Alcohol use, prohibition policies, and bidirectional intimate partner violence in India.

Introduction: This study examines associations between husbands' alcohol use and bidirectional intimate partner violence (IPV)-defined as both IPV victimization and perpetration-among married individuals in India. We also assess the impact of a state-level alcohol ban on IPV outcomes.

Methods: We used data from rounds 4 (2015-16) and 5 (2019-21) of the National Family Health Survey (NFHS) to conduct two analyses. First, multivariable multinomial regression models estimated the association between husbands' alcohol use-categorized as frequent intoxication, occasional intoxication, alcohol use without intoxication, and no alcohol use (reference)-and IPV experiences (bidirectional, unidirectional [victimization only], or none). Second, a Difference-in-Differences (DiD) model evaluated the impact of Bihar's 2016 alcohol ban (treatment) compared to Jharkhand (control) on IPV outcomes.

Results: Among currently married respondents (n = 121 148), 28.2% reported IPV victimization, including 2.6% reporting bidirectional IPV and 25.6% reporting unidirectional IPV. Compared to those whose husbands did not drink, women whose husbands drank without intoxication (AOR = 1.54), sometimes became intoxicated (AOR = 3.56), or frequently became intoxicated (AOR = 14.12) had significantly higher odds of experiencing bidirectional IPV. Similar but attenuated associations were observed for unidirectional IPV. The DiD analysis showed no significant effect of the alcohol ban on IPV outcomes.

Conclusion: Husbands' alcohol misuse is strongly associated with increased risk of IPV, particularly bidirectional IPV, which is linked to greater injury severity. However, alcohol bans alone may be insufficient to reduce IPV, underscoring need for comprehensive interventions that address both alcohol use and entrenched patriarchal norms.