Prevalence of Different Types of Intimate Partner Violence among Ever-Married Women: A Sri Lankan Study

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ISSN: 2349-8889
Volume-7, Issue-1 (January 2020)
https://doi.org/10.31033/ijrasb.7.1.4
International Journal for Research in
Applied Sciences and Biotechnology
www.ijrasb.com
Prevalence of Different Types of Intimate Partner Violence among
Ever-Married Women: A Sri Lankan Study
H Parween Reyal1
, K Manuja N Perera2
and G N Duminda Guruge3
1
Lecturer (Prof.), Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka,
SRI LANKA
2
Senior Lecturer, Department of Public Health, Faculty of Medicine, University of Kelaniya, SRI LANKA
3
Senior Lecturer, Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka,
SRI LANKA
1
Corresponding Author: parweenreyal@as.rjt.ac.lk
ABSTRACT
This study examined the prevalence of intimate
partner violence (IPV) among a sample of 600 ever-married
women from a representative health administrative area
located in the Kandy district of Sri Lanka. IPV was assessed
using the world health organization (WHO) instrument
developed for use in the WHO multi-country study on
women’s health and domestic violence against women.
Among all participants 59.5% (n=357) have experienced any
type of abuse (any form of physical, psychological, sexual
abuse and controlling behaviour) at least once during their
lifetime. Out of the total 41.3% (n=248) have experienced
abuse (any form of physical, psychological and sexual abuse)
during the last 12 months. Considering the lifetime IPV
experiences, 39.5% (n=237) reported physical abuse, 39%
(n=234) reported psychological abuse, 12.3% (n=74)
reported sexual abuse and31.3% (n=188) reported generally
controlling behaviour by the partner. During the last year
14.8% (n=89) have been physically, 26.3% (n=158) have
been psychologically and 7.17% (n=43) have been sexually
abused. The present study reveals high lifetime and past
year prevalence of IPV compared to other recent studies
conducted in Sri Lanka. Furthermore, different types of
IPV acts were present with chronic and severe experiences.
Hence, interventions should focus on different types of IPV
and various abusive behaviours. Further studies are needed
to assess the association of different types of IPV and the
contributory factors.
Keywords-- Physical Abuse, Psychological Abuse, Sexual
Abuse, Controlling Behaviour
I. INTRODUCTION
Intimate partner violence (IPV) is a major public
health problem in many developing and developed
countries. Among ever-partnered women, global lifetime
prevalence of IPV is 30% (Devries et al., 2013; World
Health Organization, 2013; WHO, 2016). Prevalence of
physical and/or sexual IPV during lifetime was highest
among the South-East Asian region, among the classified
six WHO regions (37.7%). However, among the 21
global burden of disease (GBD) regions, the South East
Asian region has reported a prevalence of 27.99% (WHO,
2013). East Asia has reported the lowest prevalence of
16.3% while the Central sub-Saharan Africa has reported
the highest prevalence of 65.6% (WHO, 2013).
Prevalence of IPV is estimated between 18.3% and 60%
in Sri Lanka (Senanayake, Navaratnasingam, &
Moonesinghe, 2008). A recent review reported a lifetime
IPV prevalence between 25% and 35% among ever-
married women in Sri Lanka(Guruge, Jayasuriya-
Illesinghe, Gunawardena, & Perera, 2015).
IPV has wide spread consequences on both men
and women with physical, psychological and
reproductive health issues and socio-economic
impact(Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002;
WHO, 2012, 2013; WHO and LSHTM, 2010).Recently
it was suggested to consider IPV as, ‘physical violence,
sexual violence, stalking and psychological aggression
(including coercive tactics) by a current or former
intimate partner (Breiding, Basile, Smith, Black, &
Mahendra, 2015). Common classification of IPV is based
on the type of act (physical, sexual, psychological abuse
and controlling behaviours), the perpetrator (male and
female) and the relationship (heterosexual and
homosexual relationships as dating, engaged and
cohabiting) (Ali, Dhingra, & McGarry, 2016; Johnson &
Ferraro, 2000; Krug et al., 2002; WHO, 2005). Among
the three classifications, the most common type of
classification is based on the type of act. WHO multi-
country study on women’s health revealed that the
prevalence of IPV significantly varied in terms of types
of IPV (WHO, 2005). Lifetime physical violence is
between 13% and 61%, sexual violence is between 6%
and 59%, emotional abuse and controlling behavioursis
between 20% and 75% (WHO, 2005). Although there are
many research findings on overall prevalence of IPV in
Sri Lanka, the research on prevalence of different types of
IPV acts are rare. Only a limited number of studies reveal
varying frequencies of physical, sexual, emotional abuse
and controlling behaviour where physical violence is
mainly reported(Guruge et al., 2015). Furthermore studies
have not documented how different abusive acts are
prevalent in Sri Lanka. Hence, this study attempts a) to
identify the prevalence of different types of IPV and b) to
explore the different abusive acts using a standardized
questionnaire in a representative study setting of Sri

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Lanka.
II. METHOD
A cross-sectional survey was conducted in the
Nawalapitiya MOH (Medical Officer of Health) area
consisting of a population of 59,917. It was purposively
selected to capture a representative population of women
in urban, rural and estate sectors with a satisfactory
representation of Sinhalese, Buddhist and other ethnic
communities. Ever-married women in between the age
group 15 to 49 years were selected as the study
population excluding the women with diagnosed mental
illnesses and women with cognitive impairments. The
sample size of 630 was calculated using an equation for
cluster sampling and further increased to 693 to
compensate non-response or non-participation errors.
(Naing, Winn, & Rusli, 2006). It was rounded up to 700
to consider a cluster size of 20 for 35 clusters.
Accordingly 1st
stage was a simple random sampling with
consideration of ten Public Health Midwife (PHM) areas
out of 27 PHM areas. The second stage was probability
proportion to size with a selection of 35 villages/
weighing centers as clusters. The final stage was a simple
random sampling of selecting households/ participants of
weighing centers.
The pretested interviewer-administered
questionnaire included the prevalence related questions
adhered to the WHO ethical guidelines for the conduct of
Violence Against Women (VAW) research and uses the
WHO VAW instrument developed for use in the WHO
multi-country study on women’s health and domestic
VAW. It incorporates sections 07, 08 and 09 from the
WHO study questionnaire (Ellsberg & Heise, 2005). The
questionnaire was translated to the local languages (i.e.
Sinhala and Tamil) and pretested in a similar MOH area.
Four research assistants were recruited and trained for
data collection. The study participants were given an
information sheet to explain the purpose and procedures
of the study. The written informed consent was obtained
from the respondent/s before conducting the interviews.
In illiterate respondents, a literate person known by the
respondent witnessed that the respondent is fully aware of
the provided information. Potential risks and discomforts
of discussing personal experiences were explained. To
ensure the privacy and the confidentiality, the information
was kept in an anonymous way ensuring the availability
of the required information.
Data was initially entered to Microsoft Excel
and Statistical Package for the Social Sciences (SPSS)
was used to analyze data. Descriptive summaries were
used to describe the types of different IPV prevalence.
The research received ethical clearance from the Ethics
Review Committee of the Faculty of Applied Sciences,
Rajarata University of Sri Lanka (Ref No. ERC/007/16).
The administrative clearance was obtained from Kandy
regional director of health services, Sri Lanka.
III. RESULTS
Study participants
Socio-demographic characteristics of the study
population is presented in the Table 1.
Table 1: Socio-demographic characteristics of the study population
Socio-demographic characteristic Total (N = 600)
No. (%)
Sector of residence
Urban 240 (40)
Rural 180 (30)
Estate 180 (30)
Age category
15 – 19 9 (1.5)
20 – 29 211 (35.2)
30 – 39 279 (46.5)
40 – 49 101 (16.8)
Marital status
Married 580 (96.7)
Divorced/Separated 13 (2.2)
Cohabit 1 (0.2)
Widowed 6 (1.0)
Educational status
No schooling 21 (3.5)
Grade 1 – 8 71 (11.8)
Grade 9 – G.C.E. O/L 214 (35.7)
Passed G.C.E. O/L 125 (20.8)
G.C.E. A/L 45 (7.5)
Passed G.C.E. A/L 105 (17.5)

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Diploma, degree, higher degree 19 (3.2)
Employment status
Housewives 449 (74.8)
Employed/Self employed 151 (25.2)
Household income category
<Rs. 20,000 120 (20.0)
Rs.20,001 – 34,999 169 (28.2)
Rs.35,000 – 49,999 111 (18.5)
Rs.50,000 – 74,999 115 (19.2)
Rs.75,000 ≤ 39 (6.5)
Don’t know, Refused / No answer 46 (7.7)
Number of household members category
< 3 members 13 (2.2)
3 – 6 members 491 (81.8)
3 < members 96 (16.0)
Abbreviations: G.C.E. O/L – General Certificate of Education - Ordinary level; G.C.E. A/L – General Certificate of
Education - Advanced level; Rs. – Sri Lankan Rupees
Lifetime and past year prevalence of any abuse
Among all participants 59.5% (n=357) have
experienced any type of abuse (any form of physical,
psychological, sexual abuse and controlling behaviour) at
least once during their lifetime. Out of all participants
41.3% (n=248) have experienced abuse (any form of
physical, psychological and sexual abuse) during the last
12 months. Distribution of participants according to
reported physical, psychological and sexual violence is
presented in the Table 2.
Table 2: Distribution of participants according to reported physical, psychological and sexual violence
Type of abuse/act of abuse
Prevalence of abuse (N=600) Frequency of abuse
Lifetime
physical
violence
During
the past
12
months
Before
the past
12
months
Occurrence of act
during the past 12
months
Occurrence of act
before the past 12
months
Single act
Multiple
acts
Single
act
Multiple
acts
n (%) n (%) n (%) n (%) n (%) n (%) n (%)
Physical abuse
Physical abuse (any)
237
(39.5)
89
(14.8)
148
(24.7)
Slapping or thrown an object
230
(38.3)
82
(13.7)
148
(24.7)
26
(31.7)
56
(68.3)
54
(36.5)
94
(63.5)
Pushed or shoved or pulled hair
64
(10.7)
28
(4.7)
36
(6.0)
4
(14.2)
24
(85.8)
7
(19.4)
29
(80.5)
Hit with fist or with an object
that could hurt
43
(7.2)
26
(4.3)
17
(2.8)
7
(26.9)
19
(73.1)
2
(11.8)
15
(88.2)
Kicked, dragged or beat
33
(5.5)
16
(2.7)
17
(2.8)
5
(31.2)
11
(68.8)
2
(11.8)
15
(88.2)
Choked or burnt
21
(3.5)
7
(1.2)
14
(2.3)
2
(28.6)
5
(71.4)
5
(35.7)
9
(64.3)
Threatened to use or actually
used a weapon
22
(3.7)
9
(1.5)
13
(2.2)
3
(33.3)
6
(66.6)
3
(23.1)
10
(76.9)
Psychological abuse
Psychological abuse (any) 234
(39)
158
(26.3)
76
(12.7)

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Prevalence and frequency of physical violence
Among the participants, 39.5% (n=237) were
physically abused by the partner at least once during their
lifetime. The most common type of physical violence
experienced by the participants was slapping or objects
thrown at them (n=230, 38.3%). Severe types of physical
violence such as choking or burning (3.5%, n=21)
threatening to use or actually using a weapon (3.7%,
n=22) were also reported. Past year prevalence of
physical violence was 14.8% (n=89). Prevalence during
the past 12 months was high for slapping or thrown
objects (n=82, 13.7%). Among the physically abused,
experiences of multiple acts were higher compared to
single acts.
Prevalence and frequency of psychological violence
Out of the 600 women, 39% (n=234) stated they
have been psychologically abused by the partner at least
once during the lifetime. At least one of four women in
the study population was scared or intimidated (n=161,
26.8%) and being insulted or made feel bad about own
self (n=150, 25.0%). Among the psychologically abused,
5% (n=30) have experienced being threaten of being hurt
of own selves or someone that they care. Among the
women who were psychologically abused during the past
12 months 18.7% (n=112) was scared or intimidated on
purpose where 17.0% (n=102) was being insulted or
made feel bad about own self. More than 85% of those
who experienced psychological abuse experienced it
multiple times.
Prevalence and frequency of sexual abuse
Among the respondents 12.3% (n=74)
experienced sexual abuse and 9.5% (n=57) stated they
engage in sexual intercourse because they are afraid to
refuse. Prevalence of sexual violence during the past year
was high compared to the occurrence of sexual abuse
before the past year. All women those experienced
sexual abuse, reported multiple times except only one
(7.1%) reporting a single act of degrading or humiliating
sexual behaviour.
Generally controlling behaviours
Distribution of participants according to reported
generally controlling behaviours is presented in the Table
3.Out of the respondents, 31.3% (n=188) reported being
generally controlled by the partner. As presented in the
Table 3, restrictions were identified on relationships with
their own families (n=63, 10.5%) and friends (n=69,
11.5%). Further, 16% (n=96) of the participants reported
that their partners get angry if they talk to another man
while 11.8% (n=71) reported their partners being
suspicious. Only 8.5% (n=51) reported that their partners
expected asking permission before seeking health care.
Table 3: Distribution of participants according to reported generally controlling behaviours
Controlling behaviour Response (N=600)
Yes No No answer/ Don't
know
N N n
Tries to keep away from seeing friends
69
(11.5)
531
(88.5)
0
(0.0)
Tries to restrict contact with the family
63
(10.5)
537
(89.5)
0
(0.0)
Being insulted or made feel bad
150
(25.0)
102
(17.0)
48
(8.00)
8
(7.8)
94
(92.2)
7
(14.6)
41
(85.5)
Belittled or humiliated
77
(12.8)
43
(7.17)
34
(5.67)
6
(14)
37
(86.1)
2
(5.9)
32
(94.1)
Scared or intimidated
161
(26.8)
112
(18.7)
49
(8.17)
15
(13.4)
97
(86.6)
4
(8.2)
45
(91.8)
Being threatened to hurt
30
(5.0)
21
(3.50)
9
(1.50)
3
(14.3)
18
(85.8)
1
(11.1)
8
(88.9)
Sexual abuse
Sexual abuse (any) 74
(12.3)
43
(7.17)
31
(5.17)
Forceful sexual intercourse
48
(8.0)
26
(4.33)
22
(3.67)
0
(0.0)
26
(100)
1
(4.5)
21
(95.5)
Having sexual intercourse due
to afraid
57
(9.5)
33
(5.50)
24
(4.00)
0
(0.0)
33
(100)
1
(4.2)
23
(95.8)
Degrading or humiliating sexual
behavior
20
(3.3)
14
(2.33)
6
(1.00)
1
(7.1)
13
(92.9)
0
(0.0)
6
(100)

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Insists on knowing where the partner is
48
(8.0)
552
(92.0)
0
(0.0)
Ignores and treats indifferently
58
(9.7)
542
(90.3)
0
(0.0)
Gets angry if spoken with another man
96
(16.0)
502
(83.7)
2
(0.3)
Often suspicious about being unfaithful
71
(11.8)
528
(88.0)
1
(0.2)
Expects to ask permission before seeking health care
51
(8.5)
548
(91.3)
1
(0.2)
IV. DISCUSSSION
The present study reveals that at least three in
five women have experienced some kind of IPV during
their lifetime while two in five women would have
experienced it during the past year. This figure of the
present study reveal higher IPV in terms of physical,
psychological, sexual abuse and controlling behvaiour
compared to the prevalence identified in other studies
conducted in Sri Lanka and the reported national IPV
prevalence (Guruge et al., 2015; Jayasuriya,
Wijewardena, & Axemo, 2011; Jayatilleke et al., 2011).
This may be due to that the results been generated from a
community based survey and including a study sample of
multi-ethnic community representing women from all
three sectors (urban, rural and estate) of Sri Lanka.
However, the reported lifetime prevalence lies between
the range of estimates presented by the WHO multi-
country study on women’s health and domestic
VAW(WHO, 2005).
IPV prevalence vary based on the type of IPV.
The present study report similar IPV prevalence in terms
of physical and psychological abuse during lifetime.
Some studies reported high physical abuse (34.4%) with
low prevalence of emotional abuse (19.3%) with a major
deviation (Jayasuriya et al., 2011). Yet, certain studies
report similar prevalence of physical abuse (32.2%) and
psychological abuse (34.2%) (Alangea et al.,
2018).However, the association of different types of
abuse is unclear. Sexual abuse is the least form of IPV
reported from Sri Lanka with a range between 5% to 18%
(Guruge et al., 2015). Consistently the present study
revealed a sexual prevalence of 12.3% with a common
behavoiur of women engaging in sexual intercourse due
to afraid of the partner. This also reflects a psychological
abuse where a Sri Lakan study indicated sexual abuse
does not occur isolately (Jayatilleke et al., 2011).
Controlling behavior reported by this study (31.3%,
n=188) is similar to a prevalence reported in a Sri Lankan
study (30.1%, n=218) (Jayasuriya et al., 2011). Studies
have identified controlling behaviours co-occurs in
violent relationship with physical and sexual violence
(WHO, 2012). However, the present study does not
examine the association of different types of IPV.
Compared to prevalence before the past year,
physical abuse (14.8%) was low andboth psychological
(26.3%) and sexual abuse (7.17%) during the past year
were high. Slapping or throwing objects was the most
common type of physical violence experienced by the
participants. Reporting choking or burning, threatening to
use or actually using a weapon indicated the presence of
severe types of physical violence. Presence of severe IPV
acts requires a serious response to address IPV. The most
common acts of psychological acts were making scared
or intimidated and being insulted or made feel bad about
own self. The most common sexual act behaviour was
having sexual intercourse due to afraid. Among the
physically, psychologically and sexually abused,
experiences of multiple acts were higher compared to
single acts. More than 50% of victims of psychological
and sexual abuse, experienced it during the past year
mainly as multiple acts. Compared to physical abuse,
presence of psychological and sexual abuse continues in
relationship. Among them, physical abuse and
psychological abuse was much common followed by
being controlled by the partner.
Comparison of IPV prevalence using a
standardized questionnaire with same study procedures
produce strong evidences on reported IPV prevalence of
Sri Lanka. Though violence is often under-reported as a
sensitive topic, the reported high prevalence indicates that
millions of women are suffering from violence in intimate
partnerships (Krug et al., 2002; Watts & Zimmerman,
2002). However, social desirability bias and recall bias
would have underestimated the IPV occurrences. Yet,
validity of past year prevalence of IPV increase compared
to the lifetime prevalence of IPV (Gil-González, Vives-
Cases, Ruiz, Carrasco-Portiño, & Álvarez-Dardet, 2008).
V. CONCLUSIONS
This study identifies high prevalence of IPV in
the study population. Physical abuse, psychological abuse
and controlling behavoiur are more prevalent than sexual
abuse. Presence of severe IPV acts requires an urgent
intervention as a public health issue. Interventions should
focus on different types of IPV. Both well perceived
forms of abuse such as physical abuse and less perceived
forms of abuse such as psychological abuse and
controlling behaviour should be treated as important
health concerns of women. Furthermore research is
required to explore the patterns, associations of types of
IPV and to examine the factors associated with different
types of IPV.

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ACKNOWLEDGMENTS
The authors acknowledge all the study
participants, staff of the Nawalapitiya and Gampola MOH
office and the four research assistants of the study.
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