Introduction

Violence against women is a worldwide phenomenon, rooted deep in its tradition most pervasive and yet the least recognised human rights abuse in the world. The World Health Organization defines domestic violence as “the range of sexually, psychologically and physically coercive acts used against adult and adolescent women by current or former male intimate partners” ₁. Violence against women include: any act of gender-based violence that results in, or is likely to result in, physical sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life₂. World-wide one of the most common form of violence against women is abuse by their male partners. Violence against women, by an intimate partner includes physical aggression, psychological abuse, forced intercourse and other forms of sexual coercion, and various controlling behaviors₃. This study found that 10% to 69% of women reported that they had experienced physical violence from a male partner during their life time. Lifetime intimate partner violence is reported to be 43% in China₄. Domestic violence occurs in all countries and transcends social, economic, religious and cultural groups. There are possible linkages between domestic violence and a range of adverse physical, mental, and reproductive health outcomes also₃₅₆₇. A recent community -based study₈ give an interesting detailed account of individual and community level influences on domestic violence in Uttar Pradesh, North India. In Indian context, some studies_910111213 conducted mostly in hospital set-up gave varied results in different populations on violence against women. Present community-based study was conducted in peri-urban area of UT, Chandigarh. India with the objectives: (1) to explore the prevalence and nature of domestic violence among women in slum population of UT Chandigarh (2) to understand factors contributing towards domestic violence (3) to explore the perceived consequences of violence on women's health (4) to examine the coping mechanism adopted by women while facing the violence.

Methods

This cross-sectional study was conducted in 2005-06 at Rural Health Training Centre (RHTC) attached with the Department of Community Medicine, Government Medical College, Chandigarh, India. A total population of about 3000 in peri-urban area attached with the RHTC and surrounding slum population was covered. All the households in the study area were enumerated and married women in reproductive age willing to participate in the survey were included as respondents. Information on background characteristics like age, age at marriage, literacy, socio-economic status etc, and various aspects of physical violence like type of violence experienced during last one year, perceptions regarding reasons of being victim of violence, coping mechanism, perceived consequences of physical violence etc was collected. Verbal consent from respondents was taken and confidentiality of individual responses was ensured following Ethical Guidelines of Helsinki ₁₃. Respondents were interviewed in privacy and they were free to withdraw at any stage of interview if they wish. A total of 296 respondents gave consent to participate in the survey and only a small proportion of non- respondents was observed. Non-response was mainly due to shyness and hesitation in sharing problems. Data were analysed using Student's t-test, Chi square test, and Odds ratios along with their confidence intervals. Logistic regression model was also used for predicting risk factor of physical violence. Data were analysed using SPSS -12 Software.

Results

Overall mean age of 294 respondents interviewed was 28.66 years and more than half (53.4%) were between 26 and 35 years of age and majority of them (70.5%) had been married for more than 5 years. Means of age and marital durations of women who faced physical violence were significantly higher (P<0.001) than those of women who never faced physical violence in their married lives. Nearly 25% women were having children more than 3 (Table - 1).

Social characteristics of respondents are shown in Table-2. Large proportion of women was belonging to a nuclear family (86.7%), low socio-economic status (64.6%) and mostly they were housewives (96.9%). Literacy was significantly associated with facing of physical violence (₂ = 9.87, P = 0.04). Illiterate women faced physical violence more as compared to literate women. Number of children (² = 1.10, P = 0.29), work status (₂ = 1.01, P = 0.31), type of family (² = 0.02, P = 0.89), and SES (² = 0.98, P = 0.32) were not found to be significantly associated with experiencing physical violence.

Among all respondents, 116(39.4%) faced some form of physical violence sometimes during their married life Respondents who faced physical violence were asked about type of violence faced. Physical violence varied from slapping (56.9%), physically hurt (33.6%), and kicking (9.5%). Most of the women (63.8%) were victim of physical violence more than once in a month. Husbands were the most frequently reported perpetrators of violence reported by 98 (84.5%) respondents. Physical violence was faced even during pregnancy by 88 (75.9%). Neighbours were also reported to be aware of violence in 99 (85.3%) cases (Table-3).

Women, who reported facing of physical violence sometime in their married life were also asked what they perceived as the commonest reasons for violence in their household. Husband's short temper (27.6%), alcohol addiction (21.5%) and disinterest of respondents in sexual activities (9.5%) were most frequently reported perceived reasons. In spite of being victims of physical violence, only 42 (36.2%) women were the opinion that only husbands were fully responsible for it. Majority of them 72 (62.1%) blamed themselves also to some extent and only 2 (1.7%) respondents blamed other members. The sex related consequences of physical violence were reported in the form of forced sexual act by partner (82.8%), STD among respondents/spouses (17.2%), and extra marital affair of husbands (10.3%) and suspicion of extra marital affair of respondents by their husbands (18.7%). Other perceived consequences of physical violence were abortion (14.8%), sense of fear from partner (51.7%), and victimization of children (34.5%) (Table-4).

On being asked about coping mechanism against violence, most of the women reported remain to be passive by (60.3%) and quitting the house temporarily (20.7%). Few women had utilised some protection by interference of family members (9.5%) while some opted counter physical action (16.4%) as coping mechanism. In spite of physical violence respondents stayed with their husband mainly for the sake of future of the children (61.2%), sake of marital bond (35.3%) and social compulsion (15.6%) (Table-5).

On the basis of multiple logistic regression analysis, age above 25 years, a single factor came out to be a highly significant (P<0.001) risk factor for physical violence (Table-6).Literacy, which was significantly associated with physical violence on the basis of bivariate analysis, lost its significance in multivariate logistic regression analysis. Other factors like working status, SES, and number of children in family were not found significant risk factors for physical violence.

Figure 1

Table 1: Reproductive Characteristics Of Respondents By Physical Violence

Figure 2

Table 2: Social characteristics of respondents by physical violence

Figure 3

Table 3: Pattern Of Physical Violence Experienced By Women

Figure 4

Table 4: Reasons, Responsibility, And Consequencies Of Physical Violence, Perceived By Women

Figure 5

Table 5: Coping Mechanisims And Reasons Of Staying With Husband Against Violence Adopted By Women Experiencing Physical Violence

Figure 6

Table 6: Logistic Regression Analysis Of Risk Factors Of Physical Violence

Discussion

This study explores the extent of physical violence against married women and its associated factors. About 40% married women in the reproductive age suffered from physical violence mainly by husbands. Women in the higher age groups faced physical violence more as compared to younger women. The study also explores the reasons, types of violence, its perceived consequences on reproductive health and coping mechanisms adopted by women. Physical violence resulted mostly in terms of forced sex which is itself a form of sexual abuse.

The study included respondents representing all age groups within reproductive age mostly housewives of low SES from nuclear families and. Husband came out to be the principal perpetrator in our study. Frequent slapping by husband was the most common form of physical violence. Short temperament and alcohol addiction of husbands were the most common perceived reasons. Sex related issues and socio-economic reasons were not so common reasons responsible for physical violence according to respondents. Respondents also blamed themselves to some extent but husbands were blamed more responsible for physical violence. Blaming themselves for physical violence by respondents reflects the traditional image of Indian housewives. Respondents reported several adverse reproductive health related outcomes, as consequences of physical violence like forced sex, abortion, fear from partners etc. No counter action to violence was adopted by most of respondents to cope with the physical violence situations. Respondents opted to quit the place temporarily at the time of violence in most of cases or interventions of family members and neighbours resolved matters in some cases. For the sake of future of children and maintaining marital bonds respondents stayed with their husbands in spite of physical violence.

Females in the higher age groups, irrespective of marital duration, SES, literacy status, and other factors were at higher risk of physical violence against the usual hypothesis that younger and uneducated women are more prone to physical violence due to some added risk factors like dowry demands etc in Indian community. Physical and sexual violence was found associated with the individual-level variables of childlessness, economic pressure and intergenerational transmission of violence₈. Higher SES was found to be protective against physical violence in this study. Risk factors of intimate partner violence in the present study also do not agree with those among women in China₄. Younger age, low literacy and low SES were among multiple risk factors among Chinese women unlike among Indian women. Probable reason of SES not found a significant correlate of violence in the present study may be that although the root causes of domestic violence are same but its expression varies significant according to SES. It may be more hidden in higher SES. Sexual violence and psychological violence may be more common than physical violence among women in high SES category as compared to their counterparts.

The prevalence rate of physical violence (39.6%) found in the present study is higher as compared to only 28.4% among pregnant women admitted in the antenatal ward of the hospital in the same city₉. In a northern Indian district, 42-48% prevalence rate of domestic violence has been reported₁₅. In Karachi, Pakistan this rate has been reported 34% among patients attending out patient clinics₁₆. In a hospital-based study about 40% prevalence of history of abuse is reported₁₇. Physical violence in intimate relationships is accompanied with abortion (53%), anxiety / depression (42%)₁₆. Nature of violence is also likely to be influenced by socio-economic conditions of women whereas, in the present study SES does not come out to be a significant factor influencing physical violence. Higher SES was found to be protective against physical violence but not sexual violence in a recent study₈.

In our study husbands came out to be the main perpetrators and their addictions came out to be one of common reasons of violence in agreement with several other studies₉₁₉. Addiction to alcohol consumption came out to be the second most reason after short-temperament of husbands in the present study. However, dowry demand does not come out to be a reason responsible for physical violence in our study unlike other studies in Indian context ₁₂₁₉.

This study conducted in an Indian community rules out some chances of selection bias present in hospital-based studies. This study also explores prevalence and different nature of physical violence existing in specific community of peri-urban and slums mainly consisting migratory population. Different types of perceived reasons and consequences of physical violence, and coping mechanisms adopted by victims in Indian situations unlike in some developed countries are also suggestive of developing some specific strategies to tackle this important public health problem having important reproductive health concerns. Higher prevalence rate of physical violence found in the present study is consistent with the finding of other studies. This study supports the need of developing community-based strategies including psychosocial interventions to tackle the problem of physical violence.

There are a number of limitations to the present study. Violence against women includes physical, sexual, psychological and economic abuse. This study was confined only to physical violence and several other aspects of gender-based violence other than physical could not be assessed due to some difficulties faced in conducting interviews on such issues. Majority of women who suffer any physical aggression generally experience multiple acts over time. Prevalence of physical violence reported in the present community-based study may also suffer under-estimation due to hesitation, shyness, reluctance and embarrassment in reporting such issues by respondents in spite of taking all possible measures to deal such issues. The study has also limitations in terms of not studying partner related characteristics as potential correlates of domestic violence. Reasons of violence may also vary with episodes of violence whereas this study reports only the most common reasons. Timing of first episode of violence and its frequency also could not be asked. The study also lacks in establishing temporal ordering between violence and related factors considered.

This study has several potentially important implications related with public health policy and practices and aims at reducing physical violence against women. These findings will not only be helpful in developing strategies to reduce violence against women but will also address several issues related with their reproductive health. Women irrespective of their socio-demographic, economic and other conditions suffer from physical violence due to some avoidable reasons in Indian communities. Physical violence against women may have some serious consequences in terms of reproductive health problems. Health of children of women victim of domestic violence may also be affected adversely and may have even intergenerational repercussions. Risks of physical violence cannot be lowered merely by improvements in educational levels of respondents and their SES. Health policies should incorporate some psycho-social interventions to prevent violence in order to improve reproductive and child health. Problem of gender-based violence must be understood in its socio-cultural context to determine its root causes.. Clinicians should develop some tools to identify the root causes of this complex phenomenon. Women may have health problems as consequences of domestic violence, which remain, to a large extent unattended. Opportunity of imparting these interventions while providing health care delivery for various health problems should also be availed.

Further community based in -depth studies addressing all aspects of gender based violence with more sophisticated interviewed techniques are desirable in order to have actual estimates of the problem and its adverse reproductive health outcomes. Effects of psychosocial interventions in reducing reproductive health problems should also be studied. Future research is also needed to establish the other health related impacts of violence.

Conclusions And Suggestions

High prevalence rate of physical violence indicates that the problem should be dealt as a public health problem. Risk of physical violence against women cannot be lowered merely by improving female literacy and SES. There is a need of some further community-based psychosocial interventions to cope with Indian situations to tackle the problem.

Correspondence to

DR. DINESH KUMAR Statistician-cum-Assistant Professor Department of Community Medicine, Govt. Medical College and Hospital, Sector 32-A, Chandigarh. (INDIA) Ph. No.: 0172-2665253-58, Ext. 1045 (O) Mobile: 9876521540 E-mail: dinesh_walia@rediffmail.com