Ahinkorah et al. BMC Women’s Health (2023) 23:48 BMC Women’s Health https://doi.org/10.1186/s12905-023-02179-5 RESEARCH Open Access Exposure to interparental violence and intimate partner violence among women in Papua New Guinea Bright Opoku Ahinkorah1, Richard Gyan Aboagye2*, Abdul Cadri3,4, Tarif Salihu5, Abdul‑Aziz Seidu6,7,8 and Sanni Yaya9,10 Abstract Introduction Evidence suggests that childhood exposure to interparental violence increases the risk of intimate partner violence (IPV) experience or perpetration in adolescence or adulthood. However, it is unclear if exposure to interparental violence increases the risk of IPV among women in Papua New Guinea. This study, therefore, seeks to fill this gap in the literature by examining the association between childhood exposure to interparental violence and IPV among women in Papua New Guinea. Methods We used data from the most recent 2016–18 Papua New Guinea Demographic and Health Survey. We included 3,512 women in our analyses. Past‑year experience of IPV was the outcome variable in this study. Exposure to interparental violence was the key explanatory variable. We used a multilevel binary logistic regression to examine the association between exposure to interparental violence and IPV. Results We found a higher probability of experiencing IPV among women exposed to interparental violence [aOR = 1.45, 95% CI = 1.13, 1.86] relative to women who were not exposed. Furthermore, we found that women living in rural areas had a lower likelihood of IPV experience [aOR = O.50, 95% CI = 0.32, 0.80] compared to those in urban settings. Finally, a greater odd of IPV experience was found among women staying in the Highlands Region [aOR = 1.44, 95% CI = 1.06, 1.96] compared to those staying in the Southern Region. Conclusion Exposure to interparental violence was found to be significantly associated with IPV among women in Papua New Guinea. The findings of this study suggest the need for proven operational strategies to reduce IPV, such as improving anti‑IPV laws in Papua New Guinea. We recommend the development and implementation of inter‑ cession strategies to reduce the experience and justification of violence among women exposed to interparental violence. In addition, health professionals should implement counseling and health education initiatives to tackle the consequences of IPV on women’s well‑being. Keywords Demographic and Health Survey, Papua New Guinea, Interparental violence, Intimate partner violence Introduction Intimate partner violence (IPV), a serious public health problem, is defined as physical violence, sexual violence, stalking, or psychological aggression (including coercive *Correspondence: acts) by a current or former intimate partner, whether Richard Gyan Aboagye or not the person is a spouse [1, 2]. Experience of IPV is raboagye18@sph.uhas.edu.gh prevalent among individuals across the diverse gender Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licens es/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/z ero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Ahinkorah et al. BMC Women’s Health (2023) 23:48 Page 2 of 11 spectrum, including males, females, transgender and prevalence of IPV in PNG are the strict gender roles and nonbinary individuals [3]. Nevertheless, the prevalence of gender relations in which IPV is used as a means of keep- IPV is disproportionately higher among people who self- ing women in their place and giving men the decision- identify as female compared to people who self-identify making power in the relationship [25, 26]. Several other as male, with further evidence indicating the likelihood factors are associated with an increased risk of IPV. Some of experiencing IPV to be higher among people who of these factors include substance use, stress, low level of identify as female than people who identify as male [3, 4]. education, ineffective communication in the relationship, Interparental violence, on the other hand, is violence unequal power relation, unemployment, gender ineq- that occurs between parents [5]. Exposure to interpa- uitable masculinities, and harmful attitudes to gender rental violence has mostly been defined as the situa- relations that result in female disempowerment and mar- tion where children see, hear, involve, or experience the ginalization [27, 28]. aftermath of physical, sexual, or emotional violence that Evidence suggests that children’s exposure to inter- occurs between their caregivers [6]. Exposure to inter- parental violence increases their risk of being victims of parental violence during youthful age has detrimental IPV or perpetrating violence in adolescence or adulthood effects on the individual [5, 6]. However, evidence on the [29]; however, it is unclear if exposure to interparental prevalence of interparental violence exposure remains violence increases the risk of experiencing IPV among scarce in Papua New Guinea (PNG). women in PNG. This study, therefore, seeks to fill this gap The experience of IPV has a huge negative impact on in literature accordingly, and contribute to efforts toward women’s health and well-being. Women who experience addressing the high prevalence of IPV in PNG. IPV report a higher likelihood of medical, gynaecological, In assessing the association between exposure to inter- and stress-related symptoms compared to women who parental violence and IPV experience, we used a multi- do not experience IPV [7, 8]. Stress due to the experience level logistic regression model, where we considered of IPV among women has been reported to activate neu- how individual and community-level factors interact to roendocrine and immune system pathways, which may explain the association between exposure to interparen- increase the risk of chronic conditions, including autoim- tal violence and IPV experience. Given the high preva- mune disorders and cancer [9]. Women of reproductive lence of IPV in PNG [30], we hypothesize that childhood age who experience IPV present with poor reproduc- exposure to interparental violence is associated with IPV tive and sexual health, including unintended pregnancy, among women in PNG. Human Immunodeficiency Virus (HIV), and other sexu- ally transmitted infections [10–12]. Factors underlying Methods these poor reproductive and sexual health outcomes Data source and study design include forced or coerced sex, a partner’s refusal to use We used data from the 2016–18 PNG Demographic and condoms, and other forms of reproductive coercion, Health Survey (PNG DHS). The PNG DHS is a nation- such as pressuring a woman to become pregnant against ally representative survey conducted periodically to pro- her wishes and sabotaging contraception (breaking or vide an update on the demographic and health situation removing condoms during sex) [13]. IPV is also associ- in PNG [31]. The 2016–18 PNG DHS is the first official ated with increased risk factors of obstetrical and gynae- DHS conducted in PNG in collaboration with the world- cologic complications, pregnancy-associated death, wide Demographic and Health Surveys Program, which preterm birth, low birth weight, peripartum depression, is a global programme coordinated by Inner City Fund and substance use [14]. (ICF), based in Rockville, Maryland, USA [31]. The PNG IPV has been reported to have an impact on women’s DHS employed a descriptive cross-sectional design in mental health, which translate to healthcare costs and collecting data from the respondents on several indica- disease burden among women [15]. IPV increases a tors such as domestic violence and other related health woman’s likelihood of experiencing depression, post- issues [31]. The dataset used can be accessed at https:// traumatic stress disorder, anxiety, suicidal behaviour, and dhspr ogram. com/ data/ datas et/ Papua- New- Guinea_ substance use behaviour [16–18]. The physical health Standa rd- DHS_ 2017.c fm? flag=1. We relied on the impact of IPV on women includes injuries such as contu- Strengthening Reporting of Observational Studies in Epi- sions, lacerations, and fractures [19, 20]. demiology (STROBE) reporting guidelines in drafting The prevalence of IPV, as well as its associated burden, this paper [32]. is highest in most low- and -middle-income countries [21, 22], and PNG is noted to be one of the countries Sampling technique and sample size with the highest prevalence, as well as the burden of IPV The PNG DHS employed a two-stage cluster sampling [23, 24]. The underlying factors that result in the high technique in recruiting the respondents for the survey. A hinkorah et al. BMC Women’s Health (2023) 23:48 Page 3 of 11 The sampling method was carried out in two stages. All and above”. Educational level was recoded into “no edu- the provinces were stratified into urban and rural areas cation”, “primary”, and “secondary or higher”. Exposure and this yielded forty-three sampling strata, except for to mass media was coded into “none”, “one”, and “two or the National Capital District, which has no rural areas. In more”. Parity was coded as “0 birth”, “1 birth”, “2 births”, the first stage, 800 census units were selected with prob- “3 births”, and “4 or more births”. Both community socio- ability proportional to the census unit size. In the second economic status and literacy level were coded as “low”, stage, a fixed number of 24 households per cluster were “medium”, and high”. selected with an equal probability of systematic selection from the newly created household listing, resulting in a Statistical analyses total sample size of approximately 19,200 households. We used Stata software version 16.0 (Stata Corpora- Detailed sampling procedure has been highlighted in the tion, College Station, TX, USA) throughout the analysis. literature [31]. In this study, we included 3,512 women First, we employed percentages to summarise the results with complete observations on all variables of interest. of the prevalence of IPV (Fig. 1). Pearson chi-square test was later used to examine the relationship between the Variables explanatory variables and IPV (Table 1). Subsequently, we Past-year experience of IPV was the outcome variable in used a multilevel binary logistic regression to examine the this study. IPV variables were derived from the domes- association between exposure to interparental violence tic violence model, which used a modified version of the and IPV, controlling for the covariates (Table  2). Five conflict tactics scale to ask questions [33, 34]. The ques- models were built to examine the association between tions used to assess physical, emotional, and sexual vio- interparental violence and IPV. Before the regression lence have been published elsewhere in the literature analysis, a multicollinearity test was conducted using the [35–39]. The response options to each of the questions variance inflation factor (VIF). The results showed that were “never” “often” “sometimes” and “yes, but not in the minimum, maximum, and mean VIFs were 1.02, 3.95, the last 12 months”. For this study’s purpose and regard- and 2.08, respectively. Hence, there was no evidence of ing literature [35–37], we recoded those whose response multicollinearity among the variables studied. The first option was either “never” and “yes, but not in the last model (Model O), which was an empty model with no 12  months” as “no” and was assigned a value “zero (0)”. explanatory factors or covariates, indicated the variation The remaining response options “often” and “sometimes” in IPV ascribed to the primary sampling units (PSUs). were coded as “yes” and labelled as “1”. We utilised the Model I contained only  the key explanatory variable, numeric labels “0 = no” and “1 = yes” in the final analysis. whereas Model II included the key explanatory variable Exposure to interparental violence was the key explan- and individual-level covariates. Model III contained the atory variable in the study. This variable was measured key explanatory variable and the community level vari- using the question “As far as you know, did your father ables. The final model (Model IV) consisted of the key ever beat your mother?”. The response options to this explanatory variable and all the covariates. The results of question were “no”, “yes”, and “don’t know”. Those who the regression analysis were presented in a tabular form answered "no" or "don’t know" were classified as "Not using crude odds ratio (cOR) and adjusted odds ratios exposed" to interparental violence, whereas those who (aOR) with 95 percent confidence intervals (CIs). Statis- answered "Yes" were classified as "Exposed”. The reclas- tical significance was set at p< 0.05. Furthermore, each sified responses were further coded as “0 = not exposed” of the five models incorporated both fixed and random and “1 = exposed”. This categorization was informed by effects. Fixed effects represented the association between literature that utilised the DHS dataset [40, 41]. the exposure to interparental violence and/or covariates We included 15 variables as covariates in the study. These variables were selected based on their association with IPV from previous studies [40–45] and their avail- ability in the DHS dataset. The variables consisted of IPV 55.3 the age of women, educational level, marital status, cur- Physical violence 45.6 rent working status, exposure to mass media (television, radio, and newspaper or magazine), parity, wealth index, Emotional violence 44.2 place of residence, region, community socioeconomic Sexual violence 23.9 status, and community literacy level. We maintained the existing coding for current working status, wealth index, 0 10 20 30 40 50 60 and place of residence in the final analysis as found in the Percentage (%) DHS. Age was recoded into “15–24”, “25–34″, and “35 Fig. 1 Prevalence of IPV among women in Papua New Guinea Ahinkorah et al. BMC Women’s Health (2023) 23:48 Page 4 of 11 Table 1 Distribution of intimate partner violence across Table 1 (continued) exposure to interparental violence and the covariates Variable Weighted Intimate partner Variable Weighted Intimate partner violence violence Frequency Percentage Yes [% CI] P value Frequency Percentage Yes [% CI] P value Community socioeconomic status 0.079 Low 1981 56.4 51.6 [48.0–55.1] Exposed to interparental violence < 0.001* Medium 307 8.7 62.8 [48.3–75.3] No 1874 53.4 49.4 [45.8–53.0] High 1224 34.9 59.5 [53.2–65.4] Yes 1638 46.6 62.0 [57.1–66.7] Women’s age (Years) [mean = 32.5, standard deviation = 7.92) < 0.001* *P value were generated from the Chi-square test 15–24 769 21.9 61.9 [56.5–67.0] 25–34 1329 37.8 58.7 [53.4–63.5] 35–49 1414 40.3 48.5 [44.0–53.1] and IPV, whereas random-effects denoted the measure Women’s educational level 0.163 of variation in the IPV dependent on primary sampling No education 1001 28.5 49.4 [42.8–56.0] units measured by intra-cluster correlation coefficient Primary 1637 46.6 55.3 [51.6–58.9] (ICC) . The Akaike’s Information Criterion (AIC) was Secondary or 874 24.9 62.1 [50.0–72.8] used to measure model fitness. The multilevel regression higher models were run using Stata’s "melogit" function. The Marital status 0.902 "svyset" command was used to correct for disproportion- Married 2902 82.6 55.4 [51.5–59.1] ate sampling and non-response, and weighting was done Cohabiting 610 17.4 55.0 [49.3–60.5] to account for the complex nature of DHS data. All the Current working status 0.268 analyses were weighted according to the DHS guidelines. No 2395 68.2 54.3 [49.7–58.7] Yes 1117 31.8 57.5 [53.4–61.5] Ethical consideration Parity 0.095 Because this study used publically available data, no ethi- Zero birth 339 9.7 60.0 [51.4–68.0] cal approval was required. Further information regard- 1 birth 633 18.0 65.9 [52.5–77.2] 2 births 563 16.0 52.6 [43.9–61.2] ing the data and ethical norms can be accessed at http:// 3 births 576 16.4 55.2 [49.7–60.5] goo. gl/ ny8T6X. We carried out this study in accordance 4 or more births 1401 39.9 50.5 [46.0–55.0] with relevant guidelines and regulations concerning the Exposure to mass media < 0.001* use of DHS dataset for publication. None 1853 52.7 49.4 [45.7–53.2] One 607 17.3 57.4 [51.3–63.3] Results Two or more 1052 30.0 64.4 [59.1–69.4] Prevalence of intimate partner violence among women Wealth index 0.055 in Papua New Guinea Poorest 659 18.8 50.8 [44.3–57.3] Figure 1 presents the prevalence of IPV among women in Poorer 695 19.8 50.6 [44.7–56.5] PNG. The overall prevalence of IPV among women was Middle 703 20.0 54.9 [49.0–60.6] 55.3% [53.6–56.9]. The prevalence of physical, emotional, Richer 663 18.9 56.8 [51.8–61.8] and sexual violence observed in this study were 45.6, Richest 792 22.5 62.2 [54.3–69.5] 44.2, and 23.9%, respectively. Place of residence 0.005* Urban 395 11.2 64.8 [58.3–70.8] Distribution of intimate partner violence Rural 3117 88.8 54.1 [50.3–57.9] across the explanatory variable and covariates Region 0.444 Table  1 displays the distribution of IPV across the Southern Region 682 19.4 52.1 [47.5–56.6] explanatory variable and covariates. The results indi- Highlands Region 1347 38.4 56.0 [51.1–60.8] cated substantial differences in IPV across the exposure Momase Region 996 28.3 58.1 [49.5–66.2] to interparental violence, women’s age, exposure to mass Islands Region 487 13.9 52.2 [47.1–57.2] media, and place of residence at p< 0.05. Particularly, Community literacy level 0.076 IPV was found to be prevalent among women exposed Low 1362 38.8 50.6 [45.6–55.6] to interparental violence [62.0% (57.1–66.7)] relative Medium 1271 36.2 57.2 [52.5–61.8] to women not exposed interparental violence [49.4% High 879 25.0 59.8 [52.1–67.0] (45.8–53.0)]. IPV was highest among women aged 15–19 [61.9% (56.5–67.0)] but lowest among those aged 35–49 A hinkorah et al. BMC Women’s Health (2023) 23:48 Page 5 of 11 Table 2 Association between exposure to interparental violence and intimate partner violence among women in Papua New Guinea Variable Model O Model I cOR [95% CI] Model II aOR [95% CI] Model III aOR [95% CI] Model IV aOR [95% CI] Fixed effects results Exposed to interparental violence No 1.00 1.00 1.00 1.00 Yes 1.53** [1.17, 2.00] 1.46** [1.13, 1.87] 1.52** [1.16, 1.98] 1.45** [1.13, 1.86] Women’s age (years) 15–24 1.00 1.00 22–34 1.12 [0.67, 1.88] 1.14 [0.68, 1.89] 35–49 0.69 [0.39, 1.24] 0.69 [0.39, 1.23] Women’s educational level No education 1.00 1.00 Primary 1.28 [0.79, 2.09] 1.32 [0.79, 2.22] Secondary or higher 1.25 [0.48, 3.23] 1.29 [0.47, 3.53] Marital status Married 1.00 1.00 Cohabiting 1.06 [0.81, 1.41] 1.05 [0.79, 1.40] Current working status No 1.00 1.00 Yes 1.17 [0.91, 1.49] 1.18 [0.92, 1.51] Parity Zero birth 1.00 1.00 1 birth 1.01 [0.61, 1.68] 1.02 [0.62, 1.71] 2 births 0.60 [0.30, 1.21] 0.61 [0.31, 1.23] 3 births 0.73 [0.43, 1.24] 0.74 [0.44, 1.25] 4 or more births 0.77 [0.49, 1.21] 0.80 [0.51, 1.25] Exposure to mass media None 1.00 1.00 One 1.12 [0.80, 1.57] 1.07 [0.77, 1.50] Two or more 1.38 [0.93, 2.05] 1.28 [0.87, 1.88] Wealth index Poorest 1.00 1.00 Poorer 0.97 [0.67, 1.40] 0.95 [0.66, 1.38] Middle 1.09 [0.74, 1.61] 1.06 [0.72, 1.56] Richer 1.01 [0.67, 1.54] 0.90 [0.57, 1.41] Richest 0.94 [0.55, 1.60] 0.68 [0.37, 1.25] Place of residence Urban 1.00 1.00 Rural 0.56** [0.40, 0.78] 0.50** [0.32, 0.80] Region Southern Region 1.00 1.00 Highlands Region 1.37* [1.02, 1.83] 1.44* [1.06, 1.96] Momase Region 1.15 [0.85, 1.56] 1.18 [0.86, 1.61] Islands Region 1.03 [0.76, 1.38] 1.03 [0.75, 1.40] Community literacy level Low 1.00 1.00 Medium 1.22 [0.93, 1.60] 1.10 [0.80, 1.51] High 1.14 [0.82, 1.61] 1.02 [0.67, 1.56] Community socioeconomic status Low 1.00 1.00 Medium 1.38 [0.86, 2.19] 1.45 [0.90, 2.35] Ahinkorah et al. BMC Women’s Health (2023) 23:48 Page 6 of 11 Table 2 (continued) Variable Model O Model I cOR [95% CI] Model II aOR [95% CI] Model III aOR [95% CI] Model IV aOR [95% CI] High 1.28 [1.00, 1.63] 1.35 [0.99, 1.86] Random effects results PSU variance (95% CI) 0.830 [0.609–1.130] 0.806 [0.590–1.103] 0.795 [0.558–1.132] 0.752 [0.546, 1.035] 0.777 [0.550–1.098] ICC 0.201 0.197 0.194 0.186 0.191 Wald chi‑square Reference 9.64 (0.002) 39.27 (0.002) 35.90 (< 0.001} 57.42 (< 0.001) Model fitness Log‑likelihood −2112.8019 −2100.4571 −2063.7284 −2088.4683 −2053.533 BIC 4241.932 4225.406 4282.572 4266.74 4327.492 N 3512 3512 3512 3512 3512 Number of clusters 750 750 750 750 750 aOR adjusted odds ratios, cOR Crude odds ratio, CI Confidence interval, *p< 0.05, **p< 0.01; 1.00 Reference category; PSU Primary Sampling Unit, ICC Intra-Class Correlation Coefficient, LR Test Likelihood ratio Test, AIC Akaike’s Information Criterion; N Total sample [48.5% (44.0–53.1)]. In terms of exposure to mass media, the clustering of the primary sampling units (PSUs) the highest proportion of IPV [64.4% (59.1–69.4)] was (σ2 = 0.83, 95% CI 0.61–1.13). The empty model showed observed among women who were exposed to two or that 20.1% of the total variance in IPV was attributed more mass media whereas those who had no exposure to the between-cluster variation of characteristics to mass media recorded the lowest proportion [49.4% (ICC = 0.201). The between-cluster variations decreased (45.7–53.2)]. With the place of residence, IPV was higher marginally in Model I, from 20.1% in the empty model to among urban women [64.8 (58.3–70.8)] compared to 19.7% in the model with only the key explanatory variable rural women [54.1% (50.3–57.9)]. Finally, apart from (exposure to interparental violence). From Model I, the exposure to interparental violence, maternal age, expo- ICC declined further to 19.4% (ICC = 0.194) in the model sure to mass media, and place of residence which were that controlled for the individual-level covariates (Model found to be significantly associated with IPV in this anal- II) and reduced further to 18.6% in the model that con- ysis, the rest of the variables were insignificantly related trolled for community-level covariates (Model III). In to IPV (see Table 1). the final model, the ICC value increased to 19.1%. This result shows that the disparities in the probability that IPV would occur could be ascribed to the differences in Mixed effect analysis of association between exposure the grouping of the sampling units. With the lowest log- to interparental violence and intimate partner violence likelihood ratio (-2053.533) and the highest BIC value Fixed effects (measures of association) results (4327.492), the final model which had the key explana- Model III of Table 2 presents the results of the associa- tory variable and controlled for both the individual and tion between interparental violence exposure and IPV community level variables was chosen as the best fit for among women in PNG, controlling for the covariates. We predicting the occurrence of IPV. found a higher probability of experiencing IPV among women exposed to interparental violence [aOR = 1.45, 95% CI = 1.13, 1.86] relative to women who were not Discussion exposed. For the covariates, we observed that women The current study examined the association between who were living in rural settings had a lower likelihood exposure to interparental violence and IPV among of IPV experience [aOR = O.50, 95% CI = 0.32, 0.80] women in PNG. The overall prevalence of IPV was relative to women living in urban settings. Finally, in 55.3%. The prevalence found in this study is similar to terms of region, greater odds of experiencing IPV was those of other studies conducted in Asia–Pacific coun- found among women staying in the Highlands Region tries including Bangladesh [46] and Afghanistan [47]. [aOR = 1.44, 95% CI = 1.06, 1.96] relative to those staying However, the finding in this current study is higher than in the Southern Region (see Table 2). those found in prior studies, which include 39% in India [48], 40% in Pakistan [49], and 45.3% in Bangladesh [50], but lower than 82.7% in rural Bangladesh [51], and 67% Random effects (measures of variation) results in the Gambia [52]. The high prevalence of IPV found As shown in Table  2, in the empty model, there were in this research may be a result of the country’s rigid substantial variations in the likelihood of IPV across A hinkorah et al. BMC Women’s Health (2023) 23:48 Page 7 of 11 conventional attitudes and gender standards, as well how women ought to act. Men utilized sexual assault as as poor access to public health education, justice, and a tool of control and punishment since it was viewed as social services, which have been reported to influence morally acceptable [57]. IPV perpetration [47, 53, 54]. Differences in cultural and The current study found interparental violence, place socioeconomic dimensions could have had a profound of residence and region to be significantly related to impact on our findings. IPV among PNG women. It was discovered that women Although rates varied depending on the type of abuse, who experienced interparental violence showed a IPV was relatively common in PNG. Generally, physical greater likelihood of IPV experience. The study findings violence was found in the present study to be the most corroborate previous studies in Pakistan [58], Bang- prevalent form of IPV (45.6%), followed by emotional ladesh [45], Nigeria [41], and Ethiopia [59] that being violence (44.2%), and then sexual violence (23.9%). This exposed to interparental violence increases women’s tendency was largely consistent with other Asia–Pacific likelihood of IPV experience. As a result, the study studies on IPV [55]. The extensive history of violent con- results support previous studies and imply that this flicts in PNG, not only affected and included a sizeable relationship exists in PNG as well. Prior research has section of the current adult population but also left a per- proposed possible explanations for this association, sistent negative imprint on the inhabitants. This could including mechanisms by which being exposed to inter- have influenced the prevalence of physical, emotional, parental violence may be linked to a greater danger of and sexual violence among women, as women usually women experiencing IPV [41, 53, 60]. For example, it become the vulnerable populace. Evidence also sug- was suggested that women who have experienced inter- gests that men who have experienced childhood trauma parental or intra-family abuse may develop psycho- were more likely to commit all measurable types of IPV, logical depictions of connections that make them more a plausible reason for the observed findings in our study susceptible to IPV [40, 61]. Daughters might develop [55, 56]. connection simulations along the dominance-sub- Despite the wide cultural diversity in PNG, men are servience and victim-victimizer scopes due to seeing typically socialized to engage in forceful and active inter- their father and mother strike one another [40, 62]. As personal interaction. In PNG, using violence to settle a result, women can select spouses and surroundings disputes, express anger, or discipline misbehaving peo- that reflect their comprehension of what affairs are all ple, especially women who defy social norms, is com- about, who they are in affairs with, and what to antici- monplace and completely justified. Young children are pate from a spouse [40, 61]. Thus, the study findings are frequently subjected to physical abuse, and the common in line with the multi-generational impact of violence wisdom holds that physical abuse improves understand- studies [63]. ing [57]. It is important to note that in PNG, fathers are Another prospect is that women who have experi- primarily responsible for enforcing household rules. The enced interparental violence will perceive IPV as a regu- PNG home culture normalizes physical abuse of both lar aspect of intimate affairs, particularly in PNG, where children and mothers, which is reflected in these strict intimate affairs are moulded and dictated by traditional parenting techniques. That is, strict parenting methods concepts and conceptualizations. This confirms Kwa- used by men are most significantly related to whether the gala et al. [64] study in Uganda stated that interparental male spouse physically punishes the children, which is violence exposure is an aspect of socialization, fostering directly tied to male IPV against women in the house, a views that approve IPV. As a result, domestic abuse could form of disciplining women [55]. Men who have experi- be an aspect of a lifelong cycle, starting with infant expo- enced child abuse or who have seen their mothers being sure to violence in the home and progressing into adult- abused are more likely to physically abuse their wives hood with violence in intimate affairs and homes [40, [55]. 61]. It is uncertain whether culprits of domestic abuse Furthermore, women who experience sexual vio- have an intergenerational or multigenerational influence. lence are seen as acting contrary to social norms that Regardless, the findings sturdily underscore the neces- hold women to be obedient to men. Men view women sity for early detection of IPV and family intervention to and girls who defy these social conventions and are lessen the possibility that abused mothers’ children may observed entering pubs or nightclubs as a fair game. suffer abuse as victims or culprits as adults. Such ideas are based on the idea that violence against In our study, place of residence was shown to be sig- women is a means of punitively enforcing male control nificantly associated with IPV among women in PNG. over women. Acts of sexual violence also have a disci- This could be related to cultural beliefs and customs plinary component because men target women who are including male dominance in decision-making, female thought to be acting contrary to social expectations of inheritance, polygamy, and religious issues, which could Ahinkorah et al. BMC Women’s Health (2023) 23:48 Page 8 of 11 make disclosing any IPV experience in rural PNG diffi- data, which limits causal explanations of the results. cult [65]. It is also likely that there was under-reporting Secondly, because the study depended on self-reported among rural women in PNG, which could be related to data that may not be objectively checked, the preva- the sensitivity around gender-based abuse and discussing lence of IPV and interparental violence may be under- female issues in the PNG environment, including rejec- estimated or overstated. Furthermore, the data for this tion, embarrassment, or stigma connected with domestic study was restricted to women alone, which is compa- violence [52, 66]. As a result, more research is required rable with the widespread perception that women are to explain why there are discrepancies between rural the most common sufferers of IPV. Whereas this widely and urban women in PNG. Furthermore, it is common held assumption may be challenged in the future, the knowledge that urban women are typically financially findings of this present study provide timely and valu- autonomous and educated and that such women are per- able insights that may be utilized to tackle the existing ceived as a danger by their husbands. IPV may be used as oppression of women in domestic violence in PNG. a mechanism by men to exert control over their female spouses [67]. It is also possible that some urban women in PNG approve of wife-beating as a result of their expo- Policy and public health implications sure to interparental violence and financial reliance on The discovery that exposure to interparental abuse men [41, 47]. In their relationships, such women fre- augments the risk of IPV has policy and public health quently become helpless and ostracized, demonstrating consequences. The findings of the study suggest that an inability to safely criticize their partners and avoid vio- prevailing policies and programs be consolidated, or lence [59]. that new strategies and programs be developed to The present study also revealed women living in the tackle interparental violence and IPV in PNG. Due to Highlands region have a greater probability of experienc- the complexities of interparental violence and its links ing IPV relative to women living in the Southern region. to IPV, coupled with demographic considerations, sin- This might be a result of the region’s high population den- gle strategies and programs are improbable to result in sity, the dominance of men and masculine values, as well long-term change and consequences. As a result, multi- as the submissive dependency of women on men for sur- ple and comprehensive techniques and approaches are vival in this area. Men in the highlands of PNG are said necessary. The supply of information and capital at the to deliberately oppose any increase in women’s power communal and societal levels, as well as emancipation because they perceive it as a loss for themselves. When programs for women, expanded social systems, and their authority over women is questioned, men will use self-assurance for women, are all feasible measures for the bride-price argument, which claims that paying the fighting interparental violence. Young women subjected bride price gives them complete control over their wives to interparental violence must be shown special con- [68]. Traditionally, wedlock in the highlands of PNG is sideration in these intercession strategies. The major- frequently understood to involve the handover of con- ity of societies, especially in urban areas in PNG, need jugal rights, granting the husband access to and control to increase public health edification and information over the wife’s body sexually. When individuals talk about about the serious health and communal repercussions "purchasing a woman/wife," they are referring to the of interparental violence and IPV. Because of concerns trade of bride price, which is progressively seen as a type such as poverty, lack of access to proper domestic vio- of commodity exchange [68]. With this in mind, women lence evidence and services, insufficient legitimate rep- are more likely to experience IPV than these men. aration for sufferers of abuse, and traditional customs, morals, and practices, policies for tackling interparen- Strengths and limitations tal violence and IPV face particular challenges in PNG To the best of our knowledge, our study is the first to settings. Nevertheless, initiatives and interventions that examine the association between exposure to interpa- are attentive to the cultural environment of people who rental violence and the experience if IPV among women are engaged in interparental violence and IPV may be using a nationally representative dataset. Furthermore, the most effective in fostering long-term transforma- the usage of a nationally representative survey (DHS) tion and results. allowed for the collection of an extremely representa- tive sample of the target population. Conclusions from Conclusion the study findings are valid due to the high sample size Exposure to interparental violence was found to be sig- and nationally representative nature of the data. Nev- nificantly associated with IPV among women in PNG. ertheless, the study’s conclusions had some limitations. The findings of this study suggest the need for proven To begin with, the study depended on cross-sectional operational strategies to reduce IPV, such as improving A hinkorah et al. BMC Women’s Health (2023) 23:48 Page 9 of 11 anti-IPV  laws in PNG. We recommend the develop- Ghana. 6 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia. 7ment and implementation of intercession strategies REMS, Consult, Sekondi‑Takoradi, Ghana. 8 Centre For Gender and Advocacy, Takoradi Technical University, P.O.Box 256, to reduce the experience and justification of violence Takoradi, Ghana. 9 School of International Development and Global Studies, among women exposed to interparental violence. In University of Ottawa, Ottawa, Canada. 10 The George Institute for Global addition, health professionals should implement coun- Health, Imperial College London, London, UK. seling and health education initiatives to tackle the Received: 23 May 2022 Accepted: 16 January 2023 consequences of IPV on women’s well-being. Abbreviations AIC Akaike Information Criterion References aOR Adjusted odds ratio 1. Centers for Disease Control and Prevention. Intimate partner violence: CI Confidence Interval definitions. 2021. Fast Facts: Preventing Intimate Partner Violence. https:// DHS D emographic and Health Survey www.c dc.g ov/v iole ncepr eventi on/ intim atepa rtner violen ce/f astfa ct. HIV Human Immunodeficiency Virus html#: ~: text= Intim ate% 20part ner% 20viol ence% 20(IPV)% 20is,and% ICC Inter‑Cluster Correlation 20how% 20seve re% 20it% 20is. ICF Inner City Fund 2. Smith SG, Basile KC, Gilbert LK, Merrick MT, Patel N, Walling M, Jain A. 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