Article Text

Original research
Is household food insecurity associated with social attitudes accepting of physical intimate partner violence against women in Nigeria? A population-level cross-sectional study
  1. Otobo I Ujah1,2,
  2. Amaka N Ocheke3,
  3. Biodun N Olagbuji4
  1. 1 Department of Obstetrics and Gynaecology, Federal University of Health Sciences Otukpo, Otukpo, Nigeria
  2. 2 College of Public Health, University of South Florida, Tampa, Florida, USA
  3. 3 Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau, Nigeria
  4. 4 Department of Obstetrics and Gynecology, Ekiti State University, Ado Ekiti, Ekiti, Nigeria
  1. Correspondence to Dr Otobo I Ujah; otoboujah{at}yahoo.com

Abstract

Objectives Although prior research suggests that household food insecurity (HFI) is associated with intimate partner violence against women (IPVAW), there is a paucity of research regarding its impact on attitudes accepting of IPVAW. We examined whether individuals experiencing HFI are more likely to accept physical IPVAW, whether the association varies by gender and whether it persists when models are adjusted for other confounders.

Design Population-level cross-sectional analysis.

Setting This study used the round 6 of the UNICEF-supported Multiple Indicator Cluster Survey (MICS) conducted in Nigeria.

Participants The sample included 23 200 women and 7087 men, aged 15–49 years, who were currently married or in union and responded to the attitudes towards domestic violence and HFI modules in the MICS.

Outcome measures and statistical analysis Attitudinal acceptance of physical IPVAW (specific forms and overall). We conducted weighted multivariable logistic regression to estimate the OR and their corresponding 95% CIs of the associations of food insecurity (FI) with attitudinal acceptance of physical IPVAW, adjusting for potential confounders.

Results Multivariable results indicate that severe HFI was positively associated with attitudinal acceptance physical IPVAW in at least one of the scenarios presented (aOR=1.11; 95% CI: 1.01 to 1.22). Individuals experiencing severe HFI had higher odds of physical IPVAW acceptance when wife neglects the children (aOR=1.15; 95% CI: 1.02 to 1.31). The likelihood of physical IPVAW acceptance if wife burns the food was lower for women experiencing moderate HFI (aOR=0.86; 95% CI: 0.74 to 0.99). Stratified analyses indicated heterogeneity in the association between HFI and attitudinal acceptance of physical IPVAW by gender.

Conclusion Our findings indicate that, depending on the severity, FI status may be associated with attitudinal acceptance of physical IPVAW, with potential variations based on gender. The public health implications are discussed.

  • EPIDEMIOLOGY
  • NUTRITION & DIETETICS
  • PUBLIC HEALTH

Data availability statement

Data are available in a public, open access repository. All data used in this study are publicly available and can be accessed from the UNICEF Multiple Indicator Cluster Survey (MICS) project website (https://mics.unicef.org/).

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STRENGTHS AND LIMITATIONS OF THIS STUDY

  • Our estimates are based on validated measures of household food insecurity (HFI) and attitudes towards physical intimate partner violence against women (IPVAW), thereby enhancing comparability of our findings across different studies and contexts.

  • The population-based nature and large sample size of our study provided sufficient statistical power, allowing for the generalisation of our findings to the broader Nigerian population.

  • The cross-sectional design of our study limits our ability to establish causality between HFI and attitudinal acceptance of physical IPVAW.

  • Our findings may not be generalisable to attitudes accepting of other forms of IPVAW, such as sexual or psychological violence.

  • Both HFI and attitudes towards IPVAW were self-reported and sensitive constructs, thus our estimates are susceptible to recall and social desirability biases.

Introduction

Intimate partner violence against women (IPVAW) refers to any behaviour perpetrated by a current or former intimate partner, whether or not the partner is a spouse, which is likely to result in sexual, physical or psychological harm.1 2 It represents a significant human rights violation and a growing public health concern with far-reaching implications for the well-being of victims and their families.1 3 Recent findings indicate that at least 1 in 3 women in 53 low-income and middle-income countries (LMICs) experienced at least 1 form of IPV within the past year.1 Of these, physical IPV was the most common (29.6%).1 IPVAW not only hampers the achievement of Sustainable Development Goal (SDG) 5.2 (eliminating all forms of violence against women and girls) but also impedes progress towards ensuring healthy lives and promoting well-being for women, regardless of age (SDG 3). As attitudes towards IPV are intricately linked to both perpetration and victimisation of IPV, there is a growing interest in understanding the factors which influence attitudes towards IPVAW.3–5

From a theoretical perspective, the theory of planned behaviour (TPB) posits that intention of an intimate partner to perpetrate violence is influenced by behavioural beliefs regarding violent behaviours (attitudes towards IPVAW), their perception of the expectations of individuals around them concerning IPVAW and the salience of those individuals (subjective norms) as well as the extent to which they can control their violent behaviour (perceived behavioural control).6 Studies have demonstrated a positive association between men’s expression of attitudes accepting of wife beating and violence perpetration.7–10 Also, women who are tolerant of IPVAW are more likely to experience IPV victimisation and are likely to hinder prevention and response efforts from family members, communities and law enforcement agencies thereby fostering the cycle of IPV perpetration.4 11 12 Hence, attitudinal acceptance (ie, endorsement and tolerance) of IPVAW is a strong determinant of violence behaviour,13 and such attitudes, might perhaps, be a reflection of the prevailing social and cultural norms regarding the acceptability of violence in intimate relationships.14 For instance, Gilbert et al showed that among young people in Nigeria, attitudinal acceptance of three or more social norms regarding IPVAW was significantly associated with IPV perpetration among men and IPV victimisation among women.15

While previous studies have explored the structural and contextual drivers of IPVAW attitudes and actual behaviours, an emerging body of literature examining the role that different dimensions of material hardship, including household food insecurity (HFI), play in the occurrence of IPV.16–18 Food insecurity (FI) occurs when there are limitations or uncertainties in the ability to access or afford safe and nutritionally adequate foods for a healthy and active lifestyle.18 19 Although FI remains a pervasive public health crisis globally, this problem is particularly acute in many parts of sub-Saharan Africa (SSA), perhaps as a result of climate change, violent conflicts and very recently, the COVID-19 pandemic.20 According to a recent report by the United Nations Food and Agricultural Organization (UN FAO), at least two out of three (67.2%) individuals experienced moderate or severe FI in 2022, with 26.6% being severely food insecure.19 Evidence suggests that gender disparities persist in experiences of FI, with women disproportionately affected by both IPV and FI.19 21 22

A recent review of the literature identified at least 56 studies (qualitative and quantitative studies) which explored the link between FI and IPV.23 Empirical evidence suggests that FI may be associated positively with a higher risk of experiencing gender based violence.16–18 24 25 Furthermore, research has shown that as the severity of FI increases, there may also be an increased likelihood of experiencing IPV. For instance, a recent study by Jewkes et al, which involved a pooled analysis using data from several LMICs, found that moderate FI was associated with a 40% higher likelihood of women experiencing physical IPV (adjusted incidence rate ratio (aIRR)=1.40, 95% CI: 1.23 to 1.60), while women experiencing severe FI had a 73% higher risk of experiencing physical IPV (aIRR=1.73, 95% CI: 1.41 to 2.12).18 Also, FI has been strongly linked to men’s perpetration of IPV. Studies in South Africa26 and Uganda27 have indicated that men who experience FI are at least two times as likely to perpetrate IPV compared with their counterparts who are food secure.

While existing studies of the relationship between FI and IPV are diverse in terms of the populations, countries and types of IPV studied, similar studies in Nigeria are explicitly lacking. Moreover, there is limited evidence globally that focuses on social norms accepting of IPV. This lack of robust evidence hampers efforts to design and implement effective FI and IPV prevention and response interventions for vulnerable populations. Thus, whether and the extent to which FI impacts attitudinal acceptance of IPVAW remains an open question.

In the current study, we investigated the associations between HFI status and attitudinal acceptance of physical IPVAW using a recent and nationally representative sample of adults in Nigeria. Further, we examined whether there are gender differences in the association between FI status and attitudinal acceptance of physical IPVAW. By doing so, we aim to expand current knowledge on the potential mechanisms underlying the relationship between HFI and physical IPVAW. We hypothesised that individuals in households experiencing moderate and severe FI will have significantly higher odds of expressing attitudes accepting of physical IPVAW compared with those from food secure households and that this association would vary by gender.

Materials and methods

Study design, data and sample population

Data for this secondary analysis were obtained from the sixth (most recent) round of the Nigeria Multiple Indicator Cluster Survey (MICS6) dataset conducted in 2021. The MICS is a nationally representative cross-sectional survey which employs a multistage stratified cluster sampling approach to collect data on health and social indicators from representative samples of children, women and men in LMICs. First, enumeration areas (clusters) were selected based on the 2006 Population and Housing Census of the Federal Republic of Nigeria, using a probability proportional to the size of enumeration area. In the second stage, 20 households were randomly selected within each enumeration area. Additional information regarding the survey’s sampling design and data collection techniques can be found elsewhere.28 For this study, we combined the household data file, which contained variables related to FI, with men’s and women’s data files.

The study sample was restricted to men and women of reproductive age (15–49 years) (unweighted n=58 792) who were currently in a marital or partnered relationship and who provided valid data on attitudes towards domestic violence as well as households with complete data on FI status. Further, we excluded observations with missing values on the covariates of interest resulting in an unweighted sample size of 30 287. As the sample was not self-weighting, we used the sample weights included in men’s and women’s sample survey to report the survey results, thereby accounting for the complex sampling design. The final weighted analytic sample comprised 23 200 women and 7087 men. Permission to access and use these datasets for our study was granted from the UNICEF/MICS website.

Measures

Outcome variable

Attitudinal acceptance of physical IPVAW was the outcome of interest and was measured during the MICS with the 6-item attitude towards domestic violence module comprising hypothetical scenarios regarding attitudes towards IPVAW. These questions included ‘Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations: (A) if she goes out without telling him? (B) if she neglects the children ? (C) if she argues with him? (D) if she refuses to have sex with him? (E) if she burns the food? (F) if she sleeps with another man?’ Response options for each question were ‘yes’, ‘no’ or ‘don’t know’. Those who answered ‘Don’t know’ were excluded from the analyses and each variable was modelled as a dichotomous variable (1=yes and 0=no). In addition, we created a binary variable, coded as ‘1’ if women answered ‘yes’ to any of the six scenarios and ‘0’ if they answered ‘no’ to all scenarios.

Primary exposure

The exposure of interest was household FI within the past 12 months, assessed using the UN FAO validated 8-item Household Food Insecurity Experience Scale (FIES). The FIES is a tool used to estimate the prevalence of moderate or severe FI within populations, consistent with SDG indicator 2.1.2. The FIES has been validated among SSA populations and shown to possess high levels of internal validity.29

Participants were asked a series of questions regarding their household’s FI status over the preceding 12 months (online supplemental file 1). For each FIES item, the response options included ‘yes’ (coded as 1), ‘no’ (coded as 0) or ‘don’t know’ (treated as missing values). Composite household FI scores (range 0–8) were derived by summing the responses across the eight-item variables. Consistent with prior studies,29–31 we created dummy variables for FI status by categorising raw scores into one of three FI groups: no/mild FI (0–3), moderate FI (4–6) and severe (7–8) FI.

Supplemental material

Covariates

We a priori identified and included variables that were plausibly associated with FI and IPV risk in the analyses, based on prior research investigating FI and IPV.14–16 These variables included gender, age group (15–19, 20–29, 30–39 and 40–49 years), religion (Christianity, other), relationship status (single, partnered/in union), number of members in household (<5, 5+), household wealth (poorest, poorer, middle, richer and richest), place of residence (rural, urban), perceived neighbourhood safety (safe, unsafe) and geographic region (North Central, North East, North West, South East, South South, South West). We build and present a directed acyclic graph illustrating the hypothesised relationships among study variables, aiming to identify our causal model regarding the association between HFI and attitudinal acceptance of IPVAW (online supplemental figure 1).

Statistical analyses

We employed univariate, bivariable and multivariable approaches for data analyses in this study. All analyses were conducted using SAS V.9.4 and incorporated the SAS survey procedures to account for the complex sampling design of the MICS. To ensure robust estimation of the effect estimates and SEs, we included the sample weights, clusters and strata variables in the analyses. For descriptive analyses, we calculated weighted frequencies and percentages (%) of categorical variables. Also, we used the Rao-Scott χ2 test for between-group differences among the categorical variables. Furthermore, we estimated weighted means and SEs for continuous variables.

To investigate the associations between HFI and attitudinal acceptance of physical IPVAW, while adjusting for the identified confounders, we fitted survey-weighted multivariable logistic regression models. To assess whether gender modifies the association between FI and the physical IPVAW norms, we stratified all models separately by gender (women, men). The results presented are based on a complete-case analysis. We computed and reported effect estimates as both crude and adjusted ORs, accompanied by their corresponding 95% CIs. All tests were two tailed, and statistical significance was determined at a p value of 0.05.

Patient and public involvement

Participants were not involved in the designing of this study. This manuscript is based on secondary analysis of data obtained from the MICS which is publicly available and can be accessed from the MICS website

Results

Characteristics of sample

The final weighted analytic sample comprised 30 374 respondents 15–49 years (women=75.9%; men=24.1%). The mean (SE) age was 34.2 (0.11) years for women and 33.1 (0.11) years for men. Table 1 presents the sociodemographic characteristics of both women and men. Overall, approximately 37.2% of individuals were aged 30–39 years, with 38.7% of men and 40.8% of women in this age category. Approximately 72% were living in households with at least 5 members, nearly 50% of individuals were residing in poor households and at least 71% were residing in rural areas. About two-thirds resided in neighbourhoods perceived as safe and about a quarter resided in the North West region.

Table 1

Sociodemographic characteristics of the sample according to gender, MICS, 2021

As illustrated in table 1, men were more likely to be older (p<0.0001) and be Christians (50.9% vs 41.5%, p<0.0001) compared with women. Furthermore, men were more likely to perceive their neighbourhoods as safe compared with women (82% vs 64%, p<0.0001). Women on the other hand were more likely to reside in households with five or more members (72% vs 62%, p<0.0001) and more likely to be living in the North West region (29% vs 23.7%, p<0.0001).

Prevalence of FI and attitudes towards IPVAW

Regarding HFI experiences, 78.9% of the respondents were worried about not having enough food to eat in the past year (12 months) prior to the MICS. Similarly, 76.7% were unable to eat healthy and nutritious foods, and 76.6% ate limited food varieties due to financial constraints. Approximately, 66.9% had to skip a meal, while nearly three-quarters (71.3%) ate less than they deemed appropriate over the past year. Nearly two-thirds (59.3%) ran out of food, and 50.4% were hungry but did not eat due to lack of money or resources during the past year. Also, about 28.7% of respondents reported going an entire day without eating due to financial constraints. In terms of the raw FIES score, the mean (SE) score was 5.1 (0.04). In terms of FI status, 75.3% of households were food insecure with 30.3% and 45.0% classified as being moderately and severely food insecure, respectively, based on their raw scores (table 1).

Regarding attitudinal acceptance of physical IPVAW, the mean (SE) IPV attitude count was 1.16 (0.02) on the 6-item scale. Table 2 presents the prevalence of attitudes accepting of physical IPVAW by HFI status. About 52% of respondents had a risk score of zero (0), suggesting that at least one in two partnered individuals do not accept physical IPVAW under any of the circumstances presented while 47.9% of participants expressed attitudes accepting of wife beating in any one of the hypothetical scenarios. Most participants (44.5%) agreed to physical IPVAW if the wife sleeps with another man. This was followed by if the wife’s refuses to have sex with her husband (20%), wife neglects children (14.8%) and wife argues with her husband (14.2%). The least prevalent scenario was if the wife burns food (8.4%). Figure 1 also shows the distribution of attitudes towards physical IPVAW stratified by gender. There were, however, statistically significant differences between men and women for all measures of physical IPVAW risk (p<0.0001). Furthermore, across all measures of attitudes towards IPVAW, the prevalence was higher among women compared with men. The prevalence of attitudinal acceptance of physical IPVAW differed by FI status. This proportion was relatively higher among those who experienced moderate FI (48.9%) and severe FI (50.5%).

Figure 1

Prevalence of attitudinal acceptance of physical intimate partner violence against women (IPVAW) by gender.

Table 2

Prevalence of physical intimate partner violence risk, overall and by food insecurity status: Nigeria, MICS, 2021

Multivariable analysis: FI and attitudinal acceptance of IPVAW

In the weighted multivariable logistic model, individuals experiencing severe HFI had an 11% higher odds of accepting any physical IPVAW compared with those from food secure households (aOR=1.11, 95% CI: 1.01 to 1.22, p=0.0272) (table 3). The likelihood of accepting any physical IPVAW was not significantly different among individuals from moderately food insecure households compared with those from food secure households (aOR=1.09, 95% CI: 0.99 to 1.21, p=0.0803). In the adjusted model, individuals in moderately food insecure households had significantly lower odds of physical IPVAW acceptance only in circumstances where wife burns the food compared with those from food secure households (aOR=0.86, 95% CI: 0.74 to 0.99, p=0.0426). For the other attitudes towards physical IPVAW, there were no significant associations between individuals from moderately food insecure households, compared with those from food secure households. In addition, those from households experiencing severe food insecurity (SFI), compared with those from food secure households, had significantly higher odds of physical IPVAW acceptance if wife neglects the children (aOR=1.15, 95% CI: 1.02 to 1.31, p=0.0278) (table 3).

Table 3

ORs (crude and adjusted) estimates for physical intimate partner violence against women risk according to food security status among Nigerian men and women aged 15–49 years, MICS, 2021*

FI and attitudinal acceptance of IPVAW by gender

The gender-stratified analyses reveal heterogeneity in the associations between FI and attitudinal acceptance of physical IPVAW (figure 2). After adjusting for confounders, there were no differences in the odds of justifying overall and specific forms of physical IPVAW among partnered men from households experiencing moderate food insecurity (MFI) and SFI compared with partnered men in food secure households. Among women, however, distinct patterns were observed in the relationship between FI and physical IPVAW acceptance. In the adjusted model, there were significantly higher odds of expressing attitudes accepting of physical IPVAW in any of the six scenarios among partnered women in MFI households (aOR=1.18, 95% CI: 1.05 to 1.34, p=0.0060) and SFI households (aOR=1.17, 95% CI: 1.05 to 1.31, p=0.0053) compared with their counterparts in food secure households. Furthermore, partnered women from households experiencing SFI, compared with those from food secure households, are more likely to justify physical IPVAW if wife neglects children (SFI: aOR=1.22, 95% CI: 1.06 to 1.40, p=0.0054) and argues with her husband (SFI: aOR=1.18, 95% CI: 1.02 to 1.38, p=0.0234). Furthermore, partnered women from moderately and severely food insecure households had significantly higher odds than their counterparts from food secure household to justify physical IPVAW if wife sleeps with another man (MFI: aOR=1.13, 95% CI: 1.01 to 1.28; SFI: aOR=1.15, 95% CI: 1.03 to 1.29, p=0.0131).

Figure 2

Forest plot showing the adjusted logistic regression results between past year food insecurity (FI) status and attitudinal acceptance of intimate partner violence against women stratified by gender. FI denotes food insecurity. Models were adjusted for age, religious affiliation, number of household members, perceived neighbourhood safety, household wealth index and place of residence, geographic region.

Discussion

We sought to assess the relationships between HFI and attitudes towards physical IPVAW in a nationally representative sample and to examine effect modification of this relationship by gender. We found that the overall prevalence of physical IPVAW acceptance was high (48%). Overall, partnered women were more likely than men to express attitudes accepting of physical IPVAW. Although puzzling, similar patterns of IPVAW acceptance have been reported in other studies conducted in Asia and Africa.15 32 33 These results are consistent with Kandiyoti’s theory of ‘patriarchal bargaining’. According to this theory, women living within patriarchal systems may feel compelled or motivated to conform to societal norms that blame wives in cases of violence as a means of coping with IPV.34 In addition, women may internalise the belief that a husband’s physical or verbal reprimand is justified and serves her interests, leading to the perception that such actions are rather legitimate responses to a wife’s perceived disobedience than acts of violence.15 34

Also, our study highlights that, overall, controlling for gender and other factors, living in households experiencing severe but not moderate FI may be influential in predicting attitudes expressing physical IPVAW acceptance. We observed distinct patterns in these associations depending on the severity of HFI and the forms of physical IPVAW acceptance. While these findings are partly consistent with our guiding hypothesis, the paucity of empirical studies focusing on FI and social norms justifying IPV precludes the extent to which we are able to compare our findings with previous literature. One study conducted in India however showed that economic debt, a proxy measure of material hardship, was associated with men’s attitudes accepting norms and promoting IPV.35 While our study did not find a significant association between household FI and attitudinal acceptance of physical IPVAW among partnered men, these disparate results collectively suggest that attitudinal acceptance of IPV may play a role in the relationship between the severity of FI and IPV as well as the role context plays in this relationship. However, since we did not perform a mediation analysis, we cannot assume these norms mediate the association between FI and actual IPV behaviours as variables on IPV experiences were not captured in the MICS dataset. Thus, this remains an open topic for future research. Another study also showed a significantly positive correlation between levels of multidimensional deprivation and attitudinal acceptance of physical IPV among men and women in 49 LMICs.34 The study, however, was not limited to individuals who were married or currently in a relationship. Also, a study by Stickley et al 36 showed that in Moscow, men who have experienced past year financial hardship had twofold higher odds of IPVAW acceptance; however, this association was not significant for women. In a conceptual framework by Hatcher et al,26 proposing the likely pathway through which FI leads to IPV perpetration by men, FI was likely to be associated with maladaptive coping strategies and consequently resulting in IPV.

Furthermore, our results indicate that gender modified the association between HFI and the likelihood of expressing attitudes accepting of physical IPVAW among food insecure individuals compared with those who were food secure. A possible explanation for this heterogeneity could be that food stress at the household level could make women perceive increased IPV vulnerability, especially within patriarchal societies characterised by unequal gender dynamics. In such contexts, women often lack autonomy and control over household resources, which could increase their susceptibility to IPV. Gendered power dynamics further reinforce traditional roles and expectations, contributing to a higher likelihood of physical IPV acceptance among food insecure women compared with men.

While our findings do not provide conclusive evidence for or against the existence of a causal relationship between HFI and physical IPVAW attitudes, they nevertheless support the need for this association to be examined in longitudinal studies, taking into consideration the intersections of other aspects of the TPB, such as subjective norms and perceived behavioural control, that could offer new insight into the mechanistic pathways linking HFI to IPVAW. In addition, as evidence suggests survivors of IPVAW are more likely to experience FI relative to the general population,37 38 future studies employing qualitative approaches can provide further explanations regarding the possibility of a bidirectional relationship between food-related hardship and social norms surrounding IPV and the specific forms. Furthermore, research should explore whether and to what extent the conclusions drawn from this study hold for attitudes towards other forms of IPVAW.

Several limitations preclude the validity of our study’s findings. As IPVAW can take many forms, our findings may not be generalisable to other forms of attitudes toward IPVAW (eg, sexual, psychological). In addition, the measures of attitudes towards physical IPV used in this study are non-exhaustive. Therefore, we are unable to establish whether the conclusions from our study would hold in the context of other scenarios, for example, ‘if wife hits him first’, ‘to discipline or keep her in line’ or ‘anytime he wants’. In addition, as this study focused on IPVAW attitudes, our findings may not hold for IPVAW intentions and actual behaviours considering that HFI may also act through other pathways as specified in the TPB. Second, an important factor to consider is that our estimates could have been severely biased due to the sensitive nature of both HFI and IPVAW, which were based on self-reports. Hence, the potential for recall bias in reporting HFI and social desirability bias in reporting IPV, which could impact our findings. Last, it is important to acknowledge that HFI was measured at the household level. However, individual experiences of food deprivation may vary even within households.39 Therefore, the generalisability of our findings to individual-level food deprivation may be limited and remains an open question.

Despite these limitations, our study has several strengths. Given the intersection of this study across several goals of the sustainable development agenda (SDG 2, 3 and 5), our findings offer comprehensive and valuable insights into the intersections between HFI, IPV and broader social and development objectives that can inform policies and interventions targeting multiple SDGs simultaneously. By using recent nationally representative data, our study provides up-to-date evidence on the prevalence of physical IPV attitudes in Nigeria and as well identifies specific subgroups within the population that are most accepting of physical IPVAW, thereby highlighting the patterns and extent to which these norms remain pervasive. Finally, our study provides reliable and robust estimates of HFI, at least to the extent to which data in the MICS are valid, based on ascertainment using a widely recognised and well-validated measure. This approach allows for comparability of our findings across various contexts and studies. Additionally, our research extends beyond the conventional approach of dichotomizing FI, which may oversimplify and mask its effect.

Conclusion

In this nationally representative sample of partnered men and women aged 15–49 years, approximately 75% lived in moderately or severely food insecure households. We found that although HFI was associated with specific and any form of physical IPVAW acceptance, the associations were not significantly different for men after stratifying by gender. The complex relationship between HFI and attitudes towards IPV suggests a need to investigate potential psychosocial and behavioural mechanisms, and moderators of these associations. Future research is needed to explore additional pathways through which HFI may impact physical IPV, as well as to consider how gender and social and cultural norms intersect to influence this association.

Data availability statement

Data are available in a public, open access repository. All data used in this study are publicly available and can be accessed from the UNICEF Multiple Indicator Cluster Survey (MICS) project website (https://mics.unicef.org/).

Ethics statements

Patient consent for publication

Ethics approval

The Nigeria Multiple Indicator Cluster Survey (MICS) procedures were reviewed and approved by the National Bureau of Statistics (NBS) and UNICEF. According to the 2021 MICS6 report, all participants provided verbal consent before the administration of questionnaires. In the case of participants under 18 years (minors), informed consent was obtained from their parents or legal guardians. Participants were assured of voluntary participation, confidentiality, the anonymity of their information and the freedom to withdraw from the interview at any point. As this study involved secondary analysis of publicly available deidentified Nigeria 2021 MICS6 data, no ethical clearance was required for this study.

Acknowledgments

The authors would like to thank the UNICEF-Multiple Indicator Cluster Survey (MICS) for making data used for this research available.

References

Supplementary materials

  • Supplementary Data

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Footnotes

  • Contributors OIU and BNO conceptualised this research. OIU performed the analysis and drafted the first version of the manuscript. ANO and BNO revised and restructured the manuscript. OIU serves as the guarantor and accepts full responsibility for the work. All authors read and approved the final manuscript.

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.