VIOLENCE AGAISNT WOMEN IN VITÓRIA, ESPÍRITO SANTO: A POPULATION-BASED STUDY

VIOLENCIA CONTRA LAS MUJERES EN VITÓRIA, ESPÍRITO SANTO: UN ESTUDEIO DE BASE POBLACIONAL

ABSTRACT

Objective:  To estimate the prevalence and factors associated with psychological, physical, and sexual violence among women victims of violence perpetrated by their intimate partners residing in the municipality of Vitória, Espírito Santo.

Method:  This cross-sectional, population-based study was conducted in the municipality of Vitória, Espírito Santo, from January to May 2022, where 1086 women aged 18 and over were interviewed. The World Health Organization's instrument on violence against women was used to track outcomes. The prevalence of violence (psychological, physical, and sexual) was calculated, and a bivariate analysis was performed using the woman’s sociodemographic, behavioral, family history, and life history characteristics. Subsequently, a Poisson regression model with robust variance was performed, including the variables of interest that obtained a p-value<0.20 in the bivariate analysis, while in the adjusted model, those with p-value <0.05 remained.

Results:  The observed prevalences were: psychological, 45.2% (95% CI: 42.3-48.2); physical, 25.6% (95% CI: 23.1-28.3); and sexual, 17.2% (95% CI: 15.1-19.6). After adjustments, the common characteristics that remained associated with violence (psychological, physical, and sexual) were: education level, marital status, Catholic religion, maternal history of violence, and history of childhood sexual abuse.

Conclusion:  Psychological, physical, and sexual violence were highly prevalent among women residing in the municipality of Vitória. Sociodemographic and behavioral factors, as well as personal and maternal experiences of violence, are associated with the phenomenon.

DESCRIPTORS:
Violence against women; Spouse abuse; Intimate partner violence; Domestic violence; Family relationships; Socioeconomic factors; Cross-sectional studies

RESUMO

Objetivo:  Estimar a prevalência e os fatores associados às violências psicológica, física e sexual nas mulheres vítimas de violência perpetrada pelo parceiro íntimo residentes do município de Vitória, Espírito Santo.

Método:  Estudo transversal, de base populacional, realizado no município de Vitória, no Espírito Santo, de janeiro a maio de 2022, onde foram entrevistadas 1086 mulheres de 18 anos e mais. Para o rastreio dos desfechos foi utilizado o instrumento da Organização Mundial de Saúde sobre violência contra a mulher. Foi calculada a prevalência de violência (psicológica, física e sexual) e realizada análise bivariada com características sociodemográficas, comportamentais, história familiar e de vida da mulher. Posteriormente, procedeu-se ao modelo de regressão de Poisson, com variância robusta, inserindo as variáveis de interesse que obtiveram valor de p<0,20 na bivariada, sendo que, no modelo ajustado, permaneceram aquelas com p<0,05.

Resultados:  As prevalências observadas foram: psicológica 45,2% (IC95%: 42,3-48,2); física 25,6% (IC95%: 23,1-28,3) e sexual 17,2% (IC95%: 15,1-19,6). Após ajustes, as características comuns que permaneceram associadas à violência (psicológica, física e sexual) foram: escolaridade, situação conjugal, religião católica, história materna de violência e histórico de abuso sexual na infância.

Conclusão:  As violências psicológica, física e sexual apresentaram alta prevalência entre as mulheres residentes do município de Vitória. Fatores sociodemográficos, comportamentais e experiências pessoais e materna de violência estão associados ao fenômeno.

DESCRITORES:
Violência contra a mulher; Maus-tratos conjugais; Violência por parceiro íntimo; Violência doméstica; Relações familiares; Fatores socioeconômicos; Estudos transversais

RESUMEN

Objetivo:  Estimar la prevalencia y los factores asociados a la violencia psicológica, física y sexual entre mujeres víctimas de violencia perpetrada por sus parejas íntimas residentes en el municipio de Vitória, Espírito Santo.

Método:  Se trata de un estudio transversal, de base poblacional, realizado en el municipio de Vitória, Espírito Santo, de enero a mayo de 2022, donde se entrevistaron 1086 mujeres de 18 años o más. Para hacer el seguimiento de los resultados se utilizó el instrumento de la Organización Mundial de la Salud sobre la violencia contra la mujer. Se calculó la prevalencia de violencia (psicológica, física y sexual) y se realizó un análisis bivariado utilizando características sociodemográficas, conductuales, antecedentes familiares e historia de vida de la mujer. Posteriormente se realizó un modelo de regresión de Poisson con varianza robusta incluyendo las variables de interés que obtuvieron un valor p.<0,20 en el análisis bivariado, mientras que en el modelo ajustado se mantuvieron aquellos con p.<0.05.

Resultados:  Las prevalencias observadas fueron: psicológica, 45,2% (IC 95%: 42,3-48,2); física, 25,6% (IC 95%: 23,1-28,3); y sexual, 17,2% (IC 95%: 15,1-19,6). Después de los ajustes, las características comunes que permanecieron asociadas con la violencia (psicológica, física y sexual) fueron: nivel educativo, estado civil, religión católica, historia materna de violencia e historia de abuso sexual infantil.

Conclusión:  La violencia psicológica, física y sexual fue altamente prevalente entre las mujeres residentes en el municipio de Vitória. Factores sociodemográficos y comportamentales, así como experiencias personales y maternas de violencia, están asociados al fenómeno.

DESCRIPTORES:
Violencia contra la mujer; Maltrato conyugal; Violencia de pareja; Violencia doméstica; Relaciones familiares; Factores socioeconómicos; Estudios transversales

INTRODUCTION

Deep cultural and historical issues underlie the greater vulnerability and exposure to violence among women in its various forms. The culture of patriarchy and male chauvinism justifies violent attitudes committed by men against women as a form of punishment, correction, and domination¹. In an attempt to overcome this situation, gender equality has been widely discussed globally, being incorporated as one of the Sustainable Development Goals (SDGs) of the 2030 Agenda defined by the United Nations (UN)².

Data from 2018 show that 31% of women aged 15 to 49 worldwide have experienced at least one episode of physical or sexual violence in their lifetime, corresponding to approximately 852 million women³. In Brazil, between 2009 and 2017, the prevalence of violence against women increased by more than 8.5%⁴. In addition, violent deaths of women without a recorded cause increased by 21.6% between 2018 and 2019 in Brazil, drawing attention and raising questions about the identification of femicide cases in the country⁵.

Between 2009 and 2017, the state of Espírito Santo presented a prevalence of 78.6% of violence against women, being the state with the highest prevalence in the Southeast region, and also occupying fourth place among all Brazilian states⁴. In Vitória, the capital of Espírito Santo, psychological violence was the most frequent type of violence among women, with a prevalence of 25.3%, followed by physical violence (9.9%) and sexual violence (5.7%)⁶. This study also identified the most frequent contributing factors to the event, such as the victim's education and income, marital status, maternal history of intimate partner violence, and lifetime drug use. These data demonstrate how socioeconomic, social, and life experience factors influence greater exposure to violence, and should be considered when creating and implementing comprehensive prevention and care measures⁶.

It should be noted that the COVID-19 pandemic further exacerbated the need to discuss this issue, as it worsened and increased the prevalence of violence against women, who found themselves more exposed to their abusers due to social isolation. Moreover, the intimate partner is one of the main aggressors, and the home is the primary location where the event occurs, hindering the cases identification and report⁷.

In this context, violence can be conceptualized as a public health problem where physical force or power is intentionally used, whether real or as a threat, against the person itself, another person, a group, or a community, and which has the potential to result in, or does result in, injury, death, psychological harm, developmental disability, or deprivation⁸. Regarding violence against women, intimate partners and/or ex-partners are among the main perpetrators, primarily through acts of physical, sexual, and psychological violence. Intimate partner violence is marked by power and control dynamics, often made invisible, and can occur in different sociocultural contexts, also exposing children and adolescents in the domestic and family environment^1,3.

Physical violence consists of the intentional use of force with the aim of causing pain, injury, or suffering, through aggression such as slaps, pushes, kicks, burns, or injuries from weapons. Psychological or moral violence involves actions that affect a woman's emotional health and dignity, such as humiliation, threats, devaluation, excessive control, discrimination, and isolation. Sexual violence, in turn, refers to any sexual act imposed without consent, using physical force, coercion, intimidation, or manipulation, including rape, intrafamily abuse, sexual harassment, forced erotic practices, and restrictions on women's sexual and reproductive rights, such as preventing the use of contraceptives, forcing pregnancy, abortion, or marriage⁹. It is important to highlight that, regardless of the type of violence suffered, the consequences of exposure negatively impact the woman and her children’s health, who deserve protection and embracement⁷.

It is worth noting that women who are victims of violence are more likely to experience depressive symptoms, as well as anxiety and stress, develop heart diseases, chronic pain, bowel and sexual dysfunction, have an increased risk of sexually transmitted infections, experience unwanted pregnancies, and have complications during pregnancy, childbirth, and the postpartum period^1,10.

Despite the existence of robust legislation in Brazil aimed at combating violence against women, the effectiveness of these policies still faces serious limitations in practice, requiring better targeting to make actions more effective. In the health field, the National Policy for Comprehensive Women's Health Care (PNAISM) proposes a comprehensive care model that includes prevention and support for victims of violence, recognizing gender-based violence as a social determinant of health¹¹. In parallel, the National Primary Care Policy (PNAB) underscores the strategic role of primary care in early detection, case referral, strengthening of preventive actions, and promotion of a culture of peace¹².

Healthcare professionals play a key role in identifying cases of violence in healthcare services and can, in addition to embracing and assisting women, contribute to generating information through the proper completion of violence notification forms, as well as encouraging them to report their abusers, allowing referrals to support services and the right to make choices about their own lives. It is known that public health services are, more often than not, the point of entry for victims of violence, who may find themselves alone and extremely vulnerable to their abusers¹³.

In light of the above, this study contributes to the understanding of the characteristics and factors associated with violence against women in Vitória, providing information that can support the improvement of prevention, identification, and comprehensive care strategies, strengthening public policies and the preparedness of health professionals. Its objective is to estimate the prevalence and factors associated with psychological, physical, and sexual violence among women victims of violence perpetrated by their intimate partners residing in the municipality of Vitória, Espírito Santo.

METHOD

This is a cross-sectional, analytical, population-based study conducted in the municipality of Vitória, Espírito Santo, Brazil. The municipality of Vitória, capital of the state of Espírito Santo, has an estimated population of 369,534 people for 2021, a territory of 97.123 km², and a municipal Human Development Index of 0.845. The municipality has 79 neighborhoods and six health regions¹⁴. According to data from the last census, the female population represented 49.98% of the total population (163,853 women)¹⁵. The STROBE guidelines were used to draft the methods section¹⁶. In addition, it should be noted that, during the preparation of this article, the authors did not use any artificial intelligence tools, models, or services.

The study population consisted of women aged 18 years or older who had an intimate partner in the 24 months prior to the interview. In this study, an intimate partner was defined as a current or former partner and/or boyfriend/girlfriend, as long as they maintain sexual relations, regardless of whether or not it is a formal union. Women who lacked the ability to understand or communicate due to intellectual or sensory deficits and who, therefore, were unable to respond to the research data collection instruments were excluded. Data collection took place between January and May 2022 and was carried out by a team of duly trained interviewers, all of whom were female. The research team also included field supervisors. The pilot study took place in December 2021. The data collected were not part of the research final sample, as fieldwork began after the analysis of the data obtained in the pilot study. The interviews were conducted in the women's homes, in a private location, respecting their privacy and confidentiality¹⁷.

The sampling process adopted was multi-stage. The primary sampling unit was the census tracts of the municipality of Vitória, provided by the 2010 Census conducted by the Brazilian Institute of Geography and Statistics (IBGE)¹⁵. The total number of households in the urban area of Vitória in 2010 (108,515 households) was divided by the number of sectors to be visited (100 sectors) to obtain the skip interval (1,085 households), respecting the probability proportional to the number of households and women within each sector. Subsequently, the list was sorted by socioeconomic level, and the number 513 (between 1 and 1,085) was randomly selected using Excel^®, corresponding to the number belonging to the first defined sector. The selection of the remaining sectors (99) occurred through the sum of the skip interval from the initial sector (184) and so on until the end of the list. After selecting the census tracts, the selection of households occurred randomly from the list available on the IBGE online platform. In each household, a list was made of eligible women, that is, those who met the inclusion criteria for the study, and then one of the women was randomly selected to participate in the interview. For the sample size calculation, the estimated prevalence of intimate partner violence in the studied population was considered to be 50%, to maximize the sample size, with a 95% confidence level and an acceptable error of 5%. To study the association of risk factors, a 95% confidence level, 80% power, and an exposed/unexposed ratio of 1:1 were considered. To this value were added 10% to account for losses and 30% for confounding factors, arriving at a necessary sample size of 1,100 women¹⁷.

The three types of violence against women (psychological, sexual, or physical) perpetrated by an intimate partner throughout their lives were the dependent variables in this study. Each instance was considered present when the woman answered yes to any of the items for each type of violence (psychological, physical, or sexual), identified through the instrument World Health Organization Violence Against Women (WHO VAW STUDY), translated and validated in Brazil¹⁸.

The independent variables relating to the women’s sociodemographic characteristics were: age group (18 to 29; 30 to 39; 40 to 49; 50 to 59; 60 or more); self-reported skin color (white; non-white); years of schooling finished (0 to 8; 9 to 11; 12 or more); family income in tertiles (1st - poorest; 2nd; 3rd - richest); marital status (married; common-law union; single; divorced); Catholic (no; yes); Evangelical (no; yes). Regarding family and life experiences related to violence, the women were asked the following questions: "Has your mother ever been beaten by an intimate partner?" and “Did you suffer sexual violence in childhood?”, with the dichotomous response options (no; yes). Regarding behavioral variables, the average frequency of alcohol consumption (never; monthly or less; 2 to 4 times per month; 2 to 3 times per week; 4 or more times per week) and smoking (never smoked; current smoker; used to smoke but quit) was analyzed.

The descriptive analysis was performed by presenting the crude and relative frequencies. The chi-square test for heterogeneity and Fisher's exact test were used in the bivariate analysis, as per assumptions.

Poisson regression with robust variance was used to calculate crude and adjusted prevalence ratios (PR) and their respective 95% confidence intervals (95% CI). In the multivariate analysis, a hierarchical model with four levels was adopted.

Initially, the variables with a p-value<0.20 in bivariate analysis were included in the model to account for potential confounding factors. In the modeling stage, the independent variables were included from the distal level (1st) to the proximal level (4th), following this order: sociodemographic factors; family experience; life experience; and behavioral characteristics. The definition of the levels was based on the work by Leite and co-authors (2017)⁶, which was used as a theoretical and analytical framework. The backward selection method was used to exclude variables. In the final model, a significance level of 5% (p<0.05) was adopted. Statistical analyses were performed using the statistical software Stata^® version 15.1.

The research was approved by the Research Ethics Committee. All interviewees signed the Free Informed Consent Form (FICF) and were informed of the objectives of the research and its potential risks and benefits.

RESULTS

A total of 1086 women participated in the study. Psychological violence perpetrated by an intimate partner throughout life was the most frequent (P: 45.2%; 95% CI: 42.3-48.2), followed by physical violence (P: 25.6%; 95% CI: 23.1-28.3). Sexual violence was the least frequent among the types of violence studied (P: 17.2%; 95% CI: 15.1-19.6) (Data not shown in table).

Table 1 shows the sample description and the prevalence of violence (psychological, physical, and sexual) throughout life according to sociodemographic characteristics, family experience, and life circumstances. Most of the women were in the 60 years or older age group (24.1%); about 60% were non-white; approximately 49% had 12 or more years of schooling; 36.2% were in the poorest tercile (1st); 55.3% were married; and 42.1% were Catholic. Regarding family experiences, 22.1% of participants reported that their mother had been beaten by an intimate partner, and approximately 11% experienced sexual violence in childhood. Most (50.7%) reported never having consumed alcoholic beverages and 74% never having smoked (Table 1). Furthermore, it can be seen in Table 1 that the outcomes under study were related to virtually all independent variables, with the exception of the relationship between sexual violence and age group, and physical violence and alcohol use.

Table 1 -
Prevalence of violence (psychological, physical, and sexual) throughout life, according to the sociodemographic, behavioral, family, and life experience characteristics of women residing in the urban area of the municipality of Vitória, ES, Brazil, 2022 (N=1,086).

Variables	Sample		Psychological violence			Physical violence			Sexual violence
	N	%	%	95% CI	p-value	%	95% CI	p-value	%	95% CI	p-value
1st - Sociodemographic Characteristics
Age group					<0.001			0.037			0.071
18 to 29 years	202	18.6	53.0	46.1-59.8		30.7	24.7-37.4		19.3	14.4-25.3
30 to 39 years	204	18.8	49.5	42.7-56.3		26.0	20.4-32.4		20.1	15.1-26.2
40 to 49 years	222	20.4	50.0	43.5-56.5		28.4	22.8-34.7		19.4	14.7-25.1
50 to 59 years	196	18.1	42.9	36.1-49.9		26.0	20.4-32.6		17.4	12.7-23.3
60 or more	262	24.1	33.6	28.1-39.5		18.7	14.4-23.9		11.5	8.1-15.9
Skin color					0.012			0.001			0.001
White	436	40.2	40.6	36.1-45.3		20.2	16.7-24.2		12.6	9.8-16.1
Non-white	650	59.8	48.3	44.5-52.2		29.3	25.9-32.8		20.3	17.4-23.6
Years of study					0.019			<0.001			0.001
0 to 8 years	203	18.7	52.7	45.8-59.5		33.5	27.3-40.3		22.2	17.0-28.4
9 to 11 years	352	32.4	46.6	41.4-51.8		29.3	24.7-34.2		20.7	16.8-25.3
12 or more	531	48.9	41.4	37.3-45.7		20.2	16.9-23.8		13.0	10.4-16.1
Family income (tertiles) (N=1,070)					<0.001			<0.001			0.001
First (poorest)	387	36.2	55.0	50.0-59.9		35.9	31.3-40.8		22.0	18.1-26.4
Second	359	33.5	42.3	37.3-47.5		24.2	20.1-28.9		17.8	14.2-22.1
Third (richest)	324	30.3	36.7	31.6-42.1		15.4	11.9-19.8		11.4	8.4-15.4
Marital status					<0,001			<0.001			<0.001
Married	601	55.3	36.8	33.0-40.7		19.1	16.2-22.5		12.7	10.2-15.6
Consensual union	285	26.3	51.9	46.1-57.7		32.6	27.4-38.3		22.1	17.7-27.3
Single	134	12.3	63.4	55.0-71.2		38.8	30.9-47.3		26.9	20.0-35.0
Divorced	66	6.1	56.1	44.0-67.5		27.3	17.9-39.2		18.2	10.6-29.4
Catholic					<0.001			<0.001			<0.001
No	629	57.9	51.5	47.6-55.4		31.3	27.8-35.1		21.8	18.7-25.2
Yes	457	42.1	36.5	32.2-41.1		17.7	14.5-21.5		10.9	8.4-14.2
Evangelical					0,006			<0.001			0.003
No	713	65.7	42.2	38.6-45.9		22.0	19.1-25.2		14.7	12.3-17.5
Yes	373	34.3	50.9	45.9-56.0		32.4	27.9-37.4		22.0	18.1-26.5
2nd Level - Family experience
Mother has been beaten by a partner (N=1,027)					<0.001			<0.001			<0.001
No	800	77.9	40.5	37.1-43.9		20.3	17.6-23.2		13.0	10.8-15.5
Yes	227	22.1	63.9	57.4-69.9		45.8	39.4-52.3		32.6	26.8-39.0
3rd Level - Life experience
Childhood sexual violence					<0.001			<0.001			<0.001
No	971	89.4	42.0	38.9-45.2		22.7	20.1-25.4		14.9	12.8-17.3
Yes	115	10.6	72.2	63.3-79.6		50.4	41.4-59.5		36.5	28.2-45.7
4th Level - Behavioral Characteristics
Average frequency of alcohol consumption (N=1,080)					0,014			0.059			0.009
Never	548	50.7	42.3	38.3-46.5		24.3	20.9-28.0		15.2	12.4-18.4
Monthly or less	250	23.2	42.4	36.4-48.6		22.8	18.0-28.4		15.6	11.6-20.6
Two to four times a month	177	16.4	48.0	40.7-55.4		28.8	22.6-35.9		20.9	15.5-27.5
2 to 3 times a week	92	8.5	59.8	49.5-69.3		30.4	21.9-40.6		22.8	15.4-32.5
4 or more times a week	13	1.2	61.5	34.3-83.0		53.9	28.1-77.7		46.2	22.3-71.9
Smoking					<0.001			<0.001			0.018
Never smoked	804	74.0	41.9	38.5-45.4		22.9	20.1-25.9		15.7	13.3-18.4
Current smoker	137	12.6	61.3	52.9-69.1		38.7	30.9-47.1		25.6	18.9-33.5
Used to smoke, but quit	145	13.4	48.3	40.2-56.4		28.3	21.5-36.1		17.9	12.5-25.0

• N: absolute frequency; %: relative frequency; 95% CI: 95% confidence interval.

After adjusting for confounding controls, it was found that psychological violence committed by an intimate partner was 40% more prevalent among women aged 40 to 49 years, when compared to older women (p<0.05). Those with up to eigth years of schooling showed a 39% higher prevalence of victimization than those with higher education. Women belonging to the poorest tercile experienced 1.27 times higher prevalence of psychological violence compared to the richest (3rd tercile) (95% CI: 1.05-1.54). Furthermore, single women had a higher incidence of this condition (PR: 1.57; 95% CI: 1.31-1.89) when compared to married women (p<0.05). Catholic women experienced 20% less prevalence of psychological violence than non-Catholic women, and participants with mothers who had previously suffered violence from an intimate partner experienced 34% more psychological violence than women without this history. Participants who experienced violence in childhood were 42% more likely to experience psychological victimization than those who did not experience sexual abuse, as were those who are currently smokers (PR: 1.18; 95% CI: 1.01-1.38) (Table 2).

Table 2 -
Crude and adjusted analysis of the prevalence of psychological violence throughout life according to sociodemographic characteristics, family and life experiences, and behavioral patterns among women residing in an urban area of the municipality of Vitória, ES, Brazil, 2022 (N=1,086).

Variables		Crude analysis			Adjusted analysis
	N	PR	95% CI	p-value	PR	95% CI	p-value
1st Level - Sociodemographic Characteristics
Age range				<0.001			0.022
18 to 29 years	202	1.58	1.27-1.95		1.19	0.92-1.54
30 to 39 years	204	1.47	1.18-1.84		1.36	1.07-1.72
40 to 49 years	222	1.49	1.20-1.85		1.40	1.12-1.74
50 to 59 years	196	1.28	1.01-1.61		1.15	0.91-1.45
60 or more	262	Ref.			Ref.
Skin color				0.014			0.754
White	436	Ref.			Ref.
Non-white	650	1.19	1.04-1.37		0.98	0.84-1.13
Years of study				0.016			0.001
0 to 8 years	203	1.27	1.08-1.50		1.39	1.18-1.65
9 to 11 years	352	1.12	0.97-1.31		1.08	0.93-1.26
12 or more	531	Ref.			Ref.
Family income (tertiles) (N=1,070)				<0.001			0.109
First (poorest)	387	1.50	1.27-1.77		1.27	1.05-1.54
Second	359	1.15	0.96-1.39		1.01	0.83-1.22
Third (richest)	324	Ref.			Ref.
Marital status				<0.001			<0.001
Married	601	Ref.			Ref.
Consensual union	285	1.41	1.21-1.65		1.34	1.14-1.56
Single	134	1.73	1.46-2.04		1.57	1.31-1.89
Divorced	66	1.52	1.20-1.93		1.54	1.21-1.97
Catholic				<0.001			0.003
No	629	Ref.			Ref.
Yes	457	0.71	0.62-0.82		0.80	0.68-0.92
Evangelical				0.005			0.586
No	713	Ref.			Ref.
Yes	373	1.21	1.06-1.38		1.04	0.89-1.22
2nd level - Family experience
Mother has been beaten by a partner (N=1,027)				<0.001			<0.001
No	800	Ref.			Ref.
Yes	227	1.58	1.39-1.79		1.34	1.14-1.56
3rd level - Life experience
Sexual violence in childhood				<0.001			<0.001
No	971	Ref.			Ref.
Yes	115	1.72	1.50-1.97		1.42	1.22-1.64
4th level - Behavioral Characteristics
Average frequency of alcohol consumption (N=1,080)				0.004			0.402
Never	548	Ref.			Ref.
Monthly or less	250	1.00	0.84-1.19		0.93	0.77-1.11
Two to four times a month	177	1.13	0.95-1.36		1.09	0.89-1.33
2 to 3 times a week	92	1.41	1.16-1.71		1.14	0.92-1.41
4 or more times a week	13	1.45	0.94-2.26		1.02	0.72-1.46
Smoking				<0.001			0.050
Never smoked	804	Ref.			Ref.
Current smoker	137	1.46	1.25-1.71		1.18	1.01-1.38
Used to smoke, but quit	145	1.15	0.96-1.39		1.18	0.98-1.43

• N: absolute frequency; PR: Prevalence Ratio; 95% CI: 95% confidence interval; Ref.: reference group.

In the adjusted analysis, women with up to eigth years of schooling and from the poorest tercile (1st) had 48% and 51%, respectively, higher prevalence of victimization of physical violence throughout their lives perpetrated by their partner when compared to women with 12 years or more of schooling and from the 3rd tercile - the richest (p<0.05). Those who identified as single reported a 62% higher frequency of physical abuse compared to those who were married (PR: 1.61; 95% CI: 1.23-2.14). Catholic participants reported an almost 30% lower prevalence of physical violence compared to non-Catholic participants. Adjusting for confounding factors, it is also observed that those who reported intimate partner violence suffered by their mother had a higher occurrence of physical violence (PR: 1.67; 95% CI: 1.36-2.05). The experience of sexual violence in childhood accounted for an 80% higher prevalence of physical victimization perpetrated by an intimate partner (p<0.001) (Table 3).

Table 3 -
Crude and adjusted analysis of the prevalence of physical violence throughout life according to sociodemographic characteristics, family and life experiences, and behavioral patterns among women residing in an urban area of the municipality of Vitória, ES, Brazil, 2022 (N=1,086).

Variables		Crude analysis			Adjusted analysis
	N	PR	95% CI	p-value	PR	95% CI	p-value
1st Level - Sociodemographic Characteristics
Age group				0.047			0.488
18 to 29 years	202	1.64	1.18-2.28		0.98	0.66-1.45
30 to 39 years	204	1.39	0.99-1.96		1.04	0.75-1.59
40 to 49 years	222	1.51	1.09-2.11		1.25	0.89-1.76
50 to 59 years	196	1.39	0.99-1.97		1.14	0.81-1.61
60 or more	262	Ref.			Ref.
Skin color				0.001			0.731
White	436	Ref.				Ref.
Non-white	650	1.45	1.16-1.81		1.04	0.82-1.32
Years of study				<0.001			0.015
0 to 8 years	203	1.66	1.28-2.15		1.48	1.13-1.94
9 to 11 years	352	1.45	1.15-1.84		1.17	0.90-1.51
12 or more	531	Ref.
Family income (tertiles) (N=1,070)				<0.001			0.027
First	387	1.57	1.15-2.15		1.51	1.08-2.11
Second	359	2.33	1.75-3.10		1.18	0.86-1.63
Third	324	Ref.			Ref.
Marital status				<0.001			0.001
Married	601	Ref.			Ref.
Consensual union	285	1.71	1.35-2.16		1.48	1.18-1.86
Single	134	2.03	1.55-2.65		1.62	1.23-2.14
Divorced	66	1.43	0.93-2.18		1.22	0.77-1.93
Catholic				<0.001			0.004
No	629	Ref.			Ref.
Yes	457	0.57	0.45-0.71		0.71	0.56-0.90
Evangelical				<0.001			0.171
No	713	Ref.			Ref.
Yes	373	1.47	1.20-1.80		1.18	0.93-1.50
2nd Level - Family experience
Mother has been beaten by a partner (N=1,027)				<0.001			<0.001
No	800	Ref.			Ref.
Yes	227	2.26	1.86-2.76		1.67	1.36-2.05
3rd Level - Life experience
Childhood sexual violence				<0.001			<0.001
No	971	Ref.			Ref.
Yes	115	2.23	1.79-2.76		1.80	1.43-2.27
4th Level - Behavioral Characteristics
Average frequency of alcohol consumption (N=1,080)				0.018			0.373
Never	548	Ref.			Ref.
Monthly or less	250	0.94	0.72-1.23		0.88	0.66-1.16
Two to four times a month	177	1.19	0.90-1.56		1.11	0.82-1.50
2 to 3 times a week	92	1.25	0.89-1.77		0.94	0.64-1.37
4 or more times a week	13	2.22	1.31-3.75		1.31	0.85-2.02
Smoking				<0.001			0.183
No, never smoked	804	Ref.			Ref.
Current smoker	137	1.69	1.32-2.16		1.21	0.92-1.58
Used to smoke, but quit	145	1.24	0.93-1.65		1.23	0.93-1.63

• N: absolute frequency; PR: Prevalence Ratio; 95% CI: 95% confidence interval; Ref.: reference group.

Women with up to eight years of education showed a 71% higher prevalence of sexual violence by an intimate partner when compared to those with 12 years or more of education. Single women were 80% more likely to experience this event than married women (PR: 1.80, 95% CI: 1.26-2.57). Catholic women were 40% less likely to experience sexual violence than non-Catholic women. Furthermore, women whose mothers had been beaten by an intimate partner had an 89% (PR: 1.89; 95% CI: 1.44-2.47) higher prevalence of sexual violence, and those who suffered sexual violence in childhood had an 84% higher frequency of sexual violence when compared to those who did not (Table 4).

Table 4 -
Crude and adjusted analysis of the prevalence of sexual violence throughout life according to sociodemographic characteristics, family and life experiences, and behavioral patterns among women residing in an urban area of the municipality of Vitória, Espírito Santo, Brazil, 2022 (N=1,086).

Variables		Crude analysis			Adjusted analysis
	N	PR	95% CI	p-value	PR	95% CI	p-value
1st Level - Sociodemographic Characteristics
Age group (years)				0.089			0.073
18 to 29 years	202	1.69	1.09-2.61		0.82	0.49-1.37
30 to 39 years	204	1.76	1.14-2.71		1.30	0.82-2.05
40 to 49 years	222	1.69	1.10-2.60		1.38	0.89-2.13
50 to 59 years	196	1.51	0.96-2.39		1.31	0.84-2.05
60 or more	262	Ref.			Ref.
Skin color				0.001			0.351
White	436	Ref.			Ref.
Non-white	650	1.61	1.20-2.15		1.15	0.85-1.56
Years of study				0.002			0.004
0 to 8 years	203	1.71	1.22-2.39		1.71	1.24-2.37
9 to 11 years	352	1.60	1.18-2.16		1.42	1.05-1.91
12 or more	531	Ref.			Ref.
Family income (tertiles) (N=1,070)				0.002			0.928
First	387	1.92	1.35-2.75		1.00	0.64-1.54
Second	359	1.56	1.07-2.27		1.05	0.70-1.57
Third	324	Ref.			Ref.
Marital status				<0.001			0.002
Married	601	Ref.			Ref.
Consensual union	285	1.75	1.29-2.37		1.62	1.20-2.17
Single	134	2.12	1.50-3.01		1.80	1.26-2.57
Divorced	66	1.43	0.83-2.50		1.53	0.89-2.63
Catholic				<0.001			0.001
No	629	Ref.			Ref.
Yes	457	0.50	0.37-0.68		0.60	0.44-0.82
Evangelical				0.003			0.243
No	713	Ref.			Ref.
Yes	373	1.49	1.15-1.94		1.21	0.88-1.67
2nd Level - Family experience
Mother has been beaten by a partner (N=1,027)				<0.001			<0.001
No	800	Ref.			Ref.
Yes	227	2.51	1.94-3.25		1.89	1.44-2.47
3rd Level - Life experience
Childhood sexual violence				<0.001			<0.001
No	971	Ref.			Ref.
Yes	115	2.45	1.84-3.25		1.84	1.38-2.46
4th Level - Behavioral Characteristics
Average frequency of alcohol consumption (N=1,080)				0.003			0.070
Never	548	Ref.			Ref.
Monthly or less	250	1.03	0.73-1.46		0.89	0.62-1.29
Two to four times a month	177	1.38	0.97-1.96		1.41	0.98-2.04
2 to 3 times a week	92	1.51	0.99-2.31		1.11	0.72-1.71
4 or more times a week	13	3.05	1.64-5.66		1.73	0.99-3.00
Smoking				0.014			0.835
Never smoked	804	Ref.			Ref.
Current smoker	137	1.63	1.17-2.26		1.00	0.70-1.43
Used to smoke, but quit.	145	1.14	0.78-1.68		1.12	0.77-1.64

• N: absolute frequency; PR: Prevalence Ratio; 95% CI: 95% confidence interval; Ref.: reference group.

DISCUSSION

This study found higher prevalences of psychological violence, results consistent with national and international studies^19-21. This finding likely stems from the fact that psychological violence is more socially normalized, occurring continuously in relationships, and often women do not even consider acts such as insults, embarrassment, and humiliation to be actual violence^18,22. It is also worth noting that this harm is often one of the partner’s first violent manifestations, preceding other types of violence²².

Globally, one in four women have experienced physical or sexual violence, or both in their lifetime. In Brazil, this prevalence is between 20 and 24%²³. In our study, the prevalence of physical violence was also one in four women, while sexual violence affected 17.2% of the sample studied. Both prevalence rates were higher than those found in another Brazilian municipality²¹ and close to some African countries²⁴.

Regardless of the type of violence, this research found an association with the victim's level of education, with a higher prevalence among those with less than eight years of schooling, as demonstrated in the literature^10,20. It is believed that this is due to greater economic dependence on their partners and greater difficulty citeding support services, which would allow breaking the cycle of violence, considering that education can be a proxy for income^25,26. Furthermore, socioeconomic inequalities are significant in the country, and women with lower levels of education generally live in regions with higher levels of structural violence, which ultimately affects interpersonal and domestic relationships²⁷.

Regarding family income, physical violence was associated with women belonging to the poorest tercile. Psychological violence was 27% higher among women in the poorest tercile compared to the richest tercile, after controlling for confounding factors. Even though present in all groups of society, this close relationship between violence and socioeconomic variables impacts the poorest to a greater extent, highlighting the challenges of breaking the cycle of aggression when financial dependence prevails in relationships²⁶.

Regarding the victims’ marital status, higher prevalence rates of psychological, physical, and sexual violence were observed among single women compared to married women. This result, similar to that found in another study, points to the existence of shared values between partners, which would not occur in weaker relationships²⁸. With regard to religion, violence against women was less prevalent among those who identified as Catholic. This apparent protective effect of the Catholic religion and its higher prevalence among evangelical women is consistent with other studies, where evangelical religion has been associated with greater victimization. It is noteworthy that these women experience the legitimization of patriarchy and male domination, supported by the place of guilt, submission, and fragility that many of these denominations impose on victims, as well as by seeking religion as a support network to endure and overcome the aggressions they have experienced^26-29.

Another important finding was about the family history of violence, which seems to perpetuate itself across generations. The three conditions studied were associated with victims who reported a mother with a history of intimate partner violence. This relationship was addressed in a similar study, emphasizing that a family environment marked by violence can be a breeding ground for violent behaviors and the repetition and/or reproduction of vulnerability^10.26. In this sense, it is also noted that the highest prevalence of victimization was present among women with a history of childhood sexual violence, corroborating a study by Barrios and co-authors (2015) in which the majority of participants reported exposure to physical or sexual violence as children, with 37.3% reporting physical violence, 24.3% reporting both physical and sexual violence, and 7.8% having suffered childhood sexual violence³⁰.

Recognized as a serious public health problem, violence, especially against vulnerable groups such as women, profoundly impacts the lives of survivors and their families. Health services are a strategic location not only for identifying but also for the appropriate management of cases²⁶. Welcoming victims through attentive listening, followed by reporting the harm and making the necessary referrals to the care network, are essential actions for professionals in ensuring the promotion of health and comprehensive care¹³.

One of the limitations of this study relates to the type of design, which does not allow testing causal relationships between exposure variables and outcomes. Self-reported outcome information can be considered a limitation, although the use of this measure is reliable and recommended in population-based studies. To minimize potential information bias, data was collected in a private and secure location at the residence, without the presence of the partner or others. Regarding methodological aspects, some precautions were taken to ensure the quality of the data collected, such as conducting a pilot study, training interviewers, checking questionnaires, and implementing quality control.

The findings of this study have important practical implications for strengthening public policies to combat violence against women, as they highlight both the magnitude of the problem and the factors associated with its occurrence, providing support for the formulation of intersectoral strategies for prevention, support, and comprehensive care. One of the study's strengths is that it is a population-based study, in which women were interviewed in their homes and not in shelters, which increases the representativeness of the results and allows for a more realistic view of the magnitude of violence in the urban context. Moreover, identifying the associated factors provides essential elements for guiding more effective and targeted policies.

CONCLUSION

It is worth highlighting that this work is the first population-based study in the state of Espírito Santo aimed at measuring the prevalence of violence and its associated factors among women aged 18 and over. The data presented show a high prevalence of violence typologies among women residing in urban areas, and demonstrate that women’s sociodemographic and behavioral characteristics, family history, and life can make them more vulnerable to intimate partner violence, reflecting the gender and social inequalities present in society.

Identifying the characteristics associated with the phenomenon and its typologies contributes to the planning, execution, and monitoring of the problem, allowing the development of prevention, embracement, and intervention measures to address intimate partner violence. It is expected that the results presented here will contribute to raising awareness and integrating managers, professionals, academics, and civil society for the proper screening, identification, notification, embracement, and referral of women in situations of violence, articulating permanent and continuous strategies and actions between the network of health care services and different sectors, such as the judiciary, public security, and social assistance. Finally, in this context, it is crucial to highlight the important role of healthcare professionals, especially nurses, as key players in promoting humanized care, attentive listening, and holistic treatment.

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NOTES

• FUNDING INFORMATION
  Study funded by the Espírito Santo Research and Innovation Support Foundation (FAPES/CNPq/Decit-SCTIE-MS/SESA Notice No. 09/2020 - PPSUS) and by the National Council for Scientific and Technological Development (303359/2021-8 - CNPq Call No. 4/2021 - Research Productivity Grants - PQ).
• APPROVAL OF ETHICS COMMITTEE IN RESEARCH
  Approved by the Ethics Committee in Research of the Health Sciences Center of the Universidade Federal do Espírito Santo, opinion no. 4.974.080/2021, Certificate of Presentation for Ethical Review 41628820.6.0000.5060.
• TRANSLATED BY
  Denise Costa Rodrigues
• DATA AVAILABILITY
  Data available upon request.

Edited by

• EDITORS
  Associated Editors: Camila Xavier Dalcol.
  Editor-in-chief: Gisele Cristina Manfrini.

Data availability

Data available upon request.

Publication Dates

• Publication in this collection
  27 Apr 2026
• Date of issue
  2026

History

• Received
  13 Jan 2025
• Accepted
  30 Sept 2025