Next steps in cross-cultural research on intimate partner violence.

Abstract

of international concern and has been recognized as an important public health problem. A first step in approaching intimate partner violence (IPV) from a public health perspective is to systematically collect data on its magnitude, distribution, and consequences. This series of papers from WorldSAFE presented in this issue represent an enormous effort in achieving this first step. Multisite collaborative research is always a challenge, but more so when it involves various countries, multiple languages, and striking differences in culture, especially when dealing with sensitive issues such as IPV. WorldSAFE researchers should be commended for accomplishing these studies with such scientific rigor. The findings from this series of papers reiterate the importance of IPV in different countries. Between 11% and 43% of women interviewed in these sites report being victims of physical abuse during their lives (Hassan et al., this issue), a range similar to that reported worldwide. Similar percentages have also been exposed to psychological abuse as well (Ramiro et al., this issue). The WorldSAFE findings also begin to document the potential consequences and costs generated by IPV in these settings. IPV was significantly associated with mental health status and suicide attempts (Vizcarra et al., this issue). In addition, about 2.7% to 10% of women interviewed required medical care while 2.4% to 9.1% indicated lost productivity as a result of IPV (Hassan et al., this issue). The second step in approaching IPV from a public health perspective is understanding why it occurs. None of the risk factors explored in the WorldSAFE study were consistently associated with both physical and psychological abuse in the six settings, aside from material wealth as measured by an asset index (Bangdiwala et al., this issue). Cultural differences among the communities studied may account for the inconsistency in risk factors among the settings. Partner’s regular alcohol use was significantly associated with higher prevalence of IPV in almost all countries, but this also may be due to the cultural norms. For example, predominantly Muslim Egypt prohibits alcohol use. Whether alcohol use is causally related or a concurrent condition, needs to be established. Moreover, many of the factors explored in this initiative are difficult if not impossible to modify and not very useful for developing policies and programs to prevent IPV. Factors such as beliefs, knowledge, attitudes, and norms, which had been explored by the WorldSAFE investigators in focus groups that helped plan these studies were not quantified or included in these manuscripts given the difficulty in assessing such variables across cultures. The major known variables for perpetrator – the husband/partner, were not fully explored in these papers which concentrated on victimization. A next step for WorldSAFE investigators and others is to gain a better understanding of why IPV occurs. Research is needed on the causes and conditions that increase or decrease the risk of violence, especially those that are amenable to intervention. Estimates of IPV are highly sensitive to the definitions used, the manner in which questions are asked, the context and place of the interview, and the characteristics of the population sampled. Consequently, the resulting rates are difficult to compare. While one of the greatest strengths of these series of papers is that WorldSAFE investigators in the various countries followed a standardized protocol, there were slight differences in interview conduct (Hunter et al., this issue), in addition to the vast cultural differences among the sampled communities. The WorldSAFE project is a land-