Health inequities related to intimate partner violence against women the role of social policy in th

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Inequities Related to Intimate Partner Violence Against Women The Role of Social Policy in the United States Germany and Norway 1st Edition Mandi M. Larsen (Auth.)

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Social Disparities in Health and Health Care

Series Editors: Ronald J. Angel · William R. Avison

Mandi M. Larsen

Health Inequities Related to Intimate Partner Violence Against Women

The Role of Social Policy in the United States, Germany, and Norway

SocialDisparitiesinHealthandHealthCare

Serieseditors

RonaldJ.Angel,Austin,TX,USA

WilliamR.Avison,London,ON,Canada

Moreinformationaboutthisseriesathttp://www.springer.com/series/8142

MandiM.Larsen

HealthInequitiesRelated toIntimatePartnerViolence

AgainstWomen

TheRoleofSocialPolicyintheUnitedStates, Germany,andNorway

MandiM.Larsen JacobsUniversityBremen Bremen

Germany

SocialDisparitiesinHealthandHealthCare

ISBN978-3-319-29563-3ISBN978-3-319-29565-7(eBook) DOI10.1007/978-3-319-29565-7

LibraryofCongressControlNumber:2016930273

© SpringerInternationalPublishingSwitzerland2016

Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpart ofthematerialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations, recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmission orinformationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodologynowknownorhereafterdeveloped.

Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthis publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfrom therelevantprotectivelawsandregulationsandthereforefreeforgeneraluse.

Thepublisher,theauthorsandtheeditorsaresafetoassumethattheadviceandinformationinthis bookarebelievedtobetrueandaccurateatthedateofpublication.Neitherthepublishernorthe authorsortheeditorsgiveawarranty,expressorimplied,withrespecttothematerialcontainedhereinor foranyerrorsoromissionsthatmayhavebeenmade.

Printedonacid-freepaper

ThisSpringerimprintispublishedbySpringerNature TheregisteredcompanyisSpringerInternationalPublishingAGSwitzerland

Acknowledgements

ThisbookisbasedonmydoctoraldissertationattheUniversityofBremenand JacobsUniversityBremeninGermany.Firstandforemost,Iamverygratefulfor the fi nancialandinstitutionalsupportoftheBremenInternationalGraduateSchool ofSocialSciences(BIGSSS),withoutwhichImayneverhaveembarkeduponthe pathofdoctoralstudy.MysincerestgratitudegoestoHeinzRothgangandKarin Gottschallforguidingmyresearchandsharingtheirwelfarestateexpertisewith me.IowePetraBrzankmanythanksforherwillingnessmanyyearsagotomeetan AmericannewcomerforcoffeeinHamburg’s Hauptbahnhof,andforhercontinuing mentorshipinthe fieldofviolenceagainstwomen.AresearchstayinNorway greatlyenrichedbothmydoctoralworkandmyancestralconnectiontothecountry. Tusentakk toLarsKristofersenandJonIvarElstadofNOVAinOslo,aswellasto TerjeEikemooftheNorwegianUniversityofScienceandTechnologyin Trondheim,fortheirtremendousNorwegianhospitality.

Iamdeeplyindebtedtothemanyfriendsandcolleagueswhohaveprovided commentaryandfeedbackonmyresearch.Inparticular,Iextendmygratitude towardNateBreznau,AlexiGugushvili,ZsófiaIgnácz,andKatjaMöhringfor makingthetimetosharevaluablecommentsonearlierversionsofthesechaptersin theirdissertationform.Myresearchhasalsobenefitedgreatlyfromthecritique providedbyLorraineFrisinaDoetter,RalfGötze,AlexanderHaarmann,Simone Haasler,MarkusKiesel,andSimoneSchergerduringtheBIGSSSColloquia.Any errorsfoundinthisworkaresolelymyown.

MyheartfeltthanksgotomydearfriendDanielSenkowskiforalwaysbelieving inme,eveninthemomentswhenIdidnot.Aboveall,Iwouldneverhavemadeit thisfarwithouttheunconditionalloveandencouragementofmyfamily my parentsTerryandSandraLarsen,mybrotherChadLarsen,mysisterand brother-in-lawKirstenandDavidGeyer,andmynephewsCoenandBlakeGeyer.

Wordscannotexpresshowmuchtheirsupporthasmeanttomeinallofmy adventuresandendeavorsthusfar,evenwhenithasmeantbeingthousandsofmiles apart.

BremenMandiM.Larsen November2015

2TheoreticalandEmpiricalPerspectivesonIntimatePartner

2.1De

2.2TheoreticalExplanationsofIPV.......................16

2.3TheEvidenceonIPVandEconomicVulnerability..........18

2.4TheEvidenceonIPVandHealth......................21

2.5TheIntersections:IPV,EconomicVulnerability,andHealth...23

3IPVfromaWelfareStatePerspective

4.3.1RedistributionofResources....................72

4.3.2EstablishingIndependentHouseholds.............74

4.3.3AccesstoHealthCare........................79

4.4.1RedistributionofResources....................84

4.4.2EstablishingIndependentHouseholds.............85

4.4.3AccesstoHealthCare........................89

5ResearchDesignandMethods

5.3.4SociodemographicControlVariables..............115

5.3.5Cross-NationalDataComparability...............116 5.4Methods.......................................118

5.4.1MissingData..............................118

5.4.2UnivariateAnalyses.........................119

5.4.3BivariateAnalyses..........................119 5.4.4MultivariateAnalyses........................121

5.4.5Cross-NationalComparison....................126

6FirstInsightsintotheRelationshipsBetweenSocialPosition,

6.2.1IPVExposureastheDependentVariable..........137

6.2.2HealthOutcomesastheDependentVariables.......141

7FindingsonDifferentialExposuretoIPV

8FindingsonDifferentialVulnerabilitytoPoorHealth

8.1IPVExposure’sImpactonHealth.....................168

8.1.1ImpactofIPVExposureonSelf-assessedHealth.....169

8.1.2ImpactofIPVExposureonMental HealthComplaints..........................177

8.2SocialPosition’sImpactonHealth:IPVExposure asaModerator...................................185

8.2.1ImpactonSelf-assessedHealth:IPVExposure asaModerator.............................186

8.2.2ImpactonMentalHealthComplaints:IPVExposure asaModerator.............................189

9ComparingPolicyContexts:IPVExposureandHealth

9.1PolicyContextandItsEffectonIPVExposure............201

9.2PolicyContextandItsEffectonVulnerability toPoorHealth...................................205

9.3FurtherRelevantContextualComparisons................209

9.4Discussion......................................214

10.1.1FindingsonDifferentialExposuretoIPV..........224

10.1.2FindingsonDifferentialVulnerability toPoorHealth.............................225

Abbreviations

AFDCAidtoFamilieswithDependentChildren

BICBayesianinformationcriterion

BMFSFJ BundesministeriumfürFamilie,Senioren,FrauenundJugend

CAHRVCoordinationActiononHumanRightsViolations

CDCUSCentersforDiseaseControlandPrevention

CTSConflictTacticsScales

EUEuropeanUnion

FMLAFamilyandMedicalLeaveAct

FRAEuropeanUnionAgencyforFundamentalRights

GDPGrossdomesticproduct

IPVIntimatepartnerviolence

IRRIncidentriskratio

NAVNorwegianLaborandWelfareAdministration

NGONongovernmentalorganizations

NIBRNorwegianInstituteofUrbanandRegionalResearch

NIJUSNationalInstituteofJustice

NISNorwegianNationalInsuranceScheme

NOKNorwegianKroner

OECDOrganisationforEconomicCo-operationandDevelopment

OROddsratio

PCPPrimarycareprovider

PMMPredictivemeanmatching

PPACAUSPatientProtectionandAffordableCareAct

PTSDPost-traumaticstressdisorder

RQResearchquestion

RRRRelativeriskratio

SAHSelf-assessedhealth

SHIStatutoryhealthinsurance

SOEPSocio-EconomicPanelStudy

SSBStatisticsNorway

TANFTemporaryAssistanceforNeedyFamilies

UKUnitedKingdom

USUnitedStatesofAmerica

VAWAUSViolenceAgainstWomenAct

WHOWorldHealthOrganization

ZIF ZentraleInformationsstelleAutonomerFrauenh äuser

Chapter1 Introduction

Abstract Violenceagainstwomenisamajorsourceofhealthinequalities,necessitatingtheinvestigationoftherelationshipsbetweenviolenceandeconomicinequality, weaksocialsafetynets,andpoverty.Whilethehealtheffectsofintimatepartnerviolence(IPV)havebeenwellresearched,thereisagapinknowledgeregardingthefactors contributingtowomen’sindividualriskofIPV,aswellasthosewhichcontributetothe stratificationofIPVwithinandacrosssocieties.Thisbookaimstoclosethisgap,and thischapterbeginsbydefiningkeyterminology,especiallyregardingIPV,thewelfare state,andhealthinequities.Innamingthisbook’sresearchpuzzle,theconceptual frameworkisbrieflymentionedbeforedescribingthekeycontributionsofthiswork. Thechaptercloseswithachapter-by-chapteroverviewofthebook.

Violenceagainstwomenisaphenomenonoccurringworldwide.Morethantwo decadesago,the ‘DeclarationontheEliminationofViolenceAgainstWomen’ explicitlyacknowledgeditasaninternationalhumanrightsconcern(United NationsGeneralAssembly 1993).Sincethen,internationalprevalencesurveyshave establishedthatviolencewithinanintimatepartnershipisoneofthemostcommon formsofviolenceagainstwomen,occurringacrosssocial,economic,andcultural boundaries(Ellsbergetal. 2008).Arecentsurveyhasshownthat22%ofwomenin theEuropeanUnion(EU)haveexperiencedphysicalorsexualviolencefroma partner(EuropeanUnionAgencyforFundamentalRights[FRA] 2014).Moreover, anothersurveyfoundthat24%ofUSwomenreporthavingexperiencedsevere physicalviolencefromapartnerintheirlifetime(Blacketal. 2011).Givenits prevalence,thereisagrowingconsensusthatintimatepartnerviolence(IPV)andits consequencesrepresentaserioussocietalandpoliticalburden.

Allformsofviolenceagainstwomenareknowntoleadtonegativehealthconsequencesandworldwideitisamajorsourceofhealthinequalities(Heiseetal. 1999; Krugetal. 2002).Researchershaverecentlybeguntodemonstratethatpoor self-perceivedhealthandpsychologicaldistressmaybemorestronglyassociated withIPVthanotherformsofviolenceagainstwomen(Vives-Casesetal. 2011).An internationalspectrumofstudieshasshownthatwhencomparedtononabused women,victimsofIPVhavepooreroverallhealth,moresymptoms,andaremore thantwiceaslikelytoreportadisability(Bonomietal. 2006;Cokeretal. 2005;

© SpringerInternationalPublishingSwitzerland2016

M.M.Larsen, HealthInequitiesRelatedtoIntimatePartnerViolence AgainstWomen,SocialDisparitiesinHealthandHealthCare, DOI10.1007/978-3-319-29565-7_1

Eberhard-Granetal. 2007;Garcia-Morenoetal. 2005;Hagemann-White 2005; Wijmaetal. 2003).Usingnationalsurveydata,anAustralianstudyconcludedthat IPVpresentsalargerpopulationhealthriskthanhighbloodpressure,tobaccouse, andbeingoverweight(Vosetal. 2006).Thenegativephysicalandmentalhealth effectsareevenmorepronouncedforwomenwhoexperienceagreaterseverityof IPV(Duttonetal. 2005;Ford-Gilboeetal. 2009;Strausetal. 2009;Wuestetal. 2010).Likewise,morerecentexposureandlongerdurationofIPVareassociatedwith incrementallyworsehealthoutcomes(Bonomietal. 2006).Anothercritical fi ndingis thatIPVcontinuestonegativelyimpactwomen’shealthupto5yearsafterleavinga violentrelationship(Alsakeretal. 2007;CampbellandLewandowski 1997; Ford-Gilboeetal. 2009).Takentogether,thesestudiesdemonstratethedevastating andoftensustainednegativeimpactofIPVonwomen’shealth.

WhilethehealtheffectsofIPVhavebeenwellresearched,thereisagapin knowledgeregardingthefactorscontributingtowomen’sindividualriskofIPV,as wellasthosewhichcontributetothestratifi cationofIPVwithinandacrosssocieties(Heise 2012).Thus,someresearchersarguethatthefocusneedstoshiftaway fromthequestionofwhetherabuseaffectshealth,andinsteadexamine “who recoversfromtheseproblems,whoismostat-riskofsustainedpoorhealth,andhow the conditionsofwomen’slives impactoutcomes overtime …” (Ford-Gilboeetal. 2009,p.1021,emphasisinoriginal).Essentially,ifeffectivepoliciesandservices addressingIPVaretobeevidence-based,thenitisvitaltoexaminewhoismost vulnerabletoIPVanditshealthconsequences,andwhetherthesevulnerabilitiesare aresultofsystematicstratification.Thisfocalshiftservesasthelaunchingpointfor thisbook.

Beforecontinuing,however,itmaybehelpfultoexplainsomeofthekey terminologyusedinthisbook.Theterm ‘intimatepartnerviolence’ isusedas opposedtoanumberofothercommontermsthathavebeenappliedtothisphenomenonsincethefeministmovementofthe1970s firstlabeleditasasocial problem.Originally, ‘wifebattering’ and ‘spouseabuse’ werecommonlyused(see forexample,Labell 1979;Martin 1976),andgraduallytheterm ‘domesticviolence’ cameintofavorasitbecameclearthatviolencealsooccursinunmarriedcouples (NicolaidisandParanjape 2009).Whiletheterm ‘domesticviolence’ isstillcommonlyused,theterm ‘intimatepartnerviolence’ wasrecommendedbytheUnited StatesCentersforDiseaseControlandPrevention(CDC)andtheWorldHealth Organization(WHO)inordertodistinguishviolencebetweenpartnersfromother commonformsofviolencecommoninfamilies(e.g.,childorelderabuse) (NicolaidisandParanjape 2009;Saltzmanetal. 1999).Thus,inordertobeclear, thisbookreferstoIPVagainstwomen.Relatedly,womenwhohaveexperienced IPVarereferredtointerchangeablyasboth ‘victims’ and ‘survivors,’ acknowledgingboththeimbalanceinpowerinherentinIPVandwomen’sactiveresistance totheviolence.

Thedefinitionofthewelfarestateappliedinthisbookcentersaroundtheextent towhichstateinterventionsattempttoalterthestructuresofsocialinequality (Orloff 1993;Pfau-Effinger 1998).Thisisoftenoperationalizedintheformof pensionsand financialprotection(i.e.,incasesofdisability,unemployment,

accidents,orsickness).IncombiningtheworkofEsping-Andersen(1990)with Korpi(1989),threekeydimensionsofthewelfarestateemerge: state–market relations, aswellastowhatextentthewelfarestateinfluences socialstrati fication and decommodification.The firstdimensionlooksatthebalanceofprovision betweenthestateandthemarket.Inotherwords,whetherthesesocialprotections areprimarilyprovidedbythestateorleftuptothemarket.Regardingthesecond mechanismofsocialstrati fication,Esping-Andersen(1990,p.23)describesthe welfarestateas “anactiveforceintheorderingofsocialrelations.” Forexample, offeringpensionstoretiredworkerscanpreventpovertyamongtheelderly,while otheremploymentprovisionsprotectworkersagainstpovertyduringspellsof unemploymentorsickness.Whileresourceredistributionandalleviationofpoverty aretraditionallyunderstoodbysomeasbeingthebroad,overarchinggoalsof welfarepolicy,othersprefertoobjectivelyexaminewhethersocialpoliciesare indeed “aimedat,oractuallyproduce,greaterequalityamongcitizens ” (Orloff 1993,p.304),arguingthatsocialprovisioncanalsohavetheeffectofstratifying basedoneconomicoroccupationalclass.Thisiscloselyrelatedtothethird dimensionofdecommodi fication,thatis,whethersocialprovisionsfromthewelfarestateenableanacceptablestandardoflivingindependentofthemarket.Thisis alsorelatedtowhetherprovisionisuniversallyavailabletoallasarightofsocial citizenship,basedonemploymentand fi nancialcontributions,orrather means-testedandavailableonlytotheverypoor(Korpi 1989).

Basedonthesedimensions,Esping-Andersen(1990)proposedathreefold typologyof “worldsofwelfarecapitalism” (e.g.,liberal,socialdemocratic,and conservative)toaidinthecomparativeanalysisofwelfarestates.Forexample,the marketdominatestheliberalregime,wherebenefitsfromthestatearetypically modestandmeans-tested,andlittleisdonetoreducepovertyorinequality(e.g., Australia,Canada,andtheUnitedStates).Inthistypeofregime,Esping-Andersen (1990,p.28),claimsthat “conceptsofgendermatterlessthanthesanctityofthe market,” soalthoughalladults(mothersincluded)aredependentonthelabormarket, thereislittlestateinterventiontoenablewomen’sparticipation.Attheoppositeend ofthespectrumarethesocialdemocraticwelfareregimes,seekingtodramatically alleviatepovertyandinequalitiesbyprovidinggenerousbenefitsbaseduponsocial citizenshipandinterventionbythestatetoensurefullemploymentandincome protection(e.g.,Denmark,Finland,Norway,andSweden).Thistypeofregimeis foundedontheideathatbothmenandwomenshouldbeintegratedintothelabor market,andthusthewelfarestatemuststructureitspoliciestomakethispossible. Finally,theconservativeregimeshaverelativelygenerousearnings-relatedassistance administeredthroughemployers,whichtypicallyreinforceexistingpatternsofsocial inequality,butminimizetheroleofthemarket(e.g.,Austria,Belgium,France,and Germany).Theseregimesarepredicatedupontheideathatmenaretheprimary breadwinnersandthuspoliciesarenotorientedtowardsensuringwomen’sintegrationintothelabormarket.Whiletherearemanywhocriticizetheseregimetypesand theirusefulness(aswillbedetailedinChap. 3),Esping-Andersen’stypologyis frequentlyusedincomparativewelfarestateliteratureinordertobeabletomake claimsaboutthevariousimpactsofsocialpolicy.

Overall,theempiricalresearchtendstodemonstratethatthewelfarestateisa predominantfactorinshapinglifechancesandinequalities(Esping-Andersen 2002; OlafsdottirandBeckfield 2011)andthatwelfarestategenerosity(e.g.,inunemployment,sickness,andpensionbenefits)decreasespovertyandeconomicinequality (Brady 2005;KorpiandPalme 1998;Mölleretal. 2012).Forexample,inacomparisonoftheUS,Germany,andSweden,thelikelihoodoffallingintopoverty(and stayingthere)washigherintheUSgivenitslimitedstateinterventions(DiPrete 2002).Likewise,levelsofincomeinequalityarefoundtobethelowestamongsocial democraticwelfareregimes,slightlyhigherintheconservativeregimes,andthe highestamongliberalwelfareregimes(OlafsdottirandBeckfield 2011).

Inaddition,theterm ‘healthinequities’ isusedthroughoutthisbookratherthan ‘healthinequalities.’ Thelatterreferstodifferencesinhealthoutcomesbetween groups.However,theformerisbasedupona “comparativeprinciple,ajudgment abouthowapersonoragroupofpeopleissituatedrelativetoothers” (Petersand Evans 2001,p.27).Byidentifyingahealthdifferenceasinequitable,oneappealsto ethicalnormsandajudgmentofwhethersuchdifferencesareavoidable,unfair, sociallyproduced,andsystematic(Evansetal. 2001;SolarandIrwin 2010). Individualdifferencesinhealthoutcomesthatconcentratethemselveswithincertain socialgroupsandarerelatedtoeducation,income,orhealthcareaccess,areunfair bydefinition.Thus,insofarasthecauseofhealthinequalitiesarerelatedto “modi fiablesocialarrangements theymaybeconsideredunjust” (Diderichsen etal. 2001,p.14).Thisimpliesthenecessityofasystematicresponsetoreduce healthinequitiesnotonlyfromthehealthsector,butfromthesocial,political,and economicsectorsaswell.Indeed,thisbookisfoundedontheideathatifcertain groupsofIPVvictimsaremorevulnerabletopoorhealththanothers,thenthese differencesaresystematicallyandsociallyproduced,andarethereforeinequitable.

1.1TheResearchPuzzle

Attheindividuallevel,researchshowsthatsocioeconomicfactors,community characteristics,andsocietalcharacteristicsinfluencehealthoutcomes(e.g.,Ansari etal. 2003).Socialdeterminantssuchaseducation,housing,income,unemployment,chronicstress,andsocialexclusion,aresometimesbetterpredictorsofhealth statusthanbehavioralvariableslikedietorexercise(Raphael 2006).Moreover,the distributionofresourceswhichpromotehealthissubstantiallyskewedtofavor thosewithhighersocioeconomicstatuses.Socioeconomicstatusservesasa ‘fundamentalcause’ ofpoorhealthbecausethosewithaccesstoresources(e.g.,money, power)canmakeuseoftheirstatustoavoidhealthrisksandreducethecostsof poorhealth(LinkandPhelan 1995).Inotherwords, “nomatterwhatthecurrent profileofdiseasesandknownriskshappenstobe,thosewhoarebestpositioned withregardtoimportantsocialandeconomicresourceswillbelessafflictedby disease” (LinkandPhelan 1995,p.87).Thisishighlyrelevantforwomenin abusiverelationshipswhomaybemoreeconomicallydependentontheirpartners,

havemorerestrictedaccesstoemploymentandincome,ormaybemoresocially deprived(Davisetal. 1999;Ford-Gilboeetal. 2009;MoeandBell 2004;Tolman andRosen 2001).Thus,thecombinationofIPVexposureandlimitedsocioeconomicresourcesmayalterthepathwayleadingtowardhealthoutcomes.

Whileaddressingthesocialdeterminantsofhealthisthekeytoimprovinghealth andcombatinginequities, “thesocialfactorspromotingandunderminingthehealth ofindividualsandpopulationsshouldnotbeconfusedwiththesocialprocesses underlyingtheirunequaldistribution” (Graham 2004,p.101).Hence,attention shouldalsobepaidtotheeffectofbroaderfactorsonhealth.Inparticular,howa welfarestateallocatesresourcesamongitscitizensplaysasignifi cantroleinthe healthopportunitiesaccordedtodifferentpopulationgroups(Burstrometal. 2010; Evansetal. 2001).Giventhatsocialpoliciesaremeanttoprotectagainstincome lossandredistributeresources,therebyaffectingkeysocialdeterminantsofhealth, socialpolicyatthemacro-levelshouldbeasignificantmeansofaffectingpopulationhealth(Lundbergetal. 2010).

Together,thisraisesthetopicofhealthinequitiesforwomenwhohaveexperiencedIPVasaresearchpuzzle.Speci fically,itisthusfarnotwellunderstood whatindividualfactorsleadtoIPVexposureandpoorhealth,andwhichgroupsare mostsusceptible.Moreover,thecontributionofthebroadersocialstructurein whichwomenareembeddedhasnotbeensystematicallyexamined(Whitaker 2014).Toaddressthesegapsinknowledge,aconceptualframeworkisapplied whichwasdevelopedbyDiderichsenetal.(2001),proposingthathealthinequities areshapedbythesocialandpolicycontextthroughtheinterconnectedmechanisms of socialstrati fication, differentialexposure tohealthrisks,and differentialvulnerability toillhealth.Byidentifyingthesemechanisms,theframeworkalsoproposesanumberofpointswherepolicycouldinterveneinordertoreduceinequities. InadaptingthisconceptualframeworktoIPV,itishypothesizedthatexposureto IPVvariessystematicallyaccordingtosocioeconomicresources,andthatIPVand limitedsocioeconomicresourcesmutuallyincreasethevulnerabilitytothehealth consequencesofIPV.Furthermore,itisexpectedthattheextenttowhichthepolicy contextprovidesasafetynetforwomenshapestheirexposuretoIPVandtheir healthoutcomes.

1.2ContributionstotheLiterature

ThisbookaddressesseveralkeygapsintheliteratureonIPVexposure,health inequities,andsocialpolicy.Firstly,itdirectlyinvestigatestheintersectionsof socialpositionandIPVexposureintheirimpactonhealth,whichhasoftenbeen neglectedintheresearchfromagenderedperspective.Muchoftheearlyfeminist researchonIPVcontrolledforeffectsofsocialpositioninordertoemphasizethat IPVcutsacrossallsocialdivisionsandisaproblemofgenderoppression,rather thanaclass,racial,orethnicissue(Goodmanetal. 2009;Meier 1997;Raphael 2003).Overtime,however,feministtheorizingandempiricalresearchhasbegunto

expandbeyondtheone-factorexplanationofpatriarchalstructure,incorporating socioeconomicexplanationsaswell.However,eventhoughareviewofthe researchwouldseemtoinferthatviolenceandpovertymaymagnifyoneanotherin theirimpactonhealth(Goodmanetal. 2009;Loya 2014),thesebodiesofliterature tendnottointersect(Romitoetal. 2005).StudiesinvestigatingthehealthconsequencesofIPVoftendonotaccountforvariationinwomen’ssocioeconomicstatus andaccesstoresources,andthuslittleisknownabouttheroleofsocialposition (BriereandJordan 2004;Ford-Gilboeetal. 2009).Byspecificallyexaminingthese intersections,myresearchshedsnewlightonthehealthoutcomesofIPVsurvivors andwheresocialpositionmayplayasystematicrole.

Secondly,theresearchpresentedhereusesnationallyrepresentativedatacoveringawiderspectrumofsocioeconomic,IPV,andhealthoutcomesthanisoften availableforresearchonIPV.Forpracticalreasons,researchfromafeministor genderedperspectiveonthistopictendstodrawitssamplefromthepopulationof womenseekingservicesfromdomesticviolenceprograms,women’sshelters, criminaljusticeprograms,orhealthcare.Whilethiscertainlyfacilitatesaccesstoan otherwisehard-to-reachpopulation,womenwhoseekservicesarenotnecessarily representativeofwomenwhodonotseekhelp,norofwomenwhodonotidentify theirrelationshipsasviolent(Ruiz-Pérezetal. 2007).Inordertounderstandthe complexitiesofIPV,allofthesegroupsofwomenmustbeincludedinresearch studies(Grauwiler 2008).Nationallyrepresentativesurveysare,therefore,vitalfor detectingandmeasuringIPVamongabroadercross-sectionofwomen.Thus,this bookprovidesawider,andpresumably,moreaccuratelensforexaminingdifferentialsinhealthforthispopulation.1

Thirdly,whileitisassumedthatmacro-levelfactorsaffectprevalenceofIPV exposure(KayaandCook 2010;Whitaker 2014),littleisknownabouttheroleof institutionalwelfarearrangementsinaffectingthehealthofIPVsurvivors.This bookaddressesthiscrucialgapintwoways.First,theconceptualframework guidingtheanalysisexplicitlylinksindividuallevelfactorsandpolicycontextto healthinequities.Second,across-nationalcomparativeapproachusingthediverse casesoftheUS,Germany,andNorwayisapplied.Examiningthepolicycontextsin whichIPVsurvivorsexperiencehealthinequitiesallowsforabroaderdiscussionof theimpactofmacro-levelsocietalstructures.Indoingso,thisresearchhasvital implicationsforpolicymakers.Bysheddinglightonwhichgroupsaremostsusceptibletopoorerhealthoutcomes,andunderwhichstructuralconditions,welfare statepolicycanthenbetargetedtowardsreducingIPVexposureandeliminating healthinequities.

1DifferencesinIPVmeasurementmethods,aswellashowthisinfluencesthetheoreticalunderstandingofIPV,willbeexploredindetailinChap. 2

1.3StructureoftheBook

Figure 1.1 providesanoutlineofthe10chapterscontainedinthisbook.This fi rst chapterpresentedtheresearchpuzzle,namely,thequestionofindividualandpolicy factorscontributingtohealthinequitiesforIPVsurvivors.Chapter 2 providesan overviewofhowIPVisdefined,itsvarioussociologicaltheoreticalexplanations, andthecontroversieswhichsurroundboththedefinitionandthetheories. Additionally,empiricalevidenceforboththeeconomicandhealthfactorsrelatedto abusiverelationships,aswellastheirintersections,areexplored.

Chapter 3 offersatheoreticalreviewofthewelfarestateliteraturerelevantto women’ssocioeconomicresourcesandtheirhealth,followedrespectivelybya reviewoftheempiricalliteraturerelatedtofamilyandhealthpolicy.Inorderto piecethisliteraturetogetherintoacompletepictureconnectingthewelfarestate withwomen’shealthoutcomes,aconceptualmodelhighlightingmechanisms leadingtohealthinequitiesisintroduced.Movingtowardstheapplicationofthis modeltoIPV,thegapsintheliteratureregardingIPV,health,andthewelfarestate arereviewed.Finally,theconceptualframeworkisadaptedtoIPVandservesasthe foundationforelucidatingfourspeci ficresearchquestionsregardingindividualand

macro-levelfactorsrelatedtodifferentialexposuretoIPVanddifferentialvulnerabilitytopoorhealth.

Chapter 4 presentsajusti ficationoftheselectionoftheUS,Germany,and Norwayasdiversecases,alongwithadetaileddescriptionoftherelevantpolicy contexts.Countrybycountry,eachcasedescriptionbeginswithbackground informationontheprevalenceofIPV,thehistoryofpoliciesonviolenceagainst women,andtheavailableservices.Next,theaspectsofthewelfarestateinfluencing socialstratifi cationarehighlighted,suchasunemploymentbenefi ts,sicknessbenefits,andbenefitsdirectedatsingle,low-incomemothers.Thisisfollowedbyan explorationoffamilypoliciesinfluencingdefamilizationandwomen’sresourcesfor establishingindependenthouseholds.Finally,thesituationforeachcountryin termsofaccesstohealthcareisdescribed,specificallylookingatentitlementto care,availabilityofhealthcareproviders,andaffordabilityofout-of-pocketpaymentsbypatients.Thechapterclosesbycomparingandcontrastingthepolicy contextsoftheUS,Germany,andNorway.

TheresearchdesignandmethodsappliedinthisbookareintroducedinChap. 5. Thechapterbeginswithadiscussionofthethreesetsofnationalsurveydatausedin theanalyses:the1995 NationalViolenceAgainstWomenSurvey intheUS,the2003 Health,Well-being,andSafetyofWomeninGermany Survey,andthe2003–04 SurveyofEverydaySafety inNorway.Nextareadescriptionofthesampleselection, andtheoperationalizationofthesocialposition,IPVexposure,health,andcontrol variables.Followingthisisanaccountoftheunivariate,bivariate,andmultivariate statisticalmethodsappliedintheanalysis,aswellasadescriptionoftheexploratory cross-nationalpolicycomparison.

Chapter 6 isthe firstofthreechapterspresenting fi ndingsfromthequantitative analysesusedtotestthehypotheses.It firstoffersadescriptiveoverviewoftheUS, German,andNorwegiansamples.Followingthisisapresentationofthebivariate analysesusedtodeterminetheinitialrelationshipsbetweenthevariables.These analysesofferaclearpictureofthecompositionofeachofthecountrysamplesand providethe firstcluestowardsansweringmyresearchquestions.

Findingsregardingsocialposition’simpactonIPVexposurearepresentedin Chap 7.Basedontheliteraturelinkingsocioeconomicresourcestotheabilityto endabusiverelationshipsandestablishindependenthouseholds,itisexamined whetherwomenwithlowersocialpositionsmaybedifferentiallyexposedtoIPV. Todothis,amultinomiallogitregressionmodelwas fitforeachcountryusingIPV exposureasthedependentvariable,withhouseholdincome,education,and employmentaspredictors.Theresultsoftheregressionmodelsarepresentedin termsofrelativeriskratios,aswellasinpredictedprobabilitiesofminorandsevere IPVateachlevelofsocialposition.

Asthe finalquantitativeempiricalchapter,Chap. 8 presentsthe findingson whetherwomenwithIPVexposurearedifferentiallyvulnerabletosocialposition’s impactonhealthoutcomes.Fromastatisticalstandpoint,thequestionposedisone ofthemoderatingeffectsofIPVexposureontherelationshipbetweensocial positionandhealth.Findingsfromaseriesofnestedmodelsarepresented, fi rst establishingwhethersocialpositionaffectshealth,andthenwhetherIPV

contributestohealthoutcomes,before finallytestingtheinteractionbetweensocial positionandIPVexposure.Logitregressionmodelsareusedforself-assessed healthasthe firstdependentvariable,presentingtheresultsintermsofoddsratios. Negativebinomialregressionmodelsarealso fitformentalhealthcomplaintsasthe seconddependentvariable,presentingtheresultsintermsofincidentrateratios. Furthermore,calculationsofpredictedprobabilitiesofpoorself-assessedhealthand predictedcountsofmentalhealthcomplaints,takingintoaccountIPVexposureand socialposition,arealsopresented.

Chapter 9 exploresthemacro-levelpolicycontextrelatedtomyresearch questions.ThecomparisonoftheUS,Germany,andNorwayenablesadiscussion ofwhetherpatternsindifferentialexposuretoIPVanddifferentialvulnerabilityto poorhealthfoundinthequantitativeanalysesvaryacrossinstitutionalarrangements.Thischapterbringstogetherevidencefromthedetailedpolicydescriptions inChap. 4 andtheempirical findingsfromChaps. 6, 7,and 8.Thisallowsforan explorationofwhetherpolicycontextsmaycontributetosystematicdifferencesin healthoutcomesforIPVsurvivors.

Inclosing,Chap. 10 discussesthemain findingsrelatedtoeachofmyfour researchquestionsandtheirtheoreticalimplications.Thisisfollowedbyabrief lookatpossiblecriticalissuesofthepresentedresearch,aswellassomesuggestionsforfutureresearchthatarisefrommyresults.Finally,basedontheconceptual framework,theimplicationsforwelfarepolicyandwhereitmayinterveneto improvehealthoutcomesforIPVsurvivorsarediscussed.

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Chapter2

TheoreticalandEmpiricalPerspectives onIntimatePartnerViolence

Abstract ThesocialproductionofhealthinequitiesforwomenwhohaveexperiencedIPVspansawidedisciplinaryspectrum,touchingonaspectsofsociology, publichealth,andgenderstudies.Therefore,thepresentchapterbeginswithalook athowIPVisdefinedandhowitistheoreticallyexplainedandunderstoodfroma sociologicalperspective.Basedonthisbackground,empiricalevidenceforboththe socioeconomicandhealthfactorsrelatedtoabusiverelationshipsareexplored, speci ficallyhighlightingtheintersectionbetweensocialpositionandhealthoutcomesforsurvivorsofIPV.Thislaysthefoundationforthelatertheoreticaland empiricalreviewoftheroleofthewelfarestateinhealthinequitiesforfemale survivorsofIPV.

ThesocialproductionofhealthinequitiesforwomenwhohaveexperiencedIPV spansawidedisciplinaryspectrum,touchingonaspectsofsociology,publichealth, andgenderstudies.Therefore,thepresentchapterbeginswithalookathowIPVis definedandhowitistheoreticallyexplainedandunderstoodfromasociological perspective.Basedonthisbackground,empiricalevidenceforboththesocioeconomicandhealthfactorsrelatedtoabusiverelationshipsareexplored,specifi cally highlightingtheintersectionbetweensocialpositionandhealthoutcomesforsurvivorsofIPV.ThislaysthefoundationforChap. 3’stheoreticalandempiricalreview oftheroleofthewelfarestateinhealthinequitiesforfemalesurvivorsofIPV.

2.1DefinitionsofIPV

TheWHOunderstandsIPVas “anybehaviorwithinapresentorformerintimate relationshipthatcausesphysical,psychological,orsexualharm” (Heiseand García-Moreno 2012,p.90).ThetypesofbehaviortypicallyconsideredtoconstituteIPVincludephysicalabuse(e.g.,slapping,hitting,kicking,beating),psychologicalabuse(e.g.,intimidation,humiliation),sexualabuse(e.g.,sexual coercion,forcedintercourse),orothercontrollingbehaviors(e.g.,isolatingapartner fromfamilyandfriends,restrictingaccessto financialresources).Theseabusive

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M.M.Larsen, HealthInequitiesRelatedtoIntimatePartnerViolence AgainstWomen,SocialDisparitiesinHealthandHealthCare, DOI10.1007/978-3-319-29565-7_2

behaviorstendtooverlapinviolentrelationships,withphysicalviolencebeing accompaniedbypsychologicalabuseandsexualviolenceinabouthalfofviolent relationships.

However,amorecomprehensivedefinitionintermsofIPV’sgendersymmetry isstillhotlycontested.AfeministdefinitionviewsIPVasacontinualpatternof behaviorsusedtoassertcontroloveranintimatepartner(NicolaidisandParanjape 2009).Ratherthanbeingunderstoodasisolatedbehaviors,importanceisplaced uponpowerdynamics,aswellastheintentandconsequencesoftheviolence.From thispointofview,IPViscommonlyperceivedofasmaleviolenceagainstafemale partner.Byandlarge,thisdefinitionofIPVwasdevelopedbycliniciansand academicsthroughthelensoffeministtheory,basedprimarilyonqualitative researchwithabusedwomenaccessinghelpservices(e.g.,DobashandDobash 1979;Walker 1979).Thefamilyconflictviewpoint,however,understandsthe majorityofIPVtooccurasaresponsetooccasionalconflictinthefamily,perpetratedequallybymenandwomen.Inthisde finition,thefocusisspecificallyon behaviors.Suchfactorsasrelationshipdynamics,intents,andconsequencesare purposelyexcludedfromthedefinition.Thisviewpointstemsfromsomeofthe fi rst attemptsbysociologiststostudyIPVusingcommunity-basedsurveys(e.g.,Straus etal. 1980).Thesedifferentperspectiveshavegeneratedmuchunresolveddebate (Winstok 2011).ThefeministperspectivecontendsthatdefiningIPVwithout addressingthecontextofviolenceneglectsthatbehaviorshavefundamentally differentconsequencesandareinherentlygendered(DeKeseredy 2011;Dobash etal. 1992;Johnson 2011).Researchersfromthefamilyconflictperspective, however,arguethatmakingassumptionsaboutgenderideologiesoverlooksthe needsofmalevictims(Dutton 2012;Straus 1999)anddeniesthatendingwomen’s violenceagainstmenisalso “morally,legally,andtherapeuticallynecessary” (Straus 2011,p.286).

Meanwhile,anumberofresearchershaveattemptedtoreconcilethese conflictingperspectives.Forexample,inameta-analyticreviewoftheliterature, Archer(2000)foundthatwhenspeci ficallyexaminingmoresevereformsofviolence,menaremorelikelytobetheperpetratoragainstwomen.However,when examiningmoreminorformsofviolence,thereisagreaterdegreeofgender symmetrybetweenvictimsandperpetrators.Anotherpotentialreconciliationcomes fromJohnson(1995),1 whosuggestedthatresearchersmayinfactbeexamining twodifferentphenomenawhichvarybytheoccurrenceofcoercivecontrol.Inlater research,heexpandeduponthistheoryandproposedfourdiscretetypesofIPV basedonbothcoercivecontrolandaggression:intimateterrorism,violentresistance,situationalcoupleviolence,andmutualviolentcontrol(Johnson 2006, 2011).

1ItisimportanttonotethatJohnsonclearlyidentifieshimselfascomingfromthefeministperspective(2011).

Theformertwoarerathergenderasymmetrical. Intimateterrorism istheexertionof controloverone’spartnerusingarangeofviolentandnonviolenttactics,usually perpetratedbymenoverwomen,typicallyescalatinginseverity.Johnsonargues thatintimateterrorismismostfrequentlyseenamongwomenseekinghelpservices foranabusiverelationship, fittingwiththefeministunderstandingofIPV,butmost likelyonlyrepresentsasmallpercentageofoverallviolenceinpartnerships.Onthe otherhand, violentresistance isonepartner ’sresponsetointimateterrorism, althoughitisclearthattheviolentresistorremainsinthepositionofleastpower, andthisistypicallyperpetratedbywomenagainstmen.ThelattertwotypesofIPV, however,tendtobegendersymmetrical. Situationalcoupleviolence isunderstood asviolencethatoccursduringconflict,butwhichisnot fixedinsystematicdominationandcontrolofonepartneroveranother.Heassertsthatthistypeofviolence islesssevereandisoftenrevealedthroughpopulation-basedsurveys, fi ttingwith thefamilyconflictperspectiveofIPV,andisthemostcommontypeofviolencein partnerships.Finally,Johnsonhypothesizesthat mutualviolentcontrol occurswhen bothpartnerssimultaneouslyseektodominatetheother,althoughthismayoccur onlyrarely.

CriticsofJohnson’scategorizationswonderifperhapsthequestionliesin clarifyingthe degree ofviolenceratherthan types ofviolence(Heise 2012).An attemptatempiricallytestingJohnson’sconceptsofintimateterrorismandsituationalcoupleviolenceusingaUSrepresentativesampleconcludedthat, theremaynotbeassharpademarcationbetweenthetwohypotheticalformsofIPVashas beenproposedbutratheracontinuumwherebothcontrollingbehaviorsandinjuryand violenceescalationarejustthreefactorsthatcharacterizethevariousformsofIPVthatmay evolveovertimeinthecourseofarelationship(Fryeetal. 2006,p.1303).

AlthoughthejuryisstilloutonwhetherIPVismadeupofdistinctcategoriesor ratheraspectrumofseverity,Johnson’sworkhasatleastopenedthedoorto discussionsthatperhapsnotallinstancesofIPVareequal(Heise 2012),evenifit hasnotendedthedebatebetweenthefeministandfamilyconflictperspectives(e.g., Dutton 2012;Straus 2011).ThisbookfocusesontheunderstandingsofIPVasboth intimateterrorismandsituationalcoupleviolenceperpetratedagainstwomen,and thenextsectionsofthischapterexploretheirtheoreticalfoundationsandempirical support.2

2Althoughitisbeyondthescopeofthisbook,itisimportanttohighlightanever-increasingbody ofliteraturechallengingheteronormativeassumptionsaroundIPV,assertingthatimbalancesin poweranddependencealsopropagatepatternsofabuseinhomosexualrelationships(e.g.,Cruz 2000;JeffriesandBall 2008;McClennenetal. 2002;Oliffeetal. 2014;Renzetti 1992).The complexintersectionsofgender,sexuality,andpowerinabusiverelationshipsamonglesbian,gay, bisexual,andtransgenderindividualsnecessitateevenfurtherresearchtounderstandtheunderpinningsofIPVinthesecommunities.

2.2TheoreticalExplanationsofIPV

IndelvingintothedefinitionsofIPV,onecannotavoidalsotouchinguponits theoreticalunderpinnings.Thereisavastbodyoftheoreticalapproachesfrom differentdisciplinesattemptingtoexplainthecausesofIPVanditsriskfactors.The theoreticalrealmspanspsychological(e.g.,frustration–aggressiontheory,social learningtheory,cognitivebehavioraltheory),biobehavioral(e.g.,neurochemical mechanisms),criminological,economic,andsociologicalexplanations(Heise 2012;MitchellandVanya 2009).Forthepurposesofthisbook,however,this sectionfocusesspecifi callyonthemostrelevantsociologicaltheoriesendeavoring toexplainIPV,including:feministtheory,familyconflicttheory,resourcetheory anditsoffshootsofrelativeresourcetheoryandgenderedresourcetheory,and dependencytheory.Althoughtherearesigni ficantdifferencesbetweenthem,these theoriessharecommonideasabouttheimportanceofstructure(patriarchalor otherwise),socioeconomicresources,andstatus.

Accordingtosomeoftheearliest feministtheorizing,IPVisprimarilytheresult ofapatriarchalsystemwhichexertsmen’sdominationandcontroloverwomen (DobashandDobash 1979).Thisoccurseither “directly,throughculturalnormsof deferenceandobediencebackedifnecessarybytheuseofforce;orindirectly,by shapingwomen’sopportunitiesandconstraintsinbasicinstitutionssuchasthe familyandworkthatreinforcewomen’ssubordination” (Rodriguez-Menesand Safranoff 2012,p.585).Simplyput,ahighlevelofgenderinequalityinlaws,the socialorder,andinstitutionsplaysitselfoutinahighlevelofmen’sviolence againstwomen,butlevelsofIPVwilldecreaseasasociety’sgenderequity increases.Researchwhichappliesfeministtheoryemphasizes “powerandcontrol inrelationships,socialnormscondoningwifebeating,andstructuralandeconomic forcesthatkeepwomentrappedinabusiverelationships” (Heise 2012,p.47). Arguably,oneoftheprimarycontributionsoffeministtheoryisitsargumentthat socialcontextisvitaltounderstandingIPV,whereaspriortothefeministmovement,victimswereoftenimplicitlyorexplicitlyblamedfortheviolencethey experienced(e.g.,ascribingthemwithdeviant,masochisticpersonalities)(Mitchell andVanya 2009).

Muchoftheearlyfeminist-basedresearchonIPVtypicallycontrolledfor socioeconomicvariablesinempiricalresearchinsteadofdirectlyinvestigatingthem (Cunradietal. 2002;Goodmanetal. 2009;Raphael 2003).Thishadtodowiththe deeplyingrainedbeliefamongearlyfeministactiviststhatIPVcutsacrossallsocial divisionsandthereforeisasocietalproblemofgenderoppression,notaclassor ethnicproblem(Meier 1997).Whileithasbeenshownthatviolenceaffectsall levelsofsociety,somefeministscholarshavearguedthatapurelyuniversalist strategymayhavetheunintendednegativeconsequenceofminimizingthesignificanceofthedifferentialsinvulnerabilitiesexperiencedbythoseinlowersocial positions(Humphreys 2007;Purvin 2007;Raphael 2003).Ratherthanreducing victims’ vulnerability,thismayinsteadcompounditthroughuninformedservices andpolicieswhichignorethespeci ficneedsanddifficultiesfacingpoorwomen

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whoareabusedbytheirpartners(Josephson 2002).Inthissense,feministtheorizinghasexpandedbeyondtheone-factorexplanationofpatriarchalstructure (DekeseredyandDragiewicz 2007;DeKeseredy 2011),andhasbeguntoexamine socioeconomicexplanationsaswell.

Evenso,thisremainsacentralpointofcriticsoffeministtheory,arguingthat societalgenderinequalityisonlyoneofmanyfactorsinvolvedintheoccurrenceof partnerviolence(Dutton 2006).Researchersfromthisstandpointinsteadproposea theoryof familyconflict,arguingthatfactorssuchasage,income,andemployment statusofcouplesplayamoreimportantrole(Anderson 1997;Gelles 1993). Essentially,noteverymanisviolenteveninsocietieswithhighlevelsofgender inequality,andthusexplanationsmustalsotakeintoaccountthedifficultiesof everydayfamilylife.Thistheoryoffamilyconflictmakesuseofsocialstructuralisminexplainingviolenceinrelationships.Basically,violenceoccursasa reactionto “sociallystructuredstress” (e.g.,lowincome,unemployment,poor health)andtheinstitutionalizedinequalitiesamongsocioeconomic,gender,and racialdivides(Gelles 1985,p.361).Inessence,IPVfromthisperspectiveis understoodas, “theoutcomeofapileupofstressorsassociatedwithaperceived excessofdemandsoverresources” (Foxetal. 2002,p.794).Thus,violenceinthe familyisinherentlyrelatedtoafamily’spositioninthesocialstructure.

Evenbeforefeministandfamilyconflicttheory,however,oneofthe fi rst researcherstoapplysociologicaltheoriestoIPVwasGoode(1971)with resource theory.Heproposedthatthepowerbalancebetweenpartnersisoftendependent upontheresourcesindividualscontributetotherelationship.Moreover,he hypothesizedthat “forceanditsthreatcanbeusedwhenotherresourcesare unavailableorhaveprovedineffective” (Goode 1971,p.628).Inotherwords,men withfewerresourcesoutsidetherelationship(e.g.,whenfacingunemploymentor financialhardship)aremorelikelytomakeuseofviolenceinordertoreestablish theircontrolwithintherelationship.Incontrast,menwithsufficientexternal resourceshavelittleneedtoreasserttheirpowerthroughviolence.Anextensionof resourcetheoryknownas relativeresourcetheory focusesnotonmen’sabsolute resources,butratheronthe(im)balanceineconomicandsocialresourcesbetween menandwomeninarelationship(MacmillanandGartner 1999;McCloskey 1996). Accordingtothistheory,menwhohavefewerresources(e.g.,educationorincome) ascomparedtotheirfemalepartnersaremorelikelytouseviolencetoregaintheir poweriftheyhavenoothermeanstodoso.The flipsideofthistheorycanalsobe usedtohypothesizethatwomenwithcomparativelylowereducationandstatusthan theirpartnersarealsoatincreasedriskif “violenceisconstruedasaprivilegeofhis greaterresourcecontributionandsimultaneouslyasareflectionofhispartner ’s relativeeconomicvulnerability” (Foxetal. 2002,p.794).Developingtheseideas evenfurther, genderedresourcetheory proposesthatIPVisratheraninteraction betweenstatusinconsistenciesinrelationshipsandthemalepartner ’sgenderideology(Atkinsonetal. 2005).Basically,ifmalepartnersviewtherelationship throughthelensofegalitarianismanddonotperceivetheneedtobetheprimary breadwinner,thentheydonothaveanyneedtouseviolencetoreasserttheir superiorityoverfemalepartnerswithhigherstatuses.