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Abstract
Background Domestic violence is a global issue of public health concern with detrimental effects on women’s physical, mental and social well-being. There is a paucity of community-based studies assessing the knowledge and attitude of women towards domestic violence in Nigeria.
Objective To assess knowledge, attitudes, prevalence and associated factors of domestic violence among women in a community in Kaduna, Nigeria.
Design A descriptive cross-sectional study.
Setting A selected community in Kaduna South Local Government Area in Kaduna State.
Participants In total, 170 women aged 15–49 years participated in the study.
Primary and secondary outcome measures The outcomes were knowledge, attitude and prevalence of domestic violence.
Results The mean age of the respondents was 28.7+7.9 years. A total of 113 (66.5%) respondents had high level of knowledge about domestic violence with 114 (67.1%) having non-tolerant attitudes towards domestic violence. The lifetime prevalence and 12-month prevalence of domestic violence were 47.1% and 35.3%, respectively. The results of logistic regression identified the educational status of women as a significant predictor of knowledge of domestic violence (adjusted OR (aOR)=0.32; 95% CI 0.15 to 0.68), while marital status (aOR=0.21; 95% CI 0.05 to 0.96), occupation of women (aOR=2.49; 95% CI 1.13 to 5.49), their tolerance of wife beating (aOR=0.33; 95% CI 0.15 to 0.72) and their partners’ consumption habit of alcohol/substance use (aOR=7.91; 95% CI 3.09 to 20.27) were identified as significant predictors of the women’s experience of domestic violence.
Conclusion Domestic violence was relatively high among women. Though a majority had high level of knowledge about domestic violence, a significant third had tolerant attitudes towards it. Appropriate health interventions need to be implemented by governmental and relevant stakeholders to target negative attitudes and address associated factors of domestic violence against women.
- public health
- primary care
- mental health
- epidemiology
- ethics (see medical ethics)
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request. All data relevant to the study are included in the article. Data are available on request by email to the corresponding author.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Strengths and limitations of this study
This study provides context to knowledge attitude and prevalence of domestic violence among women in Kaduna State, north-western Nigeria, using the Conflict Tactics Scale.
The response rate was high (100%) despite the sensitive nature of the issue.
Only women were interviewed and the potential for biased responses on their husband’s/partner’s behavioural characteristics cannot be discounted.
This study was cross-sectional, so a causal relationship could not be confirmed.
Introduction
Domestic violence (DV) against women is a hidden global epidemic that occurs in all countries with detrimental effects on the health and well-being of women. The physical, mental, sexual and reproductive health of millions of women and families is adversely affected by DV. It has dire social and economic consequences and costs for families, communities and societies.1 DV has been increasingly recognised as a serious public health problem and a violation of women’s human rights.2 The right to life and the right to bodily integrity are core fundamental rights that are protected under the international law. The WHO defines DV as the intentional use of physical force or power, threatened or actual, against oneself, another person, against a group or a community that results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.2 Although both men and women can be victims, the prevalence and detrimental effects of DV, particularly of sexual and physical violence, are higher among women.3
DV occurs internationally in both developing and developed countries, irrespective of culture, religion or socioeconomic class, and differs in prevalence, types and extent from one country to another.4 According to the World’s Women 2020: Trends and Statistics report, around one-third of women worldwide have experienced physical and/or sexual violence by an intimate partner.5 Some 18% of women have experienced such violence in the last 12 months. In extreme cases, violence against women is lethal. Globally, an estimated 137 women are killed by their intimate partner or a family member every day. The countries of sub-Saharan Africa (SSA) have very high levels of violence against women and mostly where socioeconomic status is low and education is limited.6 In Nigeria, one in four women have experienced a form of DV, common among young women and dwellers of rural areas.7 The National Demographic and Health Survey (NDHS) 2008 and 2013 data revealed that 18% and 16% of ever-married women were reported having experienced physical or sexual DV from their male spouse, respectively.8 9 The issue of DV is more relevant now during the COVID-19 pandemic as the lockdowns and the social and economic impacts have more likely increased the exposure of women to abusive partners and known risk factors while limiting their access to services.
Studies have revealed several factors that perpetuate DV. These include cultural factors like cultural beliefs about the superiority of men and inferiority of women, cultural acceptance of violence as a private affair and societal acceptability of violence as a means of resolving discords.10 Legislation and policies that discriminate against women also provide avenues for perpetuating act of violence against women.11 Sadly, legal provisions in about 155 countries have been shown to be discriminatory against women.11 Some of these include laws placing men as heads of households, legally requiring wives to obey their husbands, legal restrictions on types of jobs women can do and laws that deny women the same right to access land as men.12 13
Nigeria, despite being a signatory to many international laws protecting women from DV such as the Convention on the Elimination of All Forms of Discrimination Against Women, African Charter on Human and Peoples’ Rights, among others, has failed to domesticate such legislation at the national level, with just a few states adopting the legislation with variable success in terms of implementation.7
Scholars have strongly argued that attitude changes towards DV is an essential component for sustaining DV interventions.14 Improved knowledge can increase the management of DV while improved attitudes can reduce the acceptance and justification of DV.15 Public awareness campaigns and other interventions delivered via television, radio, newspapers and other mass media can be effective for altering attitudes towards gender norms.16 The most successful have been those that sought to understand their target audience and engage with its members to develop content. There is a paucity of community-based studies assessing the knowledge and attitude of women towards DV in Kaduna State. This study assessed the current levels of knowledge, attitude to and prevalence of DV and associated factors among women in a community in north-western Nigeria.
Materials and methods
This cross-sectional study was carried out in Kaduna South Local Government Area (LGA), Kaduna State, north-western Nigeria, from June to July 2019. It has an area of 59 km2 and an estimatedpopulation of 402 390.17 The settlement is typically urban and located within Kaduna metropolis—the capital of the fourth largest State in the most populous African country in the world. Women of reproductive age group between the ages of 15 and 49 years were included in the study. The minimum sample size was determined using a single population formula (n=z2p(1−p)/d2), where z is the normal SD set at 1.96, with a confidence level specified at 95% and a tolerable margin of error (d) at 5%, considering 10% non-response rate and prevalence of violence (p) at 11%.18 The calculated sample size for this was 165 which was approximated to 170; the women were selected through a multistage sampling technique.
Data collection tool and procedures
A pretested, structured, interviewer-administered questionnaire adapted from the Revised Conflict Tactics Scale (CTS-2) was used to assess DV among women in Kaduna South LGA.19 The instrument has previously been validated in Nigeria and SSA7 20and was thus a good measure of DV for this cultural context and region. The attitude towards wife abuse was assessed using the Revised Attitudes toward Wife Abuse Scale.21 The questionnaire had four sections: the first dealt with sociodemographic characteristics of the study participants; the second had questions addressing knowledge on DV; the third had questions that assessed the participant’s attitudes towards DV. The final part had questions to measure the participants’ experience of DV. Data were collected by trained research assistants. The principal investigator supervised the data collection procedures. Data collectors were trained for 2 days on interviewing techniques, the purpose of the study, the importance of privacy, confidentiality of the respondents, the sensitivity of the topic and approach to the interviewees. Information about the study was provided to each participant and their anonymity and the confidentiality of their responses, voluntary participation and right to withdraw at any stage was emphasised, after which informed verbal consent was obtained. The collected data were cross-checked on each day of data collection for consistency and completeness.
Data analysis
Data were analysed using the Statistical Package for Social Sciences (SPSS V.25). Descriptive statistics were used to examine the sample characteristics and to estimate the prevalence of DV.
DV as the outcome of interest was measured as physical violence, sexual violence and emotional violence which included experiences of one or several of the following acts of abuse by a current or former partner in a woman’s lifetime and the 1 year preceding the study7:
Physical violence: (1) pushing, shaking or throwing something at her; (2) slapping her; (3) twisting her arm or pulling her hair; (4) punching her with his fist or hitting her with something harmful; (5) kicking, dragging or beating her; (6) choking or burning her on purpose; and (7) threatening or attacking her with a weapon (eg, gun or knife).
Sexual violence: (1) forced sexual intercourse; (2) physically forcing her to perform any other sexual act when undesired; and (3) forcing her with threats to perform sexual acts when undesired.
Emotional violence: (1) humiliating her in public; (2) threatening to hurt or harm someone close to her; and (3) insulting or making her feel bad about herself.
The respondents’ level of knowledge on DV was assessed using a set of five questions. A response of ‘Yes’ was graded 2, ‘No’ and ‘Don’t Know’ were graded as 0. Overall knowledge scores were calculated from the knowledge of DV and subquestions. Overall knowledge scores were further calculated by summing the responses. The maximum score was 20. Knowledge score was divided into two categories: high (≥median) and low (<median).
Attitude was assessed as towards wife beating—categorical ‘yes’ or ‘no’ variables were created from responses to five scenarios7: if she goes out without telling him; if she neglects the children; if she argues with him; if she refuses to have sex with him; and if she burns food. An answer of ‘yes’ to at least one scenario would mean that the respondent justified wife beating and was coded as 1, while an answer of ‘no’ in all scenarios meant the respondent did not justify wife beating and was coded as 0. A respondent was considered to have experienced DV if she answered ‘yes’ to at least one act of any of the forms of violence (physical, sexual or emotional).
Bivariate and multivariable logistic regression analyses were performed to explore the association between independent and dependent variables. Associated factors with p<0.05 in the bivariate analysis were included in multivariate logistic regression analysis. ORs, 95% CIs and p values were calculated for each independent variable. For bivariate and logistic analysis, ‘don’t know’ responses from participants were reclassified as ‘No’.
Patient and public involvement
Participants or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.
Results
The characteristics of the respondents are shown in table 1. A total of 170 women responded to the survey, giving a response rate of 100%. The responders were mainly Hausa by ethnicity at 31.8% (54), married 64.1% (109), in monogamous relationships 81.1% (139), had tertiary education 50.6% (86), had between one and four children 57.1% (97) and of an average age of 28.7+7.9 years, a majority of 41.2% (70) in the age group of 25–34 years. Fifty-two per cent of the women (88) were employed with 95.3% (162) of them earning less than 100 000 naira per month. About 23% (39) of the respondents’ partners consumed alcohol or other substance drugs.
Sociodemographic characteristics of the respondents (n=170)
As shown in table 2, 88.2% (150) of the respondents had heard about DV, 78.2% (133) identified DV by financial neglect, 89.4% (152) by slapping/beating, 81.8% (139) by insult/humiliation and 76.5% (130) by sex against her will.
Descriptive statistics of knowledge on domestic violence (n=170)
The majority of the respondents at 66.5% (113) had high knowledge about DV while a significant 33.5% (57) had low knowledge about DV.
The overall lifetime prevalence of DV among women was found to be 47.1% while the overall prevalence of DV in the last 12 months among the women was 35.3%. The lifetime prevalence of physical abuse, emotional abuse and sexual abuse was 28.8%, 44.1% and 22.9%, respectively, while in the last 12 months the prevalence of physical abuse, psychological abuse and sexual abuse was 15.3%, 32.4% and 13.5%, respectively (figure 1). About 16% (15.8%) of women had experienced all forms of violence concurrently and 26.5% of women experienced physical and emotional violence concurrently.
Proportion of respondents who reported experience of any form of domestic violence (DV) and the different forms of DV.
About two-thirds of the respondents (67.1%, 114) felt there was no justified situation for a man to beat his partner. Twenty per cent (34) of the respondents justified a man beating his partner when a woman goes out without telling him, 22.9% (39) when she neglects her children, 14.7% (25) when she argues with her partner, 16.5% (28) when she refuses to have sex with her partner and 8.2% (14) when she burns food (table 3).
Respondents’ attitudes towards domestic violence (n=170)
Bivariate analysis showed statistically significant associations between women’s knowledge of DV and their level of education and occupation (table 4).
Associations between sociodemographic characteristics of respondents and knowledge of domestic violence (n=170)
Significant associations were found between lifetime experience of DV and respondents’ marital status (χ2=6.46; p=0.04), educational level (χ2=3.26; p=0.01), occupation (χ2=5.20; p=0.02) and respondent partners’ consumption of alcohol/substance drugs (χ2=21.36; p=0.001). Experience of DV in the past 12 months was only associated with respondents’ partners consumption of alcohol/substance drugs (χ2=29.55; p=0.001). A significant association was found between attitude towards wife beating and the level of education of respondents (χ2=11.96; p=0.008) (table 5).
Associations between sociodemographic characteristics of respondents and experience of domestic violence (n=170)
The level of knowledge on DV was not associated with the attitude towards DV concerning wife beating (χ2=3.26; p=0.07). The odds of having high knowledge about DV was significantly lesser in those with lower levels of secondary education as compared with those with tertiary education (adjusted OR (aOR)=0.32; 95% CI 0.15 to 0.68) (table 6).
Multivariate logistic regression of predictors of knowledge of domestic violence (n=170)
Married women had lesser odds of experiencing DV as compared with women who were divorced/widowed (aOR=0.21; 95% CI 0.05 to 0.96). Those with no formal education had greater odds of experiencing DV as compared with those with tertiary education (aOR=4.35; 95% CI 0.93 to 20.33). Those whose partners consumed alcohol had greater odds of experiencing DV as compared with those whose partners did not (aOR=7.91; 95% CI 3.09 to 20.27) (table 7).
Multivariate logistic regression for predictors of lifetime experience of domestic violence (n=170)
Discussion
Women in this study generally had high knowledge about DV, but about a significant third had low knowledge. This was comparable to the findings of similar studies conducted in Sokoto, north-western Nigeria.22 23 Though the majority of the women had non-tolerant attitudes towards DV, about a significant third had tolerant attitudes. The level of knowledge on DV did not translate into the same level of attitude (χ2=3.26; p=0.071), contrary to previous findings of better knowledge and less tolerant attitudes towards DV.24 Furthermore, the prevalence of DV was high in our study population, close to 50% of women had experienced at least one type of DV in their lifetime and 35.5% of women had experienced DV within the past 12 months.
The knowledge and attitude to DV among women in this study were associated with their level of education. This is in agreement with similar studies in Africa which found that the higher the level of education, the more likely women had better knowledge and less tolerant attitudes to DV.23 25 Educational empowerment interventions have been shown to be important strategies for changing attitude towards and prevention of DV.26–28 In our study, the multivariable analysis showed the educational status of women as the final predictor of the level of knowledge of women about DV. This was similar to the findings from similar studies that showed higher levels of education associated with better knowledge and less accepting attitudes towards DV,24; 29and in contrast, a study in Sri Lanka did not show an association between education and women’s knowledge of DV.30
The lifetime prevalence of DV obtained in this study was much higher than the estimated findings of the NDHS 2013, which showed a lifetime prevalence of about 20%.31 The lifetime prevalence of DV in this study is also higher than the global and African regional estimates of violence against women at 30% and 37%, respectively.32 This study reported higher lifetime prevalence than the findings of 42% in Kenya, 27% in Malawi, 32% in Rwanda and 33% in Zimbabwe.33 Studies from the Democratic Republic of Congo and Zambia have, however, reported higher lifetime prevalence (52% and 48%, respectively) than were found in our study. The finding from our study was also higher than the findings from another study conducted in the northern part of Nigeria which reported a lifetime prevalence of 42%.34 This highlights the wide variability of the prevalence of DV against women across and within different countries. This variability could probably be in part due to differences in definition and measurement of DV. With regard to the measurement of DV, some studies had different outcome variables from spousal or partner exposure, such as exposure to interparental violence as the main explanatory variable,31 some studies explored DV using the three forms of DV (physical, sexual and emotional) as explored in this study,31 while in some studies emotional violence was not included in the analysis.32 Though a number of studies used the CTS, these were modified versions and not standardised across the studies as also in our study.31 33 The Nigeria study cited above used a different scale (Composite Abuse Scale).34 Variability in prevalence of DV could also be related to differences in scope of studies, differences and peculiarities in culture and traditions across and within regions. This highlights the importance of conducting additional studies to provide more information relating to the contextual variability of DV.
Nigeria is a patriarchal society and the cultural norms that encourage DV may be one of the reasons for the high prevalence of DV in Nigeria and other countries with similar patriarchal cultural norms. The recent lockdowns as a result of the COVID-19 pandemic may also be a contributing factor to the relatively high prevalence of DV in the study population in the last 12 months prior to the study, considering that studies have documented an upsurge in DV around the world during the COVID-19 pandemic lockdown.35 36
Similar to the findings of a study conducted in Malaysia, our study found emotional violence to be the most common type of violence, followed by physical and sexual violence.37 The combination of physical and psychological abuse was depicted to be the most commonly occurring form of violence in this study, and a similar picture was seen in other studies as well.38 39
Similar to the findings from other studies, our study showed that violence was multiple in nature, and most of the women were subjected to more than one type of violence.40 41 Our study showed that 15.8% of women had experienced all forms of violence concurrently which was higher than the findings from studies in rural Nepal and Vietnam.39 42 The possible explanation for the higher occurrence observed in our study could be due to increasing awareness about the DV.
Studies have shown variability of factors such as age, educational level, socioeconomic status, employment and marital status that influence the risk of experiencing DV,43–45 and these associations have not been consistent. Mixed results have been shown with regard to the age of women and their experience of DV. Some studies have shown that the risk of DV declines with age46 while others have shown variation with age47; our study did not find an association between DV and age.
In agreement with the previous studies in Nigeria, our study has shown that the odds of DV has increased among women who justified wife beating.48 49 Though a woman’s non-approval of DV might not necessarily reduce her risk of experiencing it, her status is an important factor and has a role to play. However, some studies have found that the protective effect of women’s status against DV is not present in culturally conservative contexts.50 51 Studies have shown that men’s justification of wife beating increased a woman’s probability of experiencing intimate partner violence (IPV) even more. It has been reported that men’s views of DV are stronger predictors of DV than women’s views, as women’s perception may be more descriptive or injunctive rather than what they think.33 This is an area that requires further research in the African context as there are limited studies in this area.
However, while other studies from Nigeria and SSA7 52 53 have reported higher rates of DV among women with lower levels of education, our study, in comparison to a study in India,50 did not find any significant association between educational level and DV in the logistic regression, suggesting that other factors contributed to the higher rates of DV among the women in our study population. Four variables were identified by logistic regression with higher odds of experiencing DV in our study population—being unmarried (divorced/widowed), unemployed, justifying wife beating and having partners who consumed alcohol/had substance use habits. This finding is consistent with other studies.49 54
The finding from our study is consistent with prior research and suggests marital status might be a significant predictor of DV, and being married might be ‘protective’ against DV.34 55 56 Considering the fact that this is cross-sectional data and causal relationships cannot be determined or totally excluded either, for this study we apply the term protective in a loose manner not to indicate causality, but the possible direction of association. The results of a study conducted in China indicated that marital status predicted all forms of IPV and divorced women experienced more violence compared with married women.56 Similarly, a study in the USA reported unmarried women at higher risks of DV and within the unmarried status categories, and separated women at highest risks of both DV and acquaintance victimisation experiences as compared with never-married or divorced women.57 It has been hypothesised that unmarried women are more likely to participate in daily routines unaccompanied by other household members and perceived by motivated offenders to be more suitable targets without adequate guardianship.57
Similar to the findings in our study, women’s employment appears to be associated with lower violence in some settings7 25 40 but higher in others,44 46 with the suggestion that formal employment may be more protective than informal employment.53 Other studies reported no association between women’s employment or income and DV.46 The links between a woman’s employment status and risk of DV are complex and require further research to determine the contextual variations.
Alcohol and drug abuse has been widely documented in literature as playing facilitatory roles in either precipitating or exacerbating violence against women.58 59 Mechanisms have been thought to include and not limited to the disruption of the thinking process, manifestations of power, control and hostile personality.58 Our findings suggest that drugs and alcohol abuse should be taken into account when designing interventions for addressing IPV and family problems.
The findings of this study have potentially important implications for the development of effective strategies targeted at reducing the incidence of DV in the study population. Successfully addressing the complex issue of DV requires multipronged approaches that target factors that cut across individual, interpersonal, community and societal levels. Further studies are required to explore in depth the suggested factors that have been highlighted in this study as predictors of DV. There is a need to focus on empowering women and upgrading their socioeconomic status. Efforts should also be made to reach out to men to discourage excessive alcohol intake and associated substance abuse. Awareness-raising activities are still required to address the knowledge gaps and negative attitudes still prevalent among some women in the study population. Further studies are needed to explore how women cope with DV and whether their health needs are met; this was beyond the scope of this study. Additional studies are also required on global and regional scales to assess the impact of the COVID-19 pandemic on the landscape of DV among women.
Strengths and limitations
This is the first community-based study to collect information on the knowledge, attitude and prevalence of lifetime and past-year DV among women in Kaduna State as documented in the literature under the lens of the CTS. The response rate was high (100%) despite the sensitive nature of the issue. The limitations of the study include a small sample size and exploration of a single LGA in the State which could limit the generalisation of results. However, the high prevalence elicited in this LGA, which is one of the largest in the State, contrasts with national values9 and underscores the importance of conducting further larger scale community-based studies. The fact that only women were interviewed and the potential for biased responses on their husband’s/partner’s behavioural characteristics cannot be discounted. Moreover, there is the possibility of under-reporting of the true extent of the problem due to the sensitivity of the violence issue. Also, not all possible confounders were fully explored from other studies such as partner’s sociodemographic characteristics, history of DV in partners, among others. Finally, being a cross-sectional study, the analysis only provides evidence of the statistical associations between the variables, but the temporality of associations and causal directions cannot be established.
Conclusion
Our study found generally high level of knowledge about DV and a non-tolerant attitude towards it. There were high lifetime and past-year prevalence of DV among the women. The study provided information that DV could be related to marital status, respondent’s employment status, partners’ alcohol consumption/drug use habit and justification to wife beating. The study suggests the need for policies and programmes to empower women and improve employment opportunities. The inclusion of husbands/partners in DV prevention strategies is important to address issues related to alcohol and drug abuse that perpetuate violence against women. There is also a need to mount the interventions to cater for the high proportion of women who are exposed to DV in the community. Further longitudinal research is needed to better understand the complex range of factors related to DV among women.
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request. All data relevant to the study are included in the article. Data are available on request by email to the corresponding author.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by the Health Research and Ethics Committee (HREC) of the Barau Dikko Teaching Hospital-Kaduna State University (HREC reference number: 20-0052). Participants gave informed consent to participate in the study before taking part.
Acknowledgments
The authors thank the participants for participating in the study and the team who helped in data collection.
References
Footnotes
Contributors AGN conceived the study. AGN, AJ, TD, IAJ, BN and AM-D contributed to the survey design and data collection. AGN, AJ and TD contributed to data analysis. All authors contributed to the interpretation of data and intellectual revision of multiple drafts. AGN and AJ drafted the manuscript. All authors approved the final version of the manuscript. AGN is the designated guarantor for this document.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.