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| Is domestic violence endemic
in Pakistan: perspective from Pakistani Wives Masood Ali Shaikh Abstract: Objective: Domestic violence is an important public health problem. This study assessed the magnitude and type of domestic violence inflicted on women by their husbands. Design: A cross-sectional survey based on a sample of convenience was conducted by two trained health interviewers, using a pre-tested questionnaire. Setting: The study was conducted in three public sector hospitals in Rawalpindi and Islamabad, among women who were either themselves visiting or accompanying others who were visiting the Obstetrics and Gynecology Departments. Main outcome measure: Assessment of domestic violence in marital setting. Results: Only 7 (3.2%) out of the 216 women did not report enduring any type of domestic violence ever. Rest of the women reported enduring multiple types of violence. Being shouted or yelled at was the most frequent, while use of a weapon e.g. gun or knife was the least common type of violence reported. Among the 193 women who had been pregnant in the past, 48 (24.9%) reported that violence in general increased during pregnancy, 98 (50.8%) reported a decrease and the remaining 47(24.3%) reported no change in the violence level. Nonconsensual sex was reported by 98 (46.9%) of the women interviewed. No statistically significant association was noted between domestic violence and either living arrangements (nuclear or extended) educational and income levels of the respondents or their husband’s, and pregnancy status. Conclusion: Population based
epidemiological studies are needed to study the type, frequency and
perpetuating factors of domestic violence in the country, for informed
public health policy formulation. Introduction Domestic violence entails physical, sexual,
and psychological abuse perpetrated by a person with whom the victim has
an intimate relationship (3). Hence, shouting, physically hitting and
engaging in nonconsensual sex in the context of an intimate relationship
constitutes domestic violence (4,5). It is also an important cause of
intentional injuries in women seeking medical care in the emergency
departments (6-8), and pregnant women are especially at high risk of
domestic violence (9-13). One-fifth to one third of all the women in
United States (over 12 million) will be assaulted physically in their
lifetime by either a current or former partner (14). Domestic violence
knows no bounds, with murder being its ugliest manifestation, as a former
or current partner is responsible for half of all the women murdered in
the England and United States (3,15). Regarding psychological sequel in the
victims of domestic violence, battered women are four times more likely to
attempt suicide than non-battered women (16), and are more likely to develop
major depression, alcohol and drug dependency, and post-traumatic stress
syndromes (17). A previous study in Pakistan reported on
domestic violence from the perspective of men, with a sample size of
seventy, in which all respondents admitted to ever verbally abusing their
wives and over two-third admitted to ever engaging in non-consensual sex
with their wives (18). The profile of domestic violence has not
been adequately studied in Pakistan though this issue is now being
frequently highlighted by the media as well as various NGOs. In this study
an attempt was made to determine the magnitude and type of domestic
violence endured by married women, including its association with
pregnancy. Subjects and Methods Two trained women interviewers administered
the questionnaires after obtaining verbal consent. Women who were either
themselves visiting or accompanying visitors to the Obstetrics and
Gynecology Departments in two public sector hospitals in Islamabad and one
in Rawalpindi were approached and explained that a study is being
conducted in which sensitive questions would be asked about their
relationship with their husbands. Strict confidentiality was assured; all
the interviews were conducted at a place where no one could overhear the
conversation. Women who were married for at least one year, and were not
accompanied by any man were approached and interviewed. The last selection
criterion was used to encourage more frank and honest responses from them. Questions were asked about being subjected
to various types of physical and verbal abuse by their husbands, their
reactions, and whether this abuse ever took place while they were
pregnant. A question was also asked about their husband’s ever engaging
in nonconsensual sex with them. A sample size of 216 was calculated, based
on 95% confidence intervals, and assuming a hypothetical population
proportion of violence at 10% in married women, with an absolute precision
of 4% on either side of the proportion. However it should be emphasized
that any and every sample size calculation presupposes random sampling (19).
In this study a sample of convenience was adopted due to practical
considerations, as random sampling would have rendered this study
unfeasible. Results Both verbal and physical violence was
reported by women, during the current and previous pregnancy, as well as
while not being pregnant. Table-II shows that there was essentially no
relationship with any of the demographics characteristics and domestic
violence endured by women. While Table-III shows the type and prevalence
of violence by pregnancy status in the women interviewed. The domestic
violence was almost universally reported. Only 7 (3.2%) women did not
report ever enduring any type of domestic violence including
non-consensual sex, two of these women were living in a nuclear family
set-up and three were employed. Rest of the women reported enduring
multiple types of violence. Being shouted at or yelled at was the most
frequent, while use of weapon e.g. gun or knife was the least common type
of violence reported. Among 193 women who had been pregnant before, 48
(24.9%) reported that violence in general increased during pregnancy, 98
(50.8%) reported a decrease and the remaining 47 (24.3%) reported no
change in the violence level. Nonconsensual sex was reported by 98
(46.9%) of the women interviewed. Among the 209 women who reported
enduring domestic violence, only 74 (35.4%) replied, in an open-ended
question, that they have told someone about their husband’s violent
behavior towards them. The rest did not opt to tell anyone about it. Forty
three (58.1%) confided in their sister, while the rest complained about it
to either their own parents or their husband’s parents. Among the 31
women who complained about their husband’s violent behavior to either
their own or their husband’s parents, 17 (54.8%) reported a temporary
decrease in the violent behavior of their husbands. While the remaining
women reported no change in their husband’s behavior. Regarding women’s reaction to the
violence among the 209 women who experienced it, 108 (51.7%) reportedly
did not respond in any way and merely suffered the violence and its
attendant consequences in silence. Twenty four (11.5%) said that they try
to reason with their husband after he has calmed down, 31 (14.8%) would
yell back and use abusive language, and rest of the women did not respond
to this question. No association was noted between the prevalence or type
of domestic violence, and the various income and/or the educational levels
of either women on their husband’s. Domestic violence was almost
universally prevalent in all the strata of income and educational levels,
as well as in families with either nuclear or extended living
arrangements. As a substantially high reporting of domestic violence by
the study’s respondents, no statistically significant association was
noted between domestic violence and either living arrangements (nuclear or
extended) educational and income levels of the respondents or their
husband’s, and pregnancy status. Table I: Demographic characteristics of the survey respondents
Table II: Demographic characteristics &
their relationship with domestic violence
Percentages are calculated across the rows for each sub-category of demographic variables. Table III: Type and prevalence of violence ever endured by women perpetrated by their husbands, during current and previous pregnancy, and while not pregnant *
* Most women reported enduring multiple
types of violence; hence percentages add up to more than 100% in all three
individual categories of status, based on pregnancy. Discussion This study was an attempt to get the
victim’s perspective, and the pervasiveness of domestic violence found
is alarming. Most of the women in this study were either young or middle
aged, had twelve or more years of education, and were employed. Their
husbands also, proportionally, tended to have more education than the
general population. Yet domestic violence, often both physical and verbal
was common in these families. Pregnancy did not seem to protect study
respondents from the domestic violence, as 95 (49.2%) of the 193 women who
had ever been pregnant before said that domestic violence either increased
or remained the same during the pregnancy. For the rest, violence merely
decreased temporarily from the pre-pregnancy level. This confirms the
previous findings of pregnancy as an added vulnerability to domestic
violence (9-13). Joint family structure did not show any relationship with
domestic violence, as women living in such a family set-up were as likely
to suffer violence as the ones who lived in the nuclear family set-up.
Only one-third women told anyone about their husband’s violent behavior,
mostly confided to their sisters. Complaining to parents or in-laws did
not reportedly improve the situation in a lasting manner. Marital rape or nonconsensual sex was
reported by 98 (46.9%) of the women interviewed. A previous study of
seventy Pakistani men, reported that 77.1% of men engaged in the
non-consensual sex with their wives (18). Cumulatively these figures suggest
the need for educating men that marriage is no excuse for nonconsensual
sex. Owing to almost universal reporting of
domestic violence in this study, no statistically significant association
was noted in terms of either suffering domestic violence its various types
and the reaction to it, between women who had a job and those who were
homemakers, educational level of women or their husband’s and income.
Lack of effective reaction to domestic violence, on the part of women, is
inexplicable in this survey population of many educated women as some of
whom also had an independent economic existence. The results of this study need to be
interpreted with caution. Convenience sampling used in this study limits
the generalizability of results. As this type of sampling is inherently
prone to biases. Is domestic violence endemic in Pakistan?
Is it an occupational hazard of marriage for women in our country? To
effectively address these questions, population based surveys with random
sampling need to be conducted so as to study the epidemiology of domestic
violence. Once prevalence of violence, profile of perpetrators and factors
perpetuating domestic violence are identified and documented, only then
informed and effective public health policy and practice guidelines for
obstetricians and general medical practitioners could be formulated and
implemented. References 1. Heise L, Ellsberg M, Gottemoeller M. Ending violence against women. Popul Rep 1999; 27 (4):1-2. 2. Heise L, Ellsberg M, Gottemoeller M. The world takes notice. Popul Rep 1999; 27 (4): 3-4. 3. Council on Ethical and Judicial Affairs, American Medical Association. Physicians and domestic violence: ethical considerations. JAMA 1992; 267: 3190-3193. 4. Martin SL, Tsui AO, Maitra K et al. Domestic violence in northern India. Am J Epidemol, 1999; 150: 417-26. 5. Potter LB, Scaks JJ, Kresnow MJ et al. Nonfatal physical violence, United States, 1994. Public Health Rep 1999; 114:343-52. 6. Haywood YC, Haile-Mariam T. Violence against women. Emerg Med Clin North Am 1999; 3: 603-15. 7. Goldberg WG, Tomlanovich MC. Domestic violence victims in emergency department: new findings. JAMA 1984; 251: 3259-64. 8. McLeer SV, Anwar R. A study of battered women presenting in an emergency department. Am J Public Health 1989;79: 65-66. 9. Leung WC, Leung TW, Lam YY et al. The prevalence of domestic violence against pregnant women in Chinese community. Int J Gynaecol Obstet 1999; 66 (1): 23-30. 10. Helton AS, McFarlane J, Anderson ET. Battered and pregnant: a prevalence study. Am J Public Health 1987; 77: 1337-9. 11. McFralane J, Parker B, Socken K et al. Assessing for abuse during pregnancy: severity and frequency of injuries and associated entry into prenatal care. JAMA 1992; 267: 3176-8. 12. Purwar MB, Jeyaseelan L, Varhadpande U et al. Survey of physical abuse during pregnancy GMCH, Nagpur, India. J Obstet Gynaecol Res 1999; 25 (3): 165-71. 13. Gazmararian JA, lazorick S, Spitz AM et al. Prevalence of violence against pregnant women. JAMA 1996;275: 1915-20. 14. Council on Scientific Affairs, American Medical Association. Violence against women. JAMA 1992;267: 3184-3189. 15. Richardson J, Feder G. domestic violence against women. BMJ 1995; 311 : 964-965. 16. Stark E, Flitcraft A. Spouse Abuse. In; M. Rosenburg and M. Fenley, eds. Violence in America: A Public Health Approach. New York; Oxford University Press 1991; pp 123-157. 17. Leidig MW. The continuum of violence against women: psychological and physical consequences. Journal of Am Coll Health 1992; 40: 149-155. 18. Shaikh MA. Domestic violence against women- perspective from Pakistan. J Pak Med Assoc 2000 (9): 312-314. 19. Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual. Geneva: WHO 1991: vii, 1&25. Source: published with permission http://www.pulsepakistan.com/pakjmedsciences/article2.html Professional Medical Publications About the author: |
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