Al-Tawil BMC Public Health 2012, 12:800

http://www.biomedcentral.com/1471-2458/12/800

RESEARCH ARTICLE Open Access

Association of violence against women with

religion and culture in Erbil Iraq: a cross-sectional
study
Namir Ghanim Al-Tawil

Abstract
Background: Violence against women by intimate partners is still a public health problem. The study aims at
finding out the prevalence of violence among women residing in Erbil city (Muslim culture) and in Ankawa
sub-district (Christian culture), finding out the role of religion and culture on the prevalence, and finding out some
other factors (like occupation of husband and wife, age at marriage, woman agreement for marriage, illegitimate
relations of husband) that might be associated with violence.
Methods: A cross-sectional study was carried out in Erbil during the second half of the year 2011. Two groups
were considered; group one (G1) included women residing in Ankawa sub-district (representing Christian culture),
and group two (G2) included women residing in Erbil city (representing Muslim culture). A convenience method of
sampling was used to collect the sample (250 women of each group). Questionnaire was designed to collect
information about history of exposure to physical, sexual, and psychological violence, in addition to the related
factors. These forms were distributed (by women of the Assyrian Women Union) in sealed envelopes to women
attending the Mass in three churches located in Ankawa. Women of Erbil group were recruited from the maternity
teaching hospital of Erbil. The same questionnaire was distributed to them by the same team. Binary logistic
regression was used to show the independent effect of each factor on the prevalence of violence.
Results: Overall prevalence of violence (physical and/or sexual) in G2 (20.8%) was higher than that of G1 (18.8%).
The prevalence of psychological violence was 40% in Erbil, which was significantly higher than the prevalence
(24.8%) of Ankawa. The rates of physical and sexual violence were also higher in Erbil (18.4%, and 10.8%
respectively) than rates of Ankawa (16.8% and 8% respectively). Factors found to be significantly associated with
overall violence were: culture of Erbil, alcoholic husband, wife working as manual worker (compared with
professionals), and having children.
Conclusion: Violence against women is a serious public health issue. There was significant role of culture on the
prevalence of violence.
Keywords: VAW (Violence Against Women), Culture, Religion, Intimate partner’s violence

Correspondence: altaweeln@yahoo.com
Department of Community Medicine, College of Medicine,
Hawler Medical University, Erbil, Iraq

© 2012 Al-Tawil; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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Background of sampling was used to collect the sample (250 women

The United Nations defines violence against women as of each group). Inclusion criteria for G1 were married,
any act of gender-based violence that results in, or is Christian women, living in Ankawa sub-district; while for
likely to result in, physical, sexual or mental harm or G2, inclusion criteria were married, Muslim, Kurdish
suffering to women, including threats of such acts, coer- women residing in Erbil city. At least one year of mar-
cion or arbitrary deprivation of liberty, whether occur- riage is needed for the woman (of both groups) to be
ring in public or in private life [1]. included in the study. A questionnaire adapted from
The WHO comprehensive study on domestic violence WHO multi country study was used for data collection
(DV) revealed that intimate partner violence (IPV) is the [2]. Modifications were carried out as the controlling
most common form of violence among women, much behaviors were not considered, and the life time violence
more than assault or rape by strangers [2]. Abused was not investigated. It included questions about the
women by intimate partners have 50–70% increasing in- socio-demographic characteristics of women, also ques-
cidence of gynecological, central nervous system, and tions related to psychological, physical, and sexual types
stress related problems [3]. Nearly 50 population-based of violence. Psychological violence was defined as pres-
surveys from 35 nations around the world find that from ence of any of the following acts during past year: insult-
10 to over 50% of women are physically assaulted by in- ing, scaring/intimidation, humiliation, threatening to
timate partners during their lifetimes [4]. remarry, and threatening to harm. Physical violence was
In Baghdad, Iraq, a study done in 2006 showed that defined as presence of any of the following acts during
the percentage of DV committed by husbands was 57.6% the past year: slapping on face, pushing/shaking/throw-
for a one time incidence during life time [physical vio- ing something, twisting arm/pulling hair, hitting with
lence (39.3%), sexual violence (14.9%), and psychological fist/something, and kicking/dragging. Lastly, the sexual
violence (57.3%)], and 44% for current violence [5]. violence was defined as physically forcing the woman to
A recent study conducted in Erbil on 800 women have sexual intercourse, or forcing her to perform any
showed that the past year prevalence of any form of vio- sexual act. The overall (period) prevalence of violence
lence was 45.3%; while it was 43.3% for psychological was defined as having history of physical and/or sexual
violence, 15.1% for physical violence, and 12.1% for sex- violence during the past year. Occupations of women
ual violence [6]. and their husbands were categorized into four categories:
The current study is going to compare violence rate the first was the high professionals like doctors, dentists,
between two groups of women, the first one living in pharmacists, engineers, lawyers, in addition to managers
Ankawa sub-district of Erbil, and are Christians, whereas and business owners. The second category was the non-
the second group of women are living in Erbil city cen- manual skilled, like teachers, clerks, nurses, policemen
ter, and are Muslims. Up to the researcher’s knowledge, and military personnel. The third one was the manual,
no previous study had been conducted to find out the skilled or unskilled, workers including farmers and dri-
prevalence of violence in Ankawa sub-district. vers as examples. The last category was the unemployed.
The study aims at finding out the prevalence of vio- Alcohol drinking by husband was categorized into three
lence (overall, psychological, physical, and sexual) among categories: daily drinking, two to three times per week,
both groups of women, finding out the role of religion and on occasions.
and culture on the prevalence, and finding out some Verbal consent was taken from women after briefing
other factors that might be associated with violence. them with the aims of the study, and ensuring the confi-
dentiality of the study. Approval was taken from the re-
Methods search Ethics committee of the college of medicine, in
A cross-sectional study was carried out in Erbil during addition to the official permission of Erbil directorate of
the second half of the year 2011. Erbil city is the main health. The non-response rate was almost negligible, as
city of Erbil governorate which is the capital of Kurdistan few women refused to participate.
region, located North of Iraq. Erbil city mostly inhabited The questionnaires were translated by the researcher
by Kurdish people whose religion is Muslim. Several from English to Arabic language (the mother tongue of
decades ago, Ankawa was a sub-district located near the researcher), knowing that the researcher had studied
to Erbil city, and inhabited by Christian people who medicine (under-graduate and post-graduate studies) in
have different cultural values of people living in Erbil. English language. These forms were put inside envel-
Now, Ankawa is considered as part of Erbil city owing opes, distributed by women of the Assyrian Women
to the expansion of Erbil. Two groups of women were Union to ladies attending the Mass (in three churches of
considered; group one (G1) included women residing Ankawa). Those ladies were informed that the gathered
in Ankawa sub-district, and group two (G2) included information is confidential in addition to the fact that
women residing in Erbil city. A convenience method they contain no space for writing the names. The ladies
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were asked to fill the forms, put them inside the envel- mentioned types of violence. This variable was entered into
ops, seal the envelops and bring them back on the next the model owing to its importance, as it is part of the re-
Mass (next Sunday). It is worth to mention that the search question.
above mentioned Women Union is a non-governmental A “P” value of equal or less than 0.05 was considered
organization (NGO) that was established in 1992 in Erbil, as statistically significant.
and had a branch in Duhok governorate, Kurdistan region
Iraq. After 2003, a branch was established in Baghdad. One Results
of the main tasks of this NGO is women empowerment, Table 1 shows that both study groups were comparable
and acquainting women with their rights, and with the leg- (by the intention of the researcher) regarding educa-
islations that respects and documents women rights. tional level. Half (50.4%) of the sample were graduates of
Around 2000 women are members of this NGO. institutes, colleges, or higher levels (> 12 years of formal
The forms were also translated to Kurdish language by education). Only 4 women (0.8%) were illiterate.
two MSc holders (PhD candidates) whom mother Results showed that the overall prevalence of violence in
tongue is Kurdish, and their basic and post-graduate Erbil group (52/250; 20.8%), was higher than the overall
medical education were in English. These forms were prevalence (47/250; 18.8%) of Ankawa group (p = 0.575).
distributed (in a sealed envelope) to women accompany- Table 2 shows that the prevalence of psychological vio-
ing patients admitted to the Maternity Teaching Hos- lence was 40% in Erbil, which was significantly higher
pital in Erbil city (G2). This hospital is the only public than the prevalence (24.8%) of Ankawa (p < 0.001). The
maternity hospital in Erbil city. Women of the Assyrian rates of physical and sexual violence were also higher in
Women Union distributed the questionnaire and then Erbil than Ankawa although the differences were not
collected the sealed envelopes, and helped women who significant (p = 0.63, p = 0.28 respectively). The preva-
have problems in understanding the questions, or who lence rates of physical and sexual violence in Ankawa
were illiterate. were 16.8% and 8% respectively.
Adjustment for the level of education of women of When asking women whether husbands have the right
both groups was done. After analyzing the data of G1, to hit their wives, 26.4% of women in Erbil group vs.
women were categorized into four levels of education 1.4% of women in Ankawa group agreed that men have
according to years of formal education (Table 1). Ac- the right to hit their wives (p < 0.001).
cordingly, the same number of women lying in each Table 3 shows that the factors found to be associated
educational level was taken from G2. with physical violence were residing in Erbil compared to
Data were analyzed using the statistical package for social Ankawa (OR = 2.7), alcohol drinking by husband (OR =
sciences (SPSS, version 18). Chi square test of association 2.8), woman working as manual worker (OR = 10.6), in
was used to test whether the differences in the prevalence addition to marriage without getting the agreement of the
of the three types of violence among the study groups were woman (OR = 2.2).
significant or not. This test was also used to show the asso- In Table 4, only two factors (linked with low socio-
ciation between each of the three types of violence and dif- economic status) found to be associated with sexual vio-
ferent factors. Factors found (by bivariate analysis using lence and these were women working as manual workers
Chi square test) to be significantly associated with these (OR = 43.6), and having no car (OR = 2.3).
types of violence, were entered into a binary logistic regres-
sion model. The factor group (Ankawa/Erbil) was entered Table 2 Prevalence of violence by type and residency
into the regression model (of the physical, sexual, and over- Group Total P
value
all violence) in spite of the results of the Chi square test Type of Ankawa Erbil
which showed no significant association with the above violence
N = 250 N = 250 N = 500
No. % No. % No. %

Table 1 Distribution of sample by educational level Psychological

Years of Group Total Present 62 24.8 100 40 162 32.4 < 0.001
formal Absent 188 75.2 150 60 338 67.6
Ankawa Erbil
education
No. % No. % No. % Physical
<6 2 0.8 2 0.8 4 0.8 Present 42 16.8 46 18.4 88 17.6 0.639
6-9 42 16.8 42 16.8 84 16.8 Absent 208 83.2 204 81.6 412 82.4
10-12 80 32 80 32 160 32 Sexual
> 12 126 50.4 126 50.4 252 50.4 Present 20 8 27 10.8 47 9.4 0.283
Total 250 100 250 100 500 100 Absent 230 92 223 89.2 453 90.6
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Table 3 Binary logistic regression analysis of prevalence Table 4 Binary logistic regression analysis of prevalence
of physical violence with several covariates of sexual violence with several covariates
Factors P OR 95% C.I. for OR Factors P OR 95% C.I. for OR
Lower Upper Lower Upper
Group (Erbil) .009 2.711 1.287 5.707 Group (Erbil) .084 1.942 .915 4.123
Ankawa (reference) 1.000 Ankawa (reference) 1.000
Smoking status Age of marriage (< 18 year) .596 1.312 .481 3.575
Ex-smoker (reference) 1.000 Wife employment
Non-smoker .358 2.751 .318 23.756 High professionals (reference) 1.000
Smoker .998 .000 .000 . Non-manual skilled .095 5.876 .734 47.049
Alcohol drinking by husband .006 2.869 1.362 6.043 Manual (skilled or unskilled) .003 43.687 3.602 529.817
Wife employment Unemployed .103 6.052 .694 52.780
High professionals (reference) 1.000 Husband employment
Non-manual skilled .942 1.030 .462 2.297 High professionals (reference) 1.000
Manual (skilled or unskilled) .016 10.640 1.563 72.435 Non-manual skilled .160 2.330 .716 7.584
Unemployed .329 1.556 .641 3.777 Manual (skilled or unskilled) .488 1.546 .452 5.290
Husband employment Unemployed .380 .347 .033 3.679
High professionals (reference) 1.000 House not owned .828 .923 .447 1.904
Non-manual skilled .089 1.932 .905 4.126 Not having car .029 2.331 1.092 4.977
Manual (skilled or unskilled) .750 .869 .366 2.062 Marriage without woman agreement .402 1.517 .572 4.018
Unemployed .344 1.718 .560 5.271 Illegitimate relations of husband .137
Having children .061 4.243 .936 19.235 None (reference) 1.000
House_not owned .052 1.691 .994 2.877 Present .061 3.129 .947 10.342
Marriage without woman agreement .048 2.217 1.007 4.882 Unknown (by wife) .638 .707 .167 2.989
Illegitimate relations of husband .097 Constant .000 .005
None (reference) 1.000
Present .077 2.642 .900 7.753
Unknown (by wife) .137 2.126 .786 5.748 Discussion
Constant .000 .003 Results of a previous study done in Erbil at 2010–2011
showed that higher level of education of women (> 12 years
of formal education) is significantly associated with lower
Table 5 shows that the factors significantly asso- levels of violence [6]. Other studies showed the same effect
ciated with psychological violence were residency in [7,8]. So in order to adjust for the effect of educational
Erbil compared to Ankawa, husband employment as level as an important predictor of violence against women,
a manual worker compared to professional jobs (inverse the author decided to include the same number of women
relation), having children, marriage without woman in each of the educational level categories of the two study
agreement, and husbands’ illegitimate relations with groups. Different ethnic groups are residing in Ankawa
other women. Odds ratios were 3.6, 0.38, 5.9, 2.9, and sub-district, like the Assyrians, the Chaldians, and the
6.3 respectively. Even when the illegitimate relations Arabs, but all those included were Christians. They share
with other women were unknown by the wives, the in general the same cultural characteristics and behaviors
table shows that they were more liable for violence that are different from the cultural characteristics of
(OR = 10.7). people residing in Erbil city, who are Kurdish.
Factors found to be significantly associated (by bivari- The overall prevalence of violence in Ankawa was
ate analysis using Chi square test) with overall violence 18.8%, and in Erbil was 20.8%. Up to researcher’s know-
were entered into a binary logistic regression model ledge, no previous study had been carried out in Ankawa
(Table 6). Results showed that the factors associated with to assess violence levels among women; even in Erbil
overall violence were: women of G2 (OR = 2.6), women there was only one recent study that assessed the past
of alcoholic husbands (OR = 2.8), women working as year overall prevalence which was 45.3%. This high rate
manual workers (OR = 10.4), and women having children is attributed to the inclusion of the psychological vio-
(OR = 4.9). lence in the overall prevalence in addition to physical
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Table 5 Binary logistic regression analysis of prevalence Table 6 Binary logistic regression analysis of overall
of psychological violence with several covariates prevalence of violence (physical and/or sexual) with
Factors P OR 95% C.I. for OR several covariates
Lower Upper Factors P OR 95% CI of OR
Group (Erbil) < 0.001 3.612 2.200 5.931 Lower Upper

Ankawa (reference) 1.000 Group (Erbil) .007 2.619 1.299 5.282

Age of marriage (< 18 years) .209 .588 .257 1.347 Ankawa (reference) 1.000

Wife employment Smoking woman .998 1.222E9 .000

High professionals (reference) 1.000 Alcoholic husband .004 2.784 1.384 5.600

Non-manual skilled .416 1.318 .677 2.568 wife employment .022

Manual (skilled or unskilled) .693 1.429 .242 8.421 High professionals (reference) 1.000

Unemployed .342 1.632 .594 4.483 Non-manual skilled .681 1.178 .539 2.575

Husband employment Manual (skilled or unskilled) .010 10.444 1.733 62.944

High professionals (reference) 1.000 Unemployed .090 2.077 .891 4.839

Non-manual skilled .153 1.543 .851 2.797 husband employment .270

Manual (skilled or unskilled) .007 .380 .188 .769 High professionals (reference) 1.000

Unemployed .679 .810 .298 2.200 Non-manual skilled .075 1.934 .935 4.004

Source of family income Manual (skilled or unskilled) .580 1.251 .566 2.768

Husband (reference) 1.000 Unemployed .609 1.333 .443 4.009

Wife .211 2.156 .647 7.182 Having children .035 4.902 1.115 21.546

Husband & wife .100 .514 .233 1.137 Marriage without woman agreement .130 1.784 .844 3.773

Having children .002 5.984 1.936 18.492 Illegitimate relations of husband .355

Marriage without woman .005 2.997 1.394 6.444 None (reference) 1.000
agreement Present .236 1.874 .662 5.304
Illegitimate relations of husband Unknown (by wife) .335 1.595 .618 4.115
None (reference) 1.000 Constant .997 .000
Present .001 6.390 2.053 19.885
Unknown (by wife) < 0.001 10.757 3.840 30.137
Rates of sexual violence of this study (8% in Ankawa,
Constant .000 .038 and 10.8% in Erbil) were lower than what was recently
reported (12.1%) in Erbil [6]. Nearly comparable rates were
and sexual violence. [6] A study done in Baghdad by found by other studies: 12% in China [11], 11.5% in Samoa,
Abdul Jabbar showed a prevalence of 44% [5], and another and 12.8% in United Republic of Tanzania city [2]. Higher
one done in Sudan, found that the prevalence among rates were found in Ethiopia province (44.4%), Bangladesh
women attending Arda medical center, Omdurman was province (24.2%), Bangladesh city (20.2%), and in United
41.6% [9]. Other studies showed different results according Republic of Tanzania province (18.3%) [2].
to the sample and country. The prevalence, 58.7%, was The differences in the results of the above mentioned
detected in a sample of women attending primary health studies could be related to the sampling methods used,
care centers in Madina, Saudi Arabia [10]. Other studies and to the characteristics of women included in these
done in China and Esfahan showed lower results (26% and studies; and of course related to the country where the
29.3% respectively) [11,12]. study was carried out.
The study revealed a lower rate of physical violence Considering all these factors, it seems that violence
(16.8%) in Ankawa than in Erbil (18.4%). These rates against women by intimate partners is a public health
are little bit more than the rate (15.1%) of the 2010– problem, not only in Erbil, Iraq, but worldwide. Rates of
2011 study done in Erbil [6]. A study done in Iran different types of violence were high in both study
[13], and another one in Egypt [14] showed rates of groups, although it was higher in Erbil than in Ankawa
15% and 13% respectively. Lower rates were found in sub-district. Logistic regression analysis showed that
Japan (3%), in New Zealand (5%), in Philippines (6%) women living in Erbil were more exposed for violence
and in Thailand (8%), whereas higher rates found in than women living in Ankawa (except for sexual vio-
Ethiopia (29%), and in West Bank and Gaza Strip lence). This could be linked to the cultural differences in
(52%) [15]. the two areas, in addition to the differences of the
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religion of the two groups. The role of religion was with results of other studies done in Baghdad-Iraq [5],
investigated in a study done in Nigeria which showed and China [11].
that about 74% of Muslim women supported wife beat- The author believe that the sampling method (being
ing compared with a lower proportion (51.5%) among non-random, using two different strategies) was the
their Christian counterparts [16]. A study done in main limitation of the study, but from the other hand,
Ethiopia showed that Muslims were about two times recruiting women from the maternity hospital (the only
more likely to experience physical violence during public maternity hospital in Erbil) will make them feel
lifetime than the Christian women. The same study free to answer what they want to answer and not to be
showed that physical violence during the past 12 months affected by their partners. The churches were selected in
was higher among Muslims and Catholic religion fol- Ankawa to be the study setting because it is a place of
lower than those Orthodox Christian followers [17]. gathering a large number of Christian women. Conduct-
Many verses in Quran are misinterpreted in order to ing a household survey (in order to recruit a random
justify men’s superiority. This misinterpretation of reli- sample) is money and time consuming, and if this survey
gious beliefs together with socio-cultural norms put done in the morning, there would be no chance to meet
women in subordinate status and increase violence against the working women, and if done in the evening, hus-
them [18]. bands may be available at home and may interfere with
Results of two studies done in Erbil showed that the process of filling the forms or may ask their wives
around 40% of women believed that husbands are justi- not to participate in the study. In order to adjust for the
fied to beat their wives [6,19], while results of the incomparability between the two study groups (men-
current study showed a very big difference between the tioned above), the author have adjusted for the effect of
two study groups where 26.4% of women in Erbil group education. Other factors have been adjusted for, using
think that men are justified to hit their wives compared the regression analysis.
with only 1.4% of women in Ankawa group. This may
partly explain the cause of the differences in the violence Conclusions
rates among the two study groups. It can be concluded that the prevalence of intimate part-
Results of the present study showed that many factors ner violence against women is still high in both the
are associated with violence. One of these factors is wife study settings, although it was higher in Erbil than in
working as a manual worker (or unemployed), which Ankawa. The role of culture and religion found to be an
may reflect poverty and a low socio-economic status. important predictor of violence against women. This
Poverty increases home conflicts and reduces the calls for more efforts by the religious men, and the non-
woman’s power. It also reduces the ability of men to live governmental organizations in order to empower
in a manner that they regard successful [20]. Ellsberg women, and let them know their rights. Conducting
et al. [21] in Nicaragua, Su-Fang et al. [22] in China, and qualitative research in the future (targeting men, women,
Malco et al. [23] in USA found the positive association and religious people) may provide in depth understand-
between past year intimate partner violence and low ing of the role of religion and culture on violence. Defin-
socio-economic status. itely, these acts are worthless without issuing appropriate
Having children was associated with higher rates of legislations.
violence. This could be explained by the pressure
imposed upon fathers that is related to their children, Competing interests
which could be a financial one. The more the number of The author declare that he has no competing interest.
children, the more the economic burden on the family,
Author’s contribution
so the rates of violence are expected to increase. This is Being a single author, he was responsible for everything in the study,
consistent with the results of many studies done in Erbil including supervision of the process of data collection.
[6], Mexico [24], and Egypt [25].
Husband’s alcohol drinking was associated with phys- Acknowledgments
The author acknowledge the role of the women of the ‘Assyrian Women
ical violence (OR = 2.8) which is an expected finding. Union’ in the process of data collection.
Many studies revealed an association between alcohol
drinking and violence, such as studies done in China Received: 11 May 2012 Accepted: 17 September 2012
Published: 17 September 2012
[26], Baghdad-Iraq [5], United Kingdom [27], and
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