The effect of spousal violence on women's health: findings from the Stree Arogya Shodh in Goa, India.

BACKGROUND Spousal violence has wide-ranging effects on the physical, reproductive, sexual and psychological health of women. There are few longitudinal studies that describe this association in developing countries. AIM To test the hypothesis that spousal violence is an independent risk factor for a broad range of adverse health outcomes in women. SETTING AND DESIGN A population-based cohort study of women living in the catchment area of a primary health center in north Goa. Two thousand four hundred and ninety-four of 3000 randomly selected women were recruited of whom 1750 married women were included for this paper. MATERIALS AND METHODS Each participant was assessed at baseline with a structured interview for the assessment of exposure to spousal violence (verbal, physical, sexual) over two time periods (lifetime; recent in the past three months). The interview collected data on gynecological complaints and the Revised Clinical Interview Schedule was used for the diagnosis of depressive disorder. Laboratory tests for anemia and sexually transmitted infections (STI) were carried out. Longitudinal data was collected after six and 12 months on these outcomes. In addition, baseline measures for nutritional status and menstrual health were also obtained. STATISTICAL ANALYSIS Univariate analyses were carried out on the cross-sectional and longitudinal data to assess the association between each type of spousal violence and each health outcome. Multivariate analyses adjusted for age, literacy, household per capita income. Logistic regression was used for all analyses in Stata (Version 10). RESULTS Lifetime spousal violence was reported by 290 (16.6%, 95%CI=14.9-18.4) women; recent violence was reported by 230 (13.0%, 95%CI=11.6-14.8). The cross-sectional data showed an association between violence and a range of self-reported gynecological complaints, low Body Mass Index, depressive disorder and attempted suicide. The longitudinal analyses confirmed these associations only for STI and attempted suicide. CONCLUSION Spousal violence is specifically associated as an independent risk factor for two adverse women's health outcomes, viz., STI and attempted suicide. Public health and clinical programs targeting these outcomes must specifically address spousal violence.