The Impact of Domestic Violence on Women: A Case Study of Rural BangladeshHossain A*
Department of English, IBAIS University, Bangladesh
- *Corresponding Author:
- Hossain A
Senior Lecturer, Department of English
IBAIS University, Bangladesh
Received Date: May 13, 2016; Accepted Date: June 10, 2016; Published Date: June 17, 2016
Citation: Hossain A (2016) The Impact of Domestic Violence on Women: A Case Study of Rural Bangladesh. Social Crimonol 4:135. doi:10.4172/2375-4435.1000135
Copyright: © 2016 Hossain A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Violence against Women is a major threat in Rural Bangladesh. Unfortunately, despite remarkable achievements in the field of women’s development and bearing a magnanimous history of women’s movement, incidences of violence against women are still burning issues. It is not easy to guess whether violence against women has decreased or increased over the past decades because of lack of reliable base-line survey, but in absolute term, the number of incidences is on the increase. The majority of women are domestically violated by their husbands, in-laws and other family members. From the study, we have tried to make a sense about the types, reasons, and domestic violence against women in rural Bangladesh, collecting data and analysis from different sources. For these reasons, we have selected 118 respondents to identify the socio-economic and demographic status and causes of domestic violence. Domestic violence affects the lives of many women both in the urban and the rural areas. Domestic violence takes many forms and occurs in all settings, within the household, and in almost all cases, perpetrated by the patriarchal order. This study aims to find out the impact of violence in our society and cohere it with our social norms and values
Domestic violence; Husbands; immediate causes of violence; Intermediary causes of violence; Underlying causes of violence; Women
Violence against women is a manifestation of unequal power relation between male and female leading to discrimination against women by men and to the prevention of the full-advancement of women . The intentional use of physical force, threatened or actual, against oneself, another person, or a group or community, either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation . Violence against women is a global issue. Women are neglected, trapped within cultural framework, molded by dogmatic thoughts of the patriarchal system. As a result, violence against women is viewed as a normal phenomenon in the light of male attitudes. Still now, women, in Bangladesh, suffer from violence, domestic violence, rape, dowry death, sexual harassment, suicide, forced marriage, coerced prostitution, trafficking and other psychological problems. Violence against women has become one of the most visible social issues in the 21st century.
Domestic violence against women, especially wives beaten by husbands, is a daily affair in any male dominated society. Domestic reports published in Bangladeshi newspapers show that violence against women has increased at an alarm rate. The estimate of physical violence against women by husbands or other family members varies between 30% and 50%. Despite the seriousness of the problem in terms of violation of human rights and public health consequences, there is a dearth of knowledge, nature, and the context of Domestic Violence against Women (DVAW) in the developing countries for various reasons. Actually, the incidence of domestic violence against women involves husband, wife, and other family members is perpetuated by the societal context, a family and community-centered approach to alleviate the problem .
.Women of all economic strata are maltreated and abused by husbands, in-laws, and other family members. Brutal attacks on women are widespread across the country. Daily news reports are filled with the atrocities, including physical and psychological violence. The rate of reported violence acts against women has risen at an alarming rate since 1990 .
In this regard, the attempt of this study is to focus on the domestic violence and its types; the reasons behind domestic violence in rural Bangladesh; 12 tables through data collection and analysis; and recommendations.
State of the Art
Centuries after centuries, women became subordinated to men. They were deprived of basic necessities. In the male dominated societies, they were victimized by the male member of the family. In this regard, there are some feminist writers in Bangladesh who have criticized domestic violence against women in their own point of view as discussed below:
Sharmeen A. Farouk  focuses on the types of violence of which women are victimized. Wife beating, dowry, rape, acid throwing, murder, forced prostitution, coerced pregnancy, trafficking and the like are the major types of violence. All these types of violence are found in rural Bangladesh. The women of urban area are victimized by acid throwing and forced prostitution. But, in rural Bangladesh, a large number of women are to fall a victim of violence. The rate of domestic violence is greater in lower class people than in upper class.
According to Sharmeen , violence is caused only by the patriarchal power. It is the patriarchy which is responsible for all kinds of domestic violence. She also highlights social norm, education, employment and legal rights of women along with gender inequality in rural Bangladesh perpetuated by the patriarchy. On the other hand, to Sharmeen, most of the cases are valued so easily that are common to all women. Again, most of cases are not reported to the police as the police are male. In 2004, 12746 violence were occurred and 34061 male were accused but only 5584 were arrested (BNWLA, report from 9 Leading Dailies) .
Another feminist writer, Jahan  emphasizes the issues of violence against women in Bangladeshi society. Violence is held ‘in repugnance’ and may provoke outrage. For example, a man who threw acid on and killed his wife, on grounds of dowry, was hacked to death by villagers in Northern Bangladesh. Contrarily, violence is tolerated and in some contexts, it is legitimated. Jahan coments that gender inequality, leading to gender violence, is embedded in the social system; all social institutions permit, even encourage the demonstration of unequal power relations between the sexes . The legitimation of male violence, especially battering, allows it to have seen by the social system, as a deserved response to female transgression of male demands. Thus, women feel shame, guilt, and anger in some cases which militates against the battering. Murder, acid throwing and abduction suffer less from stigma in battering. Other factors leading to the under-reporting of violence may be included: the lack of awareness among women of legal rights; the cases have been treated with derision, or ignored by the police; and the terrific charges will have compounded problems with their husband and relatives.
Rape evokes shameful attitudes among women, and thus it is likely to be under-reported. Nevertheless, Jahan  suggests that the rise in the reported crime against women in Bangladesh may rise in rape, also an increase in the incidence of assaults on women and in the proportion of female victims of violent crimes . She comments that in 1980, 12.4% of victims of reported violent crimes were female, whereas by 1984, the proportion had risen to 32.7%. Jahan  also notes a rise in the availability of weapons, like guns, acid, the increased portrayal of violence in the mass media in imported films, as factors may be associated violent crimes.
Bhuiya, et al.  identified 68% of reasons for husbands verbally abusing wives. Among them, the most frequent reasons included the wife questioning the husband in day-to-day matters followed by failure of the wife to perform household work, economic hardship of the family, failure of the wife to take care of children, not conforming to veil or other expected behavior, inability to bring money from parents’ home, not taking a good care of in-laws and relatives, and husband’s frustrations in relation to various activities. The rest of the reasons may be included: natal home, failure to produce children, over-producing children, dark complexion of children, revenge for family-feud between husband and natal family, and suspected sexual relation with others.
Women again mentioned 53 reasons for husbands to hit their wives. The patterns were quite close to those for verbal abuse. The most frequently-mentioned reasons included questioning husband, followed by failure to perform household work satisfactorily, economic problems, poor childcare, stealing and refusal to bring dowry from natal home.
To them, in 23.9% of the cases, the family members, excepting those taking part in the violence, directly took a mediating role and appealed to the husband not to abuse verbally or hit the wife. Children sometimes cried while witnessing verbal and physical abuses by the husband. In most of the violence cases, children were kept quiet. Grown up children normally took the mothers’ side, and at times, they were confronted with the fathers to protest the violence. The neighbors in the cases, advised the husband not to abuse verbally or beat the wife. In some cases they remained indifferent and in some cases they were not sympathetic to the women. In most of the cases, the neighbors took initiatives to stop the verbal abuse or beating. The neighbors arranged arbitration to mitigate the problem in some cases. Finally, they indicated the reasons for women to live with violence. Of them, the most frequently-mentioned reasons included consideration of the sufferings of children if they chose to leave, having no place to go and the social stigma associated with a broken marriage.
Begum Rokeya Shakhawat Hossain in her book, entitled Motichur comments that the condition of women in a household is very vulnerable. To Rokeya, women are treated as the instrument of sexual passion. In her book, she also says that in the British period women were confined to their home and were deprived of education, which is the backbone of a nation. Again, women were deprived of their share of parents’ property. In Islam and in the constitution of Bangladesh, women must get half of the share of their parents’ property. But, it is only in writings and in the constitution. Actually, it is an impact of the patriarchy.
To Rokeya, a male child gets much opportunity of education and other facilities than the female child. In the recent time, female children also get equal right in education but not in property share. It is another kind of domestic violence. To her, the total development of a country depends on the equal participation of both male and female. It is not possible to develop a nation by violating women, which is a major part of the society. So, to ensure the national development of a country, a nation must have to ensure an equal participation of both male and female country and must have to eliminate all sorts of violence from all corners of the country.
In S. Kamal’s study, from the information of Mahila Parishad, a leading women’s organization of Bangladesh, only for the months of January and February 2007, the numbers stand at 332 and 462 respectively. Another source reveals, that of the 1,254 cases of violence against women reported by various newspapers in 2006, about 50% of victims were under 30 years of age, 741 women were victims of rape, 334 subjected to violence due to dowry whereas a number of fatwa issued by imams (known as religious leaders) stood at 39. Some improvement was seen in the case of acid burns, which decreased from 270 in 2005 to 221 in 2006. However, in the period between January and March 2007, Kamal documented already 4 fatwa related cases of violence, 126 incidents of rape, including- 10 deaths and 2 suicides, 67 dowry related violence with 34 deaths and 4 suicides. Cases of acid burns were 28.
Violence against Women in Bangladesh
Violence against women is a common picture in male dominated social system whether it is physical or mental. In Bangladesh, it is a daily fact of life for millions of women and girls. Women are viewed as a product of sexual enjoyment to the male attitudes. As a result, violence is considered as a normal phenomenon from men’s perspective. Women suffer from domestic violence, rape, dowry death, sexual harassment, suicide, forced marriage, trafficking, psychological trauma, and financial oppression . Here are some sorts of violence against women throughout their Life Cycle as follows:
Sex-selective abortion; effects of battering during pregnancy on birth outcomes
Female infanticide; physical, sexual and psychological abuse
Child marriage; female genital mutilation; physical, sexual and psychological abuse; incest; child prostitution and pornography
Adolescence and adulthood
Dating and courtship violence economically coerced sex; incest; sexual abuse in workplace; rape; sexual harassment; forced prostitution and pornography; women trafficking; partner violence; marital rape; dowry abuse and murder; partner homicide; psychological abuse; abuse of women with disabilities; forced pregnancy.
Forced suicide or homicide of widows for economic reasons; sexual, physical and psychological abuse .
The Declaration on the Elimination of Violence against Women, UN Resolution 48/104 defines violence against women as a genderbiased violence resulting in physical, sexual, psychological harm, or suffering to women, including threats of acts, coercion, or arbitrary deprivation of liberty. Beijing Platform for Action (PFA) retakes the above definition that “in all societies, to a greater or lesser degree, women and girls are subjected to physical, sexual and psychological abuse that cuts across lines of income, class and culture”.
Universal declaration of human rights
Universal Declaration of Human Rights states that “everyone is entitled to all rights and freedom set forth in declaration, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status” (Article 2).
Declaration on the elimination of violence against women
Declaration on the Elimination of Violence against Women cites that violence against women means as gender-based violence resulting in physical, sexual, psychological harm, or suffering to women, including threats of act, coercion or arbitrary deprivation of liberty, whether occurring in public or private life (Article 1). It also indicates that States have an obligation to “exercise due diligence to prevent, investigate and, in accordance with national legislation, punish acts of violence against women, which are perpetrated by the State, or by private persons” (Article 4-c).
The convention on the elimination of discrimination against women (CEDAW)
It defines discrimination against women as a distinction and restriction made on the basis of sex having an effect on recognition, or exercise by women on the basis of equality between men and women, of human right and fundamental freedom in political, economic, social, cultural, civil and so on (Article 1).
Women are not homogenous group; they belong to the rich, middle and poor class. They are separated from rural and urban settings. Although women constitute half of the population, their status is lower than that of men. Female literacy rate is 43.2%, which is lower than that of men (61.0%). Excessive mortality among women due to discrimination results in a sex ratio in the population of 105 men to every 100 women .
Women are subjected to violence within the household at workplace, or in the society. Their inferior status can be traced back to the patriarchal values entrenched in a society keeping women subjugated, assigning them a subordinate and dependent role, and preventing them from accessing power and resources. Men hold the power within families and control any property and income. Women are considered as men’s property, their sexual activity, income and labor is systemically controlled by men in social system. Social norms, education, employment, and legal right and gender inequality are perpetuated by the patriarchy. Since childhood, women are forced to live in a culture, which permits inhuman treatment to them .
As more women are getting entered workforce, conflict is on the increase between the patriarchal social norm and women’s urge for economic status. In recent years, there has been a significant change in women’s attitudes towards outside employment. With the breakup of an extended family, many women are seeking employment opportunities .
Types of Violence
Violence against women is rampant in many countries of the world. Such violence is a human rights’ violation, which may be typed in a number of ways:
The imbalance of power is a result of prisoners’ dependence on correctional officers’ and guards’ ability is manifest in physical force and abuse. Because incarcerated women are not visible to the public eye, little is done when the punishment of imprisonment is compounded with rape, sexual assault, and shackling during child-birth. There is a psychological care available to inmates. Though crimes in prison such as rape are prevalent, few perpetrators of violence inmates are held accountable .
Acid burning and dowry death
Women’s subjugation pervasive in political, civil, social, cultural, and economic spheres in many countries of the world. A woman who turns down a suitor along with her in-laws becomes a victim of a violent form of revenge: acid burning. Acid is thrown in her face or on her body and can blind her in addition to fatal third-degree burns. Brides are unable to pay the high price to marry, who are punished by violence and often death at the hands of their in-laws or their husbands .
Women are looked upon as representatives of the honor of the family. When women are suspected of extra-marital sexual relations, they can be subjected to the cruel form of indignity and violence by their fathers or brothers. Women, who are raped, are accused of crime of unlawful sexual relations. Such laws serve as an obstacle inhibiting women from pursuing cases against those who rape them .
Domestic violence is a violation of a woman’s right to physical integrity, to liberty, and to her right to life itself. When a state fails to take proper steps needed to protect women from domestic violence or allow these crimes to be committed with impunity, states fail in their obligation to protect women from torture .
Violations of human rights
Sexuality is maintained through strict constraint imposed by cultural norm. The community, which can include religious institution, media, family and cultural network, regulates women’s sexuality and punishes women who do not comply. Such women include lesbians, who appear masculine; who try to exercise their rights; and who challenge male dominance and who are perceived to be lesbian; experience abuses by state authorities in prisons, by the police, as well as private actors. Numerous cases document young lesbians being beaten, raped, impregnated or married, and attacked by family members to punish them sexual identity .
Reasons of Violence
The social and economic status of women can be a dire result of violence. Gender violence represents an expression of human behaviors and it is rooted in society. Traditional attitudes by which women are regarded as subordinate to men involving violence, such as family violence and abuse, forced marriage, dowry death, acid attack and female circumcision. Such prejudices may justify gender-based violence as a form of protection of women . The effect of such violence on physical and mental integrity of women is to deprive them of an equal enjoyment and knowledge of human right and fundamental freedom. The immediate causes of violence vary from any type of violence; there are different causes for different types of violence. However, causes can be categorized as immediate, intermediary and underlying as discussed below:
Immediate causes of violence
Acid assault: Male ego and problems in dealing with rejection is another important cause of acid throwing. Refusal of love (44 cases), marriage proposals and family disputes (33 cases) are three major causes of such type of violence. After marriage when dowry demands are not fulfilled, brides may fall victim of acid throwing. In 88 cases reasons for acid attack are unknown. Other causes of acid throwing include family dispute, failure to misappropriate of wife’s wealth, sterility, and getting divorced from wife, refusal of sexual relationship, failure to kidnap, the woman not being agreeable to prostitution and a woman’s refusal to agree with husband’s second marriage .
Community violence: There are diversified reasons for community violence. It depends on attitudes of the local elites and other religious persons. Pre-marital pregnancy and pre-marital and extra-marital sexual relationship was found tobe the major cause of community violence .
Murders: Enmity, political differences and land disputes were the main causes for male murder case followed by dacoits and family feuds. Other causes included dispute on uprooting a beam tree, toll collecting, and dispute over lending money, cheating while distributing goods, dispute on a sugar cane field and quarrels. On the other hand, dowry demand, family feud and rape and failure to rape were the major causes of female murder case .
Intermediary causes of violence
Dowry: Despite the Dowry Prohibition Act (1980) dowry transactions continue to become a socially legitimate part of marriage negotiations. Maleka Begum  in her book Dowry says that dowry is a major factor in violence, starting from verbal abuse, battering, torture and ending in death.
Lack of Education: Lack of education makes women more vulnerable. Statistics shows that a year of schooling is associated with prevalence of violence; no statement could be made how and why education has a role in reducing violence . Greater years of schooling may provide women with an opportunity to gain knowledge and information which they lack and as a result, they become less vulnerable. When Khan  was trying to assess the impact of education, he found that although education did not give them power to change the traditional division of labor within household, the most educated women had more equal power relationship with their husbands, who were less dependent upon husband’s approval for selfesteem. Though education does have a role on women’s power and autonomy, education cannot overcome the power of the patriarchy.
Lack of security: There is a lack of security for women’s travelling from workplace, no transport facilities are provided for them travelling at night, no housing facilities for migrant workers from rural areas and no institutionalized codes of conduct to enable the workplace to overcome some of the negative cultural perceptions of women .
Poverty: General economic causes of family violence are increasing landlessness, pauperization, unemployment which has increased tension in poor households and give rise to desertion, divorce and violence . Kabeer  also states “Violence, including systematic and random is a part of the condition of poverty is associated with relative powerlessness, and the poor are least able to defend themselves or to remove themselves from threatening situations.” Lack of resource, especially food in the poor rural households and women’s failure to accomplish traditional gender roles lead to gender violence.
Child marriage: Child marriage continues to be widespread despite the existence of the Child Marriage Restraint Act since 1983. A girl child is regarded as a burden to the poor parents. In the marriage market, the younger the bride, lesser the dowry demand. Parents’ fear for their daughters’ security, especially when she is an adolescent and is capable of conceiving a child out of wedlock, she becomes a reason to marry them off early. When a young single girl becomes pregnant not only does she stand to be condemned by her community, her parents are also punished with social isolation and shaming. Cultural stigmatization of sex outside of marriage puts the family honor at stake. Female Supporter Pilot Study (Azim, et al, 2002) found that the age of first marriage is associated with violence in marital life. Marriage at twenty-five or more years is a protective factor. Women activists believe that early marriage of girls usually starts between 12-19 years old, along with a wide age gap between spouse’s results in unequal relationship and invites marital disharmony. Lack of knowledge about sexual health aggravates the situation of violence within spousal relationship.
Religious dogmatism: Community violence occurs when community members collectively perpetrate violence on the individuals of the same community. It is the outcome of a community decision to punish a member of the community. The violence is directed to women for sexually inappropriate behavior in the name of so-called religious edicts. Precisely speaking religiously recognized persons have the authority to give any religious edicts which are the pronouncements of opinions based on religious texts. However, the practice of religious edicts is often abused as a tool of torturing women. It is not fundamental religious leaders but also influential people of the community who often issue religious edicts. Thus religious edicts are used to control subordinate women’s self determination, sexuality and bodies. Even when both man and woman are involved in a case of sex outside of wedlock; the woman and her families are punished more heavily than their male counterparts (Case of Nurjahan, Bangladesh Mahila Parishad, 1997). Because it is disguised as a religious edict and involves the complicity of the community in which a woman belongs to, it becomes a powerful tool of oppressing women (IWRAW).
Subordination of women: The basic cause of violence is reinforced by religion and culture is the subordination compared to men. Violence is a means of reinforcing subordination. The General Assembly Resolution 48/104 states “violence is a manifestation of unequal power relation between men and women, which have led to domination over women by men and to the prevention of full advancement, and that violence is a crucial social mechanism by which women are forced into a subordinate position compared with men” .
Data Collection and Analysis
Family authority and violence
Most of the families of our country are controlled by the patriarchal order. Male members are the head of the family. They are the decision makers of social, political, religious, cultural, and other matters. On the other hand, female are the dominant in the family. Due to the head of the family, the male take the role of decision making. As the male make decisions and the female have to follow those decisions without any allegations. If the female refuse to follow the taken decisions, they become the victims of violence. So, family authority is an important factor of domestic violence in rural areas.
Table 1 shows that among the 118 respondents, 85.6% families are male dominated whereas only 14.4% families are female headed which means only a small portion of families are controlled by female and a large portion of families are controlled by males.
|Number of respondents||Percentage|
Source: Field survey, January-December, 2015.
Table 1: Head of the family.
Quarrels for decision making and violence
In any family women become the sufferers of violence due to the quarrel between husband and wife or among the family members. As a result, the women become easily oppressed because of their inferior position in the family. The following table gives us an image of quarrels for decision making.
From Table 2 it is seen that there is a quarrel in 84.7% husbandwives in the decision related matters of the family. There are several causes behind these quarrels, and consequently, women become the sufferers of violence. The table represents a little portion of husbands (15.3) who do not discuss with their wives for any decision making.
|Number of respondents||Percentage|
|Table No. 2||Yes||100||84.7|
Source: Field survey, January-December, 2015.
Table 2: Quarrel for decision making.
From the Table 2.1, we see that 55.9% of husband having one wife usually discuss with them for decision making whereas only 16.1% of husbands do so if they are married twice. It shows that 5.9% (3 wives), 4.2% (4 wives) and 2.5% (5 wives) quarrel for decision making. Contrarily, 12.7% of husbands (1 wife) do not quarrel for decision making, as well as 2.5% of husbands (2 wives).
|Numbers of marriages of husbands||Total|
|Quarrel for decision making||Yes||Number of respondents||66||19||7||5||3||100|
|No||Number of respondents||15||3||0||0||0||18|
|Total||Number of respondents||81||22||7||5||3||118|
Table 2.1: Quarrel for decision making and numbers of marriages of husbands.
Marriages of husband and violence
Most husbands in rural Bangladesh possess more than one wife. As a result, violence remains among the rural people. Misunderstanding prevails among family members, husband and wife, in-laws, and so on. Husbands cause domestic violence against their wives.
Table 3 shows that age at first marriage of 43.2% of the respondent’s belonging to the age group are between 10-15 years, 50% are between 16-20 years, and 6.8% are between 21-25 years. From the table, clearly, many respondents’ marriages are taken place not in proper time. Because of the early marriage, their physical and psychological maturities do not develop well. They don’t have any earning source. Consequently, their value in the family is not adequate to their husbands and thus, they become the sufferers of different types of domestic violence.
|Table No. 3||Age at first Marriage (in years)||Number of Respondents||Percentage|
Source: Field survey, January-December, 2015.
Table 3: Age at first marriage.
Table 4 reveals that 31.4% of the respondent’s husbands are polygamous. Among them, 18.6% of husbands married (twice), 5.9% (thrice), 4.2% (four times) and 2.5% (five times). Some husbands have more than one wife at the same time.
|Table No.4||Number of Marriage||Number of respondents||Percentage|
Source: Field survey, January-December, 2015.
Table 4: Number of marriages of husband.
Addiction and violence
Almost all people from Bangladesh have simple and severe addictions. It plays a major role for the violence of women, children and even their parents. It is more common, severe, and dangerous rural regions.
From Table 5, it is revealed that among the selected respondents 35.6% husbands are addicted to smoking, 9.3% are addicted to ganja and 9.3% are addicted to drinking. Though they are addicted to different substances, they torture their wives mentally and physically when intoxicated. Those who are addicted to ganja and drinking torture wives regularly.
|Number of respondents||Percentage|
|Table no. 5||Smoking||42||35.6|
Source: Field survey, January-December, 2015.
Table 5: Types of addiction.
Table 6 shows that though 45.8% of husbands are not addicted to drugs, 54.2% of husbands have some sorts of addictions. Among them, 19.5% of husbands torture their wives when intoxicated. On the other hand, 34.7% do not torture their wives when “High”. Those who are addicted to drinking or ganja torture their wives more frequently than smoking.
|Number of respondents||Percentage|
|Table no. 6||Not addicted||54||45.8|
Source: Field survey, January-December, 2015.
Table 6: Torture when intoxicated by addictive substances.
Dowry demand and violence
Dowry is a curse and one of the major social problems in Bangladesh. Because of dowry demand more and more women are being victimized per year. Among them some are tortured, kidnapped, thrown acid, fired and so on. The atrocity of in-laws for dowry demand beggars description. Per year more and more women are committing suicide by hanging or taking poison. So, dowry demand is a social curse. Examples of dowry related domestic violence are given below.
Table 7 reveals that among 118 respondents 79.7% of women admitted that their husband demanded dowry to be in cash or any familial belongings. Only 20.3% of husbands are free from dowry demand (Table 8).
|Number of respondents||Percentage|
Source: Field survey, January-December, 2015.
Table 7: Demand of husband to In-laws family.
|Number of respondents||Percentage|
|Table no. 8||Yes||63||53.4|
Source: Field survey, January-December, 2015.
Table 8: Pressure of husband for dowry.
Only 118 women responded to this research. From these women we have learnt that in 53.4% cases the husbands create pressure on the wives to bring money from natal home. Only 46.6% of husbands do not create any kind of pressure for demanding money. In the rural families, it is as common as giving gifts to beloved ones. The daughters’ families try heart and soul to provide the proposed demand. It is more open in rural and illiterate families while it is more silent in literate and wealthier families.
Religious values are controlled by superstitions. Most women in the rural family are victimized by cultural and religious values. Though the literacy rate is increasing day by day, these situations have not changed. Religious and cultural values most of the women in our society are compelled to be victim of domestic violence. Religious and cultural values- based domestic violence are given below:
Table 9 shows that 28.8% of 118 respondents are compelled to follow the Parda system where as 71.1% of women are not compelled to follow the Parda custom. As rural people are not highly educated, this is compelled by their in-laws.
|Number of respondents||Percentage|
|Table no. 9||Yes||34||28.8|
Source: Field survey, January-December, 2015.
Table 9: Compulsion to follow parda CUSTOM.
Table 10 shows that 11.0% of 118 respondents are victimized by fatwa whereas 89.0% of are not victimized. Most of the rural people do not know how to read and write. As a result, most of them are superstitious. So, for any simple reason, the rural people go to the Moulavi, Pir, Fokir or Kobirz (known as religious persons) and follow their guidance and compel their wives or in-laws to follow that Fatwa.
|Number of respondents||Percentage|
|Table no. 10||Yes||13||11.0|
Source: Field survey, January-December, 2015.
Table 10: Victimized by fatwa.
Sexual behavior and violence
Sexual behavior and domestic violence are closely related. Sexual harassment does not happen only outside of the home. Most of the sexual abuses are caused at home. It may be related with husband-wife, sister-brother, and even in-laws and brothers of husband. Sometimes sexual harassments are perpetrated by husband’s father with their in-laws. Most husbands think that wives are their products of sexual enjoyment.
From the Table 11, we can understand that the wish of wives for union is not only violated but also they are enforced to make union. Among the selected 118 respondents 54 women (45.8%) are enforced to make union. On the other hand, 64 women (54.2%) are not forced but they have no value of their wishes.
|Number of respondents||Percentage|
Source: Field survey, January-December, 2015.
Table 11: Enforcement for union.
From the research-work, we have found that domestic violence is caused mainly by dowry, addiction, social, cultural as well as political aspects, sexual behavior of the husband, making familial decisions, giving birth to female children and so on. Though the literacy rate of our country is increasing day by day, the extremeness of domestic violence remains the same. Most of the families face disorganization among the family for violence; most children are being dropped out from school as they face quarrelsome behavior of their parents. In some cases, wives are being beaten severely, sometimes being raped by turns, sometimes being hung and tried to prove it as a suicide. Again, in most of the families, women are tortured for any simple reason, as they fail to bring money demanded by their husbands. In some situations we have found that the inability of husband to impregnate their wives or sterility is imposed on wives. Actually, most violence is caused by the patriarchal role. Moreover, domestic violence is caused by dowry demand by family authority, decision making, and wife’s appearance, existence of 7.6% for co-wives, addictions, first female child, or having a greater number of female children. Furthermore, -women are being tortured by their husbands in the home because of sterility, inauspicious treatment, unwanted sexual union, and religious and cultural values. Finally, we can realize that patriarchal social values are responsible for most of the domestic violence against women in rural areas.
Statistically, about 25% of physically abused women had lost children after they were born compared to 18% of women who were never abused. In Bangladesh, 13.8% of maternal death in pregnancy was occurred as a result of violence. Besides, children who witnessed violence were at a higher risk for the emotional and behavioral problems, including anxiety, depression, poor school performance, low self-esteem, disobedience, and nightmare violence perpetrated by the husband accounted for 49% of household death [19-22].
From the discussion above, it is true that the main reasons of domestic violence against women take place due to the lack of proper knowledge and the violation of law . Moreover, the traditional authority has been dominating women for ages. However, the following recommendations can be suggested as proper steps to ensure fair environment of women’s full-participation in the socio-economic activities in Bangladesh:
➢ Greater economic opportunities for women, ensured through access to credit, awareness increasing activities and skill training, would ensure self-esteem and status of women within households; improve spousal relationship to reduce domestic violence.
➢ Awareness can be brought among community members and family members: VAW is an extreme violation of women’s human rights, which is a criminal offense under law. Also, it has serious psychological consequences for both women and children.
➢ The primary responsibility to conduct a study of violence against women should rest on the government and the conscious citizen per year.
➢ The role of state inaction in the perpetuation of violence connected with the gender-specific nature of domestic violence being classified as a human rights concern rather than as a domestic criminal justice concern.
➢ A gender sensitization module should be incorporated in all training program for police, prosecutors, magistrates, and legal personnel and judiciary.
➢ The roles of courts in case of domestic violence play a significant role. The courts deal with such cases in a realistic manner to the objects of social legislation, more attitudinal changes on the part of the judges is essential to make gender justice a reality .
Domestic violence against is a violation of fundamental human rights. One of the most effective measurements in identifying violence is to assess official compliance with international standards relating to human rights’ abuse. In Bangladesh, it is a major concern. Although globally women’s rights are human rights, violence against women remains a pervasive issue. Recognizing domestic violence against women as a violation of human rights is a significant turning point in the struggle to end violence all over the globe. To promote human rights and prevent domestic violence, the conscious people must undertake effective steps to ensure gender equality. Government as well as citizens must be more conscious and sensitive to provide access to immediate means of redress to the victims of violence.
As a democratic country like Bangladesh, the government ought to maintain the policy of zero tolerance in bringing the perpetrators of domestic violence to justice. In fact, to make a good nation, domestic violence against women should be not only lessened but also stopped. Moreover, the conscious community should unite to achieve a world free from violence against woman to ensure a healthy, happy, and decent life for us all.
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Domestic violence against women in India: A systematic review of a decade of quantitative studies
Ameeta Kalokhe,a,bCarlos del Rio,a,bKristin Dunkle,cRob Stephenson,b,dNicholas Metheny,dAnuradha Paranjape,e and Seema Sahayf
aDivision of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
bHubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
cDepartment of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
dCenter for Sexuality and Health Disparities, University of Michigan School of Public Health and School of Nursing, Ann Arbor, MI, USA
eGeneral Internal Medicine, Temple University School of Medicine, Philadelphia, PA, USA
fDepartment of Social and Behavioral Sciences, National AIDS Research Institute, Pune, India
CONTACT Ameeta Kalokhe, ude.yrome@hkolaka
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Domestic violence (DV) is prevalent among women in India and has been associated with poor mental and physical health. We performed a systematic review of 137 quantitative studies published in the prior decade that directly evaluated the DV experiences of Indian women to summarise the breadth of recent work and identify gaps in the literature. Among studies surveying at least two forms of abuse, a median 41% of women reported experiencing DV during their lifetime and 30% in the past year. We noted substantial inter-study variance in DV prevalence estimates, attributable in part to different study populations and settings, but also to a lack of standardisation, validation, and cultural adaptation of DV survey instruments. There was paucity of studies evaluating the DV experiences of women over age 50, residing in live-in relationships, same-sex relationships, tribal villages, and of women from the northern regions of India. Additionally, our review highlighted a gap in research evaluating the impact of DV on physical health. We conclude with a research agenda calling for additional qualitative and longitudinal quantitative studies to explore the DV correlates proposed by this quantitative literature to inform the development of a culturally tailored DV scale and prevention strategies.
Keywords: Intimate partner violence, domestic violence, spouse abuse, India, review
Domestic violence (DV), defined by the Protection of Women from Domestic Violence Act 2005 as physical, sexual, verbal, emotional, and economic abuse against women by a partner or family member residing in a joint family, plagues the lives of many women in India. National statistics that utilise a modified version of the Conflict Tactics Scale (CTS) to measure the prevalence of lifetime physical, sexual, and/or emotional DV estimate that 40% of women experience abuse at the hands of a partner (Yoshikawa, Agrawal, Poudel, & Jimba, 2012). Data from a recent systematic review by the World Health Organization (WHO) provides similar regional estimates and suggests that women in South-East Asia (defined as India, Maldives, Sri Lanka, Thailand, Bangladesh, and Timor-Leste) are at a higher likelihood for experiencing partner abuse during their lifetime than women from Europe, the Western Pacific, and potentially the Americas (WHO, 2013).
Among the different proposed causes for the high DV frequency in India are deep-rooted male patriarchal roles (Visaria, 2000) and long-standing cultural norms that propagate the view of women as subordinates throughout their lifespan (Fernandez, 1997; Gundappa & Rathod, 2012). Even before a child is born, many families have a clear preference for male children, which may result in their preferential care, and worse, sex-selective abortions, female infanticide and abandonment of the girl-child (Gundappa & Rathod, 2012). During childhood, less importance is given to the education of female children; further, early marriage as occurs in 45% of young, married women, according to 2005–2006 National Family Health Survey (NFHS-3) data (Raj, Saggurti, Balaiah, & Silverman, 2009), may also heighten susceptibility to DV (Ackerson, Kawachi, Barbeau, & Subramanian, 2008; Raj, Saggurti, Lawrence, Balaiah, & Silverman, 2010; Santhya et al., 2010; Speizer & Pearson, 2011). In reproductive years, mothers pregnant with and/or those who give birth to only female children may be more susceptible to abuse (Mahapatro, Gupta, Gupta, & Kundu, 2011) and financial, medical, and nutritional neglect. Later in life, culturally bred views of dishonour associated with widowhood may also influence susceptibility to DV by other family members (Saravanan, 2000).
In addition to being prevalent in India, DV has also been linked to numerous deleterious health behaviours and poor mental and physical health. These includes tobacco use (Ackerson, Kawachi, Barbeau, & Subramanian, 2007), lack of contraceptive and condom use (Stephenson, Koenig, Acharya, & Roy, 2008), diminished utilisation of health care (Sudha & Morrison, 2011; Sudha, Morrison, & Zhu, 2007), higher frequencies of depression, post-traumatic stress disorder (PTSD), and attempted suicide (Chandra, Satyanarayana, & Carey, 2009; Chowdhury, Brahma, Banerjee, & Biswas, 2009; Maselko & Patel, 2008; Shahmanesh, Wayal, Cowan, et al., 2009; Shidhaye & Patel, 2010; Verma et al., 2006), sexually transmitted infections (STI) (Chowdhary & Patel, 2008; Sudha & Morrison, 2011; Weiss et al., 2008), HIV(Gupta et al., 2008; Silverman, Decker, Saggurti, Balaiah, & Raj, 2008), asthma (Subramanian, Ackerson, Subramanyam, & Wright, 2007), anaemia (Ackerson & Subramanian, 2008), and chronic fatigue (Patel et al., 2005). Furthermore, maternal intimate partner violence (IPV) experiences have been associated with more terminated, unintended pregnancies (Begum, Dwivedi, Pandey, & Mittal, 2010; Yoshikawa et al., 2012), less breastfeeding (Shroff et al., 2011), perinatal care (Koski, Stephenson, & Koenig, 2011), and poor child outcomes (Ackerson & Subramanian, 2009). These negative health repercussions and high DV frequency speak to the need for the development of effective DV prevention and management strategies. And, the development of effective DV interventions first requires valid measures of occurrence and an in-depth understanding of its epidemiology.
While many aspects of DV are similar across cultures, recent qualitative studies describe how some aspects of the DV experienced by women in India may be unique. These studies highlight the role of non-partner DV perpetrators for those living in both nuclear and joint-families (Fernandez, 1997; Kaur & Garg, 2010; Raj et al., 2011). (These families are patrilineal where male descendants live with their wives, offspring, parents, and unmarried sisters.) They discuss the high frequency and near normalisation of control, psychological abuse, neglect, and isolation, the occurrence of DV to women at both extremes of age (young and old), dowry harassments, control over reproductive choices and family planning, and demonstrate the use of different tools to inflict abuse (i.e. kerosene burning, stones, and broomsticks as opposed to gun and knife violence more commonly seen in industrialised nations) (Bunting, 2005; Go et al., 2003; Hampton, 2010; Jutla & Heimbach, 2004; Kaur & Garg, 2010; Kermode et al., 2007; Kumar & Kanth, 2004; Peck, 2012; Rastogi & Therly, 2006; Sharma, Harish, Gupta, & Singh, 2005; Stephenson et al., 2008; Wilson-Williams, Stephenson, Juvekar, & Andes, 2008).
This paper presents a systematic review of the quantitative studies conducted over the past decade that estimate and assess DV experienced by women in India, and evaluates their scope and capacity to measure the DV themes highlighted by recent qualitative studies. It aims to examine the distribution of the prevalence estimates provided by the recent literature of DV occurrence in India, improve understanding of the factors that may affect these prevalence estimates, and identify gaps in current studies. This enhanced knowledge will help inform future research including new interventions for the prevention and management of DV in India.
We utilised PubMed, OVID, Cochrane Reviews, PsycINFO, and CINAHL as search engines to identify articles published between 1 April 2004 and 1 January 2015 that focused on the DV experiences of women in India (Figure 1). Our specific search terms included ‘domestic violence’, ‘intimate partner violence’, ‘spouse abuse’, ‘partner violence’, ‘gender-based violence’, ‘sexual violence’, ‘physical violence’, ‘wife battering’, ‘wife beating’, ‘domestic abuse’, ‘violence’, and ‘India’. We first removed duplicate articles and then filtered the articles based on our inclusion criteria: quantitative studies evaluating original data that had been published in English and directly surveyed the DV experiences of women. While we recognise that in cultures where DV is commonplace the reporting of DV perpetration by men may be as high as the frequency of experiencing DV reported by women (Koenig, Stephenson, Ahmed, Jejeebhoy, & Campbell, 2006), we restricted our eligibility criteria to studies directly surveying women about their DV experiences to reduce further inter-study variation and allow for more accurate cross-study comparisons. We excluded reviews, case reports, meta-analyses, and qualitative studies. A single author (ASK or NM) reviewed each individual article to determine whether it met inclusion criteria. If questions arose regarding its inclusion into the review, they were discussed with a second author (SS) until concordance was reached regarding whether or not the paper was to be included.
Adapted PRISMA Flow Diagram demonstrating study selection methodologies and filter results.
We collected data from each study regarding study population; study setting; use of a validated scale; forms of, perpetrators of, and time frame during which DV was measured; whether an attempt was made to measure severity of DV; whether potential DV correlates were evaluated; and whether DV prevalence was estimated. We subcategorised the forms of violence into physical, sexual, psychological, control, and neglect based on descriptions of questions provided in the studies. Emotional and verbal forms of abuse were classified as psychological abuse and deprivation was classified as neglect. If the study asked participants about agency or autonomy, this was noted in the summary tables. In publications where information about the DV assessment tool and its validation was not provided, we contacted the authors for more information. If authors reported having conducted formative fieldwork to generate questions, pre-tested the items, and/or conducted some assessment of the measurement tool’s expert or face validity, we reported the validation as ‘limited’. If we did not hear back from the authors, we stated the data were ‘not reported’.
Article yield of systematic search
Our initial search of DV articles published in PubMed, OVID, Cochrane Reviews, PsycINFO, and CINAHL between 1 April 2004 and 1 January 2015 yielded 3843 articles (Figure 1). We identified 628 articles using search terms ‘domestic violence’ and ‘India’, 283 articles using ‘intimate partner violence’ and ‘India’, 98 articles using ‘spouse abuse’ and ‘India’, 221 articles using ‘partner violence and India’, 54 articles using ‘gender-based violence’ and ‘India’, 199 articles using ‘sexual violence’ and ‘India’, 120 articles using ‘physical violence’ and ‘India’, 1 article using ‘wife battering’ and ‘India’, 51 articles using ‘wife beating’ and ‘India’, 10 articles using ‘domestic abuse’ and ‘India’, and 2022 articles using ‘violence’ and ‘India’. Of the 3843 articles, 3705 articles were removed because they (1) were duplicated in the search, (2) focused on extraneous topics, (3) lacked Indian context, (4) were not based on original quantitative data, or (5) were based on study data that were not directly obtained through surveying women about their personal DV experiences. Thus, the selection criteria yielded a total of 137 studies examining the DV experiences of women in India: 14 international studies (see Table 1 in supplementary material), 50 multi-state India studies (see Table 2 in supplementary material), and 73 single-state India studies (see Table 3 in supplementary material).
The scope and breadth of recent studies: study populations
Collectively, the reviewed studies provide information on the DV experienced by young and middle-aged women in traditional heterosexual marriages from both urban and rural environments, joint and nuclear families, across Indian states (Figure 2). Among the studies specifying age limits, the vast majority (88% or 92/104) evaluated DV experienced by women age 15–50, with only 11% (11/104) of studies surveying DV suffered by women above age 50 and 1% (1/104) evaluating DV experienced by young adolescents (wed before age 15). Only one study assessed DV experienced by women in HIV discordant. No studies surveyed DV in non-traditional relationships, such as same-sex relationships or live-in relationships. Less than one-third (29% or 40/137) collected data differentiating DV experienced by women in joint versus nuclear families. Thirty-seven per cent (51/137) evaluated domestic abuse suffered by women living in urban settings, 18% (24/137) in rural, and the remainder (44% or 60/137) in both rural and urban environments. Only one examined DV experienced by women residing in tribes. Twenty-three per cent (32/137) and 3% (4/137) utilised a nationally representative and sub-nationally representative study population, respectively. Southern Indian states were by far the most surveyed in the literature (Maharashtra 66 studies, Tamil Nadu 59 studies, and Karnataka 51 studies) and Northern Indian states the least (Uttaranchal, Sikkim, Punjab, Haryana, Chhattisgarh, and Assam each with 33 studies).
A summary of the distribution of recent Indian DV literature by region, state, surveyed perpetrator, and family type.
Prevalence of DV in India
Collectively, the reviewed studies demonstrate that DV occurs among Indian women with high frequency but there is substantial variation in the reported prevalence estimates across all forms of DV (Figure 3). For example, the median and range of lifetime estimates of psychological abuse was 22% (range 2–99%), physical abuse was 29% (2–99%), sexual abuse was 12% (0–75%), and multiple forms of DV was 41% (18–75%). The outliers at the upper extremes were contributed by a study of in low-income slum communities with high prevalence of substance abuse(Solomon et al., 2009) and a second study conducted in a tertiary care centre where surveys were self-administered and thus participants may have felt increased comfort in reporting DV(Sharma & Vatsa, 2011). The median and range of past-year estimates of psychological abuse was 22% (11–48%), physical abuse was 22% (9–90%), sexual abuse was 7% (0–50%), and multiple forms of DV was 30% (4–56%). The outlier of 90% for physical abuse was contributed by a study of women whose husbands were alcoholics in treatment (Stanley, 2012). As expected, higher DV prevalence was noted when multiple forms of DV were assessed. Of all forms of DV, physical abuse was measured most frequently, with psychological abuse, sexual abuse, and control or neglect receiving substantially less attention. Further statistical analysis beyond these descriptive statistics was not conducted due to the large inter-study heterogeneity of designs and populations limiting comparability across studies.
A summary of the lifetime and past 12-month prevalence estimates of the various forms of DV as documented by each individual study.
The scope and breadth of recent studies: study design
The past decade of quantitative India DV research has included a breadth of large regional and international studies as well as smaller scale, single-state studies. However, the capacity to draw causal inferences from this literature has been limited by the nearly exclusive use of cross-sectional design. The country and regional-level studies utilised larger, often nationally or sub-nationally representative samples (average sample size: 25,857 women, range: 111–124,385), to provide inter-country or regional epidemiologic comparisons. The single-state studies tended to use smaller sample sizes (average: 1109 women, range: 30–9639) to provide a more in-depth evaluation of DV experienced in a particular population of women.
The vast majority of all reviewed studies utilised cross-sectional design, with only 12% (17/137) using a prospective design to draw causal inferences. Six of these 13 utilised the NFHS-2 and four-year follow-up data from the rural regions of four states to evaluate the effect of DV on mental health disorders (Shidhaye & Patel, 2010), a woman’s adoption of contraception, occurrence of unwanted pregnancy (Stephenson et al., 2008), uptake of prenatal care (Koski et al., 2011), early childhood mortality (Koenig et al., 2010), functional autonomy and reproduction (Bourey, Stephenson, & Hindin, 2013), and contraceptive adoption (Stephenson, Jadhav, & Hindin, 2013), while one used the data to evaluate the effect of autonomy on experience of physical violence (Nongrum, Thomas, Lionel, & Jacob, 2014; Sabarwal, Santhya, & Jejeebhoy, 2014). Only one study employed a case-control study to evaluate the link between DV and child mortality (Varghese, Prasad, & Jacob, 2013) and another utilised a randomised control design to evaluate the effect of a mixed individual and group women’s behavioural intervention in reducing DV and marital conflict over time (Saggurti et al., 2014). The remainder of prospective studies evaluated the causal association between DV and incident STIs and/or attempted suicide (Chowdhary & Patel, 2008; Maselko & Patel, 2008; Weiss et al., 2008), DV and maternal and neonatal health outcomes (Nongrum et al., 2014), the effect of the type of interviewing (face-to-face versus audio computer-assisted self-interviews) on DV reporting (Rathod, Minnis, Subbiah, & Krishnan, 2011), trends in DV occurrence over time (Simister & Mehta, 2010), and the effect of change in a woman or her spouse’s employment status on her experience of DV (Krishnan et al., 2010).
The scope and breadth of recent studies: DV measures
Only 61% (84/137) of studies reported use of a validated scale or made attempts to validate the instrument they ultimately used. When use of a validated instrument was reported, most (82% or 69/84) had been developed for the cultural context of North America and Europe (i.e. modified CTS, Abuse Assessment Screen, Index of Spouse Abuse, Woman Abuse Screening Tool, Partner Violence Screen, Composite Abuse Scale, and Sexual Experience Scale). In fact, only 15 of the studies reporting use of a validated questionnaire adapted or developed their instrument to the Indian context by surveying themes raised by the prior qualitative literature (i.e. use of belts, sticks, and burning to inflict physical abuse, restricting return to natal family home, not allowing natal family to visit marital home). As expected, these studies reported higher frequencies of DV. In personal communication, some authors who chose not to use validated, widely used DV scales (i.e. CTS) stated they did so because of space limitations and inadequacy of existing tools for measuring DV in the Indian cultural context.
Two-thirds of studies (64% or 87/137) assessed two or fewer forms of DV. Of all forms of DV, physical abuse was evaluated most frequently (96% or 131/137), followed by sexual abuse (58% or 79/137), psychological abuse (44% or 60/137), neglect and control (4% or 7/137). Only 11% (15/137) of studies evaluated DV perpetrated by non-partner family members. For these studies evaluating DV perpetrated by partners and non-partner family members, available estimates of lifetime sexual and psychological abuse were always higher than the median prevalence estimates of reviewed studies; available estimates of lifetime physical abuse were often, but not universally, higher. Only 20% (109/137) attempted to evaluate different levels of DV severity. While many (43% or 59/137) studies evaluated lifetime violence, a considerable number assessed recent DV (42% or 58/137 past-12 month DV, 5% or 7/137 past-6 month DV, 4% or 5/137 past-3 month DV, and 4% or 6/137 the time period of current or research partnerships). Additionally, 10% (14/137) evaluated DV occurrence during pregnancy or the peri-partum period.
The scope and breadth of recent studies: measured outcomes
Figure 4 provides a framework for synthesising the potential DV correlates measured to date. It demonstrates that the focus of the quantitative literature has largely been on the mental health and gynecologic consequences of DV but has only begun to evaluate repercussions on physical health and health behaviour. Twelve per cent (16/137) of the studies evaluated one or multiple mental health disorder as outcomes of DV, including PTSD, depression, and suicide, but not anxiety. The literature provided a comprehensive evaluation of the association between DV and gynaecologic health including sexual (15% or 21/137) and maternal health (8% or 11/137). However, only six studies were dedicated to evaluating physical health outcomes (oral health, nutrition, chronic fatigue, asthma, direct injury, and blindness during pregnancy). And while 17 studies were dedicated to evaluating the association between DV and uptake of health behaviours, 11 of the 15 were focused on behaviours related to sexual and maternal health. Thus, the association between health behaviours like the woman’s substance abuse and adherence to medical and clinical care remains largely understudied, as does the link between DV and physical health outcomes such as cardiovascular and gastrointestinal disease, chronic pain syndromes (including migraines), and urinary tract infections.
A framework for conceptualising the reviewed studies.
The past 10 years have been an incredible period of growth in DV research in India and South Asia. Our systematic review contributes to the growing body of evidence by providing an important summary of the epidemiologic studies during this critical period and draws attention to the magnitude and severity of the ongoing epidemic in India. Comprehensively, the reviewed literature estimates that 4 in 10 Indian women (when surveyed about multiple forms of abuse) report experiencing DV in their lifetime and 3 in 10 report experiencing DV in the past year. This is concordant with the WHO lifetime estimate of 37.7% (95% CI: 30.9%43.1%) in South-East Asia (defined as India, Maldives, Sri Lanka, Thailand, Bangladesh, and Timor-Leste) and is higher than the regional estimates provided by the WHO for the Europe, the Western Pacific, and potentially the Americas. In addition to highlighting the high frequency of occurrence, the studies in this review emphasise the toll DV takes on the lives of many Indian women through its impact on mental, physical, sexual, and reproductive health.
Perhaps the most striking finding of our review was the large inter-study variance in DV prevalence estimates (Figure 3). While this variability speaks to the capacity of the India literature to capture the breadth of DV experiences in different populations and settings, it also underscores the need for standardising aspects of study design in the investigator’s control to make effective inter-study and cross-population comparisons. Standardisation of the instruments used to measure DV should be a priority. To optimise the yield of such an instrument in capturing the DV experiences of Indian women, it should build upon currently available, well-validated instruments, but also be culturally tailored. Thus, it should account for the culturally prominent forms of DV identified by the Indian qualitative literature and social media, survey abuse inflicted by non-partner perpetrators, survey multiple forms abuse (i.e. physical, sexual, psychological, and control), and ideally, include a measure of DV severity (i.e. based on frequency of affirmative responses, frequency of abuse, or resultant injury). Our review demonstrates that current studies fall short, with only 61% reporting use of validated questions (rarely developed or adapted to Indian culture), 11% surveying DV perpetrated by non-partner family members, 64% assessing more than two different forms of abuse, and 20% evaluating level of DV severity. Our review also suggests that when questions assessing DV are culturally adapted and validated, evaluate multiple forms of abuse, and survey abusive behaviours by non-partner family members in addition to partners, reporting of DV increases.
While our search yielded many well-designed cross-sectional studies providing insight into the epidemiology of DV in India (i.e. patterns of occurrence, socio-demographic, and health correlates), it also revealed many gaps and thus, a potential research agenda. Future qualitative studies are needed to examine the link between DV and correlates identified by the cross-sectional literature, to inform the development of future prevention strategies, and to enhance delivery of DV supportive services by examining survivor preferences and needs. Additional longitudinal quantitative studies are also needed to better understand predictors of DV and to explore the direction of causality between DV and the physical health associations identified in the reviewed studies. They are also needed to assess the link between DV and other physical health outcomes like injury, cardiovascular disease, irritable bowel syndrome, immune effects, and psychosomatic syndromes as well as non-sexual health behaviours such as substance abuse and medication adherence. This is particularly paramount in India, where physical injury and cardiovascular disease together account for over a quarter of disability-adjusted life years lost (National Commission on Macroeconomics and Health, 2005).
Additionally, our review also exposed gaps in the current understanding of DV in some populations and regions of India. For example, most studies focused on women of age 15–50. Only 11 reported on the DV experiences of women over 50, a stage where frailty, financial and physical dependence, and culturally engendered shame and disgrace associated with widowhood may heighten their risk of experiencing DV, neglect, and control by various family members (Solotaroff & Pande, 2014). And, while 43% of Indian women aged 20–24 marry before the age of 18, we encountered few studies evaluating DV experienced by pre-adolescents or young adolescents married as children (UNICEF, 2014). An additional gap is in evaluating the DV experiences of women engaging in live-in relationships as opposed to marital relationships, divorced or widowed women, women involved in same-sex relationships, and in HIV serodiscordant and concordant relationships, settings in which social and family support systems are already weakened (Kohli et al., 2012). Next, beyond the national and multi-state data sets, there is little representation of the northern states of India (i.e. Uttaranchal, Sikkim, Punjab, Haryana, Chhattisgarh, and Assam) and of women residing in tribal villages (Sethuraman, Lansdown, & Sullivan, 2006). The vast cultural, religious, and socio-economic inter-regional differences in India highlight the need for more in-depth study of the DV experiences of women in these areas.
The high prevalence of DV and its association with deleterious behaviours and poor health outcomes further speak to the need for multi-faceted, culturally tailored preventive strategies that target potential victims and perpetrators of violence. The recent Five Year Strategic Plan (2011–2016) released by the Ministry of Women and Child Development discusses a plan to pilot ‘one-stop crisis centres for women’ survivors of violence, which would include medical, legal, law enforcement, counselling, and shelter support for themselves and their children. The significant differences in women’s empowerment and DV experience by region and population within India (Kishor & Gupta, 2004) underscore the need to culturally- and regionally tailor the screening and support services provided at such centres. For example, in resource-limited states where sexual forms of DV predominate, priority should be given to the allocation of health-care providers to evaluate, document, and treat associated injuries and/or transmitted diseases. In settings where financial control and neglect are common, legal, financial, and educational empowerment may need to be given precedence.
Our review is not without limitations. First, our analysis relied solely on data directly provided in the publications. We did not further contact the authors if information was not provided. Second, a single author (ASK or NM) reviewed the individual papers for inclusion into the review, which may have introduced a selection bias. We tried to limit this bias through discussion of the papers in which eligibility was not clear-cut with a second author (SS) until agreement about the inclusion status was reached. Next, we included studies whose main intent was to evaluate the DV experiences of Indian women as well as studies whose main aim may not have been related to DV at all, but included DV as a covariate in the analysis. Thus, many of the studies that solely included DV as a covariate may not have had the intent or resources to fully examine the DV experience. While this may be viewed as a limitation, our goal was not to critically evaluate each individual study, but to comprehensively review the information currently provided in the Indian DV literature. Lastly, inclusion of multiple studies that utilise the same data set (e.g. NFHS) may have skewed the overall median estimate of DV prevalence and the remainder of our analysis. We felt, however, that the substantial differences in DV assessment (e.g. measurement time frames, forms of DV assessed, whether DV severity was assessed, and measured health correlates) between these studies legitimised their need to be included as separate entities in the review.
In conclusion, our literature review underscores the need for further studies within India evaluating the DV experiences of older women, women in same-sex relationships, and live-in relationships, extending the assessment of DV perpetrated by individuals besides intimate partners and spouses, and assessing the multiple forms and levels of abuse. It further stresses the necessity for the development and validation (in multiple regions and study populations within India) of a culturally tailored DV scale and interventions geared towards the prevention and management of DV.
This work was supported by the US Department of Health and Human Services, National Institutes of Health, Fogarty International Center [grant number 1 R25 TW009337-01 K01 TW009664].
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