Identifying the Women Most Vulnerable to Intimate Partner Violence: A Decision Tree Analysis From 48 Low and Middle-Income Countries

Background: Primary prevention strategies are needed to reduce high levels of intimate partner violence (IPV) in low- and middle-income countries (LMICs), and their effectiveness may be improved by targeting the most vulnerable populational groups and by focusing on context-specific risk factors. Methods: We selected the most recent Demographic and Health Survey carried out since 2010 and with available information on IPV. Exposure to IPV was defined as having experienced physical and/or sexual IPV in the past 12 months. We selected 15 recognized IPV risk factors (or proxies) which were available in the surveys and had a potential for tailoring and targeting interventions. To identify groups of women most vulnerable to IPV, we applied a decision tree approach, creating individual trees for each country and for all countries combined. Findings: We identified 48 countries with suitable data. In the pooled decision tree, witnessing IPV during childhood, a lower empowerment level (attitude to violence) and partner’s alcohol use were the strongest markers of IPV vulnerability. IPV prevalence among the most vulnerable women was 43% compared to 21% in the overall sample. This high-risk group concentrated 1 in every 4 women who experienced IPV in LMICs. Across the individual national trees, the subnational regions emerged as the most frequent markers of IPV occurrence. Interpretation: This study contributes evidence that can be used to plan and improve policies and programmes aimed at reducing population levels of IPV by reaching high-risk women and families with focused interventions in LMICs. By using a decision-tree approach - a simple-to-use yet powerful statistical tool we provide important insights about subpopulations of women where IPV have very high prevalence and to which interventions could be prioritised and tailored. Funding Information: Grant number: 101815/Z/13/Z and The Bill & Melinda Gates Foundation Health - Grant Number: INV-007594 / OPP1148933 Declaration of Interests: None to declare. Ethics Approval Statement: Ethical approval was obtained by the national agencies responsible for conducting each survey. All analyses relied on publicly available, anonymized databases for which permission to access was received through the DHS Program.