Document Type : Original Article
Abstract
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STUDY OF DOMESTIC VIOLENCE AGAINST WOMEN ATTENDING OUT PATIENT CLINICS IN ASSIUT UNIVERSITY HOSPITALS
Asmaa Ghareeb Mohamed*, Hammam Mohamed Hammam**, Mahasen Ahmed Abd El-Wahed***, Hoda Diab Fahmy Ibrahim*, and Shokria Adly Labib*
*Community Health Nursing Department, Faculty of Nursing, Assiut University
** Community Medicine Department, Faculty of Medicine, Assiut University
***Community Health Nursing Department, Faculty of Nursing, Alexandria University
ABSTRACT: |
This study aimed to identify the magnitude of domestic violence and to assess the underlying factors for it among women seeking medical care from out patient clinics in Assiut University Hospitals. The study was conducted in four out patient clinics (antenatal, gynecological, family planning and sterility clinics) affiliated to Assiut University Hospitals. The studied sample age ranged from 18-49 years. The total number of the women was 1000. Two tools for data collection were used a quantitative (structured interview questionaire) used to collect data such as socio-demographic data, history of violence, underlying causes, health effects of violence upon women health status and a qualitative (FGDs) focus group discussions which utilized to gain insight and identify views of women regarding domestic violence. Data was collected during the period from October 2003 to September 2004. The results of the study revealed that 54.2% of wives and one third of (34.1%) of husbands were illiterate, while (21%) of wives and (31.3%) of husbands graduated from secondary school. The vast majority of the women were housewives, while 25.4% of husbands were employees. Regarding the residence, more than three quarters 78.2% of the study sample lives in rural areas, compared to 21.8% in urban areas. Concerning the history of violence against the wives, 41.3% of the studied sample experienced one or more types of violence. Physical violence was reported in the form of pushing, hitting, pushing on the floor and pulling hair in a percentage of 45%, 82.8%, 41.2% and 35.8%, respectively. As regard to the psychological abuse, the results show that 89.3% of wives faced violence verbally abused. The most important causes of domestic violence stated by women were husband relatives problems (33.1%), financial problems (21%), and household duties problems (e.g late preparing food, poor house hygiene) (20.8%). Concerning the psychosocial impact of violence upon wives health, 45% of wives faced violence not tell any one about abuse and keep it in her internal feeling, while 30.5% of them had a feeling of loneliness. A statistically significant difference was found between husband education, wife education and the presence of violence It was observed that as the education level of them increase the occurrence of violence became lesser. On the other hand, the results of the present study revealed that there is statistically significant difference between wife's age and violence, it was founded that about one third of wives who faced violence, their age ranged between 20-24 years and about 24.9% of them their age ranged between 25-29 years. Results of the qualitative part revealed that, women who don't face any type of violence since marriage stated that, love and respect between husbands was the key for being enjoy a stable and happy life till now. Based on the finding of the present study, it can be concluded that, domestic violence was found as a public health problem which has many consequences on health, physically and emotionally. The study recommended that health education programs should be directed toward increasing awareness of people about the problem of domestic violence and its effect upon family health and more studies should be directed toward studying the magnitude and prevalence of domestic violence. Thus community health care workers and other influential health providers can take the lead in introducing awareness and behavior change in the community. |
INTRODUCTION:
Violence against women cuts across social and economic situations and is deeply embedded in cultures around the world, so much so that millions of women consider it a way of life (Johnson, 1997). Domestic violence is a global problem that occurs regardless of culture, ethnicity, orientation, or socioeconomic class. In 2001, the U.S. Department of Justice found that more than half a million American women (588,490 women) were victims of nonfatal violence committed by Intimate Partners (Bureau of Justice Statistics Crime Data Brief, 2003).
In Egypt, an estimate of incidence of abuse is not widely available. However, the results of a survey conducted by the National Social and Criminal Research Center revealed that 50% of violent crimes were within families (Zayed & Nasr, 1996). The National Demographic Health Survey conducted in Egypt in 1996 found that 35% of ever- married women had been beaten at least once since marriage (El- Zanaty et al., 1996). Children who witnessed domestic violence are victims of abuse. Daughters who witnessed their mother abused often, accept abuse later when they grow up from their brothers and husbands, i.e. they will behave as her model (mother). (Gage, 1990). Battering also poses a significant danger to unborn children. Nursing research has found that as many as 15.9% of women and 21.7% of female adolescents report abuse during pregnancy (Parker, et al., 1993). In Arab and Islamic countries, domestic violence is also a major understudied social problem. Surveys in Egypt, Palestine, Israel and Tunisia show that at least one out of three women is beaten by her spouse (Douki et. Al., 2003). This is not to say that domestic violence is a muslim problem, since a fair reading of the Koran shows that domestic violence is entirely prohibited. It seems that the high rate of domestic violence in Islamic countries is a result of culture rather than religion. Women who are abused have poorer mental and physical health, more injuries, and a greater need for medical resources than non-abused women (Campbell, 2002). There are many different effects that are caused by domestic violence; health may be impaired, which includes any thing from minor injuries to chronic problems. Children and young women are also greatly affected through both experiencing and witnessing abuse. Intimate partner violence is associated with both short- and long- term problems, including physical injury and illness, psychological symptoms, economic costs and death (National Research Council 1996). Long term effects of domestic violence on women who have been abused may include: anxiety, chronic depression, chronic pain, death, dehydration, dissociative states, drug and alcohol dependence, eating disorders, emotional “over reactions” to stimuli, health problems, malnutrition, panic attacks, poor adherence to medical recommendations, poverty, repeated self- injury, self neglect, sexual dysfunction, sleep disorders, strained family relationships, suicide attempts and an inability to adequately respond to the needs of their children (Newton, 2001).
Nurses are often the first professionals to assess clients when they come to a health care facility; they are in position to identify women, children, and elders whose presenting problems are associated with abuse. Community health nursing is in a unique position to address the health needs related to violent behavior. Community nursing directs community health nurses toward establishing long-term relationships with individuals, families, and communities. They have the knowledge, perseverance, and sensitivity to assist clients in coping with the many concerns and health needs associated with violent behavior.
The present study aims to:
1-Study the magnitude of domestic violence against women who attend the outpatient clinics in Assiut University Hospitals.
2-Investigate the underlying factors behind it.
I-Setting: This study was conducted in four outpatient, clinics' namely antenatal, gynecological, family planning and sterility clinics affiliated to Assiut University Hospitals.
II-Subjects: women who attending the previously mentioned outpatient clinics. The total number of the interviewed women was 1000, selected by a quota sample. The magnitude of the problem (violence inflicted on the woman) was calculated as a percent from the total interviewees.
III-Tools of the study:
1-The quantitative part (structured interview):
This part consists from structured interview questionnaire which was designed to collect quantitative data about some items which includes:
Sociodemographic data such as wife and husband age, residence, educational level, wife age at marriage, occupation, family type and consanguinity, present and past history of wife abuse, history of obstetrical complications accompanied by spousal abuse, effect of spousal abuse upon the physical, psychological and social status of the women and the causes of wife's abuse.
2-The qualitative part (Focus group discussions):
Focus group discussion (FGD) are a powerful information gathering technique that uses small group discussion to identify views of people in the group about certain subject (Leebov, et al., 1991). This approach was selected to gain insight by encouraging participants to speak in their own words, to introduce related issues and to voice their concern during the course of the discussion. An interview guide was designed in Arabic language to obtain rich in- depth description of the wives belief and experiences about domestic violence, Participants were provided with an explanation of the purpose of the study, assured that their participation was voluntary and any information shared would remain confidential. To facilitate the group discussion, physical environment was prepared prior to the interview to ensure that each group member was physically comfortable as much as possible.
Methods:
I-Preparatory phase: It included the following activities:
Permission was obtained through an official letter to the Director of Assiut University Hospitals to carry out the study, after explanation of the aim and methods for data collection the data. An oral consent was obtained from women to participate in the study after explaining the purpose of the study.
Pilot study was carried out on 10% of women attend the previously mentioned clinics to test the clarity and relevance of the tools according to results of pilot study necessary modifications in the sheet were done. A structured interview method was used for data collection. The researcher read every question to the participant and obtained the participant’s responses and their feedback.
II-Data collection:
FGDs were conducted by the researcher as a moderator with the assistance of a note taker to write every thing during the interview, and a tape recorder was used. FGDs were approximately 30-40 minutes in length. The data yield from each of the focus group interviews were analyzed and categorized based on the recurrent themes that emerged.
III- Data analysis:
The obtained data were analyzed and tabulated. Descriptive statistics were calculated e.g. frequency, percentage, mean and standard deviation. Statistical analysis was applied and the relevant tests (Chi square tests) were done by SPSS version 11 statistical program. P value considered significant when its value ≤0.05% was adopted.
Results of this study were presented according in the following sequence:
Section I- results of quantitative study.
Table(1): shows sociodemographic charact-eristics of the studied sample. The mean age of wives was 26.89±6.55, more than half of women were illiterate of (54.2%). Only 5.6% of them were working for cash; more than half (56.3%) of them married at age of (15-19). The mean age at marriage was 19.01±3.72. Regarding to their husbands characteristics, their mean age was 32.84±8.43, one third of them were illiterate and about one third completed the secondary school education. Husbands were employees (25.4%) followed by farmer (23.8%). More than three quarters 78.2% live in rural areas compared to only 21.8% in urban areas, also half of them live in nuclear family, and two third of them (66.3%) had children and more than half (57%) of them had consanguinity with their husbands.
Figure (1) revealed that more than one third 41.3% of the studied sample had experienced one or more type of abuse.
As for types of abuse,table (2) shows that more than three quarters of them 89.3% verbally abused, 82.8% of them were physically abused by hitting, while about half of them were pushed, 41.2% pushed on the floor and more than one third of them pulled from hair. Regarding the psychosocial abuse facing wives, the present study revealed that, 14.2% of abused wives their husbands frustrate and inferior look to his wife, 11.1% of them their husbands prevent them from visiting relatives or friends and about 9.9% of abused wives their husbands prevent them to seek job.
Regarding the causes of domestic violence, table (3) revealed that one third 33.1% of stated causes by women who faced violence were due to husbands relatives problems, while 21% of causes were due to financial problems and 20.8% due to household duties (e.g late preparing food, poor house hygiene). Moreover, 19.1% of abused women mentioned that they were abused when refusing sex with their husbands, while 10.6% of causes due to children problems and 10.1% of causes when wife's reply on her husband instructions by bad words.
As regard the causes that prevent the abused wife from leaving home, figure (2) shows that among the abused wives who thinking about leaving home; 28% of them don't leave the house for many causes mentioned by them. The most important causes are fear about children, love her family, keeping her house from destruction and for traditions and values in a percent of 52.5%, 38.3%, 31.3%, and 16.1% respectively.
As regard the physical problems of physically abused women, table (4) shows that 26.8% had cyanosis in different parts of the body, while 9.9% of them had injuries, and there are (0.9%) women had bone fracture. Moreover, among the abused women 35.3% of them faced physical abuse during pregnancy. On the other hand, 8.2% of them had abortion and 1.3% of them had bleeding. As for the psychosocial problems facing the abused wives,it was noticed that about half of women not tell any one about abuse even their mothers and keep it secret, while more than one quarter 26.4% of them had a sense that they can not talk or discuss her own feelings with their husbands. On the other hand, about one third 30.5% of abused wives had a feeling of loneliness, and 19.9% had a feeling of unhappiness.
Table (5) shows the distribution of wife and husbands education in relation to violence. It was observed that the higher education of wives and husbands the lesser episodes of abuse. Statistically significant difference was observed between education of wife and violence also education of husband and violence, where (p ≤0.05 and p≤0.001 respectively).
Figure (3) shows the relationship between wives' age and experiences of violence. It was noticed that about one third 32.4% of abused wives, their age ranged between (20-24), while 24.9% their age ranged between (25-29). Moreover, 14.8% were in age group (30-34), and 13.8% their age between (35-39).
Table (6) shows the relationship between husbands' age and occurrence of violence. It was observed that one quarter (24.7%) of violent husband, their age ranged from (25-29), while 21.5% their age between (20-24). On the other hand, it was observed that 16.7% their age ranged from (30-34), and 14.3% their age ranged from (35-39). Statistically significant difference was observed between husband age and violence, where (P ≤ 0.05).
Table (7) shows the relationship between husbands' education and types of violence. It was noticed that verbal abuse was high (38.5%) among illiterate husbands and became lesser (3.5%) among university graduated husbands. Similarly, physical abuse by pushing, hitting, push on the floor and pulling hair was higher among illiterate husbands in a percent of (43%, 39.2%, 44.1% and 43.9%) respectively and it became lesser among husbands who achieve university education. Statistically significant difference was found between verbal abuse, physical abuse by pushing, push on the floor and pulling hair in their relation to husband education, where, (P ≤ 0.05).
Table (1): Demographic data of the studied subjects
Demographic variable |
(n= 1000) |
|
No |
% |
|
Wives age : ‹ 20 20-24 25-29 30-34 35-39 40+ |
78 349 249 150 117 57 |
7.8 34.9 24.9 15 11.7 5.7 |
Mean age 26.89±6.55 |
||
Wives age at marriage: ‹ 15 15-19 20-24 25-29 30-34 35+ |
56 563 300 61 15 5 |
5.6 56.3 30 6.1 1.5 0.5 |
Mean age at marriage 19.01±3.72 |
||
Wife Education: Illiterate Read & write Primary Preparatory Secondary University |
542 73 91 50 210 34 |
54.2 7.3 9.1 5 21 3.4 |
Wives occupation: Working for cash House wife |
56 944 |
5.6 94.4 |
Husband' age : ‹ 20 20-24 25-29 30-34 35-39 40+ |
57 246 268 177 139 113 |
5.7 24.6 26.8 17.7 13.9 11.3 |
Mean husband age 32.84±8.43 |
||
Husbands' education: Illiterate Read & write Primary Preparatory Secondary University |
341 158 63 55 313 70 |
34.1 15.8 6.3 5.5 31.3 7 |
Husband occupation: Unemployed Farmer Employee Skilled laborer Unskilled laborer Free biasness In military service Retired |
39 238 254 153 270 29 15 2 |
3.9 23.8 25.4 15.3 27 2.9 1.5 0.2 |
Residence: Rural Urban |
782 218 |
78.2 21.8 |
Family type: Nuclear Extended |
526 474 |
52.6 47.4 |
Having consanguinity |
570 |
57 |
Having children |
663 |
66.3 |
Fig.(1): Distribution of wives and husbands according to presence of violence
Table (2): Distribution of abused wives according to their exposure to the different types of violence
Variable |
(n=413) |
|
No |
% |
|
#Type of abuse: -Physical abuse: Pushing Hitting (by hand, with other object) Pushing on the floor Pulling hair
- Psychosocial abuse Verbal abuse Inferior look to his wife Prevent her visiting family/friends Prevent her seek job |
186 342 170 148
369 59 46 41 |
45 82.8 41.2 35.8
89.3 14.2 11.1 9.9 |
# More than one answer was stated
Table (3): Distribution causes of domestic violence among wives who experienced it
Causes of domestic violence# |
(n=413) |
|
No. |
% |
|
- Children problems - Household duties problems - Financial causes - Refusing to have sexual intercourse - Go out of house without his permission - delayed pregnancy/ husband refuse family planning - Husband relatives problems - Second wife/husband jealousy - Husband/children illness - wife's reply on her husband instructions by bad words - Problems in husband work/Husband addiction /smoking - Neighbors/problems with wife family |
44 86 87 79 21 34 137 32 11 42 32 4 |
10.6 20.8 21 19.1 5 8.2 33.1 7.7 2.6 10.1 7.7 1 |
# More than one cause was stated
Fig. (2): Distribution of Causes that prevent the wives from leaving their homes
Table (4): The effect of violence on wives' health
Effect of violence on health |
(n=413) |
|
No. |
% |
|
Physical violence during pregnancy Effect on pregnancy as: - Bleeding - Abortion Physical effect of violence as: # - injuries - Cyanosis - Fracture Psychosocial problems as: # -Can not talk with husband about her own feelings - Feeling of loneliness - Not tell anyone about abuse - Feeling of unhappiness |
146
2 12
41 111 4
109 126 186 82 |
35.3
1.3 8.2
9.9 26.8 0.9
26.4 30.5 45 19.9 |
# More than one answer was stated
Table (5): Wives & husbands education in relation to violence
Husbands' Education |
Violence (n=413) |
|||
Wife |
Husband |
|||
No. |
% |
No. |
% |
|
Illiterate |
239 |
57.9 |
153 |
37 |
Read& write |
33 |
8 |
75 |
18.2 |
Primary |
35 |
8.5 |
28 |
6.8 |
Preparatory |
23 |
5.6 |
24 |
5.8 |
Secondary |
79 |
19.1 |
115 |
27.8 |
University |
4 |
1 |
18 |
4.4 |
X2 |
0.005* |
0.001* |
* Significant
Fig. (3): Relationship between wives' age and experiences of violence.
Table (6): Relationship between husbands' age and occurrence of violence
Husband age' group |
Violence (n= 413) |
X2 |
|
No. |
% |
||
‹ 20 |
24 |
5.8 |
.000* |
20-24 |
89 |
21.5 |
|
25-29 |
102 |
24.7 |
|
30-34 |
69 |
16.7 |
|
35-39 |
59 |
14.3 |
|
40+ |
70 |
16.9 |
* Significant
Table (7): Relationship between husbands' education and types of violence
husbands' Education |
Types of Violence |
||||
Verbal |
Physical Violence |
||||
Pushing |
Hitting |
Push on the floor |
Pulling hair |
||
Illiterate |
142 (38.5%) |
80 (43%) |
134 (39.2%) |
75 (44.1%) |
65 (43.9%) |
Read & write |
68 (18.4%) |
32 (17.2%) |
57 (16.7%) |
26 (15.3%) |
26 (17.6%) |
Primary |
27 (7.3%) |
16 (8.6%) |
25 (7.3%) |
14 (8.2%) |
13 (8.8%) |
Preparatory |
19 (5.1%) |
12 (6.5%) |
21 (6.1%) |
10 (5.9%) |
8 (5.4%) |
Secondary |
100 (27.1%) |
40 (21.5%) |
91 (26.6%) |
39 (22.9%) |
35 (23.6%) |
University |
13 (3.5%) |
6 (3.2%) |
14 (4.1%) |
6 (3.5%) |
1 (0.7%) |
p. value |
p=0.010* |
p=0.007* |
p=0.154NS |
p=0.026* |
p=0.005* |
Total |
369 89.3% |
186 45% |
342 82.2% |
170 41.2% |
148 35.83% |
* Significant NS = Not significant
II- Results of qualitative study (FGDs):
Wives in this part of the study had verbalized their knowledge, experiences regarding domestic violence. In this regard, three main categories were expressed:
A-Wives perception of domestic violence.
B- Factors that influence domestic violence.
C-Reaction of wives regarding domestic violence.
There were a total number of 33 participants who respond to share in focus group discussion.
A- Participants perception of domestic violence (D.V):
A-1- What the term domestic violence means?
Participants were asked to describe what to them constitutes D.V. Two thirds of the participants don't know anything about D.V, and the rest of them describe D.V in different ways. Cited below, are a few sample of how FGD participants described D.V:
-To me domestic violence means using physical force.
- D.V. is any kind of abuse.
- D.V. can define as misunderstanding between the woman and man.
- D.V. is any problems between spouses in the home.
A-2- Is there any type of abuse occurred to any one of you?
Participants were asked to verbalize their experiences of abuse. After they gain a sense of confidentiality and the group became familiar to each other, they began to express their history of being abused by their husbands. About half of the participants had a past history of physical abuse and more than one third of them abused verbally.
A-Factors influence domestic violence:
What are the causes that can provoke domestic violence?
Participants were asked to describe the factors and causes that can emerge a marital conflict lead to abuse. The three most cited factors as having influence on D.V were home duties, financial pressure and children. Other factors mentioned as having negative influence on D.V were her mother in law; go out side home without husband permission and late pregnancy.
B-Reaction of wives towards domestic violence:
C-1What is your reactions when any one of you faced violence?
All Wives had a history of abuse stated that they cannot defend their selves or wife's reply on her husband instructions by bad words because it is not from their traditions and cultures they bringing up on it.
Most of participants stated that they thinking about leaving home but they don't do for bringing up their children and because there is a love between the two spouses.
C-2 what are the factors that can help domestic violence not occurring?
Wives, who don't experience any kind of abuse since they married, stated that love and understanding between spouses is the key for their happy life.
Two thirds of participants stated that it is very useful if there is a clinic present a service for domestic violence management; they will come if it is found to seek help when a marital conflict occur and it must be for the two spouses not the wife only.
DISCUSSION:
Wives' age play an important role in the occurrence of violence, the present study revealed that wives faced violence were significantly younger. It means that as the age of wife increase, the lesser that she experience violence. This result was consistent to that reported by Kandeel et al., 2003, Abou El-Naga 2001, Hassan 1997, and Goldberg & Tomlanovich 1984. The present study highlighted how wives perceived domestic violence and how they react with it. A qualitative study [FGDs] was carried out to explore the nature of domestic violence as perceived by wives. The following questions guided the analysis of the data: what the term domestic violence means? What are the types of domestic violence faced participants? What are the factors influence domestic violence? What is the reaction of wives towards domestic violence?. El Rafei and Mekheimar, 2004 stated that, interventional studies are lacking, especially in developing countries. Egypt is no exception- only limited studies can be found on what is acknowledged to be a pressing topic. Wife beating is very much under- reported and under- documented; due to the social conventions and pressures that lead individuals to keep silent about this issue. The human cost in grief and pain is difficult to calculate. Its prevalence is also under estimated around the world as it can be defined only against a backdrop of local cultures, traditions and customs. The result of the present qualitative study supports that of the quantitative study. It shows that, several factors were mentioned by the participants to be the most causes that can emerge a marital conflict on the home; it included the household duties, financial causes and concern for children.
Based on the findings of the present study, it can be concluded that, the main causes of domestic violence against women were mothers in law problems due to living in a shared house with extended families, household duties problems, children problems, sexual and financial causes. Demographic factors contributing to a predisposition for violence were pinpointed. These include a wife and husband age and education, wife age at marriage, family type and having children. Societal factors included cultural norms and attitudes play an important role in the wife decision to don't leave the home although experiencing domestic violence.
From the results of the present study the following could be recommended:
1-Reaching out the men to change their behaviors is an important part of the solution of the problem.
2-The primary goal is to make men accept personal responsibility for their violent behavior and to teach them non- violent way to manage their anger and inter-personal conflict.
3-Health education programs should be directed toward increasing awareness of people about the problem of domestic violence.
4-More studies should be conducted about the magnitude and prevalence of domestic violence and how to manage it.
5-Focus discussion sessions in this field of
study was lack, so it should be increased as it helped women to overcome their structural isolation and realize that their individual sufferings have social causes and are, in some ways, shared by other women.
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أسماء غريب محمد*، همام محمد همام**، محاسن أحمد عبد الواحد***،
هدى دياب فهمى إبراهيم *، شکرية عدلى لبيب*
* قسم تمريض صحة المجتمع بکلية التمريض- جامعة أسيوط
** قسم طب المجتمع بکلية الطب - جامعة أسيوط
*** قسم تمريض صحة المجتمع بکلية التمريض - جامعة الأسکندرية
تهدف هذه الدراسة إلى دراسة حجم العنف الأسرى بين المترددات على العيادات الخارجية بمستشفيات جامعة أسيوط والتعرف علي العوامل التي تساعد علي حدوث العنف الأسرى. وقد أجريت الدراسة علي 1000 سيدة ممن تتراوح أعمارهن ما بين 18-49 عاماً، واللائى يترددن لطلب الخدمة من بعض العيادات الخارجية بمستسقيات أسيوط الجامعية، وهي عيادة الحوامل وعيادة أمراض النساء وعيادة تنظيم الأسرة وعيادة العقم. وقد تم جمع بيانات هذه الدراسة کمى وکيفى بطريقتين الأولى هي المقابلة الشخصية والتي استخدمت لجمع البيانات الشخصية والاجتماعية، تاريخ التعرض للعنف والأسباب وراء حدوث العنف وتأثير العنف علي الناحية الصحية للمرأة. والثانية هي الجزء الوصفي عن طريق عقد مناقشات المؤثرة لبعض المجموعات من السيدات لمناقشة مشکلة العنف الأسرى ومعرفة أداء السيدات تجاه العنف الأسرى، وقد تم جمع بيانات هذه الدراسة فى الفترة من أکتوبر 2003 إلى سبتمبر 2004 .
وقد أظهرت النتائج ما يلى :بالنسبة للحالة التعليمية فإنه وجد أن (54.2٪) من الزوجات وحوالي ثلث (34.1٪) من الأزواج أميين، بينما (21٪) من الزوجات، (31.3٪) من الأزواج تخرجوا من مدارس ثانوية∙ کانتالأغلبية من السيدات ربات منزل بينما25.4٪ من الأزواج موظفين. وبالنسبة لمحل الإقامة أکثرمن ثلاثة أرباع (78.2٪) من عينة الدراسة کانوا من أماکن ريفية بالمقارنةڊ (21.8٪) من أماکن حضرية∙ وبالنسبة لتاريخ تعرض الزوجات للعنف فإنه وجد أن (41.3٪) من عينة الدراسة تعرضن لنوع أو أکثر من العنف. کان العنف الجسدي في صورة زق، ضرب، زق على الأرض، وشد شعر بنسب (45٪، 82.8٪ ،41.2٪، 35.8٪) بالتتابع.وقد أ ظهرت الدراسة أن من بين العنف النفسي الاجتماعي للزوجات اللائى تعرضن للعنف (89.3٪) منهن عنفوا لفظياکذلک أظهرت النتائج أن ثلث أسباب العنف الأسرى کانت ترجع إلى مشاکل خاصة مع أسرة الزوج، بينما (21٪) من الأسباب ترجع إلى مشاکل مادية، (20.8٪) ترجع إلى مشاکل خاصة بشئون المنزل∙ وبالنسبة للتأثير النفسي الاجتماعي للعنف على صحة الزوجات فقد أظهرت الدراسة أن (45٪) من السيدات اللائي تعرضن للعنف لا يخبرن أحد عما حدث لهن وتجعل ذلک بداخلها فقط، بينما (30.5٪) منهن لديهن الشعور يعانين من الشعور بالوحدة. ولقد أظهرت نتائج هذه الدراسة وجود علاقة ذات دلالة إحصائية بين تعليم الزوج والزوجة وحدوث العنف حيث أنه لوحظ کلما ارتفع المستوى التعليمي لأي منهما کان حدوث العنف أقل، وکذلکتبين وجود علاقة ذات دلالة إحصائية بين عمر الزوجة وحدوث العنف،حيث وجد أن حوالي ثلث السيدات اللائي تعرضن للعنف کانت أعمارهن تترواح مابين (20-24سنة)، (24.9٪) منهن کانت أعمارهن مابين (25-29 سنة). وقد أظهرت نتائج الجزء الوصفي من الدراسة أن السيدات اللائي لم يتعرضن لأي نوع من العنف الأسري منذ الزواج ذکرن أن الحب والاحترام بين الزوجين کان السبب وراء بقاء الحياة مستقرة إلى الآن.وقد استخلصت الدراسة أن العنف الأسرى هو مشکلة عامة ينتج عنها أثار جسمانية ونفسية واجتماعية تؤثر علي صحة المرأة . وقد أوصت الدراسة بأنه يجب أن توجه برامج التثقيف الصحي نحو زيادة الوعي حول مشکلة العنف الأسرى وأثارها علي صحة الأسرة ککل کما يجب أن توجه الدراسات نحو دراسة حجم ومعدل انتشار العنف وکيفية التصدي له
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AUCES |
STUDY OF DOMESTIC VIOLENCE AGAINST WOMEN ATTENDING OUT PATIENT CLINICS IN ASSIUT UNIVERSITY HOSPITALS
Asmaa Ghareeb Mohamed*, Hammam Mohamed Hammam**, Mahasen Ahmed Abd El-Wahed***, Hoda Diab Fahmy Ibrahim*, and Shokria Adly Labib*
*Community Health Nursing Department, Faculty of Nursing, Assiut University
** Community Medicine Department, Faculty of Medicine, Assiut University
***Community Health Nursing Department, Faculty of Nursing, Alexandria University
ABSTRACT: |
This study aimed to identify the magnitude of domestic violence and to assess the underlying factors for it among women seeking medical care from out patient clinics in Assiut University Hospitals. The study was conducted in four out patient clinics (antenatal, gynecological, family planning and sterility clinics) affiliated to Assiut University Hospitals. The studied sample age ranged from 18-49 years. The total number of the women was 1000. Two tools for data collection were used a quantitative (structured interview questionaire) used to collect data such as socio-demographic data, history of violence, underlying causes, health effects of violence upon women health status and a qualitative (FGDs) focus group discussions which utilized to gain insight and identify views of women regarding domestic violence. Data was collected during the period from October 2003 to September 2004. The results of the study revealed that 54.2% of wives and one third of (34.1%) of husbands were illiterate, while (21%) of wives and (31.3%) of husbands graduated from secondary school. The vast majority of the women were housewives, while 25.4% of husbands were employees. Regarding the residence, more than three quarters 78.2% of the study sample lives in rural areas, compared to 21.8% in urban areas. Concerning the history of violence against the wives, 41.3% of the studied sample experienced one or more types of violence. Physical violence was reported in the form of pushing, hitting, pushing on the floor and pulling hair in a percentage of 45%, 82.8%, 41.2% and 35.8%, respectively. As regard to the psychological abuse, the results show that 89.3% of wives faced violence verbally abused. The most important causes of domestic violence stated by women were husband relatives problems (33.1%), financial problems (21%), and household duties problems (e.g late preparing food, poor house hygiene) (20.8%). Concerning the psychosocial impact of violence upon wives health, 45% of wives faced violence not tell any one about abuse and keep it in her internal feeling, while 30.5% of them had a feeling of loneliness. A statistically significant difference was found between husband education, wife education and the presence of violence It was observed that as the education level of them increase the occurrence of violence became lesser. On the other hand, the results of the present study revealed that there is statistically significant difference between wife's age and violence, it was founded that about one third of wives who faced violence, their age ranged between 20-24 years and about 24.9% of them their age ranged between 25-29 years. Results of the qualitative part revealed that, women who don't face any type of violence since marriage stated that, love and respect between husbands was the key for being enjoy a stable and happy life till now. Based on the finding of the present study, it can be concluded that, domestic violence was found as a public health problem which has many consequences on health, physically and emotionally. The study recommended that health education programs should be directed toward increasing awareness of people about the problem of domestic violence and its effect upon family health and more studies should be directed toward studying the magnitude and prevalence of domestic violence. Thus community health care workers and other influential health providers can take the lead in introducing awareness and behavior change in the community. |
INTRODUCTION:
Violence against women cuts across social and economic situations and is deeply embedded in cultures around the world, so much so that millions of women consider it a way of life (Johnson, 1997). Domestic violence is a global problem that occurs regardless of culture, ethnicity, orientation, or socioeconomic class. In 2001, the U.S. Department of Justice found that more than half a million American women (588,490 women) were victims of nonfatal violence committed by Intimate Partners (Bureau of Justice Statistics Crime Data Brief, 2003).
In Egypt, an estimate of incidence of abuse is not widely available. However, the results of a survey conducted by the National Social and Criminal Research Center revealed that 50% of violent crimes were within families (Zayed & Nasr, 1996). The National Demographic Health Survey conducted in Egypt in 1996 found that 35% of ever- married women had been beaten at least once since marriage (El- Zanaty et al., 1996). Children who witnessed domestic violence are victims of abuse. Daughters who witnessed their mother abused often, accept abuse later when they grow up from their brothers and husbands, i.e. they will behave as her model (mother). (Gage, 1990). Battering also poses a significant danger to unborn children. Nursing research has found that as many as 15.9% of women and 21.7% of female adolescents report abuse during pregnancy (Parker, et al., 1993). In Arab and Islamic countries, domestic violence is also a major understudied social problem. Surveys in Egypt, Palestine, Israel and Tunisia show that at least one out of three women is beaten by her spouse (Douki et. Al., 2003). This is not to say that domestic violence is a muslim problem, since a fair reading of the Koran shows that domestic violence is entirely prohibited. It seems that the high rate of domestic violence in Islamic countries is a result of culture rather than religion. Women who are abused have poorer mental and physical health, more injuries, and a greater need for medical resources than non-abused women (Campbell, 2002). There are many different effects that are caused by domestic violence; health may be impaired, which includes any thing from minor injuries to chronic problems. Children and young women are also greatly affected through both experiencing and witnessing abuse. Intimate partner violence is associated with both short- and long- term problems, including physical injury and illness, psychological symptoms, economic costs and death (National Research Council 1996). Long term effects of domestic violence on women who have been abused may include: anxiety, chronic depression, chronic pain, death, dehydration, dissociative states, drug and alcohol dependence, eating disorders, emotional “over reactions” to stimuli, health problems, malnutrition, panic attacks, poor adherence to medical recommendations, poverty, repeated self- injury, self neglect, sexual dysfunction, sleep disorders, strained family relationships, suicide attempts and an inability to adequately respond to the needs of their children (Newton, 2001).
Nurses are often the first professionals to assess clients when they come to a health care facility; they are in position to identify women, children, and elders whose presenting problems are associated with abuse. Community health nursing is in a unique position to address the health needs related to violent behavior. Community nursing directs community health nurses toward establishing long-term relationships with individuals, families, and communities. They have the knowledge, perseverance, and sensitivity to assist clients in coping with the many concerns and health needs associated with violent behavior.
The present study aims to:
1-Study the magnitude of domestic violence against women who attend the outpatient clinics in Assiut University Hospitals.
2-Investigate the underlying factors behind it.
I-Setting: This study was conducted in four outpatient, clinics' namely antenatal, gynecological, family planning and sterility clinics affiliated to Assiut University Hospitals.
II-Subjects: women who attending the previously mentioned outpatient clinics. The total number of the interviewed women was 1000, selected by a quota sample. The magnitude of the problem (violence inflicted on the woman) was calculated as a percent from the total interviewees.
III-Tools of the study:
1-The quantitative part (structured interview):
This part consists from structured interview questionnaire which was designed to collect quantitative data about some items which includes:
Sociodemographic data such as wife and husband age, residence, educational level, wife age at marriage, occupation, family type and consanguinity, present and past history of wife abuse, history of obstetrical complications accompanied by spousal abuse, effect of spousal abuse upon the physical, psychological and social status of the women and the causes of wife's abuse.
2-The qualitative part (Focus group discussions):
Focus group discussion (FGD) are a powerful information gathering technique that uses small group discussion to identify views of people in the group about certain subject (Leebov, et al., 1991). This approach was selected to gain insight by encouraging participants to speak in their own words, to introduce related issues and to voice their concern during the course of the discussion. An interview guide was designed in Arabic language to obtain rich in- depth description of the wives belief and experiences about domestic violence, Participants were provided with an explanation of the purpose of the study, assured that their participation was voluntary and any information shared would remain confidential. To facilitate the group discussion, physical environment was prepared prior to the interview to ensure that each group member was physically comfortable as much as possible.
Methods:
I-Preparatory phase: It included the following activities:
Permission was obtained through an official letter to the Director of Assiut University Hospitals to carry out the study, after explanation of the aim and methods for data collection the data. An oral consent was obtained from women to participate in the study after explaining the purpose of the study.
Pilot study was carried out on 10% of women attend the previously mentioned clinics to test the clarity and relevance of the tools according to results of pilot study necessary modifications in the sheet were done. A structured interview method was used for data collection. The researcher read every question to the participant and obtained the participant’s responses and their feedback.
II-Data collection:
FGDs were conducted by the researcher as a moderator with the assistance of a note taker to write every thing during the interview, and a tape recorder was used. FGDs were approximately 30-40 minutes in length. The data yield from each of the focus group interviews were analyzed and categorized based on the recurrent themes that emerged.
III- Data analysis:
The obtained data were analyzed and tabulated. Descriptive statistics were calculated e.g. frequency, percentage, mean and standard deviation. Statistical analysis was applied and the relevant tests (Chi square tests) were done by SPSS version 11 statistical program. P value considered significant when its value ≤0.05% was adopted.
Results of this study were presented according in the following sequence:
Section I- results of quantitative study.
Table(1): shows sociodemographic charact-eristics of the studied sample. The mean age of wives was 26.89±6.55, more than half of women were illiterate of (54.2%). Only 5.6% of them were working for cash; more than half (56.3%) of them married at age of (15-19). The mean age at marriage was 19.01±3.72. Regarding to their husbands characteristics, their mean age was 32.84±8.43, one third of them were illiterate and about one third completed the secondary school education. Husbands were employees (25.4%) followed by farmer (23.8%). More than three quarters 78.2% live in rural areas compared to only 21.8% in urban areas, also half of them live in nuclear family, and two third of them (66.3%) had children and more than half (57%) of them had consanguinity with their husbands.
Figure (1) revealed that more than one third 41.3% of the studied sample had experienced one or more type of abuse.
As for types of abuse,table (2) shows that more than three quarters of them 89.3% verbally abused, 82.8% of them were physically abused by hitting, while about half of them were pushed, 41.2% pushed on the floor and more than one third of them pulled from hair. Regarding the psychosocial abuse facing wives, the present study revealed that, 14.2% of abused wives their husbands frustrate and inferior look to his wife, 11.1% of them their husbands prevent them from visiting relatives or friends and about 9.9% of abused wives their husbands prevent them to seek job.
Regarding the causes of domestic violence, table (3) revealed that one third 33.1% of stated causes by women who faced violence were due to husbands relatives problems, while 21% of causes were due to financial problems and 20.8% due to household duties (e.g late preparing food, poor house hygiene). Moreover, 19.1% of abused women mentioned that they were abused when refusing sex with their husbands, while 10.6% of causes due to children problems and 10.1% of causes when wife's reply on her husband instructions by bad words.
As regard the causes that prevent the abused wife from leaving home, figure (2) shows that among the abused wives who thinking about leaving home; 28% of them don't leave the house for many causes mentioned by them. The most important causes are fear about children, love her family, keeping her house from destruction and for traditions and values in a percent of 52.5%, 38.3%, 31.3%, and 16.1% respectively.
As regard the physical problems of physically abused women, table (4) shows that 26.8% had cyanosis in different parts of the body, while 9.9% of them had injuries, and there are (0.9%) women had bone fracture. Moreover, among the abused women 35.3% of them faced physical abuse during pregnancy. On the other hand, 8.2% of them had abortion and 1.3% of them had bleeding. As for the psychosocial problems facing the abused wives,it was noticed that about half of women not tell any one about abuse even their mothers and keep it secret, while more than one quarter 26.4% of them had a sense that they can not talk or discuss her own feelings with their husbands. On the other hand, about one third 30.5% of abused wives had a feeling of loneliness, and 19.9% had a feeling of unhappiness.
Table (5) shows the distribution of wife and husbands education in relation to violence. It was observed that the higher education of wives and husbands the lesser episodes of abuse. Statistically significant difference was observed between education of wife and violence also education of husband and violence, where (p ≤0.05 and p≤0.001 respectively).
Figure (3) shows the relationship between wives' age and experiences of violence. It was noticed that about one third 32.4% of abused wives, their age ranged between (20-24), while 24.9% their age ranged between (25-29). Moreover, 14.8% were in age group (30-34), and 13.8% their age between (35-39).
Table (6) shows the relationship between husbands' age and occurrence of violence. It was observed that one quarter (24.7%) of violent husband, their age ranged from (25-29), while 21.5% their age between (20-24). On the other hand, it was observed that 16.7% their age ranged from (30-34), and 14.3% their age ranged from (35-39). Statistically significant difference was observed between husband age and violence, where (P ≤ 0.05).
Table (7) shows the relationship between husbands' education and types of violence. It was noticed that verbal abuse was high (38.5%) among illiterate husbands and became lesser (3.5%) among university graduated husbands. Similarly, physical abuse by pushing, hitting, push on the floor and pulling hair was higher among illiterate husbands in a percent of (43%, 39.2%, 44.1% and 43.9%) respectively and it became lesser among husbands who achieve university education. Statistically significant difference was found between verbal abuse, physical abuse by pushing, push on the floor and pulling hair in their relation to husband education, where, (P ≤ 0.05).
Table (1): Demographic data of the studied subjects
Demographic variable |
(n= 1000) |
|
No |
% |
|
Wives age : ‹ 20 20-24 25-29 30-34 35-39 40+ |
78 349 249 150 117 57 |
7.8 34.9 24.9 15 11.7 5.7 |
Mean age 26.89±6.55 |
||
Wives age at marriage: ‹ 15 15-19 20-24 25-29 30-34 35+ |
56 563 300 61 15 5 |
5.6 56.3 30 6.1 1.5 0.5 |
Mean age at marriage 19.01±3.72 |
||
Wife Education: Illiterate Read & write Primary Preparatory Secondary University |
542 73 91 50 210 34 |
54.2 7.3 9.1 5 21 3.4 |
Wives occupation: Working for cash House wife |
56 944 |
5.6 94.4 |
Husband' age : ‹ 20 20-24 25-29 30-34 35-39 40+ |
57 246 268 177 139 113 |
5.7 24.6 26.8 17.7 13.9 11.3 |
Mean husband age 32.84±8.43 |
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Husbands' education: Illiterate Read & write Primary Preparatory Secondary University |
341 158 63 55 313 70 |
34.1 15.8 6.3 5.5 31.3 7 |
Husband occupation: Unemployed Farmer Employee Skilled laborer Unskilled laborer Free biasness In military service Retired |
39 238 254 153 270 29 15 2 |
3.9 23.8 25.4 15.3 27 2.9 1.5 0.2 |
Residence: Rural Urban |
782 218 |
78.2 21.8 |
Family type: Nuclear Extended |
526 474 |
52.6 47.4 |
Having consanguinity |
570 |
57 |
Having children |
663 |
66.3 |
Fig.(1): Distribution of wives and husbands according to presence of violence
Table (2): Distribution of abused wives according to their exposure to the different types of violence
Variable |
(n=413) |
|
No |
% |
|
#Type of abuse: -Physical abuse: Pushing Hitting (by hand, with other object) Pushing on the floor Pulling hair
- Psychosocial abuse Verbal abuse Inferior look to his wife Prevent her visiting family/friends Prevent her seek job |
186 342 170 148
369 59 46 41 |
45 82.8 41.2 35.8
89.3 14.2 11.1 9.9 |
# More than one answer was stated
Table (3): Distribution causes of domestic violence among wives who experienced it
Causes of domestic violence# |
(n=413) |
|
No. |
% |
|
- Children problems - Household duties problems - Financial causes - Refusing to have sexual intercourse - Go out of house without his permission - delayed pregnancy/ husband refuse family planning - Husband relatives problems - Second wife/husband jealousy - Husband/children illness - wife's reply on her husband instructions by bad words - Problems in husband work/Husband addiction /smoking - Neighbors/problems with wife family |
44 86 87 79 21 34 137 32 11 42 32 4 |
10.6 20.8 21 19.1 5 8.2 33.1 7.7 2.6 10.1 7.7 1 |
# More than one cause was stated
Fig. (2): Distribution of Causes that prevent the wives from leaving their homes
Table (4): The effect of violence on wives' health
Effect of violence on health |
(n=413) |
|
No. |
% |
|
Physical violence during pregnancy Effect on pregnancy as: - Bleeding - Abortion Physical effect of violence as: # - injuries - Cyanosis - Fracture Psychosocial problems as: # -Can not talk with husband about her own feelings - Feeling of loneliness - Not tell anyone about abuse - Feeling of unhappiness |
146
2 12
41 111 4
109 126 186 82 |
35.3
1.3 8.2
9.9 26.8 0.9
26.4 30.5 45 19.9 |
# More than one answer was stated
Table (5): Wives & husbands education in relation to violence
Husbands' Education |
Violence (n=413) |
|||
Wife |
Husband |
|||
No. |
% |
No. |
% |
|
Illiterate |
239 |
57.9 |
153 |
37 |
Read& write |
33 |
8 |
75 |
18.2 |
Primary |
35 |
8.5 |
28 |
6.8 |
Preparatory |
23 |
5.6 |
24 |
5.8 |
Secondary |
79 |
19.1 |
115 |
27.8 |
University |
4 |
1 |
18 |
4.4 |
X2 |
0.005* |
0.001* |
* Significant
Fig. (3): Relationship between wives' age and experiences of violence.
Table (6): Relationship between husbands' age and occurrence of violence
Husband age' group |
Violence (n= 413) |
X2 |
|
No. |
% |
||
‹ 20 |
24 |
5.8 |
.000* |
20-24 |
89 |
21.5 |
|
25-29 |
102 |
24.7 |
|
30-34 |
69 |
16.7 |
|
35-39 |
59 |
14.3 |
|
40+ |
70 |
16.9 |
* Significant
Table (7): Relationship between husbands' education and types of violence
husbands' Education |
Types of Violence |
||||
Verbal |
Physical Violence |
||||
Pushing |
Hitting |
Push on the floor |
Pulling hair |
||
Illiterate |
142 (38.5%) |
80 (43%) |
134 (39.2%) |
75 (44.1%) |
65 (43.9%) |
Read & write |
68 (18.4%) |
32 (17.2%) |
57 (16.7%) |
26 (15.3%) |
26 (17.6%) |
Primary |
27 (7.3%) |
16 (8.6%) |
25 (7.3%) |
14 (8.2%) |
13 (8.8%) |
Preparatory |
19 (5.1%) |
12 (6.5%) |
21 (6.1%) |
10 (5.9%) |
8 (5.4%) |
Secondary |
100 (27.1%) |
40 (21.5%) |
91 (26.6%) |
39 (22.9%) |
35 (23.6%) |
University |
13 (3.5%) |
6 (3.2%) |
14 (4.1%) |
6 (3.5%) |
1 (0.7%) |
p. value |
p=0.010* |
p=0.007* |
p=0.154NS |
p=0.026* |
p=0.005* |
Total |
369 89.3% |
186 45% |
342 82.2% |
170 41.2% |
148 35.83% |
* Significant NS = Not significant
II- Results of qualitative study (FGDs):
Wives in this part of the study had verbalized their knowledge, experiences regarding domestic violence. In this regard, three main categories were expressed:
A-Wives perception of domestic violence.
B- Factors that influence domestic violence.
C-Reaction of wives regarding domestic violence.
There were a total number of 33 participants who respond to share in focus group discussion.
A- Participants perception of domestic violence (D.V):
A-1- What the term domestic violence means?
Participants were asked to describe what to them constitutes D.V. Two thirds of the participants don't know anything about D.V, and the rest of them describe D.V in different ways. Cited below, are a few sample of how FGD participants described D.V:
-To me domestic violence means using physical force.
- D.V. is any kind of abuse.
- D.V. can define as misunderstanding between the woman and man.
- D.V. is any problems between spouses in the home.
A-2- Is there any type of abuse occurred to any one of you?
Participants were asked to verbalize their experiences of abuse. After they gain a sense of confidentiality and the group became familiar to each other, they began to express their history of being abused by their husbands. About half of the participants had a past history of physical abuse and more than one third of them abused verbally.
A-Factors influence domestic violence:
What are the causes that can provoke domestic violence?
Participants were asked to describe the factors and causes that can emerge a marital conflict lead to abuse. The three most cited factors as having influence on D.V were home duties, financial pressure and children. Other factors mentioned as having negative influence on D.V were her mother in law; go out side home without husband permission and late pregnancy.
B-Reaction of wives towards domestic violence:
C-1What is your reactions when any one of you faced violence?
All Wives had a history of abuse stated that they cannot defend their selves or wife's reply on her husband instructions by bad words because it is not from their traditions and cultures they bringing up on it.
Most of participants stated that they thinking about leaving home but they don't do for bringing up their children and because there is a love between the two spouses.
C-2 what are the factors that can help domestic violence not occurring?
Wives, who don't experience any kind of abuse since they married, stated that love and understanding between spouses is the key for their happy life.
Two thirds of participants stated that it is very useful if there is a clinic present a service for domestic violence management; they will come if it is found to seek help when a marital conflict occur and it must be for the two spouses not the wife only.
DISCUSSION:
Wives' age play an important role in the occurrence of violence, the present study revealed that wives faced violence were significantly younger. It means that as the age of wife increase, the lesser that she experience violence. This result was consistent to that reported by Kandeel et al., 2003, Abou El-Naga 2001, Hassan 1997, and Goldberg & Tomlanovich 1984. The present study highlighted how wives perceived domestic violence and how they react with it. A qualitative study [FGDs] was carried out to explore the nature of domestic violence as perceived by wives. The following questions guided the analysis of the data: what the term domestic violence means? What are the types of domestic violence faced participants? What are the factors influence domestic violence? What is the reaction of wives towards domestic violence?. El Rafei and Mekheimar, 2004 stated that, interventional studies are lacking, especially in developing countries. Egypt is no exception- only limited studies can be found on what is acknowledged to be a pressing topic. Wife beating is very much under- reported and under- documented; due to the social conventions and pressures that lead individuals to keep silent about this issue. The human cost in grief and pain is difficult to calculate. Its prevalence is also under estimated around the world as it can be defined only against a backdrop of local cultures, traditions and customs. The result of the present qualitative study supports that of the quantitative study. It shows that, several factors were mentioned by the participants to be the most causes that can emerge a marital conflict on the home; it included the household duties, financial causes and concern for children.
Based on the findings of the present study, it can be concluded that, the main causes of domestic violence against women were mothers in law problems due to living in a shared house with extended families, household duties problems, children problems, sexual and financial causes. Demographic factors contributing to a predisposition for violence were pinpointed. These include a wife and husband age and education, wife age at marriage, family type and having children. Societal factors included cultural norms and attitudes play an important role in the wife decision to don't leave the home although experiencing domestic violence.
From the results of the present study the following could be recommended:
1-Reaching out the men to change their behaviors is an important part of the solution of the problem.
2-The primary goal is to make men accept personal responsibility for their violent behavior and to teach them non- violent way to manage their anger and inter-personal conflict.
3-Health education programs should be directed toward increasing awareness of people about the problem of domestic violence.
4-More studies should be conducted about the magnitude and prevalence of domestic violence and how to manage it.
5-Focus discussion sessions in this field of
study was lack, so it should be increased as it helped women to overcome their structural isolation and realize that their individual sufferings have social causes and are, in some ways, shared by other women.
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أسماء غريب محمد*، همام محمد همام**، محاسن أحمد عبد الواحد***،
هدى دياب فهمى إبراهيم *، شکرية عدلى لبيب*
* قسم تمريض صحة المجتمع بکلية التمريض- جامعة أسيوط
** قسم طب المجتمع بکلية الطب - جامعة أسيوط
*** قسم تمريض صحة المجتمع بکلية التمريض - جامعة الأسکندرية
تهدف هذه الدراسة إلى دراسة حجم العنف الأسرى بين المترددات على العيادات الخارجية بمستشفيات جامعة أسيوط والتعرف علي العوامل التي تساعد علي حدوث العنف الأسرى. وقد أجريت الدراسة علي 1000 سيدة ممن تتراوح أعمارهن ما بين 18-49 عاماً، واللائى يترددن لطلب الخدمة من بعض العيادات الخارجية بمستسقيات أسيوط الجامعية، وهي عيادة الحوامل وعيادة أمراض النساء وعيادة تنظيم الأسرة وعيادة العقم. وقد تم جمع بيانات هذه الدراسة کمى وکيفى بطريقتين الأولى هي المقابلة الشخصية والتي استخدمت لجمع البيانات الشخصية والاجتماعية، تاريخ التعرض للعنف والأسباب وراء حدوث العنف وتأثير العنف علي الناحية الصحية للمرأة. والثانية هي الجزء الوصفي عن طريق عقد مناقشات المؤثرة لبعض المجموعات من السيدات لمناقشة مشکلة العنف الأسرى ومعرفة أداء السيدات تجاه العنف الأسرى، وقد تم جمع بيانات هذه الدراسة فى الفترة من أکتوبر 2003 إلى سبتمبر 2004 .
وقد أظهرت النتائج ما يلى :بالنسبة للحالة التعليمية فإنه وجد أن (54.2٪) من الزوجات وحوالي ثلث (34.1٪) من الأزواج أميين، بينما (21٪) من الزوجات، (31.3٪) من الأزواج تخرجوا من مدارس ثانوية∙ کانتالأغلبية من السيدات ربات منزل بينما25.4٪ من الأزواج موظفين. وبالنسبة لمحل الإقامة أکثرمن ثلاثة أرباع (78.2٪) من عينة الدراسة کانوا من أماکن ريفية بالمقارنةڊ (21.8٪) من أماکن حضرية∙ وبالنسبة لتاريخ تعرض الزوجات للعنف فإنه وجد أن (41.3٪) من عينة الدراسة تعرضن لنوع أو أکثر من العنف. کان العنف الجسدي في صورة زق، ضرب، زق على الأرض، وشد شعر بنسب (45٪، 82.8٪ ،41.2٪، 35.8٪) بالتتابع.وقد أ ظهرت الدراسة أن من بين العنف النفسي الاجتماعي للزوجات اللائى تعرضن للعنف (89.3٪) منهن عنفوا لفظياکذلک أظهرت النتائج أن ثلث أسباب العنف الأسرى کانت ترجع إلى مشاکل خاصة مع أسرة الزوج، بينما (21٪) من الأسباب ترجع إلى مشاکل مادية، (20.8٪) ترجع إلى مشاکل خاصة بشئون المنزل∙ وبالنسبة للتأثير النفسي الاجتماعي للعنف على صحة الزوجات فقد أظهرت الدراسة أن (45٪) من السيدات اللائي تعرضن للعنف لا يخبرن أحد عما حدث لهن وتجعل ذلک بداخلها فقط، بينما (30.5٪) منهن لديهن الشعور يعانين من الشعور بالوحدة. ولقد أظهرت نتائج هذه الدراسة وجود علاقة ذات دلالة إحصائية بين تعليم الزوج والزوجة وحدوث العنف حيث أنه لوحظ کلما ارتفع المستوى التعليمي لأي منهما کان حدوث العنف أقل، وکذلکتبين وجود علاقة ذات دلالة إحصائية بين عمر الزوجة وحدوث العنف،حيث وجد أن حوالي ثلث السيدات اللائي تعرضن للعنف کانت أعمارهن تترواح مابين (20-24سنة)، (24.9٪) منهن کانت أعمارهن مابين (25-29 سنة). وقد أظهرت نتائج الجزء الوصفي من الدراسة أن السيدات اللائي لم يتعرضن لأي نوع من العنف الأسري منذ الزواج ذکرن أن الحب والاحترام بين الزوجين کان السبب وراء بقاء الحياة مستقرة إلى الآن.وقد استخلصت الدراسة أن العنف الأسرى هو مشکلة عامة ينتج عنها أثار جسمانية ونفسية واجتماعية تؤثر علي صحة المرأة . وقد أوصت الدراسة بأنه يجب أن توجه برامج التثقيف الصحي نحو زيادة الوعي حول مشکلة العنف الأسرى وأثارها علي صحة الأسرة ککل کما يجب أن توجه الدراسات نحو دراسة حجم ومعدل انتشار العنف وکيفية التصدي له