Kadına yönelik şiddet sıklığı ve bunu etkileyen faktörler: iki sağlık ocağına müracaat eden kadınlarda yapılan bir çalışma

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Introduction
Domestic violence, also called intimate partner violence (IPV), spouse abuse or battering, is a pattern of
behaviors manifested primarily against women by an
intimate partner or spouse, usually male. The behaviors
include physical and sexual violence, emotional abuse
*Department of Family Physician, Medicine Faculty of Meram,
University of Selçuk, Konya
Reprint request: Dr. Ruhuþen Kutlu, Department of Family Physician,
Medicine Faculty of Meram, University of Selçuk, 42080 Konya
E-mail: ruhuse@yahoo.com
Date submitted: January 28, 2008
Accepted: May 27, 2008
ARAÞTIRMA/ORIGINAL ARTICLE Gülhane Týp Dergisi 2008; 50: 110-116
© Gülhane Askeri Týp Akademisi 2008
Summary
Gender-based violence is being increasingly recognized as a
major public health concern and a violation of basic human
rights. This is not only a social problem but also a significant burden on the public health. We have determined the
frequency of and factors affecting the violence against
women in Konya in this study. This descriptive study was
carried out at two primary health care units selected randomly between 15th January and 15th February 2005. We
evaluated domestic violence among 405 cases. Women
were asked about their socio-demographic characteristics
and experiences about violence. The median age of the
respondents was 32.0 (15-77) years. Eighty four (20.7%) of
the women experienced violence at least once in their life.
Low economic position was a significant factor contributing
to the increase in violence against women (p=0.004). Whilst
low education levels of husbands (p=0.040) and mothers
(p=0.002) and high numbers of sibling (p=0.032) were significantly associated with violence, the woman's own education level was not a significant factor (p=0.850). The following feelings were statistically significant among battered women: disappointment with marriage (p<0.001), suicide idea (p<0.001), leaving home (p<0.001) and feeling
insecure (p<0.001). Consequently, low economic position,
low education levels of husbands and mothers and high
numbers of offspring have been found as risk factors among
battered women.
Key words: Domestic violence, psychological abuse, violence against woman
Özet
Kadýna yönelik þiddet sýklýðý ve bunu etkileyen faktörler:
iki saðlýk ocaðýna müracaat eden kadýnlarda yapýlan bir
çalýþma
Cinsiyete dayalý þiddet giderek artan bir hýzda büyük bir halk
saðlýðý problemi ve insan haklarýnýn ihlali olarak tanýmlanmaktadýr. Bu sadece sosyal bir problem deðil, ayný zamanda
toplum saðlýðý açýsýndan da önemli bir sorundur. Bu çalýþmada Konya'da kadýna yönelik þiddet sýklýðý ve etkileyen faktörleri araþtýrdýk. Tanýmlayýcý tipte olan bu çalýþma 15 Ocak-15
Þubat 2005 tarihlerinde randomize olarak seçilen 2 saðlýk
ocaðýnda yapýldý. Aile içi þiddet 405 olguda deðerlendirildi.
Kadýnlara sosyodemografik özellikleri ve þiddetle ilgili
deneyimleri soruldu. Katýlanlarýn ortalama yaþ deðeri 32
(15-77) yýl idi. Kadýnlarýn 84’ü (%20.7) hayatlarý boyunca en
az bir kez þiddete maruz kalmýþlardý. Ekonomik seviyenin
düþük olmasý kadýna yönelik þiddeti artýrýcý anlamlý bir faktördü (p=0.004). Eþlerin (p=0.040) ve annelerin (p=0.002)
eðitim düzeyinin düþük olmasý ve kardeþ sayýsýnýn fazlalýðý
(p=0.032) kadýna karþý þiddette önemli iken, kadýnýn kendi
eðitim düzeyi anlamlý bir faktör deðildi (p=0.850). Þiddete
maruz kalan kadýnlar arasýnda aþaðýdaki duygulanýmlar istatistiksel olarak anlamlý idi: evlilikten umduðunu bulamama
(p<0.001), intihar düþüncesi (p<0.001), evi terk etme
(p<0.001) ve kendini güvende hissetmeme (p<0.001). Sonuç
olarak ekonomik durumun, eþlerin ve annelerin eðitim
düzeyinin düþük olmasý ve çocuk sayýsýnýn fazlalýðý þiddete
maruz kalan kadýnlarda risk faktörleri olarak bulundu.
Anahtar kelimeler: Aile içi þiddet, psikolojik suistimal,
kadýna yönelik þiddetCilt 50 · Sayý 2 · Gülhane TD Violence against women · 111
context (8).
In the cycle of violence, victims of partner abuse will
often be told (by the batterer) that the violence is their
fault or that they have somehow provoked the violence
through an offensive action or inaction (9).
Although IPV is known to occur among all social
classes, individuals from lower socio-economic status
(SES) strata may have greater exposure to childhood
violence, have higher rates of depression, experience
more alcohol-related problems, have poorer coping
mechanism, and more commonly endorse the use
physical aggression as a tactic in marital disputes (10).
In this study, we aimed to evaluate the frequency of
the violence against women and the factors affecting
this.
Material and Methods
With the aim of examining the prevalence and
affecting factors of domestic violence, this descriptive
study was conducted between 15th January and 15th
February 2005, in Konya, a metropole city of Turkey. By
the permission of the Provincial Health Administration,
two primary health care units were selected randomly.
This study included 405 women who were at the age 15
and over and who applied to these primary health care
units with any complaints during this period. Informed
consent was obtained before recruitment. Those who
were not willing to take part and refused were excluded. A questionnaire was applied in the private rooms of
the primary health care units. In our country, 15 years
old is regarded as the beginning of the fertility period,
so we selected women whose ages were 15 years and
over. We conducted the study with the respondents at
busy hours every day and face-to-face interviews were
carried out. In the questionnaire, characteristics such as
age, native place, living place, occupation, education,
income, marital status, demographics of husbands, features of their marriage and their family were asked.
These characteristics are the factors affecting the violence among women. Moreover, they were asked
whether they were exposed to violence, the type, frequency and cause of the violence and how long it lasted. The battering status of women is the result.
Violence experiences during their childhood, pregnancy and at present were asked. Domestic violence was
defined as psychological abuse by an intimate partner or
another person from their families (father, mother, siblings, parents-in-law, and siblings-in-law). The demographics of perpetrators and their perception of violence
were examined by using open ended questions.
Additionally, the questions about finding expectations
and neglect, threats and spontaneous behaviors (1).
Around the world at least one woman in every three
is battered, coerced into sex, or otherwise abused in her
lifetime. Mostly, the abuser is a member of her own
family. Increasingly gender-based violence is recognized
as a major public health concern and a violation of
human rights (2).
In the last two decades, many in the medical professional have become increasingly aware that domestic
violence is not only a social problem but also a significant burden on the public health system (3). Amnesty
International describes violence against women as
"today's most pervasive human rights challenge".
Studies have reported that abused women have poorer
physical and mental health status than non-abused
women (4).
Violence against women has become a research priority for a wide variety of disciplines because of its
broad scope and negative health consequences for its
victims (5). Despite growing support and recommendations for domestic violence screening, most physicians
do not screen their patients. Recent studies found that
only one physician in ten asked patients about domestic
violence, and only one third of managed care organizations had policies, guidelines, or materials on scanning
for domestic violence. Despite the lower scanning rates
and potentially inhibiting beliefs regarding domestic
violence, the great majority of physicians believe that
domestic violence intervention is an essential part of
their role. More and more evidence is accumulating to
support scanning practices for domestic violence. In
addition, studies have suggested that scanning for partner abuse can be a powerful intervention in and of itself.
Direct asking in a nonjudgmental, compassionate manner could facilitate patient-physician communication
about the abuse, create openings for future disclosure,
and send the message to the public and to victims that
violence is wrong and help is available (6).
Interpersonal violence, especially spousal violence,
remains hidden and underreported least because it
occurs within the family, precisely the institution that is
conventionally assumed to be driven by altruism, and
instrumental in enhancing rather than diminishing
human well-being. Worldwide, IPV by husbands
against wives is estimated to range from 25% to 54%.
Psychological abuse is even more common, and often,
physical, psychological, and sexual abuse overlap (7).
Understanding the causes of IPV is substantially
more difficult than studying a disease. For example, diseases usually have a biological basis and occur within a
social context, but IPV is entirely a product of its social112 · Haziran 2008 · Gülhane TD Çivi et al.
from marriage, idea of committing suicide or leaving
home, any corporation to help and feeling security at
home or not were asked.
The SPSS 13.0 statistical software package was used
in data entry and analysis. The statistical analysis and
evaluations were carried out by the authors. The variables were described by median, frequency and range.
To compare the statistical significance between groups,
chi-square test was used. Statistical significance was
defined as p<0.05.
Results
Characteristics of the women
The median age of respondents was 32.0 years
(ranged 15-77). Sociodemographic features of women
with or without violence exposure are shown in Table I.
Throughout their life time, 20.7% (n=84) of the
reported women experienced violence at least once.
Birth place of the most respondents (70.6%, n=286)
was Konya, and 70.4% (n=285) were living in the city
since their childhood. The percentage of housewives
was 95.8% (n=388), 88.6% (n=359) were never occupied, 8.9% (n=36) had a work in the past. Eighty eight
of them (21.7%) were illiterate, 22 (5.4%) were literate,
257 (63.5%) had primary school education, and only 5
(1.2%) had university degree.
Mostly, women were coming from large families
and the number of siblings was 1 to 3 in 13.8% (n=56),
4 to 6 in 51.4% (n=208), 7-9 in 26.7% (n=108), 10 and
above in 8.1% (n=33), respectively. Of the total subjects, 61.5% (n=249) described their economic status as
normal, while 22.2% (n=90) defined as bad, and 16.3%
(n=66) defined as good. However, more than half
(53.1%, n=215) were in debt. One point seven percent
(n=7) of the women were divorced and 8.1% (n=33)
had never married, 84.9% (n=344) married and 5.2%
(n=21) reported being a widow. Almost all of them
(97.9%, n=334) had civil marriage, 247 (71.8%) married traditionally, and of 96.2% (n=331) was the first
marriage. The duration of the marriage was 0-4 years
(20.1%, n=69), 5-9 years (19.5%, n=67), 10-14 years
(16.6%, n=57), 15-19 years (12.5%, n=43), and 20
years and above (31.4%, n=108), respectively. While
68.6% (n=236) married women reported that they had
nuclear families, 30.2% (n=104) had large families, and
1.2% (n=4) family was dispersed.
In this study, the age distribution, birth place, living
place, occupation, social security, education, marital status, civil marriage, husband jobs, duration of marriage,
ways of marriage, number of marriage, type of family,
father's education and job, migration, and contribution
to family income were not significantly higher among
Table I. Sociodemographic characteristics of abused and non-abused women
___________________________________________________________________________________________________________
Abused women (%) Non-abused women (%) p value
(n=84) (n=321)
___________________________________________________________________________________________________________
Age (years)
15-24 19.0 28.3
25-34 40.5 28.7 0.208
35 and over 40.5 43.0
Birth place
In Konya 65.5 72.0
Out of Konya 34.5 28.0
Living place
City and country 77.4 83.2
Village 22.6 16.8
Occupation
Housewife 98.8 95.0
Working 1.2 5.0
Social security
Yes 77.4 81.3
No 22.6 18.7
Education
Uneducated 28.6 26.8
Educated 71.4 73.2
Economic status
Good 10.7 17.8
Moderate 53.6 63.6 0.004
Bad 35.7 18.6
Debtor
Yes 59.5 51.4
No 40.5 48.6
to be continued
0.304
0.284
0.217
0.513
0.850
0.184Cilt 50 · Sayý 2 · Gülhane TD Violence against women · 113
battered women. Economic status was a contributing
factor to violence in this study, too (p=0.004). While
women (p=0.850) and her fathers' education
(p=0.460) were not significant factors, her mothers'
(p=0.002) and husbands' education (p=0.040) were
considerable effective factors on violence. Presence of
childhood abuse was found to be significantly higher
among battered women in this study as a contributing
factor to violence (p<0.001). Being exposed to violence
was significantly higher (p=0.032) among the women
who had 4 and more siblings. Violence among the
women with 1-3 children was considerably higher
compared to the women with 4-6 children. This result
may be related with another variable such as the duration of marriage. However, there was no significant
(p=0.201) relation between the number of children and
___________________________________________________________________________________________________________
Abused women (%) Non-abused women (%) p value
(n=84) (n=321)
___________________________________________________________________________________________________________
Marital status
Married 97.6 90.3
Single 2.4 9.7
Civil marriage
Yes 83.3 82.2
No 6.0 2.5
Divorced/widowed 10.7 15.3
Husbands’ occupational status
Yes 92.0 94.8
No 8.0 5.2
Husbands' education
Uneducated 13.3 5.5
Educated 86.7 94.5
Duration of marriage
1-9 years 38.1 32.7
10-19 years 28.6 23.7
20 years and above 33.3 43.6
Way of marriage
Traditionally 79.5 71.0
Being in love 20.5 29.0
Number of marriage
One 91.7 86.3
Two 4.8 3.4
Number of siblings
1-3 sibling 6.0 15.9
4-14 sibling 94.0 84.1
Type of family
Nuclear 65.5 68.5
Disperse 3.6 1.6
Wide 31.0 29.9
Fathers' education
Uneducated 34.5 29.6
Educated 65.5 70.4
Mothers' education
Uneducated 81.0 62.3
Educated 19.0 37.7
Fathers' job
Yes 89.3 92.5
No 10.7 7.5
Migration
Yes 21.4 15.6
No 78.6 84.4
Contribution to family income
Yes 28.6 23.1
No 71.4 76.9
Number of children
1-3 96.3 87.1
4-6 3.7 12.9
___________________________________________________________________________________________________________
Chi-square or Fisher exact test were used.
a: There was no significant (p=0.201) relation between the number of children and being exposed to violence when the duration
of marriage (1-9 years and 10 years and over) was used as a control variable
continuing
0.052
0.205
0.400
0.040
0.227
0.176
0.141
0.032
0.523
0.460
0.002
0.458
0.265
0.364
0.031
a114 · Haziran 2008 · Gülhane TD Çivi et al.
being exposed to violence when the duration of marriage (1-9 years, 10 years and over) was used as a control
variable.
Contributing factors and outcomes of violence among women
Contributing factors and outcomes of violence
among women can be seen in Table II. Of all married
respondents, 68.6% (n=236) said that they could not
find the expectations related love, respect, security,
money etc. that they hoped before marriage. Most of
the violence victims (81.0%, n=68) were abused after
their marriage. The frequency of violence among perpetrated women was respectively as; every day (36.9%,
n=31), once a week (13.1%, n=11), once a month
(19.0%, n=16) and different times (31.0%, n=26).
In this study, disappointment of marriage
(p<0.001), idea of suicide (p<0.001), leaving home
(p<0.001) and not feeling security (p<0.001) were statistically higher among battered women.
Discussion
Worldwide, physical violence by husbands against
wives is estimated to range from 10% to 50%. In our
study, throughout their lives, 20.7% (n=84) of the
women experienced violence at least once.
Psychological abuse is even more common, and often,
physical, psychological, and sexual abuse overlap (7).
The life time prevalence of physical IPV alone was
13.3% and the prevalence of psychological IPV alone
was 12.1% (11). Nationwide representative surveys of
couples in the United States indicate 15-20% of dyads
experience an incident of IPV each year (12). The
prevalence of physical violence against women by an
intimate or former partner was found as 29% in
Canada, 25% in England, 28% in Korea, 35% in Egypt,
32% in Israel, and 41% in Uganda (13,14). In a study of
Mayda and Akkuþ, in Düzce, Turkey, physical violence
prevalence was 39.7% (14). These different percentages
can be attributed to the study management. Because
measurement of social conditions thought to be risk
factors, such as the status of women, gender norms, and
socioeconomic status poses difficulties, especially across
cultures. Although a consensus has emerged on the
need to explore male and female factors and aspects of
the dynamics of relationships, this has been focused in
very few studies. Additionally, the validity of research
on sensitive topics is dependent on the context of the
interview and good interviewer training (8). We
encountered with the women for the first time, and
asked questions about their private lives. In other conditions, we may find higher prevalence of violence.
In this study, the age distribution, birth place, living
place, occupation, social security, education, marital status, civil marriage, husband's job, duration of marriage,
way of marriage, number of marriage, type of family,
father's education and job, migration and contribution
to family income were not effective factors on violence
(p>0.05). With the exception of men power, most
demographic and social characteristics of men and
women documented in this research are not associated
with increased risk of IPV. For example age has occasionally been noted to be a risk factor for such violence,
with a greater risk attached to youth, but in most
researches a relation with the age of either partner has
not been observed. Most household characteristics are
not associated with intimate partner violence. These
characteristics include living in large or crowded homes
Table II. Factors affecting and outcomes of violence among the abused women
___________________________________________________________________________________________________________
Abused women (%) Non-abused women (%) p value
(n=84) (n=321)
___________________________________________________________________________________________________________
Finding expectations from marriage
Yes 18.3 81.4
No 81.7 18.6
Idea of suicide
Yes 57.1 14.6
No 42.9 85.4
Leaving home
Yes 40.5 5.6
No 59.5 94.4
Receiving any help
Yes 29.8 5.6
No 70.2 94.4
Feeling in security
Yes 81.0 98.8
No 14.3 1.2
Sometimes 4.7 0.0
___________________________________________________________________________________________________________
Chi-square or Fisher exact test were used
<0.001
<0.001
<0.001
<0.001
<0.001Cilt 50 · Sayý 2 · Gülhane TD Violence against women · 115
and living with in-laws. Similarly, urban or rural residences are not factors (8).
Economic status was a contributing factor to violence in this study (p<0.05). While women and their
father's education were not significant factors (p>0.05),
their mothers' and husbands' education were apparent
contributing factors to violence (p<0.05). Cunradi et al.
have reported that low SES links with increased risk of
IPV and low income makes a greater contribution to the
probability of IPV than education or employment status
category (10). The same investigators found that annual household income had the greatest relative influence
on the probability of partner violence (10).
Unfortunately, these results may show the ineffectiveness of the women's status and the greater effect of
mother in traditional learning than father. As can be
seen in this study and other studies, violence against
women is related to the subcomponents of SES such as
low economic status, low education level and having
multiple siblings.
Unlike many health problems, there are few social
and demographic characteristics that define risk groups
for IPV. Power is the exception and increases risk
through effects on conflict, women's power and male
identity. Violence is used as a strategy in conflict.
Relationships full of conflict and especially those in
which conflicts occur about finances, jealousy, and
women's gender role transgressions are more violent
than peaceful relationships. Heavy alcohol consumption also increases the risk of violence. Women who are
more improved educationally, economically, and socially are most protected, but below this high level, the
relation between empowerment and risk of violence is
non-linear. Violence is frequently used to resolve a crisis of male identity, at times caused by poverty or an
inability to control women. Risk of violence is the
greatest in societies where the use of violence in many
situations is a socially accepted norm (8).
Although partner abuse does not exclusively involve
abusing of women by men, clearly being female is a risk
factor for becoming a victim of partner abuse (9).
Perpetrators were husbands in 77.4% of the violence
events in this study. The main factors contributing to
violence like husbands' education and economic status
may be the result of being a traditional family. Ninety
five point eight percent (n=388) of women were
housewives. Of the women, 88.6% were never occupied, 8.9% had a work in the past, and only 2.5% was
working then. These results are similar to the results of
Mayda and Akkuþ. They reported that the absence of
physical violence at home was significantly related to
the formal education of the husband compared to the
education of women (14).
Gerbert et al. have stated that women make an estimated 694.000 visits to the healthcare institution per
year as a result of injuries due to physical assault, most
of which are related to domestic violence. The prevalence of domestic violence in primary care patients
ranges from 8% to 14%. In addition to death and immediate trauma, domestic violence results in a number of
chronic health problems, including chronic pain in any
organ systems, depression, anxiety, alcohol and substance abuse (6).
In a study of Castro et al. 29.2% of women in
California and 24.5% of women in Morelos reported at
least one episode of violence during pregnancy (5).
Mayda and Akkuþ found 5.1% prevalence rate for experienced physical violence during marriage on 653 pregnant women (15).
Most women want the violence to stop but do not
want to end the relationship. Major reasons why
women stay while they are able to leave include: the
perception that the violence is her fault; shame and
denial; religious or cultural beliefs that such behavior
must be endured to preserve the marriage or family.
The welfare of any children is paramount and women
often lack the financial means to support their children
alone, or fear reprisal if they leave their partner. In fact,
women are at much greater risk of serious violence if
they indicate to the abuser that they intend to leave, so
such fears are warranted (1).
In this study, the percentage of leaving home, idea of
suicide, not finding expectations from marriage, not
receiving any help was significantly higher among
abused women compared to non-abused women
(p<0.001). Besides, abused women felt themselves in
security less than the other group (p<0.001).
Many researchers have discussed IPV as a learned
social behavior for both men and women. The intergenerational cycling of violence has been documented
in many settings. The sons of women who are battered
in their childhood are more likely to batter their intimate partners. The daughters of women who are beaten are more likely to be beaten as adult (16). Women
who are beaten in childhood by parents are also more
likely to be abused by intimate partners as adults.
Experiences of violence at home in childhood teach
children that violence is normal in certain settings. In
this way, men learn to use violence and women learn to
tolerate it or at least tolerate aggressive behavior (8).
Limitations: The study samples comprised a group of
women sharing their experiences. These results can not116 · Haziran 2008 · Gülhane TD Çivi et al.
reflect the whole society as it was carried out on the
women who applied to two primary care units only in a
month. All these results may differ from the others.
The self-report design also warrants consideration. Fear
of alienating or offending the woman are common concerns of medical professionals like us. We did not
include the information except for education level and
employment in our questionnaire. Inquiring the components such as abusing alcohol, tendency to crime,
having been sentenced or not, defect in controlling
impulse, using violence in other settings or not could
have been more helpful to establish the settings where
violence takes place. These points should be taken into
consideration for the further studies.
Violence against women is one of the most major
public health problems worldwide. Because of its social
conditions and effects, this problem is becoming greater
and greater. We believe that violence is a threat for each
member of the family, for each family of society, and for
each society of the world. Increasing the education
level, thus improving the financial status are fundamental undertakings that can reduce violence against
women both in childhood and adulthood.