Examining the association between structural-level patriarchy and intimate partner violence: evidence from India’s national demographic and health survey

Background Causal frameworks of intimate partner violence (IPV) emphasize a complex interplay between multilevel determinants. Although patriarchy is conceptualized as structural-level driver of IPV in these causal frameworks, empirical examinations are typically constrained to use of individual-level proxy measures of patriarchy. In response, this study employs a validated index of structural patriarchy in nationally-representative data to examine associations between structural patriarchy and multiple forms of IPV. Methods Using India’s latest National Family Health Survey (NFHS-5, n = 61,180 females, ages 18–49), we examine patterning and prevalence of patriarchy as measured using the structural-level index. Next, we empirically test links between structural patriarchy and past 12-month female IPV victimization by a male partner via survey-weighted mixed effects logistic regression models. Regression models disaggregate by: report of any type of IPV, emotional-only, physical-only, sexual-only, and experience of all forms of IPV. Results We find positive linear associations between structural patriarchy and report of IPV after adjusting for other social stratification systems (i.e., caste, religion, and wealth), attitudinal and behavioral indicators, and socio-demographic characteristics. As compared to women in districts with lower levels of structural patriarchy, we find that the highest levels of structural patriarchy are associated with 1.9 times the odds of female-reported experience of IPV (any type) (aOR = 1.92 (95% CI: 1.58, 2.34)). Conclusions This study design permits the disentangling of structural patriarchy from other structural and individual-level determinants of IPV, some often used as proxy measures for patriarchy. Findings underscore the need for district-level planning and the use of structural indicators alongside individual- and couple-level gender norms transformative programming to inform IPV prevention strategies under India’s national health and rights initiatives.