ONLINE SUBMISSION
  April, 2008

Violence against Women in Pakistan: A Framework for Analysis

  Parveen Azam Ali  ( University of Sheffield, United Kingdom )
Maria Irma Bustamante Gavino  ( Aga Khan University School of Nursing, Karachi, Pakistan )
 

Abstract
Understanding violence against women is as complex as its process. As a perusal of literature shows that most of the explanations were contextually and culturally based, this review attempts to analyze the issue of violence against women using theories applicable within the Pakistani context. Literature examining the issue of violence against women and its various theories was reviewed.  A framework using the determinants of violence against women as proposed, include intrinsic and extrinsic factors within the people, the socio-economic- political and cultural system of Pakistan and the influences of surrounding countries. The Pakistani scenario has been described and the theoretical bases were presented. Each determinant has been discussed with supporting literature. Further studies are needed to strengthen the framework; however, it provided a modest view of violence against women in Pakistan. The framework would help the policy and decision makers to understand the dynamics of violence against women and may move them to action to bring about improvements in women's' lives.

Introduction
Understanding violence against women is a complex issue. Several explanations coming from various theories have been offered to understand the phenomenon. Research reports from countries all over the world show that violence against women still occurs, though the form may vary from one society and culture to another. It is a major public health and social problem requiring considerable attention, as it entails severe physical, psychological, social and emotional consequences.
The term violence against women has been defined as the range of sexually, psychologically, and physically coercive acts used against women by current or former male intimate partners.1 It is the most pervasive yet least recognized human right abuse in the world. Some of the other terms that are used interchangeably to describe the issue include intimate partner violence, courtship violence, domestic violence, domestic abuse, spouse abuse, battering, and marital rape.2 It is difficult to estimate the prevalence of violence against women due to the inconsistency in definitions, under reporting, and lack of epidemiological studies concerning the subject.3,4 However, available statistics from around the globe indicate that one out of every three women experiences violence in an intimate relationship at some point in her life.1 In 48 population based studies from different parts of the world, ten to sixty nine percent (10- 69%) of the women reported having been physically assaulted by an intimate partner during their lifetime.5 A woman is battered, usually by her intimate partner; every 15 seconds and more than three women are murdered by their intimate partners every day in the United States.6  As perusal of literature shows that most of the explanations are contextually and culturally based, this paper attempts to analyze the issue of violence against women using several theories applicable within the Pakistani context. Literature examining the issue and its various theories is reviewed and a framework using the determinants of violence against women as a unit of analysis is proposed.
In Pakistan, domestic violence is considered a private matter, as it occurs in the family, and therefore not an appropriate focus for assessment, intervention or policy changes.7 Women have to face discrimination and violence on a daily basis due to the cultural and religious norms that Pakistani society embraces.8 According to an estimate, approximately 70 to 90% of Pakistani women are subjected to domestic violence.9 Various forms of domestic violence in the country include physical, mental and emotional abuse. Some common types include honor killing, spousal abuse including marital rape, acid attacks and being burned by family members. Spousal abuse is rarely considered a crime socially unless it takes an extreme form of murder or attempted murder which could range from driving a woman to suicide or engineering an accident (frequently the bursting of a kitchen stove).10
According to a survey conducted on 1000 women in Punjab, 35% of the women admitted in the hospitals reported being beaten by their husbands. The survey reported that on an average, at least two women were burned every day in domestic violence incidents and approximately 70 to 90% of women experience spousal abuse . In 1998, 282 burn cases of women were reported in only one province of the country. Out of the reported cases, 65% died of their injuries.10 The official figures given for murder of women during the year 1998 were 1974 including 885 murder cases reported in only one province.10 A study conducted in Karachi reported that a large proportion of women are subjected to physical violence that has serious physical and mental health consequences.7
Honor killing is another form of familial violence against women in Pakistan. The practice of karo kari is known to occur in many parts of the country.10 Official figures show that more than 4000 people including 2800 women have died during 1998 to 2004 . Previous figures reveal that in 1997 there were eighty-six karo kari killings in Larkana, Sindh, alone, with fifty-three of the victims being women.11 The entire scenario clearly reflects that violence against women is an enormous public health and social problem in Pakistan, which has never been appropriately responded and dealt by the government.8
Theoretical Base
Several theories and frameworks have been proposed by various authors to explain the phenomenon of violence against women. No single theory would fully explain violence against women, since women abuse is multifactorial.
The nested ecological framework is one of the most commonly used frameworks to study this issue. Brofenbrenner (1986, 1979 &1977) is one of the most widely read and cited author concerning this framework.12,13 A number of authors have used this framework in relation to child abuse, neglect14 and domestic violence.15-18 The framework suggests that behavior is shaped through interaction between individual human beings and their social environment. Development is a result of interaction at various levels of social organization.12,13 The framework proposes five levels including individual, microsystem, mesosystem, exosystem and macrosystem levels. The individual level caters the biological and personal factors, which influence individual behaviour. The microsystem levels encompass the family, and work place situations. The mesosystem level involves the interaction between a person's microsystems. The exosystem level relates to the structures and systems of the society where the person lives. Finally, the macorosystem level considers the role of culture and larger background.12
Feminist theory views social phenomena as determined by the patriarchal structure of most societies. According to this theory woman abuse is one of the outcomes of a structure that allows prostitution and other sexist restrictions to keep women in servile positions. The feminist view also holds that until women are seen as other than subservient, compliant victims, little will change. It is a deeply embedded social problem that has to be addressed by social change.19
The Bandura’s social learning theory is based on the principle that both perpetration and acceptance of physical and psychological abuse is a conditioned and learned behaviour. Bandura20 believes that the social situation is most important in determining the frequency, form circumstances and target of aggressive actions.
Exchange theory21 is a variant of learning theory approach. It proposes that batterers hit people because they can. As long as the cost for being violent does not outweigh the rewards, invariably violence as a method of control will be used.
Sets of cultural rules and values guide the behaviours of members of the society. Role expectations within a culture may also support violence. Males are expected to be "masculine" characterized by machismo, bravery and courageousness. Females are expected to be "feminine" characterized by fragility, timidity, and submission. It would appear that males would posses greater power and females be the weaker sex.22,23 Many religions expect members to adhere to traditional values. For instance, divorce is discouraged in Islam and is viewed unacceptable by the Catholic Christians. Such attitude makes it very difficult for a woman to end even a violent relationship. Women tend to believe that they were committing a sin by dissolving even an abusive marriage.24 In addition, the influence of media may also increase the likelihood of violence against women. It has been observed that violence is a common theme on movies, television, radio, stage, and has even been emphasized in newspaper and tabloids.
By examining the literature on the dynamics of violence against women it appears that factors like ideology of patriarchy, culture and society, religion, media and individual characteristics come together to explain violence against women. The proposed framework is a conglomeration of the factors identified.
The Framework
As mentioned above in the light of the above-mentioned literature review a framework to examine the factors related to violence against women is proposed by the authors. Please refer to Figure 1 developed by the authors, for a graphic or pictorial summary of the framework. As shown in the figure, the issue may be analyzed by examining both intrinsic and extrinsic factors influencing the phenomenon. Intrinsic factors are those that are inherent in the persons. They are part of their personality characteristics and behaviour. Extrinsic factors are those that are outside of the person, like environment, culture, religion and society.[(0)]
Indirect factors (represented by broken lines, see Figure 1) are those found within the   socio-economic-political system of the country. There are also influences, which lie outside of the country. These may be coming from the neighbouring Islamic countries and the rest of Southeast Asia.   It is by looking in to the interplay of these factors that violence against women in this country may be understood. This understanding then may be used as pathways for change, which may eventually provide substantial improvement in women's lives.
Intrinsic Factors
Biological and personal factors influence individual behaviour. This includes personal characteristics like age, education, income, personality influences and acceptance of interpersonal violence. The effects of the factors like substance abuse, witnessing marital violence as a child, being abused as a child, absentee or rejecting father on the personality of a person are also considered intrinsic factors.5,12,15
Studies have shown that younger women are more susceptible to experience violence.25 In a cross-sectional study, no association was found between the younger age and prevalence of domestic violence in Pakistan. The findings suggested that as far as the Pakistani culture was concerned, age of the women did not play any role in protecting her from domestic violence. Therefore, women abuse occurs in all ages.26 Women whose educational attainment levels are inferior to those of their husbands are more likely to suffer beating and intimidation than those women whose educational attainment levels are equal or exceed their husbands.27,28
Literature suggests that there are inherited and ingrained personality traits that predispose some men to behave in a malicious and aggressive manner towards other people especially women. These habits are deeply ingrained and resistant to change. Violent intimate partners report more depression, lower self-esteem, and more aggression than in non-violent intimate partners. Studies suggest that such people are more likely to suffer with personality problems such as schizophrenia, borderline personality, antisocial or narcissistic behaviours, dependency and attachment problems.29 In Pakistan, where awareness and acceptance of mental health problems is limited, up to the authors' knowledge no attempt has been made to study the relationship between personality influences and violence against women. Hence, this factor needs to be explored in detail.
Substance abuse especially use of alcohol is frequently found associated with violence between intimate partners.27,28,30 In a study, out of 150 women participants only 3.3% perceived use of drug as a reason of marital conflict in the society7, however the factor needs to be further investigated. According to literature, males who witness marital violence as a child or adolescent are more likely to exhibit violent behaviour when they are in an intimate relationship.31 It is also mentioned that experiencing violence from caregivers as a child increases one's risk of both perpetrating violence against women and becoming a victim of domestic violence.15 Bandura's (1977) social learning theory concentrates on the power of example. The major premise of the theory is that one can learn by observing others. This phenomenon is known as modeling which has as much impact as direct experiences. Majority of the families especially in Pakistani cultures are close knit and tribal, where parents and elders are the role models. Therefore, if the father beats his wife then his son would beat his wife. When parents/elders beat their daughters then their sons beat their daughters.  As this phenomenon is very common in this society, it is one of the major determinants of domestic violence. 
Extrinsic Factors
Extrinsic factors constitute the context within which the abuse takes place. These factors include male dominance in the family, male control of wealth, and marital/ verbal conflict.5,12,15 Other factors include employment opportunities, economic influences, women access over power and resources, social support network and societal norms regarding gender roles, and power hierarchies.5,12,13,15
Male dominance is frequently mentioned as a determinant of the domestic violence.15 Decision making authority makes the man more dominant in the family and society and increases the likelihood of violence against women.28 Pakistani society is a patriarchal society in which, male members who bear the decision-making authority, head the families. Women are usually not included in making decisions and are considered socially and economically dependent on men.32-34 Women "consider themselves insecure, incomplete, ineffective and inefficient without males".35 Therefore, the male dominance becomes one of the significant predictor of the violence against women in the country. Marital conflict has been found to be related with the domestic violence.15 Majority of the studies around the globe have shown that marital conflict associated with verbal and physical abuse is common in all strata of the society regardless of geographic, cultural, psychosocial and financial differences.4,7,13,26 In a study, out of 150 participants, 34% reported to be physically abused by their husbands due to marital conflicts. The reason of the marital conflict included financial constraints, presence of in-laws, children and absence of a male child.7
Studies have found that unemployment increases the risk of depression, aggressiveness and violent behaviours which in turn can result in an increased risk of physical, sexual and emotional abuse.27,28,30 As unemployment is one of the big problems in the country, it is one of the important determinants of the violence against women.
Economic independence of the people in any society has an impact on women. If the women are allowed to work and are economically independent, they are less likely to become the victims of violence. However, the statement cannot be generalized, as the studies have shown that economic independence of the women does not protect them from domestic violence.26 In some places especially urban areas women have been encouraged to work outside the house and contribute to the economy of the family. However, it is considered as a privilege granted by men. It is "permission" and not a right.33 Economic independence could be a sign of women getting power, which is not acceptable in many societies. Therefore, when the women try to be economically independent, the men try to regain the control by violent acts.35
In the region of Southeast Asia, people usually live in extended families, where mothers-in-law have major influences on family size, family planning and household decision-making.33 It is believed that interference from the mother-in-law is a factor that precipitates violence against the daughter-in-law. Thirty percent (30%) of the participants in a study reported presence of in-laws as a common reason of marital conflict leading to verbal and physical abuse of the wife by her husband.7 Various studies, however, have found no evidence which suggest that women who co-reside with their mothers-in-law are more prone to suffer beating from their husbands than are other women.26-28
 In the patriarchal societies such as Pakistan, "sons are perceived to have economic, social, or religious utility; daughters are often felt to be an economic liability…".32 Studies have revealed that women who have more daughters are more likely to suffer from violence than the women who have more sons.10,27,28 In a similar manner, women who do not have children are subjected to not only violence by their husbands and in-laws, but are harassed by the society as well. 
Marriage at an early age is another factor, which predisposes women to violence by intimate partner. Early marriages are a very common practice in the Southeast Asian countries particularly in Pakistan as the girls are considered a social, economical and religious liability on the families, which needs to be disposed off as soon as possible.32 Research reports have indicated that marriage at a young age makes women vulnerable to abuse in the husband's home.9,27,28 Furthermore, the practice of dowry also plays an important role in precipitation of violence against women in the country. According to literature, women whose dowries are perceived inadequate, by their husband and in-laws, suffer considerably more harassment in the husband's home than do women whose dowries are more substantial.9,27,28
Historically, in the Indo-Pak's tribal and rural cultures, women were treated as the property of men. Role of woman has been submission, to serve as a commodity and to sacrifice herself for the sake of values determined by man.35 When there used to be disputes between tribes, goats, sheep and women were traded for reconciliation. Marriages, for political and tribal peace were common.27 Similar practices are still ongoing and many families do not allow their women to marry in case someone out of the family would share their ancestral lands.35 These restrictions are applied to control women from inheriting land, property and precluding their offspring's, from another man, to inherit the family land and influence. She is beaten and killed, for the sake of man's ethics and man-made values. 
If a woman is respected in a culture, she is less likely to be abused and beaten. It is important to note that in many countries like Pakistan, one of the very interesting phenomenon is that older women are respected but the young women are not. This does not necessarily mean that older women are not abused. Wife beating is even considered normal in the culture9,27,28,35 and therefore, is unreported.
Unfortunately, Pakistani and Indian societies still run on tribal and feudal system and the majority of the population lives under rural and feudal control.35  In feudal system, there is no education; no freedom and women are treated like slaves or prisoners in the households making violence against women in these societies very common.  Some tribal societies consider women as the source of all evils and men are not mentioned in any evil doing.  There is a famous proverb, used and believed so universally, in such societies, "Zan, Zar, Zameen" (Woman, Money, Land) being the source of everything evil.  This is a sound wisdom in these cultures. This is used, not as a source of learning but as a tool to put blame on the women and not on the men in case of any undesirable behaviour on part of the men. In such societies, women's personality is determined by the man's wishes.  If she is non-compliant, and rebellious, she is punished through beatings, isolation, virtual imprisonment and sometimes murdered.
In summary, it is the interplay of the identified determinants that violence against women may be analyzed. Factors which are found in persons makes them either vulnerable to be abused or to have the tendency to be violent and abusive. The conditions which set the stage for violence against women are found in the extrinsic factors which are heavily present in the culture of Pakistan. The prevailing system of patriarchy both in Pakistan and its neighboring countries supports and influences violence against women.
If the decision and policymakers would be made aware to recognize these factors, appropriate interventions may be initiated. The framework may assist women to view their situation in a different light and realize that they have equal rights. Men on the other hand may also realize the negative effects of violence and on their own volition opt for a more egalitarian society.

Conclusion
The proposed framework which had intrinsic factors within people, extrinsic factors, the socio-economic-political and cultural system of Pakistan and the influences of surrounding countries as determinants of violence against women provided useful insights towards the understanding of the phenomenon. While the authors recognize that further studies are needed to strengthen the framework, it is a modest attempt to view violence against women in the Pakistani context. The framework may help men, women, public health professionals and policy and decision makers to understand the dynamics of violence against women, thus moving them to action. A milieu of cultural change may be initiated to bring forth improvements in women's lives.

References
1. World Health Organization (WHO). Violence against women. A health priority issue.Geneva, 1997.
2. Saltzman LE, Fanslow JL, McMahon PM, Shelley GA. Intimate partner violence surveillance: uniform definitions and recommended data elements, Version 1.0. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 1999
3. Raphael B. Domestic violence. Med J Aust 2000; 173: 513-4.
4. Bradley F, Smith, M, Long, J, O'Dowd T. Reported frequency of domestic violence: cross sectional survey of women attending general practice.  BMJ 2002; 324 (7332): 271.
5. Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet 2002; 360:1083-8.  
6. Rennison C. Intimate partner violence, 1993-2001. Washington (DC): Bureau of Justice Statistics, Department of Justice (US); 2003. Publication No. NCJ197838.
7. Fikree FF, Bhatti LI. Domestic violence and health of Pakistani women. International J Gynaecol Obstet 1999; 65:195-201.
8. Bettencourt A. Violence against women in Pakistan. Human Rights Advocacy Clinic; Litigation Report Spring 2000, [online] 2000 [cited 2005 November 3] 2000. Retrieved November 3]. Available from: URL: www.du.edu/intl/ humanrights/violencepkstn.pdf
9. Human Rights Watch, 'Crime or Custom? Violence against Women in Pakistan, Report of Human Rights Watch 1999. [online][cited 2006 March]. Available from: URL: http://www.hrw.org/reports/1999/pakistan/index.htm
10. Human Rights Commission of Pakistan (HRCP).State of human rights in 1999. Lahore: HRCP, 2000.
11. Felix Q. Honour killing and "karo kari" in Pakistan. [online] [cited 2007 May 30]. Available from: URL:  http://www.asianews.it/view.php?l= en&art=1187: Date accessed May 30, 2007.
12. Dasgupta, S.D. Towards an Understanding of Women's Use of Non-Lethal Violence in Intimate Hetrosexual  Relationships. Applied Research Forum, National Electronic Network on Violence Against Women, February 2001. [online] [cited March 2006]. Available from: URL: http://www.vawnet.org/ VNL/library/general/AR_womviol.pdf
13. Edleson JL. Primary prevention and adult domestic violence. Paper presented at the meeting of the Collaborative violence prevention initiative, San Francisco 2000.
14. Belsky, J. Child maltreatment: an ecological integration. Am Psyc 1980; 35: 320-35.
15. Heise LL. Violence against women: an integrated, ecological framework. Violence Against Women 1998; 4: 262-90.
16. Dutton DG. Patriarchy and wife assault: The ecological fallacy. Violence Vict 1994; 9: 167-82.
17. Edleson JL, Tolman RL. Intervention for men who batter: an ecological approach. Newbury Park, CA: Sage Publication, 1992.
18. Carlson, B. Causes and maintenance of domestic violence: An ecological analysis. Social Service Review 1984; 58: 569-87.
19. Gondolf EW, Fisher ER. Battered women as survivors: An alternative to treating learned helplessness. Lexington, MA: Lexington Books, 1988.
20. Campbell J, Humphreys J. Nursing care of survivors of family violence.2nd  ed. St. Louis: Mosby-Yearbook 1993.
21. Galles RJ, Cornell CP. Intimate violence in families. Beverly Hills: Sage Publications, 1985.
22. Dobash RE, Dobash RP. Women, violence and social change. New York: Routledge, 1992.
23. Dobash RE, Dobash RP. Violence against wives. New York: Free Press, 1979.
24. Hoffeler K. Battered women shattered lives. Saratoga: R & E Publishers, 1983.
25. Schuler SR, Hashemi SM, Riley AP, Akhter S. Credit programs, patriarchy and men's violence against women in rural Bangladesh. Soc Sci Med 1996; 43: 1729-42.
26. Shaikh MA. Is domestic violence endemic in Pakistan: perspective from Pakistani wives. Pak J Med Sci 2003; 19: 23-8.
27. Visaria L. Violence against women in India: Evidence from rural Gujarat. Domestic violence in India; A summary report of three studies. Washington, DC: International Center for Research on Women (ICRW), 1999; pp 14-25.
28. Jejeebhoy S. Associations between wife beating and fetal and infant death: Impressions from a survey in rural India. Stud Fam Plann 1998; 29: 300-8.
29. Holtzworth-Monroe A, Bates L, Smutzler N, Sandin E. A brief review of the research on husband violence: part I: Martially violent versus nonviolent men. Aggression and Violent behavior 1997;2: 65-99.
30. Coker AL, Smith PH, McKeown RE, Melissa KJ. Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering. Am J Public Health 2000; 90: 553-9.
31. Ellsberg M, Peña R, Herrera, A, Winkvist A, Kullgren G. Domestic violence and emotional distress among Nicaragua women: Results from a population-based study. Am Psychol 1999; 54: 30-6.
32. Fikree FF, Pasha O. Role of gender in health disparity: the South Asian context. BMJ 2004; 328: 823-6.
33. Kadir MM, Fikree FF, Khan A, Sajan F. Do mother-in-law matter? Family dynamics and fertility decision-making in urban squatter settlements of Karachi, Pakistan J Biosoc Sci 2003; 35: 545-58.
34. Jejeebhoy SJ, Sathar ZA. Women's autonomy in India and Pakistan: the influence of region and religion. Pop Deve Rev 2001; 27: 687-712.
35. Niaz U. Violence against women in South Asian countries. Arch Women's Ment Health 2003; 6:173-84.

News & Events

Dear Friends and Colleagues,
May you have a very Happy EID with your friends and Family.
May all of us be Blessed with peace and tranquility.
Let us all jointly say a prayer for all troubled persons all over the world
Warm regards,
Dr. Fatema Jawad
Editor-in-chief,
Journal of Pakistan Medical Association, Karachi
President, PAME
Pakistan Association of Medical Editors



WHO/GOARN Request for technical assistance for Cholera Control in Northern Iraq

Request for assistance

WHO is requesting assistance from GOARN partners to identify the following cholera and diarrhoeal diseases expertise to support the Ministry of Health of Iraq in cholera risk assessment and immediate preparedness activities to improve the health outcomes of the Syrian refugees current living in camps in the Kurdistan region of Iraq.

  • two (2) epidemiologists
  • two (2) clinical management experts
  • one (1) environmental health expert (WATSAN)
  • one (1)laboratory expert

Duration

6 day mission starting 13 June 2014 (this excludes travel time).

Location

Northern Iraq (Kurdistan region).

Language requirements

All candidates must be fluent in English- written, spoken and comprehension. Fluency in Arabic is an asset. Knowledge, abilities and skills All candidates are expected to demonstrate the following

  • Ability to conceptualize and promote innovative strategies and policies.
  • Ability to communicate and write in a clear concise manner, and to develop effective guidelines.
  • Excellent negotiation and interpersonal skills complemented by ability to motivate and lead others and to promote consensus. Tact, discretion and diplomacy
  • Demonstrated ability for project appraisal, project management, monitoring and evaluation and project impact assessment.
  • Ability to work with host governments and their agents, INGOs and national NGOs an advantage.
  • Proven experience of managing a large workload and multiple priorities.
  • Ability to work in difficult conditions.

Support to the mission

WHO/GOARN will cover the travel and per diem (to cover daily expense in the field) expenses for the duration of their mission. GOARN missions do NOT offer salary, consultancy fees or any other form of remuneration.

WHO will provide appropriate logistics support for the field mission. Pre-deployment orientation/training may be required at WHO.

Partners offers of assistance

Partners are requested to reply with offers of assistance, together with CVs and details of the availability of staff for this mission by email to goarn@who.int latest by 30 May 2014. Details of all offers from partners and eventual deployments will be maintained on the GOARN SharePoint.

Operational Contacts

Mamunur Malik WHO EMRO malikm@who.int

William Perea WHO HQ pereaw@who.int

Patrick Drury GOARN druryp@who.int



News



Index



Supplement