Open Access

Original Article

Prevalence, instigating factors and help seeking behavior

of physical domestic violence among married
women of Hyderabad, Sindh
Seema Bibi1, Sanober Ashfaq2,
Farhana Shaikh3, Pir Mohammad Ali Qureshi4
ABSTRACT
Background and Objectives: Domestic violence against women is highly prevalent but under reported
issue having social, legal, health and economic implications. It needs to be identified and addressed in
order to decrease the sufferings of women. Our objective was to find out prevalence, instigating factors
and help seeking behavior of physical domestic violence against married women.
Methods: A total of 378 married women who were attending Department of Obstetrics & Gynaecology,
Liaquat University Hospital from January 1, 2013 to March 31, 2013 for different obstetrical & gynaecological
problems were randomly selected and interviewed. After informed consent, required information was
collected on predesigned performa including demographic details, prevalence, instigating factors, help
seeking behavior for physical domestic violence.
Results: About 31%(120) of women reported lifetime physical domestic violence. Husbands and in-laws were
perpetrators in 70% (84) and 30% (36) cases respectively. Wives being disobedient and making arguments
were the most common instigating factors for violence followed by husband’s drug addiction, extra marital
relationship and infertility. It was severe enough to require medical care in 24%( 29) cases. Only 2% (2)
women sought social and legal aid.
Conclusion: Domestic violence was quite common among married women, however help seeking was
minimal. There is need to identify and address this menace effectively.
KEY WORDS: Domestic violence, Risk factors, Help seeking behavior.
doi: http://dx.doi.org/10.12669/pjms.301.4533
How to cite this:
Bibi S, Ashfaq S, Shaikh F, Qureshi PMA. Prevalence, instigating factors and help seeking behavior of physical domestic violence
among married women of Hyderabad, Sindh. Pak J Med Sci 2014;30(1):122-125. doi: http://dx.doi.org/10.12669/pjms.301.4533
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Dr. Seema Bibi, MBBS, FCPS, INTRODUCTION

Department of Obstetrics & Gynaecology,
2. Sanober Ashfaq, MBBS, DGO, MS,
Department of Obstetrics & Gynaecology,
Domestic violence against women is common
Liaquat University Hospital, Hyderabad, Pakistan. but underreported global epidemic having health,
3. Farhana Shaikh, MBBS, FCPS, educational, legal, economic and above all human
Department of Obstetrics & Gynaecology,
4. Pir Mohammad Ali Qureshi, MBBS, MPH, right implications. UNICEF defined the term
Department of Community Medicine & Public Health Sciences domestic violence as violence against women and
1,3,4: Liaquat University of Medical and Health Sciences,
Jamshoro, Sindh, Pakistan. girls by an intimate partner, including cohabiting
partner, and other family members, wherever this
Correspondence:
violence takes place and in whatever form.1 It is
Dr. Seema Bibi, MBBS, FCPS,
H. No. 87-A/100, Street A, Abdullah Blessings,
manifested as physical, sexual, psychological and
Qasimabad, Hyderabad (71000). economic abuse. Physical abuse includes slapping,
E-mail: drseemabibi@yahoo.com beating, arm twisting, stabbing, strangling,
* Received for Publication: October 26, 2013 kicking, burning, choking, threats with an object or
* Revision Received: November 12, 2013 weapon and murder. It is associated with adverse
* Revision Accepted: * November 16, 2013 reproductive health consequences for women

122 Pak J Med Sci 2014 Vol. 30 No. 1 www.pjms.com.pk

 A study of physical domestic violence among married women

including unwanted pregnancy, miscarriage, pelvic lized for enrolling study participants. Sample size
inflammatory disease, sexually transmitted disease of 378 subjects was used taking the frequency of
(STD), suicide, homicide and maternal mortality. physical violence as 44%4. They were interviewed
Worldwide women continue to suffer from this face to face by principal investigator and her team
menace with World Health Organization (WHO) members and required information was collected
reported estimates of 10 to 69%.2 It is not uncommon on predesigned performa. Data included demo-
in Pakistan. According to survey conducted by graphic details, prevalence, instigating factors, help
Human Rights Watch, about 70 to 90% women seeking behavior for domestic violence.
have suffered from some form of violence.3 Faryal Physical domestic violence was defined as slap-
Fikree and colleagues reported that 44% of women ping, beating, kicking, arm twisting, hair pulling,
suffered from life time marital physical abuse in stabbing, strangling and threats with an object or
a cross sectional survey conducted in postnatal weapon by husband or any other family member.
wards of tertiary referral hospitals of Karachi.4 In Statistical analysis: Data was entered and
an another survey conducted in Rawalpindi and analyzed on SPSS version II. Simple frequencies
Islamabad, 97% of participants admitted that they and percentages were drawn. Instigating factors
had been subjected to some form of violence from for physical violence were compared between
verbal abuse to physical assaults or non consensual physically abused versus never abused women. P
sex.5 It can be anticipated that domestic violence value of <0.05 was considered significant.
is prevalent but hidden reproductive health issue
which needs to be recognized and addressed. RESULTS
This study was planned to find out the The prevalence of physical domestic violence
prevalence, instigating factors and help seeking was found to be 31% (120 out of 378 women).
behavior associated with physical domestic Husbands and in-laws were perpetrators in 70%
violence in married women in order to help health (84) and 30% (36) cases respectively. Respondents
care providers and policy makers for designing and were six years younger than their husbands with
implementing preventive and treatment strategies mean age of 29.87± 8.7 and 35.59 ± 11.98 years
for Pakistani women. respectively. They have been married for 10 years
METHODS (10.6 ± 8.38) and having four children (mean 3.59
± 2.58). Average monthly income was about
A cross sectional survey was conducted in the Rs.8000. Educational status of women was low in
Department of Obstetrics and Gynaecology, Li- comparison to their husbands as 160(42.3%) women
aquat University Hospital Hyderabad from Janu- and 230 (60.8%) husbands were literate. Instigating
ary 1, 2013 to March 31, 2013. Approval was taken factors for physical domestic violence are shown
from Research Ethics Committee of Liaquat Univer- in Table-I. Physical violence was severe enough to
sity of Medical and Health Sciences Jamshoro (Ref require medical care in 24%(29) cases. Out of which
# LUMHS/REC/-106). All married women who 17%(n=21) attended family physicians clinic while
were attending the hospital for different obstetri- 7%(n=8) required hospitalization.
cal or gynaecological problems as patients were in- Regarding help seeking behavior, only 2% (2)
cluded in the study. Unmarried Women and those women sought social or legal help by reporting to
who were not willing to participate were excluded. police or NGO, while 50%(n=60) just complained to
Verbal informed consent was taken before enrolling their parents and 48% (n=58) remained silent after
the participants. Simple random technique was uti- sustaining physical violence.
Table-I: Instigating factors associated with violence between women abused/never abused.
Risk Factors History of violence (n=120) No History of violence (n=258) P. Value
1 Wife Disobeying / Argues 70 (58.3%) 9 (3.5%) 0.00
2 Spouse drug addiction 52 (43.3%) 3 (1.2%) 0.00
3 Disliking by in-laws 29 (24.2%) 1 (0.4%) 0.00
4 Infertility 24 (20%) 4 (1.6%) 0.00
5 Spouse psychological problem 19 (15.8%) 0 0.00
6 Spouse extramarital relation 18 (15.0%) 0 0.00
7 Failure to produce male child 12 (10%) 2 (0.8%) 0.00

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Seema Bibi et al.

DISCUSSION Spouse extramarital relationship was another

important risk factor noted in this study in line with
Domestic violence is a social issue, hidden but international figures. In a nationally representative
prevalent in almost every society irrespective survey from Bangladesh, it was documented that
of race, region, religion, caste and language. It wife abuse is associated with husband’s premarital
includes acts of physical, psychological and sexual and extramarital sex relations.12 Researchers have
abuse by someone who is involved in intimate found that women who were exposed to intimate
partner relationship with the aim of controlling or partner violence were at increased risk of sexually
punishing the victim. Most of the time husbands are transmitted infections, including HIV.13,14 This may
perpetrators, but any member of the house hold can have roots with highlighted factor found in our
be involved. Our reported prevalence of 31% is in study.
line with national figures quoted as 35% and 44% in It is depressing to reveal that despite high
various studies.4,6 Data from other developed and level of domestic violence, rate of disclosure and
underdeveloped countries reflect similar situation. help seeking behavior was minimal. Findings are
In an Indian study, 26% of women attending consistent with reports from developed and under
antenatal clinics reported physical domestic developed countries.15,16 Reasons for non disclosure
violence, mostly by their husbands.7 In another are complex and multifactorial. Women continue
cross sectional survey conducted in emergency to suffer in silence due to socio-cultural norms,
department of UK university hospital, revealed misinterpretation of religious beliefs, subordinate
life time prevalence of domestic violence between status, and economic dependence. Other important
22.1% to 30.5% among women.8 barriers are fear of abuser, concerns for children,
The most common instigating factors for physical social isolation and lack of knowledge and
domestic violence in our study was wife being familiarity with legal systems such as police and
disobedient or making argument with husband. judiciary.17
Similar figures were quoted by Faryal Fikree Domestic violence has been associated with
and colleagues in a study done in three tertiary adverse reproductive health outcome including
referral hospitals of Karachi.4 This highlights maternal morbidity and mortality. A report on
lack of women’s autonomy and decision making confidential enquiries on maternal deaths in United
power related to her personal and family matters. Kingdom showed that lack or poor antenatal care
Pakistani society is male dominant society, where was higher in women who died due to direct
women are supposed to be submissive and causes of maternal deaths. It also highlighted
obedient for every decision, even pertaining to other indicators of domestic violence related to
her household affairs, contraception, number of antenatal care including poor obstetrical history,
children and their education. Secondly they are unexplained admissions, non compliance with
illiterate, lack economic resources and supposed treatment regimens, recurrent sexually transmitted
to obey their husbands according to socio-cultural infections and constant presence of partner during
norms. Jejeebhoy SJ and Sather ZA in their study consultation.18 Therefore there is dire need that
conducted in India and Pakistan found restricted all health care professionals should be aware of
women’s autonomy in terms of decision making, presence of violence, its causes, possible treatments
economic empowerment, mobility and freedom. and preventive measures. One of the simple and
Moreover Pakistani women have less control over cost effective measures for identification of problem
their lives as compared to their Indian counterparts.9 is incorporating violence history into routine
Therefore any deviation from society’s set norms, history taking by health care providers particularly
subject them to be disliked by their in-laws, as primary care physicians and obstetricians and
revealed by this study and ultimately being gynaecologists.
physically abused by whole family. Interestingly In conclusion, domestic violence is not
most of the instigating factors for violence were uncommon in our society and responses of women
due to husband’s attitude and behavior including were open and positive on this sensitive issue. It is
drug addiction, psychological disturbance and the responsibility of state, society and health care
extramarital relations. Strong links of alcoholism providers to plan and implement both preventive
and intimate partner’s violence have been reported and treatment strategies in order to help women
from United Kingdom8, India10 and Uganda.11 sufferers morally, medically and legally.

124 Pak J Med Sci 2014 Vol. 30 No. 1 www.pjms.com.pk

 A study of physical domestic violence among married women

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violence of UK emergency department. Emergency Med J.
of the study is reporting about a hidden, sensitive
2003;20(5):438-442.
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