Studies in North America and Europe have documented the deleterious physical and mental health consequences of family violence against children and women. Manifested in varying forms, family violence may not only compromise the quality of life of women and children around the world, but may also be a hidden obstacle in the economic and social development of both developed and lesser developed countries.

In response to apparent widespread lack of recognition of the problems of child abuse and domestic violence in some areas of the world, a group of physicians and social scientists working within the International Clinical Epidemiology Network (INCLEN) have developed a protocol for parallel studies of domestic violence and child abuse in their countries. The name that the investigators have taken for this international collaboration is WorldSAFE--World Studies of Abuse in Family Environments. This effort began with an initial planning meeting as part of the INCLEN global conference in Cairo in 1992. Subsequent planning meetings have occurred yearly in Chiang Mai, Thailand; Bogota, Colombia; Victoria Falls, Zimbabwe; Lucknow, India; and Queretaro, Mexico.

Over this time, the collaborating investigators have developed and refined a core instrument designed to survey population-based samples of mothers, aged 15-49, about their experiences with domestic violence and about various discipline practices (including harsh punishments that might be considered abusive) that they use with their children. The instrument also includes questions related to risk and protective factors related to family violence like alcohol use, witnessed or experienced violence in childhood, isolation vs. social connectedness, and utilization of social supports and services. Sociodemographic characteristics of the family and the mental and physical health status of the woman are also assessed. In addition to the quantitative surveys, a structured focus group protocol has also been designed to elicit local norms and definitions of what constitutes child abuse and  domestic violence. The focus group findings are used to inform the survey terminology and to aid in the interpretation of the survey results.

It is hoped that the data gathered will not only help document the prevalence of family violence within these communities, but will also inform the development of interventions to address the problems. Observed similarities or differences in rates, examined in terms of social beliefs, community norms, family stresses and resources, and sociodemographic characteristics will provide valuable information for the design of future preventive efforts. For example, social support and neighborhood cohesiveness has been shown to be protective against child abuse in the United States. These areas are part of the construct of “social capital” first proposed by James Coleman in 1988. Social capital is derived from interpersonal relationships and an array of obligations, expectations, information channels, and norms within families and communities. It is conceptualized as a resource, like other forms of capital, that can be drawn on or accessed as needed. Analysis of the differences in prevalence of specific violent behaviors, using the wider range of social capital likely to be found in cross-cultural comparisons, may generate new hypotheses on the origins and potential strategies to prevent family violence.

In summary, WorldSAFE has the following specific aims:

• To develop the descriptive epidemiology of family violence with a focus on individual, family, community, and cultural factors, as well as on the health outcomes that are thought to be related to violent behavior within families.

• To identify modifiable risk factors with the goal of informing future preventive efforts.

Pilot studies

The first WorldSAFE pilot studies were conducted at Government Medical College in Nagpur, India, in 1996 (urban slums, N=434) and in 1997 (rural villages, N=500). In the urban slum sample, 31% of the women said they had been beaten by their husbands, while 66% reported being slapped. Percentages were lower in the rural villages (17% beaten, 48% slapped). Factors associated with domestic violence in both locales included husband’s drunkenness, witnessing family violence as a child, and in-law dissatisfaction with dowry. In terms of child discipline, more than 75% of the mothers in both samples reported that the index child had been slapped in the last year, while 30-35% said that they or another family member had beaten the child with an object. Very severe practices, such as burning the child or hanging the child by his hands were reported by 3-4% of the mothers in each sample. The results of these studies revealed that the survey methodology is feasible with high rates of participation, that women are willing to talk about private and potentially embarrassing family matters, and that family violence is quite common in this particular area of India.

Current studies

Having no reason to believe that domestic violence and child abuse are any less common in other areas of India, the International Council of Research on Women (ICRW) has now funded a multi-site project in India with separate studies conducted out of seven different medical schools in Lucknow, New Delhi, Bhopal, Chennai, Vellore, Nagpur, and Trivandrum. Each of the India sites will select and interview two distinct random samples (N=700 per sample; Total IndiaSAFE N=9800) with a focus on comparing data from urban slums, urban non-slums, and rural villages.

Also in the past year, the investigators from the Philippines, Egypt, and Chile received funding from INCLEN to field the WorldSAFE protocol. The core funding from INCLEN is also supporting the construction of a common data entry system and core data management (at the Chile site) for these three studies. Standardized training (provided by faculty from the University of North Carolina) has now been conducted at all WorldSAFE sites (including India). At this writing, the Philippines has just concluded data collection in an urban district of Manila (N=1000); Egypt is in the midst of data collection in several urban districts in Ismailia (N=700); and Chile is about to begin data collection in an urban district of Temuco (N=400). The latter two sites should be finished with data collection by March 1999.

We anticipate that current WorldSAFE sites will not only disseminate the results of their surveys in local and global forums and in the scientific literature, but will work with within their communities to address any compelling findings.

Funding needs

Because each of these studies is being carried out in urban areas of one municipality, it would be highly desirable to conduct rural comparison studies to determine if the urban-rural difference noted in the first Indian pilots is replicated in other countries. Ideally, country-wide studies, like IndiaSAFE, would also be implemented in the Philippines, Egypt, and Chile.

Other countries currently interested in fielding a WorldSAFE project are Brazil, Thailand, Malaysia, Indonesia, and New Zealand. Enhanced understanding of the etiology and dynamics of family violence and its relationship to culture would be furthered by additional studies in sub-Saharan Africa, east Asia, and even North America, Europe, and Australia. While numerous studies have been conducted in the last three continents, none have used the integrated methodology of WorldSAFE in population-based surveys.

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