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Pooled analysis of the association between food insecurity and violence against women : evidence from low- and middle-income settings
BACKGROUND : Intimate partner violence impacts relationships across the socioeconomic
spectrum, nonetheless its prevalence is reported to be highest in areas
that are most socio-economically deprived. Poverty has direct and indirect
impacts on intimate partner violence (IPV) risk, however, one of the postulated
pathways is through food insecurity. The aim of this paper is to describe the association
between food insecurity (household hunger) and women’s experiences,
and men’s perpetration, of intimate partner violence and non-partner sexual
violence in data from Africa and Asia.
METHODS : We conducted a pooled analysis of data from baseline interviews with
men and women participating in six Violence Against Women prevention intervention
evaluations and present a meta-analysis using mixed-effects Poisson
regression models. Data were from South Africa (two studies), Ghana, Rwanda
(two data sets), and Afghanistan and comprised interviews with 6545 adult
women and 8104 adult men. We assessed food insecurity with the Household
Hunger Scale.
RESULTS : Overall, 27.9% of women experienced moderate food insecurity
(range from 11.1% to 44.4%), while 28.8% of women reported severe food insecurity
(range from 7.1 to 54.7%). Overall food insecurity was associated with an
increased likelihood of women experiencing physical intimate partner violence,
adjusted incidence rate ratio (aIRR) = 1.40 (95% CI = 1.23 to 1.60) for moderate
food insecurity and aIRR = 1.73 (95% CI = 1.41 to 2.12) for severe food insecurity.
It was also associated with an increased likelihood of men reporting perpetration
of physical IPV, with aIRR = 1.24 (95% CI = 1.11 to 1.39) for moderate
food insecurity and aIRR = 1.18 (95% CI = 1.02 to 1.37) for severe food insecurity.
Food insecurity was not significantly associated with women’s experience of
non-partner sexual violence, aIRR = 1.27 (95% CI = 0.93 to 1.74) for moderate or severe food insecurity vs none, nor men’s perpetration of non-partner sexual
violence aIRR = 1.02 (95% CI = 0.90 to 1.15).
CONCLUSIONS : Food insecurity is associated with increased physical intimate partner
violence perpetration and experience reported by men and women. It was
not associated with non-partner sexual violence perpetration, although there was
some evidence to suggest an elevated risk of non-partner sexual violence among
food-insecure women. Prevention programming needs to embrace food insecurity
as a driver of intimate partner violence perpetration, however, non-partner
sexual violence prevention needs to be shaped around a separate understanding
of its drivers.
Description:
DATA AVAILABILITY : De-identified individual participant data for Stepping Stones and Creating Futures (South Africa),
Sonke Change trial (South Africa), and Evaluation of the COMBAT intervention (Ghana) and Afghanistan intervention,
are available to anyone who wishes to access the data for any purpose at https://medat.samrc.ac.za/index.php/catalog/
WW. De-identified individual participant data from the Indashyikirwa couples surveys (Rwanda) are available from
the Principal Investigator of the study, Dr Kristin Dunkle: kristin.dunkle@mrc.ac.za, but may require permission from
the Rwandan Ministry of Gender and Family Promotion (MIGEPROF) before transfer.