Domestic Violence Against Women:

Domestic Violence Against Women: Systematic Review
of Prevalence Studies
Samia Alhabib & Ula Nur & Roger Jones
Published online: 15 December 2009
# Springer Science+Business Media, LLC 2009
Abstract To systematically review the worldwide evidence
on the prevalence of domestic violence against women, to
evaluate the quality of studies, and to account for variation
in prevalence between studies, using consistent definitions
and explicit, rigorous methods. Systematic review of
prevalence studies on domestic violence against women.
Literature searches of 6 databases were undertaken for the
period 1995 to 2006. Medline, Embase, Cinahl, ASSIA,
ISI, and International Bibliography of the Social Sciences
were searched, supplemented by hand searching of the
reference lists from studies retrieved and specialized
interdisciplinary journals on violence. A total of 134 studies
in English on the prevalence of domestic violence against
women, including women aged 18 to 65 years, but
excluding women with specific disabilities or diseases,
containing primary, empirical research data, were included
in the systematic review. Studies were scored on eight predetermined
criteria and stratified according to the total
quality score. The majority of the sudies were conducted in
North America (41%), followed by Europe (20%). 56% of
studies were population-based, and 17% were carried out
either in primary or community health care settings. There
was considerable heterogeneity both between and within
geographical locations, health care settings, and study
quality The prevalence of lifetime domestic violence varies
from 1.9% in Washington, US, to 70% in Hispanic Latinas
in Southeast US. Only 12% scored a maximum of 8 on
our quality criteria, with 27% studies scored 7, and 17%
scored 6. The mean lifetime prevalence of all types of
violence was found to be highest in studies conducted in
psychiatric and obstetric/gynecology clinics. Results of this
review emphasize that violence against women has reached
epidemic proportions in many societies. Accurate measurement
of the prevalence of domestic violence remains problematic
and further culturally sensitive research is required to
develop more effective preventive policies and programs.
Keywords Domestic violence .Women . Prevalence .
Violence against women includes all verbal, physical, and
sexual assaults which violate a woman’s physical body,
sense of self and sense of trust, regardless of age, race,
ethinicity, or country (Campbell 1995). Violence against
women has been identified as a major public health and
human rights issue (Joachim 2000), and has been estimated
by the World Health Organization (WHO) to account for
between 5–20% of healthy years of life lost in women aged
15 to 44 (WHO 1997).
Twenty years ago, violence against women was not
considered an issue worthy of international attention or
concern. This began to change in the 1980s, as women’s
groups were organized locally and internationally to
S. Alhabib (*)
Academic Unit of Primary Health Care, University of Bristol,
25 Belgrave Road,
Bristol BS8 2AA, UK
U. Nur
Cancer Statistics-Cancer Research UK,
London School of Hygiene and Tropical Medicine,
London, UK
R. Jones
Department of General Practice & Primary Care,
King’s College London,
London, UK
J Fam Viol (2010) 25:369–382
DOI 10.1007/s10896-009-9298-4
demand attention to the physical, psychological, and
economic abuse of women. Gradually, violence against
women has come to be recognized as a legitimate human
rights issue and a significant threat to women’s health and
well being (Ellsberg and Heise 2005). The process began in
Europe and North America, but even in the United States,
where this trend was most apparent, it took 20 years for
rising awareness to lead to legislation and to potentially
effective preventive measures. Only in the early 1990s were
comprehensive laws enforced and effective resources
allocated to deal with gender violence (Gelles 1997).
Worldwide, domestic violence is as serious a cause of
death and incapacity among women aged 15–49 years as
cancer, and a greater cause of ill health than traffic
accidents and malaria combined (The World Bank 1993).
In addition to causing injury, violence increases women’s
long-term risks of a number of other health problems,
including chronic pain, physical disability, drug and alcohol
abuse, and depression (Heise et al. 1999). Secondary to the
biopsychosocial effects of battering are the high costs of
such violence. Abused women have more than double the
number of medical visits, an 8-fold greater mental healthcare
usage, and an increased hospitalization rate compared
to non-abused women (Wisner et al. 1999). The WHO
multi-country study on women’s health and domestic
violence has recently confirmed significant associations
between lifetime experiences of partner violence and self
reported poor health (Ellsberg et al. 2008).
Prevalence studies of violence against women report
wide variations in levels of violence within and between
health care settings. The reported lifetime prevalence of
physical or sexual violence, or both, varied from 15% to
71% among the countries studied in the WHO multi-country
study (Garcia-Moreno et al. 2006). Few studies have used
standard methods to derive comparative prevalence figures.
The World-Safe initiative represents a successful model that
has been used in five countries (Brazil, Chile, Egypt,
Philippines, and India) to study intimate partner violence
against women and children (Sadowski et al. 2004). The
WHO multi-country study uses another model, which has
been applied in 10 different countries. While confirming that
physical and sexual partner violence against women is
widespread, the variation in prevalence within and between
study settings emphasizes that this violence is not inevitable,
and needs to be addressed.
Over the last 10 years, a number of prevalence surveys on
intimate partner violence has been published from around
the world. However, despite a number of initiatives, such as
the European Network on Conflict, Gender, and Violence, the
launching of a European Society of Criminology and efforts to
develop an international survey on violence against women
(Hagemann-White 2001), information from these studies has
not been systematically collated and analyzed. The aim of
this systematic review is to systematically summarize the
worldwide evidence on the prevalence of domestic violence
against women, to evaluate the quality of studies, and to try
to account for variation in prevalence rates between studies.
Literature Searches
Parallel literature searches of 6 databases (Medline, Embase,
Cinahl, ASSIA, ISI, and International Bibliography of the
Social sciences) were undertaken for the period1995–2006.
The reference lists from retrieved studies and specilaized
interdisciplinary journals in violence (Violence Against
Women, Journal of Interpersonal Violence) were hand
searched to look for further studies that might not have
been retrieved by the database searches. Authors of
unpublished studies, e.g., PhD theses, were contacted to
obtain copies of their studies. We contacted experts in the
field before and during the process to obtain feedback and
advice with regard to methodology and analysis. All
citations were exported into Reference Manager software
(version 11). Searches included MeSH and text words terms,
with combinations AND OR Boolean operator (Box 1).
Box 1: words used in the search
1. Domestic violence. 13. Frequency.
2. Spouse abuse. 14. Prevalenc$.tw.
3. Battered women. 15. Incidenc$.tw.
4. Partner abuse. 16. Propotion$.tw.
5. Domestic 17. Frequenc$.tw.
6. Spouse 18. 10 or 11 or 12 or 13 or 14
or 15 or 16 or17.
7. Battered 19. Women.
8. Partner 20.
9. 1 or 2 or 3 or 4 or 5 or 6
or 7 or 8.
21. 19 or 20.
10. Prevalence. 22. 9 and 18 and 21.
11. Incidence. 23. Limit 22 to “all adult
(19 plus years)”
12. Proportion. 24. Limit 23 to female.

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