October 2016, Volume 66, Issue 10

Short Reports

Domestic violence in consanguineous marriages - findings from Pakistan Demographic and Health Survey 2012-13

Masood Ali Shaikh  ( Independent Consultant, Karachi. )

Abstract

Domestic violence is a pandemic and estimated to affect one in three women globally, in their lifetime. Marriages within blood relations in Pakistan are common. In this study a secondary analysis of Pakistan Demographic and Health Survey 2012-13 was done to study the prevalence and profile of domestic violence in the context of consanguineous marriages in Pakistan. Almost 65% of women had some kind of blood relationship with their husbands. Women having a blood relationship with husbands were more likely to report having ever been subjected to marital control behaviours, emotional and physical violence by their husbands, compared to ones without such relationship. However, these associations fail to reach statistical significance; underscoring the ubiquitous nature of marital control and violence. More effective public health education campaigns for just and equal treatment of wives by their husbands to speedily curb the scourge of domestic violence in the country are needed.
Keywords: Domestic, Violence, Abuse, Pakistan.

Introduction
Domestic violence, or intimate partner violence, is defined as "behaviour within an intimate relationship that causes physical, sexual or psychological harm, including acts of physical, sexual coercion, psychological abuse and controlling behaviours." 1 It is a pandemic and estimated to affect one in three women globally in their lifetime.2 A national household survey in Pakistan on domestic violence reported that one third of 23,430 women reported having experienced some type of physical violence.3
Marriages between first and second cousins or among other blood relations in Pakistan are described as within \\\'Biraderi\\\'; a term that is used in many local languages of Pakistan and literally translates into membership in \\\'brotherhood\\\'. Wikipedia defines consanguinity as "the property of being from the same kinship as another person. In that aspect, consanguinity is the quality of being descended from the same ancestor as another person."4 Consanguineous marriages are widely practiced in Pakistan and Muslim world 5,6 One study on relationship between domestic violence and consanguineous marriage, based on a sample of 1010 married women, reported that being married to one\\\'s cousin did not bestow protection from being either emotionally or physically abused.7
In this study a secondary analysis of a recently conducted nationally representative survey was done to study the prevalence and profile of domestic violence in the context of consanguineous marriages in Pakistan.

Methods and Results
Pakistan Demographic and Health Survey 2012-13 was conducted by the Pakistan\\\'s National Institute of Population Studies (NIPS) and the Measure DHS of the United States to collect data on demographic and select health indices. The data and detailed report on methodology and results are available at the NIPS and Measure DHS website.8,9 Data were analyzed in terms of weighted prevalence (proportions), their 95% confidence intervals, and design-based statistical associations between blood relationship with husband and various violent behaviours using Pearson Chi-Square test using STATA 14.


A subsample of 3743 ever-married women between the ages of 15-45 years were selected for administering the domestic violence (DV) module, out of which 3687 (98.5%) were successfully interviewed. Type of blood relationship with husband was determined in terms of being a first cousin from mother\'s/father\'s side, second cousin, other blood relationship, or no blood relationship. For one record, exact type of blood relationship with husband was missing and was recoded as having \'other relationship\' with husband. For the question on whether a woman had a say in choosing her husband, three records were coded as either \'don\'t know\' or \'missing information\\\'; these records were recoded as not having had a say. Similarly, for the six marital control, seven physical violence, three emotional violence, and three physical consequences of physical violence questions, responses coded as either \'dont know\' or \'missing information\' were recoded as not having these behaviours exhibited by husbands. 


Table-1 shows the unweighted frequencies, weighted prevalence and their 95% confidence intervals of blood relationship status with husband as well as whether women had a say in choosing their husband. Almost 65% of women had some kind of blood relationship with their husbands, and the most commonly reported relationship was the husband being a first cousin from the father\'s side, while 53% women had some kind of blood relationship with their husband and also had a say in choosing their husband. Table-2 shows the weighted proportion of wives who had ever experienced marital control, emotional, or physical abuse by current or former husbands. Husbands being jealous or angry if wives talk to other men was reported by 25% of women and was the most common type of marital control behaviour, while 31.5% of women reported having ever experienced any of the five marital controls behaviours. Husband ever saying or doing something to humiliate her in front of others was reported by 25.9% of women and was the most common type of emotional abuse, while 32.2% of women reported having ever experienced any of the three emotional abuses inquired about. Husband having ever slapped her was reported by 25.2% of women and was the most common type of physical violence, while 26.8% of women reported having ever experienced any of the seven physical violence inquired about. 



Table-3 shows the prevalence of ever having experienced marital control, disaggregated by blood relationship with, and having had a say in choosing husband. Women having a blood relationship with husbands or having had a say in choosing their husbands were more likely to report having ever been subjected to marital control behaviours by their husbands, compared to ones without such relationship or having had no say in choosing their husbands, for all five controlling behaviours studied.

Among women having a blood relation with their husbands, those who were married to their first cousins from their father\'s side reported highest proportion of ever having been subjected to all marital control behaviours studied. However, using design-based Pearson chi-square test, statistically significant association was found only between having ever experienced any kind of marital control behaviour and having had a say in choosing a husband (p-value = 0.015). The relationship between having ever experienced any kind of marital control behaviour and having any blood relationship with husband was not statistically significant. Table-4 shows the prevalence of ever having experienced physical or emotional violence, disaggregated by blood relationship, and having had a say in choosing a husband. Women having a blood relationship with husbands or having had a say in choosing their husbands were more likely to report having ever been subjected to physical or emotional abuse from their husbands, compared to ones without such relationship or having had no say in choosing their husbands for all physical and emotional abuse behaviours studied.

Among women having had a blood relation with their husbands, those who were married to their first cousins from their father\\\'s side reported highest proportion of ever having been subjected to all physical or emotional abuse behaviours studied; only exception being two physical abuse behaviours i.e. husband having ever tried to choke or burn on purpose, and husband ever threatened or attacked with a knife, gun, or some other weapon. For these two physically abusive behaviours, women married to their first cousins from mother\'s side reported highest proportions. However, no statistically significant association was found between having ever experienced any kind of physical or emotional abuse and either having any kind of blood relationship with husband or having had a say in choosing a husband. Table-5 shows the prevalence and type of sequel following physical violence perpetrated by husbands, by blood relationship and having had a say in choosing a husband. Women having a blood relationship with husbands or having had a say in choosing their husbands were more likely to report having ever had three types of physical violence sequel studied compared to ones without such relationship or having had no say in choosing their husbands. Among women having had a blood relation with their husbands, those who were married to their first cousins from their father\\\'s side reported highest proportions of physical violence sequel with the exception of serious injuries, in which case women having \\\'other\\\' type of blood relationship reported highest proportion of physical violence sequel. However, statistically significant association was found only between having ever experienced any kind of sequel following physical violence and having had some kind of blood relationship with husband (p-value = 0.011).



Discussion
Almost two-third marriages in Pakistan involved blood relations between spouses based on PDHS 2012-13 data. Encouragingly, a whopping 79% women reported that they had a say in choosing their husband. Among consanguineous marriages, marriages with husband being a first cousin from the father\\\'s side were the most common, closely followed by husband being the first cousin from the mother\\\'s side. In about half of marriages, women reported to have had a say in choosing their husband with whom they had a blood relationship as well. However, marrying a first cousin, or for that matter anyone with whom a woman had any blood relationship, did not confer protection from physical, emotional abuse, or marital controlling behaviours. If anything, such abusive practices were more common against the backdrop of consanguinity. Though the relationship between consanguinity and abuse did not always reach the level of statistical significance, it nonetheless underscores the importance of discerning practical significance, which in this case trumps the statistical significance. More importantly, even though most women had some say in choosing a husband, it also did not provide immunity from marital control and/or abuse.


The fact that consanguinity and having a say in choosing one\\\'s husband did not particularly protect women from domestic violence and abuse, coupled with results from this analyses that cumulatively 31.5% women reported ever been subjected to any one of the marital control behaviours studied; 32.2% and 26.8% reported having ever endured some kind of emotional or physical abuse, respectively, from their husband clearly delineates the endemic nature of violence, control, and abuse in the context of marriage for women in Pakistan. Blood relationships and having a say in choosing one\\\'s husband does not guarantee any escape from this menace either. If anything the closer the blood relationship with husband, the more experience of violence.


There is a clear and present need to realign the status of married women in the country and bring it in conformity with the times to realize the full potential of half of the country\\\'s population. Better laws to protect and provide safety nets for married women from abuse and violence are a good beginning in the country.10 One of modern history\\\'s recurring themes is the inadequacy of laws alone in changing the deeply ingrained cultural and social practices and norms. Education and involvement of religious leaders in the public health education campaigns for fair, just, and equal treatment of wives by their husbands hold promising potential in the country to more effectively and speedily curb the scourge of domestic violence in Pakistan.

Disclaimer: None.

Conflict of Interest: None.

Funding Disclosure: None.

References
1.Preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva: World HealthOrganization, 2010.
2.World Health Organization. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and nonpartner sexual violence. Geneva, Switzerland: World Health Organization, 2013.
3.Andersson N, Cockcroft A, Ansari U, Omer K, Ansari NM, Khan A, et al. Barriers to disclosing and reporting violence among women in Pakistan: findings from a national householdsurvey and focus group discussions. J Interpersonal Violence. 2010; 25:1965-85.
4.Consanguinity.[Online][Cited2016 May 18]. Available from: URL:https://en.wikipedia.org/wiki/Consanguinity.
5.Ahmad B, Rehman AU, Malik S. Consanguinity and inbreeding coefficient in tribal Pashtuns inhabiting the turbulent and war-affected territory of Bajaur Agency, North-West Pakistan. J Biosoc Sci. 2016;48:113-28.
6.Sandridge AL, Takeddin J, Al-Kaabi E, Frances Y.Consanguinity in Qatar: knowledge, attitude and practice in a population born between 1946 and 1991.J Biosoc Sci. 2010;42:59-82.
7.Shaikh MA, Kayani A, Shaikh IA.Domestic violence and consanguineous marriages - perspective from Rawalpindi, Pakistan.East Mediterr Health J. 2014; Suppl 3:S204-7.
8.The DHS Program. Available Datasets.[Online][Cited 12 May 2015].Available from: URL:http://dhsprogram.com/data/available-datasets.cfm..
9.NIPS II. Pakistan Demographic and Health Survey 2012-13. Islamabad [Online] 2013[Cited 2015 May 12]. Available from: URL:http://nips.org.pk/abstract_files/Priliminary%20Report%20Final.pdf.
10.Global Citizen. Pakistan\\\'s new law protecting women against violence may be a game changer.[Online] [Cited 2016 May 18]. Available from : URL:.https://www.globalcitizen.org/en/content/pakistan-law-women-violence-honourkilling/.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: