Ethical and Safety Recommendations for Research on

Domestic Violence Against Women

Department of Gender and Women's Health Family and Community HealthWorld Health Organization

Geneva, Switzerland

PUTTING WOMEN FIRST:

WHO/FCH/GWH/01.1Distribution: General

The Dharma-Charkra or 'Wheel of Law' is the most important symbolBuddhism. In an individual's life, 'Dharma' becomes manifest as 'good' or noble conduct. Chakra means the wheel and symbolizes a constantly changing universe. The 8 spokes of the wheel correspondto the 8 paths to enlightenment, namely:

1.� Right view2.� Right resolution3.� Right speech4.� Right conduct5.� Right means of livehood6.� Right effort7.� Right mindfullness8.� Right concentration

The Dharma-Chakra, orWheel of Law

Cover design: Máire Ní Mhearáin

Design inspired by the stone wheels of the Konarak Sun Temple in Orissa (province of Orissa, India)(source: Ikat Textiles of India, by Chelna Desai).

Putting Women First:

Ethical and SafetyRecommendations forResearch on DomesticViolence AgainstWomen

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World Hea lth OrganizationWorld Hea lth OrganizationWorld Hea lth OrganizationWorld Hea lth OrganizationWorld Hea lth OrganizationGeneva , SwitzerlandGeneva , SwitzerlandGeneva , SwitzerlandGeneva , SwitzerlandGeneva , Switzerland

© World Hea lth Organization, 2001

This document is not a forma l publication of the World Hea lthOrganization (WHO), and all rights are reserved by theOrganization. The document may, however, be freely reviewed,abstracted, reproduced or translated, in part or in whole, but notfor sa le or for use in conjunction with commercia l purposes. Theviews expressed in documents by named authors are solely theresponsibility of those authors.

Document layout: Maureen Dunphy

These recommendations were developed for WHO from thoseprepared for the World Health Organization Multi-Country Studyon Women’s Hea lth and Domestic Violence by Charlotte Watts,Lori Heise, Mary Ellsberg and Claudia Garcia Moreno⌫. They buildon the collective experiences of the Internationa l ResearchNetwork on Violence Aga inst Women. We would like to acknowl-edge the guidance of the WHO Steering Committee of the Studyand the va luable input of the Scientific and Ethica l Review Group(SERG) of the WHO Special Programme of Research, Develop-ment and Research Training in Human Reproduction, in particularRuth Macklin. We a lso thank Henriette Jansen, Shana Swiss andCathy Zimmerman for their comments and suggestions on theearlier version of this document (WHO/EIP/GPE/99.2).

For further information on these Guidelines and the Multi-CountryStudy please contact:

Dr Claudia Garcia-MorenoCo-ordinatorWHO Study of Women’s Health and Domestic ViolenceGender, Women and HealthWorld Health Organization20 Avenue AppiaGeneva 1211Switzerland

Tel: 41 (22) 791-4353Fax: 41 (22) 791-4328Email: garciamorenoc@who.int

⌫ Claudia Garcia-Moreno, WHO, is the Co-ordinator of the WHOMulti-Country Study on Women’s Hea lth and Domestic ViolenceAga inst Women. Lori Heise and Mary Ellsberg of PATH are Technica lAdvisers to the Multi-Country Study. Charlotte Watts is a SeniorLecturer in Epidemiology and Hea lth Policy at the London School ofHygiene and Tropica l Medicine, and Senior Technica l Adviser to theStudy.

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Violence aga inst women, in its various forms, isendemic in communities and countries aroundthe world, cutting across class, race, age,

religious and nationa l boundaries. According to theUnited Nations Declaration, violence aga inst womenincludes “any act of gender-based violence thatresults in, or is likely to result in, physica l, sexua lor psychologica l harm or suffering to women,including threats of such acts, coercion or arbitrarydeprivations of liberty, whether occurring in publicor private life (United Nations, 1993)”. The mostcommon type of violence aga inst women worldwideis “domestic violence” or the physica l, emotiona land/or sexua l abuse of women by their intimatepartners or ex-partners (Heise et a l., 1999). There areother forms of violence, such as dowry harassmentand wife inheritance, which are linked to traditiona lor customary practices and are limited to specificregions and communities.

It is only now, through the susta ined activism bywomen’s organizations that violence aga inst women,including domestic violence, is starting to receivesubstantia l attention internationa lly. As domesticviolence aga inst women becomes increasingly

Introduction

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recognized and discussed, important questions arebeing ra ised concerning its magnitude in differentsettings, and its causes, consequences and relatedrisk factors. Likewise, there is increasing recognitionof the need for better data on the effectiveness ofdifferent interventions.

Due to the limitations of service-based data ,accurate figures on the preva lence of domesticviolence must be obta ined through population-basedsurveys in which a representative sample ofrandomly selected women are asked directly abouttheir experiences of violence. Population-basedsurveys can a lso be used to obta in importantinsights into some of the consequences of violenceand risk factors associated with violence and in thelong term, to monitor trends and to explore theimpact of different interventions. On the other hand,more in-depth qua litative research provides a meansfor obta ining greater insights into the settings andcontexts in which violence occurs, the dynamicsof abuse, and to better understand how women,children and communities are affected by thisviolence. Likewise, research on men can provideimportant insights into the causes of violence, andthe impact of different forms of intervention.

Research on violence aga inst women ra ises impor-tant ethica l and methodologica l cha llenges in addi-tion to those posed by any research. The nature ofthe topic means that issues of safety, confidentia lity

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and interviewer skill and tra ining are even moreimportant than for other areas of research. It is notan exaggeration to say that the physica l safety andpsychologica l well-being of both the respondents andthe research team can be put in jeopardy if adequateprecautions are not taken.

In order to guide future research in this area , theWorld Hea lth Organization has developed thefollowing recommendations regarding the ethica lconduct of domestic violence research. These buildon the collective experience of the Internationa lResearch Network on Violence Aga inst Women(IRNVAW). They have been reviewed and approvedby the WHO Steering Committee for the Multi-CountryStudy on Women’s Hea lth and Domestic ViolenceAga inst Women, and a lso reviewed by key membersof the Scientific and Ethica l Review Group (SERG) ofthe Specia l Programme on Research and ResearchTra ining on Human Reproduction (HRP). The recom-mendations are in addition to those outlined in theCIOMS Internationa l Guidelines for Ethica l Review ofEpidemiologica l Studies (1991).

These recommendations are designed for use bothby anyone intending to do research on domesticviolence aga inst women (such as investigators,project co-ordinators and others implementing suchresearch), and a lso by those initiating or reviewingsuch research (such as donors, research ethica lcommittees etc.). The guidelines focus on the specific

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ethica l and safety issues associated with planningand conducting research on this topic. They do notintend to give genera l guidance or recommendationson the planning, methodology, and logistics ofresearch on domestic violence aga inst women, orissues associated with the ethica l conduct ofresearch in genera l. (The latter is addressed by theCIOMS Guidelines referred to above).

These recommendations emerged from discussion ofthose prepared for the WHO Multi-country Study onWomen’s Hea lth and Domestic Violence Aga instWomen. They focus in particular on the ethica l andsafety considerations associated with conductingpopulation-based surveys on domestic violenceaga inst women. However, many of the principlesidentified are a lso applicable to other forms ofquantitative and qua litative research on this issue.

The recommendations were not written for researchon other forms of violence aga inst women, such asviolence in conflict situations, or trafficking ofwomen. Whilst it is likely that some aspects of theguidelines will be applicable in those situations,there may a lso be some important differences.

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Researching DomesticViolence Against

Women

It is often felt that domestic violence aga instwomen is too sensitive a topic to be explored ina population-based survey, and that shame,

self-blame or fear of further violence will preventwomen from discussing their experiences. However,more than 50 community-based studies on this issuehave been successfully conducted in Asia , Africa , theMiddle East, Latin America , Europe and NorthAmerica (Heise, 1994; WHO, 1997; Heise et a l.,1999), and a number of instruments have beendeveloped to quantify the extent, nature, severityand frequency of different forms of interpersona lviolence. Studies show that research on domesticviolence aga inst women can be conducted with fullrespect of ethica l and safety considerations. Theya lso illustrate how, when interviewed in a non-judg-menta l manner in an appropriate setting, manywomen will discuss their experiences of violence.Indeed, rather than being a barrier, evidence sug-gests that many women find participating in violenceresearch beneficia l (Center for Hea lth and GenderEquity, 1996).

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Despite these positive findings to date, there is therea l danger that research conducted without duesensitivity and attention to safety and confidentia litycould be distressing and put respondents, and attimes researchers, at risk. All research on domesticviolence aga inst women needs to prioritize women’ssafety, and build into the study design plans on howto protect the safety of a ll participants and to ensurethat the research is conducted in an ethica l andappropriately sensitive manner. Box 1 summarizeskey ethica l and safety principles that should guidea ll such research. Recommended actions that shouldbe taken to ensure that the research adheres tothese principles are then described.

a) The safety of the respondents and theresearch team is paramount and should guideall project decisions

The physica l safety of respondents and interviewersfrom potentia l reta liatory violence by the perpetratoror perpetrators is of prime importance. If the focus ofa household survey on domestic violence becomesknown - either within the household, or among thewider community - a perpetrator may find out aboutthe topic of the interview. For women experiencingviolence, the mere act of participating in a surveymay provoke further violence, or place the respon-

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a . The safety of respondents and the researchteam is paramount, and should guide a llproject decisions.

b . Preva lence studies need to be methodologi-ca lly sound and to build upon current re-search experience about how to minimize theunder-reporting of violence .

c . Protecting confidentia lity is essentia l toensure both women’s safety and dataqua lity.

d . All research team members should be carefully selected and receive specia lized tra iningand on-going support.

e . The study design must include actions a imedat reducing any possible distress caused tothe participants by the research.

f . Fieldworkers should be tra ined to referwomen requesting assistance to ava ilableloca l services and sources of support. Wherefew resources exist, it may be necessary forthe study to create short-term supportmechanisms.

g. Researchers and donors have an ethica lobligation to help ensure that their findingsare properly interpreted and used to advancepolicy and intervention development.

h . Violence questions should only be incorpo-rated into surveys designed for other pur-poses when ethica l and methodologica lrequirements can be met.

BOX 1: ETHICAL AND SAFETY RECOMMENDATIONSFOR DOMESTIC VIOLENCE RESEARCH

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dent or the interview team at risk. At the same time,the woman, as the subject and beneficiary of theresearch, needs to give full informed consent. Thus,for both ethica l and safety reasons, it is importantthat the survey is not introduced to the householdand wider community as a survey on violence.Instead, at this level the study should be framed ina different manner - such as a study on women’shea lth and life experiences. However, the womanherself has to be fully informed about the natureof the questions. During the initia l consentprocedure, the sensitivity of the research topicshould be ra ised. During the course of the interview,the interviewer should introduce any sectionenquiring about violence carefully, forewarning therespondent about the nature of the questions andgiving her the opportunity to either stop theinterview, or not to answer these questions.

! Interviews should be conducted only in aprivate setting. The participant should feel free toreschedule (or relocate) the interview to a time (orplace) that may be more safe or convenient for her.

! The study should be framed as a study onwomen’s hea lth, life experiences or family relations.This will enable the respondent to expla in the surveyto others safely. This explanation should a lso be usedby the researchers/ interviewers to describe thesurvey to the community and to other members of

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the household. Once the respondent and interviewerare a lone, further information on the exact nature ofthe study should be provided to her as part of theconsent procedure.

! In instances where the sampling unit is thehousehold, only one woman per household shouldbe interviewed about her experiences of domesticviolence. In households with more than one eligiblewoman, a single respondent should be selectedrandomly for interview. Any interviews conductedwith other household members (either ma le orfema le) should not include questions exploring theirattitudes, experience or use of violence - as this mayresult in their suspecting that the key respondentwas a lso asked about domestic violence.

! When interviewing in the context of a house-hold survey, interviewers should be tra ined toterminate or change the subject of discussion if aninterview is interrupted by anyone - includingchildren. As a possible strategy, a short diversionaryquestionna ire on a less sensitive topic concerningwomen’s hea lth (such as menstruation, familyplanning or child spacing) can be developed to assistwith this. The interviewer can then forewarn therespondent that she will start to discuss this othertopic if an interview is interrupted, and if needed,turn to the diversionary questionna ire.

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! Logistics planning should include consider-ation of respondent safety. This will require thatthe study’s budget anticipate the likely need tore-schedule some interviews. It should a lso includeadvance identification of additiona l locations (suchas a loca l hea lth centre) where interviews can beconducted if women so desire.

! Logistics planning and budgeting should a lsoconsider the safety needs of interviewers. To ensuresafety, it may be necessary for interviewers to travelin pa irs, to carry mobile phones, to use designatedmeans of transport /drivers or to assign a trustedma le escort to accompany teams into certa inneighbourhoods known to be unsafe for womena lone. This is particularly true in circumstanceswhere interviewers may have to conduct interviews inthe evenings.

b) Prevalence studies need to bemethodologically sound and build uponcurrent research experience about how tominimize the under-reporting ofviolence

The increasing attention being given to violenceaga inst women has, in some settings, resulted inthe rapid implementation of population-basedsurveys to document the preva lence of differentforms of violence and abuse. As with other studies on

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sensitive topics, the tendency will be for participantsto under-report their experiences. Thus, there is thedanger that a well-intentioned but poorly conceptua l-ized or implemented study may result in a seriousunder-reporting of violence. This ra ises both ethica land practica l concerns.

Ethica lly, it is unacceptable to conduct a poorlydesigned study that cannot hope to address itsprimary study a ims. This is particularly true forstudies on violence aga inst women, where womenare asked to disclose difficult and pa inful experi-ences and where, moreover, the nature of the subjectmatter may put women at risk.

Practica lly, too, it is of concern if a study documentslow levels of domestic violence in a setting wherepreva iling evidence is to the contrary. Bad data maybe worse than no data , because low preva lenceestimates could potentia lly be used to question theimportance of violence as a legitimate area of con-cern. Consequently, it is important that domesticviolence surveys are methodologica lly sound andbuild upon current research about how to minimizeunder-reporting.

Current research suggests that rates of disclosure arelinked to the manner in which questions are wordedand asked. Genera lly, questions should avoid usingloaded terms such as ‘abuse,’ ‘rape,’ or ‘violence’and instead ask respondents about whether or not

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they have experienced certa in specific acts, such asbeing hit, slapped, or beaten. For each type of abuse,it is useful to ask about a range of behaviours a longwith specific cues directing the respondent to con-sider different settings (such as at home, work orschool) or potentia l perpetrators (such as currentpartners, former partners, other ma le relatives,ma les in positions of authority). Single, broadquestions on abuse /violence, are genera llyinadequate for capturing true rates of abuse /violence(Center for Hea lth and Gender Equity, 1995). Rates ofdisclosure are a lso related to the nature and lengthof other questions in the interview, the number ofopportunities respondents are given to disclose, andthe presence or absence of others during the inter-view (Ellsberg et a l., 2001).

The extent to which women will discuss their experi-ences of violence is a lso influenced by the sex, skill,attitude and tra ining of the interviewer. Mostviolence aga inst women is perpetrated by men, andexperience to date suggests that fema lerespondents feel most comfortable ta lking aboutviolence with other women. It has a lso beenfound that adult women prefer not to discussviolence with interviewers whom they perceivemay not understand or be sympathetic to theirexperiences. Consequently, in some settings, difficul-ties have been encountered when using young orunmarried women as interviewers, or when usinginterviewers who are not experienced at discussing

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sensitive issues. This highlights the importance ofensuring that interviews are conducted by carefullyselected and appropriately tra ined fema leinterviewers, the need for the careful pre-testing andpiloting of the research tools, and the importance ofmonitoring the qua lity of a study’s implementation.

In situations where very low levels of violence aredocumented or there are results that are otherwisenot expected, the findings should be discussedwith key informants and different community groupsbefore being widely disseminated. Where thesegroups question the va lidity of the findings, theirconcerns should a lso be presented duringdissemination activities.

c) Protecting confidentiality is essential toensuring both women’s safety and dataquality

Much of the information provided by respondentswill be extremely persona l. The dynamics of a violentrelationship are such that the act of revea ling deta ilsof violence to someone outside the family could a lsoprovoke another violent episode. For these reasons,the confidentia lity of information collected duringa survey or from in-depth interviews with survivorsof violence is of fundamenta l importance. A numberof mechanisms should be used to protect the confi-dentia lity of the information collected, including:

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! All interviewers should receive strictinstructions about the importance of ma inta iningconfidentia lity. This must a lso be addressed in theirtra ining. No interviewers should conduct interviewsin their own community.

! No names should be written onquestionna ires. Instead, unique codes should beused to distinguish questionna ires. Where identifiersare needed to link a questionna ire with thehousehold location or respondent, they should bekept separately from the questionna ires, and uponcompletion of the research, destroyed. In a ll furtherana lysis, the codes should be used to distinguishquestionna ires. Participants should be informed ofconfidentia lity procedures as part of the consentprocess.

! Where tapes are made of in-depth interviewswith survivors of violence, these should be kept in alocked cabinet with limited access, and erasedfollowing transcription. The permission of therespondents should be sought before taping. Aga in,no record of the name of the women interviewedshould be kept and women should be informed ofwho will have access to the tapes and for how longthey will be kept.

! Particular care should be taken duringthe presentation of the research findings that theinformation presented is sufficiently aggregated toensure that no one community or individua l can be

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identified. Where case-study findings are presented,sufficient deta il should be changed to ensure that itis not possible to identify the source of thisinformation.

! Although photographs of abused women canbe a powerful and emotive way of communicatingabout domestic violence, particular care shouldbe used when using this form of documentation.Women should be asked specifica lly whetherphotographs may be taken and shown, and mustagree to this as part of the informed consent process.They should be informed how and where thephotographs will likely be shown or displayed.

d) All research team members should becarefully selected and receive specializedtraining and on-going support

One of the enduring lessons to emerge from theexperience of IRNVAW members is that a ll researchteam members involved in violence aga inst womenresearch, including interviewers, need specia lizedtra ining and support over and above that norma llyprovided to research staff. This tra ining shouldinclude a basic introduction to domestic violenceissues and an overa ll orientation to the concepts ofgender, and gender discrimination/ inequa lity. Thetra ining must provide a mechanism for fieldworkersto confront and overcome their own biases, fears andstereotypes regarding abused women. Many

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fieldworkers will have interna lized the “victim-blaming” attitudes that permeate the culture at large- a rea lity that is likely to undermine their ability toget full and honest disclosure from the women theyinterview. Indeed, rates of reported violence havebeen shown to be very sensitive to intimation ofjudgement or blame on the part of interviewers.

In addition, tra ining should include an opportunityfor research staff to come to terms with their ownexperiences with abuse. The high preva lence ofviolence aga inst women worldwide means that it isvery likely that one or more research staff will havebeen a direct target, or have familia l experiences ofviolence. While this may improve the interviewers’skills and empathy, the process of being involved inthe study (either as an interviewer, supervisor, dataprocessor or statistician) may awaken images, emo-tions, interna l confusion and conflict. These reactionsmay affect their ability to work, may have a negativeimpact on their hea lth, and may create tension in thehome. Even where a researcher or fieldworker herselfhas not experienced violence, listening to stories ofviolence and abuse, not unlike research in fieldssuch as death and dying, may be dra ining and evenoverwhelming. Experience has shown that unlessthis rea lity is confronted directly, research projectscan experience high rates of attrition among staff.

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There are a number of ways to address the emotiona lneeds of researchers and fieldworkers. During thetra ining process it is important that the subject ofviolence is openly discussed, and that research teammembers are given the option of withdrawing fromthe project without prejudice. During the fieldwork,regular debriefing meetings should be scheduled toenable the research team to discuss what they arehearing, their feelings about the situation, and how itis affecting them. These meetings should a im toreduce the stress of the fieldwork, and avert anynegative consequences. Interviewers should a lso begiven the opportunity to discuss this in private withstudy leaders if they so wish.

Despite these measures, some fieldworkers mayneed to be given less emotiona lly taxing tasks, begiven a break from the study, or may have towithdraw from the research a ltogether. Interviewersmust a lso be helped to understand their role inrelation to a woman who reports experiencingviolence. They should be open to assisting her ifasked (see below), but they should not tell her whatto do or to take on the persona l burden of trying to“save her”. Interviewers should not take on a role ascounsellor and any counselling activity that may beoffered in the context of the study should be entirelyseparate from the data collection.

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e) The study design must include actionsaimed at reducing any possible distresscaused to participants by the research

Active efforts must be made to minimize anypossible distress caused by the research. Domesticviolence is a sensitive and stigmatized issue, andwomen are often blamed for the violence theyexperience. All questions about violence and itsconsequences should be asked in a supportive andnon-judgementa l manner. In addition, care needsto be taken to ensure that the language of thequestionna ire cannot be interpreted as beingjudgementa l, blaming or stigmatizing (Liss andSolomon, 1996).

As noted above, there is some evidence that manywomen find that ta lking about their experiences ofviolence is beneficia l. Nevertheless, the respondentmay reca ll frightening, humiliating or extremelypa inful experiences, which may cause a strongemotiona l reaction. Interviewers therefore need to betra ined to be aware of the effects that the questionsmay have on the informant and how best to respond,based on the woman’s level of distress. Some womenmay become emotiona l during an interview, but stillchoose to proceed after being given a moment tocollect themselves. Interviewer tra ining shouldinclude practice on how to terminate an interview ifthe impact of the questions becomes too negative.All interviews should end in a positive manner(Parker and Ulrich, 1986), reinforcing the woman’s

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own coping strategies and reminding her that theinformation she has shared is important and will beused to help other women. Likewise, interviewersshould affirm that no one deserves to be abused andinform the respondent of her rights under the law.

f) Fieldworkers should be trained to referwomen requesting assistance to available localservices and sources of support. Where fewresources exist, it may be necessary forthe study to create short-term supportmechanisms

It is important that researchers anticipate and beprepared to respond appropriately to women whomay need additiona l assistance during or followingan interview. Prior to conducting the research,researchers need to meet with potentia l providersof support, which may include existing hea lth, lega land socia l services and educationa l resources in thecommunity, and less forma l providers of support(including community representatives, religiousleaders, traditiona l hea lers and women’s organiza-tions). Discussions should be held to obta in provid-ers’ agreement to assist and to identify the forms ofsupport that each is able to provide. A list of re-sources should then be developed and offered to a llrespondents, irrespective of whether they havedisclosed experiencing violence or not. The resourcelist should either be sma ll enough to be hidden or

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include a range of other services so as not to a lert apotentia l perpetrator to the nature of the informationsupplied.

Where few resources exist, it may be necessary tohave a tra ined counsellor or women’s advocateaccompany the interview teams and provide supporton an “as needed” basis. Genera lly this can take theform of a lerting participants that a staff persontra ined in counselling for women’s and/or violenceissues will be ava ilable to meet with anyone whoneeds it or is interested at a set time and place.Preferably this location should be a hea lth centre,church or loca l organization where women can easilygo without arousing suspicion.

g) Researchers and donors have an ethicalobligation to help ensure that their findingsare properly interpreted and used to advancepolicy and intervention development

It is important that research findings are fed intoongoing advocacy, policy making and interventionactivities. Too often critica l research findings neverreach the attention of the policymakers andadvocates best positioned to use them. The enor-mous persona l, socia l and hea lth-related costs ofviolence aga inst women places a mora l obligation onresearchers and donors to try to ensure that studyfindings are applied in the rea l world. It is a lso

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important that the study community receives earlyfeedback (in their own language) on the results ofthe research in which they have participated.

One way to improve the relevance of researchprojects is, from the outset, to involve advocacyand direct service groups either as full partnersin the research or as members of an advisorycommittee. Such committees can play an importantrole in helping guide the study design, advise on thewording of questions, assist with interviewer tra iningand give guidance on ana lysis and the interpretationof results. They a lso have a centra l role to play inpublicizing and applying the project’s findings.

A range of activities, using forma l and informa lmedia , can be used to disseminate the studyfindings loca lly and nationa lly, and to explorepossible follow-on activities. Wherever possible,findings should be fed into ongoing advocacy, policydevelopment and intervention activities, such as theinternationa lly recognized “Sixteen Days of ActivismAga inst Gender Violence (November 25th to Decem-ber 10th)”2.

2 The “16 days of Activism Aga inst Gender Violence” is part ofthe Globa l Campa ign for Women’s Human Rights initiated in 1991 bythe Center for Women’s Globa l Leadership in the USA.

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Researchers need to be pro-active in helping toensure that research findings are interpreted appro-priately by the public and the media . Althoughana lysis may highlight sub-groups at higher risk ofparticular forms of violence, researchers should takecare when presenting such findings not to feed intoany negative stereotypes of particular ethnic or socia lgroups, and to ensure that no one community orindividua l can be identified or stigmatized. Onestrategy is to highlight that violence aga inst womencuts across a ll communities and socioeconomicgroups. Another is to emphasize the similarities andpara llels among sub-groups and to describe howparticular forms of inequa lity may contribute todifferences (Aronson and Fontes, 1997). For example,higher levels of physica l violence have frequentlybeen reported among lower socioeconomic groups.In such situations, it is important to use the findingsto advocate for positive change, rather than to a llowthe results to further stigmatize this group.

h) Violence questions should only beincorporated into surveys designed for otherpurposes when ethical and methodologicalrequirements can be met

Increasingly, researchers have become interested inintegrating questions related to violence aga instwomen into studies designed primarily for otherpurposes. This approach can, in principle, be usefulfor providing basic data on violence when a more

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in-depth focused study is not feasible, and for provid-ing insights into the links between violence andother hea lth and development issues (e.g. includingquestions on victimization into a study exploringwomen’s suicide attempts).

However, experience indicates that there are oftentradeoffs to such a strategy. The cha llenges ofensuring data qua lity and ensuring respondentsafety are often greater in such circumstances thanin focused studies on violence (Ellsberg et a l., 2001).Since disclosure rates for violence are affected by avariety of factors (including the length of the inter-view, the type and number of questions, as well asthe rapport established between interviewer andrespondent), “sandwiching” a few violence questionsbetween lengthy questions on unrelated issuestends to reduce women’s willingness to disclose, andas a result, negatively affects preva lence rates.Furthermore, a lthough measures such as specia lizedtra ining for interviewers, confidentia lity and follow-upsupport for both interviewers and informants iscritica l in any survey addressing violence aga instwomen, it is often much more difficult to ensure thatthese guidelines are followed when violence repre-sents only a sma ll part of the research objective.

Because of these drawbacks, “integrating” violencequestions into other studies makes sense onlywhen the primary research team is willing and ableto address the basic ethica l and methodologica l

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guidelines outlined herein. Where this is not feasible,it is preferable to avoid asking women directly abouttheir own experiences of abuse. In such instances itis genera lly more appropriate to ask less persona lquestions regarding attitudes towards violenceand/or the respondents knowledge of others whohave experienced violence, rather than to probedirectly into a woman’s life history. The more exten-sively women are asked about their own experiencesof violence, the more imperative it becomes to ensurebackup support and confidentia lity.

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Conclusion: Putting Women’s

Safety First

Domestic violence is now receiving substantia lattention, resulting in increased funding forresearch on violence aga inst women

worldwide. The recommendations deta iled in thisdocument reflect current knowledge concerning theethica l and safety considerations that need to beaddressed when conducting research on domesticviolence. The specia l nature of this research topicdemands that safety concerns be considered fromthe very beginning of a study through its implemen-tation and dissemination. This means that violenceresearch will likely require a longer timeframe and agreater investment of resources to ensure theseissues are fully addressed. Donors and researchersa like can make their own contribution to women’ssafety by following these guidelines and neverputting research objectives above women’s well-be ing.

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References

Aronson Fontes L. (1997) Conducting ethica l cross-cultura l research on family violence. Chapter 23 inOut of the darkness: contemporary perspectives onfamily violence. Eds. Kaufman Kantor, Jana Jasinski.Sage Publications.

Council for Internationa l Organizations of Medica lScience (CIOMS) (1993) Internationa l Guidelines ForEthica l Review Of Epidemiologica l Studies, Geneva ,Switzerland.

Ellsberg M., Heise L., Peña R., Agurto S., andWinkwist A., (2001) Researching violence aga instwomen: methodologica l and ethica l considerations.Studies in Family Planning 32 (1): 1-16 .

Center for Hea lth and Gender Equity (1995) Measur-ing Violence Aga inst Women Cross-Cultura lly. Notesfrom a Meeting. June 29 , 1995 . Unpublisheddocument.*

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Putting Women First

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