Have you been forced to do something sexual that you find degrading or humiliating? | 1. Yes 2. No | |__|__| |
2.3. Psychological violence | ||
Have you been insulted or made to feel bad about yourself? | 1. Yes 2. No | |__|__| |
Have you been humiliated or made to feel bad in front of others? | 1. Yes 2. No | |__|__| |
Have you been intimidated or scared on purpose (for example by a partner yelling and smashing things) | 1. Yes 2. No | |__|__| |
Have you been threatened with harm (directly or indirectly in the form of a threat to hurt someone the respondent cares about). | 1. Yes 2. No |
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3. Assessing Risk factors | ||
Who carries out the violence | 1. Intimate partner 2. Non-partner | |__|__| |
Age of partner | |__|__| | |
Educational level of partner | 1. uneducated 2. primary education 3. secondary education 4. university | |__|__| |
Does your partner smoke | 1. Yes 2. No | |__|__| |
Is your partner an alcoholic? | 1. Yes 2. No | |__|__| |
Did you experience sexual assault as a child? Example |
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a) When you were a child, before you were 15 years of age, did a man ever touch you sexually or force you to touch him sexually when you didn’t want to? | 1. Yes 2. No | |__|__| |
b) When you were a child, before you were 15 years of age, did anyone ever persuade or force you to have sex when you did not want to? Total | 1. Yes 2. No | |__|__| |
Is your mother being violated by your father//or did your mother experience gender-based violence | 1. Yes 2. No 3. I don’t know | |__|__| |