Introduction
Intimate partner violence (IPV) is increasingly being viewed as a serious public health concern. While IPV is preventable, it is estimated that between 10-69% of women have reported some form of IPV at some point in their lives globally (Sabri et al., 2018). Among ever-partnered women, the prevalence of IPV is estimated to be 30% (Sabri et al., 2018). A 2013 study by the World Health Organization established that the highest prevalence of IPV occurred in Southeast Asia at 37.7% (Sabri et al., 2018). The South Asian population in the United States has grown drastically over the past decades and is now estimated to be over three million. Among this population, 21-55% of the women experience IPV and/or sexual violence in their lifetime CITATION Yos15 \l 1033 (Yoshihama & Dabby, 2015). The high prevalence of IPV in this population can be attributed to various structural, cultural, and situational risks. Some of them include the arranged marriage system, patriarchal cultural norms, societal views that either normalize or support the vice, gendered racism, and cultural resistance to disclosure of IPV to protect the honor of the family. These risks lead to double victimization in that the victims endure the assault from their families first, and then also have to face a society that does not offer them appropriate support and interventions. Therefore, for the issue to be comprehensively addressed and interventions developed, the structural, cultural, and situational contexts of IPV must be well understood.
Structural Risks
Structural context refers to the macro-level social conditions and structural arrangements that directly affect one's quality of life as well as their access to opportunity. It also covers formal and informal social structures such as extended family, neighborhoods, social networks, as well as various other institutions. Regarding South Asian women, gendered racism is among the primary structural risks to IPV. Gendered racism is a form of oppression that is based on race or gender. South Asian women are seen as weak and submissive, both within and outside the community, a factor that increases their predisposition to IPV. Family interactions are also rooted in gendered racism, as seen in the need for partners and in-laws to control the women (Sabri et al., 2018). Such behaviors are also categorized as risk factors. Growing up in environments where they witnessed or experienced IPV has also been identified as risk factors (Kamimura et al., 2020).
Language barriers can also be categorized as a structural risk. Owing to this barrier, South Asian women find it difficult to utilize the existing supportive services, and hence abuse persists. Their low economic muscle has also further exposed them to abuse. Besides, research has shown that the situation is worse for working women. For instance, they have to work and also take care of household responsibilities. Failure to meet these gender role expectations increases their risk of exposure to IPV. Lack of support has also been cited as a major contributor to IPV in this population. Owing to these entrenched beliefs, it is usually challenging to get help in the community. Formal sources of support are also not always helpful. For instance, one of the respondents in Sabri et al. (2018) stated that a social worker placed her children under the custody of their abusive father. A lack of compassion within the court system has also been cited as a risk factor.
Cultural-Community Risks
The cultural-community context incorporates Meso-level factors unique to the South Asian culture that have been historically shaped by immigration and acculturation and increase the vulnerability of women to IPV. Studies in the South Asian immigrant communities have shown that conscious effort has been historically made to control or resist the course of acculturation. Therefore, this population maintains particular traditional values and attitudes that promote IPV (Soglin et al., 2019). The patriarchal cultural system is among these values. This system propagates the dependence of women on their partners, a factor that contributes to the high prevalence of IPV in this community. The culture also pressures the women to uphold family honor and values, factors that also promote IPV. For instance, women in abusive relationships might be pressured to stay to maintain family reputation (Sabri et al., 2018). The community places the responsibility of abuse on the woman, making it almost impossible for her to leave the abusive partner. Religion also acts as a barrier to walking out of abusive relationships in some instances. Abuse is also seen as a private issue, and hence reporting might not be an option.
Other cultural factors that lead to IPV include the arranged marriage system, which is still alive among the South Asian immigrants. When women get into such marriages, they are often young and have little education. Their socioeconomic status is also low, and hence their likelihood of adhering to norms that justify IPV is higher. Most of these cultural factors also hold back the women from reporting instances of IPV and hurts their recovery. From past studies, South Asian immigrant women often face immigration threats from their partners (Sabri et al., 2018). The problem is exacerbated by the fact than most of these women are financially dependent on their partners. Reports of abuse from in-laws, as well as the extended families, have also been recorded (Sabri et al., 2018). While the community has generally resisted acculturation, some South Asian women adopt various egalitarian beliefs on gender roles, begin to assert their rights in relationships, and even seek help when they suffer abuse. Unfortunately, this shift places them at a higher risk of IPV from family members on the basis that certain family values and attitudes must be maintained. Such occurrences are also a reflection of gendered racism that objectifies South Asian womanhood as passive, weak, exotic, and submissive.
Situational Risks
IPV is seen as interpersonal transactions that take place within a specific situational context. The particular social occasion or setting within which IPV occurs constitutes the situational context. It also includes factors present as the encounter unfolds. Past studies have shown that most cases of IPV occur at or near the woman's home. It has also been shown to occur mostly between 6 PM and midnight (Sabri et al., 2018). As such, it can be concluded that IPV occurs mostly within the privacy of the victims' homes. In most instances, the victims do not have much choice in such circumstances. Studies in this population have also shown that the characteristics of the abusive partner, as well as the presence of children, increase a woman's predisposition to IPV. For instance, partners with mental illnesses are more likely to engage in IPV. Women with children are bound to remain with their abusive partners since they want financial and emotional support. The fear of losing children also deters women from walking out of abusive relationships (Sabri et al., 2018). However, some studies have also indicated that children also serve as a protective resource against IPV (Sabri et al., 2018).
A majority of South Asian women in the United States live with the husband's family as a result of cultural and economic dictates. Lee (2014) identified patrilocality, the proximity of patrilineal family members, as another situational risk. The author held that family members play various roles in enabling or perpetuating IPV. As mentioned earlier, in-laws might join in the verbal or emotional abuse of the woman CITATION Lee14 \l 1033 (Lee, 2014). Immigration into the United States disrupts traditional economic roles and suppresses economic mobility. To this end, Lee (2014) holds that economic dislocation is a situational risk factor of IPV. For instance, while immigrant women have higher access to menial jobs, men often reject such jobs to preserve their status. Resultantly, an economic shift that leads to greater conflict occurs CITATION Lee14 \l 1033 (Lee, 2014). Geographic/physical, cultural, and language-based isolation are also situational factors that increase the risk of South Asian women to IPV, particularly in the search for help CITATION Lee14 \l 1033 (Lee, 2014).
Interventions
Literature shows that IPV leads to physical and mental suffering among the victims. Other than physical and psychological abuse, South Asian women also face sexual abuse. Studies have linked IPV to adverse health outcomes such as anxiety, depression, traumatic brain injuries, gynecological disorders, as well as various sexually transmitted diseases, including HIV (Sabri et al., 2018). According to research, multiple forms of IPV lead to worse health outcomes. The above discussion has shown that the high prevalence of IPV among South Asians is caused by a combination of structural, cultural-community, and situational factors. As such, the interventions developed to address IPV in this population must intentionally target these factors. For instance, culturally responsive interventions can be used to address cultural factors. The interventions should be aimed at preventing IPV and helping the victims where it has already occurred.
Establishment of Social Support Services
It has been shown that a lack of or an inadequacy of social support services promotes IPV among South Asian women. Therefore, there should be efforts by both the local and federal governments to establish more support services targeting this population. Particularly, culturally specific trauma-informed services should be established to address the needs of these women (Sabri et al., 2018). Similar interventions have been found to be effective in other populations. Owing to the negative attitudes associated with IPV in this population, privacy, and confidentiality should be incorporated in such interventions. Emphasis should be placed on education and awareness since many immigrants are unaware of the existence of such services.
Incorporation of IPV into the Country's Public Health System
As mentioned earlier, IPV is a public health concern. Therefore, the country's healthcare workforce should be trained to address IPV within the community. Healthcare providers must also be engaged to support the various systems-level strategies developed (Niolon et al., 2017). The training can be carried out in various ways. First, there is a need to create culturally competent, trauma-informed, and evidence-based educational materials as well as technical assistance for healthcare professionals regarding IPV. Literature shows that minimal research has been done to determine the protective factors as well as ease of access to support services for IPV victims in the South Asia population. Thus, more research should be carried out to help in the development of evidence-based programs. Cross-sharing of best practices as well as peer-to-peer connections, should also be encouraged amongst professionals working in the different South Asian communities across the country. This intervention also calls for collaboration between different stakeholders, including federal and non-federal entities. Secondly, training opportunities should be availed for healthcare providers. For instance, IPV content should be integrated into existing national programs.
Moreover, there is a need to increase access to health services for South Asian women experiencing IPV. A report by the World Health Organization (WHO) on IPV among minority migrant women in the world revealed that they face several barriers in their efforts to access health services (Vives-Cases et al., 2014). To this end, efforts should be targeted at improving...
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