Does domestic violence legislation reduce permissive attitudes about intimate partner violence? Longitudinal evidence from men and women from 61 countries

Background Intimate partner violence (IPV) is highly prevalent and has substantial implications for women’s health. Changing IPV attitudes is one pathway to reduce IPV. While evidence suggests that interventions targeting individuals may change IPV attitudes, the effect of wider-scale interventions, such as legislation, remain unknown. Methods We used individual-level IPV attitudes information collected between 1997 and 2020 by the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS), which we linked with national-level domestic violence (DV) legislation information. We evaluated the effect of adoption of DV legislation on changes in IPV attitudes using a difference-in-differences study design that controlled for time-varying country-level confounding and accounted for staggered timing of legislation adoption. Findings Our sample included 2,184,047 women from 60 countries and 390,877 men from 40 countries. After controlling for country-level confounders, adoption of DV legislation reduced IPV acceptability among women (average treatment effect among treated (ATT) = -0.07, 95% CI: -0.16, 0.06) and men (ATT = -0.11, 95% CI: -0.22, 0.03) although estimates were imprecise and included the null. Interpretation DV legislation may reduce permissive IPV attitudes, especially among men, although conclusions should be interpreted cautiously due to imprecise estimates. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development (5R00HD104896). Evidence before this study Ecological models identify attitudes about intimate partner violence (IPV) as an important driver of IPV. Almost all empirical research has focused on individual-level determinants of permissive IPV attitudes, and the effect of large-scale factors, including domestic violence (DV) legislation, is not well known. We performed a search in Google Scholar, PubMed, SCOPUS, PsycINFO, and Web of Science, without language restrictions, using search terms relevant to DV legislation (e.g., DV law, IPV legislation, etc.) and IPV attitudes (e.g., intimate partner violence beliefs, attitudes on wife beating, perception about acceptability of violence, etc.). The terminal date of this search was May 23, 2023. We also searched reference lists of relevant studies to widen our search. We found two papers that estimated the association between DV legislation and IPV attitudes, both of which investigated multiple individual and contextual risk factors simultaneously using cross-sectional data from a large selection of low-and middle-income countries (i.e., 41 and 49 countries). Both studies found no association between DV legislation and IPV attitudes among women (first study) or among men and women (second study). Added value of this study The present study is the first longitudinal assessment of DV legislation on changing IPV attitudes. Prior research was cross-sectional and investigated many determinants simultaneously, which may obscure specific relationships (e.g., by over-controlling for factors that are consequences of changes in IPV attitudes, such as women’s household decision-making) and cannot establish temporal ordering (e. g., if countries with less permissive attitudes about IPV enacted legislation vs. if legislation reduced permissive IPV attitudes). Using comprehensive longitudinal data from men and women from 61 countries, coupled with a difference-in-differences study design that accounts for inherent differences across countries, the present study provides the most rigorous evidence to-date of this relationship. Implications for all available evidence We found that DV legislation resulted in modest reductions in permissive IPV attitudes among women and slightly more pronounced reduction in permissive IPV attitudes among men, although estimates were imprecise. Given that the majority of IPV is perpetrated by men, coupled with the fact that IPV attitudes is a strong predictor of IPV perpetration, our results suggest that DV legislation may be one strategy to reduce IPV. However, estimates were imprecise, and more research is needed to confirm this relationship. Future research could replicate findings in additional countries and could clarify this relationship among men by exploring specific aspects of DV legislation that may be most relevant for changing IPV attitudes (e.g., criminal sanctions) or evaluate if DV legislation is only effective in the presence of other contextual factors (e.g., equitable gender norms, government institutions with high levels of democracy). ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (5R00HD104896). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was reviewed by Emory University Institutional Review Board and was determined to be non-human subjects research. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All individual-level data used in this study is publicly available (with application) through the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys. Country-level policy information is publicly available at the World Bank's website.