An analysis of this data also showed that girls who had experienced violence from their family as a teenager were more likely to go into a violent marriage.
As part of the DFID funded Bihar Sector Wide Approach to Strengthening Health (SWASTH) programme (2010-2016), a sub-set of data collected for the District-Level SWASTH Survey (DLSS) was used to identify the strongest causes of spousal violence (SV). Findings have also been used to develop policy suggestions for the Government of Bihar. 2,046 households from 62 villages in each of the 11 SWASTH priority districts were surveyed, with households representing their district in terms of socio-economic and demographic characteristics.
Existing evidence from multiple countries, including India,    suggests that SV happens as a result of multiple factors. The ‘ecological framework’ developed by the WHO, helps to explain these factors which include societal, community, relationship and individual level factors. We included household as an additional level in order to examine any influencers at this level (Figure 1)
Nearly six percent (5.8%) of women reported that they had experienced violence as a teenager and data analysis showed this was the strongest risk factor that women would then encounter violence within their marriage. The violence experienced by these women as adolescents was not restricted to spousal violence but included other members of the family including, in order, her husband (66.5%), her mother (16.2%), her father (8.25%) and her mother-in-law (7.1%).
The frequency of alcohol intake by a woman’s husband was also a strong predictor of violence. Strict gender norms limiting women’s freedom and autonomy were also risk factors, coupled with the perception, among women (41.5%) as well as men, that a husband was sometimes justified in being violent towards his wife. It is encouraging, however, that perceived justification for violence has reduced 10-12 percentage points since the National Family Health Survey (NHFS3 2005-06).
In common with other studies, our findings reiterate the multiple benefits of investing in women’s education  as one of the very few protective factors against SV. Residence in SWASTH CBA districts also appeared to be a protective factor although it is unclear to what extent CBA exposure directly reduced violence.
Key policy recommendations from the study are:
- There is a need to focus interventions not just on women as victims and men as perpetrators but on the wider family context.
- Interventions that increase opportunities for women’s freedom of movement and employment should be accompanied by support and education about SV/intimate partner violence.
- Adolescent marriage should continue to be discouraged through community mobilisation, campaigning and legislation.
- Investing in women’s education reaps multiple benefits for physical, mental and emotional health. This should also be accompanied by gender-equity education for both boys and girls, or ‘life-skills’ education in public and private schools to address gender based violence
- SV is not restricted to the poorest households in terms of social group/caste or financial assets. and hence programmes addressing SV need to target all sections of the population
 Any physical or sexual violence by husband/partner in the last 12 months
 SWASTH provided support to ‘priority districts’ which have a greater burden of poor health outcomes and other disadvantages relative to other districts in Bihar.