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

Figures & data

Figure 1. PRISMA flowchart.

Figure 2. Schema of harms arising from men’s drinking and impacts on women.

Table 1. Themes and related studies.

Alcohol-related actions by alcohol-affected man		Impact on women
Harms	Included Studies	Harms	Included studies
General aggression and violence (Physical violence; use of weapons; verbal aggression; psychological violence; intimidation; threats; irritability)	[21,22,29,34–37,39,40,44–46,48,49,51,52,56]	Physical health (Death; injury; disease; injury while pregnant; risk of HIV infection; STI infection; sleep problems, fatigue; pain) Reproductive harm (Unwanted pregnancy; loss of foetus; inability to conceive) Mental health (Fear; anxiety; psychological strain; lack of self-care)	[21,22,29,31,33,35,36,39,41–43,45–47,50–52,54,56]
Sexual coercion/violence (Forced sex; refusal to use condom; infidelity; sexual dysfunction)	[21,29,30,34,37,42,48,51,52,56]
Alcohol-related economic abuse and related behaviours (Diversion of household spending on alcohol; loss of employment due to drinking; conflict over finances)	[21,22,29,35,42,43,52,56]	Relationship and family (Marital discord; carrying burden; quality of relationship; impact on family unit; harm to children; burden of caring)	[22,31,35–37,39,41,49,50,55]
Alcohol-related controlling actions (Reinforcing authority, jealousy; restricting women’s activities and isolating women; threat of violence; unsafe male drinking environments restricting women’s public movement; normalising male drinking cultures)	[21,22,29,34–36,42,43,48,52,53,56]	Social harm (Shame, embarrassment, humiliation, stigma arising from partner’s drinking, social isolation from avoiding drinking situations)	[21,22,31,33–37,42,43,50,55,56]

Table

Search ID#	Search Terms	Search Notes
S1	exp Alcohol Drinking/	Subject Heading (MeSH)
S2	exp alcoholism/	Subject Heading (MeSH)
S3	‘alcohol use’ or ‘alcohol abuse’ or ‘binge drinking’ or alcoholism or ‘binge alcohol consumption’ or ‘alcohol* drink*’ or ‘alcohol misuse’ or ‘harmful alcohol use’ or ‘alcohol use disorder’ or ‘alcohol* intoxicat*’ or intoxicat* or ethanol or ‘ethanol use’ or ‘ethanol abuse’ or ‘risky alcohol use’ or ‘hazardous drink’ or ‘alcohol addiction’ or ‘alcohol dependen*’ or ‘problem* drink*’ or ‘risky* drink*’ or ‘high risk drink*’ or ‘alcohol consumption’ or ‘alcohol drink* habit*’ or ‘alcohol intake*’ or ‘alcohol drink* attitudes’ or drunkenness* or family stress coping	Keyword
S4	S1 or S2 or S3	Combination OR
S5	exp Intimate Partner Violence/	Subject Heading (MeSH)
S6	exp Domestic Violence/	Subject Heading (MeSH)
S7	‘intimate partner violence’ or ipv or ‘domestic violence’ or ‘domestic abuse’ or ‘spous* abuse*’ or ‘family violence’ or ‘violence against wom?n’ or ‘intimate partner abuse’ or ‘partner abuse’ or ‘wife abuse’ or ‘abused wom?n’ or ‘battered wom?n’ or ‘battered female*’ or ‘wife beating’ or ‘battered wives’ or ‘battered wife’ or ‘domestic assault’ or ‘marital abuse’ or ‘partner aggression’ or ‘partner assault’ or ‘dating violence’ or ‘sexual* abus$*’ or ‘sexual* aggress*’ or ‘sexual* assault’ or rape or fear or ‘physical* violen*’ or ‘physical* assault’ or ‘physical* abus*’ or ‘physical* aggress*’ or ‘emotional* abus*’ or ‘psychological* abus*’ or ‘psychological* aggress*’ or ‘coercive control’ or ‘control* behavio?r’ or ‘spous* assault’ or ‘husband abuse’ or ‘husband aggress*’ or ‘intimate terrorism’ or ‘common couple violenc*’ or ‘situational couple violence*’ or ‘violent resistance’ or ‘intimate homicide’ or ‘domestic homicide’ or conflict or argument* or femicide	Keyword
S8	S5 or S6 or S7	Combination OR
S9	Wives of alcoholics or spouse* of alcoholics or family	Keywords
S10	qualitative study or qualitative ethnograph* or narrative account or participant observation or grounded theory or interpretative or phenomenological analysis or case stud* or focus group or thematic analysis or framework analysis or framework approach in-depth interview or semi-structured interview or mixed-method*	Keywords
S11	S4 AND S8 AND S9 AND S10	Combination AND
Limiters:	1. Peer reviewed 2. English language 3. Age: adult (19–44) & middle age (45–64) … used in CINAHL only	Used only on CINAHL as Medline database includes peer-reviewed studies

Table

Author	Country	Study aim	Method and study approach	Sample and setting	Key findings (related to alcohol)
Annan & Brier [40]	Uganda	To describe the experience of women who return from abduction in Northern Uganda, and how violence from an armed group interacts with family violence, poverty, and structural factors, including IPV.	Grounded theory	21 females who returned from abduction in Northern Uganda	Alcohol use was a cause of conflict and exacerbated tension caused by scarce resources. Public drinking and intoxication were common. Brewing of alcohol as a main source of work placed single women who had no male protection in the home at risk. Alcohol was stated as a problem in every case of IPV. Participants reported aggression and physical abuse related to partners’ heavy drinking and intoxication; arguments over resources; alcohol-related conflict between family members and abuse, verbal abuse and shaming from (drunk) mother-in-law
Backe et al. [29]	South Africa	To examine relationship of alcohol and IPV in Soweto townships	Ethnography, life history narratives	77 women in Soweto, Johannesburg, South Africa	Alcohol use by an intimate partner, or an abusive family member, was a consistent through-line in women’s testimonies, sometimes as a contributing factor to physical violence and infidelity and, in other instances, a habit that depleted the financial resources of families, constituting a form of economic abuse. One woman reported two child deaths which she attributed to alcohol-related violence during pregnancies. 70% of those experiencing IPV attributed violence to the man’s alcohol use (referred to as coercive violence). Several women witnessed IPV and alcohol-related IPV stemming from father’s drinking as children.
Bloom et al. [41]	Uganda	To examine intimate partner violence among Ugandan women living with HIV, their experiences of disclosing such violence and how culturally normative factors affected disclosure-related outcomes.	Sequential explanatory mixed-methods study; thematic analysis of qualitative component	Sample of 168 Ugandan women living with HIV and with experience of IPV completed survey; 14 in-depth interviews	Alcohol use by an intimate partner was a significant contributor to women’s experience of IPV and barrier to disclosure. Two main themes from interviews: (1) women who disclosed IPV were advised to ‘endure’ the violence; (2) alcohol ‘excuses’ violence from a partner with the focus on drinking as the culprit, not the man.
Cash [42]	Uganda	To understand experiences and interpretations of the relationship between sexual violence and transmission of HIV AIDS	Qualitative (ethnographic focus group discussions and In-depth interviews)	450 Ugandan men and women	Men’s alcohol use contributed to infidelity, forced and unprotected sex and domestic violence. Women reported experiencing forced sex frequently during menstruation, and following childbirth. Approximately 65% of men who had forced sex with their wives, said alcohol was a contributing factor. Financial harms were experienced by the women and the household due to money spent on alcohol. Alcohol contributed to sexual risk behaviour (no condom, multiple partners, transactional sex) and women felt shame when their (drunk) husbands sought sexual relationships outside the marriage. 86% of male respondents viewed alcohol as a means of socialising with other men and essential to Ugandan culture.
Chowdhury et al. [30].	India	To determine how social changes in the region influence changing patterns of acceptable and problem use of alcohol.	Ethnographic study using participant observation and focus group discussions	Average of 9–10 group interviews (single-sex/mixed-sex) per village and a total of 88 in-depth interviews were conducted in Sagar and Gosaba Blocks of the Sundarban Region	Drinking was observed to be an integral feature of the cultural landscape. Effects of problem drinking included: social disturbances, family discord, and domestic violence. Men’s drinking was the cause of marital and family conflict; men controlled earnings and spending and the cost of drinking affected domestic finances. Men also demanded higher dowries. Men’s drinking behaviour also made them less willing to work, leading to economic distress, family conflicts, and criminality. Women experienced physical and mental violence, sometimes fatal, and shame due to experiencing violence. Women’s movement was constrained due to men being drunk in public spaces.
Clark et al. [46]	Nepal	To examine the prevalence and risk and protective factors for physical/sexual IPV within marriages	Mixed methods, but qualitative component included case-based analysis	36 (18 women and 18 men) couples from 3 districts in Nepal	Wives/partners reported experiencing physical violence, intimidation and threats of violence from a drunk partner, particularly if they questioned or quarreled with their husband/partner about his drinking or drunkenness. They reported feeling fearful of their husband/partner when he threatened violence when drunk.
Deuba et al. [47]	Nepal	To better understand the IPV experienced by young pregnant women in urban slums of the Kathmandu Valley, and identify their coping strategies, care and support seeking behaviours.	Qualitative content analysis	20 pregnant women aged 15–24 years from 13 urban slums in the Kathmandu valley	Fourteen women were survivors of violence. Husband’s heavy use of alcohol was linked to IPV. Women reported that they were more likely to experience violence if a husband had an alcohol use disorder. Husband coming home intoxicated was one of five major reasons given for physical and psychological violence.
Ezard [31]	Thailand	To better understand the use and role of alcohol within a Mae La refugee camp in Thailand.	Qualitative interviews	97 participants aged 15 years + (Karen men and women from Myanmar) living in a refugee camp	IPV emerged as a prominent theme with four sub-themes: ‘Alcohol is Happy Water’ (for men); alcohol use is changing in displacement; IPV is an emergent alcohol-related harm; and the relationship between IPV and alcohol is complex. Alcohol use is subject to strongly gendered social controls. Partners’ excessive alcohol use led to failure to contribute to household resources, selling or exchanging rations and possessions as a source of income for alcohol; children going to school with empty stomachs; and women’s depression (affecting her ability to look after children properly).
Fox et al. [51]	South Africa	To examine the intersections of risk for intimate partner violence and HIV infection in South Africa.	Qualitative descriptive study. Semi-structured interviews	18 women (aged 18–53 years) seeking services for relationship violence	Women reported that substance use, particularly alcohol, was related to their experience of physical, sexual and emotional abuse. Common pattern of partner arriving home drunk, rapidly becoming violent and demanding sex. Women reported that intoxication made men less likely to agree to condom use and more likely to have sex outside the relationship, increasing STI risk for women; alcohol could increase unwanted pregnancies and infidelity.
Galvani [32]	UK	To explore women’s views and experiences of alcohol’s role in men’s violence to them.	Grounded theory adapted to suit feminist research principles	20 women who had been involved in an incident dealt with by the police domestic assault unit in Kingston-Upon-Hull	Participants reported alcohol’s role as initially positive in partner opening up but leading to violent and aggressive behaviour; partner’s capacity to drink; some women believed they provoked his violence by answering back, especially when they had been drinking; seven of nine believed alcohol played key role in their partner’s violence, but additional factors were considered to play a role in the violence. Proposed theory of ‘responsible disinhibition.’
Guggisberg [54]	Australia	To understand the nature of violence experienced by a current or former intimate partner	Phenomenological approach	3 Aboriginal women (mean age = 32.8 years)	Partners’ drinking was implicated in economic abuse and severity of abuse and sexual violence victimization. Women faced demands for their money at payday to buy alcohol; women felt intimidated and scared when their partner drank alcohol and then gets angry; fear from threats of being hurt with objects or weapons. Women’s readiness to retaliate was influenced by their own intoxication.
Hellum et al. [33]	Denmark	To investigate the difficulties, prior to seeking professional help, of female ‘concerned significant others’ of people with alcohol problems; and what led them to seek professional help.	Interpretative phenomenological	12 female help-seeking concerned significant others (CSOs) of men with alcohol problems recruited through RCT CRAFT study.	Participants reported high impacts on their physical and mental health, and quality of life, from a significant other’s drinking. These impacts stemmed from experiencing physical violence and mental abuse and included severe stress, social impacts, increased burden of care, loneliness and embarrassment, worry about children, and worry for the drinker themselves.
Kaur & Garg [44]	India	To understand the factors that perpetuate domestic violence and approaches to address it as felt by the women themselves.	Qualitative descriptive study	8 focus group discussions (FGD) with 72 married women 18–35 (8 to 10 women per FGD) in rural village, and 10 key informant interviews	IPV was commonly experienced by women in the focus groups (61%) and was more common for lower caste women. Almost 100% of the women blamed alcohol/alcoholism for IPV, although 20% also said violence sometimes occurs when their husband was not drinking. Some saw the violence as socially learned behaviour aiming at control.
Keenan et al. [48]	Lebanon and Egypt	To identify patterns of wife and child abuse	Qualitative content analysis of interview narratives	60 low-income women victims of abuse from Middle Eastern families living in Lebanon and Egypt; recruited from maternal child health settings	Small portion of the sample experienced abuse when their husband was drinking. Substance abuse was identified as one cause of physical abuse. Violence related to substance abuse was dramatic and severe. Beatings often occurred after challenge to husband’s authority by woman’s disapproving actions or words.
Kohli et al. [43]	Democratic Republic of Congo (DRC)	Study aims: 1) to describe the social and behavioral risk factors for IPV perpetration and victimization; 2) to describe the multiple and interrelated social, health and economic consequences of IPV on women and their families; and 3) to describe family and community driven response to IPV in rural villages	Grounded theory study	Five male IPV perpetrators and 13 female survivors who are participants in Pigs for Peace microfinance program in 3 villages in eastern DRC	Theme: Social and behavioral circumstances that increase risk for IPV. Male alcohol use was described as a direct ‘cause’ of IPV harms and indirectly through increased marital conflict. Study noted the role of male peer influence encouraging alcohol use leading to increased conflict in family and contributing to attitudes towards authority of male and subjugation of women. All participants highlighted the importance of male alcohol use, including excessive consumption, lack of employment, household financial stress, male infidelity and fear of female infidelity as a consequence of instability in rural communities and conflict and directly related to male use of physical and psychological violence. Among conflict-affected populations, elevated alcohol use was observed to deal with the prolonged stress and trauma.
Kyriakakis et al. [56]	USA	To gain a greater understanding of what Mexican immigrant women consider abusive in an intimate partner relationship, the abusive tactics employed and what abusive behaviour they found most hurtful	Phenomenological approach	29 Mexican immigrant women living in New York and St. Louis	Alcohol use was inextricably linked to husband’s abusive behaviour. More than two thirds of women had partners who drank heavily. There was no consistent pattern between husband’s level of intoxication and severity of violence. Participants reported subject to economic abuse, fear, infidelity, physical abuse, and brandishing of weapons linked to alcohol use. Participants viewed alcohol treatment as a solution for the abuse. However, partners were reluctant to seek treatment. Alcohol use was normalised.
Lennon et al. [53]	Colombia	To investigate factors that influence IPV against women.	Qualitative focus groups and interviews	28 female survivors of IPV and 15 key informants (professionals from psychological, social and legal services and community leaders)	Alcohol was one of four factors associated with IPV and was a big problem in the study population. Women associated their partner’s drinking with jealousy. Women explained that the primary reason for physical abuse was because he was drunk. The second reason was that he was jealous.
Mazibuko & Umejesi [34]	South Africa	To examine women’s narrative on alcohol consumption as the cause of domestic violence in relationships	Qualitative	27 survivors of domestic violence residing in a low-income black neighbourhood of Mamelodi Township, Pretoria	Common view from women was that alcohol is to blame for domestic violence; violence is driven by unseen external forces – the ‘devil.’ Women reported having to comply with their husbands’ sexual demands when he was drunk. Women experienced alcohol-related physical abuse; verbal and emotional abuse; social harm (embarrassment at their workplace); sexual coercion and abuse; and financial abuse (husband spending household income on alcohol).
Nascimento et al. [35]	Brazil	To know the daily life of women with alcoholic companions and their care options	Thematic oral history; interpretation guided by King’s Theory of Goal Attainment	11 women with alcoholic companions registered at a family health unit in Mato Grasso province, aged 18–45 years	Participants reported a range of impacts from their partner’s drinking including health harms from physical violence, fatigue, sleeplessness; mental harms from fear, instability, embarrassment and guilt, and anxiety over impacts on children including loss of a ‘father figure’; financial difficulties; and social and personal harms from loss of freedom, giving up on their life plans, and loss of motivation for self-care.
Rao [45]	India	To study the determinants of wife abuse	Ethnographic and econometric methods	Interviews with 70 women and 30 men across 3 villages in community of potters in Southern India; 14 focus group discussions	Determinants of domestic violence were excessive liquor consumption (mostly by men) and perceived inadequacy of dowries. Drunkenness was sometimes a catalyst for arguments becoming violent; other times drunken husbands assaulted partners without any provocation.
Satyanarayana et al. [36]	South India	To explore the intersection among alcohol consumption, gender roles, intimate partner violence and mental health from the perspective of heavy drinking men who also perpetrate IPV and their spouses (survivors)	Phenomenological approach – in-depth interviews	10 married heavy drinking men perpetrators and 10 IPV survivors (married spouse – currently cohabiting); not same dyad	Both perpetrators and survivors viewed drinking as the ‘root cause of all evil.’ Perpetrators attributed their aggression, violence and related behaviour to alcohol. Survivors reported depletion of household financial resources and increased debt due to spending on alcohol. Survivors reported sleep disturbances, body aches and pains, tiredness, not eating regular meals, losing weight and death wishes, shame, embarrassment, social estrangement and isolation (avoiding social situations due to humiliation from partner’s drinking and abuse).
Sedziafa et al. [49]	Ghana	To explore the health effects of IPV among 15 ever-partnered Ghanaian patrilineal women	In-depth interviews	15 ever-partnered Ghanaian patrilineal women aged between 25–65 years	Alcohol was viewed as the cause of male partner’s abusive attitudes. Women experienced physical violence and coerced sex when the husband was drunk.
Sørensen et al. [50]	Sri Lanka	To investigate daily life stressors in marriages and intimate relationships focusing on alcohol use and events of self-harm	In-depth narrative life story interviews and focus group discussions	44 participants aged 19–69 years (who had experienced alcohol-related events of self-harm and their family members)	Alcohol-related daily life stressors aggravated non-alcohol-related stressors (e.g. violence and financial difficulties) which contributed to partner conflict and episodes of self-harm. Alcohol aggravated overall levels of stress. Women described self-harm in response to stressors including husband alcohol use and gendered marriage expectations. Husbands’ alcohol use was shameful for wives. Alcohol often involved in domestic violence. Gendered alcohol norms were considered one of several acceptable excuses for the husband’s inappropriate behaviour.
Stockl & Gardner [55]	Germany	To investigate how abused women perceive their pregnancy to influence the context in which IPV occurs and the mechanisms leading to IPV	In-depth, semi-structured interviews	19 women who experienced violence during pregnancy	Participants with a heavy drinking partner reported loneliness as pregnancy restricted women from joining their partner in socialising. Home life was impacted as the expectations of the partner to stay home to support her during pregnancy were not met.
Tamutiene & Laslett [37]	Lithuania	To identify and contextualize the harms Lithuanian families experience when they include a heavy drinker	Grounded theory (Glaser and Strauss, 2009) analysis of in-depth, semi-structured interviews	20 women and 4 men cohabiting spouses and ex-partners of heavy drinkers purposively recruited via snowballing from Al-Anon and AA members and contacts	Direct harms caused by the drinker included: physical violence (including towards children); emotional abuse – disrespect, humiliation, contempt; financial abuse and debt. There was indirect harm to children from witnessing harm inflicted on others. Family functioning was affected by abdication or redirection of drinker’s responsibilities to other family members; care burden – care of the intoxicated drinker after heavy drinking, and care of family matters. Drinker-centred coping strategies neglected children’s (and other adults’) needs.
Wechsberg et al. [52]	South Africa	To investigate how alcohol and other drug use, gender power and gender violence are related to sexual risks for HIV among couples in established heterosexual relationships.	Content analysis	10 focus groups with men and women recruited from local taverns (67 participants) in two communities. Focus groups comprised women-only, men-only and couples.	Relationships issues were precursors to conflict and violence including disagreements over drinking and spending money. Discrepant drinking between the couple (both male and female) led to verbal arguments. Alcohol and other drug purchases affected financial well-being of household with males not providing for women and children. Men physically abused female partners because of lack of money for alcohol and/or other drugs and traded female partners for alcohol and other drugs. Women were forced to engage in ‘survival sex’ (prostitution) to make money for the household. Women had little condom negotiating power as drinking impaired men’s judgment around condom use.
Wilson et al. [21]	Australia	To explore the dynamics of drinking and IPV from the perspectives of women with lived experience of alcohol-related IPV	Grounded theory	18 women (20–50 years) who had experienced fear or harm from an alcohol-affected male partner	Findings describe a cycle of drinking and IPV and women’s safety strategies. Participants experienced the following related to partner’s alcohol use: sexual coercion/pressure; fear, threats, verbal abuse; humiliation; prioritising household spending on drinking, controlling finances, threatened/coerced to buy alcohol for partner; social restriction (work activities, contact with friends and family); jealousy, monitoring movements, control
Wilson et al. [22]	Australia	To understand the evolution of relationships involving alcohol-related IPV and how women identify and adapt to the changing nature of a partner’s drinking and violence	Grounded theory	18 women (20–50 years) who had experienced fear or harm from an alcohol-affected male partner	Findings describe processes engaged in by women to respond to and manage male partner’s alcohol-related IPV over key relationship stages – early relationship; committed relationship; relationship end, and beyond the abusive relationship. Women experienced physical, financial, social and emotional harms associated with partner drinking.
Wilson [38]	Australia	To examine the personal impacts of partner problem drinking and alcohol and other drug (AOD) use on individuals	Thematic analysis	100 partner transcripts from anonymous online chat counselling service for problematic AOD use extracted between 2013–2014 (females 85% of partners; males 15%)	Themes: (1) cognitions (depressive cognitions, responsibility beliefs, and thoughts around trust); (2) behaviours (helpful and unhelpful coping) and (3) emotions (anger, sadness, and fear).
Wilson et al. [39]	Australia	To examine the broad range of interpersonal impacts described by partners from online counselling transcripts sourced from a national online AOD counselling service	Thematic analysis	100 partner transcripts from anonymous online chat counselling service for problematic AOD use extracted between 2013–2014 (females 85% of partners; males 15%)	Themes: (1) Intimate partner relationship issues, (2) parenting issues, (3) impacts on/from partners’ social networks arising from partners’ drinking. Communication problems and conflict centred around problem AOD use, escalated to verbal and physical confrontations. AOD use impacted quality time in relationships. Concerns about impact on children of exposure to AOD problem use, parental conflict and partner abuse.

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