The role of education and income as protective factors against intimate partner violence and HIV exposure among Kenyan women

Abstract

Introduction:

Intimate partner violence (IPV) is a public health problem that impacts approximately one in three women worldwide in their life-time. The purpose of the study was to explore the lived experiences of women teachers and violence in Kenya. It also explores the intersection between intimate partner violence, HIV risk, and gender inequality.

Method:

Data were collected through two focus groups of a total of 15 women teachers. We recruited women ages 21–44 from two geographically diverse urban and rural schools. The data were analyzed using a thematic analysis method to identify text themes and meaning patterns.

Results:

Three contextual experiences emerged: socio-cultural influences of gender norms, masculinity and patriarchy; uneven power dynamics; and institutionalized gender inequality.

Discussion:

Findings suggest that education alone is not sufficient to end GBV. Comprehensive and gender transformative governmental policy approaches are needed to mitigate GBV in Kenya.

Introduction

Intimate partner violence (IPV) is a worldwide public health problem that occurs in homes, schools, workplaces, and communities (Leach et al., 2003). Much of the violence women experience is at the hands of their intimate partners. The World Health Organization (WHO) reports that globally, as many as 38% of the murders of women are committed by a male intimate partner (WHO, 2021). Further, the World Report on Violence and Health (Krug et al., 2002; WHO, 2021) indicates that an estimated 30% of women worldwide have experienced physical and/or sexual violence by their partners. According to The Well Project (2020), many women victims of violence who also report having HIV suffered physical or sexual abuse before discovering their HIV status.

Intersectionality, which refers to the interdependent and mutually constitutive relationship between the violence women face and structural inequities, is a lens to understanding gender-based violence. The legal scholar Kimberlé Crenshaw coined the term intersectionality in 1989 to describe how systems of patriarchy and oppression overlap to create violence (Crenshaw, 1995). Intersectionality posits that individual identities, such as race, ethnicity, Indigeneity, gender, class, sexuality, geography can produce axes of inequality and oppression (Hancock, 2007). Another overlapping category that can be a source of violence against women is the HIV epidemic, which may involve multiple pathways, directly through rape/sexual assault, or indirectly through fear of violence when negotiating safe sex and condom use (WHO, 2013).

The connection between IPV and HIV is complex (The Joint United Nations Programme on HIV/AIDS, 2021). Forced, or coercive sexual intercourse with an infected partner are examples of sexual violence that elevate HIV acquisition risks. Psychological violence (e.g. belittling, preventing a person from seeing family or friends, intimidation, withholding resources, preventing employment, or confiscating earnings) is also common (The Joint United Nations Programme on HIV/AIDS, 2021). Women involved in transactional sex have increased exposure to violence (Dunkle et al., 2004; Jewkes, 2002; Muula, 2008). Other indirect HIV transmission risks include the difficulties for survivors to negotiate condom use with their abusive partners because they are afraid of retaliation (The Joint United Nations Programme on HIV/AIDS, 2014; WHO, 2006). Studies conducted in the United States, for example, reveal that women living in abusive relationships were four times more likely to be verbally abused and nine times more likely to be threatened with physical abuse when they ask their partners to use condoms than those who did not have abusive partners (Huecker et al., 2021; Seth et al., 2015).

The intersection between poverty, risk of intimate partner violence, and HIV has also been observed (Kapiga et al., 2019). A study from the U.S. Centers for Disease Control and Prevention (CDC), found that poverty may be the most critical risk factor for HIV infection among individuals living in poor urban areas (Denning & DiNenno, 2011). Similarly, Magadi (2016), found a disproportionately higher risk of HIV infection among the urban poor in Kenya. Research by the Brookings Institute found some associations between HIV transmission and severe social and economic distress. These experiences of distress were attributable to life in poor neighborhoods that lacked resources including sexual health literacy and reproductive health education (Berube & Katz, 2005). Poverty and poor health outcomes are often linked (Nikolova & Small, 2018; Patrikar et al., 2017), thus, the CDC has recommended substantial investments in anti-poverty programs to accelerate HIV prevention in poor communities (Patrikar et al., 2017).

Intimate partner violence has also been linked to lower levels of education. A systematic review and meta-analysis evaluating the link between intimate partner violence and victimization found that having parents with less than a high school education was one of the most reliable modifiable risk factors for IPV (Yakubovich et al., 2018). Further, although intimate partner violence affects nearly one in three women worldwide within their lifetime (WHO, 2021), women in high-income countries fare relatively better with less prevalence of IPV. In a multi-national study of 44 countries involving a sample of 481,205 women (Heise & Kotsadam, 2015), education was a protective factor against IPV. The IPV prevalence rate was 4% in high-income countries compared with 40% in low-income countries (Heise & Kotsadam, 2015).

Building on this literature, the objective of the current study was to examine the relationship between education, income, and gender-based violence among urban and rural working women living in Kenya, a country with high HIV prevalence. Kenya has the joint third largest HIV epidemic worldwide (alongside Tanzania) with 1.6 million people reported living with HIV in 2018 (The Joint United Nations Programme on HIV/AIDS, 2019). We conducted focus groups with women in Kenya to explore their lived experiences and to understand the interaction between education, income, IPV, and HIV. We will first provide a general overview of the literature on Intimate partner violence and HIV exposure in developing countries, its relation to income and education, then give a summary specific to Kenya. Finally, we provide detailed methods, results, and the findings of our study.

Intimate partner violence and HIV exposure in the low-to-middle-income countries (LMIC)

A growing number of population-based surveys (i.e. Demographic Health Surveys and García-Moreno et al., 2005) have measured the prevalence of IPV in low- and middle-income countries (LMICs). García-Moreno et al. (2005) study, was a WHO multi-country study that focused on women’s health, and domestic violence, which sampled over 24,000 women from 10 countries. The study reported a multidimensional experience of violence, including physical (13–61%), sexual (6–59%), and emotional (20–75%) violence among participants. A most recent study by Nabaggala et al. (2021) concluded that violence against women was widespread in sub-Saharan Africa; however, the levels were much higher among women with lower levels of education and residing in rural areas. Comparative analyses using DHS data from African, Asian, and Latin American countries also show that women overwhelmingly experience (17–75%) violence perpetuated by their partners (Bott et al., 2012; Hindin et al., 2008).

Income and education as protective factors

Economic empowerment and income are associated with a lower risk for experiencing IPV in LMICs (Dunkle et al., 2004; Pronyk et al., 2006; Stöckl et al., 2021; Vyas & Watts, 2009). A study by Vyas and Watts (2009) found that education and household assets were protective factors against partner violence. However, although educational policies are significantly associated with positive health outcomes, many of these policies fall short (Schuler et al., 2013). For example, governments have successfully extended access to primary and secondary education and reduced gender disparities in LMICs (The Joint United Nations Programme on HIV/AIDS, 2021). Despite these efforts, the outcomes for women regarding risks for IPV are still relatively modest. Professor Mojola (2014) in her award-winning book, “Love, money, and HIV: becoming a modern African woman in the age of AIDS,” demonstrated that young women in Kenya who had higher levels of income and education were more likely than their counterparts who did not have similar income and education to enter into “sugar daddy” relationships. The value of education and income among women in LMICs, therefore, requires further examination. Governments and the United Nations Educational, Scientific, and Cultural Organization (UNESCO) promote education as one way of advancing gender inequity (Mutume, 2005). Such efforts need to be complemented with initiatives that examine and interrogate the influence of cultural and social norms on IPV.

A WHO multi-country study on Women’s Health and associated intimate partner risk (Abramsky et al., 2011) identified significant factors that predicted IPV across countries. In the randomly selected sample of women aged 15–49 years across 16 study sites in different countries, the study analyzed data of women reporting having ever had a male partner and their experiences of physically and sexually violent. Data revealed that secondary education, high socio-economic status (SES), and formal marriage offered protection against IPV. The authors concluded that higher SES status provided women with resources and the opportunity to make independent decisions and reduced overreliance on men for material support. The study also observed that schools offered settings that were essential for primary violence prevention activities with potential opportunities to address issues of relationship difficulties, gender roles, power negotiations, and identifying coercion. Similarly, a World Bank report in 2014 concluded that girls’ schooling has a protective effect against IPV, rape, and child marriage (World Bank, 2014). Thus, studying women educators and their social–cultural experiences is a significant step to understand the utility of education against IPV in Kenya.

The Kenyan case

It is critical to discuss violence prevalence in the broader general context, and in relation to geographical regions. For example, in a 2013 report on intimate partner violence in major regions of the globe, the World Health Organization concluded that Africa had one of the highest lifetime rates of physical and/or sexual intimate partner violence among ever-partnered women (36.6%), with only the Eastern Mediterranean and South East Asian regions having higher rates (WHO, 2013). The rate in Kenya is similarly high—the Kenya National Bureau of Statistics (KNBS) found that in 2008, ~34% of women age 15–49 had experienced emotional, physical, or sexual violence perpetrated by their spouses in the preceding 12 months (KNBS, 2017). However, prior estimates of the magnitude of physical and sexual violence against married women in Kenya are limited, in part, because violence perpetrated against women is mostly unreported, and even when women report instances of violence, authorities rarely record these reports (Kimuna & Djamba, 2008). A 2002 Amnesty International report found that in Kenya, rape survivors rarely reported violence because the police and other prosecuting authorities often subjected women who filed a complaint to humiliations and additional trauma. For example, victims had to prove that rape was not consensual. Further, the stigma attached to sexual abuse in many Kenyan cultures prevents women from reporting abuse because they fear they will be blamed and socially ostracized (Ward et al., 2007).

There are many risk factors for IPV exposure in Kenya. Prior studies have found that low-status occupation, low level of education, illiteracy, economic dependency, and husband’s alcohol abuse place women at a higher risk of intimate partner violence (Kimuna & Djamba, 2008; Mugoya et al., 2015). For example, Kimuna and Djamba (2008) found that, compared to their counterparts with less education, Kenyan women who had completed at least high school were significantly less likely to report physical abuse experiences. Even though the quantitative research on IPV in Kenya is limited, these extant studies provide important initial findings. Few qualitative studies have examined partner violence perpetrated against women in Kenya, associations between partner violence and HIV exposure, or factors that mitigate the risks of violence among Kenyan women. A recent study that was conducted by Edwards et al. (2021) describes a gender-enhanced life skills training curriculum (GE-LSTC) currently being developed to prevent gender-based violence and HIV among slum-dwelling youth in Nairobi, Kenya. It affirms the need to develop a sound theoretical and experiential understanding of gender-based violence. To fill the gap in the literature, this study explores women’s perceptions of and experiences with IPV and HIV exposure, including beliefs about whether income and education have a protective effect and other risk factors for IPV. Specifically, the study aims to explore perceptions and experiences of intimate partner violence and HIV among Kenyan female teachers.

Theoretical framework

To understand the experiences of Kenyan women, we assess the intersection between family violence theory and feminist theory. At the center of violence, according to different family violence theories (including systems theory, ecological theory, exchange/social control theory, resource theory, and the subculture-of-violence theory), is the role of gender. Further, sociological theories propose that the underlying causes of Intimate partner violence are social structures and traditional practices (Lawson, 2012). They view partner violence as an expression of conflict within the family. This conflict can best be understood through an examination of social structures and traditional practices contributing to the use of violence (Lawson, 2012). Feminist theory on the other hand explains IPV as an expression of gender-based domination of women by men (Humm, 2003). It proposes that violence is a systematic structural problem based on inequality, legitimized through political, social, economic, legal, cultural, religious, and military institutions (Humm, 2003). It argues that IPV is a function of the social roles, attitudes, and cultural factors that subordinate women (Hughs & Paxton, 2014; Mbugua, 2017; Uchem & Ngwa, 2014). Accordingly, gender roles and status beliefs amplify the attitude that men are more competent than women (Ridgeway, 2014), further reproducing gender inequality (Weiner, 2004).

Guided by the feminist theoretical perspective, this research uses a focus group approach for research on IPV. We hypothesized that men perpetrate Intimate partner violence in larger systems of oppression that create environments of fear and submission (Mbugua, 2017).

Methods

Study design

This study uses a qualitative research design to explore the perceptions and experiences of Kenyan women regarding intimate partner violence and HIV. Women were asked broad and general questions that included: (1) What are your general experiences being a woman in Kenya, (2) what challenges have you experienced in dealing with HIV/AIDS, (3) What is the role and relationship between poverty and HIV in your community, (4) reflect on your experiences as educated and income-earning women in your community and how they intersect with your other identities? We applied a qualitative approach because this type of analysis can produce rich descriptions of women’s perceptions and experiences that quantitative research may not capture (Timmermans, 2013). Further, participants in focus groups build on each other’s ideas through “piggybacking”; and allow researchers to look beyond the facts and numbers that might be obtained via survey methodology (Krueger, 1994; Mansell et al., 2004). We then utilized a feminist perspective (Humm, 2003) and interpretive approach to analyze data from the focus group discussions. The Institutional Review Boards at the researchers’ University approved the study protocol in 2015. The study was designed to ensure the physical and psychological safety of the research participants was assured by having women interviewers present to minimize any potential risk of distress.

Setting

Focus groups were conducted at two elementary schools in Kenya, one in Kibera, a slum in Nairobi (the capital and the largest city in Kenya), and the other in the rural county of Busia, ~280 miles west of Nairobi. Kibera is the largest urban slum in Africa with a population of about 1 million people (KNBS, 2017). Busia County has a population density of 743,946 people and covers about 1695 square kilometers (654 square miles) in western Kenya. The poverty level in Busia is 66%, and about 75% of households are involved in agriculture (KNBS, 2017). Busia is a high HIV prevalent region, with HIV rates nearing 25.7% in some communities (WHO, 2021). Kibera slums of Nairobi, where the second focus group was conducted, has an HIV prevalence rate of about 10% (WHO, 2021). Schools were selected due to the researcher’s familiarity with the schools and school administrations.

Study participants

Participants were invited to take part in the study by the first author by first approaching the administration for permission to conduct the study. After receiving permission, female teachers were invited to join the study. Almost all female teachers (90%) in each of the schools volunteered to participate. The team conducted two focus groups that included 15 participants (eight in Kibera; seven in Busia) in the summer of 2015 (see Table 1 for a summary of participants and group characteristics). No incentives were provided to the participants.

Table 1.

Sociodemographic characteristics of participants in the focus groups.

Variables	Participants
Education
Vocational training	3 (20.1%)
Only high School	7 (46.6%)
College certificate	5 (33.3%)
Marital status
Single	5 (31.7%)
Married	8 (53.3%)
Separated	2 (15%)
County
Busia	8 (56.1%)
Nairobi	7 (43.9%)
Language spoken
English and Swahili	7 (46.6%)
English	15 (100%)
English and other local language	8 (53.4%)
Experience of violence
Yes	7 (43.9%)
No	8 (56.1%)
Type of violence
Physical	1 (7.3%)
Sexual	1 (7.3%)
Emotional	4 (19.5%)
Physical and emotional	2 (13.6%)
Not reported	7 (52.3%)
Age range 21–44	Mean = 33 [±10.16]
Have children
Yes	11 (73.3%)
No	4 (26.7%)
Age at having first child
14–19 years	3 (27.2%)
20–25 years	5 (45.5%)
26–34 years	2 (18.1%)
35 and above	1 (9.2%)

Data collection

The research team that conducted the focus groups included three researchers: one male, originally from Busia, and two females from the United States. Thus, with respect to gender and nativity, each team member was both an insider and an outsider (e.g. the western women were insiders with respect to gender and outsiders with respect to the country of origin). Participants felt comfortable with the male researcher because he was from the community, and his presence did not affect participants’ willingness to discuss specific information. We were aware of our own social positions and how “gender filters knowledge” (Denzin, 1989, p. 116). Both focus groups were conducted in private rooms in the respective schools and lasted for about 1.5 h each.

Before initiating the focus group discussions, the research team described the goals of the study, obtained informed verbal consent from all participants, and explained to participants that they could leave at any time if they so desired. Also, participants were instructed to only share information they felt comfortable sharing. The researchers also described their professional background before focus group sessions.

A semi-structured interview guide was used. As mentioned above, participants were asked about their lived experiences in general terms as working women living in Kenya. Questions also touched on violence, HIV, social and cultural norms, as well as the strategies women used to navigate a male-dominated society. The source of questions for the study, and study topic areas was from the review of literature and theory (e.g. Eves, 2007; Jewkes et al., 2002). The first author of the current study is a native Kenyan who also moderated the interviews. The two female facilitators were present and primarily observed the interviews and took notes. The moderator first asked participants to talk broadly about their understandings of Intimate partner violence in Kenya, and then inquired about the general types of violence and their relation to HIV. Other issues covered related to employment, income, child-rearing, cultural norms, such as polygamy and wife inheritance. The interviews were conducted in English. There was no identifying information; all participants used the pseudonym of their choice.

Data analysis

Focus group discussions were audio-taped (with the permission of participants) and later transcribed. Three co-authors were engaged in the preliminary analysis and subsequent iterative reviews of the data. The inclusion of the co-authors (who were not involved in the data collection) increased the number of ways of understanding the data and therefore increased the trustworthiness of the findings.

We used the coding process developed by Tesch (2013) to analyze the focus group transcripts. The first step was to read all transcribed transcripts to get the context of the information. The next step was to go through each document asking, “What is this about?” and record our thoughts in the margins. After reading several of the transcripts, we developed a list of topics and grouped the issues into broader categories. We then created a code for each item and recorded the codes next to the relevant segments of the text. We subsequently followed the process described as “interrogating the text” (Creswell, 2014; Morgan & Youssef, 2006). Assembling the data for each category in a single place helped us “keep track” of the information while looking for the “presence” and “absence” of the phenomenon in the transcripts (Morgan & Youssef, 2006). Based on this data, we discussed the codes and categories until we reached an agreement on the overarching themes, which we used to create a thematic map (Braun & Clarke, 2006). Saturation was attained once no new themes emerged relative to either transcript. Reporting of the study data followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) (Tong et al., 2007).

Participants’ characteristics

Over half of the participants were married (53.3%, n = 8), while 31.7% were single (n = 5) and 17.1% were separated (n = 2). The average age of sample members was 33 (±10.16). Just under half (46.6%) had completed high school, 33.3% had obtained a college certificate, and 20.1% had completed vocational training. Almost half of the participants spoke both Swahili and English (46.6%). Approximately three-quarters (73.3%) of participants had children. Among those with children, 45.5% (n = 5) had their first child between the ages of 20 and 25, while 27.2% (n = 3) had their first child between the ages of 14 and 19. Just under one-fifth of the women reported that they had experienced emotional violence (19.5%), while 24.4% reported experiencing physical violence.

Results

During the focus groups, participants discussed several aspects of their experiences being Kenyan women. Overall, three overarching themes emerged from the data. First, socio-cultural influences of gender norms, masculinity, and patriarchy, shaped the intersection between IPV, HIV, income, and education. Second, uneven power dynamics excluded women from decision-making. Third, participants expressed the intractability of the complex institutionalization of gender and the associated inequalities.

Women’s complex understanding of the relationship between IPV, HIV, income, and education

Participant narratives revealed that this sample of Kenyan women teachers had a nuanced understanding of how IPV, HIV exposure, income, and education interacted. Participants described several ways in which income and education offered protection from partner violence and HIV exposure, but also observed several limitations of this protection.

Protective effects of income and education against IPV and HIV

It was clear from the group discussions that the women saw a close connection between poverty and health in their communities. Women’s comments indicated that traditional gender norms informed the relationships between genders. They observed that the current intimate partner violence in the community was intrinsically associated with HIV transmission. Harriet described this association:

Domestic violence is directly linked to HIV. [An] unfaithful man is obviously abusive not only emotionally, but physically because he is exposing you to the HIV virus. Such men are controlling and although their wives are aware of such relationships, they never speak up because of fear. Women can equally be unfaithful and could also bring the disease to the man.

A majority of women (90%) reported that poverty contributed to HIV transmission in the community. A lack of adequate resources for women, according to the participants, forced some women to engage in sexual practices that elevated HIV risk. Nelly, described this dynamic:

Young girls are desperately seeking men, older men especially, because they see themselves as poor and cannot afford to buy their basic needs. Consequently, they are used by men by being paid money for sex. Unfortunately, this is risk undertaking because men may not want to use condoms. Such risks contribute to sexually transmitted diseases such as HIV.

Women also observed that seeking help from men affected young women currently in schools. Accordingly, Kioni indicated that part of her role as a teacher was encourage young women to work hard and be independent.

I talk to girls about how to escape or maneuver their own way, rather than depending on boys or men. So I always tell them that education should be at least your “husband”, to provide for you.

Similar to other findings (e.g. Gabrysch et al., 2008; Muula, 2008), our sample revealed that poverty is a significant driver of HIV, with young women engaging in condomless sex because they cannot afford condoms, or were unable to negotiate condom use with male partners (Onyango et al., 2015). This observation is consistent with Nyariro (2018), who observed that teen pregnancy was a barrier to school continuation for girls and young mothers living in low-income and marginalized contexts in Nairobi.

The sexual risk was also exacerbated by cultural gender norms, which expect women to “listen and not talk” and that a “good wife” should always obey her husband and pay attention to him. Thus, participants found marriage relationships to be oppressive, hostile, and disrespective in spite of education or income. For example, Damaris, bluntly proclaimed, “Education does not mean anything to our husbands, it is nothing.” This pattern was also described by Anyago when she concluded,

Even if you are working, like some of us women teachers, it is irrelevant. You are still a married African woman who cannot make her [own] decision. In fact, the salary that you earn does not belong to you; you may not buy anything for yourself without permission from your husband.

Other participants discussed education and income provided little power in the context of social–cultural norms. According to Pauline, her education was not valued as equally important as her role as a woman. This is what she said:

As a woman in this society, I am expected to do certain things, such as cooking and cleaning. Sometimes it becomes so difficult that marriage becomes a worthless status. Unfortunately, this kind of traditional norm is embraced and entertained by older women who expect their sons to marry a traditionally leaning woman. You go to your mother-in-law; she forces you to cook that traditional ugali [corn meal]. And for some of us who are educated and never raised that way, making traditional ugali is difficult. I certainly cannot make it.

Echoing what Pauline stated above, Esther added: “Some men in my culture believe that women are only good for giving birth to several children ... .” “they are expected to cook, do shamba work [farming] and satisfy their husbands.” These roles were culturally ingrained rendering the value of education lower due to inequitable gender roles.

Equally potent to cultural beliefs is the collective and social institutionalization of inequitable gender roles due to patriarchy. The power accorded to men to marry more than one wife (polygyny) was detested by all of our participants. According to Pauline,

For us who are educated and know the value of a small family, we may not express our thoughts freely because, if you draw a line in the sand and say, “I will only have two children,” he will tell you that he will marry another wife who is willing to give him more children. This is why polygamy has festered for so long.

Demaris, in the validation of what Pauline and Esther had stated, explained,

In my culture, women are expected to be seen and not heard. We get orders from men and are expected to follow the orders, and if we don’t, we are beaten. For women like me, we have no[t] much choice because I cannot return to my family and I cannot divorce him because of the stigma attached to a divorced woman.

Finally, some participants explained that although education was a protective factor, it had limited value especially with the high rate of unemployment in Busia County. According to the East African Public Health Laboratory Network Project (Wafula, 2018), Busia County’s unemployment rate is estimated at 70%. The vast majority of the County’s economic activities are concentrated in small family farms and, insignificantly, in fishing, trading, and informal sectors. Demaris observed that educated women without work or employment had to fend for themselves by all means necessary even if this required HIV exposure, as she indicated:

You find that many women who have come from school are not employed. And in this poverty environment, you need money to survive. So, you find someone who can be able to provide. Young boys equally go for sugar mums (older women) and young girls go for sugar daddies and then, they infect themselves.

Such observations are consistent with existing research, which indicates that a lack of financial independence contributes to HIV risk among college graduates (Creighton et al., 2006; WHO, 2009).

Factors perceived as increasing violence vulnerability

The focus groups revealed that although most participants (60%) appreciated the value of education and income, there were some social-cultural push factors that impacted them directly even more than education. These included traditional family structure, family dynamics, and gender norms.

Family structure and family dynamics

According to our participants, family structure and family dynamics were often disempowering. The social system in its current form promoted structural violence wherein social institutions of dowry payments may harm women by preventing them from realizing fundamental human rights. Mwajuma observed that dowry payments solidified family ties between the groom and bridegroom family. However, it has increased risks of gender violence:

Once a woman leaves her home and gets married, she loses her independence. Her husband and his family have this belief that since the dowry has been paid to the woman’s family, the new bride is now their property. They can now use her and control her as much as they want. It sends a message to them that, yeah ... they have bought you, and you belong to them.

Similarly, Faraji, explained that the institution of marriage as traditionally constituted meant that a man did not have to leave his home to get married. He gets to stay in their parents’ home. They protected them and implicitly encouraged “wife abuse” because they often are oblivious or excused their sons’ abusive behaviors toward their wives. All women, not just wives, risk violence in their relationships with men; however, certain gender norms put women more at risk. This is what Mwajuma said to make the point:

It is sad that even when the parents of a man who is abusive and physically harmful to you notice violence, they will not intervene to stop him. They will either look away or simply ignore it. Sometimes it is perhaps your parents who may listen to you, but they too can be complicit because it is a culturally acceptable norm. In fact, in some instances, a man can be beating you and his parents and family cheer him on because that is the manly thing to do; they call it discipline, and [being a] “strong man.”

Substance abuse and vulnerability to violence and HIV

Our participants mentioned two additional factors that exacerbated violence risks: alcohol use, and child protection needs. Some women explained that their husbands would drink, and were verbally and physically abusive. Alcohol use was also a factor in HIV transmission in the two communities. According to Hasina, “our men abuse alcohol and we suffer as a result.” Research indicates that alcohol use is linked with violence and HIV risk (e.g. Abramsky et al., 2011; Kalichman et al., 2009; Pitpitan et al., 2013; Weinhardt & Carey, 2000).

The desire to protect their children against abusive husbands also prevented women from leaving abusive relationships. Since most African cultures are patrilineal, where the children’s lineage and kinship were attributed to the father’s heritage, a woman who left her children behind would likely lose them, which was often detrimental to both the woman and her children (Balogun & John-Akinola, 2015). As a result, women chose to stay in violent relationships to care for their children and maintain their relationships despite the abuse.

Structural constraints to reporting IPV or seeking help

A final factor described by the women that heightened their vulnerability to violence was the lack of authorities’ support. Consistent with research, which shows that women victims of abuse are reluctant to seek help (Goodson & Hayes, 2021; Liang et al., 2005), our participants indicated that they faced institutional constraints to seeking help. Some of the limitations expressed by our participants and supported by published data included the mistrust that no one would listen to them, fear of retaliation by an abusive husband, or the cultural normalization of abuse (Akl Moanack et al., 2016; Rico & Mendez, 2015). Zahra summarized it this way.

You may report violence to the local chief or community, but they will not take it seriously. They will ask you questions such as, what did you do to him? They will simply advise you to remain obedient to your husband. They will just tell you, stick to your marriage. Whether you like it or not, you will just be told to stick to your marriage, and you will just be found guilty over the issues.

Discussion

Disturbingly, a significant number of our study participants reported that they had experienced domestic violence. Most women attributed IPV to structural and gender norms. Our data revealed three significant findings. First, while Kenyan women believed that income and education provided some protection from IPV and HIV exposure, societal gender norms significantly reduced the protective role of these factors. This is consistent with other studies on gender which have found that gender interacts with the social, economic, and biological determinants to create different health outcomes for males and females (Vlassoff, 2007). Second, the traditional family structure where they lived and worked disadvantaged women. Although all of our participants were employed, they live in communities where most women are unemployed and rely largely on men for support. In the absence of income support programs, including cash welfare, food stamps, and the Earned Income Tax Credit, as is often in high-income countries, there is a strong influence of family members in decisions affecting women, and most of these decisions are patriarchal (Humm, 2003; Lawson, 2012). A study by Kohli et al. (2015) found that women living in a post-conflict environment in the Democratic Republic of Congo (DRC), and survivors of IPV, also indicated that IPV was linked to community-driven structural norms, as well as the husband’s alcohol consumption, household economic instability, male desire to maintain his position as head of the family, and perceived disrespect of husband by wife.

Third, the intersection between IPV and other social and health disparities, such as HIV risk, alcohol abuse, and child neglect were evident. Consistent with other studies that have shown associations between IPV and depression, PTSD, and anxiety (Hameed et al., 2020; Paulson, 2020; Thompson et al., 2000) our participants described violence they faced because of their gender. Many programs have been initiated to mitigate IPV, particularly programs to dismantle the systematic social structure of violence (Edwards et al., 2021; Levy et al., 2020); however, as our participants suggest, these programs have not penetrated rural or poor Kenyan communities. For example, programs to reduce IPV through community mobilization and training interventions have been implemented (Ellsberg et al., 2015). Nevertheless, they do not specifically target the structural factors described by our participants. The current programs aimed at empowering adolescent girls through life skills training, self-defense, and vocational training should inform young women about their social world and the interactions they make, including relationship choices (Bandiera et al., 2012; Sarnquist et al., 2014). Further, some researchers (e.g. Dworkin et al., 2013), have argued that conducting gender-transformative interventions can increase protective sexual behaviors, prevent partner violence, modify inequitable attitudes, and reduce STI/HIV. Thus, targeting boys and men or changing social norms to talk with parents and community or religious leaders are some of the gender-transformative approaches necessary to reduce IPV.

Some of the implications for practice are increasing teachers’ awareness of potential implicit bias against female students. As our results indicate, even the most dedicated and well-meaning teachers can hold stereotypes that affect their students, as expressed by one participant who suggested that some teachers have an anti-female student bias that male students are better learners than female students. It was also evident from our focus group discussions that the local administrators, the police, and chiefs in these two communities did not take IPV seriously. Given that over 40% of married women in Kenya have reported physical or sexual violence (Djamba & Kimuna, 2008), the government of Kenya should take violence prevention seriously. Some of the possible ways are to require accountability to ensure an appropriate response to domestic violence reports. The police departments in Kenya should require officers to receive specialized domestic violence training, as well as building partnerships with community advocate groups.

Although our study provides important lessons, the study results should be considered in light of certain limitations. First, the sample size, while appropriate for qualitative research, does not support population-level inferences. Future studies should conduct quantitative or mixed methods studies to understand the complex nuances surrounding IPV. Second, the study used self-reported data, which is vulnerable to social desirability and other biases, although we hope that the focus group setting meant that the women were able to “self-check” the information they shared. Finally, although we took measures to maximize the objectivity of the analysis, there could be bias in the interpretation of the quotes. Lastly, having a man as part of the interviewing staff can be a limitation bearing in mind that women may find it difficult to disclose to a man about their abusive relationships and experiences.

To conclude, reducing Intimate partner violence and girls in low and middle-income countries is a global priority. To reduce violence, multi-level strategies are needed that address structural inequalities that deepen and exacerbate gendered fault lines. In the COVID-19 pandemic, IPV is reported to be high due to prolonged lockdowns and increased poverty (Kavanagh et al., 2021). This increases the need for urgent attention by community and state actors in Kenya to address intimate partner violence.