Spousal abuse is a serious public health and social problem, which includes a variety of physical, emotional, and sexual violence directed at the spouse. This kind of violence is the leading cause of injury to women, higher than car accidents, muggings, and rapes combined. According to domestic violence statistics, nearly 1 in 5 teenage girls who have been in a relationship said a boyfriend threatened violence or self-harm if presented with a breakup.1
Studies show that women are subjected to spousal abuse 5 to 8 times more often than men,2 however, surprisingly in some conditions such as pregnancy, due to psychological stress, partner abuse may increase against men.3
According to a World Bank report, domestic violence frequently leads to threats to the health of 15- to 44-year-old women, more often than diseases like breast and uterine cancer, or accidents. In total, approximately 29% of Western married women had experienced sexual or physical abuse from their husbands.4
The American Psychological Association (APA) has reported that 1 to 4 million women are injured and harassed by their husbands annually. The APA has also stated that nearly 47% of the men, who physically abuse their wives, repeat this behavior at least 3 times a year and approximately 1 in 3 women are physically harassed by their husbands (AMA, 1994; http://www.ama-assn.org/resources/doc/csaph/csai-94.pdf).
In a study conducted on a group of Iranian university students (both male and female), it was shown that 93.6% of the students experienced violence and mistreatment; 91% of which was emotional, 55% physical, and 42% sexual abuse. Among the male students who experienced abuse, 53.4% experienced emotional and 19.5% sexual violence.5 Unfortunately, this problem is a common phenomenon in many countries (eg, England), and it often presents as controlling behaviors, such as isolating a woman from her family and friends and limiting her access to different sources of support,6–8 which can have irreversible negative consequences on the family, especially the children.9
The consequences of domestic violence can include a variety of physical and psychological problems. Studies have shown that physical symptoms such as headaches, stomach problems, chronic pain, vaginal bleeding, irritable bowel syndrome, and sexually transmitted diseases occur frequently in victims of domestic violence.10–12
One of 3 women is beaten, violated, or abused in such a manner at least once in her lifetime.4 Studies have shown that just 1 of 7 cases of violence toward women, including spousal abuse, is reported to police; and its prevalence was reported to have a somewhat increasing growth rate within European and American countries, with the prevalence of domestic violence in England estimated to be 39% to 60%.6 Moreover, the prevalence of violence in developing countries is much higher as studies show that 1 in 4 women and 1 in 3 women in Chile had experienced physical or emotional abuse, respectively.5,13 A study in Nigeria on a sample group of 100 women showed that 81% of the women had experienced different kinds of violence.14 One of 3 women in Athens had experienced violence from her husband.15 There are also significant statistics of spousal abuse in Russia16 and Nicaragua.17 The prevalence of psychological problems such as depression and personality disorders among couples who experience violence or abusive behavior is higher than for other couples. Many studies show a higher prevalence of abusive behavior and violence against their partners among young couples. A survey on 2211 Norwegian adolescents by Pape18 showed that 6% of men and 4% of women have injured or violated their spouses during the previous 6 months. The study of Yoshihama and Sorenson19 in Japan also showed that three quarters of a group of Japanese women (n = 796), who had young spouses, had experienced some kind of abuse in recent months.
Some unexpected emotional cues (like football) may also increase the incidence of violent behaviors, for example, an empirical analysis showed an increase in violent incidents on Sundays during the professional football season.20
In many countries, spousal violence may be aggravated by cultural beliefs, and women are often under pressure to produce a male child, if this does not occur, the women may be violated by their husband.21
An Indian study mentioned that domestic violence may result from not obtaining a dowry or one which is insufficiently large, and this may even lead to the criminal death of the wife (dowry-related death).22
Because this type of violence normally occurs between family members and in a private setting, it often does not result in a prosecution; therefore, real statistics of this type of abuse are much greater than can be seen at first glance.23
On the other hand, in Iranian culture, women often consider that keeping the family intact is more important than their health and happiness, leading them to occasionally tolerate their husband’s violent behavior, and this is another reason for a lack of accurate statistics in this context.24
Legal medical organizations and related centers are widespread throughout Iran, and they are prepared to have such victims referred to them. However, according to Iranian law, examination at the Legal Medicine Organization (LMO) may only occur with the ruling of a judge; therefore, a woman who has been abused by her husband is personally required to go to the police station and only then can she be referred to the LMO. An alternate way is to go to a physician or a hospital and then they can be referred to the police station or other judiciary authorities before gaining access to the LMO.
In these centers, physicians visit the victims and carefully document their examination findings for authorities and judiciary. According to the law in Iran, sexual violence is not considered a type of spousal abuse, and in cases where it is proved, the husband is not sentenced to pay for the harm. Therefore, women often do not go to the LMO for such abuse, and try to use psychology counseling to correct their husband’s behavior instead. That is why the study population did not give us any documentation regarding this type of abuse. However, when asked about their history of sexual abuse, 17.4% responded positively without any supporting legal documents.
In general, the LMO and relating departments in Iran are the centers that are commonly faced everyday with women who make complaints concerning harm and injuries perpetrated by their husbands.23 In Iranian culture, men do not normally complain about spousal abuse and only 1 man filed a lawsuit in this regard during the study period. Therefore, the study was conducted only in the women’s department.
MATERIALS AND METHODS
In this present study (cross-sectional, descriptive), 500 women who had been referred to the clinical examination unit of the central department of the LMO with complaints of spousal abuse were included and the data were gathered through an author-constructed questionnaire, content validity and reliability was in an acceptable range (Cronbach α = 92%). The questionnaire consisted of 2 parts: the first part contained demographic information and the other part was dedicated to the subject of spousal abuse. A pilot study was initially conducted on 20 subjects, and then presented to other target populations. All subjects gave their informed consent before being involved in the research. Finally, the data were analyzed with statistical tests (like mean, SD, P value, etc) and SPSS 19 software.
The age range of the women in this study was 16 to 62 years [mean (SD), 32.02 (9.13)], whereas the age of their husbands was 24 to 71 years [mean (SD), 36.13 (10.64)], and the length of marriage range was 13 to 34 years (mean, 21.38). In this study, there was no significant statistical relationship between husbands in different age ranges from a spousal abuse viewpoint (P = 0.07). Age differences between victims and spouses are shown in Table 1, and the educational levels of the victims and their husband are shown in Table 2.
According to the findings of this study, 72.3% of the victims were living alone with their husband and children, 14.3% of the referred cases were living with the wife’s family, 8.9% with the husband’s family, 1.2% with the spouse’s child, and 2.3% did not answer this question. There was no relationship between the presence of domestic violence and the type of family group arrangement in our study (P > 0.05). Among the wife abuse victims, 94.6% of the cases had been living with their parents before marriage, with just 5.4% living with their father or mother only, whereas 73.4% of their husbands had been living with their parents, 17.2% with their father or mother only, 4.3% with a stepfather or stepmother, 4.1% with other relatives, and 1% did not reply to this question.
This present study showed that 69.2% of the victims were housekeepers and 30.8% worked outside the home. A total of 87.3% of the subjects stated that they had married by their own choice and volition, whereas 12.7% stated that they had married without any personal desire to do so and it had not been their choice. There was no significant relationship between being a victim of spousal abuse and nonchoice marriage (P = 0.2)
Concerning the length of time that had passed after marriage, 11.2% of the cases were abused in the first year of marriage, 28.1% between 1 and 5 years, 20.3% between 6 and 10 years, and 40.4% in the second decade of their marriage. In this study, there was no significant relationship between the time passed after marriage and the incidence of spousal abuse (P = 0.32).
Overall, 92.2% of the referred women had married just once and 7.8% had married twice. No relationship was found between remarriage and spousal abuse in this study (P = 0.64). In 18.6% of the cases, the abuse victim had a kinship relationship with their spouse, and in 19.2% of the cases the abuser also had another spouse.
In this study, the victims reported the number of children as 36.2% without children, 38.1% had 1 child, 16.5% had 2 children, 6.1% had 3 children, and 3.1% had more than 3 children. According to the findings of this study, there was no significant relationship between having children and spousal abuse (P > 0.05).
A total of 43.2% of the cases declared that they had referred to the LMO for domestic violence before this time and 56.8% of these cases had made their first visit to the LMO. A total of 84.8% experienced this type of situation during the first year of their married life, whereas the remaining 15.2% of the cases referred for the first time to the LMO after the first year of marriage. However, 69.1% of the cases reported that they had experienced the first physical injuries during the first year. It has also been reported that in 79.2% of the cases, the mother was beaten and violated in front of her children, and in 42.6% of the cases, the children were also beaten and injured by their fathers (Fig. 1).
In the current study, 10.3% of the cases had injuries which led to hospitalization, and in 53.1% of the cases the victim harbored suicidal thoughts. Furthermore, 52.7% of the cases in this study had temporary separation from their husband after the violation (Fig. 2).
In 40.4% of the cases, the victims referred to the court after the first violation. The reasons for not going to the judiciary after the first quarrel are given in Figure 3.
From the viewpoint of the type and location of injuries, 23.6% of the injuries were made to the face and neck and 20.7% to the other body parts. In 67% of the cases, the most common type of injury was an impact trauma, 53.8% of the injuries resulted in visible bruises, 33% of the injuries were lesions, and the most common type were scratches (67.4%).
There was a history of drug use such as antidepressants in 40.2% of the husbands, a history of addiction to narcotics in 53.7%, and in 43.4% of the cases, a history of alcohol usage was observed. (Although drinking alcoholic beverages in Iran is illegal and is not indulged in publicly, many people still drink.)
There was a significant relationship between domestic violence and drug and alcohol abuse in this study (P = 0.01), but no significant relationship was found between this kind of abuse and mental disorders (P = 0.15). In 27.5% of the cases, there was a history of suicide and self-mutilation in the men. Regarding the history of spousal abuse in the first-degree relatives of the abuser, in 85.3% of the cases, there was a positive history with their father and/or brother.
In 26.4% of the cases, the abuser was a fervent religious believer; in 59.3%, the religious beliefs were relatively strong; in 26%, there was low religious adherence; and 1.3%, they were almost entirely atheists.
DISCUSSION AND CONCLUSIONS
Similar results have been found for the average age of men and women both in this present study and similar studies; for example, in a study in Iran, the average age of men and women was reported to be 33 and 37 years, respectively.25 In this study, no significant relationship was found between the husbands’ age and spousal abuse, whereas results of another study found a relationship between age, education level, job, and salary, with spousal abuse.24
In Iran, people generally live with their family before marriage and then with their husband or wife, children, and sometimes near relatives such as grandparents may live with them. Therefore, it is not unusual for many spousal abuse victims to live in such way. Other studies have shown that the women who live together with the husband’s family in the same home are beaten more than the others26,27; but in the current study, no relationship was found with this kind of living arrangement and spousal abuse. Another study in Iran showed that a quarter of abuser and abused groups had grown up in broken families, without the presence of a father or in conditions where there was conflict between the parents. However, the subject of whether the husbands were used to living in a large family with many brothers and sisters or in a small family had no effect on an increase or decrease in spousal abuse.25
A study in Denmark has shown that violence against a spouse in young couples is far more common than in older couples.28 Moreover, the results of another study showed that most of the violence occurred in the age range of 20 to 40 years,29 which is compatible with our study.
In some studies such as the current one, no relationship was found between educational levels and spousal abuse30; whereas in other studies, the researchers came to the conclusion that the higher the education level was, the less spousal abuse was seen.5,23,31,32
From the viewpoint of women’s work, according to statistical data in Tehran, 6% to 26% of the normal population of women worked outside the home.33 In one study in Iran, 28% of domestic violence victims were employed; compared with our study, the working rate in victims was a little higher than normal. There may be a number of reasons for this finding: women may be so tired that they cannot manage their household duties, or they may be independent and may not feel any obligation to tolerate unacceptable behavior from their husbands. It has also been mentioned in other studies, as in the current one, that in most of the cases, the marriage was based on personal choice.34
It has been stated in many of the studies that spousal abuse in a marriage does not decrease with the passage of time; this may be due to a lowering of the couples’ tolerance levels and ability to cope with their problems. However, according to the results of some studies, spousal abuse is most likely to occur in the first years of marriage.35,36
According to the findings of this study, the numbers and types of marriage were almost similar to the findings of other studies, as a study made in the Iranian population has shown that 91.6% of the victims have married only once and 17.4% of all marriages have a kinship relationship with their spouses.34
Some studies found that there is a direct relationship between the number of children and spousal abuse,30 whereas some others consider it a reverse relationship.29,36 A similar conclusion was also made regarding the history of referring to the LMO due to spouse abuse (28%, 24%).25,29 According to similar results of a study made in Urumiyeh concerning the first referral of a victim to the LMO, 79.9% of all women were referred in the first year of their marriage, 24.1% of whom had just passed the first 3 months of their married life.4
A study carried out on a Tehran population showed that in 81% of the cases, the first injuries occurred in the first year of married life, and in 67% of cases it was mentioned that other family members such as children were violated or physically abused by the father, and that is comparable with the current study’s results.25 A study in the Netherlands showed that the children of parents who presented at an emergency department due to domestic violence may have experienced maltreatment.37
According to similar studies, the frequency of injuries leading to hospitalization was greater than that seen in the current study, as existing statistics suggest a frequency of 24% and 25%.21,25
On the basis of reports from 10 countries, 55% to 95% of women who had been physically abused by their partners had never contacted a nongovernmental organization, domestic violence shelter, or the police for help.1
With regard to the results of another study on the reasons for not going to court after a violent attack, in 18.5%, the children were the main consideration; 15.4% were hoping to solve the problems themselves; and 15% reported that it was to retain their honor.34
Studies made on alcohol abuse in Lebanon, United States, and Norway reported a significant relationship between alcohol abuse and spousal abuse; this is obviously due to an inability to make accurate judgments, and increasing aggressive behaviors after using this substance.38–41 Another study in India showed that the 39% of women who were at higher risk of being abused had lower household incomes, were illiterate, belonged to a lower caste, and had a partner who drank.42 Another study mentioned that drug use, alcoholism, family breakdown, and poverty may also lead to domestic violence.43
A study in Tehran showed that the incidence of spousal abuse among men who had a history of mental disorders was higher than in other couples.23 The results of the study of Nazparvar25 showed that 25% of the victims’ spouses had a history of criminal conviction, which is comparable with the current study’s results. Of the findings from another study performed in an Isfahan population, it is understood that 92% of the abusing men had a history of spousal abuse between their parents.30 In addition, according to another study, men who witnessed their parents’ domestic violence as children were twice as likely to abuse their own wives, than the sons of nonviolent parents.1
Racial and ethnic disparities may also increase the incidence of domestic violence.44
Nowadays, there is widespread evidence of spousal abuse around the world. However, the scale of abuse for women in developing countries, and countries where women are less familiar with their rights, seems to be higher. As we mentioned in this article, there are many cultural factors that affect the frequency of this behavior (eg, abusing women because they were born female or they had an insufficient dowry). Trying to change these erroneous beliefs and spreading information on how to deal with this problem would be useful in managing this social problem. Some cultural commentators insist that male power must be reduced in an attempt to reduce the possibility of abuse over their female victims. With regard to the psychological, cultural, social, economic, and environmental factors that play a key role in spousal abuse, a variety of factors must be addressed to reduce the aggression that underlies the violence. Appropriate culture building, legal-judicial protections, making women aware of their rights, and the establishment of centers for the support and shelter of female victims, are just some of the appropriate strategies that can be used to reduce this phenomenon. It is essential for managers, along with staff and the community to discuss the problem and ways to approach it in the context of the territories.
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