Violence against Educated Women by Intimate Partners in Urban Karnataka, India

Abstract

Background:

Initially viewed as a human rights issue, partner violence is increasingly seen as an important public health problem of international concern.

Objectives:

To assess the extent of physical, sexual, psychological, and controlling behavior of intimate partners against women in an educated society and find the association with age, age of marriage, married years, educational status of the women and that of partner.

Materials and Methods:

A prevalence of 15% was taken and final sample was 200, after considering loss of follow-up.

Statistical Methods:

Proportion, Z-test, Chi-square test.

Results:

The prevalence of violence against intimate partner in educated society was found to be 40.5% in a South Indian city. Physical assault was high in 30–50 years and increased with duration of marriage from 5.5% at 5 years to 33.3% in 10–20 years of married life. Sexual and psychological assault also increased in <5 years of married life to 35% and 47.6% in 10–20 years duration of marriage, which was statistically significant. Sexual and psychological assault showed a bimodal presentation. Less educated women and their partners were found to report more violence, which was statistically significant.

Conclusion:

Violence against women is not uncommon in the educated society.

INTRODUCTION

Intimate partner violence (IPV) is abuse that occurs between two people in a close relationship. The term “intimate partner” includes current and former spouses and dating partners. IPV exists along a continuum from a single episode of violence to ongoing battering.[1] Globally, 30%–38% of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner. These women have been found to report health problems and are 1.5 times more likely to acquire HIV.[2]

In a population-based survey from around the world, 10%–69% of women reported being physically assaulted by an intimate male partner at some point in their lives, which is often accompanied by psychological abuse and in one-third to over half of the cases by sexual abuse.[3] Victims suffer injuries such as bruises, broken bones, internal bleeding, and head trauma. IPV can also cause emotional harm, eating disorders, depression, and suicidal tendencies. Victims also may get involved with substance abuse and engage in risky sexual activity.[4]

Although men may be abused, women are overwhelmingly the victims of IPV. IPV also affects children's mental and physical health.[5] Effective interventions are required to tackle current cases of IPV and to prevent new ones.

This study was planned to understand the extent of physical, sexual, psychological, and controlling behavior of intimate partners against women in an educated society and to find an association of violence with regards to age, age of marriage, married years, educational status of women and that of partner to the abuse.

MATERIALS AND METHODS

Sample size

This study was conducted in a South Indian city of Karnataka. IPV ranged from 10%–69% and physical, psychological, and sexual abuses were 57% based on previous study.[3] Based on this, 15% was taken as the prevalence in our study as we considered only educated working society (assuming a low prevalence of violence in educated society). The sample was calculated based on the formula of 4pq/d² and 204 women (+12 educational statuses) were taken. Considering 25% loss to follow-up, the sample was rounded to 260.

Three hundred and fifty women from different educational backgrounds who were working were contacted (nurses, technicians, doctors, engineers, lecturers, teachers) and consent was taken. Ninety who did not give consent were teachers, nurses, and technicians, with the reason being unwillingness to reveal personal matters. Among 260 women who gave consent, 60 were lost to follow-up or had lost the questionnaire, so the final sample consisted of 200 women.

The questionnaire was prepared as per WHO guidelines given in WHO report of Violence on intimate partners 2004[1] for physical, psychological, sexual, and controlling behaviors. The definition of intimate partner was based on the WHO global prevalence report.[2] Pilot study and validation of the questionnaire were carried out. The questionnaire contained multiple choice questions and was collected in mass. Strict confidentially was maintained.

Five focus group discussions were carried out in different institutions after consent was taken. Each group had 8–10 women discussing major causes of violence, different types of violence, the reasons for living with violence, and how to overcome violence. The discussion was for 20–30 min, verbatim entry of the discussion and interpretation was done.

Statistical methods

Proportions were used to estimate the extent of violence in the study group. Z-test was used to determine whether the sample was similar to the study sample in Japan[6] and India,[7] which includes whole population, i.e., educated and noneducated. Univariate analysis (Chi-square test) was used to determine the association with different factors. People who did not answer were taken out from the total number of study participants during the analysis.

RESULTS

Our study found that 81 of the 200 (40.5%) women reported physical, mental, or psychological abuse including controlling behavior of the partner in the South Indian city. The study participants ranged from 20 to 60 years of age, and the marital age was from 18 to 35 years. The number of years of marriage ranged from 18 to 40 years.

All three abuses were reported in 8 of the 200 women. Psychological abuse following physical abuse was seen in 24 of the 200 women (12%), and 9 of the 200 women (4.5%) had both sexual and psychological abuse. About 25.5% of the total women had combination of abuses.

Table 1 shows that among 44 of the 200 women who reported physical violence, 50% of them had it only once, 50% had been assaulted within a year, and 26% had the abuse in the recent past (<1 month).

Table 1.

Percentage of Women Receiving Different Forms of Physical Violence

It was found that 23 of the 200 women experienced sexual violence by intimate partner. Victims sexually abused within a year were 30.4% and 17.4% in the recent past (<1 month).

Psychological assault was high among the different types of assaults consisting of 29%. The study participants informed that it occurred 27.6% sometime in the victims lifetime, while abuse in a year and recent past (<1 month) was 41.3% and 31.03%, respectively. Thirty-five of the 200 women had been emotionally battered which constituted 60.5% of those with psychological assault. It was seen that 8.3% of the professional women suffered from both physical and psychological assaults [Table 2]. Men with a lower educational status were found to assault women more as compared to highly educated men [Table 3]. Physical assault was found to be higher in the age group of 30–50 years and sexual assault was higher in 30–40-year-old women and >50 years aged women [Table 4].

Table 2.

Educational Status of Women Versus Assault of Women

Table 3.

Educational Status of Partner Versus Assault of Women

Table 4.

Age of Women Versus Assault of Women

As the married years increased, sexual assault was found to increase (0% from <5 years to 31% in 10–20 years). Psychological assault was significantly high in the age group of 20–30 years (52.4%) and >50 years of age (46%) and those who were less educated.

The focus group discussions revealed that the reasons for physical violence are doubt of infidelity and loyalty (38.83%), going out without man's permissions (34.1%), arguing back with the partner (29.5%), not taking care of the man properly (20.4%), not taking care of children adequately (16.4%), not cooking on time (3.4%), not obeying the partner (45%), simple reasons such as spoilt dish and no good food (15%), saying no for sex (23%), and teaching women a lesson (4.63%). The reasons for sexual violence as told by focus group discussions are teaching women a lesson (13%), saying no for sex (8.7%), partner intoxicated with alcohol (26.3%), to keep women under control (74%), the multiple choice answers were not answered, and 39.13% of women had marked others against the blank space, and specification of others was not written. The reasons for psychological violence are unspecified (39.7%), going out without man's permission (26%), not being a good wife, women earning more (22.41%), saying no for sex (17.24%), women who were more educated than partner (10.34%), and partner intoxicated with alcohol (7%).

The majority of women (51.5%) still considered marriage as a form of companionship and husband as a friend (72.5%). About 32.5% of women felt marriage was a part of life and 21% of them felt it gave social security.

DISCUSSION

The study revealed that 40.5% of women being abused are in an educated society. The Z-test showed that this educated sample did not belong to the whole population sample and this forms a different pattern by itself. A study by Koenig et al. found that women married to educated men experienced higher risks of coercive sexual intercourse.[8] The reason being male dominance and social acceptance of male partner abusing female partner.

We found that even economically independent females were also victims of violence, unlike other studies.[4,9]

Nearly, 20% of women had physical violence accompanied with psychological abuse and <2% had only physical abuse. Sexual violence was seen in one-third of those who had physical abuse (9% of women), with 4.5% of the sexually abused reporting psychological abuse.

Chi-square test revealed physical violence increased as the married years increased, which is also seen in an earlier study.[9] Psychological and sexual violence increased up to 20 years of marriage and then decreased. The focus group discussions revealed that women get habituated to the nature of men and try to avoid their husband by interacting with children.

As the age at marriage increases, psychological abuse was found to increase. Physical assault was also found to be lower in women married at 18–20 years which is not found so in Abramsky et al. study[9] where younger women reported more violence as compared to older women. Women at younger age group said they had less marital disharmony as they are more immature and try to develop their personality according to male partner's environment but as age increases, her own individuality comes into picture and adjustment decreases.

Psychological abuse was inversely proportional to the educational status of women which is also seen in another study.[9] Sexual violence had no relation to educational status of women. Physical assault increased in women with low educational status but again increased in postgraduates as compared to graduates and professionals. Reasons may be arguing back and going out without permission, which may be higher in this group, along with increased stress levels. The strength of association between women's education and IPV varied from one community to the next with evidence that the acceptance of mistreatment at the community level mutes the protective influence of higher education. There was no association at the community level once living standards are taken into account for educating women acting as a protective factor. Policy planners must keep in mind community factors that modify educations’ protective influence.[7,10] Sexual, psychological, and physical abuse were inversely proportional to the educational status of the partner, similar to earlier studies.[7,9] A higher socioeconomic status had a protective effect in an earlier study, but when we assessed for socioeconomic status, we found it did not have any impact on violence.

Sexual abuse increased in 30–40 years, above 50 years, and nil at 20–30 years of age. The focus group discussion revealed that after few years of marriage, interest in sex for female partner decreases as her interest is on children, and men may feel they have to keep women under control in 30–40 years age group. Above 50 years, most women would have attained menopause and abstained from sex, increasing risk of abuse. The reason for decrease in 40–50 years was unanswered. The findings were contrary to an earlier study where women in younger age group experienced higher violence.[9]

Psychological abuse again had a bimodal presentation, which was also seen in studies done in the US and South Africa.[11,12] Marital adjustment may play a role for increase in abuse at 20–30 years and stress may play a role in increased abuse above 50 years.

The focus group discussions revealed that abused women never revolted back and were waiting for their husband to change and felt tolerance was important in the relationship and for family welfare.

Limitations

Only working educated women were taken and educated homemakers were left out. Sensitive nature of the topic may have affected the answers.

CONCLUSION

Violence is present among educated population, with psychological abuse being more common. Different factors were found to play a role; hence, there is a need for social revolution for this public health concern.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.