Is economic dependence on the husband a risk factor for intimate partner violence against female factory workers in Nepal?

Intimate Partner Violence (IPV) against women is a serious public health concern and a human rights issue worldwide [1‐3]. IPV refers to any behavior that causes physical psychological and sexual harm to those who are involved in the intimate relationship. Such kind of harms are due to physical aggression (hitting, kicking, beating or slapping), psychological abuse (humiliation, threatening or insulting) or sexual abuse (forced sexual intercourse or controlling inappropriately) [2]. Intimate partner violence is associated with certain characteristics of males, such as young age, low level of education, witnessing or experiencing violence as a child, harmful use of alcohol and drugs, personality disorders, and acceptance of violence [1]. IPV includes all verbal expressions, manners and actions that violate one’s physical body, sense of self-esteem, or sense of trust and happens regardless of age, ethnicity and country of origin [3]. The prevalence of IPV varies within communities, countries and regions reflecting that the violence against women is not inevitable throughout the world [4]. A study of the World Health Organization (WHO) in 2013 showed that 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence [5]. Other studies about the prevalence of IPV have shown that between 20% and 68% of women aged 15–49 years have experienced physical or sexual violence or both from the male intimate partner in their lifetime and it has been noted that there is scarcity of research with regard to male perpetration although the problem is enormous [5‐7].

In Nepal, IPV against women is encouraged due to the male dominance social system which discriminates against women and is also connected to cultural factors that limit women’s choices to leave a violent marriage [7]. Women have lower accessibility to ownership, less employment opportunities and poorer economic background [8]. There are only few studies focusing on the conditions of violence among female factory workers from other household members and especially from their intimate partners [9‐11]. The Nepal Demographic and Health Survey (NDHS) 2011 showed that one-third of ever-married women aged 15–49 reported having experienced emotional, physical, or sexual IPV at some point, and 17% reported having experienced one or more of these forms of violence in the past 12 months [9]. Another study regarding domestic violence among 1296 women aged 15 to 24 years in rural Nepal showed that overall more than half of young married women (52%) reported having ever experienced some type of violence from their husbands, nearly half (46%) reported sexual violence, one-fourth (25%) reported physical violence, and nearly one in five (20%) women reported ever experiencing both sexual and physical violence [12]. Factors associated with IPV were female illiteracy, low economic status, violent family history, the husband’s level of education, higher number of children, and lack of decision making autonomy [9]. In addition, in many women working in the factories in the capital city of Kathmandu, Nepal migrated from rural Nepal to the capital due to which they have experienced changes in their lifestyle and behaviors. The social and geographic isolation from their home and communities can lead to influencing their traditional values and behavioral norms and this is likely to increase unprotected sexual activities followed by extramarital affairs. Such kinds of activities may pose challenges to marital relationships and may also contribute to the root cause of IPV among female factory workers [13].

The risk for IPV in Nepal also seems dependent on various socio-economic factors. Most of the women from under-privileged castes and ethnic groups are at higher risk for IPV than women from higher castes [9]. In addition, the risk of violence on women has been shown to be higher for women who are economically dependent on their husband than for economically independent women [14].

In the Nepalese context, economic dependency of women on their husband is generally high as compared to the western part of the world [8], which makes it highly relevant to study the association between economic dependence and IPV in Nepal. There are no studies on IPV among women working in factories in Nepal, although the risk factors for IPV are very common in these groups [15]. Due to the relatively low salary for female factory workers this group of women still depend economically on their husband, although they are employed [11, 16]. The population of female factory workers was chosen for this study, because this population represents the urban-rural population with lower socioeconomic status and lower educational level in Nepal [11, 13]. Since IPV is a neglected issue in Nepal with low priority given by policy makers and planners and even in the civil society, there is a need to establish new knowledge for health planning in communities.

Therefore, this study aimed at estimating the prevalence of physical, sexual and psychological IPV and at studying demographic, educational, social and economic factors associated with IPV among married women in the reproductive age between 15 and 49 years working in factories in Kathmandu.

The first aim of our study was to study the prevalence of three different forms of IPV among female factory workers aged 15–49 years in Kathmandu Nepal. It was found that of 22% of women reported having experienced sexual IPV, 28% reported physical IPV and 35% reported psychological IPV at least once in their last 12 months. The NDHS 2011, a national level survey, reported slightly lower figures with 14% of women aged 15–49 years reporting sexual abuse by their husband at least once in their lifetime, 23% of them reporting physical abuse, one thirds of them reporting physical, sexual or psychological abuse once in their lifetime [9]. However, the comparison of the data from NDHS with our study may not be fully justifiable because NDHS was the national level study comprising of the women from the general population of Nepal, whereas in our study the respondents were recruited from the population of women working in factories of Kathmandu. In addition, the NDHS asked for lifetime abuse, while we asked for experienced IPV during the last 12 months. However, one can carefully conclude that the prevalence of IPV seemed to be higher among factory workers as compared to the general population.

As our second aim, this study focused on a number of relevant factors potentially affecting IPV which included age of women, age of women at their first marriage, number of children (parity), marriage type, education of women, education of husbands, economic dependence of women on their husbands, decision making capacity of women, knowledge about IPV on women and alcohol use of the husband. All these factors except for age of women at first marriage were significantly associated with the different types of IPV, but for most of the factors the association disappeared when adjusting for the other factors. The variables that were independently associated with at least one form of IPV were: higher age of the woman, alcohol consumption of the husband, low education of the husband and economic dependency of the woman on the husband. Out of these four variables, two of them showed a consistent association with all three forms of IPV even when adjusted for all other factors: higher age of women and alcohol use of the husband. Women whose age was 29 years and over had 3–7 times higher odds of having experienced psychological, physical or sexual IPV than younger women. The IPV risk for older women may increase due to more marital quarrelling that may be followed by violence [20], or older women may be more willing to reveal IPV than younger women or perhaps are more capable of challenging their husband with resulting violence. In line with our findings, a multi-cultural cross-sectional study from the United Nations about IPV showed that the prevalence of IPV against women by their husbands increased with increasing age of women [6] and a study in Columbia showed similar results [21]. However, another study in Tansania found higher IPV against younger women [22] indicating that the IPV dependence on age of women may differ from country to country.

Also, alcohol consumption of the husband was a strong independent risk factor for all forms of IPV. Alcohol consumption among men in Nepal is very high in comparison with the alcohol use of women [23]. Our results are in line with other studies showing that men who drink alcohol are more likely to be violent against their wife [24, 25]. Since the study participants were female factory workers who resided inside the factories premises and were not allowed to drink alcohol, only alcohol consumption of the husband was included in the study. Our study also indicated that a husband’s education above primary level was a protective factor for all forms of IPV without adjusting for other variables, but after adjustment the association of husband’s education remained only significant for psychological IPV. In agreement with our findings a study in the United States about characteristics of men who perpetrate IPV showed that education of the husband beyond high school was a protective factor for IPV [26]. School attendance of women was also found to be a protective factor for all forms of violence in the study, but the association disappeared when adjusting for the other variables. Another study on factors associated with IPV in women conducted in Nepal confirmed that female illiteracy was associated with IPV [7]. It can be assumed that the negative association between female literacy and IPV disappeared when adjusted for education of the husband, because the educational level of husband and wife are often correlated. In principle, education both of males and females could serve as a protective factor against IPV, because it may improve the competency for non-violent conflict solving.

Economic dependence on the husband was found to be a risk factor for all forms of IPV in this study and after adjustment remained significant for physical and psychological IPV. Previous studies about the association between IPV and economic dependence of women on their husband also showed that the risk of violence against women was higher for women who were economically dependent on their husband [14]. In Nepal, the economic dependency of women on their husband is higher than in many western countries, which limits the possibility of women to separate from a violent husband and to live an independent life. Although our study was carried out in female factory workers who were able to earn some money on their own, they still have to depend on their husband because of the low salary paid to them [11, 16].

Several other factors showed some association with IPV, but only in the unadjusted models. E.g. women with an arranged marriage were less likely to report IPV. In Nepal, marriages that were arranged by their family are more frequent than love marriages and this type of marriage is also more secured by the families that arranged the marriage [25].

Knowledge of women about IPV was found to be the protective factor for all forms of IPV in the study, but only without adjusting for other variables. A previous study about IPV conducted in Nepal concluded that women’s decision making autonomy was a strong predictor of IPV on women [7]. However, the results from our study did not show any significant association between decision making of women and any form of IPV after adjustment. We also identified an association between parity and all forms of IPV and women having more than 2 children were at higher risk for all forms of IPV, but when adjusted for other factors the associations disappeared. Another study about parity and IPV in the United States explored that each additional pregnancy was associated with 10% greater odds of IPV [26]. We explain the lack of significant associations regarding the factors above in the adjusted models as well as the differences compared to other research as we adjusted our analysis for more factors than most of the other studies that found significant associations.

We also found that age at first marriage was not associated with any form of IPV and therefore the variable was not included in the logistic models. This is in line with another study, which describes causes of IPV showing that age at marriage was not associated with IPV [20].

Our study has limitations and it is crucial to note that the data collection was cross-sectional and no conclusions regarding causal relationships can be drawn. The study population is also limited to factory workers in Kathmandu and the results may be different in rural areas or in other professional sectors. However, the response rate was extremely high which limits a potential selection bias towards only excluding women who may be absent from work due to IPV. Our study also relied on self-reported data and due to the fact that IPV and the associated factors are a sensitive issue, we cannot rule out potential under-reporting of IPV.

In summary, we conclude that the prevalence of IPV is high in this group of women and that the odds of IPV was higher in women of higher age, for those with alcohol consumption of the husband, with low education of the husband and with economic dependency on the husband. Future research should identify underlying reasons for the high level of IPV.

The findings from this study are important in order to make Nepalese women aware of the problem and to enable advocacy about IPV. A holistic approach is essential to gain family and community trust as well as support for women at the micro, meso and macro levels for the prevention and control of IPV issues in Nepal [27]. The results of our study can be used to develop preventive programs. Such programs should aim at protecting women, including behavioral and educational programs for husbands and wives, as well as policy measures to reduce the underlying risk factors such as poverty and illiteracy. Strategies aiming at livelihood and economic empowerment and at increasing the economic independence of women would be suggested for the long-term prevention of IPV against women.