Freedom of Movement and Adolescent Sexual Violence in India

Abstract

This study assesses associations between freedom of movement and sexual violence, both in marriage and outside of marriage, among a representative sample of adolescents in India. We analyzed data from girls aged 15 to 19 years (n = 9,593) taken from India’s nationally representative National Family Health Survey 2015–2016. We defined freedom of movement using three items on whether girls could go unaccompanied to specified locations; we summated responses and categorized them as restricted, or unrestricted. We used multivariable regression to assess associations between restricted movement and nonmarital violence, and with marital sexual violence among ever-married girls. Results show that only 2% of girls reported nonmarital sexual violence, among married and unmarried girls; 6% of married girls reported marital sexual violence. Most girls (78%) reported some restriction in movement. Restricted movement was negatively associated with nonmarital sexual violence (adjusted odds ratio [AOR] = 0.52, 95% confidence interval [CI] = [0.31, 0.87], p = .01) but positively associated with marital sexual violence (AOR = 3.87, 95% CI = [1.82, 8.25], p < .001). Further analyses highlight that the observed association with nonmarital sexual violence was specific to urban and not rural girls. These findings reveal that approximately one in 30 adolescent girls in India has been a victim of sexual violence. Restricted movement is associated with lower risk for nonmarital sexual violence for urban adolescent girls, possibly due to lower exposure opportunity. Married girls with restricted movement have higher odds of marital sexual violence, possibly because these are both forms of control used by abusive husbands. Freedom of movement is a human right that should not place girls at greater risk for nonmarital violence or be used as a means of control by abusive spouses. Social change is needed to secure girls’ safety in India.

Introduction

Adolescents represent one fifth of India’s population, and sexual violence, affecting one in every 16 women in the country, most commonly first occurs in adolescence (International Institute for Population Sciences [IIPS], 2018). Sexual violence increases women and girls’ risk for poor mental health outcomes, injury, reproductive health concerns, and HIV and other sexually transmitted diseases (World Health Organization [WHO], 2013). In addition, there is emerging evidence that sexual violence in youth affects allostatic load, indicative of accumulated stress and trauma, leading to increased risk for a variety of illnesses in later life (Groer et al., 2016). Most sexual violence against adolescents in India occurs in marriage, and significant national declines in marriage of adolescent girls in the past decade correspond to a reduction in sexual violence in India (IIPS, 2018; Raj, 2010). However, among never-married women and girls, prevalence of nonmarital sexual violence remains unchanged. Although these percentages appear small, they are at a population level and, thus, indicate that there are hundreds of thousands of adolescent girls in India, married and unmarried, who have been sexually assaulted (Population Division of UN Department of Economic and Social Affairs [UNDESA], 2017).

Awareness increased and stigmatization of victimization from sexual violence declined in India following the Nirbhaya rape case of December 2012, in which a woman was brutally and fatally raped on public transport (Bandewar et al., 2018). Subsequently, rape reporting to police increased, particularly in Delhi and proximal urban locations, though prosecution and conviction rates have not improved (Bandewar et al., 2018; McDougal et al., 2021). The 2018 #MeToo movement has further galvanized women around these issues, with a focus on nonmarital sexual assault, despite ample evidence of greater risk for sexual assault in marriage, and especially for adolescent wives (Raj & McDougal, 2014). Largely, these movements have not prioritized focus on adolescents, despite overrepresentation of this age group in incidents of sexual violence in India (IIPS, 2018; McDougal et al., 2021; Raj & McDougal, 2014). India’s national adolescent health strategy, known as Rashtriya Kishor Swasthya Karyakram (RKSK), was established in 2014 to support adolescent health and well-being, including focus on violence and injury, but little effort has been placed on the issue of adolescent sexual violence (Government of India, 2014a, 2014b). To better consider and support adolescents and prevent sexual violence in India, we need greater understanding of sexual violence against adolescents, both in and outside the context of marriage.

Too often, populations view sexual violence as occurring outside of marriage and perpetrated by strangers, a stereotype reinforced by the Nirbhaya case. However, as noted above, evidence from India consistently demonstrates that most sexual violence faced by women, including adolescents, occurs within marriage (IIPS, 2018; Raj & McDougal, 2014). Although less common, the fear of nonmarital violence is ever present and is used as a justification for restriction of female mobility and justification of early marriage of girls in India (Raj, 2010; Ramanaik et al., 2018); evidence on sex differences in freedom of movement correspond to these findings, demonstrating greater restriction of movement of girls relative to boys over time (Sanchez et al., 2017). These restrictions in movement can severely compromise female opportunities, in education, occupation, health care seeking, and social engagement (Banerjee et al., 2015; Rahman & Rao, 2004; Ramanaik et al., 2018). Research on whether restricted mobility is associated with risk for sexual violence is scarce, with one smaller study from India suggesting that this association does hold true for sexual violence from dating partners (Santhya & Francis Zavier, 2014). Low reporting of sexual violence has often precluded examination of these issues among adolescents in India and other low- and middle-income nations due to small cell sizes for analysis. The most recent nationally representative data from India for the first time offer a sufficient sample size to explore the issue of sexual violence, and in particular nonmarital sexual violence, among both married and unmarried girls.

In this study, we use nationally representative data from India to assess marital and nonmarital sexual violence against adolescent girls and to determine whether freedom of movement is associated with risk for these forms of violence. These findings can help guide prevention and intervention efforts for adolescent females in India, as part of the government of India’s RKSK adolescent health strategy. Furthermore, the findings can offer some clarity in understanding the intersection of freedom of movement and sexual violence for girls in contexts such as India where restricted movement of girls remains a norm that impedes girls’ social participation and opportunity.

Method

We used data from the fourth round of the National Family Health Survey (NFHS-4), a nationally representative household survey administered across India in 2015–2016 (IIPS, 2018). NFHS-4 included interviews with 699,686 girls and women from ages 15 to 49 on a range of topics including sociodemographics, reproductive, and maternal health and children’s health. In this survey, violence against women was assessed in a representative subsample of households, in which one woman per household was selected and interviewed by trained female interviewers in a private location (n = 79,729 women, of whom 9,649 were aged 15–19). The Institutional Review Boards of IIPS and ICF provided ethical approval for NFHS-4 questionnaires, sample design, and implementation. The University of California San Diego Institutional Review Board reviewed our planned secondary analysis of these publicly available, de-identified data and deemed the study exempt.

We restricted our analyses to females aged 15 to 19 who were interviewed in the violence subsample. Fifty-six women had missing responses to some analyzed variables (<0.1%) and were omitted from analysis. The final analytic sample was thus 9,593.

Our primary outcomes of interest were nonmarital sexual violence (NMSV), asked of all women, and marital sexual violence (MSV), asked only of ever-married women. We defined NMSV as respondent reporting of an affirmative response to the question: “At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?” For ever-married women, this question was preceded by the statement: “Now I want to ask you about things that may have been done to you by someone other than (your/any) husband.” This allowed the response to be distinct from MSV.

We defined MSV as respondent reporting of an affirmative response to any of the following three questions: “(Does/did) your (last) husband ever do any of the following things to you: (1) Physically force you to have sexual intercourse with him even when you did not want to? (2) Physically force you to perform any other sexual acts you did not want to?, or (3) Force you with threats or in any other way to perform sexual acts you did not want to?.” For women who had been married 2 or more times, we also included them as reporting MSV if they provided an affirmative response to the question: “Did any previous husband physically force you to have intercourse or perform any other sexual acts against your will?”

Descriptive variables on related experiences and responses to sexual violence were also included, specifically help-seeking, disclosure, age at first forced sex and perpetrator of first nonmarital forced sex. Help-seeking was asked of women who reported any physical or sexual violence, irrespective of perpetrator. For those who did seek help, the sources from whom that help was sought were identified; women could identify as many sources of help as they utilized. Separately, disclosure was assessed using a binary no/yes measure assessing whether the respondent disclosed their experience of violence (sexual or physical) to anyone. Disclosure could indicate that the respondent sought help (as previously described), or if they did not seek help, that they told someone else about their experience. The help-seeking and disclosure items were asked for all women reporting physical and/or sexual violence, and thus do not necessarily represent help-seeking and disclosure surrounding experiences of sexual violence. Our analyses of these additional measures were restricted to 15- to 19-year-old girls who reported sexual violence and only used for descriptive purposes.

Among women who indicated that they had experienced NMSV at some point in their lives, perpetrator of the first nonmarital sexual act was assessed by the question “Who was the person who was forcing you the very first time this happened?” Responses were categorized as current husband (may be indicative of an episode prior to marriage), current/former boyfriend, relative (father/step-father, brother/step-brother, other relative, and in-law), friend (includes own friend/acquaintance and family friend), stranger, and other (includes teacher, employer/someone at work, police/soldier, priest/religious leader, and other). Age at first forced sexual act was assessed only for the ever-married sample.

Our primary independent variable, freedom of movement, was categorized as restricted (requires accompaniment to go to at least one of the following locations: the market, health facility or places outside her village/community), and unrestricted (able to go alone to the market, health facility and places outside her village/community).

Covariates in regression models included age (years), scheduled caste/scheduled tribe or “other backwards caste” status (SC/ST or OBC), household wealth (continuous factor score derived from principal components analysis of household characteristics and assets; Rutstein & Johnson, 2004), rural/urban residence, education (in years), and whether the respondent had access to a mobile phone (yes/no).

Data Analysis

Analyses included descriptive statistics and logistic regression models. We included ever-married and never-married girls in analyses on NMSV, adjusting for marital status, as married and unmarried girls had comparable crude associations between freedom of movement and NMSV. To create more parsimonious models for our outcomes with small cells, multivariable models only included covariates significant at p < .20 in bivariate models. Region was included as a fixed effect given known geographic variation on reports of sexual violence. All analyses were adjusted for survey design and weights and were conducted using Stata SE 15.

Results

Across India, 2.0% of girls aged 15 to 19 reported experiences of NMSV, irrespective of their marital status (Table 1). At current population levels, this is equivalent to more than 1.1 million girls across India. Among ever-married 15- to 19-year-old girls, the prevalence of MSV was nearly 3 times higher than NMSV (5.8% vs. 2.0%) and equates to more than 518,000 ever-married 15- to 19-year-old adolescent girls having experienced MSV. (Note: Estimates of female 15- to 19-year-old population of India were derived from the average of 2015 and 2016 estimates from the World Population Prospects (Population Division of UNDESA, 2017).

Table 1.

Experiences and Characteristics of Sexual Violence Among Female Adolescents Aged 15 to 19 in India, 2015–2016.

Sexual Violence Experiences	Total			Ever-married			Never-married
	N	%	95% CI	N	%	95% CI	N	%	95% CI
Total	9,593	100		1,631	15.8	[14.7, 17.0]	7,962	84.2	[83.1, 79.6]
Marital sexual violence
None	—	—		1,525	94.3	[92.5, 95.6]	—	—
Any	—	—		106	5.8	[4.4, 7.5]	—	—
Nonmarital sexual violence
None	9,454	98.0	[97.3, 98.6]	1,612	98.1	[95.2, 99.2]	7,842	98.0	[97.4, 98.5]
Any	139	2.0	[1.4, 2.8]	19	2.0	[0.8, 4.8]	120	2.0	[1.5, 2.6]
Help-seeking among women who experienced sexual violencea
None	181	71.8	[61.2, 80.4]	99	72.5	[49.2, 87.8]	82	71.3	[57.0, 82.4]
Own family	36	16.5	[10.0, 26.2]	14	17.7	[5.5, 44.2]	22	15.7	[9.4, 25.2]
Husband’s family	10	4.4	[1.6, 11.3]	10	10.5	[3.8, 26.1]	—	—
Friend	17	4.2	[2.3, 7.4]	3	2.2	[0.6, 7.5]	14	5.6	[2.9, 10.6]
Social service organization	1	3.5	[0.5, 20.8]	0			1	6.0	[0.9, 31.9]
Police	3	0.2	[0.1, 1.0]	0			3	0.4	[0.1, 1.7]
Other	6	3.2	[1.0, 9.8]	2	4.5	[0.8, 21.0]	4	2.3	[0.6, 9.1]
Disclosure
No	153	59.5	[49.7, 68.6]	87	61.4	[41.9, 77.9]	66	58.1	[42.4, 72.4]
Yes	87	40.5	[31.4, 50.3]	33	38.6	[22.1, 58.1]	54	41.9	[27.6, 57.6]
Age at first forced sexual actb,c		—	—		16.7	[13, 19]		—	—
Perpetrator of first nonmarital forced sex
Current husband	7	9.4	[2.6, 29.2]	7	59.2	[21.8, 88.3]	—	—
Current/former boyfriend	20	14.5	[5.9, 31.3]	2	0.8	[0.1, 5.8]	18	17.1	[7.3, 34.9]
Relative	57	37a.1	[24.1, 52.3]	6	30.6	[8.5, 67.8]	51	38.4	[26.0, 52.4]
Friend	26	24.6	[14.0, 39.6]	2	6.4	[1.1, 29.4]	24	28.1	[14.1, 48.1]
Stranger	11	4.8	[2.0, 10.9]	0			11	5.7	[2.5, 12.6]
Other	16	9.5	[4.7, 18.3]	2	3.0	[0.5, 15.1]	14	10.8	[5.3, 20.5]

Note. Numbers are unweighted Ns and weighted percentages. CI = confidence interval.

^aCategories are nonexclusive—women are counted in, however, many categories in which they indicated they sought help.

^bExcludes 10 women who responded “don’t know.”

^cM (range).

Among adolescent girls aged 15 to 19 who experienced sexual violence, marital, or nonmarital, the majority (71.8%) never sought help (Table 1). Never-married girls who experienced sexual violence reported seeking help from their own families (15.7%), social service organizations (6.0%), and friends (5.6%). Ever-married 15- to 19-year-olds who had experienced sexual violence reported help-seeking from their own families (17.7%) and their husband’s family (10.5%). Less than 1% reported the violence to police. Most girls never disclosed their experience of violence to anyone (59.5%).

Among never-married 15- to 19-year-olds, the perpetrator of first sexual violence incident was most commonly a relative (38.4%) or friend (28.1%). Among ever-married 15- to 19-year-olds, the perpetrator of the first instance of sexual violence was most commonly the current husband (59.2%) or a relative (30.6%) (Table 1); only perpetrator at first incident was available in these data.

Multivariable models found that 15- to 19-year-old girls with restricted freedom of movement had reduced odds of NMSV, relative to those with unrestricted freedom of movement (adjusted odds ratio [AOR] = 0.51, 95% confidence interval [CI] = [0.30, 0.88]; Table 2). Marital status was not associated with risk of NMSV in our sample. To explore this issue further, we conducted an exploratory analysis examining the association between freedom of movement and NMSV in the past 12 months, which was reported by less than 1% of our sample (n = 39), affecting our power to explore this outcome. Despite the very small cell size, we continued to see an association between restricted freedom of movement, relative to unrestricted movement, and NMSV (AOR = 0.47; 95% CI = [0.21, 1.03], p = .06), with a comparable effect size compared with that seen with the ever NMSV outcome.

Table 2.

Descriptive, Bivariate, and Multivariable Associations With Nonmarital Sexual Violence Among 15- to 19-Year-Old Females in India, 2015–2016.

Independent Variables	Bivariate modelsa		Multivariate modela,b
	OR	95% CI	aOR	95% CI
Freedom of movement
Restricted	0.51**	[0.30, 0.88]	0.52**	[0.31, 0.87]
Unrestricted	REF		REF
Marital status
Never-married	REF
Ever-married	0.99	[0.43, 2.30]
Age (years)	1.05	[0.87, 1.26]
SC/ST
No/don’t know	1.23	[0.66, 2.27]
SC/ST or OBC	REF
Household wealth	1.12	[0.83, 1.50]
Residence
Rural	0.54	[0.26, 1.14]	0.65	[0.33, 1.27]
Urban	REF		REF
Education (years)c	1.03	[0.96, 1.10]
Mobile phone access
No	REF		REF
Yes	1.58*	[0.93, 2.68]	1.28	[0.79, 2.05]

Note. OR = odds ratio; aOR = OR = adjusted odds ratio; CI = confidence interval.

^aOutcome is any nonmarital sexual violence; reference group is no nonmarital sexual violence.

^bModel adjusts for region fixed effects.

^*p < .1.

^**p < .05.

^***p < .01.

Ever-married 15- to 19-year-old girls with restricted freedom of movement had significantly higher odds of MSV than those with unrestricted freedom of movement (AOR = 3.87, 95% CI = [1.82, 8.25]; Table 3). In terms of covariates associated with the outcome in our adjusted model, we additionally found a marginal negative association between wealth and MSV (AOR = 0.54, 95% CI = [0.26, 1.05]).

Table 3.

Descriptive, Bivariate, and Multivariable Associations With Marital Sexual Violence Among Ever-Married 15- to 19-Year-Old Females in India, 2015–2016.

Independent Variables	Bivariate modelsa		Multivariate modela,b
	OR	95% CI	aOR	95% CI
Total	—	—	—	—
Freedom of movement
Restricted	4.47***	[2.14, 9.36]	3.87***	[1.82, 8.25]
Unrestricted	REF		REF
Age (years)	0.94	[0.76, 1.17]
SC/ST
No/don’t know	1.60	[0.58, 4.36]
SC/ST or OBC	REF
Household wealth	0.41***	[0.27, 0.63]	0.52*	[0.26, 1.05]
Residence
Rural	2.71**	[1.04, 7.04]	1.27	[0.42, 3.80]
Urban	REF		REF
Education (years)	0.94*	[0.88, 1.00]	1.01	[0.92, 1.11]
Mobile phone access
No	REF		REF
Yes	0.62	[0.34, 1.14]	0.93	[0.47, 1.82]

Note. OR = odds ratio; CI = confidence interval.

^aOutcome is any marital sexual violence; reference group is no marital sexual violence.

^bModel also adjusts for region fixed effects.

^*p < .1.

^**p < .05.

^***p < .01.

Recognizing that freedom of movement restrictions are likely to differ by urbanicity, with greater freedom of movement seen in urban areas (IIPS, 2018), we conducted exploratory analyses stratified by urban/rural residence. There was no significant association between freedom of movement and NMSV among rural-residing 15- to 19-year-old girls, but urban-residing adolescent girls with restricted movement had lower odds of NMSV (odds ratio [OR] = 0.33, 95% CI = [0.15, 0.76]; Appendix Table 3). For ever-married 15- to 19-year-olds, the association between restricted freedom of movement and increased odds of MSV was significant only among those in rural areas (rural OR = 4.63, 95% CI = [2.02, 10.63]; urban OR = 2.63, 95% CI = [0.49, 14.16]).

Discussion

Findings from this study estimate that more than 1.1 million adolescent girls aged 15 to 19 have experienced NMSV, and 518,000 ever-married girls aged 15 to 19 have experienced MSV in India. Our results also show no difference in prevalence of NMSV for married and unmarried girls, suggesting that early marriage offers no protection from NMSV, a finding that counters commonly held assumptions regarding the value of early marriage in protecting girls from sexual violence (Lal, 2015). As with previous research (Raj et al., 2010; Raj & McDougal, 2014), current findings demonstrate an increased risk for sexual violence against adolescent girls in the context of marriage as compared with outside of marriage. Overall, these findings support other research showing the value of early and child marriage prevention as a strategy to reduce sexual violence against girls (Kidman, 2017; Raj et al., 2010; Seff et al., 2020).

With regard to our primary research question regarding associations between freedom of movement and sexual violence, findings differed based on whether the violence occurred within marriage or not. Restricted freedom of movement was negatively associated with NMSV against adolescent girls, a finding consistent with prior smaller scale research from India (Santhya & Francis Zavier, 2014). Further analysis revealed this association to hold true only for the urban subsample. Findings may be indicative of increased likelihood of exposure to perpetrators of NMSV among more mobile girls in cities, or may be indicative of restrictive movement among girls, possibly self-enforced, subsequent to an experience of NMSV. Given the cross-sectional nature of these findings, we cannot assume causality. While one could use these findings to justify restrictive freedom of movement for unmarried girls in cities as a means of protection by families, as noted previously, such an approach ultimately compromises girls’ social autonomy and opportunity (Banerjee et al., 2015; Rahman & Rao, 2004; Ramanaik et al., 2018). The choice for girls should not be between safety from sexual violence or freedom of movement, but rather communities and law enforcement must provide freedom of movement with safety from sexual violence both outside and inside their homes. Such an approach would be important both to prevent NMSV and to support girls who have experienced it to feel safe in their ability to move freely in society.

Importantly, the issues of safety and mobility are complex when considering the circumstances in which NMSV most commonly occurs. As seen from our data at first incident of sexual violence, perpetrators are largely known to girls, with stranger perpetrators rare in the current large representative sample and in other studies (Abrahams et al., 2014; WHO, 2013). The most common perpetrators were family members and friends, allowing for exposure regardless of mobility in public spaces. Possibly, mobility may offer access to these known individuals to be able to isolate the girl for abuse, but again, findings may be interpreted as restricted mobility being a consequence of abuse for girls, as they may then self-isolate for coping and healing. Such self-isolation, along with nondisclosure, which was also reported by the majority of girls reporting sexual violence, can compromise healing and resilience over time. Research from the United States in the 1990s, a time of increasing consciousness of sexual violence as a source of trauma, found that self-isolation and nondisclosure were the norm for victims and that these behaviors can affect long term health and social participation (Koss, 1993), a major cost to adolescents.

Findings as related to MSV, in contrast, document that restricted freedom of movement was associated with increased odds of MSV, which occurs at more than twice the rate of NMSV for married adolescent girls in India. This finding has been documented in other research using NFHS-4 data (Ahmad et al., 2021). Restrictive freedom of movement may be a marker for broader entitlement to control and abuse an adolescent wife, or greater fear on the part of the wife to move freely, linking this variable with the spousal violence outcome (Fleming et al., 2015). Importantly, even for the married subsample of participants, we still see restricted mobility associated with lower likelihood of NMSV, even as it is associated with increased odds of MSV. Overall, these findings demonstrate that efforts to restrict female freedom of movement reinforce girls’ vulnerability in marriage while offering no real protection against sexual violence, and in fact, reducing culpability for abusive men and society to end this violence. This analysis also showed that poorer married adolescents are more vulnerable to MSV, a finding that corresponds with previous study documenting that both poverty and early marriage are ecological factors associated with marital violence more generally in India (Ahmad et al., 2021). Notably, the association between wealth and NMSV is not observed; urbanicity appears to be the more salient risk factor for NMSV for adolescent girls, as noted above. Overall, these findings highlight the relevance of social determinants as contributing to girls’ risk for sexual violence is India.

As reported above, findings from this research reinforce those seen globally—perpetrators of sexual violence are typically known to the victim, most often being a partner, family member, or friend. Normalization of male sexual aggression in terms of both harassment (Zietz & Das, 2018) and coercion or assault (Daruwalla et al., 2018) remains a concern in India, and targeting change in these norms should receive more focus than restricting the freedoms of girls as an means of eliminating sexual violence (Fleming et al., 2018; Raj et al., 2016; Schensul et al., 2015; Verma et al., 2006). Simultaneously, with recognition that 78% of girls in this nationally representative sample report some level of restriction on their freedom of movement, social norm change is needed both in terms of girls’ freedom to move through society and the unacceptability of sexual harassment and violence in impeding that movement. A recent study from India shows the value of girl mentors to alter norms and demonstrate comfort and safety in freedom of movement (Bankar et al., 2018). Such efforts are needed in both urban and rural areas; while findings related to NMSV were specific to urban areas, rural girls face more restrictions in movement (IIPS, 2018).

An additional concern highlighted by the current findings is the very low rates of disclosure and help-seeking among those experiencing sexual violence. The majority of girls disclosed their assaults to no one, and less than 1% reported the violence to the police, a notable concern in light of evidence of increased reporting of sexual violence to police more broadly in India, subsequent to the high profile Nirbhaya fatal rape case in 2012 (McDougal et al., 2021). Current findings indicate that improvements in support of sexual violence victims in India are not reaching adolescent girls at a national level. Given the recognized link between violence and mental health trauma among adolescents in India (Sivagurunathan et al., 2015), low rates of disclosure of experiences of sexual violence are a major concern that requires greater prioritization within policy, such as India’s RKSK adolescent health strategy and other national strategies focused on adolescents.

Findings from this study should be considered in light of certain limitations including reliance on self-reported data, increasing its vulnerability to social desirability and recall biases. Social desirability in particular is a concern; very low rates of reported sexual violence in India relative to that seen in other nations, likely due to the relatively high social cost, do call into question whether there is underreporting (Abrahams et al., 2014). Regular monitoring of prevalence of sexual violence in light of the #MeToo movement, designed to both increase awareness and decrease stigmatization of victims, may increase reporting. Generalizability is also limited to India, though use of a nationally representative sample allows for nation-level understanding of this issue. Findings may be comparable to other low- and middle-income nations with high rates of child marriage and restricted movement of adolescent girls.

An additional issue is our reliance on cross-sectional analyses for this study, which impedes assumptions of causality. Interpretation of these findings must consider reverse-causality. Related to this concern relates is our use of the ever sexual violence outcome when the freedom of movement variable related to the respondent’s current situation. In terms of MSV, ongoing exposure to the perpetrator and largely comparable ever and past month prevalence of sexual violence among married women render that variable indicative of a current situation. This is not the case for NMSV, where the perpetrator may no longer be in the life of the respondent. Also, freedom of movement can change over time, making it difficult for us to connect current movement with past experience of violence from a mechanistic perspective. Thus, we examined the association between freedom of movement and NMSV in the past 12 months and found a slightly stronger effect size. These findings reinforce the connection between our exposure variable and our outcome. Nonetheless, longitudinal analyses would offer important insight into the causal pathway. In addition, a larger and more comprehensive measure of sexual violence inclusive of harassment, as well as a more nuanced measure of women and girls’ freedom of movement would also support greater insight into these issues.

Conclusion

More than one million adolescent girls in India have been victims of NMSV, and more than half a million adolescent girls have been sexually victimized by their husbands. Families often restrict movements of girls to reduce vulnerability to sexual violence, which leads to costs to girls’ autonomy and opportunity (Fleming et al., 2018; Raj et al., 2016; Schensul et al., 2015; Verma et al., 2006). Findings from this study demonstrate that restricted freedom of movement is associated with decreased odds of NMSV in urban settings. This may be due to greater vulnerability to exposure, although most victims know their perpetrators, or due to greater isolation and restricted movement subsequent to victimization. In either case, this is an unacceptable, as sexual violence as a threat and source of trauma should not compromise girls’ freedom of movement. In contrast, findings indicate that restricted freedom of movement is associated with greater odds of MSV, likely as part of a constellation of controlling behaviors from abusive husbands. Freedom of movement and safety from violence are fundamental human rights, and we should not compromise these rights as a means of social protection or control of girls. Rather, we must strive for social change in norms and structures to ensure women and girls’ safety and mobility in India.

Author Biographies

Anita Raj, PhD, is the tata chancellor professor of Society and Health, professor of Medicine, and professor of Education Studies at the University of California, San Diego. She is also Director of the Center on Gender Equity and Health.

Abhishek Singh, PhD, is a professor at the International Institute of Population Sciences; he is trained a demographer and works on issues of fertility and health.

Jay G. Silverman, PhD, is professor of Medicine and a professor in the Center on Gender Equity and Health, University of California San Diego.

Nandita Bhan, ScD, is a research scientist/consultant with the Center on Gender Equity and Health, Department of Medicine, University of California San Diego.

Kathryn M. Barker, ScD, is a post-doctoral fellow with the Center on Gender Equity and Health, Department of Medicine, University of California San Diego.

Lotus McDougal, PhD, is an associate project scientist at the Cener on Gender Equity and Health, Department of Medicine, University of California San Diego.

Appendix

Table A1.

Descriptive Summary of NonMarital Sexual Violence and Associated Variables Among 15- to 19-Year-Old Females in India, 2015–2016.

	Total			No nonmarital sexual violence			Any nonmarital sexual violence
Variable	N	%	95% CI	N	%	95% CI	N	%	95% CI
Total a	9,593	100		9,454	98.0	[97.2, 98.6]	139	2.0	[1.4, 2.8]
Freedom of movement
Restricted	7,497	78.2	[76.7, 79.6]	7,390	78.5	[76.9, 79.9]	107	65.2	[52.5, 76.0]
Unrestricted	2,096	21.8	[20.4, 23.3]	2,064	21.5	[20.1, 23.1]	32	34.8	[24.0, 47.5]
Marital status
Never-married	7,962	84.2	[83.1, 85.3]	7,842	84.2	[84.0, 85.3]	120	84.3	[70.0, 92.5]
Ever-married	1,631	15.8	[14.7, 17.0]	1,612	15.8	[14.7, 17.0]	19	15.7	[7.5, 30.0]
Age (years)b		17.0	[15, 19]		17.0	[15, 19]		17.0	[15, 19]
SC/ST
No/don’t know	2,324	25.5	[24.0, 27.0]	2,298	25.4	[23.9, 27.0]	26	29.5	[18.4, 43.6]
SC/ST or OBC	7,269	74.5	[74.5, 76.0]	7,156	74.6	[73.0, 76.1]	113	70.5	[56.5, 81.6]
Household wealth		0.0	[−2.1, 2.5]		0.0	[−2.1, −2.5]		0.2	[−1.8, −2.1]
Residence
Rural	7,006	68.3	[67.1, 69.4]	6,904	68.6	[67.4, 69.7]	102	54.3	[36.5, 71.0]
Urban	2,587	31.7	[30.6, 32.9]	2,550	31.4	[30.3, 32.7]	37	45.7	[29.0, 63.5]
Education (years)b		8.9	[0, 16]		8.9	[0, 16]		9.2	[0, 14]
Mobile phone access
No	7,001	74.9	[73.5, 76.3]	6,907	75.1	[73.6, 76.5]	94	65.7	[53.1, 76.3]
Yes	2,592	25.1	[23.7, 26.5]	2,547	24.9	[23.5, 26.4]	45	34.3	[23.7, 46.9]

^aRow percents. All other percents are column.

^bM (range).

Table A2.

Descriptive Summary of Marital Sexual Violence and Associated Variables Among Ever-Married 15- to 19-Year-Old Females in India, 2015–2016.

	Total			No marital sexual violence			Any marital sexual violence
Variable	N	%	95% CI	N	%	95% CI	N	%	95% CI
Totala	1,631	100.0		1,525	94.3	[92.5, 95.6]	106	5.8	[4.4, 7.5]
Freedom of movement
Restricted	1,314	79.4	[75.1, 83.1]	1,223	78.5	[74.0, 82.4]	91	94.2	[89.0, 97.1]
Unrestricted	317	20.6	[16.9, 24.9]	302	21.5	[17.6, 26.0]	15	5.8	[3.0, 11.0]
Age (years)b		18.2	[15, 19]		18.2	[15, 19]		18.1	[16, 19]
SC/ST
No/don’t know	288	20.9	[18.1, 24.1]	272	20.4	[17.3, 23.9]	16	29.1	[13.9, 51.0]
SC/ST ora OBCa	1,343	79.1	[75.9, 80.9]	1,253	79.6	[76.1, 82.7]	90	71.0	[49.0, 86.1]
Household wealthb		−0.2	[−2.1, 2.4]		−0.2	[−2.1, 2.4]		−0.8	[−1.9, 1.4]
Residence
Rural	1,327	76.5	[72.4, 80.2]	1,236	75.8	[71.4, 79.7]	91	89.4	[77.7, 95.4]
Urban	304	23.5	[19.8, 27.6]	289	24.2	[20.3, 28.7]	15	10.6	[4.6, 22.3]
Education (years)b		7.3	[0, 15]		7.4	[0, 15]		6.4	[0, 14]
Mobile phone access
No	1,014	60.9	[56.8, 64.9]	941	60.3	[56.1, 64.4]	73	71.0	[57.4, 81.6]
Yes	617	39.1	[35.1, 43.2]	584	39.7	[35.6, 43.9]	33	29.0	[18.4, 42.6]

^aRow percents. All other percents are column.

^bM (range).

Table A3.

Bivariate Associations Between Freedom of Movement and Sexual Violence Among Adolescent Girls Aged 15 to 19, Stratified by Urban/Rural Residence.

	Nonmarital Sexual Violencea				Marital Sexual Violenceb
	Rural Residencec		Urban Residencec		Rural Residenced		Urban Residenced
	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Freedom of movement
Restricted	0.90	[0.45, 1.80]	0.33**	[0.15, 0.76]	4.63***	[2.02, 10.63]	2.63	[0.49, 14.16]
Unrestricted	REF		REF		REF		REF

Note. OR = odds ratio; CI = confidence interval.

^aAmong all 15- to 19-year-old girls (regardless of marital status).

^bAmong ever-married 15- to 19-year-old girls.

^cThe interaction between freedom of movement and urban/rural residence when predicting nonmarital sexual violence is marginally significant (.07), indicating that the differences between the stratified urban/rural estimates are significantly different.

^dThe interaction between freedom of movement and urban/rural residence when predicting marital sexual violence is not statistically significant (p = .55), indicating that the differences between the stratified urban/rural estimates are not significantly different.

^*p < .1

^**p < .05.

^***p < .01.