SOCIODEMOGRAPHIC FACTORS ASSOCIATED WITH DOMESTIC VIOLENCE IN WOMEN IN PERU, 2021

ABSTRACT

Introduction: Domestic violence is based on phenomena that establish a relationship of subordination, whose behaviors are related to physical, psychological and sexual damage, through the real or symbolic use of force, with the aim of dominating the will, mind and body of the victim.
Objective: Determine the sociodemographic factors associated with women victims of domestic violence in Peru during the year 2021.
Material and Methods: It is an observational, retrospective, analytical and cross-sectional study, developed through the ENDES 2021 secondary databases, using information from 21,557 women. Said information was analyzed using the SPSS vers.27 statistical software, making use of the prevalence ratios using the Poisson regression model with robust variance.
Results: A prevalence of 47.7% of psychological violence was determined. The multivariate analysis identified that the variables associated with psychological violence were the level of primary education (RPa:1.10) and the metropolitan Lima region (RPa:1.14), regarding sexual violence, the level of poor wealth (RPa:2.35) was The associated variable, and with respect to physical violence, were age between 20 and 29 years (RPa:1.21), poor wealth level (RPa:1.495) and the coastal region (RPa:0.79).
Conclusions: It was identified that the factors associated with psychological violence were the level of education and the natural region, the marital status was a protective factor against sexual violence, and the variables of age and wealth level were associated with physical violence.

Keywords: Violence against women, domestic violence, risk factors (source: MeSH NLM)


RESUMEN

Introducción: La violencia intrafamiliar se basa en fenómenos con una relación de subordinación, cuyos comportamientos se relacionan con el daño físico, psicológico y sexual, mediante el uso real o simbólico de la fuerza, con el objetivo de dominar la voluntad, mente y cuerpo de la víctima.
Objetivo: Determinar los factores sociodemográficos asociados a las mujeres víctimas de violencia intrafamiliar en el Perú durante el año 2021.
Material y Métodos: Es estudio observacional, retrospectivo, analítico y transversal, desarrollado mediante las bases secundarias ENDES 2021; se utilizó la información de 21 557 mujeres, la cual fue analizada mediante el software estadístico SPSS versión 27. Se hizo uso de las razones de prevalencia mediante el modelo de regresión de Poisson con varianza robusta.
Resultados: Se determinó una prevalencia del 47.7 % de violencia psicológica. El análisis multivariado identificó que las variables asociadas a violencia psicológica fueron el nivel de educación primaria (RPa: 1.10) y la región Lima Metropolitana (RPa: 1.14), respecto a la violencia sexual, el nivel de riqueza pobre (RPa: 2.35) fue la variable asociada, y en cuanto a la violencia física, la edad de 20 a 29 años (RPa: 1.21), nivel de riqueza pobre (RPa: 1.49) y la región costa (RPa: 0.79).
Conclusiones: Se identificaron como factores asociados a la violencia psicológica el nivel de instrucción y la región natural, el estado civil fue un factor protector ante la violencia sexual, y las variables de edad y nivel de riqueza fueron asociadas a la violencia física.

Palabras clave: Violencia contra la mujer, violencia doméstica, factores de riesgo. (fuente: DeCS-BIREME)

INTRODUCTION

Domestic violence is based on phenomena that establish a relationship of subordination, whose behaviors are associated with physical, psychological, and sexual harm, through the actual or symbolic use of force, with the aim of dominating the will, mind, and body of the victim ⁽¹⁾.

According to the Demographic and Family Health Survey (ENDES, by its acronym in Spanish), the rate of domestic/spousal violence against women of childbearing age in Peru experienced a reduction of 19.2% between 2009-2019, with a prevalence of 54.8% in 2020 ⁽²⁾. However, when categorizing these types of violence as psychological, physical, and sexual, ENDES found that in 2020 alone, 50.1% of women reported psychological violence; 27.1% physical violence and only 6% sexual violence ⁽²⁾, which establishes this problem as a silent pandemic where women face their aggressor with fear or distrust ⁽³⁾.

With this in mind, it is necessary to clarify the overall picture of victims of domestic violence and to understand the sociodemographic factors related to it, as violence can be present in many homes and damage family structures from very early stages ⁽⁴⁾.

MATERIALS AND METHODS

Study Design and Population

This is an observational, retrospective, analytical, and cross-sectional study developed from information collected from 21,557 women through the secondary database ENDES 2021.

Sample

The study included women aged 15 to 49 years, registered in the ENDES 2021 survey, whose data were complete in the study variables, having voluntarily agreed to complete the survey. Additionally, women aged 15 to 49 years who did not have complete data in the study variables and answered "I don't know" or "I don't remember" to selected survey questions were excluded. The sampling types were two-stage, probabilistic, balanced, stratified, and independent, divided into departmental, urban, and rural levels.

Variables and Instruments

To analyze all the information, the complex samples module of the statistical software SPSS version 27 was used, which was generated from the microdata obtained by the Instituto Nacional de Estadística e Informática (INEI) through its ENDES 2021 questionnaire.

Then, the databases were read using the SPSS v27 program, in which the variables of interest required for this study were identified, obtained from the following modules: Basic data of women of childbearing age (1631), nuptiality-fertility-spouse and woman (1635), maternal mortality-domestic violence (1637).

Procedures

A data file for the dependent variable of our study was created with the base REC84DV, and independent variables were added: marital status from the base REC16171, natural region from REC091, and age, level of education, area of residence, and wealth level from REC0111.

Variables V005, corresponding to the weighting factor for women of childbearing age, V001, identifying the conglomerate, and V022, for the strata, were taken into account. These were incorporated into the file with the purpose of recruiting the sample design of ENDES 2021. The identifiers HHID and CASEID were considered for the merging of files.

Statistical Analysis

A univariate analysis was conducted using complex samples through the weighting factors. Likewise, for the bivariate analysis, crude prevalence ratios accompanied by their confidence intervals were calculated using the weighting factors.

Similarly, a multivariate analysis was performed in which adjusted prevalence ratios were calculated, using the Poisson regression model with robust variance for binary response, accompanied by their confidence intervals for each type of violence.

Ethical Aspects

The information from the ENDES micro-database has informed consent, in which the principles of ethics in research are respected; likewise, all information was corroborated and approved by the Research Ethics Committee of the Faculty of Human Medicine of Universidad Ricardo Palma.

RESULTS

The study is based on a total of 21,557 women aged 15 to 49, victims of domestic violence in Peru, using records from the Instituto Nacional de Estadística e Informática in their ENDES 2021 database.

Table 1 describes the prevalence in relation to the type of domestic violence suffered by women during 2021, of which 47.7% (n=9846) of women were victims of psychological violence, 1.8% (n=459) of sexual violence, and 7.0% (n=1852) of physical domestic violence in Peru.

Table 2 describes the association between sociodemographic factors and psychological violence in women. When evaluating age, there was no significant association between psychological violence and the group of women aged 20 to 29 years (APR = 0.877; 95% CI: 0.831 - 0.926), compared to those aged 30 to 49 years.

A significant association was found between psychological violence and educational level. Specifically, women with primary (p=0.006) or secondary education (p<0.001) were at higher risk of being victims of psychological violence compared to those with a higher educational level. Also, women whose marital status was married (APR = 0.527; 95% CI: 0.495 - 0.562) or cohabiting (APR = 0.619; 95% CI: 0.588 - 0.651) did not show a significant association with psychological violence compared to non-cohabiting women. Regarding natural regions, women from the Lima Metropolitan area (p=0.002) and the highlands (p<0.001) were associated with being victims of psychological violence compared to those from the jungle region.

Table 3 evaluates the association between sociodemographic factors and sexual violence in women, determining that married women did not show a significant association with being victims of sexual violence compared to non-cohabiting women (APR = 0.654; 95% CI: 0.445 - 0.962).

In relation to economic level, women at a poor wealth level (p<0.001) were associated with a higher risk of being victims of sexual violence compared to women at a higher wealth level.

When evaluating the association between sociodemographic factors and physical violence in women (table 4), it was determined that women aged 15 to 19 years (p=0.042) or 20 to 29 years (p=0.004) were associated with being victims of physical violence, compared to those aged 30 to 49 years. Similarly, women with no educational level (APR = 0.506; 95% CI: 0.275 - 0.932) were not associated with a higher risk of physical violence, compared to those with a higher educational level. Also, it was determined that women whose marital status is married (APR = 0.561; 95% CI: 0.468 - 0.673) or cohabiting (APR = 0.724; 95% CI: 0.630 - 0.832), were not associated with the risk of experiencing physical violence, compared to those in a non-cohabiting partnership.

Regarding natural regions, women living in the Lima Metropolitan area (APR = 0.777; 95% CI: 0.635 - 0.951) and the coast (APR = 0.790; 95% CI: 0.650 - 0.960) were not associated with a higher risk of suffering physical violence compared to those from the jungle.

DISCUSSION

This study demonstrates the presence of sociodemographic factors associated with domestic violence in the sample studied; psychological violence is the most common in our environment. Factors associated with it were age, level of education, natural region, and marital status; the latter, as well as the wealth level, were significant for sexual violence. All the factors described are associated with physical violence.

In this study, 47.7% of women were victims of psychological violence, 1.8% suffered sexual violence, and 7.0% experienced physical violence. These figures are comparable with previous research, such as the study by Das BN and Mohandas A. ⁽⁵⁾, who found rates of 38.5%, 3%, and 70.6% for psychological, sexual, and physical violence, respectively. Similarly, León P ⁽⁶⁾ determined in a study in San Juan de Lurigancho, Peru, that 68.4%, 2.4%, and 7.6% of women suffered psychological, sexual, and physical violence, respectively. Therefore, the high prevalence of psychological violence could be due to its masking under a lack of recognition as a victim, with women feeling guilty and responsible and often minimizing the situation by mistakenly thinking about the remorse of the aggressor, contributing to the lack of perception of being a mistreated woman.

Various sociodemographic factors associated with psychological violence in women were identified in our study. However, no association was found in the age group of 20 to 29 years, differing from the findings of Kanougiya S ⁽⁷⁾, who identified the age between 25 and 34 years as a protective factor. This result suggests that women in this age range are less likely to be victims of psychological violence, possibly influenced by media awareness, allowing them to recognize behaviors that incite violence, a key aspect in the dynamics of power and submission in the home.

Women with primary or secondary education face more risk of psychological violence in our study. These findings coincide with those of Vasconcelos NM ⁽⁸⁾, who indicates a 26% increase in risk for women with primary education. Lazarte M ⁽⁹⁾ also identifies a higher risk in women with secondary education, representing 45.5% of their study. Therefore, the sociocultural context is crucial, as limited education can lead to a poor perception of violence, being tolerated by sectors of society and exploited by the aggressor.

Regarding marital status, married or cohabiting women are not associated with psychological violence compared to non-cohabiting women in our study. These results differ from those obtained by Lazarte M ⁽⁹⁾, who reports a 40.7% and 55.9% risk of suffering psychological violence in married or cohabiting women, respectively. A similar result to the study by León P ⁽⁶⁾, who associated a 43.3% risk for women with a cohabiting partner. This discrepancy may be explained by the perception of marriage in specific sociocultural contexts, where women may feel pressure to assume traditional roles. Psychological violence, often related to controlling behaviors, is overlooked and remains hidden in the domestic sphere.

When evaluating natural areas, women from the Lima Metropolitan area and the highland region are at greater risk of suffering psychological violence, with values of 14% and 19%, respectively. This agrees with the results obtained by Lazarte M ⁽⁹⁾, who identified 32.4% of women from the Lima region and 29.9% from the highland region associated with psychological violence. Variations may arise due to different social contexts in each population group, demonstrating that psychological violence is a complex and multicausal problem, present at all social levels, regardless of the geographical region.

Regarding the various sociodemographic factors associated with sexual violence, marital status was analyzed, establishing in our study that being a married woman is a protective factor against the risk of being a victim of sexual violence, as also confirmed by Lazarte M ⁽⁹⁾. This type of violence can manifest in all forms and types of relationships; however, the state of marriage may break these patterns of violence by creating an emotional bond with the partner.

Also, women at a poor wealth level have a 35% higher risk of suffering sexual violence. These findings are consistent with previous research such as that of Tun T ⁽¹⁰⁾, who found that low economic levels are significantly associated with sexual violence. Additionally, they coincide with Yasmin S ⁽¹¹⁾, who identified 51.9% of women affected by sexual violence belonging to a low socioeconomic level. Similar results were obtained in the study by Tiravanti D. ⁽¹²⁾, where 48.5% of economically disadvantaged and very poor women were victims of sexual violence. We believe that women in situations of sexual violence, lacking resources and income, face greater difficulties in escaping such environments, increasing their vulnerability to being more abused and sexually mistreated.

Regarding the sociodemographic factors associated with physical violence, we found that women aged 15 to 19 years and 20 to 29 years have a higher risk for this type of violence. This finding is similar to the research by Subhaschandra K ⁽¹³⁾, where 33.8% of women who suffered physical violence were between 21 and 30 years, and with Yasmin S ⁽¹¹⁾, who identified 28.21% of women aged 18 to 25 years affected by physical violence.

As for the level of education, in our research, the lack of education was not associated with an increased risk of physical violence, contrary to what was reported by Tiravanti D ⁽¹²⁾ and Lazarte M ⁽⁹⁾ in the Peruvian population. This discrepancy could be due to the size of our sample, as unequal power relations towards women are often linked to the belief in an educational advantage ^{(9, 12)}.

Regarding marital status, it is noteworthy that married or cohabiting women did not show an association with a protective effect against the risk of physical violence. However, this finding contrasts with previous studies, such as that of Rodríguez I ⁽¹⁴⁾, who reports 55.2% of physical violence in women with a cohabiting partner; or that of Lazarte M ⁽⁹⁾ with 47.7%.

In terms of wealth level, the study reveals that women considered poor or moderately rich face a higher risk of physical violence. These results coincide with previous research, such as those by Tun T ⁽¹⁰⁾ and Kanougiya S ⁽⁷⁾, who indicate an association between low economic level and physical violence. Lazarte M ⁽⁹⁾ reports 46.5% of women in low poverty levels with physical violence, and 22.9% in medium wealth levels. The evidence suggests that wealth indices are a factor associated with physical violence. It is inferred that due to their low socioeconomic status, women may feel powerless to secure family economic support, which would justify the acceptance of patriarchy based on an inferiority complex. This might lead them to accept any form of mistreatment in pursuit of satisfying their needs, due to their economic limitation.

Regarding the natural region, it is highlighted that women from the Lima Metropolitan area and the coastal region did not show an association with a protective effect against physical violence. This finding coincides with Lazarte M. ⁽⁹⁾, who identified 34.7% and 26% of women residents in the Lima Metropolitan area and the coastal region, respectively, not experiencing this type of violence. However, it contrasts with the results of Berrocal A. ⁽⁴⁾, who reports a significant association of 19.41% of physical violence in women from the coastal region. This discrepancy can be explained by differences in the population size and sociodemographic characteristics of the sample used in our study, reflecting the various social contexts in which each studied population lives and highlighting the importance of addressing violence as a latent problem in the country.

Finally, as a study that considered secondary databases as the main source, the variety of available questions and answers limited the variables to be studied considered in the literature; therefore, the limitations present in the study lie in the violence data reported by INEI in its ENDES 2021 survey, which are based on self-reports of the female population; this can underestimate the actual number of abuse cases given the subjectivity and privacy of women facing these acts; therefore, there are biases from the source of information itself, either as incomplete, false, or ambiguous responses. Finally, a strength of the study to highlight is the sample design of ENDES itself, the results are representative and reliable at the national level.

CONCLUSIONS

Psychological violence was the type of violence with the highest prevalence rate in our study. The sociodemographic factors associated with psychological violence were the level of education and the natural region. Marital status was a protective factor against sexual violence. Age and wealth level were associated with physical violence.

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