Predictors of Help-Seeking Behavior Among Women Exposed to Violence in Nigeria: A multilevel analysis to evaluate the impact of individual and contextual factors

Objectives: We examined contextual and individual-level predictors of help-seeking behavior among women exposed to physical and sexual violence in Nigeria. Methods: Using data from the 2008 Demographic and Health Survey, we fit three 3-level random intercepts models to examine contextual factors associated with help-seeking while accounting for individual-level predictors. Results: Of the 5,553 Nigerian women in our sample exposed to physical and sexual violence, 39.7% reported that they sought help to stop the perpetrator from hurting them again. Rates of help-seeking were geographically patterned by state and ranged from 12% to 65%. State-level development, measured by the Human Development Index (HDI), was positively associated with a woman's help-seeking (z-score OR=1.30, 95% CI=1.05,1.61), after adjusting for individual-level characteristics. State-level prevalence of violence was negatively associated with help-seeking (OR=0.98, 95% CI=0.97,0.99). A small number of individual-level variables were significantly associated with victimization, including a woman's marital status, employment status, history witnessing domestic violence, and relationship to perpetrator. Conclusions: Our paper is the first to document area-level determinants of help-seeking behavior among women exposed to violence. Our multi-level analysis goes beyond a victim blaming ideology premised around why some women ‘take control' and seek help and others do not, and simultaneously accounts for some structural factors that may facilitate this decision. We believe the insight provided is relevant for different countries, in both the developed and developing world, and can help guide policies to ensure that the needs of survivors of violence are fully met.