Skip to main content
The European Journal of Public Health logoLink to The European Journal of Public Health
. 2019 Sep 24;30(2):293–299. doi: 10.1093/eurpub/ckz162

Does country-level gender equality explain individual risk of intimate partner violence against women? A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) in the European Union

Anna-Karin Ivert 1,2,, Enrique Gracia 3, Marisol Lila 3, Maria Wemrell 1,4, Juan Merlo 1,5
PMCID: PMC7183361  PMID: 31549148

Abstract

Background

Gender equality is widely accepted as an important explanatory factor for the occurrence of intimate partner violence (IPV) against women. However, the relationship is not straightforward, as high country-level gender equality is not always associated with lower IPV prevalence. We apply ‘multilevel analysis of individual heterogeneity and discriminatory accuracy’ (MAIHDA) to (i) quantify the extent to which the country of residence determines individual risk of IPV and (ii) investigate the association between country-level gender equality and individual experience of IPV, and to which extent this association explains the observed between-country differences.

Methods

Using data from the 2012 European Union Agency for Fundamental Rights survey on violence against women we applied MAIHDA to analyse experiences of physical and sexual IPV among 42 000 women living in the EU. We fitted three consecutive models, and calculated specific individual contextual effects (measures of association) as well as the general contextual effects (measures of variance) and the discriminatory accuracy (DA).

Results

Our findings show that the relationship between experiences of IPV and country-level gender equality is weak and heterogeneous. The general contextual effect is small and the DA is low, indicating that country boundaries are rather irrelevant for understanding the individual risk of IPV.

Conclusions

Findings from the present study do not imply that that gender equality is unimportant in relation to IPV, but rather that information on country of residence or country-level gender equality does not discriminate very well with regards to individual experiences of IPV in cross-national comparisons.

Introduction

Gender equality is widely accepted as an important explanatory factor for the occurrence of intimate partner violence (IPV) against women and, accordingly, its prevalence is expected to be higher in countries with low levels of estimated gender equality.1–3 However, the relationship between country-level gender equality and IPV does not appear to be straightforward, as high country-level gender equality is not always associated with lower IPV prevalence.4–6 For example, a survey conducted by the European Union Agency for Fundamental Rights (FRA)7 showed the lifetime prevalence of IPV in the three EU Nordic countries (Denmark: 32%; Finland; 30%; Sweden: 28%) to be higher than the EU average (22%; 13% being the lowest prevalence), despite these countries ranking the highest in gender equality. This puzzling finding, labelled as the ‘Nordic paradox’,4,8 illustrates the need to further investigate the link between macro or societal levels of gender equality, and individual experiences of IPV.

Three possible types of relationships between country-level gender equality and violence against women have been proposed:5,6 ‘amelioration’ (increasing gender equality decreases violence against women), ‘backlash’ (increasing gender equality increases violence against women) and ‘convergence’ (increasing gender equality makes men and women more similar both in experiencing and perpetrating violence). However, literature reviews show that neither the relationship between macro-level gender equality and violence against women nor the direction of this relationship could be assumed,6 and that the association appears to be complicated.5 This apparent confusion could in part be due to the limited attention paid in research, so far, to macro-level explanatory factors, as compared to individual-level factors.9,10 While multilevel modelling investigating both macro- and individual-level IPV predictors appears as an ideal analytical approach, only a small number of such studies have been performed.11–13 Existing multilevel analyses have mainly focused on ‘specific contextual effects’ based on differences between country-average risks (i.e. measures of association), without specifically attending to the ‘general contextual effects’ based on measures of variance and heterogeneity around the averages [i.e. measures of variance partition and of discriminatory accuracy (DA)].14,15

To increase our knowledge on how the country context influences the individual risk of IPV, we need to apply a suitable methodology, like ‘multilevel analysis of individual heterogeneity and discriminatory accuracy’ (MAIHDA).14,16,17 MAIHDA simultaneously considers both specific and general contextual effects. That is, through MAIHDA we not only investigate the association between country characteristics and individual IPV but also the ability of the information on country of residence to accurately discriminate between women with and without experiences of IPV.14,16,17

Disregarding the general contextual effects might give misleading information to decision-makers planning interventions to prevent IPV (cf.14,17). From a European Union perspective, the question is to what extent specific countries should be pointed out for targeted interventions or to what extent such intervention should be universal and cover the whole of the EU. Today, the idea of ‘proportionate universalism’ appears as a suitable approach for resource allocation in public health.18 As Marmot advocated,19 health actions must be universal, not targeted, but with a scale and intensity that is proportionate to the level of disadvantage. The MAIHDA approach provides a suitable instrument within ‘proportionate universalism’, enabling the making of informed decisions about to which degree public health interventions should be universal of targeted.

Therefore, in this study we apply MAIHDA with two main objectives. First, we aim to quantify the extent to which the country of residence—as a whole—determines the individual risk of IPV over and above individual characteristics (i.e. the general contextual effect). Second, we aim to investigate the association between country-level gender equality and individual IPV (i.e. specific contextual effect) and to which extent this association explains the observed between-country differences.

Methods

Population

Our data were drawn from the 2012 FRA survey on violence against women.7 The FRA survey comprises data from structured interviews with 42 002 women aged 18 years or older across the 28 EU member states. An average of 1500 women were interviewed in each country, ranging from 908 (Luxembourg) to 1620 (Czech Republic). Data were primarily collected through structured face-to-face interviews, but also through self-report. The self-report section was intended to offer the respondents a more anonymous way of disclosing experiences of violence. Details of the survey can be found elsewhere.7,20 The FRA approved our use of the survey, and provided a special license for the analyses (reference number 120715).

Assessments of variables

Outcomes

We analysed two related IPV outcomes: experiences of ‘physical violence’ and of ‘sexual violence’ over the life-course. Both measures were self-reported and based on the participant’s answer to the statements ‘My partner or an ex-partner has been physically violent against me’ and ‘My partner or an ex-partner has been sexually violent against me’, by ‘Yes’ (=1) or ‘No’ (=0). Women who answered ‘I have not had a partner or an ex-partner’ were excluded from the analysis, as were women with missing information on the IPV outcomes, leaving 39 429 women eligible for analysis of experience of physical IPV and 39 436 for experience of sexual IPV.

Individual-level variables

A number of individual-level variables, found to be associated with IPVAW in previous studies,9,11–13 were included in the analysis.

‘Age’ was divided into seven groups with the youngest, aged 18–24, used as reference.

‘Marital status’ was categorized as being married or in civil partnership (reference category) or not.

‘Educational level achievement’ was divided into three groups: primary (reference category), secondary and university education.

Parental country of birth was used as a proxy for ‘immigrant background’ and divided into three groups, (i) both parents born in the country of residence (reference category), (ii) one parent born in the country of residence or (iii) both parents born in another country.

‘Type of residential area’ was categorized as big city or suburb (reference category), town or small city and rural area or country village.

We also included measures of self-reported ‘childhood experiences of physical abuse’ and ‘childhood experiences of sexual abuse’ before age 15 (‘yes’ versus ‘no’). These measures were based on questions about childhood experiences (six regarding physical and five regarding sexual abuse). We considered childhood experience of physical/sexual abuse to be present if the participant answered affirmative to any of these questions.

Missing values for the covariates ranged from 0.3% (age) to 1.2% (immigrant background).

Further information on the variables is available in the FRA survey technical report.20

Country-level variables

To assess the level of gender equality, we used the Gender Equality Index (GEI) from 2012.21 The GEI is built from country-level, gender-specific aggregated variables covering six core domains (work, money, knowledge, time, power and health). The index relies on gender gaps, i.e. differences between women and men in each domain, without distinguishing the direction of the gap. The index ranges from 1, indicating total gender inequality, to 100, indicating full gender equality, the minimum is 50.1 (Greece) and the maximum 79.7 (Sweden). We categorized the countries into three groups according their GEI; low (≤59), medium (60–69) and high (≥70) (see table 1).

Table 1.

Gender equality index (GEI) and prevalence of physical and sexual IPV in the countries of the EU according to the FRA 2012 survey on violence against women

GEI group Country GEI (units) Physical IPVAW (%) Sexual IPVAW (%)
Low Greece 50.1 13.5 4.4
Cyprus 50.6 13.1 3.7
Romania 51.2 21.0 5.1
Hungary 51.8 17.6 6.3
Slovakia 52.4 19.3 7.3
Croatia 52.6 12.4 3.6
Estonia 53.5 18.8 5.9
Lithuania 54.2 24.1 6.3
Portugal 54.4 15.9 3.7
Latvia 56.2 24.9 7.7
Italy 56.5 12.6 5.5
Czech Republic 56.7 17.2 7.6
Bulgaria 56.9 19.7 8.0
Poland 56.9 11.7 4.3
Malta 57.8 10.8 5.0
Medium Austria 61.3 12.0 5.6
Germany 64.9 17.3 6.3
Luxembourg 65.9 16.3 5.8
Slovenia 66.1 9.5 2.2
Spain 67.4 9.6 3.4
Ireland 67.7 11.8 4.5
France 68.9 16.0 6.8
UK 68.9 22.0 7.3
High Belgium 70.2 18.5 7.1
Netherlands 74.0 17.4 8.2
Finland 74.4 23.4 8.1
Denmark 75.6 19.3 6.0
Sweden 79.7 19.5 7.3

Analytical strategy

Multilevel analysis of individual heterogeneity and discriminatory accuracy

Following a previously described MAIHDA design,16 we performed three consecutive models for each outcome. For an elaborated description of the analytical strategy, see the Supplementary Material.

In the first model, or the ‘single-level individual effects model’, we fitted a conventional single-level logistic regression for IPV experience, including only the individual-level covariates. Here, the countries are ignored. This model informs on associations between the individual-level variables and the outcome [expressed as odds ratios (ORs) and 95% confidence intervals]. In addition, we calculated the predicted probabilities from this model and used them to compute the receiver operating characteristic (ROC) curve, and the corresponding area under the ROC curve (AU-ROC), as a measure of DA16,22,23 of the model (see Supplementary Material for further information). Thus, the AU-ROC of the first model quantifies the accuracy of the included individual-level covariates alone for identifying individuals with or without IPV experience.

The second or ‘general contextual effects model’ is a multilevel logistic regression model constructed by adding a random country-level intercept to the first model. This second model decomposes the total individual variance into between- and within-country variance. From this model we can estimate the general contextual effect using two different measures, the variance partition coefficient (VPC) and the AU-ROC.

The VPC quantifies the share of the total individual variance in the propensity of having experienced IPV that is located at the country-level. Interpreting the VPC as a measure of DA implies that the higher the variance, the better the country context is for classifying women with or without experiences of IPV.24–26 The VPC was calculated using the latent variable method25,26 and is expressed as a percentage

VPC=100xσu2σu2+3.29

where 3.29 denotes the variance of a standard logistic distribution of latent continuous response and σu2 is the between-country variance.

In the second model, the predicted probabilities are based on both the individual-level covariates and the country intercepts (i.e. random effects). Consequently, the AU-ROC of model 2 can be compared with that of model 1, to quantify the added value of having information on the women’s country of residence for classifying them according to IPV experience. The increase in the AU-ROC can be calculated as

AU-ROCchange=AU-ROC[Model2]AU-ROC[Model1].

The larger the AU-ROCchange, the bigger is the general contextual effect and the better the accuracy of the country information for classifying women according to the presence or absence of IPV.

In the third ‘specific contextual effects model’, we add the country-level variable on gender equality (GEI) to estimate the specific contextual effect (i.e. OR) of this variable. We also calculated the proportion of opposed odds ratios (POOR),25,27 i.e. the proportion of ORs with the opposite direction to the overall OR.25 The values of the POOR range from 0% to 50%. A POOR of 0% means that all ORs have the same sign, while a POOR of 50% means that half of the ORs are of the opposite sign, showing that the association is very heterogeneous.

Finally, we calculated the adjusted VPC and the proportional change in variance (PCV), i.e. country-level variance explained by the GEI, as

PCV=σuModel22-σuModel32σuModel22.

We calculated the AU-ROC, which is, however, not expected to change as the model 2 provides the ceiling or maximum AU-ROC obtained by combining the available individual information and the country of residence (see Merlo et al.16 for an elaborated explanation).

The models were estimated using Markov chain Monte Carlo methods as implemented in the MLwiN multilevel modelling software.28 The Bayesian deviance information criterion (DIC) was used as a measure of goodness of fit of our models.29 The DIC considers both the model deviance and its complexity. Models with smaller DIC are preferred to models with larger DIC, with differences of five or more considered as substantial.30 We used the statistical programmes MLwiN 3.01 and SPSS 25 to perform the analyses.

Results

Table 1 shows the country-specific GEI values as well as the prevalence of physical and sexual IPV. The figures presented in this table indicate that there is a clear association between GEI and IPV prevalence at the country-level.

Table 2 shows the characteristics of the study sample stratified by country GEI categories and by IPV experience. The highest prevalence of IPV is found among women living in countries in the high-GEI group, and the lowest levels among women living in countries in the middle-GEI group, indicating a J-shaped association between gender equality and IPV.

Table 2.

Characteristics of the study sample (N = 42 002) from the European Union Agency for Fundamental Rights 2012 survey on violence against women by categories of Gender Equality Index (GEI) and life time experience of physical and sexual violence

Column % Row %
Low GEIa Middle GEIb High GEIc Physical violence Sexual violence
Number of countries (individuals) 15 (22.865) 8 (11.552) 5 (7.585)
Life time experience of IPVAW
    Physical 16.8 14.2 19.6 29.6
    Sexual 5.6 5.2 7.2 84.6
Age
    18–24 years 9.5 8.5 8.3 11.8 4.0
    25–29 years 7.5 7.0 7.0 13.8 5.0
    30–34 years 8.6 8.9 7.1 16.5 5.9
    35–39 years 9.7 9.8 7.9 18.0 6.3
    40–49 years 18.4 21.6 20.8 19.5 6.5
    50–59 years 19.7 18.9 21.5 18.3 6.7
    60 years or above 26.5 25.3 27.3 14.9 5.1
Marital status
    Married/partnership 61.8 61.5 54.7 12.6 4.2
    Not married/partnership 38.2 38.5 45.3 23.1 8.4
Educational achievement
    Primary education 29.1 34.8 15.6 17.9 6.5
    Secondary education 51.9 44.8 51.7 17.0 6.0
    University education 18.9 20.1 32.5 13.9 4.4
Immigrant background
    Both parents born in the country 89.1 80.3 84.8 16.1 5.6
    One parent born in the country 4.2 4.8 5.2 20.6 7.4
    Both parents born in another country 6.2 14.0 8.0 18.5 6.6
Type of residential area
    Big city or suburb 35.9 30.6 36.7 17.3 6.1
    Town or small city 34.0 37.1 36.9 17.0 5.8
    Rural area or country village 29.8 31.8 26.4 15.5 5.5
Physical abuse in childhood
    Yes 24.6 26.2 30.4 25.1 9.5
    No 75.4 73.8 69.6 13.5 4.5
Sexual abuse in childhood
    Yes 5.2 12.2 15.3 29.1 12.8
    No 94.8 87.8 84.7 15.4 5.1

Note: Values are percentages.

a

Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, Greece, Hungary, Italy, Latvia, Lithuania, Malta, Poland, Portugal, Romania, Slovakia.

b

Austria, France, Germany, Ireland, Luxemburg, Slovenia, Spain, UK.

c

Belgium, Denmark, Finland, Netherlands, Sweden.

The age distribution was roughly similar across GEI categories, as was the type of residential area. Single and highly educated women were more frequent in high-GEI countries. Women with both parents born in another country were more frequent in middle-GEI countries. Experience of physical or sexual abuse in childhood increased by increasing GEI.

Multilevel analysis of individual heterogeneity and discriminatory accuracy

Single-level individual effects

Table 3 informs on the associations between the individual-level variables and physical and sexual IPV, respectively. The patterns of association are similar for both outcomes and in both the single-level (model 1) and the multilevel (model 2 and 3) models. The probability of suffering from IPV is lowest among the youngest and the oldest women and higher among unmarried women and those with low educational achievement. While women with both parents born abroad have similar odds of experiencing IPV as women with both parents born in the country of residence, those with only one parent born in the country of residence have higher odds of IPV. Women with experience of physical or sexual abuse in childhood have higher odds of suffering from IPV as adults. As a whole, the DA of information on the individual characteristics of the woman was moderate, since the AU-ROC were 0.671 and 0.680 for physical and sexual IPV, respectively.

Table 3.

Single (model 1) and multilevel (models 2 and 3) logistic regression analyses modelling experiences of physical and sexual IPVAW in relation to individual-level variables

Physical intimate partner violence Sexual intimate partner violence
Single-level model Multilevel models Single-level model Multilevel models
Model 1 Model 2 Model 3 Model 1 Model 2 Model 3
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Individual-level effects
Age
    18–24 years Reference Reference Reference Reference Reference Reference
    25–29 years 1.55 (1.33–1.81) 1.58 (1.35–1.84) 1.57 (1.33–1.86) 1.60 (1.27–2.02) 1.63 (1.29–2.08) 1.63 (1.29–2.08)
    30–34 years 2.18 (1.90–2.50 2.22 (1.90–2.61) 2.22 (1.90–2.59) 2.08 (1.67–2.59) 2.10 (1.67–2.68) 2.11 (1.67–2.68)
    35–39 years 2.59 (2.27–2.96) 2.62 (2.26–3.03) 2.62 (2.24–3.06) 2.46 (1.98–3.05) 2.45 (1.94–3.11) 2.46 (1.96–3.08)
    40–49 years 2.73 (2.69–2.76) 2.77 (2.43–3.16) 2.77 (2.41–3.17) 2.36 (1.96–2.85) 2.39 (1.95–2.94) 2.39 (1.95–2.94)
    50–59 years 2.43 (2.16–2.74) 2.41 (2.11–2.75) 2.40 (2.09–2.75) 2.36 (1.96–2.84) 2.34 (1.90–2.89) 2.34 (1.91–2.87)
    60 years or above 1.68 (1.49–1.89) 1.60 (1.40–1.82) 1.59 (1.39–1.83) 1.57 (1.31–1.88) 1.54 (1.25–1.89) 1.54 (1.25–1.88)
Married/civil partnership (no vs. yes) 2.49 (2.35–2.63) 2.47 (2.32–2.62) 2.46 (2.32–2.62) 2.39 (2.18–2.61) 2.37 (2.17–2.58) 2.36 (2.16–2.57)
Education achievement
    Primary Reference Reference Reference Reference Reference Reference
    Secondary 0.90 (0.85–0.96) 0.81 (0.75–0.87) 0.81 (0.75–0.87) 0.89 (0.81–0.98) 0.81 (0.73–0.90) 0.80 (0.72–0.89)
    University 0.64 (0.59–0.70) 0.56 (0.52–0.61) 0.56 (0.51–0.62) 0.58 (0.51–0.66) 0.53 (0.46–0.62) 0.53 (0.46–0.61)
Immigrant background
    Both parents born in the country Reference Reference Reference Reference Reference Reference
    One parent born in the country 1.21 (1.07–1.37) 1.20 (1.06–1.36) 1.20 (1.07–1.36) 1.20 (0.99–1.45) 1.20 (0.99–1.45) 1.19 (0.98–1.46)
    Both parents born in another country 1.09 (0.99–1.20) 1.17 (1.06–1.30) 1.18 (1.06–1.30) 1.11 (0.96–1.30) 1.18 (1.01–1.39) 1.20 (1.03–1.40)
Type of residential area
    Big city/suburb Reference Reference Reference Reference Reference Reference
    Town/small city 1.01 (0.94–1.08) 1.02 (0.95–1.09) 1.02 (0.95–1.09) 0.99 (0.89–1.09) 0.98 (0.89–1.09) 0.99 (0.89–1.09)
    Rural area/village 0.96 (0.89–1.03) 0.96 (0.89–1.03) 0.96 (0.89–1.03) 0.99 (0.88–1.11) 0.97 (0.88–1.08) 0.98 (0.88–1.09)
Abuse in childhood (yes vs. no)
    Physical 1.96 (1.84–2.07) 1.95 (1.84–2.07) 1.96 (1.84–2.08) 1.98 (1.81–2.16) 1.97 (1.79–2.16) 1.96 (1.78–2.15)
    Sexual 1.92 (1.77–2.08) 2.02 (1.85–2.21) 2.02 (1.85–2.21) 2.31 (2.06–2.59) 2.29 (2.03–2.58) 2.31 (2.06–2.59)

Specific contextual effects

We observed a weak and inconclusive J-shaped association between GEI categories and both physical (OR = 0.70 and 1.08 for the middle- and high-GEI categories, respectively, compared with the low-GEI category) and sexual IPV (OR = 0.78 and 1.08) (table 4). Besides, the POOR indicated that between 20% and 43% of the ORs were in the opposite direction. That is, the association is not clearly supported by the multilevel analysis.

Table 4.

Single (model 1) and multilevel (models 2 and 3) logistic regression analyses modelling experiences of physical and sexual IPVAW

Physical intimate partner violence Sexual intimate partner violence
Single-level model Multilevel models Single-level model Multilevel models
Model 1 Model 2 Model 3 Model 1 Model 2 Model 3
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Specific contextual effects
    Gender Equality Index
        Low Reference Reference
        Middle 0.70 (0.54–0.91) 0.78 (0.60–0.99)
            POOR 20% 24%
        High 1.08 (0.81–1.44) 1.08 (0.81–1.45)
            POOR 43% 41%
General contextual effects
    σ2 0.111 (0.034) 0.088 (0.028) 0.076 (0.028) 0.066 (0.025)
    VPC (%) 3.26 2.61 2.26 1.97
    PCV (%) 20.72 16.16
    AU-ROC 0.671 0.691 0.691 0.680 0.694 0.694
    Change in AU-ROC 0.020 0.000 0.014 0.000
Goodness of fit
    DIC 32 360.93 31 916.95 31 916.93 16 003.99 15 907.61 15 906.51
    Change in DIC compared with previous model −443.98 −0.02 −96.38 −1.10

Note: The table informs on both specific and general contextual effects.

POOR: proportion of opposed odds ratios; σ2: variance; VPC: variance partition coefficient; PCV: proportional change in variance; AU-ROC: area under the receiver operator characteristics curve; DIC: Bayesian deviance information criterion.

General contextual effects

The size of the VPC was small; 3.26% for physical and 2.26% for sexual IPV, in model 2 (table 4). This indicates a very small general contextual effect. Thus, differences in country prevalence comprise only a small part of the total individual differences in the latent propensity of experiencing IPV. This conclusion was confirmed by the small change in AU-ROC from model 1 to model 2. That is, the moderate DA of the individual-level variables (model 1) only scarcely increased when the country of residence was added as a random effect in the multilevel regression analysis (model 2). This small general contextual effect needs to be considered when interpreting the country differences presented in table 1. Also, even if the GEI explained 21% of the country variance in physical IPV and about 13% of the variance in sexual IPV, these relatively large percentages were based on small initial country-level variances.

Discussion

Gender equality if often presented as an important explanatory factor of IPV prevalence,1–3 but previous research on the link between country-level gender equality and individual experiences of IPV is inconclusive, as a high level of gender equality is not always associated with low prevalence of IPV.4–6 Previous research investigating this issue through multilevel analysis have focused on the ‘specific contextual effects’ while disregarding the ‘general contextual effects’.11–13

In previous research, three hypotheses regarding the association between gender equality and IPV have been presented: amelioration, backlash and convergence.5,6 Our findings do not support any of these hypotheses, since we find weak and heterogeneous associations between country-level gender equality and individual IPV experiences. In addition, and perhaps more importantly, the results of our multilevel analysis show that the general contextual effect and DA of country of residence is small. The low VPC (i.e. 2.3–3.3%) and small change in the AU-ROC (i.e. 0.014–0.020 units) indicate that country boundaries are rather irrelevant for understanding the individual risk of IPV. This does not imply that gender equality is unimportant in relation to IPV, but rather that information on country of residence or country-level gender equality does not discriminate very well in relation to individual experiences of IPV in cross-national comparisons.

The small general contextual effect found in the present study is in line with previous studies by Sanz-Barbero et al.12,13 However, these previous studies focus on measures of association without considering that the DA of the country context is small. Even if the individual and contextual variables explained almost all of the between-country variance, the between-country variance was rather small to begin with and a significant part of individual differences in experiences of IPV remained unexplained. The small general contextual effects found in our study, and by Sanz-Barbero et al., underscore the need to identify other contexts and categorizations that are more relevant for understanding individual, self-reported experiences of IPV.

Methodological considerations

In the present study, we used the self-reported binary questions on lifetime experiences of physical and/or sexual violence. However, the FRA survey also contains acts-based questions on IPV experiences, over the life-course and over the past year (e.g. being slapped, burned or threatened with violence). These questions have been used in previous studies.12,13 We fitted models identical to the ones presented above but using the acts-based questions on lifetime experience of physical and sexual IPV (if the respondent answered yes to any of the questions, she was considered to have experienced physical or sexual IPV) with almost identical results with regard to between-country variance and DA.

It is important to acknowledge, when conducting comparative research, that survey questions may be interpreted differently within different contexts and that this might influence observed between-country differences. This needs to be addressed in forthcoming studies.

It should also be noted that the GEI perhaps does not cover all aspects of gender in/equality relevant to IPV, such as private-sphere norms of masculinity, femininity and heterosexual interaction.31–33

Conclusion

Within the framework of ‘proportionate universalism’, as an approach for public health resource allocation,18,19 our results suggest that IPV interventions in the EU need to be universal, not targeted to specific countries, but with a scale and intensity that is proportionate to the IPV prevalence.

Since the EU countries yield a very small general contextual effect, we need to identify other, more relevant contexts for identifying women who risk suffering from IPV. Rather than geopolitical evaluation based on country boundaries, an ‘intersectional’ perspective based on demographic and socioeconomic contexts17,34,35 might provide a better understanding of the heterogeneous distribution of IPV in the population and thereby allow for more effective structural interventions towards those societal context that are most exposed to IPV.

Funding

This research was supported by Grants #2017-03093 (A.-K.I. and M.W.) and 2017-01321 (J.M.) from the Swedish Research Council (VR) (https://www.vr.se/english.html), and by Grant PSI2017-84764-P (E.G. and M.L.) from the Spanish Ministry of Economy, Industry, and Competitiveness.

Conflicts of interest: None declared.

Key points

  • We address the issue of the complex association between country level of gender equality and the occurrence of intimate partner violence (IPV) against women in the European Union by applying multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

  • Our findings show that that the relationship between experiences of IPV and country-level gender equality is weak and heterogeneous.

  • The MAIHDA shows that only about 2–3% of the individual variance in experience of IPV can be found at the country level, and that the discriminatory accuracy of knowing the country of residence of a woman is low.

  • Our results suggest that IPV interventions in the EU need to be universal not targeted to specific countries, but with a scale and intensity that is proportionate to the IPV prevalence.

Supplementary Material

ckz162_Supplementary_Data

References

  • 1. García-Moreno C, Zimmerman C, Morris-Gehring A, et al. Addressing violence against women: a call to action. Lancet 2015;385:1685–95. [DOI] [PubMed] [Google Scholar]
  • 2. Jewkes R. Intimate partner violence: causes and prevention. Lancet 2002;359:1423–9. [DOI] [PubMed] [Google Scholar]
  • 3. Jewkes R, Flood M, Lang J. From work with men and boys to changes of social norms and reduction of inequities in gender relations: a conceptual shift in prevention of violence against women. Lancet 2015;385:1580–9. [DOI] [PubMed] [Google Scholar]
  • 4. Gracia E, Merlo J. Intimate partner violence against women and the Nordic paradox. Soc Sci Med 2016;157:27–30. [DOI] [PubMed] [Google Scholar]
  • 5. Latzman NE, D′Inverno AS, Niolon PH, Reidy DE. Gender inequality and gender-based violence: extensions to adolescent dating violence In: Wolfe DA, Temple JR, editors. Adolescent Dating Violence. Theory, Research, and Practice. New York: Academic Press, 2019: 283–94. [Google Scholar]
  • 6. Roberts S. What can alcohol researchers learn from research about the relationship between macro-level gender equality and violence against women? Alcohol Alcohol 2011;46:95–104. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.European Union Agency for Fundamental Rights. Violence against Women: An EU-Wide Survey. Main Results Report. Luxemburg: Publications Office of the European Union, 2014.
  • 8. Gracia E. Intimate partner violence against women and victim-blaming attitudes among Europeans. Bull World Health Organ 2014;92:380–1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Heise LL. What Works to Prevent Partner Violence. An Evidence Overview. 2011. Working Paper. STRIVE Research Consortium, London School of Hygiene and Tropical Medicine, London. Available at: http://strive.lshtm.ac.uk/resources/what-works-prevent-partner-violence-evidence-overview (13 December 2018, date last accessed).
  • 10. Heise L, Fuku E What Works to Prevent Violence against Women and Girls Evidence Reviews. State of the Field of Research on Violence against Women and Girls: What Do We Know and What Are the Knowledge Gaps? 2014. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/337603/What-know-what-knowledge-gaps-D.pdf (13 December 2018, date last accessed).
  • 11. Heise LL, Kotsadam A. Cross-national and multilevel correlates of partner violence: an analysis of data from population-based surveys. Lancet Glob Heal 2015;3:e332–2340. [DOI] [PubMed] [Google Scholar]
  • 12. Sanz-Barbero B, Corradi C, Otero-García L, et al. The effect of macrosocial policies on violence against women: a multilevel study in 28 European countries. Int J Public Health 2018;63:901–11. [DOI] [PubMed] [Google Scholar]
  • 13. Sanz-Barbero B, López Pereira P, Barrio G, Vives-Cases C. Intimate partner violence against young women: prevalence and associated factors in Europe. J Epidemiol Community Health 2018;72:611–16. [DOI] [PubMed] [Google Scholar]
  • 14. Merlo J. Invited commentary: multilevel analysis of individual heterogeneity-a fundamental critique of the current probabilistic risk factor epidemiology. Am J Epidemiol 2014;180:208–12. [DOI] [PubMed] [Google Scholar]
  • 15. Ivert AK, Merlo J, Gracia E. Country of residence, gender equality and victim blaming attitudes about partner violence: a multilevel analysis in EU. Eur J Public Health 2018;28:559–64. [DOI] [PubMed] [Google Scholar]
  • 16. Merlo J, Wagner P, Ghith N, Leckie G. An original stepwise multilevel logistic regression analysis of discriminatory accuracy: the case of neighbourhoods and health. PLoS One 2016;11:e0153778. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17. Merlo J. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework. Soc Sci Med 2018;203:74–80. [DOI] [PubMed] [Google Scholar]
  • 18. Carey G, Crammond B, De Leeuw E. Towards health equity: a framework for the application of proportionate universalism. Int J Equity Health 2015;14:81. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Marmot M, Bell R. Fair society, healthy lives. Public Health 2012;126:S4–10. [DOI] [PubMed] [Google Scholar]
  • 20.European Union Agency for Fundamental Rights. Violence against Women: An EU-Wide Survey—Survey Methodology, Sample and Fieldwork. Technical Report. Luxemburg: Publications Office of the European Union, 2014.
  • 21.European Institute for Gender Equality. Gender Equality Index 2017: Measuring Gender Equality in the European Union 2005-2015. Eige. 2017. Avaliable at: https://eige.europa.eu/rdc/eige-publications/gender-equality-index-2017-measuring-gender-equality-european-union-2005-2015-report (5 December 2018, date last accessed).
  • 22. Merlo J, Mulinari S, Wemrell M, et al. The tyranny of the averages and the indiscriminate use of risk factors in public health: the case of coronary heart disease. SSM Popul Health 2017;3:684–98. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Pepe MS, Janes H, Longton G, et al. Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. Am J Epidemiol 2004;159:882–90. [DOI] [PubMed] [Google Scholar]
  • 24. Merlo J, Chaix B, Yang M, et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon. J Epidemiol Commun Health 2005;59:443–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Merlo J, Chaix B, Ohlsson H, et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health 2006;60:290–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Goldstein H, Browne W, Rasbash J. Partitioning variation in multilevel models. Underst Stat 2002;1:223–31. [Google Scholar]
  • 27. Larsen K, Merlo J. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 2005;161:81–8. [DOI] [PubMed] [Google Scholar]
  • 28. Browne WJ. MCMC Estimation in MLwiN. Bristol: Centre for Multilebel Modelling, 2015: 429. [Google Scholar]
  • 29. Spiegelhalter DJ, Best NG, Carlin BP, Van Der Linde A. Bayesian measures of model complexity and fit. J Royal Statistical Soc B 2002;64:583–639. [Google Scholar]
  • 30. Lunn D, Jackson C, Best N, et al. The BUGS Book: A Practical Introduction to Bayesian Analysis. Boca Raton, FL: Chapman and Hall/CRC, 2012. [Google Scholar]
  • 31. Agevall C. Våldet Och Kärleken: Våldsutsatta Kvinnors Begripliggörande av Sina Erfarenheter (Love and Violence. Victimised Womeńs Accounts of Experiences of Violence). Lund: Lund University Press, 2012. [Google Scholar]
  • 32. Hearn J, Nordberg M, Andersson K, et al. Hegemonic masculinity and beyond: 40 years of research in Sweden. Men Masc 2012;15:31–55. [Google Scholar]
  • 33. Lister R. A Nordic nirvana? Gender, citizenship, and social justice in the Nordic welfare states. Soc Polit Int Stud Gender State Soc 2009;16:242–78. [Google Scholar]
  • 34. Axelsson Fisk S, Mulinari S, Wemrell M, et al. Chronic obstructive pulmonary disease in Sweden: an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. SSM - Popul Heal 2018;4:334–46. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35. Wemrell M, Mulinari S, Merlo J. An intersectional approach to multilevel analysis of individual heterogeneity (MAIH) and discriminatory accuracy. Soc Sci Med 2017;178:217–19. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

ckz162_Supplementary_Data

Articles from The European Journal of Public Health are provided here courtesy of Oxford University Press

RESOURCES