Food insecurity and intimate partner violence among married women in Nepal.

Background: Intimate Partner Violence (IPV) is an important public health concern globally, including in Nepal. Food insecurity (being without reliable access to a sufficient quantity of affordable, nutritious food) has been associated with IPV, but no known studies have explored this relationship in South Asia, or Nepal specifically. Women's level of empowerment is an important factor to consider when understanding the relationship between food insecurity and IPV.

Methods: Using data from the 2011 Nepal Demographic and Health Survey, we explore the relationship between different levels of food insecurity (none, mild, moderate, severe) and three types of IPV: physical, sexual and emotional. In a second set of models we adjust for indicators of women's empowerment. We use multi-variable logistic regression to test for an association between these factors, adjusting for individual and household level demographic variables.

Findings: About half of married women in our sample experience food insecurity and approximately 10% of women experienced each of the three different types of IPV in the past 12 months: emotional, sexual and physical. Food insecurity is significantly associated with increased odds of experiencing emotional (odds ratio OR = 1.75 95% confidence interval CI = 1.06-2.77 for severe food insecurity) or physical (OR = 2.48, 95% CI = 1.52-4.04 for severe food insecurity) IPV, but not sexual IPV, after adjusting for individual and household level demographic variables. After adjusting for empowerment related factors, this relationship still holds, although it is somewhat attenuated. Women's level of household decision-making power is significantly associated with higher odds of emotional, sexual and physical IPV, and whether she lives with her in-laws is protective against emotional IPV.

Conclusions: Among married women in Nepal, being food insecure is associated with higher odds of some types of IPV, specifically emotional and physical IPV. Accounting for women's level of empowerment explains some of the relationship between food insecurity and IPV. It is essential that interventions to prevent IPV address household stressors such as food insecurity among married, Nepalese women, perhaps through cross-sectoral approaches. Such structural interventions are likely to reduce IPV for married women across South Asia who live in a similar levels of gender discrimination and food insecurity.