Title: Prevalence of Intimate Partner Violence among Indian women and their determinants: a
cross-sectional study from National Family Health Survey – 5
Version: 1 Date: 18 Mar 2024
Reviewer's report:
Dear Authors,
Thank you for the opportunity to review your manuscript and important study. This work is
extremely important and I commend you on the conception and completion of your work. The
subject matter is of great importance as understanding how to combat IPV  is a necessary step
towards gender equity, women's empowerment and more just society.
Below, I have made recommendations/suggestions for your consideration to help clarify some
key concepts and expand on others as the paper does require some major revisions.
I would recommend another full proofread to check grammatical/tense errors, incomplete
sentences, clarification of meaning of some of the sentences.
I identified some and made suggestions, but a thorough proofread is necessary. Please note that I
began providing some editing suggestions, but this was not exhaustive as some sentences needed
to be restructured/edited.
Please find my comments below in point form for your consideration:
ABSTRACT
**INTRODUCTION:**
The aim to evaluate the prevalence of IPV and its variants among "empowered" women should
be clarified as it seems the study also investigates women with low or no empowerment. Suggest
rewording for accuracy. In the introduction, it states "in this study, we estimated the prevalence
of different IPV categories against the empowerment status of women and determined the
sociodemographic behavior associated with IPV."
**METHODS:**
Suggest indicating which country … The India National Family Health Survey is used.
**RESULTS:**
The prevalence was reported for “empowered women” but wasn’t the study of participating
partnered women who were not necessarily empowered. In the results it refers to the women
included in the study.
**GENERAL:**
Be mindful of sentence endings where the period is after the reference; the convention is that
the reference sits before the sentence-ending period. Ensure consistency with the terms "IPV"
and "DV" throughout the paper [see comment below on terms].
MANUSCRIPT
**INTRODUCTION**
Line 96: Add a descriptor such as "enhance" or "advance" to clarify the statement about
eliminating gender inequality AND women empowerment [you don’t want to eliminate
women’s empowerment].
Line 97: Insert a period after the references AND suggest  “Intimate partner violence is
"recognized" as the most common form of gender-based violence.” [as opposed to addressed]
Line 98: Revise to reflect the nuanced differences between IPV and domestic violence. IPV
and domestic or spousal violence are not identical, there are nuanced differences between them.
Although they are used synonymously, IPV and domestic violence have distinctions - domestic
violence also includes children and parental violence; while spousal violence is specific to
spousal/married relationships, and IPV is specific to intimate relationships (i.e., not only spousal
but also partnerships outside of marriage). Please be mindful of the distinctions - although they
are similar, they are not identical.
Line 98-101: Provide a reference to support the statement.
Line 102: Revise "hustles" to "mental strains." [assume it was meant to be hassles]
Line 114 - Although Lakh is a unit used in population numbering, the general audience reading
may not know, suggest defining or providing the definition of what per lakh means.
Line 120 - suggest "on the contrary" vs. "in the contrary".
Line 121 - should be "act" not "acts"
Line 122 - formatting off with the period and reference at beginning of the sentence.
Overall, your introduction lacks a comprehensive discussion of empowerment. Given its
central role in the study, it's essential to clearly define empowerment and provide contextual
background on its significance, particularly in the Indian context. Strengthen your argument by
explaining why examining women's empowerment is crucial, especially in addressing gender-
based violence (GBV) and advancing the Sustainable Development Goals (SDGs). Consider
elaborating on your chosen indicators for empowerment and providing literature to support their
selection. This additional context will enhance the relevance and importance of your work in
supporting a women's empowerment approach.
**METHODS**
Line 131: Ensure a reference for the statement about India's population.
Line 136: Remove the period after CAPI.
Line 145: Be consistent with the terms "IPV" and "DV."
Lines 165-174: Clarify the indicators for women's empowerment. Ensure consistency with the
number of indicators used.  Methods say there are three, however, you list four in Table A1. It
seems you have lumped/missed the details about Beating indicator in the methods. So, should
there be 4 indicators you are using for women's empowerment?
Please provide the details on how you actually decided it was low, medium or high based on the
indices you used. How did you build the indices?
Under outcomes characteristics DV status (again, make sure you're consistent...IPV vs. DV) -
line 187 - should read "Physical IPV includes any physical  violence....."
line 205 - awkward wording...rephrase...suggest "...replies to all are classed as..."
The statistical analysis section mentions the use of Figure 2, which serves as a conceptual
framework. However, there is no explanation or justification provided for its inclusion. Further
context is necessary to clarify why this framework was chosen and how it will be utilized in
the analysis. Discussing the importance of the different levels within the framework, whether
in the methods or introduction section, would provide valuable context for the analysis. This
additional information will help readers understand the significance of the framework, its role
in the study and its later use in the discussion and ensuing conclusion.
**RESULTS**
Line 240: Include "I" in "IPV."
Line 246: Correct the spelling of "equally."
Line 248-249: Rephrase to avoid starting with a percentage.
Line 254: Correct the spelling of "variable"
Line 268: Revise the sentence for clarity. "Partner controlling behavior was a determining factor
for any violence:" . If this is what you meant, suggest listing all of them rather than just pick
two of them (emotional and sexual) to list.
Table 2 - although you provide the AOR & 95% CI, it would be helpful to also provide the p-
value in the table or indication of p-value (i.e., *** p < 0.001, ** p < 0.01, * p < 0.05).
Table 1 - is there a reason why you did not test for significant differences across the types of
violence? Why is this piece missing from the analysis. It is difficult to tell what factors or results
should be highlighted in the results (and later discussion) without the details of significant factors
in the model.
**DISCUSSION**
Line 276, suggest rewording "...and specifically among less empowered women....with
statistical significance..."
Line 277 - is it exposure for empowered women or participants in the study (not all of whom were
empowered)? Be mindful of wording....Suggest taking out this "Odds ratios with ... demonstrated
the elevated" as it does not seem to make sense....or please clarify what is meant here?
Line 279-281 is not clear. The household and community level factors should be clarified.
Line 282 - what is "microlevel factors" referring to? first time use of micro level, is this the same
as individual level? Use "spousal" violence as opposed to IPV (which is what you analyzed).
Need to be consistent with terms.
Line 285 - What is SC and ST? And by previous evidence, was this also about wealth, education
or belonging to scheduled Caste, or all of the above? Suggest more context as to where this other
evidence has come from and to what factors it is referring to?
Line 286 - unclear what is meant by security vulnerabilities or "highly susceptible of
women"...susceptible to what? IPV?
Lines 287-295 - This section requires reworking as it discusses the association between alcohol
consumption and IPV, a relationship well-supported by literature. The word "However" suggests
a contrast with the preceding discussion on caste system, education, or wealth, which is not
aligned. Consider removing "However" as it does not fit the flow of thought. The role of alcohol
should be discussed separately, highlighting its significance and the increased likelihood of
experiencing IPV across all types when a partner consumes alcohol. It's essential to discuss if
similar findings exist in other studies in India or similar regions and provide recent references
to support your findings.
Regarding empowerment and alcohol, clarification is needed on which study
found that empowered women whose spouses reported drinking once a week
or less were less likely to face violence. If it's this study (reference #4 in
your list) - https://pubmed.ncbi.nlm.nih.gov/33530840/#:~:text=However%2C%20increasing
%20frequency%20of%20husband's,of%20IPV%2C%20except%20sexual%20violence. -
ensure proper citation and discussion of its findings.
- The study indicates that while higher empowerment may offer protection against IPV for
women whose husbands drink occasionally, it may not be sufficient when husbands consume
alcohol frequently. Your discussion section would benefit from a more detailed discussion of
gender and cultural norms to explain the findings, supported by relevant literature.
Lines 296 - 304 require clarification. Are you suggesting that economic empowerment (job
and money) combined with higher education offers protection against IPV, despite the apparent
contradiction that working women with higher education had higher IPV exposure? Clarify
what is meant by "rates of IPV low enough," as these sentences lack clarity and require further
explanation.
Line 300-302 - unclear what is meant by higher education and empowered women are more
significant to each other?
What do you mean by challenges related to IPV? Do you mean, you combat IPV with increased
economic empowerment, improved education b.c of awareness and a platform to protest? This
requires more discussion and supporting literature as unclear.
You provide a conceptual framework at the beginning for individual, household and community
level - yet there is no discussion. Where there no key findings to discuss here related back to
the conceptual framework?
**Strengths and limitations**
Line 308: Remove "on the other hand."
Line 309: Be consistent with the term "IPV."
**Implications**
Line 323: Revise for clarity – “This research demonstrates the link between inflexible,
discriminatory gender standards and intimate partner violence, elucidating the mechanisms that
drive domestic violence beyond financial status.” Sentence unclear - please use the terms that
were used in your study as what is meant by inflexible, discriminatory gender standards" what
is meant by "drive domestic violence beyond financial status"?
Line 325: Ensure consistency with the terms "IPV" and "DV."
Lines 327-329: The suggestions for women's empowerment here appear to focus primarily
on economic empowerment, whereas your study examines empowerment through various
dimensions such as decision-making, freedom from beating, and control, in addition to economic
indicators.
- Are there no other implications for access to education on gender-related issues for both men
and women, facilitated through community-based participatory approaches?
- Consider the impact of gender sensitization workshops, media, and cultural campaigns on
empowerment.
- Furthermore, discuss the potential of policy advocacy for reforms aimed at promoting gender
equality, continuing efforts to address gender-based violence (GBV), and supporting decision-
making and women's economic development.
**CONCLUSION**
The conclusion mentions the levels of the conceptual framework, but these should also be
discussed in the discussion (as mentioned above). Authors are drawing conclusions that are not
fully supported by the analyzed data or discussed in the discussion (e.g., autonomy, poverty,
child marriage), the authors must ensure that their conclusions are directly related to their
findings.