Prevalence of Intimate Partner Violence in Thailand

Prevalence of Intimate Partner Violence in Thailand There is no recent national data on the prevalence of intimate partner violence in Thailand. This study proposed to examine the prevalence of intimate partner violence in 4 regions of Thailand by using a standardized questionnaire from the WHO multi country study on women’s health and domestic violence. Two thousand four hundred and sixty-two married or cohabiting women aged 20–59 years were interviewed about their experiences of psychologically, physically, sexually violent, and/or controlling behaviors by their male partners. The study found that 15% of respondents had experienced psychological, physical, and/or sexual violence in their life time which suggests that 1 in 6 of Thai women have faced intimate partner violence. Of the 15% of women who reported intimate partner violence within the past 12 months, psychological violence was the most common (60–68%), followed by sexual violence (62–63%) and physical violence (52–65%). In addition, the percentage of women who faced various forms of controlling behaviors varied from 4.6% to 29.3%. Men who were more controlling were more likely to abuse their female partners. The results reveal that partner violence against women is a significant public health issue in Thai society that must be addressed. . . . Keywords Intimate partner violence Domestic violence Thailand National prevalence Violence against women is a significant problem and a uni- social problem, and women’s human rights violation (WHO versal phenomenon around the world, including in Thailand. 2016), (WHO 2005a) which negatively affects women’sphys- One in 3 (35%) women around the world have experienced ical, mental, sexual and/or reproductive health (WHO 2016). physical and/or sexual violence by their partner in their life- time (WHO 2016). The United Nations defines violence against women as any acts of violent behavior that results in Intimate Partner Violence in Thailand physical, sexual or psychological harm to women (UN 1993). There are many forms of violence against women. One of the In Thai society, IPV is considered as a private issue and family most common forms is Intimate Partner Violence (IPV) matter because the family is an important social institution, (WHO 2002). IPV is a major public health issue, a hidden and portrayed as a space of love and care, however, in reality family violence exists. Most Thais learn they should not tell outsiders about internal family matters. As a result, IPV re- mains an invisible and unrecognized issue in Thai society and * Montakarn Chuemchit women victims have to deal with their intimate violence in Montakarn.ch@chula.ac.th their lives alone (Archavanitkul et al. 2005). When violence occurs in families, it is not reported, thus the statistics on IPV College of Public Health Sciences, Chulalongkorn Univerisity, in Thailand are likely to be underestimated. Most of IPV sta- Institute Building 2, Phayathai Road, Patumwan, Bangkok 10330, tistics in Thailand are reports from Government Organizations Thailand (GOs) and Non-Government Organizations (NGOs) such as The Royal Thai Ministry of Public Health, Nonthaburi, Thailand the One Stop Crisis Centre (OSCC). The OSCC is run by the Faculty of Nursing, Naresuan University, Phitsanulok, Thailand Ministry of Public Health and is a unit in government hospi- Faculty of Public Health, Burapha University, Chonburi, Thailand tals aimed to assist victims of violent situations from police station, NGOs’ and shelters. Individuals who notify the police The Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands or visit a hospital are likely severe cases of violence. Statistics 316 J Fam Viol (2018) 33:315–323 show that the numbers of domestic violence cases have sig- by male partner varied from 4.7% to 31.3%. Furthermore, in nificantly increased from 25,767 to 31,866 between 2010 and all settings, women who had experienced either physical and/ 2013 respectively (Thai Health Promotion Foundation 2011), or sexual violence regularly reported more emotional suffer- (The Women's Affairs and Family Development 2013). In ing and identified physical health issues such as pain (WHO addition, the report from the OSCC, Ministry of Public 2005b). Health (MOPH) found that, in 2015, there were 23,977 wom- In 2006, there was a cohort study on domestic violence en who used their services. Furthermore, there were 460 cases among pregnant Thai women in one province. They recruited of partner violence wherein police were notified and 373 cases 421 women in third trimester of pregnancy and followed them which were sent to the court (The Women's Affairs and until 6 weeks postpartum. The study revealed that 53.7% re- Family Development 2015). ported psychological violence, 26.6% faced physical violence, To address intimate partner violence, in 2007, Thailand and 19.2% confronted sexual violence by their partner during launched BDomestic Violence Victim Protection Act, B.E. the current pregnancy. Whereas, in the postpartum period re- 2550^ and amended the criminal law B.E. 2550 section 276 spondents who had experienced some type of intimate partner (Penal Code Amendment Act (No.19) B.E. 2550 (2007) violence ranged from 9.5% to 35.4% (Sricamsuk 2006). 2007). The BDomestic Violence Victim Protection Act, B.E. The latest National Reproductive Health Survey from 2009 2550^ comprises 18 sections; many sections are important to (Social Statistics Bureau 2010) revealed that the rate of inti- victims, perpetrators, and government officers. For example, mate partner violence among Thai women across the country section 4 states that BWhoever conducts any act of domestic was 2.9%. More recently, Chuemchit and Perngparn (2014) violence or is said to commit domestic violence shall be liable reported that between July – December, 2010 there were 471 to imprison for a term of not exceeding six months or to a fine women in Bangkok city who used the services at One Stop of not exceeding six thousand Baht or both^;section 5stats Crisis Centre and more than 70% of women had been victim- that BA domestic violence victim or a person who has found or ized more than once (Chuemchit and Perngparn 2014). known of domestic violence shall have the duty to notify a These data are the tip of the iceberg; the true extent of the competent official for the execution of this Act..^ Prior to issue cannot be seen. In Thailand, there have been no large- 2007, the criminal law B.E. 2550 section 276, did not include scale IPV prevalence studies since the 2005 WHO Multi- marital rape as a crime so spouses were not legally protected country study on Women’s Health and Domestic Violence against sexual abuse by their partner (Penal Code Amendment Against Women. In response, the aim of this study was to Act (No.16) B.E. 2546 (2003) 2003). However, changes to the examine the current prevalence of the various forms of inti- law in 2007 added legal protection for spouses who are mate partner violence, including physical, psychological, sex- victims of sexually violence by their partner. ual violence, and controlling behaviors and to identify factors associated with partner violence. Intimate Partner Violence Research in Thailand The WHO Multi-country study on Women’s Health and Method Domestic Violence Against Women (2005) examined the prevalence of intimate partner violence in 10 countries: Participants Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Tanzania, and Thailand. This study was a cross-sectional study in 4 regions of The study found that of the 24,097 women participants, Thailand: central, northern, southern, and northeastern which 16.0% to 61.0% had experienced some act of physical partner are the official government-categorized zones. A multi-stage violence in their lifetime. Sexual violence was reported by sampling technique was used; first, simple random sampling 6.0% to 58.0% of respondents. In addition, 16.0% to 69.0% was used for selection of one province in each region, second, of women reported that they had experienced either sexual all districts from the region were chosen for the study. and/or physical violence by their partners. In Thailand, the N∑N πðÞ 1−π h h h The sample size was calculated by n = , stra 2 2 study found that 22.9% of women in urban areas reported N D þ∑N πðÞ 1−π h h h physical violence, 29.9% reported sexual violence, and π = The proportion of IPV in Thailand (5.13%), based on 41.1% reported physical or sexual violence, or both. National Statistic Office 2006. Therefore, a total sample size Whereas, 33.8% of women in rural areas reported physical of 2,462 eligible persons was sought. Then the sample was violence, 28.9% reported sexual violence, and 47.4% reported calculated as proportionate to the size of each province and physical or sexual violence, or both. It is interesting to note district. Finally, convenience sampling was used to select the that urban Thai women reported more sexual violence than participants at each community site. At the community level, physical violence. The percentage of both urban and rural first, researchers went to see a community leader to request the women revealing one or more acts of controlling behaviors names and addresses of married or cohabiting women. J Fam Viol (2018) 33:315–323 317 Second, researchers visited women’s houses based on the list Research Subjects, Health Science Group, Chulalongkorn to conduct interviews. All eligible women we met were select University (COA No.201/2016), Thailand. as respondents. While both men and women can be victims, women are more likely than men to face various forms of Measurement Tool partner violence and report IPV-related injury (Hegarty 2000), (Breiding et al. 2008), (Tjaden and Thoennes 2000). A questionnaire was developed from the WHO multi country Therefore, this study focused on women age 20–59 years, still studyonwomen’s health and domestic violence married or cohabiting with a partner, and willing to participate (Archavanitkul et al. 2005), (Garcia-Moreno et al. 2006). in the study. Table 1 provides a brief description of the study The WHO multi country study on women’s health and domes- areas. tic violence, measures three items of Bsexual abuse^, six items of Bphysical abuse^,four items of Bpsychological abuse^,and seven items of Bcontrolling behaviors^ which were examined Procedure and Data Collection separately from psychological abuse. After the pre-test, the Cronbach alphas for this measurement tool was 0.94. Each province had research assistants under the supervision of The participants were asked questions related to their ex- the principal investigator. In order to ensure quality data was perience of specific acts of psychological, physical, and sexual captured, the female research assistants recruited for the data abuse by their current husband and/or cohabiting male partner. collection had at a minimum a bachelor degree, worked in the Furthermore, we also followed the WHO framing of the ques- area of public health, and were experienced in community- tions which highlighted Bhow partner’s treat each other rather based research. In each site, the interviews were conducted than so-called conflict negotiation^ (Garcia-Moreno et al. by trained interviewers who passed the standardized training 2006), (Heise and Garcia-Moreno 2002) because much inti- based on WHO women’s health and domestic violence study mate abuse in the Thai context can be conceptualized as (Jansen et al. 2004) covering issues of gender-based violence punishment. and its consequences, gender sensitivity, interviewing tech- The questions on psychologically violent acts focused on niques and skills, ethic, and the questionnaire. To ensure the insulting, humiliating, scaring, and threatening behaviors. The confidentiality and safety of participants, each participant had questions on physically violent acts were categorized as: 1) a separate and private interview by a trained female interview- mild-to-moderate violence and 2) severe violence based on er. All these processes were intended to protect the privacy of physical injury. Mild-to-moderate violence included pushing, the participants and minimize the shame of respondents for shoving, grabbing or slapping and severe violence included disclosing details of their relationship. After finishing the in- choking, kicking, or using a weapon (WHO 2005b)(see terview, all respondents received useful information about Table 2). Sexually violent acts included using physical force available services, for instance, hotline call center, shelter for sexual intercourse, having sexual intercourse against houses, and OSCCs in each province. Interviewers also pro- women’s will, and sexual humiliation. For each act of vio- vided respondents with additional support from local health lence, each participant was asked whether it had occurred over service providers if requested. The data collection was con- a year ago or within the year and then asked about the fre- ducted in 2016. quency of each act: 1) once or twice 2) a few times or 3) more Ethical permission for this study was obtained from the than five times. The lifetime prevalence of IPV was defined as Ethics Review Committee for Research Involving Human women who reported any kind of violent experience by a Table 1 Study sites by region and Region Female population Province Sample size province* (20–59 years old) Central 5,113,691 Chonburi: Famous province for Oceanside. Lots of 725 factory and tourism business. 80 km from Bangkok Northern 3,644,532 Phitsanulok: 383 km from Bangkok. Mountainous area 457 mostly in Agriculture Southern 2,659,222 Surat Thani: Large City in the region. Center for tourism 378 along seaside. Mostly in tourism and fishery business. 639 km from Bangkok Northeastern 6,595,363 Khonkaen: Big city and the center of northeastern. 902 Mostly in agriculture and tourism service business. 449 km from Bangkok Total 2462 *Thailand consist of 77 provinces 318 J Fam Viol (2018) 33:315–323 Table 2 Items of the questionnaire used to define psychological, physical, sexual violence, and controlling behaviors by intimate male partner Psychological violence Physical violence Sexual violence Controlling behaviors Insulted or made feel bad Mild-to-moderate: Physically forced you to have sex Tried to keep you from seeing friends about oneself when you did not want Humiliated or belittled in Slapped or threw something Had sexual intercourse when did Tried to restrict you to contact your family front of other people that could hurt not want because afraid of what partner might do Did things to scare or frighten Pushed or shoved Was forced to do sexual activity Insisted on knowing where you were at all times that degrading or humiliating Threatened to hurt you or Severe violence: Ignored you and treated you indifferently someone you care about Hit with fist or something Got angry if you spoke with another man that could hurt kicked, dragged, or beaten up Was often suspicious that you were unfaithful Chocked or burnt Expected you to ask permission before going out Threatened to use weapon current partner over a year before the interview. Current prev- education, respectively. About 10.7% of participants were alence was defined as women revealing at least one act of housewives and/or no occupation, while 89.3% had an occu- partner violence during the past year. pation (See Table 3). In addition, this study also focused on seven forms of con- trolling behaviors by women’s male partners which consisted Table 3 Selected socio-demographic characteristics of 2462 married/ of various acts to force and restrict women’s daily life. For cohabiting women of the 4 regions of Thailand each act of controlling behavior, each respondent was asked whether it had happened within the past year (Yes or No). Characteristics n (%) BYes^ responses were given a score of one and BNo^ re- Province (n = 2462) sponses were given a score of zero. Total scores were catego- Chonburi 725 (29.4) rized into four levels (Garcia-Moreno et al. 2006): (1) None Phitsanulok 457 (18.6) (2) low (3) medium and (4) high. Surat Thani tourism 378 (15.4) Khonkaen 902 (36.6) Data Analysis Age (n =2441) All data was entered, cleaned and coded before analyzing. 20–29 years 487 (20.0) Statistical Package for Social Sciences (SPSS Version 22) 30–39 years 712 (29.2) was used to perform Uni-variate, Bivariate, and multivariate 40–49 years 766 (31.4) analysis. Uni-variate analysis was used to describe and sum- 50–59 years 476 (19.5) marize variables and find patterns in the data. (e.g. frequen- Mean ± SD 39.4 ± 10.2 cies, percentages, means and standard deviation). Bivariate Range 20–59 years and multivariate analysis were used to test relationships be- Education (n = 2396) tween variables. For bivariate analysis, Pearson’s Chi square No education 25 (1.0) test with statistical level of P value <0.05 was used to analyze Primary 576 (23.5) the association between controlling behaviors by male partner Secondary 398 (16.3) and experiences of violence. Multivariate regression was used High school 608 (24.8) to examine differences in lifetime IPV by demographic Higher education 840 (34.3) variables. Occupation (n = 2458) Housewife/ no occupation 262 (10.7) Agriculture 521 (21.2) Results Permanent employee 682 (27.7) Temporary employee 144 (5.9) In this study, four provinces from 4 regions were sampled Business owner 242 (9.8) according to the proportion of the population. The mean Company staff 221 (9.0) age of the respondents was 39.4. Thirty-four percent of wom- Government officer 338 (13.8) en had finished higher education, the rest had completed Other 48 (1.9) high-school, primary school, secondary school, and no J Fam Viol (2018) 33:315–323 319 Table 5 Lifetime (over 1 year ago) and current prevalence (with past Results demonstrate that out of 2,462 respondents, 15.4% year) of psychological, physical, or sexual intimate partner violence had encountered psychological, physical, or sexual violence, among married/cohabiting Thai women suggesting that 1 in 6 married or cohabiting Thai women have Violent Act Abused Over Past experiences intimate partner violence in their lifetime (See women 1year year Table 4). (%) ago (%) (%) Table 5 reflects the proportion of married/cohabiting wom- en who disclosed having experienced psychological, physical, Psychological or sexual intimate partner violence in their lifetime (over 1 year Insulted or made feel bad (14.8) (39.5) (60.5) ago) or currently (within the past year). The study revealed Humiliated or belittled (10.9) (39.6) (60.4) that the most commonly reported type of partner violence was Did things to scare (15.4) (38.1) (61.9) psychological violence. Sexually violence by a partner was Threatened to hurt (7.5) (31.6) (68.4) noticeably less prevalent than the other 2 types of violence. Physical Mild to moderate physical violence were more prevalent than slapped or threw (8.3) (40.6) (59.4) severe physical violence. Pushed or shoved (10.6) (47.5) (52.5) The most common form of psychological violence was hit with fist (5.4) (46.9) (53.1) being scared (15.4%), followed by being insulted (14.8%), kicked, dragged, beaten up (4.1) (40.4) (59.6) being humiliated or belittled (10.9%), and being threatened Chocked or burnt (2.6) (34.9) (65.1) (7.5%). Reports of physical violence included being pushed Threatened to use weapon (4.4) (43.4) (56.6) or shoved (10.6%), follow by being slapped or thrown (8.3%), sexual being hit with a fist (5.4%), being threatened with a weapon physically forced you to have sex (5.4) (37.4) (62.6) (4.4%), being kicked/dragged/beaten up (4.1%), being Had sexual intercourse because afraid of (10.4) (37.3) (62.7) chocked/burnt (2.6%). Reports of sexual violence, found that was forced to do sexual activity that (3.3) (36.2) (63.8) 10.4% of respondents revealed unwanted sexual intercourse, degrading or humiliating 5.4% were physically forced to have sex and 3.3% were forced to do sexual activities that were degrading or humiliating. There were considerable differences between the propor- behaviours by an intimate partner and highlight the associa- tion of women who experienced lifetime violence and current tion between experiences of violence and controlling behav- violence. More than 60% of respondents faced all forms of iours. The most frequently reported act of controlling behavior psychological violence and all forms of sexual violence in the by a male partner was Binsisted on knowing where the female past year, more than half (>50%) had experienced both mild to partner was at all times^ (29.3%) followed by Bgot angry if moderate and severe physical violence in the past year as well. female partner spoke with another man^ (28.5%), Bsuspicious The lifetime prevalence of IPV varied by the type of vio- that female partner is unfaithful^ (21.3%), Bignored and treat- lence experienced. Psychological violence varied from 31.6% ed indifferently^ (16.5%), Bkeeps female partner from seeing (threatened to hurt you or someone you care about) to 39.6% friends^ (15.2%), Bexpected female partner to ask permission (humiliated or belittled in front of other people); physical vi- before going out^ (10.7%), and Btried to restrict female part- olence varied from 34.9% (chocked or burnt) to 47.5% ner to contact your family^ (4.6%). (pushed or shoved); whereas, sexual violence varied from The percentage of women who reported one or more acts of 36.2% (was forced to do sexual activity that was degrading controlling behaviors by their male partner varied from 13.5% or humiliating) to 37.4% (physically forced you to have sex to 39.3%, which suggests that the level of male control over when you did not want). Most respondents reported repeated female behavior is normative to a certain degrees. The respon- acts of IPV. dents who had experienced IPV were significantly more likely Tables 6 and 7 show the proportion of married/cohabiting to have also experienced controlling behavior by their male women who reported having experienced controlling partner than women who had not faced partner violence. Table 8 illustrates multivariate logistic regression models to determine relationships between lifetime IPV victimization and demographic variables. There were significant differences Table 4 The proportion of married/cohabiting women who revealed in IPV prevalence among provincial settings. Compared to facing violent experiences by male partner women in Chonburi province (central), Phitsanulok province Experiences of violence n (%) (northern) were significantly more likely to have experienced lifetime IPV victimization (OR 2.34; 95% CI = 1.34–4.06). Never 2,083 (84.6) Women who worked in Bwhite collar^ occupations were sig- Ever 379 (15.4) nificantly less likely to report lifetime IPV victimization than 320 J Fam Viol (2018) 33:315–323 Table 6 Portrays the proportion Controlling behaviours n Ever Never of married/cohabiting women who reported having experienced n% n % controlling behaviours by an intimate partner Tried to keep you from seeing friends 2461 374 15.2 2087 84.8 Tried to restrict you to contact your family 2460 114 4.6 2346 95.4 Insisted on knowing where you were at all times 2462 722 29.3 1740 70.7 Ignored you and treated you indifferently 2461 405 16.5 2056 83.5 Got angry if you spoke with another man 2462 702 28.5 1760 71.5 Was often suspicious that you were unfaithful 2462 524 21.3 1938 78.7 Expected you to ask permission before going out 2462 264 10.7 2198 89.3 women who worked in Bblue collar^ occupations (OR 0.66; behaviorally specific questions in order to encourage respon- 95% CI = 0.52–0.85). Women who completed higher educa- dents to disclose the entire scope of their violent experiences tion were significantly less likely to report lifetime IPV vic- (Garcia-Moreno et al. 2006), (Straus et al. 1996), (Ellsberg timization than those who had no education and those who et al. 2001). completed only primary education (OR 0.37; 95% CI = 0.15– This study also showed that across the country, psycholog- 0.91) and (OR 0.66; 95% CI = 0.49–0.89), respectively). ical violence had the highest prevalence followed by physical Women who had sufficient income and savings were signifi- violence and then sexual violence. Similar findings have been cantly less likely to report lifetime IPV victimization than recorded in the WHO multi-country study (Garcia-Moreno those who had insufficient income and those who had suffi- et al. 2006)on women’s health and domestic violence, across cient but no saving (OR 0.26; 95% CI = 0.17–0.41) and (OR 10 countries, sexual violence was greatly less prevalent than 0.46; 95% CI = 0.30–0.72), respectively). physical violence. However, Thailand was an exception with rates of sexual violence higher than physical violence in the WHO multi-country study. Forty-four percent of women in Discussion the city and 29% of women in the province had experienced sexual violence by their partner (Archavanitkul et al. 2005), According to this study 15.4% of married/cohabiting Thai (Garcia-Moreno et al. 2006), (Heise and Garcia-Moreno women have experienced psychological, physical, and/or sex- 2002). ual intimate partner violence at some point in their lives. This To explain these contradictory results, we had look back number is considerably higher than the latest National over the past decades, particularly the Thai policies and cam- Reproductive Health Survey in 2009 (Social Statistics paigns on IPV prevention. For example, BDomestic Violence Bureau 2010), which found that the national prevalence of Victim Protection Act, B.E. 2550^ and BAmended the crimi- partner violence among Thai women was 2.9%. This wide nal law B.E.2550 section 276^. Prior to the amended law, discrepancy in results could be due to the measurement tool. section 276 stated that Bany person who commits sexual in- The 2009 survey asked only one question about experience of tercourse with a woman who is not his wife, and against the physical partner violence in the past 12 months, if the response latter’s will, by threatening her, or doing any act of vio- was yes, then there were 2 following questions: 1) what was lence…, shall be punished with imprisonment…^ (Penal Code Amendment Act (No.16) B.E. 2546 (2003) 2003). the reason for the violence and; 2) have you ever asked for any help. This single question is a limitation of the previous survey However, changes to the law, by removing the sentence Bwith because intimate partner violence can be psychological, phys- a woman who is not his wife^, added protection to spouses ical, and/or sexual violence and surveys should ask against sexually violence by their partners (Penal Code Table 7 Controlling behaviours Number of married/ Experiences Act of controlling behaviours P* Number of P by intimate male partner reported cohabiting women of violence Act, mean by married/cohabiting women None 1 2or 3 4–7 (%) (%) (%) (%) 2,079 Never 56.2 17.7 17.9 8.2 1.0 379 Ever 21.6 13.5 25.6 39.3 <0·0001 2.6 <0·0001 The percentage presents controlling behaviours act regard to partner violence experience. *Pearson χ22×4table. ⍶ ANOVA J Fam Viol (2018) 33:315–323 321 Table 8 Relationship between lifetime IPV victimization and 2016). In the USA, 5.3% of postpartum women stated that demographic variables they were physically victimized by an intimate partner in the year prior to becoming pregnant (Stewart et al. 2017). AWHO Lifetime IPV Study recorded that the 12-month prevalence of partner vio- OR 95% CI lence was much higher in developing countries as compared to developed countries such as Canada and the USA Province (McCormick et al. 2016), (Stewart et al. 2017) which suggests Phitsanulok 2.335 1.34–4.06 that a good legal framework, effective government cam- Khonkaen 0.36 0.26–0.49 paigns, sufficient shelters and women’s individual empower- Suratthani 0.19 0.13–0.27 ment are important and provide a foundation from which Chonburi Ref Ref women have more resources to choose to withdraw from abu- Age (years) sive relationships. Findings that emphasize the importance of 20–29 1.29 0.92–1.81 resources and social status have been noted in Vietnam (Yount 30–39 1.31 0.96–1.79 and Carrera 2006) and others, and suggest that partner vio- 40–49 1.29 0.95–1.76 lence might be different in settings of low income and unem- 50–59 Ref Ref ployment status compare with higher socio-economic settings Occupation (Mallory et al. 2016). Finally, controlling behaviors by male Housewife 1.78 0.52–1.15 partners were significantly associated with partner violence, Blue collar 0.66 0.52–0.85 which is consistent with WHO findings showing that men White collar Ref Ref who are a perpetrators also show higher rates of controlling Education behaviors than men who do not abuse their partner (Garcia- None 0.37 0.15–0.91 Moreno et al. 2006). Therefore, resources to support women Primary school 0.66 0.49–0.89 coupled with campaigns to educate men and deemphasize High school 0.79 0.60–1.03 traditional gender norms may be critical to reducing rates of Higher education Ref Ref IPV in Thailand. Years of conjugal living < 10 1.10 0.73–1.66 11–20 1.12 0.72–1.73 Limitations 21–30 0.95 0.61–1.47 > 30 Ref Ref This study only asked about rates of IPV against women, Income although women may also be perpetrators of violence in Insufficient 0.26 0.17–0.41 relationships. However, research has consistently demon- Sufficient but no saving 0.46 0.30–0.72 strated that men are the dominant perpetrators of violence Sufficient and saving Ref Ref in relationships including married and cohabiting relation- ships (Archavanitkul et al. 2005), (Garcia-Moreno et al. 2006), (Zhang et al. 2012). Some studies have documented Amendment Act (No.19) B.E. 2550 (2007) 2007). These tools that women are almost eight times more likely to be vic- may gradually reduce the prevalence of sexual violence in tims of violence by a partner than men (Stuckless et al. Thai society but do not appear to have had a major impact 2015). Another limitation was this study based on self-re- over the last 10 years. However, today the campaigns related port, which may be affected by recall bias, as well as cul- to IPV prevention are rarely seen in mainstream Thai society. tural biases in disclosure which affect to participants’ will- All of the women who reported physical violence had ex- ingness to reveal their violent experiences. We recognize perienced more violence in the past year than over her life- that in the Thai context, IPV is viewed as a family affair. time. These study results confirm that IPV is a common expe- The privacy of the family in Thai society strengths gender rience worldwide. In a Japanese city, the lifetime prevalence power imbalance and hierarchies that are often dependent of physical abused by an intimate partner was 13%, whereas, on the sustainability of male domination and violence in Bangladeshicityitwas 40% (Garcia-Morenoet al. 2006). (Mohamad and Wieringa 2014). This research highlights In Vietnam, the prevalence rate of physical partner violence the prevalence of psychological, physical and sexual inti- was 30.9% (Vung et al. 2008). In Cambodia, 25% of women mate partner violence in Thai society. Although some dif- interviewed experienced partner violence since marriage, with ferences in prevalence were noted in the results according 23% disclosing such violence in the prior year (Yount and to education, occupation, and number of partners these Carrera 2006). Whereas, in Canada 6% of women revealed differences did not account for the varying rates of vio- having been abused by their male partner (McCormick et al. lence across provinces. 322 J Fam Viol (2018) 33:315–323 Thank you to Dr. Marion Doull to revise and edit a final draft. Thank Strengths you to everyone who partcipated in this study. Contributions made by all participants are greatly appreciated. This study had significant methodological strengths in- cluding: using a standardized questionnaire, pre-testing Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// the questionnaire, training interviewers, and collaborating creativecommons.org/licenses/by/4.0/), which permits unrestricted use, with communities to account for the ethical complexities of distribution, and reproduction in any medium, provided you give appro- working on sensitive issues within communities in priate credit to the original author(s) and the source, provide a link to the Thailand. All these methodological techniques may help Creative Commons license, and indicate if changes were made. to reduce bias in the study and increase disclosure. However, we believe that in Thai culture, violence is a deeply personal issue which likely leads to an underesti- References mation of the overall violence situation in Thai society. 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Violence Against Women, social support services and professional sensitivity training 10,831–849. for multi-disciplinary practitioners on issues concerning Mallory, A. B., Dharnidharka, P., Deitz, S. L., Barros-Gomes, P., violence against women and the enhancement of a public Cafferky, B., Stith, S. M., & Van, K. (2016). A meta-analysis of campaign through the mass media and social media to cross cultural risk markers for intimate partner violence. Aggression and Violent Behavior, 31,116–126. https://doi.org/10. eradicate all forms of violence against women. Moreover, 1016/j.avb.2016.08.004. we must challenge social norms to ensure that domestic McCormick, A. V., Cohen, I. M., & Plecas, D. (2016). 1 Intimate partner violence is a public rather than a private issue and create violence in Canada.. Domestic Violence in International Context networks and community participation to prevent and to (27), 20. monitor domestic violence in the community. Media mes- Mohamad, M., & Wieringa, S. 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Prevalence and consequences of Canada: Department of Justice Canada. male-to-female and female-to male intimate partner violence as http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Family Violence Springer Journals

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Abstract

There is no recent national data on the prevalence of intimate partner violence in Thailand. This study proposed to examine the prevalence of intimate partner violence in 4 regions of Thailand by using a standardized questionnaire from the WHO multi country study on women’s health and domestic violence. Two thousand four hundred and sixty-two married or cohabiting women aged 20–59 years were interviewed about their experiences of psychologically, physically, sexually violent, and/or controlling behaviors by their male partners. The study found that 15% of respondents had experienced psychological, physical, and/or sexual violence in their life time which suggests that 1 in 6 of Thai women have faced intimate partner violence. Of the 15% of women who reported intimate partner violence within the past 12 months, psychological violence was the most common (60–68%), followed by sexual violence (62–63%) and physical violence (52–65%). In addition, the percentage of women who faced various forms of controlling behaviors varied from 4.6% to 29.3%. Men who were more controlling were more likely to abuse their female partners. The results reveal that partner violence against women is a significant public health issue in Thai society that must be addressed. . . . Keywords Intimate partner violence Domestic violence Thailand National prevalence Violence against women is a significant problem and a uni- social problem, and women’s human rights violation (WHO versal phenomenon around the world, including in Thailand. 2016), (WHO 2005a) which negatively affects women’sphys- One in 3 (35%) women around the world have experienced ical, mental, sexual and/or reproductive health (WHO 2016). physical and/or sexual violence by their partner in their life- time (WHO 2016). The United Nations defines violence against women as any acts of violent behavior that results in Intimate Partner Violence in Thailand physical, sexual or psychological harm to women (UN 1993). There are many forms of violence against women. One of the In Thai society, IPV is considered as a private issue and family most common forms is Intimate Partner Violence (IPV) matter because the family is an important social institution, (WHO 2002). IPV is a major public health issue, a hidden and portrayed as a space of love and care, however, in reality family violence exists. Most Thais learn they should not tell outsiders about internal family matters. As a result, IPV re- mains an invisible and unrecognized issue in Thai society and * Montakarn Chuemchit women victims have to deal with their intimate violence in Montakarn.ch@chula.ac.th their lives alone (Archavanitkul et al. 2005). When violence occurs in families, it is not reported, thus the statistics on IPV College of Public Health Sciences, Chulalongkorn Univerisity, in Thailand are likely to be underestimated. Most of IPV sta- Institute Building 2, Phayathai Road, Patumwan, Bangkok 10330, tistics in Thailand are reports from Government Organizations Thailand (GOs) and Non-Government Organizations (NGOs) such as The Royal Thai Ministry of Public Health, Nonthaburi, Thailand the One Stop Crisis Centre (OSCC). The OSCC is run by the Faculty of Nursing, Naresuan University, Phitsanulok, Thailand Ministry of Public Health and is a unit in government hospi- Faculty of Public Health, Burapha University, Chonburi, Thailand tals aimed to assist victims of violent situations from police station, NGOs’ and shelters. Individuals who notify the police The Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands or visit a hospital are likely severe cases of violence. Statistics 316 J Fam Viol (2018) 33:315–323 show that the numbers of domestic violence cases have sig- by male partner varied from 4.7% to 31.3%. Furthermore, in nificantly increased from 25,767 to 31,866 between 2010 and all settings, women who had experienced either physical and/ 2013 respectively (Thai Health Promotion Foundation 2011), or sexual violence regularly reported more emotional suffer- (The Women's Affairs and Family Development 2013). In ing and identified physical health issues such as pain (WHO addition, the report from the OSCC, Ministry of Public 2005b). Health (MOPH) found that, in 2015, there were 23,977 wom- In 2006, there was a cohort study on domestic violence en who used their services. Furthermore, there were 460 cases among pregnant Thai women in one province. They recruited of partner violence wherein police were notified and 373 cases 421 women in third trimester of pregnancy and followed them which were sent to the court (The Women's Affairs and until 6 weeks postpartum. The study revealed that 53.7% re- Family Development 2015). ported psychological violence, 26.6% faced physical violence, To address intimate partner violence, in 2007, Thailand and 19.2% confronted sexual violence by their partner during launched BDomestic Violence Victim Protection Act, B.E. the current pregnancy. Whereas, in the postpartum period re- 2550^ and amended the criminal law B.E. 2550 section 276 spondents who had experienced some type of intimate partner (Penal Code Amendment Act (No.19) B.E. 2550 (2007) violence ranged from 9.5% to 35.4% (Sricamsuk 2006). 2007). The BDomestic Violence Victim Protection Act, B.E. The latest National Reproductive Health Survey from 2009 2550^ comprises 18 sections; many sections are important to (Social Statistics Bureau 2010) revealed that the rate of inti- victims, perpetrators, and government officers. For example, mate partner violence among Thai women across the country section 4 states that BWhoever conducts any act of domestic was 2.9%. More recently, Chuemchit and Perngparn (2014) violence or is said to commit domestic violence shall be liable reported that between July – December, 2010 there were 471 to imprison for a term of not exceeding six months or to a fine women in Bangkok city who used the services at One Stop of not exceeding six thousand Baht or both^;section 5stats Crisis Centre and more than 70% of women had been victim- that BA domestic violence victim or a person who has found or ized more than once (Chuemchit and Perngparn 2014). known of domestic violence shall have the duty to notify a These data are the tip of the iceberg; the true extent of the competent official for the execution of this Act..^ Prior to issue cannot be seen. In Thailand, there have been no large- 2007, the criminal law B.E. 2550 section 276, did not include scale IPV prevalence studies since the 2005 WHO Multi- marital rape as a crime so spouses were not legally protected country study on Women’s Health and Domestic Violence against sexual abuse by their partner (Penal Code Amendment Against Women. In response, the aim of this study was to Act (No.16) B.E. 2546 (2003) 2003). However, changes to the examine the current prevalence of the various forms of inti- law in 2007 added legal protection for spouses who are mate partner violence, including physical, psychological, sex- victims of sexually violence by their partner. ual violence, and controlling behaviors and to identify factors associated with partner violence. Intimate Partner Violence Research in Thailand The WHO Multi-country study on Women’s Health and Method Domestic Violence Against Women (2005) examined the prevalence of intimate partner violence in 10 countries: Participants Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Tanzania, and Thailand. This study was a cross-sectional study in 4 regions of The study found that of the 24,097 women participants, Thailand: central, northern, southern, and northeastern which 16.0% to 61.0% had experienced some act of physical partner are the official government-categorized zones. A multi-stage violence in their lifetime. Sexual violence was reported by sampling technique was used; first, simple random sampling 6.0% to 58.0% of respondents. In addition, 16.0% to 69.0% was used for selection of one province in each region, second, of women reported that they had experienced either sexual all districts from the region were chosen for the study. and/or physical violence by their partners. In Thailand, the N∑N πðÞ 1−π h h h The sample size was calculated by n = , stra 2 2 study found that 22.9% of women in urban areas reported N D þ∑N πðÞ 1−π h h h physical violence, 29.9% reported sexual violence, and π = The proportion of IPV in Thailand (5.13%), based on 41.1% reported physical or sexual violence, or both. National Statistic Office 2006. Therefore, a total sample size Whereas, 33.8% of women in rural areas reported physical of 2,462 eligible persons was sought. Then the sample was violence, 28.9% reported sexual violence, and 47.4% reported calculated as proportionate to the size of each province and physical or sexual violence, or both. It is interesting to note district. Finally, convenience sampling was used to select the that urban Thai women reported more sexual violence than participants at each community site. At the community level, physical violence. The percentage of both urban and rural first, researchers went to see a community leader to request the women revealing one or more acts of controlling behaviors names and addresses of married or cohabiting women. J Fam Viol (2018) 33:315–323 317 Second, researchers visited women’s houses based on the list Research Subjects, Health Science Group, Chulalongkorn to conduct interviews. All eligible women we met were select University (COA No.201/2016), Thailand. as respondents. While both men and women can be victims, women are more likely than men to face various forms of Measurement Tool partner violence and report IPV-related injury (Hegarty 2000), (Breiding et al. 2008), (Tjaden and Thoennes 2000). A questionnaire was developed from the WHO multi country Therefore, this study focused on women age 20–59 years, still studyonwomen’s health and domestic violence married or cohabiting with a partner, and willing to participate (Archavanitkul et al. 2005), (Garcia-Moreno et al. 2006). in the study. Table 1 provides a brief description of the study The WHO multi country study on women’s health and domes- areas. tic violence, measures three items of Bsexual abuse^, six items of Bphysical abuse^,four items of Bpsychological abuse^,and seven items of Bcontrolling behaviors^ which were examined Procedure and Data Collection separately from psychological abuse. After the pre-test, the Cronbach alphas for this measurement tool was 0.94. Each province had research assistants under the supervision of The participants were asked questions related to their ex- the principal investigator. In order to ensure quality data was perience of specific acts of psychological, physical, and sexual captured, the female research assistants recruited for the data abuse by their current husband and/or cohabiting male partner. collection had at a minimum a bachelor degree, worked in the Furthermore, we also followed the WHO framing of the ques- area of public health, and were experienced in community- tions which highlighted Bhow partner’s treat each other rather based research. In each site, the interviews were conducted than so-called conflict negotiation^ (Garcia-Moreno et al. by trained interviewers who passed the standardized training 2006), (Heise and Garcia-Moreno 2002) because much inti- based on WHO women’s health and domestic violence study mate abuse in the Thai context can be conceptualized as (Jansen et al. 2004) covering issues of gender-based violence punishment. and its consequences, gender sensitivity, interviewing tech- The questions on psychologically violent acts focused on niques and skills, ethic, and the questionnaire. To ensure the insulting, humiliating, scaring, and threatening behaviors. The confidentiality and safety of participants, each participant had questions on physically violent acts were categorized as: 1) a separate and private interview by a trained female interview- mild-to-moderate violence and 2) severe violence based on er. All these processes were intended to protect the privacy of physical injury. Mild-to-moderate violence included pushing, the participants and minimize the shame of respondents for shoving, grabbing or slapping and severe violence included disclosing details of their relationship. After finishing the in- choking, kicking, or using a weapon (WHO 2005b)(see terview, all respondents received useful information about Table 2). Sexually violent acts included using physical force available services, for instance, hotline call center, shelter for sexual intercourse, having sexual intercourse against houses, and OSCCs in each province. Interviewers also pro- women’s will, and sexual humiliation. For each act of vio- vided respondents with additional support from local health lence, each participant was asked whether it had occurred over service providers if requested. The data collection was con- a year ago or within the year and then asked about the fre- ducted in 2016. quency of each act: 1) once or twice 2) a few times or 3) more Ethical permission for this study was obtained from the than five times. The lifetime prevalence of IPV was defined as Ethics Review Committee for Research Involving Human women who reported any kind of violent experience by a Table 1 Study sites by region and Region Female population Province Sample size province* (20–59 years old) Central 5,113,691 Chonburi: Famous province for Oceanside. Lots of 725 factory and tourism business. 80 km from Bangkok Northern 3,644,532 Phitsanulok: 383 km from Bangkok. Mountainous area 457 mostly in Agriculture Southern 2,659,222 Surat Thani: Large City in the region. Center for tourism 378 along seaside. Mostly in tourism and fishery business. 639 km from Bangkok Northeastern 6,595,363 Khonkaen: Big city and the center of northeastern. 902 Mostly in agriculture and tourism service business. 449 km from Bangkok Total 2462 *Thailand consist of 77 provinces 318 J Fam Viol (2018) 33:315–323 Table 2 Items of the questionnaire used to define psychological, physical, sexual violence, and controlling behaviors by intimate male partner Psychological violence Physical violence Sexual violence Controlling behaviors Insulted or made feel bad Mild-to-moderate: Physically forced you to have sex Tried to keep you from seeing friends about oneself when you did not want Humiliated or belittled in Slapped or threw something Had sexual intercourse when did Tried to restrict you to contact your family front of other people that could hurt not want because afraid of what partner might do Did things to scare or frighten Pushed or shoved Was forced to do sexual activity Insisted on knowing where you were at all times that degrading or humiliating Threatened to hurt you or Severe violence: Ignored you and treated you indifferently someone you care about Hit with fist or something Got angry if you spoke with another man that could hurt kicked, dragged, or beaten up Was often suspicious that you were unfaithful Chocked or burnt Expected you to ask permission before going out Threatened to use weapon current partner over a year before the interview. Current prev- education, respectively. About 10.7% of participants were alence was defined as women revealing at least one act of housewives and/or no occupation, while 89.3% had an occu- partner violence during the past year. pation (See Table 3). In addition, this study also focused on seven forms of con- trolling behaviors by women’s male partners which consisted Table 3 Selected socio-demographic characteristics of 2462 married/ of various acts to force and restrict women’s daily life. For cohabiting women of the 4 regions of Thailand each act of controlling behavior, each respondent was asked whether it had happened within the past year (Yes or No). Characteristics n (%) BYes^ responses were given a score of one and BNo^ re- Province (n = 2462) sponses were given a score of zero. Total scores were catego- Chonburi 725 (29.4) rized into four levels (Garcia-Moreno et al. 2006): (1) None Phitsanulok 457 (18.6) (2) low (3) medium and (4) high. Surat Thani tourism 378 (15.4) Khonkaen 902 (36.6) Data Analysis Age (n =2441) All data was entered, cleaned and coded before analyzing. 20–29 years 487 (20.0) Statistical Package for Social Sciences (SPSS Version 22) 30–39 years 712 (29.2) was used to perform Uni-variate, Bivariate, and multivariate 40–49 years 766 (31.4) analysis. Uni-variate analysis was used to describe and sum- 50–59 years 476 (19.5) marize variables and find patterns in the data. (e.g. frequen- Mean ± SD 39.4 ± 10.2 cies, percentages, means and standard deviation). Bivariate Range 20–59 years and multivariate analysis were used to test relationships be- Education (n = 2396) tween variables. For bivariate analysis, Pearson’s Chi square No education 25 (1.0) test with statistical level of P value <0.05 was used to analyze Primary 576 (23.5) the association between controlling behaviors by male partner Secondary 398 (16.3) and experiences of violence. Multivariate regression was used High school 608 (24.8) to examine differences in lifetime IPV by demographic Higher education 840 (34.3) variables. Occupation (n = 2458) Housewife/ no occupation 262 (10.7) Agriculture 521 (21.2) Results Permanent employee 682 (27.7) Temporary employee 144 (5.9) In this study, four provinces from 4 regions were sampled Business owner 242 (9.8) according to the proportion of the population. The mean Company staff 221 (9.0) age of the respondents was 39.4. Thirty-four percent of wom- Government officer 338 (13.8) en had finished higher education, the rest had completed Other 48 (1.9) high-school, primary school, secondary school, and no J Fam Viol (2018) 33:315–323 319 Table 5 Lifetime (over 1 year ago) and current prevalence (with past Results demonstrate that out of 2,462 respondents, 15.4% year) of psychological, physical, or sexual intimate partner violence had encountered psychological, physical, or sexual violence, among married/cohabiting Thai women suggesting that 1 in 6 married or cohabiting Thai women have Violent Act Abused Over Past experiences intimate partner violence in their lifetime (See women 1year year Table 4). (%) ago (%) (%) Table 5 reflects the proportion of married/cohabiting wom- en who disclosed having experienced psychological, physical, Psychological or sexual intimate partner violence in their lifetime (over 1 year Insulted or made feel bad (14.8) (39.5) (60.5) ago) or currently (within the past year). The study revealed Humiliated or belittled (10.9) (39.6) (60.4) that the most commonly reported type of partner violence was Did things to scare (15.4) (38.1) (61.9) psychological violence. Sexually violence by a partner was Threatened to hurt (7.5) (31.6) (68.4) noticeably less prevalent than the other 2 types of violence. Physical Mild to moderate physical violence were more prevalent than slapped or threw (8.3) (40.6) (59.4) severe physical violence. Pushed or shoved (10.6) (47.5) (52.5) The most common form of psychological violence was hit with fist (5.4) (46.9) (53.1) being scared (15.4%), followed by being insulted (14.8%), kicked, dragged, beaten up (4.1) (40.4) (59.6) being humiliated or belittled (10.9%), and being threatened Chocked or burnt (2.6) (34.9) (65.1) (7.5%). Reports of physical violence included being pushed Threatened to use weapon (4.4) (43.4) (56.6) or shoved (10.6%), follow by being slapped or thrown (8.3%), sexual being hit with a fist (5.4%), being threatened with a weapon physically forced you to have sex (5.4) (37.4) (62.6) (4.4%), being kicked/dragged/beaten up (4.1%), being Had sexual intercourse because afraid of (10.4) (37.3) (62.7) chocked/burnt (2.6%). Reports of sexual violence, found that was forced to do sexual activity that (3.3) (36.2) (63.8) 10.4% of respondents revealed unwanted sexual intercourse, degrading or humiliating 5.4% were physically forced to have sex and 3.3% were forced to do sexual activities that were degrading or humiliating. There were considerable differences between the propor- behaviours by an intimate partner and highlight the associa- tion of women who experienced lifetime violence and current tion between experiences of violence and controlling behav- violence. More than 60% of respondents faced all forms of iours. The most frequently reported act of controlling behavior psychological violence and all forms of sexual violence in the by a male partner was Binsisted on knowing where the female past year, more than half (>50%) had experienced both mild to partner was at all times^ (29.3%) followed by Bgot angry if moderate and severe physical violence in the past year as well. female partner spoke with another man^ (28.5%), Bsuspicious The lifetime prevalence of IPV varied by the type of vio- that female partner is unfaithful^ (21.3%), Bignored and treat- lence experienced. Psychological violence varied from 31.6% ed indifferently^ (16.5%), Bkeeps female partner from seeing (threatened to hurt you or someone you care about) to 39.6% friends^ (15.2%), Bexpected female partner to ask permission (humiliated or belittled in front of other people); physical vi- before going out^ (10.7%), and Btried to restrict female part- olence varied from 34.9% (chocked or burnt) to 47.5% ner to contact your family^ (4.6%). (pushed or shoved); whereas, sexual violence varied from The percentage of women who reported one or more acts of 36.2% (was forced to do sexual activity that was degrading controlling behaviors by their male partner varied from 13.5% or humiliating) to 37.4% (physically forced you to have sex to 39.3%, which suggests that the level of male control over when you did not want). Most respondents reported repeated female behavior is normative to a certain degrees. The respon- acts of IPV. dents who had experienced IPV were significantly more likely Tables 6 and 7 show the proportion of married/cohabiting to have also experienced controlling behavior by their male women who reported having experienced controlling partner than women who had not faced partner violence. Table 8 illustrates multivariate logistic regression models to determine relationships between lifetime IPV victimization and demographic variables. There were significant differences Table 4 The proportion of married/cohabiting women who revealed in IPV prevalence among provincial settings. Compared to facing violent experiences by male partner women in Chonburi province (central), Phitsanulok province Experiences of violence n (%) (northern) were significantly more likely to have experienced lifetime IPV victimization (OR 2.34; 95% CI = 1.34–4.06). Never 2,083 (84.6) Women who worked in Bwhite collar^ occupations were sig- Ever 379 (15.4) nificantly less likely to report lifetime IPV victimization than 320 J Fam Viol (2018) 33:315–323 Table 6 Portrays the proportion Controlling behaviours n Ever Never of married/cohabiting women who reported having experienced n% n % controlling behaviours by an intimate partner Tried to keep you from seeing friends 2461 374 15.2 2087 84.8 Tried to restrict you to contact your family 2460 114 4.6 2346 95.4 Insisted on knowing where you were at all times 2462 722 29.3 1740 70.7 Ignored you and treated you indifferently 2461 405 16.5 2056 83.5 Got angry if you spoke with another man 2462 702 28.5 1760 71.5 Was often suspicious that you were unfaithful 2462 524 21.3 1938 78.7 Expected you to ask permission before going out 2462 264 10.7 2198 89.3 women who worked in Bblue collar^ occupations (OR 0.66; behaviorally specific questions in order to encourage respon- 95% CI = 0.52–0.85). Women who completed higher educa- dents to disclose the entire scope of their violent experiences tion were significantly less likely to report lifetime IPV vic- (Garcia-Moreno et al. 2006), (Straus et al. 1996), (Ellsberg timization than those who had no education and those who et al. 2001). completed only primary education (OR 0.37; 95% CI = 0.15– This study also showed that across the country, psycholog- 0.91) and (OR 0.66; 95% CI = 0.49–0.89), respectively). ical violence had the highest prevalence followed by physical Women who had sufficient income and savings were signifi- violence and then sexual violence. Similar findings have been cantly less likely to report lifetime IPV victimization than recorded in the WHO multi-country study (Garcia-Moreno those who had insufficient income and those who had suffi- et al. 2006)on women’s health and domestic violence, across cient but no saving (OR 0.26; 95% CI = 0.17–0.41) and (OR 10 countries, sexual violence was greatly less prevalent than 0.46; 95% CI = 0.30–0.72), respectively). physical violence. However, Thailand was an exception with rates of sexual violence higher than physical violence in the WHO multi-country study. Forty-four percent of women in Discussion the city and 29% of women in the province had experienced sexual violence by their partner (Archavanitkul et al. 2005), According to this study 15.4% of married/cohabiting Thai (Garcia-Moreno et al. 2006), (Heise and Garcia-Moreno women have experienced psychological, physical, and/or sex- 2002). ual intimate partner violence at some point in their lives. This To explain these contradictory results, we had look back number is considerably higher than the latest National over the past decades, particularly the Thai policies and cam- Reproductive Health Survey in 2009 (Social Statistics paigns on IPV prevention. For example, BDomestic Violence Bureau 2010), which found that the national prevalence of Victim Protection Act, B.E. 2550^ and BAmended the crimi- partner violence among Thai women was 2.9%. This wide nal law B.E.2550 section 276^. Prior to the amended law, discrepancy in results could be due to the measurement tool. section 276 stated that Bany person who commits sexual in- The 2009 survey asked only one question about experience of tercourse with a woman who is not his wife, and against the physical partner violence in the past 12 months, if the response latter’s will, by threatening her, or doing any act of vio- was yes, then there were 2 following questions: 1) what was lence…, shall be punished with imprisonment…^ (Penal Code Amendment Act (No.16) B.E. 2546 (2003) 2003). the reason for the violence and; 2) have you ever asked for any help. This single question is a limitation of the previous survey However, changes to the law, by removing the sentence Bwith because intimate partner violence can be psychological, phys- a woman who is not his wife^, added protection to spouses ical, and/or sexual violence and surveys should ask against sexually violence by their partners (Penal Code Table 7 Controlling behaviours Number of married/ Experiences Act of controlling behaviours P* Number of P by intimate male partner reported cohabiting women of violence Act, mean by married/cohabiting women None 1 2or 3 4–7 (%) (%) (%) (%) 2,079 Never 56.2 17.7 17.9 8.2 1.0 379 Ever 21.6 13.5 25.6 39.3 <0·0001 2.6 <0·0001 The percentage presents controlling behaviours act regard to partner violence experience. *Pearson χ22×4table. ⍶ ANOVA J Fam Viol (2018) 33:315–323 321 Table 8 Relationship between lifetime IPV victimization and 2016). In the USA, 5.3% of postpartum women stated that demographic variables they were physically victimized by an intimate partner in the year prior to becoming pregnant (Stewart et al. 2017). AWHO Lifetime IPV Study recorded that the 12-month prevalence of partner vio- OR 95% CI lence was much higher in developing countries as compared to developed countries such as Canada and the USA Province (McCormick et al. 2016), (Stewart et al. 2017) which suggests Phitsanulok 2.335 1.34–4.06 that a good legal framework, effective government cam- Khonkaen 0.36 0.26–0.49 paigns, sufficient shelters and women’s individual empower- Suratthani 0.19 0.13–0.27 ment are important and provide a foundation from which Chonburi Ref Ref women have more resources to choose to withdraw from abu- Age (years) sive relationships. Findings that emphasize the importance of 20–29 1.29 0.92–1.81 resources and social status have been noted in Vietnam (Yount 30–39 1.31 0.96–1.79 and Carrera 2006) and others, and suggest that partner vio- 40–49 1.29 0.95–1.76 lence might be different in settings of low income and unem- 50–59 Ref Ref ployment status compare with higher socio-economic settings Occupation (Mallory et al. 2016). Finally, controlling behaviors by male Housewife 1.78 0.52–1.15 partners were significantly associated with partner violence, Blue collar 0.66 0.52–0.85 which is consistent with WHO findings showing that men White collar Ref Ref who are a perpetrators also show higher rates of controlling Education behaviors than men who do not abuse their partner (Garcia- None 0.37 0.15–0.91 Moreno et al. 2006). Therefore, resources to support women Primary school 0.66 0.49–0.89 coupled with campaigns to educate men and deemphasize High school 0.79 0.60–1.03 traditional gender norms may be critical to reducing rates of Higher education Ref Ref IPV in Thailand. Years of conjugal living < 10 1.10 0.73–1.66 11–20 1.12 0.72–1.73 Limitations 21–30 0.95 0.61–1.47 > 30 Ref Ref This study only asked about rates of IPV against women, Income although women may also be perpetrators of violence in Insufficient 0.26 0.17–0.41 relationships. However, research has consistently demon- Sufficient but no saving 0.46 0.30–0.72 strated that men are the dominant perpetrators of violence Sufficient and saving Ref Ref in relationships including married and cohabiting relation- ships (Archavanitkul et al. 2005), (Garcia-Moreno et al. 2006), (Zhang et al. 2012). Some studies have documented Amendment Act (No.19) B.E. 2550 (2007) 2007). These tools that women are almost eight times more likely to be vic- may gradually reduce the prevalence of sexual violence in tims of violence by a partner than men (Stuckless et al. Thai society but do not appear to have had a major impact 2015). Another limitation was this study based on self-re- over the last 10 years. However, today the campaigns related port, which may be affected by recall bias, as well as cul- to IPV prevention are rarely seen in mainstream Thai society. tural biases in disclosure which affect to participants’ will- All of the women who reported physical violence had ex- ingness to reveal their violent experiences. We recognize perienced more violence in the past year than over her life- that in the Thai context, IPV is viewed as a family affair. time. These study results confirm that IPV is a common expe- The privacy of the family in Thai society strengths gender rience worldwide. In a Japanese city, the lifetime prevalence power imbalance and hierarchies that are often dependent of physical abused by an intimate partner was 13%, whereas, on the sustainability of male domination and violence in Bangladeshicityitwas 40% (Garcia-Morenoet al. 2006). (Mohamad and Wieringa 2014). This research highlights In Vietnam, the prevalence rate of physical partner violence the prevalence of psychological, physical and sexual inti- was 30.9% (Vung et al. 2008). In Cambodia, 25% of women mate partner violence in Thai society. Although some dif- interviewed experienced partner violence since marriage, with ferences in prevalence were noted in the results according 23% disclosing such violence in the prior year (Yount and to education, occupation, and number of partners these Carrera 2006). Whereas, in Canada 6% of women revealed differences did not account for the varying rates of vio- having been abused by their male partner (McCormick et al. lence across provinces. 322 J Fam Viol (2018) 33:315–323 Thank you to Dr. Marion Doull to revise and edit a final draft. Thank Strengths you to everyone who partcipated in this study. Contributions made by all participants are greatly appreciated. This study had significant methodological strengths in- cluding: using a standardized questionnaire, pre-testing Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// the questionnaire, training interviewers, and collaborating creativecommons.org/licenses/by/4.0/), which permits unrestricted use, with communities to account for the ethical complexities of distribution, and reproduction in any medium, provided you give appro- working on sensitive issues within communities in priate credit to the original author(s) and the source, provide a link to the Thailand. All these methodological techniques may help Creative Commons license, and indicate if changes were made. to reduce bias in the study and increase disclosure. However, we believe that in Thai culture, violence is a deeply personal issue which likely leads to an underesti- References mation of the overall violence situation in Thai society. 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Journal of Family ViolenceSpringer Journals

Published: Apr 7, 2018

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