Understanding Women’s Help-Seeking With Intimate Partner Violence in Tanzania

Abstract

Intimate partner violence (IPV) is a serious global health problem affecting millions of women worldwide. Despite increased investments into its reduction, little research has been conducted into how women in low- and middle-income countries deal with IPV. This study seeks to explore this by looking in depth into help-seeking strategies utilized by abused women in Tanzania, using the 2015–2016 Tanzania Demographic and Health Survey. The prevalence of lifetime physical and/or sexual IPV was 41.6% in this study, but only half of all affected women sought help from anyone. The only clear association found with help-seeking was the severity of IPV.

Keywords

intimate partner violence help-seeking disclosure Tanzania

Introduction

Over the years, intimate partner violence (IPV) has been recognized as a serious global health problem affecting millions of women, irrespective of their socio-economic status, educational attainment, or marital status (García-Moreno & Stöckl, 2009). It is estimated that almost 30% of women worldwide have experienced some form of physical and/or sexual IPV in their lifetime, while 1 out of 4 women in Tanzania have experienced physical and/or sexual IPV in their lifetime (García-Moreno et al., 2005; Ministry of Health, Community Development, Gender, Elderly and Children et al., 2016). IPV has been linked with a wide array of both physical and mental health effects such as depression, suicidality, posttraumatic stress disorder (PTSD), miscarriages, injuries, and, in severe cases, death (Devries et al., 2013; Mahenge et al., 2013; Mapayi et al., 2013; Stockl et al., 2013). Not only women get affected by IPV, their children and family’s economic wellbeing suffer as well (Adams et al., 2012; Jouriles et al., 2018; Neamah et al., 2018).

Despite the fact that IPV has tragic consequences, in most instances, IPV goes unreported, and only a few women seek help (Okenwa et al., 2009; Roelens et al., 2008). Women who have experienced IPV develop different patterns to cope with IPV. The types of help-seeking strategies that exist for those who seek help are either termed “informal,” when women seek help from their families or their partner’s family, friends, or neighbors and they are termed “formal,” when women seek help from social services, doctors, lawyers, or the police (Ragusa, 2013; Sylaska & Edwards, 2014). According to a study of Demographic and Health Surveys (DHS) from 24 developing countries between 2004 and 2011, only 40% of women who experienced physical and/or sexual IPV sought any help, out of which 36.8% sought informal help, and 7% sought formal help (Palermo et al., 2014).

Literature from several studies from Western countries highlight the conditions under which women try to seek both formal and informal help to end IPV, and the factors they are associated with are women’s socio-economic status, ethnicity, culture, and religion (Taket et al., 2014). Although social norms have also been said to play a part, as IPV might be viewed as a private matter and seeking help comes with the loss of privacy (Liang et al., 2005), research has moved over the years to understand individual factors that may hinder help-seeking. One of the factors highlighted is stigma. Stigma can range from anticipated stigma from the formal or informal support or service providers, or internalized stigma associated with feelings of shame and embarrassment that one has experienced IPV, or finally cultural stigma, which is fear of judgemental attitudes and victim-blaming from service providers (Kennedy & Prock, 2016; Overstreet & Quinn, 2013).

The phenomenon of stigma and shame was a prominent finding in a qualitative study on help-seeking in Tanzania among 96 male and female community members. Although women understood what constituted violence against women, still most women normalized IPV as part of a normal relationship and were reluctant to seek help due to stigma, shame, fear, and lack of trust in existing response systems (McCleary-Sills et al., 2016).

While these existing studies underlined that help-seeking is an important issue to investigate to address IPV, there is a scarcity of quantitative studies from low- and middle-income countries like Tanzania with high prevalence rates of IPV on the different forms of help-seeking for IPV and from whom help is sought beyond formal services. Studies investigating factors associated with help-seeking have mainly looked at the associations with women’s characteristics, ignoring the importance of their partner’s characteristics, the type of IPV experienced, and relationship characteristics. This study aims to bridge the current research gap and establish help-seeking strategies women used and its associated factors in Tanzania, using a national representative data set of the 2015–2016 Tanzanian DHS.

Methodology

This study employed secondary data analysis of the 2015–2016 Tanzanian DHS that covered all 30 regions in Tanzania mainland and Zanzibar. The DHS used multistage cluster sampling from the 2012 Tanzanian census, whereby 608 clusters were selected, ending up with a representative probability sample of 13,376 households, and a total of 13,266 women aged 15 to 49 were interviewed in this survey. In this study, we excluded all women who did not take part in the domestic violence module, resulting in a sample of 7,597 women, as one in every third household was eligible to participate in the domestic violence module. Permission to conduct data analysis was sought through the DHS program website (http://dhsprogram.com/data/available-datasets.cfm).

Measures

The help-seeking outcome was determined by the first question which all women who reported any form of physical or sexual violence were asked: “Thinking about what you have experienced among the different things we have been talking about, have you ever tried to seek help?” If she responded positively, she was asked from whom she sought help, with the answer categories: (a) own family, (b) husband’s/partner’s family, (c) friend, (d) neighbor, (e) religious leader, (f) doctor/medical personnel, (g) police, (h) lawyer, and (i) social services. In the analysis, seeking help was categorized into four groups, seeking help from anyone included seeking help from anyone in (a) to (i); seeking help from family, either their own family or their partner’s family; seeking help from friends and neighbors; and finally, seeking help from official sources including the police, lawyers, social services, or religious leaders. Given the high prevalence rates for informal help-seeking suggested in other studies in sub-Saharan Africa, informal help-seeking was broken down into her own family, his family, and friends and neighbors (Katiti et al., 2016).

The domestic violence module in the DHS 2015–2016 is based on the Conflict Tactics Scales that asked respondents if they had experienced physical or sexual IPV, psychological abuse, and controlling behaviors. Women were asked if they had experienced the above forms of IPV in their lifetime and the past 12 months. For physical IPV, women were asked seven questions: if they had ever been pushed, shook, or had something thrown at them, and had ever been slapped. Women were also asked if they had ever been kicked or dragged or beat up, ever been strangled or burned, whether their arm got twisted, or hair pulled, ever been punched with a fist or hit by something harmful, and finally, if they had ever been threatened with a knife/gun or any other weapon. For sexual IPV, women were asked three questions: if they had ever been physically forced into unwanted sexual intercourse, physically forced to perform any other sexual acts, and if they had ever been threatened to perform any other sexual acts. Psychological IPV was measured with a total of four questions: if the partner had insulted them, being belittled in front of other people, intimidated on purpose, and if the partner threatened to hurt the respondent. For controlling behaviors, five questions were asked: if their partner had tried to restrict them seeing a friend, had restricted contact with the family of birth, insisted on knowing where the respondent was most of the time. Acted jealous or angry if the respondent spoke to another man, and was often suspicious she is unfaithful. A woman was considered to have experienced any form of IPV if she answered yes to any questions on IPV.

Factors that were perceived to influence women’s help-seeking that were considered in the analysis include women’s age (15–19, 20–30, or 31–49), marital status (previously married or currently married), educational attainment (none/primary incomplete, primary education, secondary education, or above), partner’s age (17–29, 30–40, or 41–91), partner’s education (none/primary incomplete, primary education, secondary education, or above), partner’s occupation (agriculture, unskilled labor, professional/clerical, or sales), duration of relationship (0–4 years, 5–9 years, or 10+ years), if the woman is working (no, yes), number of living children (none, 1–2, or 3–4), decision on earnings (woman alone, partner alone, both woman and partner), partner’s alcohol intake ( no, yes), and other outcomes of IPV such as being afraid of the partner most of the time (never, sometimes, or most of the time) and having eye injuries, sprains, dislocations, or burns as a result of IPV (no, yes).

Analysis

This study made use of the Tanzania DHS’s individual women’s data of 2015–16, who participated in the domestic violence module and was either in a relationship at the time of the interview or had been previously in a relationship, meaning during the time of the interview they were separated, divorced, or widowed. Data were analyzed using Stata, version 15, and weights recommended by the DHS were used to adjust for sampling design and domestic violence survey participation.

Frequencies were run to estimate the prevalence of different forms of lifetime IPV among all women who participated in the domestic violence module and the prevalence of different forms of help-seeking among all women who experienced any lifetime physical and/or sexual IPV. The sample was later reduced to women who reported any lifetime physical and/or sexual IPV, to determine factors associated with help-seeking among women who had experienced physical and/or sexual IPV. We then screened for all potential factors that could influence our dependent variable, any help-seeking, with separate analyses conducted for the different types of help-seeking: help-seeking from anyone, help-seeking from his or her family, friends and neighbors, and official sources. Cross-tabulations and chi-square statistics were carried out to determine associations between IPV and all the different forms of helping-seeking and other socio-demographic characteristics. Variables that were significant in each of the different categories of help-seeking were then used in the multivariable logistic regression model. We used a probability value of p ≤ .05 to define the level of statistical significance, and an odds ratio <1 represents a protective factor, whereas an odds ratio >1 was considered a risk factor.

Results

A total of 7,597 women were included in the analysis, aged 15 to 49 with a mean age of 32. Half of the women (52%, n = 3,899) were between 31 and 49 years old, and a small proportion (6.6%, n = 466) were between 15 and 19 years at the time of the interview. The majority of women had primary education (66.8%, n = 4,833), were working at the time of the interview (80.9%, n = 6,048), were married (82.7%, n = 6,479), and had 3-4 living children (55.4%, n = 4,329). Women’s partner’s age ranged from 17 to 91 with a mean age of 38. Of the partners, 39.1% (n = 2,679) were between 30 and 40 years old and 22.5% (n = 1,438) were 17 to 29 years old. Primary education was the most frequent level of educational attainment among the partners (69.0%, n = 4,290), and more than half of them were working in the agricultural sector (55.8%, n = 3,722; see Tables 1 and 2).

Table 1.

The Association of Women Life Time Experiences of Physical and/or Sexual IPV.

Variables	Respondent’s characteristics (n = 7,597)	Ever experienced physical and/or sexual IPV(n = 7,597)		Y ²	p
Variables	Respondent’s characteristics (n = 7,597)	No	Yes	Y ²	p
Woman’s age				12.080	.02
31+	3,899 (52.5%)	2,382 (52.1%)	1,517 (53.0%)
20–30	3,232 (40.9%)	1,990 (40.4%)	1,242 (41.5%)
15–19	466 (6.6%)	312 (7.5%)	154 (5.5%)
Woman’s education				49.999	<.0001
None/incomplete primary	1,439 (17.8%)	906 (17.6%)	533 (18.1%)
Primary	4,833 (66.8%)	2,774 (64.6%)	2,059 (69.9%)
Secondary/higher	1,325 (15.4%)	1,004 (17.9%)	321 (12.0%)
Woman is working				24.102	.0003
No	1,549 (19.1%)	1,085 (21.0%)	464 (16.5%)
Yes	6,048 (80.9%)	3,599 (79.0%)	2,449 (83.5%)
Marital status				233.638	<.0001
Was previously married	1,118 (17.3%)	484 (11.7%)	634 (25.2%)
Currently married	6,479 (82.7%)	4,200 (88.3%)	2,279 (74.9%)
Type of partnership				4.706	.12
Polygamy	1,250 (16.0%)	762 (15.3%)	488 (17.1%)
Monogamy	6,347 (84.0%)	3,922 (84.7%)	2,425 (82.9%)
Duration of relationship				15.395	<.0001
10+ years	4,333 (57.1%)	2,564 (54.2%)	1,769 (61.2%)
5–9 years	1,508 (19.6%)	909 (19.4%)	599 (20.0%)
0–4 years	1,756 (23.2%)	1,211 (26.4%)	545 (18.8%)
Number of living children				75.131	<.0001
None	569 (8.1%)	416 (10.1%)	153 (5.3%)
3–4	4,329 (55.4%)	2,567 (52.3%)	1,762 (59.8%)
1–2	2,699 (36.5%)	1,701 (37.6%)	998 (34.9%)
Partner’s age (years)				5.163	.275
41+	2,361 (38.4%)	1,585 (39.2%)	766 (37.1%)
30–40	2,679 (39.1%)	1,691 (38.1%)	988 (40.9%)
17–29	1,428 (22.5%)	924 (22.8%)	514 (22.0%)
Partners education level				48.045	<.0001
None /incomplete primary	835 (11.9%)	543 (10.8%)	292 (13.9%)
Primary	4,290 (69.0%)	2,629 (67.7%)	1,661 (71.1%)
Secondary/higher	1,354 (19.1%)	1,028 (21.5%)	326 (15.1%)
Partner’s occupation				30.028	.0002
Agriculture	3,722 (55.7%)	2,342 (53.2%)	1,380 (59.8%)
Unskilled labor	852 (31.0%)	556 (13.6%)	296 (13.0%)
Professional, clerical, and sale	190 (13.4%)	1,302(33.3%)	603 (27.2%)
Decision making on how earnings are spent				5.496	.183
Woman only	1,206 (36.5%)	857 (36.5%)	349 (36.5%)
Woman and partner	1,602 (54.9%)	1,042 (55.7%)	560 (53.2%)
Partner alone	267 (8.7%)	152 (7.8%)	115 (10.2%)
Who earns more				12.594	.08
Woman earns more than him	276 (11.2%)	184 (9.9%)	92 (13.8%)
Husband/partner earns more	2,198 (68.7%)	1,451 (69.0%)	743 (68.2%)
About the same	605 (20.1%)	416 (21.1%)	189 (18.0%)
Urban/rural				17.261	.01
Rural	5,560 (67.6%)	3,428 (65.7%)	2,132 (70.3%)
Urban	2,067 (32.4%)	1,256 (34.3%)	781 (29.8%)
Wealth index				51.584	.0001
Poorest	1,379 (18.2%)	762 (18.1%)	617 (45.6%)
Poorer	1,414 (18.6%)	828 (17.5%)	586 (45.5%)
Middle	1,559 (20.5%)	936 (18.4%)	623 (43.2%)
Richer	1,753 (23.1%)	1,139 (20.6%)	614 (40.3%)
Richest	1,492 (20.1%)	1,019 (25.4%)	473 (35.1%)
Number of people living in the household				11.782	.007
1–5	4,212 (48.3%)	2,621 (49.9%)	1,591 (46.0%)
6–48	3,385 (51.7%)	2,063 (50.1%)	1,322 (54.0%)
Partner’s alcohol intake
No	5,208 (66.5%)	3,690 (76.8%)	1,518 (52.0%)	506.295	<.0001
Yes	2,389 (33.5%)	994 (23.2%)	1,395 (48.0%)
Eye injuries, sprains, dislocations, or burns				0.651	.658
No	2,502 (85.4%)	5 (100%)	2,497 (85.4%)
Yes	416 (14.6%)	0 (0%)	416 (14.6%)
Afraid of the partner
Never	4,313 (56.0%)	3,285 (70.8%)	1,028 (35.2%)	1083.46	<.0001
Most	1,123 (16.5%)	290 (7.4%)	833 (29.3%)
Sometimes	2,163 (27.5%)	1,109 (21.7%)	1,052 (35.5%)
Psychological/emotional IPV				2356.20	<.0001
No	5,145 (64.1%)	4,142 (86.6%)	1,003 (32.4%)
Yes	2,452 (36.0%)	542 (13.4%)	1,910 (67.4%)
Controlling behaviors				460.29	<.0001
No	2,180 (25.8%)	1,779 (34.9%)	401 (13.1%)
Yes	5,417 (74.2%)	2,905 (65.1%)	2,512 (86.9%)

Note. IPV = Intimate partner violence.

Table 2.

The Association of Women Life Time Experiences and Help-Seeking for IPV.

Variables	Respondent’s characteristics (n = 7,597)	Sought help for IPV (n = 2,913)		Y ²	p
Variables	Respondent’s characteristics (n = 7,597)	No	Yes	Y ²	p
Woman’s age				6.494	.133
31+	3,899 (52.5%)	1,027 (52.3%)	800 (54.9%)
20–30	3,232 (40.9%)	875 (41.5%)	612 (40.6%)
15–19	466 (6.6%)	121 (6.2%)	60 (4.5%)
Woman’s education				2.362	.564
None/incomplete primary	1,439 (17.8%)	374 (18.1%)	258 (17.4%)
Primary	4,833 (66.8%)	1,439 (70.5%)	1,048 (70.6%)
Secondary/higher	1,325 (15.4%)	210 (11.4%)	166 (12.0%)
Woman is working				0.423	.633
No	1,549 (19.1%)	333 (16.8%)	218 (16.1%)
Yes	6,048 (80.9%)	1,690 (83.2%)	1,254 (83.9%)
Marital status				60.666	<.0001
Was previously married	1,118 (17.3%)	370 (20.9%)	401 (31.1%)
Currently married	6,479 (82.7%)	1,653 (79.2%)	1,071 (68.9%)
Type of partnership				0.477	.648
Polygamy	1,250 (16.0%)	344 (17.4%)	227 (15.9%)
Monogamy	6,347 (84.0%)	1,679 (82.6%)	1245 (84.1%)
Duration of relationship
10+ years	4,333 (57.1%)	403 (19.8%)	929 (62.9%)	5.004	.209
5–9 years	1,508 (19.6%)	421 (20.4%)	299 (19.0%)
0–4 years	1,756 (23.2%)	403 (19.6%)	244 (18.0%)
Number of living children				11.337	.02
None	569 (8.1%)	124 (6.2%)	62 (4.3%)
3–4	4,329 (55.4%)	1,205 (59.4%)	919 (59.1%)
1–2	2,699 (36.5%)	694 (34.1%)	491 (35.6%)
Partner’s age (years)				2.658	.42
41+	2,361 (38.4%)	547 (36.5%)	776 (37.1%)
30–40	2,679 (39.1%)	717 (40.7%)	988 (40.9%)
17–29	1,428 (22.5%)	388 (22.8%)	514 (22.0%)
Partners education level				0.154	.932
None /incomplete primary	835 (11.9%)	210 (13.7%)	292 (13.9%)
Primary	4,290 (69.0%)	1,210 (71.3%)	1,661 (71.1%)
Secondary/higher	1,354 (19.1%)	233 (15.1%)	326 (15.1%)
Partner’s occupation				0.748	.789
Agriculture	3,722 (55.7%)	1,003 (59.3%)	1,380 (59.8%)
Unskilled labor	852 (31.0%)	215 (13.4%)	296 (13.0%)
Professional, clerical, and sale	190 (13.4%)	435 (27.1%)	603 (27.2%)
Decision making on how earnings are spent				1.395	.637
Woman only	1,206 (36.5%)	248 (36.3%)	349 (36.5%)
Woman and partner	1,602 (54.9%)	427 (54.0%)	560 (53.2%)
Partner alone	267 (8.7%)	83 (9.6%)	115 (10.3%)
Who earns more				7.234	.219
Woman earns more than him	276 (11.2%)	65 (14.3%)	92 (13.8%)
Husband/partner earns more	2,198 (68.7%)	533 (66.0%)	743 (68.2%)
About the same	605 (20.1%)	160 (19.7%)	189 (18.0%)
Urban/rural				0.505	.610
Rural	5,560 (67.6%)	1,484 (70.7%)	1,081 (71.0%)
Urban	2,067 (32.4%)	539 (29.3%)	391 (29.0%)
Wealth index				4.937	.621
Poorest	1,379 (18.2%)	421 (20.6%)	196 (34.0%)
Poorer	1,414 (18.6%)	421 (21.2%)	165 (29.7%)
Middle	1,559 (20.5%)	438 (20.2%)	185 (29.9%)
Richer	1,753 (23.1%)	413 (18.9%)	201 (33.9%)
Richest	1,492 (20.1%)	330 (19.0%)	143 (32.8%)
Number of people living in the household				7.324	.04
1–5	4,212 (48.3%)	1,124 (47.6%)	804 (45.9%)
6–48	3,385 (51.7%)	899 (52.3%)	668 (53.8%)
Partner’s alcohol intake				13.428	.006
No	5,208 (66.5%)	1,097 (54.7%)	688 (46.2%)
Yes	2,389 (33.5%)	926 (45.6%)	784 (53.8%)
Eye injuries, sprains, dislocations, or burns				47.851	<.0001
No	2,502 (85.4%)	1,841 (91.8%)	1,224 (85.0%)
Yes	416 (14.6%)	182 (8.2%)	248 (15.0%)
Afraid of the partner				64.823	<.0001
Never	4,313 (56.0%)	793 (39.2%)	396 (27.6%)
Most	1,123 (16.5%)	491 (25.1%)	538 (36.5%)
Sometimes	2,163 (27.5%)	739 (35.8%)	538 (36.0%)
Past year physical IPV
No	5,726 (73.1%)		467 (31.9%)
Yes	1,871 (27.0%)		1005 (68.1%)
Past year sexual IPV				37.195	<.0001
No	6,898 (90.1%)	140 (7.3%)	1,107 (76.7%)
Yes	699 (9.9%)	1,883 (92.7%)	365 (23.3%)
Moderate physical IPV				117.586	<.0001
No	6,240 (80.7%)	1,205 (60.4%)	614 (41.2%)
Yes	1,357 (19.3%)	818 (39.6%)	858 (58.8%)
Severe physical IPV				37.226	.0001
No	4,952 (62.2%)	227 (11.5%)	614 (41.2%)
Yes	2,645 (37.8%)	1,796 (88.5%)	858 (58.8%)
Psychological/emotional IPV				70.988	<.0001
No	5,145 (64.1%)	805 (37.4%)	348 (22.1%)
Yes	2,452 (36.0%)	1,218 (62.5%)	1,124 (71.9%)
Controlling behaviors				22.630	.0002
No	2,180 (25.8%)	315 (15.1%)	159 (10.2%)

Note. IPV = intimate partner violence.

The lifetime prevalence of physical and/or sexual IPV was 41.6% (n = 2,913) and that of the past 12 months was 29.3% (n = 2,037). Among the 2,913 women who experienced lifetime physical and/or sexual IPV, 51% (n = 1,472) reported help-seeking from anyone, with 43.6% (n = 1,233) of women reporting they either sought help from his or her family, 32.1% (n = 890) reporting seeking help from her own family, 28.4% (n = 796) reporting seeking help from his family, 10.8% (n = 336) seeking help from either their friends or neighbors, 4.5% (n = 110) seeking help from the police, 2.6% (n = 45) from religious leaders, 1.1% (n = 27) from social services, 0.4% (n = 10) from medical doctors, and 1.4% (n = 44) from lawyers (see Table 3).

Table 3.

From Whom the Women Sought Help for Lifetime Physical and/or Sexual IPV.

Help-seeking	n (%)N = 2,913
Sought help from her family
No	2,023 (67.9)
Yes	890 (32.1)
Sought help from his family
No	2,117 (71.6)
Yes	796 (28.4)
Sought help from her friends
No	2,811 (96.7)
Yes	102 (3.3)
Sought help from the neighbor
No	2,637 (91.6)
Yes	276 (8.4)
Sought help from official sources
No	2,686 (91.5)
Yes	227 (8.5)

Note. IPV = intimate partner violence.

Results displayed in Table 4 show that help-seeking from anyone was associated with being afraid of the partner most of the times (adjusted odds ratio [AOR]: 1.8, 95% confidence interval [CI]: 1.4, 2.3); ever having had eye injuries, sprains, dislocations, or burns because of husband/partner (AOR: 1.6, 95% CI: 1.1, 2.2); emotional IPV (AOR: 2.3, 95% CI: 1.9, 2.8); partner’s alcohol intake (AOR 1.3, 95% CI: 1.1,1.6); and severe physical IPV (AOR: 2.5, 95% CI: 1.7, 3.7).

Table 4.

Factors Associated With Women’s Help-Seeking for Lifetime Physical and/or Sexual IPV From Anyone.

Variable	AOR	95% CI	p value
Marital status
Previously married	REF
Currently married	0.63	(0.49, 0.82)	< .0001
Partners alcohol intake
No	REF
Yes	1.3	(1.1, 1.6)	.013
Afraid of the partner
Never	REF
Most of the times	1.8	(1.4, 2.3)	<.0001
Sometimes	1.4	(1.1, 1.8)	.008
Eye injuries, sprains, dislocations, or burns
No	REF
Yes	1.6	(1.2, 2.2)	.003
Emotional IPV
No	REF
Yes	2.3	(1.9, 2.8)	<.0001
Controlling behaviors
No	REF
Yes	1.2	(0.93, 1.6)	.138
Severe physical IPV
No	REF
Yes	2.5	(1.7, 3.7)	<.0001

Note. IPV = intimate partner violence; CI = confidence interval; AOR = adjusted odds ratio.

Help-seeking from his or her family was associated with being previously married (AOR: 1.4, 95% CI: 1.1, 1.7), having 1-2 children (AOR: 1.4, 95% CI: 1.1, 1.7) compared to those who have 3-4 children or no children; being afraid of the partner most of the time (AOR: 1.7, 95% CI: 1.3, 2.2) compared to those who were sometimes or never afraid of their partner; ever having had eye injuries, sprains, dislocations, or burns because of their husband/partner (AOR: 1.4, 95% CI: 1.0, 1.9); emotional IPV (AOR: 1.9, 95% CI: 1.5, 2.3); and severe physical IPV (AOR: 2.4, 95% CI: 1.5, 3.7).

Seeking help from official sources (police, social services, lawyers, doctors, and religious leaders) was associated with being previously married (AOR: 2.3, 95% CI: 1.6, 3.4) compared to those who were currently married; being afraid of the husband/partner most of the time (AOR: 1.8, 95% CI: 1.1, 2.9) compared to those who were afraid of their partner sometimes; ever having had eye injuries, sprains, dislocations, or burns because of their husband/partner (AOR: 2.0, 95% CI: 1.4, 3.0) compared to those who reported not having had eye injuries, sprains, dislocations, or burns because of their husband/partner; and emotional IPV (AOR: 1.9, 95% CI: 1.2, 3.1).

Seeking help from neighbors and friends was associated with partner’s alcohol intake (AOR: 1.7, 95% CI: 1.2, 2.3) and emotional IPV (AOR: 2.3, 95% CI: 1.6, 3.5).

Discussion

This study found that 4 out of 10 women experienced lifetime physical and/or sexual IPV, and 3 out of 10 women experienced physical and/or sexual IPV in the past 12 months in Tanzania. Of those women who experienced lifetime physical and/or sexual IPV, half of them sought help, and help-seeking from the respondents own family ranked the highest followed by seeking help from the perpetrator’s family.

The findings are consistent with a study among pregnant women in Tanzania, of which only a quarter (n = 79/339) of women who experienced IPV during pregnancy sought help; the study also reported similarly low levels of formal help-seeking (Katiti et al., 2016; Palermo et al., 2014). Some of the reasons that prevent women from seeking help in Tanzania are that IPV is normalized in the society and therefore seen as insignificant; it is associated with shame and stigma; women do not trust the available structures; corruption; and the feeling they may not be able to attain the justice they deserve (McCleary-Sills et al., 2016). Other factors that have been mentioned include being threatened by the partner, being afraid that the family would find out about the violence, or the woman not wanting the family to know (Frias, 2013).

Another finding in our study is that many women who sought help, sought it mainly from their own family and the perpetrator’s family, which is in contrast to the study mentioned above from Northern Tanzania among pregnant women (Katiti et al., 2016). The study found out that pregnant women disclosed IPV more often to their own family, followed by friends. The trend of women seeking help from the partner’s family can be explained as a cultural aspect that women in patrilineal societies become part of the man’s family and all problems should be reported to the family. Similar suggestions have been reported in Kenya, where women sought help from their partner’s family, as they are the ones to settle marital disputes (Odero et al., 2013).

Another contributing factor across all forms of help-seeking among women who have experienced physical and/or sexual IPV is the severity of IPV and its overlap with other forms of intimate partner abuse. Women who sought help also reported controlling behaviors and emotional IPV. Not only were these women afraid of their partner most of the time, but they also suffered eye injuries, sprains, dislocations, or burns because of the IPV. Across studies, we see that women wait for IPV to become severe before seeking help which can become lethal (Evans & Feder, 2016; Stockl et al., 2013). Similar findings have been found in studies in Ghana and Nigeria that showed that women who had a perceived risk of injury from physical violence and had controlling partners were more likely to seek help (Tenkorang et al., 2017, 2018).

Currently, interventions addressing IPV in sub-Saharan Africa are focused at the community level, individual women and men, or the couple as a whole (Ellsberg et al., 2015). While those interventions are important to empower women and men, challenging existing gender and social norms at both the individual and community levels, up to now, they do not focus on the natal and in-law family, who may play a significant role in reducing IPV. Any intervention designed to either challenge cultural norms or provide education on the effects of IPV to society at large should start with the family unit. Our study, similar to several other studies, indicates the importance of the family unit in sub-Saharan Africa on reporting violence among couples (Odero et al., 2013; Okenwa et al., 2009).

The DHS are rigorously conducted surveys with national representation, but it is important to note the limitations of this study, as it is a quantitative cross-sectional study and thus fails to understand in detail why women chose to report to their own family and their partner’s family instead of others. Besides, due to its cross-sectional nature, it is impossible to understand when women sought help and whether associated factors were causes or consequences of help-seeking. Another limitation is that IPV is a sensitive topic coupled with social stigma, so IPV might be under-reported. Unfortunately, important measures related to help-seeking such as social norms, shame stigma, and trust in the system were not available to be included in the model. Finally, due to the study’s cross-sectional nature, we cannot establish causality between IPV and help-seeking, as in other cases help-seeking has been said to cause more violence (McCleary-Sills et al., 2016).

Conclusion

IPV is a serious problem in Tanzania, with 4 out of 10 women having experienced physical and/or sexual IPV; only half of the women who experienced lifetime IPV sought help from anyone. The findings of the study highlight the need for interventions to incorporate the wider family unit, including parents of married couples instead of only focusing on empowering individual women. Another important aspect is the need for further research to understand the dynamics of seeking help, especially on how to improve formal help-seeking by women in Tanzania, so that tailored recommendations can be made to the government to improve existing services and their accessibility. The Tanzanian government has made an important pledge to reduce the prevalence of IPV through its National Action Plan, and further research is needed on how to effectively support Tanzanian women who experience IPV.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Bathsheba Mahenge is currently funded by the Commonwealth Rutherford Fellowship. Heidi Stöckl is funded by an ERC Starting Grant. The funders had no influence on this study.

ORCID iD

Bathsheba Mahenge

Author Biographies

Bathsheba Mahenge is a lecturer at the University of Dodoma, College of Health Sciences in Dodoma, Tanzania. She is also a Commonwealth Rutherford fellow at the London School of Hygiene and Tropical Medicine. Her main area of interest is the epidemiology of intimate partner violence, mental health disorders, sexual harassment, and HIV/AIDS among most at-risk populations. With respect to intimate partner violence research, she has tried to establish the link between intimate partner violence and mental health disorders during pregnancy and postpartum in Tanzania. She also works on violence and common mental health disorders among adolescents.

Heidi Stöckl is the director of the Gender Violence and Health Center at the London School of Hygiene and Tropical Medicine and head of the WHO Collaborating Center on gender-based violence. Her main research is focused on the epidemiology of intimate partner violence, violence-related mortality, and human trafficking, including studies on the prevalence and health effects of intimate partner violence among the general population, pregnant, and older women; the global prevalence of intimate partner homicide and perpetrators of child homicide; trafficking for sexual exploitation; and forced marriage in Uzbekistan and China.

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