September 2000, Volume 50, Issue 9

Short Reports

Domestic Violence against Women - Perspective from Pakistan

Masood Ali Shaikh  ( Public Health Physician, Islamabad. )

Abstract

Objective: Domestic violence is an important public health concern. This study assessed the prevalence and type of domestic violence perpetrated liv men on their wives.
Setting: The study was conducted in a public sector hospital among men accompanying patients. Methods: A cross-sectional survey based on a sample of convenience was conducted by the author, using a pre­tested questionnaire with mos tly close-ended questions.
Results: All the respondents admitted to ever shouting or veIling at their wives, including while she was pregnant. Twenty-three (32.8%) respondents admitted to ever having slapped their wives and 54 (77.1%) admitted to ever engaging in a non—consensual sex with their wives.
Conclusion: Population based studies are required to assess the type, frequency risk factors and sequel of wife abuse, so as to establish practice guidelines (JPMA 50:312, 2000).

Introduction

Domestic violence entails shouting. physically hitting and engaging in nonconsensual sex and has been defined as a controlling behavior in the context of an intimate relationship1,2. It is an important cause of intentional injuries in women, especially those seeking medical care in the emergency departments3-5. Pregnant women are at an increased risk of violence, husband/partner being the instigator6-10.
A study in India, based on 6700 respondents from live districts, reported district-specific rates of 18 to 45% for men who physically abused their wives1. While 18 to 40% of men reported engaging in nonconsensual sex with their wives.
Regarding association of pregnancy and domestic violence, a study on 63 1 pregnant women in a Chinese community reported that 17 (4.3%) had a history of verbal abuse with husband being the perpetrator. While an Indian study, based on 600 pregnant women reported physical abuse in 132 (22%) pregnant women9. In Pakistan, there is paucity of literature on domestic violence, its prevalence. phenomenology and associated sequel.

Subjects, Methods and Results

Between November 24th and December 4th, 1999, a cross-sectional survey was conducted in Islamabad, using a structured questionnaire with close-ended questions except one. This questionnaire was pre-tested on eleven men and questions perceived to be offensive by six or more men, were deleted from the final study questionnaire. Questions on frequency of any abuse and frequency of non-consensual sex were deleted after pre-test, since men perceived these questions to be offensive.
The author (physician) conducted all the interviews. Men accompanying patients in a public sector hospital were approached and explained that a study is being conducted in which sensitive questions would be asked about their relationship with their wives. Strict confidentiality was assured and it was emphasized that honest and correct answers were very important. Men who agreed to be interviewed were advised that they could terminate the interview at any time and if they so wished and their filled questionnaire would be torn. All the interviews were conducted at a place where no one could over-hear the conversation. Men between the ages of 25 to 45 and those who were married for at least one year were interviewed.
Questions were asked about ever engaging in various types of verbal and physical abuse with their wives, including their wife’s reaction to it and whether she sustained any injuries, and did this abuse ever take place while she was pregnant. Questions on ever engaging in nonconsensual sex were also asked. In the end of the interview a hypothetical open-ended question on what would ever prompt them to kill their wife was asked.
One hundred and twenty-seven men were approached, 34 refused to be interviewed at the outset. Seventeen subjects terminated the interview before completion, while 6 changed their minds after the interview was completed. Seventy (55.1%) respondents agreed to be interviewed and their results are presented. The average age of the respondents was 33.5 years (SD±6.4), with mean duration of marriage being 8.8 years (SD±6.1). Ten (14.3%) respondents had ten years of education or less, 45 (64.3%) had between 11 to 12 years, while remaining had more than 12 years of education. Regarding monthly income of the household, 50 (71 .4%) respondent’s monthly household income was less than rupees five thousand, while the rest had between rupees five to ten thousand.
All the respondents admitted to ever shouting or yelling at their wives, including while she was pregnant. In response, only 12(17.1%) wives tended to react in the same manner and 7(100%) just cried. The rest opted to stay quite and did not react in any discernable way, at least to their husbands. Twenty-three (32.8%) respondents admitted to ever having slapped their wives and 8 (1 .4%) also slapped their wives while she was pregnant. Their wives either cried and/or screamed in reaction and none hit back. Thirteen (18.6%) respondents admitted to ever having kicked their wives, while four (5.7%) admitted to this abuse while she was pregnant. Wives belmvior in this instance was again hmited to crying and screaming. As a result of these kicks three sustained bruises, while two suffered internal injuries and received medical treatment. No respondent ever used a weapon on their wives. Fifty four (77.1%) admitted to ever engaging in a non-consensual sex with their wives. While 41 (58.7%) respondents said that illicit relations of their wives would prompt them to kill her, the rest said nothing would ever lead them to killing her.

Comments

Domestic violence is a complex behavior that resists simple solutions and documenting its prevalence, phenomenology and associated sequel are important preventive measures. This study is an attempt to document the existence of domestic violence in the context of wife abuse. The respondents, universally, reported shouting at their wives even while she was pregnant. Physical abuse was also not uncommon.
Wives of the respondents tended to be docile and reportedly, reacted in a submissive manner. Nonconsensual sex was reportedly a norm in the men interviewed. While over half of the respondents felt that they would resort to killing if they ever found out that their wife was having illicit relations with others.
Perhaps the economic dependence of wives on their husbands tend to mute their reaction towards violence and cultural norms also dictate a rather passive acceptance of abuse. The results of this study must be viewed in light of the methodological limitations and constraints. Firstly almost half of the men approached declined to be interviewed. Secondly, respondents wives were not interviewed. Furthermore, the methodology and small sample size did not allow determination of bivariate association between age, income or education with the wife abuse.
Problem of wife abuse warrants recognition as a public health concern. And population based studies are required to assess the type, frequency. risk factors and sequel of wife abuse, so as to establish practice guidelines for general practitioners and obstetricians in Pakistan.

References

1. Martin SL, Tsu AU, Maitra K. CI al. Domestic violence in Northern India Am. J. Epidemiol., 1999;150:4 7-26.
2. Potter LB. Sacks JJ, Krcsnow MJ. et at. Nonfatal physical violence, United States. 1994. Public Health Rep.. 1999;114:343-52.
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4. Haywood YC, Haile-Mariam T, Violence against women. Emerg. Med. Clin. North Am., 1999;3:603-15
5. Goldberg WG, Tomlanovich MC Domestic violence victims in emergency department: new findings. JAMA, 1984;251:3259-64
6. Leung WC. Lcung TW. Lam YY. et at. The prevalence of domestic violence against pregnant women in a cli mese coin munity. Int. J. Gnaecol Obstet.. 1999;66:23-30
7. H elton AS. McFarlane J. Anderson ET Battered and pregnant: a prevalence study. Ant. J, Public Health. 1987;771337-39.
8. MeFarlane J, Parker B. Socken K, et al Assessing for abuse during pregnancY: Severity and frequency of inluries and associated entry in to prenatal care. .IAMA. 1992;267:3 176-78.
9. Purwar MB, Jevascelan 1.. Varhadpande U. et al. Survey of physical abuse  during pregnancy GMCH Nagpur. India J. Obstet. Gynaecol. Rcs..999;25:165-71
10. Gazmararian JA, t.azorick S, Spitz AM et al. Prevalence of violence against pregnant women JAMA, 1996:275:1915-20.

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