Exploring a family-level approach to characterize the patterns, predictors, and outcomes of violence against women and adolescents within the home in Ethiopia

Abstract

Intimate partner violence (IPV) and children (VAC) are global epidemics with shared mental health consequences. While the home serves as a shared locale of exposure and research demonstrates longitudinal linkages between violence exposure in childhood and IPV exposure in adulthood, measurement and intervention strategies commonly use a one-woman or one-child approach, masking overlaps in forms of violence, predictors, and consequences, in the home. To address these gaps, this dissertation drew from socio-ecological, social norms, and family systems theories to address the question, “What are the distinct typologies and predictors of violence against women and their adolescent children in the home, and what is the association between these typologies of violence and adolescent and female caregiver mental health over a one-year period?” A quantitative secondary analysis used two rounds of data from the Gender and Adolescence: Global Evidence cohort study in Ethiopia with 4,195 dyads of adolescents aged 10-12 and their female caregivers. Latent class analysis identified six distinct classes of IPV and three classes of VAC at baseline (Aim 1). IPV classes were characterized by type of violence and included three classes with only emotional and/or economic IPV, and VAC classes were characterized by frequency of violence. Multilevel logistic regression models identified predictors of IPV, VAC, and broad family violence typologies (Aim 2). Risk factors for co-occurring IPV and VAC included caregiver disability, attitudes towards gender inequality and tolerance of VAC, male caregiver alcohol use, women’s sole decision-making, community-level normalization of corporal punishment, and political conflict exposure, alongside protective factors such as positive parenting and higher household economic status. Multilevel linear regression models found that co-occurring IPV and VAC at baseline was associated with greater caregiver and adolescent mental distress one year later (Aim 3). For adolescents, the association was moderated by male caregiver alcohol use and adolescent sex. This study found that a family-level approach reveals distinct typologies of family violence, predictors, and consequences, without losing information specific to women or adolescents. Multisectoral approaches to address men’s alcohol use and normalization of violence may prevent co-occurring IPV and VAC and mental distress among adolescents and female caregivers