A Global Analysis of the Impact on Women From Men’s Alcohol Use

A global review of the impact on women from men’s alcohol drinking: the need for responding with a gendered lens

Review Article

How the study was conducted

The study was conducted at Latrobe University in two phases. During first phase, which commenced in October 2022, researchers collected qualitative literature. During the second phase the study team analyzed the data using advanced search methods.

Main findings

The study revealed that men’s alcohol use causes various harms to women, such as violence, sexual coercion, mental health issues, economic problems, and social isolation. It also emphasized that these harms often go unnoticed, leaving women without the help they need.

Alcohol significantly worsens violence against women in close relationships. This finding reconfirms the previous evidence linking alcohol to intimate partner violence.

The study stressed the importance of holding men accountable for their use of alcohol and the harm caused. In addition the study emphasized the need to listen to women’s experiences related to harm they suffer.

The study highlighted that low- and middle-income countries bear a disproportionate burden of harm due to alcohol. This has created an even more disadvantaged status for women in these regions.

Alcohol-related actions by the alcohol-affected man

General aggression and violence

Studies of alcohol’s role in violence towards women described a range of harmful acts from moderate to severe.

Physical violence

Women’s descriptions revealed that they were subject to severe forms of alcohol-related physical violence, including hitting, beating with fists and/or other objects, shoving, pushing downstairs, pulling hair, threats with weapons, burning, and throwing a woman off a balcony, with ‘beating’ the most common term used.

Women also described being punched or kicked in the abdomen while pregnant.

Verbal aggression

Women reported being on the receiving end of alcohol-related verbal abuse, e.g. cursing and bullying, scolding, yelling, screaming, shouting, intimidating, ‘in your face’.

Commonly alcohol-related emotional abuse included insulting, belittling, humiliating in private or public (e.g. calling names, degrading comments) and treating the woman with contempt and disrespect.

Intimidation/threats

Studies revealed that women (and children) experienced alcohol-related intimidation that instilled fear such as threats to kill or hurt her or someone whom she cares about, and damaging property (e.g. punching holes in the wall).

Women also described fear and their avoidance strategies relating to a partner’s irritability when coming down from a big alcohol use session.

Alcohol-related sexual aggression and coercion

Several studies emphasised the role of men’s alcohol use in sexual aggression with partner’s alcohol use directly implicated in sexual violence and coercion.

Alcohol-related economic abuse and related behaviours

The economic impact of men’s alcohol use on women, and by extension on the household, was also common. Women often reported the diversion of money intended for household spending (e.g. food, clothing and medicine) towards expenditure on alcohol.

They spoke of being threatened or coerced to hand over their earnings or even to buy alcohol for their partner. In this way, men’s alcohol use contributed to a loss of resources for the household, and overall household financial instability.

Resistance by women relating to financial issues often led to conflict and argument and further violence by the alcohol-affected man.

Men were commonly seen as abdicating their ‘traditional role as provider’ through loss of employment or missed work due to alcohol use, being unable to provide children with basic necessities, so that responsibility for supporting the family defaulted to women whose income potential was typically much less than that of men.

Thus, men’s alcohol use (particularly in low-income settings) placed women in precarious financial positions; in cases of extreme economic deprivation and poverty, women reported being forced into engaging in ‘survival sex’ (prostitution, sex trading) to support alcohol-affected households.

Alcohol-related controlling actions

For some participants, the pattern of alcohol-related abuse operated as a means of exerting control over the female partner.

Sexual jealousy, a common manifestation of patriarchal control, was reported to be heightened when the partner was under the influence of alcohol.

Alcohol-related abuse was presented as part of controlling behaviours such as restricting women’s involvement in economic decision-making, access to resources, mobility, work and socialising.

Fear of violence from an alcohol-affected partner also operated as a tool of control of women.

Several studies pointed to the male alcohol consumption culture; for example, alcohol consumption was identified as essential to Ugandan culture and an important vehicle for male socialising and male-dominated environments were often unsafe for women in South Africa. Thus, male alcohol consumption cultures of intoxication and violence served to constrain women’s movement and access to public space.

Impacts on women

Physical, reproductive and mental health harms

In addition to physical health harms such as injury and death from alcohol-related IPV, the review highlighted reproductive harms experienced by women including:

• unwanted pregnancy,
• reproductive injury,
• inability to conceive, and
• child deaths caused by alcohol-related violence during pregnancy.

In several studies, women claimed that alcohol contributed to their husband/partners’ infidelity and risky sexual activity, increasing women’s risk of HIV or other STIs.

Studies described how men’s alcohol use led to long-term physical effects for women, including fatigue, anxiety, sleeping problems, body aches and pains, and losing weight.

The impact of alcohol-related actions on women’s mental health was identified in many studies. Women reported psychological distress, self-harm, depression and suicidality, particularly in response to experiencing sexual violence. One study in Sri Lanka reported incidents of self-harm as a cumulative effect from the stressors from men’s alcohol use that aggravated non-alcohol-related life stresses. Women also reported anxiety arising from the need for constant vigilance in facing the partner’s unpredictable behaviour or threats of violence when consuming alcohol or recovering after an alcohol consumption episode.

In other studies, women described feelings of fear and anxiety regarding their children’s safety when their partner was alcohol-affected, concern for the future, suicide ideation and loss of hope for the future. Persistent fear by women due to their partners’ alcohol use was associated with a lack of self-care and care of their children.

Analysis of online helpline chat scripts from women with partners with alcohol and other drug (AOD) issues revealed a pervading sense of sadness and despair, highlighting the impact of men’s alcohol use on all aspects of women’s lives. The experience of verbal abuse from a partner under the influence of alcohol also has an impact on women’s self-esteem and identity.

Harms to the intimate relationship and family functioning

A common finding was the contribution of men’s alcohol use to marital discord and family dysfunction. Participants described how a husband’s intoxication contributed to more verbal aggression and fights, with alcohol use becoming the catalyst leading to arguments becoming violent with corresponding impacts on family functioning.

Men’s alcohol use and its impact on the household and family functioning appeared as a central focus of conflict and arguments with women reporting being intimidated and threatened with violence if they questioned or quarrelled with their husband/partner about his alcohol use.

The quality of intimate relationships was affected by men’s alcohol use in several ways. As noted, alcohol was viewed as culpable in men’s infidelity, and men’s jealousy under the influence of alcohol resulted in accusations of female infidelity.

Women also reported loneliness, especially during pregnancy, because of exclusion from socialising at alcohol consumption occasions. The avoidance of alcohol consuming husbands as a protective measure also created emotional distance in intimate relationships over time. Women also reported anxiety and ambivalence about the future of the relationship with a confluence of emotions of fear, hope, and love.

Men’s alcohol use affected families in a range of ways beyond the partner relationship. As an example of the impact on limited household economic resources, one study of participants in a refugee camp in Thailand described children going to school with empty stomachs. Studies also reported the effect of men’s alcohol use on quality family time and communication; men were reported to withdraw from social and family relationships and display irritability with family members. Husbands’ loss of employment due to alcohol use and neglect of family responsibilities meant that women had to assume the burden of household responsibilities, earning and parenting.

Studies also highlighted the impact of men’s alcohol use on the children. Women feared for the safety of children who were sometimes also targets of physical and verbal abuse from their father, faced neglect and loss of a father figure, and suffered indirect harm from witnessing alcohol-related violence.

Social harm – shame, loneliness and isolation

Participants spoke of feelings of shame, humiliation, embarrassment, loneliness, and social isolation connected to their partner/husbands’ alcohol use. In one study, women expressed feelings of shame from forced sex coupled with knowledge that their alcohol inebriated husbands would seek sexual relationships outside the marriage. Others experienced social harm arising from husbands creating disturbance at their workplace or taking responsibility for his care in public situations.

Some women reported avoiding social situations due to humiliation they anticipated from their husband’s heavy alcohol use. Even after ending the relationship with an alcohol-affected partner, some women evaded social situations involving alcohol to avoid being reminded of experiences of alcohol-related abuse.

Studies revealed the loneliness and isolation from partners’ alcohol-related absences, but also being kept away from friends, family and a wider social network, due to a partner’s alcohol use.

The sense of despair and hopelessness expressed by women in several studies stemmed from the inability to effect change in their circumstances due in part to their partner/husband’s lack of recognition of a problem and unwillingness to seek help, as well as the impact of cultures that normalise men’s alcohol use.

Study limitations

The study’s scope was restricted to heterosexual relationships. Moreover, data collection was limited to English-language publications.

Study background

Harm due to alcohol is a leading population health risk factor contributing to the global burden of disease with low- and middle-income countries (LMIC) carrying a disproportionate burden. Globally, 18.4% of adults engage in heavy episodic alcohol use.

Accordingly, reducing alcohol consumption is a specific health target in the 2030 Sustainable Development Goals (SDGs).

Alcohol’s second-hand effects on women

There is also growing recognition that alcohol use results in harms towards others and the gendered nature of this impact. According to the World Health Organization (WHO) men in all societies consume more alcohol than women and men’s alcohol use causes more harm to others.

Further, there is substantial evidence of alcohol’s role as a consistent risk factor in violence within the family and intimate relationships, and that it increases the severity of intimate partner violence (IPV). Accordingly, the WHO identified reducing alcohol-related harm as a factor in reaching other goals such as ending discrimination against women and girls (SDG 5–1).

Alcohol policy rarely focuses on harms to women from men’s alcohol use

Despite this increasing awareness, reviews show that alcohol policy and interventions rarely focus on harms to women from men’s alcohol use.

In their rapid review of alcohol policy and harms to women and children, Karriker-Jaffe and colleagues (2023) confirmed the small evidence base and argued that future policies and interventions need to include explicit attention to the impacts of men’s alcohol use on women. Current evidence is largely drawn from quantitative research focused on alcohol-related physical and verbal IPV and sexual aggression, and on measuring levels of risk and severity. While these reviews expand the knowledge base in important ways, the diversity of effects of men’s alcohol use on women’s lives is less well-understood, especially from a global perspective.

The aim of this paper is to expand understanding of the broad impact of men’s alcohol use on women by reviewing the global qualitative literature. Qualitative research can provide a rich and nuanced understanding of the experience of alcohol-related harm, including inter-relationships of different impacts from men’s alcohol use, the process by which harms occur, and long-term impact on intimate relationships. This review aims to contribute greater understanding of alcohol-related harm to inform the development of interventions that reflect the complexity of harm to women from men’s alcohol use.

The research question driving this review is: What are the harms experienced by women from men’s drinking and how do these harms impact women?

This narrative review is informed by a feminist ecological perspective that acknowledges that complex behaviours rarely have a single explanation and are influenced by an interplay of factors at various levels of the social ecology (e.g. individual, relationship, community, societal). No single factor explains why someone is violent or someone consumes alcohol in high-risk ways, and the kinds of harms that result. These are influenced by individual traits, interpersonal relationships, community and social environments, and societal norms. A feminist perspective further identifies the gendered nature of the harms from alcohol use and the inequitable power dynamics in intimate relationships and in the broader social context that affect these harms. A feminist ecological perspective also accounts for the harmful way in which men consume alcohol, often informed by social and gendered norms that place women at risk of alcohol harm.

The researchers acknowledge that harm to women from men’s alcohol use occurs in the LGBTQI population and extends to non-partner alcohol-related harms (e.g. rape, sexual assault, generalised violence), the present review focuses on harms from men’s alcohol use to women within heterosexual intimate relationships.

Abstract

Background

Global evidence shows that men’s alcohol use contributes to intimate partner violence (IPV) and other harms. Yet, interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men’s alcohol use have not been well articulated, particularly from an international perspective.

Aim

To document the breadth and nature of harms and impact of men’s alcohol use on women.

Methods

A narrative review, using inductive analysis, was conducted of peer-reviewed qualitative studies that:

1. focused on alcohol (men’s alcohol consumption),
2. featured women as primary victims,
3. encompassed direct/indirect harms, and
4. explicitly featured alcohol in the qualitative results.

Papers were selected following a non-time-limited systematic search of key scholarly databases.

Results

Thirty papers were included in this review. The majority of studies were conducted in low- to middle-income countries.

The harms in the studies were collated and organised under three main themes:

1. harmful alcohol-related actions by men (e.g. violence, sexual coercion, economic abuse),
2. impact on women (e.g. physical and mental health harm, relationship functioning, social harm), and
3. how partner alcohol use was framed by women in the studies.

Conclusion

Men’s alcohol use results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women’s disempowerment.

An explicit gendered lens is needed in prevention efforts to target men’s alcohol use and the impact on women, to improve health and social outcomes for women worldwide.

Source Website: Global Health Action