ABSTRACT

Objective:

To analyze the trend and spatial pattern of intimate partner rape reports against women in Northeast Brazil.

Methods:

Ecological time-series study and spatial analysis with secondary data from the Notifiable Diseases Information System between 2013 and 2022. Gross rape rates were calculated by type of intimate partner and by age group of the victim. Prais-Winsten regression was used to calculate the trend, and the global and local Moran indices were used for spatial analysis.

Results:

A total of 5,542 cases of intimate partner rape were reported. Spousal rates ranged from 0.34/100,000 women in 2013 to 0.51/100,000 in 2017, with greater increases between 2018 (1.04/100 thousand) and 2022 (1.28/100 thousand). There was an upward trend in the Northeast as a whole (APC=19.47; 95%CI 15.88–23.22) and in almost all states, except Paraíba and Sergipe. Cases perpetrated by boyfriends (APC=23.90; 95%CI 12.80–36.09) and among women aged 15 to 19 years (APC=22.63; 95%CI 4.18–44.35) showed the highest annual variation. A concentration of high rates was observed in several municipalities in the northwest of Ceará and southeast of Pernambuco.

Conclusion:

The trend in intimate partner rape rates against women increased in the Northeast, especially among younger women and by boyfriends, with a greater agglomeration of notifications in Ceará and Pernambuco.

Keywords:
Violence against women; Intimate partner violence; Sexual violence; Rape; Northeast

INTRODUCTION

Intimate partner violence against women is a significant public health and human rights concern globally, as it profoundly impacts the lives, physical well-being, and health of women¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02... ,²2 World Health Organization. Violence against women [Internet]. 2023 [cited on Jul 24, 2023]. Available at: https://www.who.int/health-topics/violence-against-women#tab=tab_1
https://www.who.int/health-topics/violen... . Statistics indicate that approximately 1 in 3 women have experienced physical and/or sexual violence at some stage in their lives, often perpetrated by an intimate partner³3 World Health Organization. WHO multi-country study on women's health and domestic violence against women: initial results on prevalence, health outcomes and women's responses [Internet]. 2005 [cited on Jul 24, 2023]. Available at: https://www.who.int/publications/i/item/9241593512
https://www.who.int/publications/i/item/... . Intimate partner violence encompasses various forms of harmful behavior within marital relationships — and may also be perpetrated by a former partner —, including physical, psychological, sexual, emotional, economic, and coercive control tactics¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02...

2 World Health Organization. Violence against women [Internet]. 2023 [cited on Jul 24, 2023]. Available at: https://www.who.int/health-topics/violence-against-women#tab=tab_1
https://www.who.int/health-topics/violen...

3 World Health Organization. WHO multi-country study on women's health and domestic violence against women: initial results on prevalence, health outcomes and women's responses [Internet]. 2005 [cited on Jul 24, 2023]. Available at: https://www.who.int/publications/i/item/9241593512
https://www.who.int/publications/i/item/... -⁴4 Moroskoski M, Brito FAM, Queiroz RO, Higarashi IH, Oliveira RR. Aumento da violência física contra a mulher perpetrada pelo parceiro íntimo: uma análise de tendência. Cien Saude Colet 2021; 26(Supl. 3): 4993-5002. https://doi.org/10.1590/1413-812320212611.3.02602020
https://doi.org/10.1590/1413-81232021261... .

Sexual violence, a prevalent form of intimate partner violence, encompasses any sexual contact obtained without consent²2 World Health Organization. Violence against women [Internet]. 2023 [cited on Jul 24, 2023]. Available at: https://www.who.int/health-topics/violence-against-women#tab=tab_1
https://www.who.int/health-topics/violen... ,⁵5 d’Oliveira AFPL, Schraiber LB, França-Junior I, Ludermir AB, Portella AP, Diniz CS, et al. Fatores associados à violência por parceiro íntimo em mulheres brasileiras. Rev Saude Publica 2009; 43(2): 299-311. https://doi.org/10.1590/S0034-89102009005000013
https://doi.org/10.1590/S0034-8910200900... ,⁶6 Leite FMC, Luis MA, Amorim MHC, Maciel ELN, Gigante DP. Violência contra a mulher e sua associação com o perfil do parceiro íntimo: estudo com usuárias da atenção primária. Rev Bras Epidemiol 2019; 22: e190056. https://doi.org/10.1590/1980-549720190056
https://doi.org/10.1590/1980-54972019005... . Among its various manifestations, rape is considered the most severe. In accordance with Brazilian law, rape is defined as coercing or compelling someone, through serious threats or physical force, to engage in sexual intercourse or to perform or endure any other sexual act⁷7 Brasil. Presidência da República. Casa Civil. Subchefia para Assuntos Jurídicos. Lei nº 12.015, de 7 de agosto de 2009. Altera o Título VI da Parte Especial do Decreto-Lei nº 2.848, de 7 de dezembro de 1940 – Código Penal, e o art. 1º da Lei nº 8.072, de 25 de julho de 1990, que dispõe sobre os crimes hediondos, nos termos do inciso XLIII do art. 5º da Constituição Federal e revoga a Lei nº 2.252, de 1º de julho de 1954, que trata de corrupção de menores [Internet]. Brasília: Diário Oficial da União; 2009 [cited on Aug 18, 2023]. Available at: https://www.planalto.gov.br/ccivil_03/_ato2007-2010/2009/lei/l12015.html
https://www.planalto.gov.br/ccivil_03/_a... . Similar to the repercussions of sexual violence perpetrated by unknown assailants, intimate partner sexual violence inflicts serious consequences on women's health, including depression, substance abuse, and suicidal ideation⁸8 Barker LC, Stewart DE, Vigod SN. Intimate partner sexual violence: an often overlooked problem. J Womens Health (Larchmt) 2019; 28(3): 363-74. https://doi.org/10.1089/jwh.2017.6811
https://doi.org/10.1089/jwh.2017.6811... .

Data from 161 countries in 2018 showed that 27% of women aged 15 to 49 have experienced physical or sexual violence (or both) caused by an intimate partner throughout their lives¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02... . Furthermore, 38 to 50% of all murders of women in the world are committed by partners or ex-partners⁹9 Stöckl H, Devries K, Rotstein A, Abrahams N, Campbell J, Watts C, et al. The global prevalence of intimate partner homicide: a systematic review. Lancet 2013; 382(9895): 859-65. https://doi.org/10.1016/S0140-6736(13)61030-2
https://doi.org/10.1016/S0140-6736(13)61... . In Brazil, intimate partners were responsible for 62.4% of reported violence against women between 2011 and 2017, with sexual violence disproportionately affecting pregnant women and individuals with disabilities¹⁰10 Mascarenhas MDM, Tomaz GR, Meneses GMS, Rodrigues MTP, Pereira VOM, Corassa RB. Análise das notificações de violência por parceiro íntimo contra mulheres, Brasil, 2011-2017. Rev Bras Epidemiol 2020; 23(supl. 1): E2007. https://doi.org/10.1590/1980-549720200007.supl.1
https://doi.org/10.1590/1980-54972020000... . Moreover, during the COVID-19 pandemic (March 2020 to December 2021), over 100,000 cases of rape against women were documented, with 18 Brazilian states surpassing pre-pandemic levels, particularly in the Northeast region (Paraíba, Maranhão, Alagoas, Piauí, Sergipe, and Rio Grande do Norte)¹¹11 Fórum Brasileiro de Segurança Pública. Violência contra mulheres em 2021 [Internet]. 2021 [cited on Oct 07, 2023]. Available at: https://forumseguranca.org.br/wp-content/uploads/2022/03/violencia-contra-mulher-2021-v5.pdf
https://forumseguranca.org.br/wp-content... .

Indeed, there is a lack of studies specifically addressing rape by intimate partners. Although it is known that intimate partners are more likely to perpetrate some type of sexual violence against their partners or ex-partners¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02... ,⁵5 d’Oliveira AFPL, Schraiber LB, França-Junior I, Ludermir AB, Portella AP, Diniz CS, et al. Fatores associados à violência por parceiro íntimo em mulheres brasileiras. Rev Saude Publica 2009; 43(2): 299-311. https://doi.org/10.1590/S0034-89102009005000013
https://doi.org/10.1590/S0034-8910200900... ,⁶6 Leite FMC, Luis MA, Amorim MHC, Maciel ELN, Gigante DP. Violência contra a mulher e sua associação com o perfil do parceiro íntimo: estudo com usuárias da atenção primária. Rev Bras Epidemiol 2019; 22: e190056. https://doi.org/10.1590/1980-549720190056
https://doi.org/10.1590/1980-54972019005... , this type of aggression may be less identified by women and, consequently, underreported. Many, for example, may not have internalized one of the most common stereotypes about rape: that it can occur within an intimate relationship¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02... ,²2 World Health Organization. Violence against women [Internet]. 2023 [cited on Jul 24, 2023]. Available at: https://www.who.int/health-topics/violence-against-women#tab=tab_1
https://www.who.int/health-topics/violen... .

Furthermore, the Northeast region has recently been identified as having the highest percentage of exposure to violence among adults¹²12 Mascarenhas MDM, Melo AS, Rodrigues MTP, Bahia CA, Lima CM, Corassa RB, et al. Prevalência de exposição à violência entre adultos – Brasil, 2019. Rev Bras Epidemiol 2021; 24(supl. 2): E210019. https://doi.org/10.1590/1980-549720210019.supl.2
https://doi.org/10.1590/1980-54972021001... and a place where many women still find themselves in a patriarchal regime with great stratification of gender, social status, and race¹³13 Azevedo AKS, Dutra EMS. Era uma vez uma história sem história: pensando o ser mulher no Nordeste. Pesqui Prat Psicossociais 2019; 14(2): 1-14.. Based on this data, this study aimed to analyze the trend and spatial pattern of notifications of rape by an intimate partner against women in the Northeast.

METHODS

This study adopted an ecological approach to conduct temporal and spatial analysis, focusing on the examination of publicly available secondary data. These data were sourced from the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação – SINAN) within the Information Technology Department of the Unified Health System (Departamento de Informática do Sistema Único de Saúde – DATASUS). All information was filtered according to the following categories: Northeast region, female gender, age range >15 years, rape (yes), and intimate partner (boyfriend, ex-boyfriend, spouse, and ex-spouse). The variables of interest were considered: year of notification, state of occurrence, municipality of occurrence, race/skin color, education, place of occurrence, repeated violence and suspected alcohol use.

The year of the reported rape incidents (spanning from 2013 to 2022) was treated as the independent variable, while the crude rate of intimate partner rape served as the dependent variable, categorized by state, age range, and type of intimate partner. Crude rates of intimate partner rape were computed by dividing the number of reported rape cases involving women aged 15 years old and older by an intimate partner, by the corresponding population of women aged 15 years old and older within the same location and time frame. Intercensal estimates spanning from 2013 to 2022 provided by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística – IBGE) were utilized for this calculation¹⁴14 Instituto Brasileiro de Geografia e Estatística. Projeção da população do Brasil e das Unidades da Federação [Internet]. 2021 [cited on Jul 24, 2023]. Available at: https://www.ibge.gov.br/apps/populacao/projecao/index.html
https://www.ibge.gov.br/apps/populacao/p... .

A descriptive analysis was conducted, presenting absolute frequencies (n), relative frequencies (%), mean (M), and standard deviation (SD). To assess the temporal trend, Prais-Winsten regression was employed. Logarithmic transformation of the dependent variables to base 10 logarithms was performed to address issues of variance heterogeneity and facilitate the calculation of the annual percentage change (APC) along with its corresponding 95% confidence interval (95%CI)¹⁵15 Antunes JLF, Cardoso MRA. Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol Serv Saude 2015; 24(3): 565-76. https://doi.org/10.5123/S1679-49742015000300024
https://doi.org/10.5123/S1679-4974201500... . A positive APC, in conjunction with a statistically significant regression model (p<0.05), suggests an increasing trend. Conversely, a negative APC, alongside a statistically significant regression model (p<0.05), indicates a decreasing trend. A stationary trend is inferred if the regression model lacks statistical significance (p>0.05). Durbin-Watson values (corrected by Prais-Winsten) were computed to identify the presence of first or second-order autocorrelation (results falling between 1.5 and 2.5 are considered conducive for trend interpretation).

For the spatial analysis, the univariate Moran Global and Local Index (GMI/LMI) was utilized. The entire northeastern macro-region served as the geographical scope for this model, with municipalities acting as the units of analysis and the rape rate as the focal event. The map was derived from the IBGE cartographic base (version 2020).

The Moran Index assesses the presence of spatial dependence, indicating whether the event of interest exhibits discernible spatial patterns on the map. The Global Moran Index (GMI) values range from -1 to +1, where positive values (between 0 and +1) denote direct correlation (high-high or low-low), while negative values (between 0 and -1) signify inverse correlation (high-low or low-high). Statistically significant results indicate the presence of overall spatial dependence on the map. However, GMI does not pinpoint where these dependency patterns occur. Therefore, the Local Moran Index (LMI) was employed to identify clusters within each municipality¹⁶16 Câmara G, Carvalho MS, Druck S, Monteiro AMV. análise espacial de dados geográficos. Brasília: Embrapa; 2004..

For mapping the data, Bayesian Empirical Spatial Rates (BESR) were utilized, deemed most suitable for generating maps that display significant regional disparities or encompass numerous polygons. BESR takes into account the neighborhood matrix (local average of neighboring municipalities)¹⁷17 Carvalho AXY, Silva GDM, Almeida Júnior GR, Albuquerque PHM. Taxas bayesianas para o mapeamento de homicídios nos municípios brasileiros. Cad Saude Publica 2012; 28(7): 1249-62. https://doi.org/10.1590/S0102-311X2012000700004
https://doi.org/10.1590/S0102-311X201200... . This rate was computed using the total reported rape cases from 2013 to 2022, alongside the corresponding population figures obtained from the IBGE Census¹⁴14 Instituto Brasileiro de Geografia e Estatística. Projeção da população do Brasil e das Unidades da Federação [Internet]. 2021 [cited on Jul 24, 2023]. Available at: https://www.ibge.gov.br/apps/populacao/projecao/index.html
https://www.ibge.gov.br/apps/populacao/p... . The model parameters included the cartographic projection in the Geocentric Reference System for the Americas 2000 (SIRGAS 2000) and the queen contiguity neighborhood matrix with first-order neighbors. Municipalities with no reported rape incidents were excluded from the analysis.

To assess the significance of all generated models (GMI or LMI), the pseudo-significance test was conducted using 99,999 permutations¹⁶16 Câmara G, Carvalho MS, Druck S, Monteiro AMV. análise espacial de dados geográficos. Brasília: Embrapa; 2004.. The cartographic representation was achieved using the Local Indicators of Spatial Association (LISA) map, which categorizes municipalities based on LMI. The time series analysis was performed using Stata (version 17). GMI/LMI and BESR were executed in GeoDa (version 1.20), and the maps were generated in QGIS 4.24 Tisler. A significance level of 5% (p<0.05) was adopted for trend estimates, while a significance level of 1% (p<0.01) was applied for maps to address the issue of multiple comparisons (99,999 permutations).

This study was not submitted for consideration by the Research Ethics Committee because it involves secondary data, as per Resolution No. 510/2016 of the National Health Council¹⁸18 Brasil. Resolução nº 510, de 07 de abril de 2016 [Internet]. Brasil: Diário Oficial da União; 2016 [cited on Jul 24, 2023]. Available at: https://conselho.saude.gov.br/resolucoes/2016/Reso510.pdf
https://conselho.saude.gov.br/resolucoes... .

RESULTS

5,542 cases of intimate partner rape against women were reported. The highest number of notifications occurred in 2022 (18.9%), while the lowest was recorded in 2014 (4.0%). Table 1 reveals that throughout the period, Pernambuco had the highest number of notifications (42.4%), followed by Bahia (17.9%). Most victims were up to 39 years old (76.5%), with nearly a quarter of them (23.3%) being teenagers. Additionally, there was a higher frequency of individuals with brown race/skin color (63.1%), with education up to elementary school (39.9%). Violence was primarily perpetrated by spouses (41.3%) and ex-spouses (31.0%), occurring predominantly at home (82.5%), repeatedly (71.8%), and without the aggressor having consumed alcoholic beverages (48.2%).

There was a gradual increase in crude rape notification rates for all types of intimate partners, with higher rates observed for spouses. Between 2013 and 2017, the rates perpetrated by spouses ranged from 0.34 per 100 thousand women in 2013 to 0.51 per 100 thousand in 2017, with more significant increases noted between 2018 (1.04 per 100 thousand) and 2022 (1.28 per 100 thousand). Regarding other intimate partners, there was a slight increase in rates during the period, except for rape committed by a boyfriend, where the year 2022 exhibited the highest notification rates in the time series (Table 2).

Table 3 presents the temporal trend in crude rape rates. Among the states, only Paraíba (APC = -0.35; 95%CI -15.81–17.94) and Sergipe (APC = 12.65; 95%CI -14.92–49.15) exhibited a stationary trend, while the remaining states showed an increasing trend. Ceará had the highest percentage of annual growth (APC = 42.11; 95%CI 22.46–64.91), followed by Alagoas (APC = 34.51; 95%CI 20.91–49.63), with Piauí showing the lowest annual growth (APC = 14.40; 95%CI 1.94–28.38). Concerning the main aggressor, an increase was observed for all types, with cases perpetrated by boyfriends (APC = 23.90; 95%CI 12.80–36.09) and ex-boyfriends (APC = 22.39; 95%CI 16.40–28.69) exhibiting the greatest annual variation. Regarding the age range, a higher increase in rape rates was noted among women aged 15 to 19 (APC = 22.63; 95%CI 4.18–44.35).

Figure 1 illustrates the spatial distribution of Bayesian rape rates. A concentration of high rates is observed in several municipalities located in the states of Ceará and Pernambuco. This pattern is evident in both total rates and incidents caused by spouses and boyfriends, showing a higher concentration of rape rates. The global spatial dependence analysis (GMI) indicated that total rape rates, as well as those perpetrated by spouses (I=0.333), boyfriends (I=0.472), and ex-boyfriends (I=0.308), exhibited direct spatial autocorrelation (p<0.001). However, occurrences by ex-spouses were not statistically significant (p=0.108).

Figure 2 displays the results of Moran's local indices, categorized by types of aggressors. Spatial clusters of high Bayesian rape rates were identified in several municipalities in Ceará and Pernambuco. With the exception of cases of rape perpetrated by ex-spouses, the clusters are located in municipalities in the northwest of Ceará and the southeast of Pernambuco, near the border with Alagoas.

DISCUSSION

The notification profile revealed a predominance of young, brown women experiencing violence in their own homes, primarily by their spouses and without reported alcohol involvement. There was a notable trend of increasing crude rape rates across almost all states, involving various types of intimate partners and victim age groups. Additionally, the spatial analysis unveiled clustering of cases in Pernambuco and Ceará. These findings underscore that intimate partner rape, occurring within marital partnerships¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02... ,¹⁹19 Fontes KB, Alarcão ACJ, Nihei OK, Pelloso SM, Andrade L, Carvalho MDB. Regional disparities in the intimate partner sexual violence rate against women in Paraná State, Brazil, 2009-2014: an ecological study. BMJ Open 2018; 8(2): e018437. https://doi.org/10.1136/bmjopen-2017-018437
https://doi.org/10.1136/bmjopen-2017-018... ,²⁰20 Bott S, Guedes A, Ruiz-Celis AP, Mendoza JA. Intimate partner violence in the Americas: a systematic review and reanalysis of national prevalence estimates. Rev Panam Salud Publica 2019; 43: e26. https://doi.org/10.26633/RPSP.2019.26
https://doi.org/10.26633/RPSP.2019.26... , constitutes a particularly demeaning form of violence, as it is perpetrated by someone with whom the victim shares close emotional ties, often in what should be a safe environment¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02... ,⁸8 Barker LC, Stewart DE, Vigod SN. Intimate partner sexual violence: an often overlooked problem. J Womens Health (Larchmt) 2019; 28(3): 363-74. https://doi.org/10.1089/jwh.2017.6811
https://doi.org/10.1089/jwh.2017.6811... ,²¹21 Acosta DF, Gomes VLO, Fonseca AD, Gomes GC. Violência contra a mulher por parceiro íntimo: (in)visibilidade do problema. Texto & Contexto Enferm 2015; 24(1): 121-7. https://doi.org/10.1590/0104-07072015001770013
https://doi.org/10.1590/0104-07072015001... .

The concentration of notifications among women up to the age of 39 aligns with findings from previous studies on intimate partner violence in general¹¹11 Fórum Brasileiro de Segurança Pública. Violência contra mulheres em 2021 [Internet]. 2021 [cited on Oct 07, 2023]. Available at: https://forumseguranca.org.br/wp-content/uploads/2022/03/violencia-contra-mulher-2021-v5.pdf
https://forumseguranca.org.br/wp-content... ,¹⁹19 Fontes KB, Alarcão ACJ, Nihei OK, Pelloso SM, Andrade L, Carvalho MDB. Regional disparities in the intimate partner sexual violence rate against women in Paraná State, Brazil, 2009-2014: an ecological study. BMJ Open 2018; 8(2): e018437. https://doi.org/10.1136/bmjopen-2017-018437
https://doi.org/10.1136/bmjopen-2017-018... ,²²22 Waiselfisz JJ. Mapa da violência 2015: homicídio de mulheres no Brasil [Internet]. 2015 [cited on Sep 09, 2023]. Available at: http://www.onumulheres.org.br/wp-content/uploads/2016/04/MapaViolencia_2015_mulheres.pdf
http://www.onumulheres.org.br/wp-content... ,²³23 Garcia LP, Silva GDM. Violência por parceiro íntimo: perfil dos atendimentos em serviços de urgência e emergência nas capitais dos estados brasileiros, 2014. Cad Saude Publica 2018; 34(4): e00062317. https://doi.org/10.1590/0102-311X00062317
https://doi.org/10.1590/0102-311X0006231... . For instance, data from 86 urgent and emergency services across 25 Brazilian capitals in 2014 indicated that 65% of women subjected to intimate partner rape were aged between 20 and 30 years old. Similarly, a survey spanning nine countries from 2000 to 2004 revealed that adolescents and young adults are particularly vulnerable to experiencing physical and/or sexual violence from an intimate partner, with this risk decreasing as individuals age²⁴24 Stöckl H, March L, Pallito C, García-Moreno C; WHO Multi-country Study Team. Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health 2014; 14: 751. https://doi.org/10.1186/1471-2458-14-751
https://doi.org/10.1186/1471-2458-14-751... . Risk factors commonly associated with such violence include alcohol consumption and controlling behaviors by the partner, while higher levels of education and formal marriage are considered protective factors¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02... ,²⁴24 Stöckl H, March L, Pallito C, García-Moreno C; WHO Multi-country Study Team. Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health 2014; 14: 751. https://doi.org/10.1186/1471-2458-14-751
https://doi.org/10.1186/1471-2458-14-751... .

Although influenced by various factors such as low socioeconomic status and unemployment, lower levels of education appear to correlate with higher rates of intimate partner violence¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02... ,²⁴24 Stöckl H, March L, Pallito C, García-Moreno C; WHO Multi-country Study Team. Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health 2014; 14: 751. https://doi.org/10.1186/1471-2458-14-751
https://doi.org/10.1186/1471-2458-14-751... ,²⁵25 Schraiber LB, D’Oliveira AFPL, França Junior I. Violência sexual por parceiro íntimo entre homens e mulheres no Brasil urbano, 2005. Rev Saude Publica 2008; 42(Supl 1): 127-37. https://doi.org/10.1590/S0034-89102008000800015
https://doi.org/10.1590/S0034-8910200800... , as evidenced in this study. A population-based study conducted in Florianópolis (Santa Catarina) between 2009 and 2010 revealed that women with less than 5 years of education experience three times higher rates of moderate violence and five times higher rates of serious intimate partner violence compared to those with 5 or more years of education²⁶26 Lindner SR, Coelho EBS, Bolsoni CC, Rojas PF, Boing AF. Prevalência de violência física por parceiro íntimo em homens e mulheres de Florianópolis, Santa Catarina, Brasil: estudo de base populacional. Cad Saude Publica 2015; 31(4): 815-26. https://doi.org/10.1590/0102-311X00159913
https://doi.org/10.1590/0102-311X0015991... . Additionally, among women with lower levels of education and income, incidents of sex forced out of fear or physical coercion were more prevalent²⁵25 Schraiber LB, D’Oliveira AFPL, França Junior I. Violência sexual por parceiro íntimo entre homens e mulheres no Brasil urbano, 2005. Rev Saude Publica 2008; 42(Supl 1): 127-37. https://doi.org/10.1590/S0034-89102008000800015
https://doi.org/10.1590/S0034-8910200800... . Further research suggests an elevated risk of intimate partner violence when there exists an educational disparity between partners, particularly when the woman possesses a higher level of education²⁷27 Abramsky T, Watts CH, García-Moreno C, Devries K, Kiss L, Elsberg M, et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women's health and domestic violence. BMC Public Health 2011; 11: 109. https://doi.org/10.1186/1471-2458-11-109
https://doi.org/10.1186/1471-2458-11-109... . It is plausible that increased education and financial independence may decrease women's tolerance for intimate partner violence⁸8 Barker LC, Stewart DE, Vigod SN. Intimate partner sexual violence: an often overlooked problem. J Womens Health (Larchmt) 2019; 28(3): 363-74. https://doi.org/10.1089/jwh.2017.6811
https://doi.org/10.1089/jwh.2017.6811... ,²⁴24 Stöckl H, March L, Pallito C, García-Moreno C; WHO Multi-country Study Team. Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health 2014; 14: 751. https://doi.org/10.1186/1471-2458-14-751
https://doi.org/10.1186/1471-2458-14-751... .

Consistent with the present study, prior research indicates that sexual violence predominantly occurs within current partnerships, whether defined as marital or boyfriend-girlfriend relationships, with over half of reported rape cases perpetrated by the spouse¹⁹19 Fontes KB, Alarcão ACJ, Nihei OK, Pelloso SM, Andrade L, Carvalho MDB. Regional disparities in the intimate partner sexual violence rate against women in Paraná State, Brazil, 2009-2014: an ecological study. BMJ Open 2018; 8(2): e018437. https://doi.org/10.1136/bmjopen-2017-018437
https://doi.org/10.1136/bmjopen-2017-018... ,²⁰20 Bott S, Guedes A, Ruiz-Celis AP, Mendoza JA. Intimate partner violence in the Americas: a systematic review and reanalysis of national prevalence estimates. Rev Panam Salud Publica 2019; 43: e26. https://doi.org/10.26633/RPSP.2019.26
https://doi.org/10.26633/RPSP.2019.26... ,²²22 Waiselfisz JJ. Mapa da violência 2015: homicídio de mulheres no Brasil [Internet]. 2015 [cited on Sep 09, 2023]. Available at: http://www.onumulheres.org.br/wp-content/uploads/2016/04/MapaViolencia_2015_mulheres.pdf
http://www.onumulheres.org.br/wp-content... . Nevertheless, marital status is strongly linked to intimate partner violence, as cohabiting women are more inclined to report instances of violence compared to women in formal marriages²⁶26 Lindner SR, Coelho EBS, Bolsoni CC, Rojas PF, Boing AF. Prevalência de violência física por parceiro íntimo em homens e mulheres de Florianópolis, Santa Catarina, Brasil: estudo de base populacional. Cad Saude Publica 2015; 31(4): 815-26. https://doi.org/10.1590/0102-311X00159913
https://doi.org/10.1590/0102-311X0015991... ,²⁷27 Abramsky T, Watts CH, García-Moreno C, Devries K, Kiss L, Elsberg M, et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women's health and domestic violence. BMC Public Health 2011; 11: 109. https://doi.org/10.1186/1471-2458-11-109
https://doi.org/10.1186/1471-2458-11-109... .

In sub-Saharan African countries from 2010 to 2019, married women who exhibited greater sexual autonomy — manifested through their ability to refuse sex or request their partner to use a condom — were found to be at a heightened risk of experiencing sexual violence from an intimate partner²⁸28 Aboagye RG, Dadzie LK, Arthur-Holmes F, Okyere J, Agbalo E, Ahinkorah BO, et al. Intimate partner violence against married and cohabiting women in sub-Saharan Africa: does sexual autonomy matter? Reprod Health 2022; 19(1): 79. https://doi.org/10.1186/s12978-022-01382-1
https://doi.org/10.1186/s12978-022-01382... . This phenomenon can be understood within the context of deeply ingrained cultural norms that prioritize women's submission to men's desires. In such settings, husbands may perceive refusals or inquiries as a challenge to their authority, potentially leading to violent sexual acts against their partners¹³13 Azevedo AKS, Dutra EMS. Era uma vez uma história sem história: pensando o ser mulher no Nordeste. Pesqui Prat Psicossociais 2019; 14(2): 1-14.,²⁹29 Sunmola AM, Mayunbgo DA, Fayehun OA, Opayemi RS, Morakinyo LA. Is women tendency to negotiate safer sex another opportunity for intimate partner violence in Nigeria? J Interpers Violence 2021; 36(7-8): NP3624-NP3645. https://doi.org/10.1177/0886260518779071
https://doi.org/10.1177/0886260518779071... .

While intimate partner violence is acknowledged to transcend social classes, races, religions, educational levels, and even occur during pregnancy, there is consensus that certain factors can contribute to aggression, including alcohol intake¹1 Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet 2022; 339(10327): 803-13. https://doi.org/10.1016/S0140-6736(21)02664-7
https://doi.org/10.1016/S0140-6736(21)02... ,¹⁰10 Mascarenhas MDM, Tomaz GR, Meneses GMS, Rodrigues MTP, Pereira VOM, Corassa RB. Análise das notificações de violência por parceiro íntimo contra mulheres, Brasil, 2011-2017. Rev Bras Epidemiol 2020; 23(supl. 1): E2007. https://doi.org/10.1590/1980-549720200007.supl.1
https://doi.org/10.1590/1980-54972020000... ,²⁴24 Stöckl H, March L, Pallito C, García-Moreno C; WHO Multi-country Study Team. Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health 2014; 14: 751. https://doi.org/10.1186/1471-2458-14-751
https://doi.org/10.1186/1471-2458-14-751... ,²⁷27 Abramsky T, Watts CH, García-Moreno C, Devries K, Kiss L, Elsberg M, et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women's health and domestic violence. BMC Public Health 2011; 11: 109. https://doi.org/10.1186/1471-2458-11-109
https://doi.org/10.1186/1471-2458-11-109... ,²⁸28 Aboagye RG, Dadzie LK, Arthur-Holmes F, Okyere J, Agbalo E, Ahinkorah BO, et al. Intimate partner violence against married and cohabiting women in sub-Saharan Africa: does sexual autonomy matter? Reprod Health 2022; 19(1): 79. https://doi.org/10.1186/s12978-022-01382-1
https://doi.org/10.1186/s12978-022-01382... ,³⁰30 Conceição HN, Coelho SF, Madeiro AP. Prevalência e fatores associados à violência por parceiro íntimo na gestação em Caxias, Maranhão, 2019-2020. Epidemiol Serv Saude 2021; 30(2): e2020848. https://doi.org/10.1590/S1679-49742021000200012
https://doi.org/10.1590/S1679-4974202100... . Consumption of alcoholic beverages by an intimate partner heightens the likelihood of aggressive behavior, emotional abuse, and sexual misconduct²⁴24 Stöckl H, March L, Pallito C, García-Moreno C; WHO Multi-country Study Team. Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health 2014; 14: 751. https://doi.org/10.1186/1471-2458-14-751
https://doi.org/10.1186/1471-2458-14-751... ,²⁶26 Lindner SR, Coelho EBS, Bolsoni CC, Rojas PF, Boing AF. Prevalência de violência física por parceiro íntimo em homens e mulheres de Florianópolis, Santa Catarina, Brasil: estudo de base populacional. Cad Saude Publica 2015; 31(4): 815-26. https://doi.org/10.1590/0102-311X00159913
https://doi.org/10.1590/0102-311X0015991... ,³⁰30 Conceição HN, Coelho SF, Madeiro AP. Prevalência e fatores associados à violência por parceiro íntimo na gestação em Caxias, Maranhão, 2019-2020. Epidemiol Serv Saude 2021; 30(2): e2020848. https://doi.org/10.1590/S1679-49742021000200012
https://doi.org/10.1590/S1679-4974202100... ,³¹31 Aboagye RG, Ahinkorah BO, Tengan CL, Salifu I, Acheampong HY, Seidu AA. Partner alcohol consumption and intimate partner violence Against women in sub-Saharan Africa. PLoS One 2022; 17(12): e0278196. https://doi.org/10.1371/journal.pone.0278196
https://doi.org/10.1371/journal.pone.027... , with bidirectionality observed between substance abuse and marital violence⁵5 d’Oliveira AFPL, Schraiber LB, França-Junior I, Ludermir AB, Portella AP, Diniz CS, et al. Fatores associados à violência por parceiro íntimo em mulheres brasileiras. Rev Saude Publica 2009; 43(2): 299-311. https://doi.org/10.1590/S0034-89102009005000013
https://doi.org/10.1590/S0034-8910200900... ,²⁶26 Lindner SR, Coelho EBS, Bolsoni CC, Rojas PF, Boing AF. Prevalência de violência física por parceiro íntimo em homens e mulheres de Florianópolis, Santa Catarina, Brasil: estudo de base populacional. Cad Saude Publica 2015; 31(4): 815-26. https://doi.org/10.1590/0102-311X00159913
https://doi.org/10.1590/0102-311X0015991... . Alcohol abuse affects both men and women, leading to diminished self-control and compromised cognitive function, thereby deteriorating marital relationships and exacerbating violent behavior³²32 Ally EZ, Laranjeira R, Viana MC, Pinsky I, Caetano R, Mitsuhiro S, et al. Intimate partner violence trends in Brazil: data from two waves of Brazilian National Alcohol and Drugs Survey. Braz J Psychiatry 2016; 38(2): 98-105. https://doi.org/10.1590/1516-4446-2015-1798
https://doi.org/10.1590/1516-4446-2015-1... . However, data from the current research revealed a higher proportion of reported cases of rape without suspicion of alcohol use by partners. This finding warrants careful evaluation as the assessment of the partner's alcohol consumption is solely based on the woman's perception, and there is also a notable frequency of missing/blank responses on this topic.

The temporal trend analysis conducted in this study revealed an escalation in intimate partner rape rates across the Northeast region as a whole and in nearly all states. Although there are no national data available for comparison, a systematic review examining violence against women by intimate partners in the Americas identified a significant decrease in the lifetime prevalence of sexual violence in six countries (Colombia, Guatemala, Haiti, Mexico, Nicaragua, and Peru) out of the 24 evaluated during the period 1998–2018²⁰20 Bott S, Guedes A, Ruiz-Celis AP, Mendoza JA. Intimate partner violence in the Americas: a systematic review and reanalysis of national prevalence estimates. Rev Panam Salud Publica 2019; 43: e26. https://doi.org/10.26633/RPSP.2019.26
https://doi.org/10.26633/RPSP.2019.26... . The observed increase in sexual violence trend in this investigation may partly be attributed to women's improved access to information and support from health and security services, which can facilitate the cessation of the cycle of violence and encourage reporting by victims to their intimate partners. However, it is also essential to consider other factors contributing to the perpetuation of intimate partner violence, including various social and economic vulnerabilities that constrain women's capacity to exit abusive relationships¹⁹19 Fontes KB, Alarcão ACJ, Nihei OK, Pelloso SM, Andrade L, Carvalho MDB. Regional disparities in the intimate partner sexual violence rate against women in Paraná State, Brazil, 2009-2014: an ecological study. BMJ Open 2018; 8(2): e018437. https://doi.org/10.1136/bmjopen-2017-018437
https://doi.org/10.1136/bmjopen-2017-018... .

Despite the observed increasing trend in rape rates perpetrated by all categories of intimate partners and across all age groups, it is notable that the highest percentage of annual growth occurred among cases involving boyfriends/ex-boyfriends and victims aged 15 to 19. These findings underscore the significance of violence within dating relationships, a phenomenon well-documented in other research³³33 Clayton HB, Kilmer G, DeGue S, Estefan LF, Le VD, Suarez NA, et al. Dating violence, sexual violence, and bullying victimization among high school students – Youth Risk Behavior Survey, United States, 2021. MMWR Suppl 2023; 72(1): 66-74. http://doi.org/10.15585/mmwr.su7201a8
http://doi.org/10.15585/mmwr.su7201a8... ,³⁴34 Patrocino LB, Bevilacqua PD. Sobre risco, violência e gênero: revisão da produção de saúde sobre sexting entre jovens. Cienc Saude Colet 2021; 26(7): 2709-18. https://doi.org/10.1590/1413-81232021267.07482021
https://doi.org/10.1590/1413-81232021267... , where women are primarily victimized, particularly in cases of sexual and/or physical aggression. It is also important to highlight that this form of violence is increasingly facilitated by technology, such as the dissemination of sexual images and videos without consent³³33 Clayton HB, Kilmer G, DeGue S, Estefan LF, Le VD, Suarez NA, et al. Dating violence, sexual violence, and bullying victimization among high school students – Youth Risk Behavior Survey, United States, 2021. MMWR Suppl 2023; 72(1): 66-74. http://doi.org/10.15585/mmwr.su7201a8
http://doi.org/10.15585/mmwr.su7201a8... ,³⁴34 Patrocino LB, Bevilacqua PD. Sobre risco, violência e gênero: revisão da produção de saúde sobre sexting entre jovens. Cienc Saude Colet 2021; 26(7): 2709-18. https://doi.org/10.1590/1413-81232021267.07482021
https://doi.org/10.1590/1413-81232021267... . A study examining sexual violence notification rates among adolescents revealed a rising trend across all regions of Brazil between 2011 and 2018, with the Northeast exhibiting the lowest rates and percentage variation³⁵35 Viana VAO, Madeiro AP, Mascarenhas MDM, Rodrigues MTP. Tendência temporal da violência sexual contra mulheres adolescentes no Brasil, 2011-2018. Cienc Saude Colet 2022; 27(6): 2363-71. https://doi.org/10.1590/1413-81232022276.14992021
https://doi.org/10.1590/1413-81232022276... . Additionally, findings from a systematic review indicate that young women who cohabit with their partners are at even greater risk of experiencing violence, including sexual violence. This heightened vulnerability can be attributed to factors such as limited educational opportunities, power imbalances within relationships, and increased economic dependence, all of which constrain autonomy and predispose individuals to aggression³⁶36 Finnie RKC, Okasako-Schmucher DL, Buchanan L, Carty D, Wethington H, Mercer SL, et al. Intimate partner and sexual violence prevention among youth: a community guide systematic review. Am J Prev Med 2022; 62(1): e45-e55. https://doi.org/10.1016/j.amepre.2021.06.021
https://doi.org/10.1016/j.amepre.2021.06... .

The study identified spatial heterogeneity in the crude notification rates of intimate partner rape in the Northeast, with heightened clusters observed in the states of Ceará and Pernambuco. Between 2009 and 2014, the majority of municipalities in Paraná that contributed to the formation of high-high clusters were associated with lower human development indices, a higher proportion of economically active women, and higher average female income¹⁹19 Fontes KB, Alarcão ACJ, Nihei OK, Pelloso SM, Andrade L, Carvalho MDB. Regional disparities in the intimate partner sexual violence rate against women in Paraná State, Brazil, 2009-2014: an ecological study. BMJ Open 2018; 8(2): e018437. https://doi.org/10.1136/bmjopen-2017-018437
https://doi.org/10.1136/bmjopen-2017-018... . On the one hand, apart from this geographic alignment with sociodemographic determinants, it is plausible that the promotion and perpetuation of violence are also intertwined with social and cultural norms surrounding ideals of masculinity and gender relations, which reinforce prevalent sexism in society, still pervasive in many locations in the Northeast³⁷37 Brilhante AVM, Nations MK, Catrib AMF. "Taca cachaça que ela libera": violência de gênero nas letras e nas festas de forró no Nordeste do Brasil. Cad Saude Publica 2018; 34(3): e00009317. https://doi.org/10.1590/0102-311X00009317
https://doi.org/10.1590/0102-311X0000931... . However, it is recognized that women residing in smaller municipalities or rural contexts may encounter greater difficulty in reporting domestic violence or rape³⁸38 Stochero L, Pinto LW. Violência contra mulheres que vivem em contextos rurais: uma revisão integrativa. Saude Soc 2023; 32(3): e210595pt. http://doi.org/10.1590/S0104-12902023210595pt
http://doi.org/10.1590/S0104-12902023210... .

Data from the World Health Organization (WHO) indicates that less than 40% of women who experience any form of violence seek assistance. The majority tend to rely on their support networks, primarily family and friends, while a smaller percentage turn to institutional resources such as health and security services (with less than 10% choosing to involve the police)³⁹39 World Health Organization. World health statistics 2015 [Internet]. 2015 [acessado em 6 ago. 2023]. Disponível em: https://www.who.int/docs/default-source/gho-documents/world-health-statistic-reports/world-health-statistics-2015.pdf
https://www.who.int/docs/default-source/... . Despite progress, the support network for women victims of violence in the Northeast remains limited. In 2022, only 10.7% of Police Stations Specialized in Women's Assistance operated 24 hours a day⁴⁰40 Brasil. Ministério da Justiça e Segurança Pública. Secretaria Nacional de Segurança Pública. Ministério das Mulheres. Secretaria Nacional de Enfrentamento à Violência contra Mulheres. Observatório Brasil da Igualdade de Gênero. 8º Diagnóstico das Unidades de Polícia Civil Especializadas em Atendimento às Mulheres [Internet]. Brasília: Ministério da Justiça; 2023 [cited on Feb 02, 2024]. Available at: https://www.gov.br/mj/pt-br/assuntos/sua-seguranca/seguranca-publica/estatistica/download/pesquisa-perfil/outrasperfil/deams/relatorio-8o-diagnostico-nacional-das-unidades-especializadas-em-atendimento-a-mulher-2022.pdf
https://www.gov.br/mj/pt-br/assuntos/sua... , and in 2018, the region had 23.5% of the specialized service network and 23.8% of shelters for situations involving death threats⁴¹41 Instituto Brasileiro de Geografia e Estatística. Perfil dos municípios brasileiros: 2018 [Internet]. Rio de Janeiro: IBGE; 2019 [cited on Feb 02, 2024]. Available at: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101668.pdf
https://biblioteca.ibge.gov.br/visualiza... . A study conducted in Spain with 849 cases of sexual violence by an intimate partner revealed that common reasons for not reporting included the termination of the relationship, lack of awareness about reporting options, and expressions of shame, guilt, or fear undermining the credibility of the report⁴²42 Pastor-Moreno G, Ruiz-Pérez I, Sordo L, Henares-Montiel J. Frequency, types, and manifestations of partner sexual violence, non-partner sexual violence and sexual harassment: a population study in Spain. Int J Environ Res Public Health 2022; 19(13): 8108. https://doi.org/10.3390/ijerph19138108
https://doi.org/10.3390/ijerph19138108... .

Finally, it is important to acknowledge several limitations of this study. Firstly, there may have been underreporting of rape, stemming from difficulties in women identifying violence and potential barriers to accessing healthcare facilities, as there remains an insufficient number of units providing specialized care for sexual violence, particularly in smaller municipalities⁴³43 Melo CM, Soares MQ, Bevilacqua PD. Violência sexual: avaliação dos casos e da atenção às mulheres em unidades de saúde especializadas e não especializadas. Cienc Saude Colet 2022; 27(9): 3715-28. http://doi.org/10.1590/1413-81232022279.07242022
http://doi.org/10.1590/1413-81232022279.... . Secondly, the comparison of rates and APC between states should be interpreted cautiously, considering the heterogeneity in data quality and significant variation in the completeness of various fields on the notification form⁴⁴44 Sousa CMS, Mascarenhas MDM, Lima PVC, Rodrigues MTP. Incompletude do preenchimento das notificações compulsórias de violência – Brasil, 2011-2014. Cad Saude Colet 2020; 28(4): 477-87. https://doi.org/10.1590/1414-462X202028040139
https://doi.org/10.1590/1414-462X2020280... ,⁴⁵45 Platt VB, Coelho EBS, Bolsoni C, Höfelmann DA. Completitude, consistência e não duplicidade dos registros de violência sexual infantil no Sistema de Informação de Agravos de Notificação em Santa Catarina, 2009-2019. Epidemiol Serv Saude 2022; 31(2): e2021441. https://doi.org/10.1590/S2237-96222022000100012
https://doi.org/10.1590/S2237-9622202200... . Another limitation arises from the variables analyzed, which were constrained to those available in SINAN. Additional information common to the dynamics of intimate partner violence — such as whether there was overlap with physical and/or psychological aggression or whether the female victim was under the influence of alcohol/illegal drugs — would enhance understanding of the phenomenon. Furthermore, due to database constraints, it was not possible to select more than one answer for the type of intimate partnership. Given that revictimization and polyvictimization of women are common occurrences²2 World Health Organization. Violence against women [Internet]. 2023 [cited on Jul 24, 2023]. Available at: https://www.who.int/health-topics/violence-against-women#tab=tab_1
https://www.who.int/health-topics/violen... ,³3 World Health Organization. WHO multi-country study on women's health and domestic violence against women: initial results on prevalence, health outcomes and women's responses [Internet]. 2005 [cited on Jul 24, 2023]. Available at: https://www.who.int/publications/i/item/9241593512
https://www.who.int/publications/i/item/... , it was impossible to compare the prevalence of violence committed by the current/most recent partnership with the assessment of violence by any partner throughout life.

The findings of this study underscore the prevalence of sexual violence against women by intimate partners as a significant issue in the Northeast of Brazil. To attain a more comprehensive understanding of this phenomenon, future research should seek to obtain estimates in diverse sociocultural contexts. Moreover, it is imperative that health services tailored to women's health address this issue in a manner that fosters a sense of safety and encourages victims to come forward and report incidents. The observed growing trend across the region, encompassing all types of intimate partners and victim age groups, along with the identification of geographic areas of heightened vulnerability, underscores the ongoing necessity for sustained efforts to prevent and respond to such violence.

REFERENCES

Publication Dates

History