

  

  Partner 10+ years older

248

23.9

[19.2,29.5]

 

265

46.5

[40.4,52.6]

  

Household wealth

   

0.516

   

0.005

Household

  Top 4 quintiles

1229

23.7

[21.5,26.1]

 

1689

48.2

[45.7,50.7]

  

  Bottom quintile

317

25.6

[20.7,31.1]

 

358

55.8

[50.8,60.6]

  

Household residence

   

0.084

   

0.037

Household

  Urban

187

19.4

[14.7,25.1]

 

259

43.4

[37.7,49.4]

  

  Rural

1360

24.7

[22.5,27.2]

 

1788

50.4

[47.9,52.9]

  

Polygynous couple

   

<0.001

   

<0.001

Women

  No

1388

22.3

[20.2,24.5]

 

1926

48.2

[45.9,50.5]

  

  Yes

156

40.2

[32.7,48.2]

 

116

70.0

[59.7,78.6]

  

Woman’s children

   

0.040

   

<0.001

Women

  Has no children

101

14.1

[8.7,22.1]

 

138

30.8

[23.1,39.7]

  

  Has at least one son

1195

24.9

[22.4,27.5]

 

1558

51.9

[49.2,54.6]

  

  Has daughters only

250

24.5

[20.0,29.6]

 

351

46.4

[41.6,51.2]

  

Number of children <15 in household

   

0.229

   

0.003

Household

  None

95

16.2

[10.4,24.4]

 

131

34.2

[27.0,42.2]

  

  1 or 2

592

23.7

[20.4,27.4]

 

881

49.7

[46.5,52.8]

  

  3 or 4

611

25.8

[22.5,29.5]

 

763

51.5

[47.9,55.2]

  

  5+

249

23.7

[18.6,29.7]

 

272

50.8

[44.3,57.2]

  

Number of adults in addition to couple in household

   

0.087

   

0.167

Household

  None

1042

26.1

[23.6,28.7]

 

1343

50.8

[48.3,53.3]

  

  1 or 2

393

20.8

[16.4,26.1]

 

558

48.8

[44.1,53.6]

  

  3+

111

16.8

[9.4,28.3]

 

146

40.2

[28.9,52.7]

  

Partner’s employment

   

0.628

   

<0.001

Men

  Employed, for cash

700

25.1

[22.0,28.4]

 

1630

47.7

[45.1,50.3]

  

  Employed, in - kind

202

23.9

[18.9,29.7]

 

390

58.4

[54.1,62.6]

  

  Not working

636

22.9

[19.8,26.4]

 

25

34.9

[17.4,57.7]

  

Partner’s education

   

<0.001

   

0.020

Men

  Less than secondary

1376

25.6

[23.3,28.0]

 

1804

50.6

[48.2,53.1]

  

  Secondary or higher

170

12.2

[8.3,17.7]

 

243

41.4

[34.3,48.8]

  

Woman’s employment

   

0.204

   

0.002

Women

  Employed, for cash

264

28.3

[23.2,34.1]

 

1165

52.9

[49.8,55.9]

  

  Employed, in - kind

773

23.7

[20.8,26.9]

 

464

45.1

[40.4,49.8]

  

  Not working

507

22.6

[19.2,26.4]

 

419

45.1

[40.8,49.5]

  

Woman’s education

   

0.002

   

0.073

Women

  No school

438

22.5

[18.9,26.6]

 

396

48.3

[43.1,53.5]

  

  Primary

988

26.1

[23.5,29.0]

 

1458

50.8

[48.1,53.5]

  

  Secondary or higher

121

13.2

[8.6,19.6]

 

193

42.1

[35.2,49.2]

  

 IPV overalla

1546

24.1

[22.0,26.3]

 

2047

49.5

[47.2,51.8]

  

a Covariate frequencies may not add to total due to missing responses

In 2010, many of the same socio-demographic factors were associated with IPV, however, a number of beliefs and behaviors were newly associated with IPV (p < 0.1) including partner believes a man can beat his wife, woman believes a man can beat his wife, woman is not involved with her own health decision-making, woman is not involved with decision-making about her earnings, husband/partner has sex with non-wife partner(s), and the woman says she cannot refuse sex with her partner or request use of a condom.

In the 2005 multivariable analysis, two factors stand out as being strongly associated with IPV (Table 3). Women who experienced emotional IPV in the last year had 18 times the odds (p < 0.001) of sexual or physical IPV, and women who reported beating their husband/partner unprovoked had 12 times the odds (p < 0.01) of sexual or physical IPV. Having a partner that consumes alcohol very often (OR = 3.13, p < 0.001), witnessing physical IPV against her mother in childhood (OR = 1.82, p < 0.001), and being in a polygynous marriage (OR = 1.51, p < 0.05) were also associated with increased odds of sexual or physical IPV. Women who had a partner with secondary or higher education had lower odds of IPV (OR = 0.43, p < 0.01). When emotional violence, woman beats husband/partner unprovoked, woman witnessed IPV against mother in childhood, and husband/partner consumes alcohol often were removed from the model to make it comparable to the 2010 analysis, two additional demographic characteristics were associated with IPV: women’s primary education versus no education (OR = 1.40, p < 0.05), and woman has at least one son (OR = 2.04, p < 0.05) or daughters only (OR = 2.11, p < 0.05) versus no children.
Table 3

Multivariable odds ratios between risk factors and sexual or physical IPV in the last 12 months

 

2005

2010

 

Full

Reduced

Full

Reduced

Full

Reduced

Beliefs and behaviors

      

Emotional violence by partner last 12 months

      

 No

1.00

1.00

  

Not

Not

 Yes

19.0***

18.1***

  

available

available

Woman beat partner unprovoked last 12 months

      

 No

1.00

1.00

  

Not

Not

 Yes

10.8*

12.3**

  

available

available

Woman’s father beat mother

      

 No

1.00

1.00

  

Not

Not

 Yes

1.80***

1.82***

  

available

available

Partner consumes alcohol very often

      

 Never or sometimes

1.00

1.00

  

Not

Not

 Very often

3.16***

3.13***

  

available

available

Partner believes a man can beat his wife

      

 0 reasons

1.00

 

1.00

 

1.00

1.00

 1+ reasons

1.11

 

1.12

 

1.29*

1.30*

Woman believes a man can beat his wife

      

 0 reasons

1.00

 

1.00

 

1.00

 

 1+ reasons

1.00

 

1.03

 

1.35**

1.36**

Woman involved in her own health decisions

      

 Partner only, other

1.00

 

1.00

 

1.00

1.00

 Woman involved

0.80

 

0.84

 

0.78*

0.79*

Woman involved with decisions about her earnings

      

 Partner only, other

1.00

 

1.00

 

1.00

1.00

 Woman involved

1.04

 

0.93

 

0.59**

0.57**

 No earnings

0.71

 

0.64

 

0.48***

0.47***

 Not working

0.75

 

0.72

 

0.65*

0.62*

Partner had sex with non-wife last 12 months

      

 No

1.00

 

1.00

 

1.00

1.00

 Yes

0.94

 

1.13

 

2.49***

2.52***

Woman says it is okay to refuse sex

      

 No

1.00

 

1.00

 

1.00

 

 Yes

1.05

 

0.98

 

0.81

 

Socio-demographics

      

Woman’s age

      

 15–19

1.00

 

1.00

 

1.00

 

 20–29

1.15

 

1.22

 

1.47

 

 30–39

1.07

 

1.09

 

1.62

 

 40–49

1.48

 

1.33

 

1.89

 

Household wealth

      

 Top 4 quintiles

1.00

 

1.00

 

1.00

1.00

 Bottom quintile

0.98

 

0.99

 

1.22

1.25*

Household residence

      

 Urban

1.00

 

1.00

 

1.00

 

 Rural

1.44

 

1.17

 

1.06

 

Polygynous couple

      

 No

1.00

1.00

1.00

1.00

1.00

1.00

 Yes

1.55*

1.51*

2.35***

2.41***

2.31***

2.29**

Woman’s children

      

 Has no children

1.00

 

1.00

1.00

1.00

1.00

 Has at least one son

1.95

 

2.04*

2.04*

1.67

2.05**

 Has daughters only

2.24*

 

2.13*

2.11*

2.09*

2.58***

Number of children <15 in household

      

 None

1.00

 

1.00

 

1.00

 

 1 or 2

0.98

 

1.00

 

1.30

 

 3 or 4

0.99

 

1.20

 

1.23

 

 5+

1.04

 

1.17

 

1.18

 

Number of adults in addition to couple in household

      

 None

1.00

 

1.00

 

1.00

 

 1 or 2

0.61*

 

0.67*

 

0.90

 

 3+

0.49

 

0.47

 

0.63

 

Partner’s employment

      

 Employed, for cash

1.00

 

1.00

 

1.00

1.00

 Employed, in - kind

0.77

 

0.76

 

1.54***

1.58***

 Not working

0.72*

 

0.85

 

0.67

0.65

Partner’s education

      

 Less than secondary

1.00

1.00

1.00

1.00

1.00

 

 Secondary or higher

0.46**

0.43**

0.44**

0.45**

0.88

 

Woman’s education

      

 No school

1.00

 

1.00

1.00

1.00

 

 Primary

1.34

 

1.38*

1.40*

1.30

 

 Secondary or higher

0.85

 

0.88

0.88

1.27

 

N (weighted)a

1502

1520

1527

1544

2027

2029

***p < 0.001, **p < 0.01, *p < 0.5

aSample size reduced by missing responses among covariates

Several beliefs and behaviors that were not associated with IPV in 2005 were significant in the 2010 multivariate analysis. Partner believes a man is justified to beat his wife (OR = 1.30, p < 0.05), woman believes a man is justified to beat his wife (OR = 1.36, p < 0.05), and partner has sex with non-wife partner(s) (OR = 2.52, p < 0.001) were all associated with greater odds of IPV. Furthermore, woman being involved with decisions about her own health (OR = 0.79, p < 0.05) or about her own earnings (OR = 0.57, p < 0.05) versus her partner alone were protective against IPV. Being a household in the bottom wealth quintile (OR = 1.25, p < 0.05), being in a polygynous marriage (OR = 2.29, p < 0.01), having a son (OR = 2.05, p < 0.01) or only daughters (OR = 2.58, p < 0.001) versus no children, and having a partner employed with in-kind versus cash earnings (OR = 1.58, p < 0.001) were associated with greater odds of IPV.

Discussion

Physical or sexual intimate partner violence (IPV) self-reported in household surveys doubled between 2005 and 2010 which coincided with a rise in the percent of women who say that IPV is justified from 46.7 % to 57.0 %. In 2010, nearly half of all partnered women experienced physical or sexual IPV in the previous 12 months, and IPV tended to occur in tandem with multiple other forms of violence. Our 2005 finding that women who experienced emotional violence [26], who witnessed IPV as a child [2124], or who were violent toward their husband/partner [26] were more likely to self-report IPV in the last year is consistent with other studies. The huge differential in experience of IPV among women versus male partners in 2005 suggests that violence against women is normalized. This is supported by surveys from around the world that find a high proportion of women and men believe that IPV against women is justified [17, 25]. We discuss two potential hypotheses for the sharp rise in self-reported IPV in Rwanda, and ways that individuals and communities might address IPV against women. Since women in this study were somewhat different from other partnered women, particularly divorced or separated women, caution should be used when generalizing these results.

Individuals and couples

In our study, IPV was associated with high alcohol usage by husbands/partners, which is consistent with findings from diverse settings including Brazil, Kenya, and India [24, 2729]. Other studies found that both woman’s and men’s alcohol usage was an important factor for IPV [22, 24]. Alcohol use directly affects cognitive and physical function, reducing self-control and leaving individuals less capable of negotiating a non-violent resolution to conflicts within relationships [30]. Excessive drinking by one partner can exacerbate financial difficulties, child abuse, infidelity or other stressful situations, which may fuel conflicts between partners. Because alcohol dependency is linked to numerous health and social problems for drinkers, their families, and communities [31], alcohol dependency is estimated to account for 4 % of global disability adjusted life years (DALYs) [32]. Responsible drinking campaigns, alcohol advertising bans, drinking and driving laws, and increased pricing of alcohol can be implemented by governments to deter drinking, and training of health, social, and legal professionals to support individuals who seek alcohol treatment can help to address IPV risk within couples [31].

Our 2010 finding that IPV was associated with husbands/partners who earned in-kind rather than cash compensation may provide evidence of social power disruptions within relationships as a source of increased incidence of IPV in Rwanda. In-kind rather than cash compensation may be related to the husband/partner having low education [21, 22, 33] which limits income potential, job security, and contributes to financial stress at home, a trigger for violence [28], whereas men who attend secondary school are typically exposed to ideas of human rights and gain skills for self-expression, which can reduce tolerance of IPV [28, 34]. In Rwanda, men have traditionally been heads of household, the primary cash earners, and decision-makers about household resources, however this has changed rapidly in recent years. Qualitative research about the impacts of Rwanda’s improved opportunities for women found that, in addition to numerous positive outcomes, non-submissive, independent women experienced increased conflict within their relationships when husbands felt their own roles were challenged or that their wives where skirting home responsibilities [18]. In India, South Africa, and elsewhere, increases in IPV have been linked with rapid changes in gender roles, including changes in husband/partner employment [31, 35]. In these settings, involvement of men in redefining masculinity has been important toward shifting public opinion about IPV and reducing incidence of IPV [34, 36]. The rise in reported acceptance of IPV among women in Rwanda suggests that women, too, are in need of involvement and support to redefine gender roles.

Certain family dynamics such as polygynous marriage and having children are slow to change in response to women’s changing roles in society, and it is therefore not surprising that these two factors remained significantly associated with IPV across years in our study. The practice of polygyny in Rwanda is illegal, uncommon, and may be falling [32]. In 2005, 12 % of married women were in a polygynous union, and in 2010, 8 % of women reported being in polygynous union [9]. Hypothesized links between polygyny and IPV are that the presence of more than two spouses contributes to more marital disagreement [37], and that the practice of polygyny reflects acceptance of male dominance in intimate partnership [38]. The link between having a child and increased risk of IPV among women could reflect that men who act violently toward their spouse/partner are also likely to act violently toward children [39]. Our finding that number of children in the household was not associated with IPV suggests that IPV in the context of having children is not instigated by economic or parenting stressors alone. Other studies found that in households with multiple forms of domestic violence including violence toward children, the level of violence against women sometimes increased if the woman directed aggression or neglect toward the child, or if she intervened in violence toward the children [40].

Communities

While there is great variability in risk factors for IPV across countries, IPV beliefs and behaviors are commonly associated with IPV incidence [41, 42]. The addition of numerous belief and behavioral risk factors for IPV in the 2010 analysis may be evidence of improved reporting of IPV. Improved self-reporting during the time of this study is expected as a result of new laws and programs. Several laws passed between 1998 and 2008 addressed sexual violence used during the Genocide, the 2003 constitution created gender quotas and promoted gender equality, and the 2008 law on Prevention and Punishment of GBV made domestic violence illegal. To help overcome fears by women victims of IPV that their reports of violence will not be taken seriously, nearly all police stations staff a gender desk with trained, usually female, personnel. In 2009, the Rwanda National Police in partnership with the Ministry of Health and with the technical and financial support of UN agencies, namely UNICEF, UNWOMEN and UNFPA, launched the One Stop Center project that offers free, integrated medical, psycho-social, and legal services to victims of IPV and child abuse. In 2014, Isange One Stop Center Scale Up Project was launched with an aim of establishing this multidisciplinary service in all 44 district hospitals.

Given the complexity of IPV and the mixed evidence in this analysis, the higher incidence of IPV in 2010 may have resulted from both improved self-reporting and increased incidence of IPV due to social disruption. As such, we recommend multiple avenues to address IPV in Rwanda at a social-level. To the extent that prevalent violence against women already existed due to entrenched social, cultural, or historical norms, or has been inflamed by disrupting those norms, we recommend improved legal systems to protect women against violence, and campaigns to reduce acceptance of IPV and to redefine gender roles.

Extending legal protections

An alternative to the One Stop Center program is the Abunzi community mediation system [36] which was introduced in 2004 to deal with a backlog of cases in the court system, and has since been formalized with the creation of an Abunzi Secretariat which oversees mediator training and coordination with the Ministry of Justice. Like the gacaca courts, which heard genocide cases, the Abunzi system is a hybrid of traditional and modern methods of conflict resolution, and is perceived by many as more accessible and responsive than legal courts. Each Abunzi committee is comprised of at least 12 members, 30 % of whom are supposed to be women, and serve a local group of villages. While the Abunzi system may present fewer social barriers to victims of IPV than the justice system, many Abunzi committees do not maintain 30 % + women representation, mediations are public, and mediators are often unfamiliar with existing laws and turn to customary laws that may be prejudiced against women [41]. The Abunzi system may be a positive forum for certain IPV cases, especially if the victim is comfortable with the process, and the system is able to support couples to effectively communicate through differences that prevent future violence. However, better support and training of Abunzi mediators is needed to appropriately protect victims of domestic violence according to national law.

Redefining the roles of women and men in society

Pressure on men to change their behaviors and perception of themselves as men without well-formed alternative models of masculinity will not lead to sustained reductions in violence [28, 42]. This is likely true of women in terms of femininity, as well. As such, effective IPV policies and programs require men’s participation in redefining masculinity. Although much work has already taken place in Rwanda to redefine gender roles, it has happened relatively recently mostly through top-down approaches [14]. Successes include the 2008 law against gender-based violence which was brought to parliament by four women and four men who effectively fostered buy-in from the mostly male parliament at that time [43]. Other programs to prevent and respond to gender-based violence have been implemented within the Rwanda National Police and the Rwanda Defense Force, and gender quotas have been adopted for UN peace keeping forces [20]. Among the only grassroots initiatives on this issue in Rwanda, however, is the Men’s Resource Centre (RWAMREC) which is run by men who advocate for gender equity and promotion of non-violent ideals of masculinity [20].

Perhaps as a result of atypically top-down approaches, Rwandans overall hold highly inequitable attitudes about gender roles; for example, 61 % of Rwandan men agree with the statement “changing diapers, giving kids a bath and feeding kids are the mother’s responsibility” [44], and DHSs show increasing rather than decreasing tolerance for IPV. More bottom-up approaches may be needed in Rwanda. Grassroots approaches that have proven successful to shift attitudes about gender and IPV in other African contexts include single-sex group trainings with dialogues [45]. Although RWAMREC sensitizes communities to IPV laws during umaganda, the monthly national day of service, and facilitates dialogues about IPV in umugoroba w’abashakanye evening meetings of five to ten couples [20], further initiatives like these, along with time, may be needed to shift attitudes toward gender roles in Rwanda.

The doubling in self-reported IPV in Rwanda between 2005 and 2010 is deeply concerning, and further investigations of reasons for this increase are urgently needed. This study summarizes trends, correlates, and broad hypotheses for IPV, however, the cross-sectional nature of the DHS does not allow us to draw causal conclusions about predictors or consequences of IPV. Furthermore, measurement of physical and sexual IPV in household surveys is subject to under-reporting due to interviewer traits and difficulty securing privacy in smaller, densely populated homes [46]. We find it unrealistic that privacy was secured in 100 % (2005) and >99 % (2010) of interviews, and suspect that under-reporting of IPV occurred in both surveys. Finally, the 2010 DHS did not ask about emotional violence, IPV witnessed in childhood, woman’s violence against her husband/partner, and alcohol usage, all of which are important risk factors for IPV that could not be tested in our 2010 analysis.

The 2015 DHS was recently completed but not released at the time of this writing, and results from that survey might provide important insight about trends in IPV. Preliminary results of the 2015 DHS indicate continued rapid economic development in Rwanda, which is expected to correlate with a drop in IPV [12, 17]. We recommend additional research to tease out to what extent-increased self-reports of IPV are due to increased incidence of IPV versus greater empowerment by women to report violence. Researchers should investigate how changes in gender roles in Rwanda, and the unique demographic distribution of women and men in Rwanda, may relate to experiences of IPV. Furthermore, research is needed to evaluate the effectiveness of IPV interventions such as police station gender desks, district hospital Isange One Stop Centers toward reducing incidence of IPV. Concerns about how well Abunzi mediators are able to address IPV should be investigated. Campaigns that involve men and women in redefining gender roles could be an important contribution to the gender equality agenda moving forward in Rwanda, and the effects of these campaigns on IPV and IPV perceptions should be systematically evaluated.

Conclusions

Rwanda has one of the highest self-reported rates of intimate partner violence against women worldwide, and multiple forms of current or past violence are reported by the same women. Doubling in self-reported violence between 2005 and 2010 coincided with major political and social gains. While the Rwandan health and legal sectors have multiple initiatives to support victims, additional campaigns may be needed to shift public perception and perpetration of intimate partner violence. The impact of these programs, and changes in reported violence, need further investigation.

Declarations

Acknowledgments

We thank Shafiga Murebwayire, Coordinator of the Isange One Stop Center project, for her insights to the daily experiences of women and men reporting intimate partner violence, and Bethany Hedt-Gauthier and Daniel Corsi for their valuable input about statistical methodologies. We also thank Mara Goldman and Kristin Dunkle for their very helpful reviews and suggestions to improve this manuscript.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
School of Public Health, College of Medicine and Health Sciences, University of Rwanda
(2)
Department of Global Health and Social Medicine, Harvard Medical School
(3)
Isange One Stop Center Scale up Project, Rwanda National Police
(4)
College of Medicine and Health Sciences, University of Rwanda

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