research paper on domestic violence in pakistan

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• Pak J Med Sci
• v.36(4); May-Jun 2020

Prevalence and risk factors of domestic violence and its impacts on women’s mental health in Gilgit-Baltistan, Pakistan

Hina hussain.

1 Mrs. Hina Hussain, M.Phil. Department of Behavioral Sciences, Karakoram International University, Gilgit, Pakistan

Sadiq Hussain

2 Dr. Sadiq Hussain, PhD. Department of Behavioral Sciences, Karakoram International University, Gilgit, Pakistan

Samar Zahra

3 Mrs. Samar Zahra, M.Phil. Department of Behavioral Sciences, Karakoram International University, Gilgit, Pakistan

Talib Hussain

4 Dr. Talib Hussain, PhD. Department of Business Management, University of Baltistan, Skardu, Pakistan

To assess the prevalence of domestic violence, associated risk factors, and its impacts on women’s mental health in Gilgit-Baltistan (GB), Pakistan.

This is a sequential explanatory strategy that is a mixed-method research design was conducted at Department of Behavioral Sciences, Karakoram International University Gilgit from January 2017 to June 2018 on 160 married women. Quantitative data were collected using Karachi domestic violence screening scale and mental health inventory and qualitative data were collected through interview guides. Descriptive and inferential statistical techniques were applied to analyze quantitative data while qualitative data were analyzed using thematic analysis.

Married women in GB reported higher levels of domestic violence (88.8%; psychological (69.4%), physical (37.5%) & sexual (21.2%). Abused women reported lower levels of mental health ( t =3.19, p =0.00); psychological wellbeing ( t =2.03, p =0.04), general positive affect ( t =2.09, p =0.03), and life satisfaction ( t =2.39, p =0.01) and higher levels of psychological distress ( t =3.27, p =0.00), anxiety ( t =3.06, p =0.00), depression ( t =2.60, p =0.01), and loss of emotional/behavioral control ( t =3.05, p =0.00) as compared to non-abused women. Risk factors behind domestic violence were identified as; poverty, the influence of in-laws, second marriage, stepchildren, forceful intimate relationships, husband’s irresponsibility, and addiction, and handicapped children.

Conclusions:

We found higher level of domestic violence, associated risk factors, and poor mental health of abused women in GB.

INTRODUCTION

Domestic violence as the supremacy exploited by one adult in a relationship to control another is not simply an argument, but the abuser uses physical and sexual violence, emotional offences, and economic denial against women. 1 It is a global issue, which is prevalent throughout nations, socio-economic classes, cultures, and race. 1 According to the World Health Organization report, 35% women globally have experienced either physical and/or sexual violence. Globally, around one third of all women experienced either physical or sexual violence, and in some regions, the figure increased to 38%. 2 The worldwide prevalence of non-partner sexual violence only in 2010 was 7.2%. The highest prevalence was in African countries and lowest in Asian countries while limited data were available regarding Europe, Middle East, Asia pacific, and high-income countries. 3

In Pakistan, domestic violence appeared in different forms, which, ranged from shouting to the use of weapons, including nonconsensual sex and only 3.2% women did not report any type of domestic violence. 4 In rural Pakistan, the prevalence of physical abuse against women was 56% while in urban settings, the lifetime prevalence of physical, sexual, and psychological abuse were 57.6%, 54.5%, and 83.6% respectively. 5 , 6 Another study that reviewed empirical studies published from 1998 to 2008 found that 30% to 79% of women reported intimate partner violence in Pakistan. 7

Distressing impacts of domestic violence are limited not only to physical injuries but contribute to the ill health of women and weak psychological and emotional wellbeing. 1 Victims of intimate partner violence reported the increasingly adverse effects on their mental health; depression, posttraumatic stress disorder, and anxiety as compared to those who never experienced intimate partner violence. 8 Findings of a meta-analysis revealed that the weighted mean prevalence of mental health issues among abused women were; 47.6%, 17.9%, 63.8%, 18.5%, and 8.9% for depression, suicidality, PTSD, alcohol abuse, and drug abuse respectively. 9 Other researchers claimed that domestic violence is linked with many mental disorders such as; anxiety, depression, PTSD, eating disorders, and even psychosis. 10 In rural Pakistan, 98% of women reported mental tension due to the maltreatment by their husbands. 5

Keeping in view, the unrelenting negative consequences of domestic violence on women’s mental health, researchers have identified a number of risk factors such as cultural and social norms, religious practices, and economic and political circumstances. 1 Specific to the Pakistani context, the identified risk factors associated with domestic violence against women were; women’s low education and low empowerment, miss concepts of Islamic reflections and customary norms such as justifying honor killing, and poverty and the prevalent custom of the undue-traditional dowry system in the society. 7 Another study reported in-laws, disobedience and arguments with husband, husbands’ addiction, extra marital relationship and infertility as risk factors of domestic violence. 11 In rural Pakistan, risk factors of domestic violence against women were; age, education, and income of women while in urban Pakistan different risk factors for different types of violence were classified, i.e. husband’s low education, unskilled work, and five or more family members in the family for physical violence, wife’s low education, low socioeconomic status, and five or more family members in the family for sexual violence, and husband’s unskilled working status and low socioeconomic status of the family for psychological violence. 5 , 6

The reviewed literature shows that the prevalence, causes, and the consequences of domestic violence against women are well-studied globally as well as within Pakistan, but an actual condition in Gilgit-Baltistan (GB) has not been studied. GB, the region of Pakistan, with difficult access, being far-flung, and lacking basic necessities of life remained unexplored in terms of the prevalence of domestic violence, its risk factors, and impacts on women’s mental health. Therefore, this first scientific study was conducted with objectives to assess the prevalence, risk factors, and impact of domestic violence on women’s mental health in GB.

This is a sequential explanatory strategy that is a mixed-method research design was conducted at Department of Behavioral Sciences, Karakoram International University Gilgit from January 2017 to June 2018. In the first phase of study, after approval of research protocols from institutional ethical review committee (KIU-IMARC/2019/252 dated July 19, 2019), quantitative data were collected from 160 married women age ranged from 18-50 years. Karachi domestic violence screening Scale-Urdu and mental health inventory were used to assess domestic violence and mental health respectively. 12 , 13 In the second phase, 142 (88.8%) women were included who were characterized/screened as abused based on the result of the first phase. A self-constructed interview guide was used to conduct in-depth interviews (IDIs) and focus group discussions (FGDs) to identify risk factors of domestic violence. Demographic information form was used to collect participants’ demographic information like age, education, family system, married years, occupation, and monthly income of respondents.

In the first phase, collected data were analyzed using descriptive statistical techniques. In this phase, respondents were classified into two groups; abused and non-abused women based on their scores on KDVSS-U. Then using independent sample t-test compared both groups’ mental health by using Statistical Package for Social Sciences (SPSS, v-20). In the second phase, qualitative data were analyzed using content analysis to identify the underlying risk factors of domestic violence. 14 Level of significance p ≤0.05 was considered significant and effect sizes of associations were also calculated “ d ”.

Out of the total participants, 120(75.0%) belong to age rang 18-33 years, 73(46.8%) have reported more than 10 married years, 75(49.9%) have obtained graduation and above education level, 85(53.1%) were housewives, 82(51.3%) were from joint family background, and a good number of them 72(45.0%) reported less than ten thousand monthly incomes ( Table-I ).

Demographic characteristic of participant.

According to overall KDVSS scale scores 142(88.8%) women were found abused. Physical abuse, psychological abuse, and sexual abuse were found among 60(37.5%), 111(69.4%) and 34 (21.2%) women respectively ( Table-II ).

Abused and non-abused women on KDVSS.

Abused women reported lower levels of mental health, psychological wellbeing, general positive affect, and life satisfaction and higher levels of psychological distress, anxiety, depression, and loss of emotional/ behavioral control as compared to non-abused women. The effect size was medium for mental health and psychological distress and small for psychological wellbeing, general positive affect, life satisfaction, anxiety, depression, and loss of emotional/behavioral control ( Table-III ).

Comparison of mental health between abused and non-abused women.

Based on qualitative data, seven major themes have been generated while exploring the risk factors of domestic violence. Among the most frequent responses, poverty comes out to be the major bone of contention (89%). Second, most frequently reported category (67%) was the influence of in-laws in exacerbating disagreements among spouses. The second marriage was another major risk factor of quarrel among couples (50%); either husband went for second marriage, or the wife herself was the second wife and step children creates issues. Therefore, 42% reported stepchildren as a reason for the quarrel. The forceful intimate relationship (25%) along with irresponsibility of husband (15%) and addicted husband (15%), handicapped children (7%), husband’s demand of financial assistance from wife’s family (6%), and husband reluctance for children (6%) were also found risk factors of domestic violence in GB ( Table-IV ).

Risk factors of domestic violence.

The current study shows higher prevalence of domestic violence in GB (88.8%). Among different types of abuse, psychological (69.4%) one was found to be highly prevalent among the study sample followed by physical (37.5%) and sexual violence (21.2%). These results are in accordance with the findings of other studies conducted in Pakistan but inconsistent with those reported from other contries. 6 , 12 , 15 Another research conducted in Azad Kashmir, Pakistan that is more similar to GB from sociocultural perspective revealed that the psychological violence was found to be higher among women than physical violence. 16

Finding that women who experienced domestic violence reported lower levels of mental health, psychological wellbeing, general positive affect, and life satisfaction and higher levels of psychological distress, anxiety, depression, and loss of emotional, behavioral control. Researchers from different socio-cultural and religio-political milieus reported similar findings i.e. domestic violence against women leads to their poorer psychological and emotional wellbeing, overall wellbeing, poorer mental health including depression, PTSD, anxiety, suicidality, alcohol abuse, drug abuse, eating disorders, psychosis, psychological distress, and psychological illness. 1 , 8 , 10 , 17 - 19 Similar findings are reported by researchers from Pakistani context where different types of domestic violence; physical, psychological, and sexual strongly associated with higher levels of negative states of mental health including depression, mental tension, and hysteria. 5 , 20

In the present study, the risk factors behind domestic violence were found as; poverty, the influence of in-laws, second marriage, stepchildren, forceful intimate relationships, husband’s irresponsibility, and addiction, handicapped children, husband’s demand of financial assistance from wife’s family, and husband’s reluctance for children. Similar findings were reported by Hossain from Bangladesh, i.e. more similar with Pakistan from religio-cultural perspectives, where role of in-laws and other family members, polygamous husbands, husbands’ addiction, husbands’ demand for dowry from in-laws, husbands’ cognitions that wives are product for their sexual enjoyment (nonconsensual sexual union), and giving birth to the female child were risk factors of domestic violence against women. 21 Within Pakistani context, Bibi, Ashfaq, Shaikh, and Qureshi reported in-laws as perpetrators (30%) along with husbands’ drug addiction and extra marital relationship as risk factors. 11 According to Shaikh, Shaikh, Kamal, and Masood, 21.1% women in Pakistan reported that their husband forced them to have nonconsensual sexual relationship supports our findings, i.e. forceful intimate relationships. 22 Lois, David, and Zachary reported unwanted pregnancy by perpetrator along with lower socio-economic status as a risk factor of abuse is in line with our findings, i.e., the husband did not want children. 23 However, we found poverty as a dominant risk factor of domestic violence in the present study, also endorsed by other researchers. For example, lower socioeconomic status was found as an important risk factor of domestic violence against women in Pakistan and elsewhere. 6 , 7 , 24 Ali and Gavino grouped all risk factors of domestic violence in Pakistan into two major categories: intrinsic factors (income, substance abuse etc.) and extrinsic factors (socio-economic, political, & cultural system of Pakistan along with the influence of neighboring countries). 25

Limitations of the study

The present study documented only the wives’ perspective. Secondly, the sample was small and represented only a single province of Pakistan (GB).

CONCLUSIONS

The prevalence of domestic violence in GB was at an alarming level, and it has significant impacts on women’s mental health. Poverty, the influence of in-laws, and second marriage were found as dominant risk factors behind domestic violence. To address the alarming level of domestic violence promulgation of legislation and community-based awareness programs against domestic violence and the establishment of rehabilitation centers with mental health services for the victims of domestic violence are strongly suggested. Despite vital contributions, the present study is not free from limitations like other scientific studies.

Author`s Contribution

HH & SH conceived, designed and did data collection and statistical analysis & editing of manuscript. Both authors are responsible and accountable for the accuracy and integrity of the work.

SZ & TH did manuscript writing, review, and final approval of manuscript.

Grant Support & Financial Disclosures: None.

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Intimate partner violence against women: a comprehensive depiction of Pakistani literature

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Tazeen Ali, 1 Rozina Karmaliani, 1 Rida Farhan, 2 Syeda Hussain 3 and Fatima Jawad 1

Background : Intimate partner violence against women is a significant problem in Pakistan associated with an alarming set of mental health issues.

Aims : To identify the prevalence of intimate partner violence in Pakistan and the causes, health effects and coping strategies used by women.

Methods : A comprehensive search based on the identified keywords was conducted using Google Scholar and PubMed. Relevant literature was also searched and included. Abstracts were then shortlisted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and 25 studies were selected. Quantitative studies on intimate partner violence were included in the review. The review comprises only reports published in English from 2008 to 2018.

Results : The review accounts for the overall prevalence of violence and its various subtypes against women in Pakistan: psychological 31.3–83.6%, physical 10.0–98.5%, sexual 2.5–77.0%, physical and sexual combined 1.0–68.0% and any other type 6.9–90.0%.

Conclusion : The evidence generated will help notify policy-makers and health officials about the determinants and effects of intimate partner violence, making it easier to address these issues and identify victims as early as possible. It also sheds light on the limitations of this study: tools used by the published studies not specifically designed for Pakistan and there is no standardized definition of violence against women. This calls for more studies to be conducted to help find a solution.

Keywords: intimate partner violence, women, spousal, domestic, Pakistan

Citation: Ali T; Karmaliani R; Farhan R; Hussain S; Jawad F. Intimate partner violence against women: a comprehensive depiction of Pakistani literature. East Mediterr Health J. 2021;27(2):183-194. https://doi.org/10.26719/emhj.20.107

Received: 02/09/19; accepted: 01/03/20

Copyright © World Health Organization (WHO) 2021. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo)

Introduction

Intimate partner violence (IPV) has been a topic of discussion since the 2000s and continues to be an issue that needs to be addressed. The World Health Organization (WHO) defines IPV as “any behaviour within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship”. A WHO study of 10 developing countries estimated lifetime prevalence of physical and/or sexual violence of up to 71% (1). Most often, violence is conducted by the husband but in-laws or close family members can also be common perpetrators (2).

While issues of IPV occur all over the world, the incidence may be more widespread in developing countries. One of the earliest studies reported the prevalence of overall domestic violence by husbands in 34.0–54.8% of married women (3). However, a large proportion of IPV cases are not documented as women are made to think that the forms of violence they face are acceptable due to cultural norms. According to a published study, “violence can increase a woman’s risk of a number of health problems, including chronic pain, physical disability, drug and alcohol abuse and depression” (4). This statement reflects accurately why this issue needs to be addressed and solved since it greatly decreases a woman’s quality of life. However, to formulate effective interventions, it is essential to understand the forces that encourage or lead to IPV. Research assessing IPV has found socioeconomic factors, low level of education and unemployment were found to be leading causes contributing to domestic violence (5,6).

Recently, data on violence against women has been collected through the population-based Pakistan Demographic and Health Survey (DHS) 2012–2013. A 2015 systematic review in Pakistan by Ali et al. included studies from 1985–2011 (7), however, to the best of our knowledge, no recent systematic analysis has been done on the available literature on domestic violence within the Pakistani context despite an increasingly alarming rate. Our literature review is an attempt to fill the gap and collate available data from multiple sources over the past several years to provide a comprehensive picture of different types of domestic violence in Pakistan so that effective interventions and measures can be taken based on the causes and trends and, thus, improve the quality of life of married women.

The aims of this review are to identify the range of prevalence of IPV and all forms of domestic violence (psychological, physical, sexual, and controlling) reported in published studies and reports from 2008 to 2018 and to identify the reported determinants, health effects, and coping strategies of women in Pakistan.

Methodology

Literature search strategy.

A literature search was performed using 2 databases: PubMed and Google Scholar. Three authors (TSA, RF, SNFH) independently performed an extensive literature search and shortlisted articles which were then cross-checked by 2 of the authors (RF, SNFH) and selected based on the eligibility criteria. The following keywords and phrases were used: IPV, domestic violence, violence against women, domestic abuse, spousal violence and Pakistan. Quantitative and Boolean operators were used to narrow down the search results. Moreover, all the available grey material and reports from organizations such as WHO and the Aurat Foundation were also reviewed and selected based on the inclusion criteria.

Since this is a review article, approval by the ethics committee was not required.

Eligibility criteria

Since the focus of the search was prevalence of IPV, all the related articles and reports were studied. Articles from 2008 to 2018 were assessed and those including: women undergoing any form of IPV (physical, psychological and sexual); a quantitative study design; English as the publication language; and where Pakistan was the study setting were selected. To control the quality of the chosen articles, only those which had provided a detailed methodology and clear results were included.

Articles were excluded if they were not conducted in Pakistan, or studied spousal violence against men or domestic violence involving in-laws or other family members.

Study selection

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) chart was used for study selection. We identified 9879 articles by database searching of MeSH words (Figure 1). After removing duplicates (n = 49) and checking relevance, 87 were shortlisted. The full text of the shortlisted articles was evaluated for the eligibility criteria and 25 were selected for the final analysis: 14 from PubMed, 10 from Google Scholar and 1 report from the grey literature. The quality of the selected studies was reviewed using a STROBE (Strengthening the Reporting of Observational studies in Epidemiology) checklist, which ensured that all articles were following a structured approach, including an introduction, methodology, results and a discussion section. It was also determined that all selected articles were published in peer-reviewed journals and had used nationally or internationally established tools to conduct their study. The selected studies were approved by one of the authors (TSA), who is an expert in the field of IPV. The one report selected was from Rutgers WPF, a reputable nongovernmental organization which has been working on women’s empowerment and domestic, sexual and gender-based violence since 1997 in over 18 countries.

Ethical considerations

Since domestic violence is a sensitive topic and can put the women interviewed at risk of danger if due safety and confidentiality are not taken into consideration, WHO has laid down recommendations for research on domestic violence against women (8). The selected studies were therefore reviewed to see if they had reinforced ethical considerations. Of the 25 articles, 18 had followed ethical guidelines, of which 11 had followed the WHO recommendations, while 7 had obtained approval from the ethical review committee of their respective institutions. Two articles had used secondary data for analysis, for which ethical approval was not required, while 5 articles did not mention any ethical considerations they might have taken in their research.

Data extraction

Data were extracted by 3 authors (TSA, RF, SNFH) by carefully studying the methodology and results of the selected articles. The methodology was entered into an extraction template which summarized the location, study design and sample size in the articles (Table 1). The results covered the title, authors, publication year and lifetime prevalence of IPV faced by women, which was further categorized into psychological/emotional violence, physical violence, sexual violence, both combined and violence of any other type (Table 2). The prevalence of each type of IPV was plotted against the publication year using Microsoft Excel and a trend line generated to better understand individual forms of IPV (Figure 2). The combined prevalence range of IPV from all the selected articles, causes and outcomes are described in the Results section. The IPV assessment tools used in the research are listed below.

Tools used by the selected studies to assess intimate partner violence

WHO Multi-Country Study on Women’s Health and Life Experiences: This tool has the ability to “estimate the prevalence of violence against women, with particular emphasis on physical, sexual, and emotional violence by male intimate partners”. It also assesses the extent to which IPV is associated with a range of health outcomes, identifies factors that may either protect women or put them at risk of partner violence, and documents and compares the strategies and services that women use to deal with violence by an intimate partner.

Aga Khan University Anxiety and Depression Scale: This is an Urdu language screening tool used for screening psychiatric morbidity (anxiety and depression) in Pakistan. This scale has 81% specificity and 74% sensitivity, 63% positive predictive value and 88% negative predictive value.

Conflict Tactics Scale (CTS): This measures family violence and IPV. The ability of the CTS to measure physical violence in the family (child and spouse abuse) makes it stand out. It assesses conflict-resolving tactics used by couples, reasoning, verbal aggression and physical violence. The reasoning subscale has a Cronbach’s alpha of 0.6 while the value for the other 2 subscales is 0.87.

Women’s Experience with Battering (WEB) Scale: This scale is a measure of a causal link between battering and health. It also evaluates the impact of interventions on battered women or violence prevalence. This tool conceptualizes violence based on severity, frequency and incidence of violent acts. It has a Cronbach’s alpha of 0.88.

Domestic Abuse Checklist (DAC): The DAC is a thorough evaluation of various types of violence inflicted on women by men. It uses international experience to make it functional for local use. It covers: violence, control, threats, severe violence and sexual abuse. This checklist can help health professionals identify victims early in cases with a family history (current or past) of domestic abuse and violence. The DAC Cronbach alpha is 0.89.

Prevalence of violence in published primary data level studies

These studies have shown the prevalence of violence to be 31.3–83.6% for psychological violence, 10.0–98.5% for physical, 2.5–77.0% for sexual, 1.0–68.0% for physical and sexual combined and 6.9–90.0% for any other type of violence, including verbal abuse, controlling behaviour or all types combined (Table 3). Figure 2 shows the trends seen in IPV over the years: psychological and physical violence have decreased, sexual violence and physical and sexual violence combined have increased, while other forms of violence have stayed constant.

The Pakistan Demographic and Health Survey 2012–13 report showed the highest physical violence in Khyber Pakhtunkhwa (57%), followed by Balochistan (43%), Punjab (29%) and Sindh (25%); 79% of the violence was perpetrated by the husband, followed by in-laws (20%). For IPV, it was reported that 52% of the women did not seek help or tell anyone (9).

The Demographic and Health Survey report comparing the attitudes of women and men towards spousal violence showed that generally women were more likely than men to justify at least one reason for violence (9): 34% of men agreed that they were justified in beating their wife, whereas 43% of women found the husband’s violence to be justified, showing that women blame themselves more than the men.

Reasons for violence

The reasons for violence most commonly identified in the selected articles included family problems (45%), household work (9%) and husbands’ negative behaviours (6%) (10). Low level of education also showed a significant association with domestic violence (5). Furthermore, low socioeconomic status, living in a joint family, household crowding, arranged marriage, conflicts between husband and wife, seasonally-based income, women’s low autonomy and younger age for first sexual intercourse were all identified as significant risk factors for IPV (11,12).

There is a considerable lack of mental health education in Pakistan and a high acceptance level for violence against women. Most women are involved in low-paid jobs, which provide them with economic support but cannot secure social and economic autonomy, resulting in performing dual duties both at the workplace and home (13). Owing to cultural attitudes, weak community sanctions against partner violence, and religio-political forces reinforcing patriarchy and gender domination (14), men feel justified in being violent when their needs are neglected. History of violence in the family or poverty during childhood and adolescence also foster insecure men who are unable to control their impulses (15).

Husband’s unemployment, lazy work attitude, drug addiction, increasing age (6), mistrust of the wife’s moral character, restriction on the wife stepping out of the home, womanizing or quarrelling with in-laws because of poor attention towards children (16) lead to battering and verbal or sexual violence. Unskilled husbands earning a low income resort to violence when their wives ask for money to fulfil their household chores (17). Research has established that the risk of depression, aggressiveness and violent behaviours is linked with unemployment, which can lead to an increased risk of physical, sexual and emotional abuse. Stressful life events, marital discord, financial difficulty, child marriage and misinterpretation of religion result in a high prevalence of anxiety, depression and common mental disorders in Pakistani women (18). Inability to make decisions and lack of mobility are common problems of women living in an extended family (14). There is also a lack of reproductive autonomy (19) as 14% of unwanted index pregnancies were reported (14).

Another major reason for the continued violence over the years is the woman’s adherence to patriarchal norms and having no say in the decision-making in domestic matters (20). A large number of women (35.8%) believe that hitting is valid if the wife argues with her husband and a further 22.4% reported their mothers also endured spousal violence, hence the huge acceptance for violence (21). Moreover, it was found that men felt threatened if their wives had any ownership of assets, and this resulted in an increase in controlling behaviours (22).

Outcome of intimate personal violence being reported in selected studies

The health outcomes are serious conditions such as injuries, forced abortions and chronic pain syndromes (2); mental health consequences such as stress disorder, sexual dysfunction, fear and anxiety (23); gynaecological disorders (24); chemical dependency, substance abuse and attempting suicide (25); psychiatric distress and feelings of anger in women (15); and difficulties in decision-making (10). Physical injuries (16.5%) reported over the last 12 months included: 13.9% associated with pain lasting for one day, 7.3% sprain/bruise/cut, 4.1% broken bone and 7.6% requiring medical attention (18).

It was also found that severely physically abused women had a greater likelihood of unplanned pregnancies, poor antenatal care, poor reproductive health and husband’s noncooperation in using contraceptives (24). These women were also more prone to experiencing complications during birth such as intrauterine fetal death, miscarriage, low birth weight, placental abruption and premature labour or birth (11). One study showed that 36% of the women felt they were compelled to indulge in sexual activity they deemed as humiliating while 19% yielded to their husband’s commands in fear of their reaction in case of refusal (14).

The occurrence of a great number of diverse mental health issues, including thoughts of suicide, illustrate the powerful links between mental health and exposure of women to IPV. There was an immense increase of depression and suicidal thoughts in women exposed to IPV (5,10,17,26,27). “Problems in performing usual activities”, “loss of interest in previously enjoyable things”, “feelings of worthlessness”, “memory and concentration problems” and “suicidal thoughts” were among the symptoms of depression, as shown in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) (10,17). Furthermore, depression can also lead to a feelings of low self-esteem. Studies from Palestine, Ethiopia and Sweden showed that a low self-esteem was directly proportional to the length of the abusive relationship, this being known as the “normalization process”, where the woman blames herself and gradually comes to see her abuse as “normal” (28–30). In Pakistan, women are considered inferior to men and therefore, within marriage, violence against women is taken as a cultural norm, especially by elderly women and those who lack an adequate education, further increasing the likelihood of low self-esteem, resulting in psychiatric distress and consequently unhappy relationships (15).

Trends in violence

The published articles indicate a high magnitude of all forms of violence. A decreasing trend was seen for psychological and physical violence, mainly because, over the years, women have gained awareness regarding IPV and are not only empowered but are also demanding equal rights. However, since sexual violence still remains a taboo topic and marital rape is yet to be considered as violence, there is an increasing trend in sexual violence as well as physical and sexual violence combined. Other forms of violence, such as verbal abuse and controlling behaviours, remained constant throughout the period studied, indicating that not enough interventions have been undertaken thus far to reduce these forms of IPV. Moreover, considering the sensitive nature of the topic, there is always an iceberg phenomenon present while reporting cases, thus making it difficult to gauge the actual prevalence of violence.

Lack of context within the tool

With no indigenous tool for violence against women, all Pakistani studies have utilized tools developed elsewhere, which may account for differences in the magnitude and forms reported when compared with other cultures. The tools used in the published articles, which include WHO, WEB and the CTS, need to be standardized to measure the social and economic costs incurred due to violence against women.

Despite the help quantitative data offer to understanding the situation among women, they do not provide any information about how women experience and interpret violence in different public and private settings in Pakistan. Everyday violence, such as verbal abuse, humiliation, degradation, and threats of violence, is not adequately explored and is considered the norm in many households.

Most studies undertaken lack a theoretical foundation, with quantitative data focusing on a specific

region while indirect information forms the major part of the grey literature. All the empirical quantitative studies perform assessments on the nature, prevalence, severity, causes and impact of violence against women in Pakistan on a smaller scale, either in a single province or in urban or rural areas of another province. Reports, theses and review articles provide information at national level; however, their source is secondary data produced by police records, media reports, shelter homes, etc. It is known that secondary data might not produce evidence that can be generalized at population level.

It was also noted that different studies in Pakistan employed different sample sizes and study settings, making it difficult to arrive at a conclusive picture. Data available through empirical and grey sources can be thought of as depicting just the tip of the iceberg, projecting only the extreme cases. Numerous cases of abuse and violence go unrecorded because a great segment of the population firmly believes in privacy, making it a societal taboo to discuss or report personal family matters in public due to the notion that such matters are better resolved within the family.

It is a necessity for studies done on IPV to cast some light on the minds of the male perpetrator, especially concerning their views of gender roles. Efforts are needed to increase our understanding of masculinity and views on IPV and its connection to the masculine identity. Thus, it is essential to engage in a dialogue with men regarding data on gender-based violence, which could make an important contribution to studies on issues of violence against women. By emphasizing the role of gender stereotypes, it brings attention to the insecurities that often lie beneath the male identity, revealing areas for extended studies. Both men and women should be able to question their dreams alongside the realities that shape their psyches and force them to take on stereotypes to live a secure life, which ends up being rigid and uncompromising.

Urban areas verses rural areas studies

Women in rural areas file more IPV complaints than those in urban areas, even though rural areas are far less likely to have other violent crimes. Even if there are services for the victims of IPV in every district, rural women will find it difficult to ask for assistance as there is usually a stigma attached to those who complain about abuse. A “rural culture” usually means a close community, so people know what is happening in the lives of others. It is possible that the police, judiciary, social workers, health workers, religious representatives and other people know both the sufferer and the perpetrator.

The geography of the rural areas, as compared with the urban areas, is such that the residents face physical and social isolation, socioeconomic distress, population loss due to the outmigration of young people in the search of opportunities, and a lack of health care services. This is further combined with low education status and a more traditionalist, conservative view of women, leading to rigid political and social confines for women. Survivors of IPV may require legal aid for matters that result from domestic abuse such as protection orders, divorce and child custody proceedings. There can be more difficulties in obtaining an affordable attorney or legal help in contrast to urban areas. Law enforcement agencies as well as the courts in rural communities may not be acquainted with issues of IPV and the required solutions (31).

Small scale studies published in Pakistan lack analysis in identifying correlates and establishing causal linkages with factors that may increase women’s vulnerability to various form of violence. The existing body of literature is unable to identify causality with risk factors and outcome. Studies done to date only identify associations and then causality, establishing the dire need for longitudinal studies or interventional studies to test interventions for the prevention of violence.

Future implications

This study provides insight into the different types of IPV, causes, trends and effects, therefore allowing interventions to be carried out and each intervention to be tested for its effectiveness in different settings. Future systematic reviews can eliminate limitations by using a mixed methodology approach, reviewing articles from within and outside Pakistan and focusing on interventional study designs.

In conclusion, the prevalence of multiple forms of violence is quite high and is still on the rise, especially sexual violence and the combination of sexual and physical violence. The selected articles identified the common causes including family problems, unemployment, misunderstanding between couples, and violence being justified by men and accepted by women (normalization). The reported consequences result in psychological stress, physical injuries, gynaecological disorders, miscarriages and grave detrimental mental health leading to suicidal ideations.

Funding : None

Competing interests : None declared.

Violence exercée par un partenaire intime à l'encontre des femmes : une représentation exhaustive de la littérature pakistanaise

Contexte  : La violence exercée par un partenaire intime à l’encontre des femmes est un problème important au Pakistan, lié à un ensemble alarmant de problèmes de santé mentale.

Objectifs  : Identifier la prévalence de la violence exercée par un partenaire intime au Pakistan et ses causes, ses effets sur la santé et les stratégies d’adaptation utilisées par les femmes.

Méthodes  : Une recherche exhaustive basée sur les mots-clés identifiés a été menée à l'aide de Google Scholar et PubMed. La littérature pertinente a également été consultée et incluse. Les résumés ont ensuite été présélectionnés à l'aide des lignes directrices relatives aux éléments de rapport préférés pour les examens systématiques et les méta-analyses, et 25  études ont été sélectionnées. Des études quantitatives sur la violence exercée par un partenaire intime ont été incluses dans la revue. L’analyse comprend uniquement des rapports publiés en anglais de 2008 à 2018.

Résultats  : L’analyse prend en compte la prévalence globale de la violence contre les femmes au Pakistan et ses différents sous-types : psychologique 31,3-83,6 %, physique 10,0-98,5 %, sexuelle 2,5-77,0 %, physique et sexuelle combinés 1,0-68,0 % et tout autre type 6,9-90,0 %.

Conclusion  : Les données probantes produites aideront à informer les responsables de l’élaboration des politiques et de la santé sur les déterminants et les effets de la violence exercée par un partenaire intime, ce qui facilitera la résolution de ces problèmes et l’identification des victimes dès que possible. Elles mettent également en lumière les limites de cette étude : les outils utilisés par les études publiées ne sont pas spécifiquement conçus pour le Pakistan et il n'existe pas de définition standardisée de la violence à l’encontre des femmes. Il est donc nécessaire de mener de nouvelles études pour contribuer à trouver une solution.

عنف الشريك المُمارَس ضد المرأة - وصف شامل للأدب الباكستاني

تازين علي، روزينا كارمالياني، رضا فرحان، سيدة حسين، فاطمة جواد

الخلفية : يمثل عنف الشريك المُمارَس ضد النساء مشكلة كبرى في باكستان ترتبط بمجموعة مثيرة للقلق من مشكلات الصحة النفسية.

الأهداف : هدفت هذه الدراسة إلى تحديد معدل انتشار عنف الشريك في باكستان، وأسبابه، وآثاره الصحية، واستراتيجيات المواجهة التي تطبقها النساء.

طرق البحث : أُجري بحث شامل يستند إلى الكلمات الرئيسية المحددة باستخدام برنامجيْ Google Scholar وPubMed. كما بُحث في المؤلفات ذات الصلة وجرى إدراجها. ثم أُدرجت الخلاصات في قائمة مختصرة باستخدام بنود التبليغ المفضلة للاستعراضات المنهجية والمبادئ التوجيهية للتحليلات الوصفية، وبذلك اْختيرت 25 دراسة. وأُدرجت في الاستعراض دراسات كمية حول عنف الشريك. ويقتصر الاستعراض على التقارير المنشورة باللغة الإنجليزية في الفترة من 2008 إلى 2018.

النتائج : يفسر الاستعراض معدل الانتشار العام للعنف ضد النساء وأنماطه الفرعية المختلفة في باكستان، أي: العنف النفسي (83.6 - % 31.3)، والعنف البدني (98.5 - % 10.0 )، والعنف الجنسي (77 - % 2.5)، والعنف الجسدي والجنسي مجتمعيْن (68 - % 1.0)، وأي نوع آخر من أنواع العنف (90.0 - %6.9).

الاستنتاج : ستساعد الدلائل المتولدة في إخطار راسمي السياسات ومسؤولي الصحة بمحدِّدات عنف الشريك والآثار المترتبة عليه، مما يُسهِّل التصدي لتلك المشكلات وتحديد الضحايا في أقرب وقت ممكن. كما ستلقي الضوء على القيود المفروضة على تلك الدراسة، والمتمثلة في: عدم تصميم الأدوات المستخدمة في الدراسات المنشورة خصيصاً لباكستان، وعدم توافر تعريف موحد للعنف ضد المرأة. ويتطلب ذلك إجراء المزيد من الدراسات للمساعدة في إيجاد حل.

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National Report on the Status of Women in Pakistan - A Summary

In seeking to uphold its international and national commitments on gender equality and women’s empowerment (GEWE), limited availability and analysis of comprehensive gender disaggregated data remain key gaps that hinder quality reporting as well as priority setting and decision-making. To address this gap, the National Gender Data Portal (NGDP) was established in 2021 by the National Commission on the Status of Women in collaboration with UN Women Pakistan. It is the first effort to consolidate gender data at a national level using digital tools, triangulating data from various official sources. This data will be used to publish periodic reports on the status of women, which will be instrumental for analyzing trends and reviewing progress, and, most importantly, formulating evidence-based policies and programmes to advance the gender equality agenda in the country.

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Do Justice and have Justice….

Pakistan’s democratic canvas: patterns of struggle and hope, irrefutable reality, making sure justice is blind, a simple buffalo disease, anthrax and toilet cleaners, lahore flourishes with seasonal blooms before eid, uog student leads team as environmental initiative takes root at fc…, mps to boycott uk prime minister’s eid celebration in protest against…, iran tells russia it will react decisively to any israeli provocation, landslides kill 18 on indonesia’s sulawesi island, two missing, iran tells unsc attack on israel was ‘self-defence’, had no choice, israel continues air strikes on gaza after iran attack as un…, pakistan, new zealand series likely to be affected by rain, new zealand cricket team arrives in islamabad for t20i series, amir, imad make a comeback as pakistan team for nz t20…, army chief hosts iftar for pakistan cricket team, pcb selection committee meets with players in islamabad ahead of nz-series…, domestic violence against women in pakistan.

There’s too much of it

Despite strict laws and social awareness, domestic violence is prevalent in Pakistan at an alarming rate. Almost one in three Pakistani women report facing domestic physical violence by partners, in-laws, and in some circumstances by their brothers and parents. The informal estimates are much higher. Such violence, when widespread in society, is also normalized. According to a study conducted by the Bureau of Statistics, more than half of the women respondents in one province believe that it is acceptable for a husband to beat his wife under certain circumstances; and such sentiments also prevail in the rest of the country. According to media reports, more than 51,241 cases of violence against women’ were reported between January 2018 and October 2020.

According to a survey conducted on 23 September 2018, by Thomson Reuter Corporation, Pakistan was ranked as the sixth most dangerous nation on the planet for women. The predominant power structure in Pakistan is patriarchy, in which the male figure is in control of all affairs, public and private, thus assuming a dominant position. Women have been excluding from settling on choices and are considered socially and financially dependent on men. Women have to face discrimination and violence daily due to the cultural and religious norms that Pakistani society embraces.

About 70 to 90 percent of Pakistani women are subjected to domestic violence. Domestic violence perpetrated upon a spouse can precede the mistreatment of children; this can, in turn, leave a long-term emotional and psychological impact such as behavioral disturbances, with the child replicating the abuse. Women who have experienced domestic violence or abuse are at a significantly higher risk of experiencing a range of mental health conditions including, depression, anxiety, substance abuse, and thoughts of suicide. Domestic violence and oppression of women, especially at home, is unacceptable, and needs to be treated as such.

Recently, a heart-wrenching video of a rebellious young man beating his mother went viral. Similarly, painful videos of women’s abuse have also surfaced in recent times. A recent case was of Sadaf Zahra , a married woman whose body founded hanging from the ceiling fan by a bedsheet tied around her neck and a ladder lying close by. The deceased’s friend has held her friend’s husband responsible for her death. Similarly, hundreds of thousands of women across the country face the same plight but have not been able to lift their voices.

In the late 1970s and 1980s, Pakistan witnessed regression of women’s rights laws, which have been amending to reflect this discrimination. In the last 10 to 15 years, there has been some success in passing policies to prevent practices such as early-age marriages, honour killings, sexual harassment, domestic violence, and rape. Pressure needs to be maintained upon the central and provincial governments to tackle domestic violence and treat it as a priority; this is a problem that impacts society as a whole. As part of a dialogue recently organized by the KP office of UN Women and the KP’s EVAW Alliance, the scholars have signed a declaration condemning gender-based violence and vowing to spread awareness in their relevant communities to put an end to the practice. The increased focus of religious sermons on ending violence against women can make a notable difference over time.

The time is right to act on this issue in Pakistan. Society, too, needs to step up for its women. Regardless of the introduction of pro-women laws that criminalize domestic abuse, the barriers to ensuring justice to the victims are too many. Merely introducing laws that lack proper implementation and establishing helplines do not mean that the state has fulfilled its responsibilities regarding women’s protection. The law also needs further improvements and clarity in its language. It is the responsibility of the state to give protection to its citizens in public and private spaces. There is no way the state could allow its citizens to be subjected to abuse just because it takes place in a personal setting. If we do not address violence against women and girls, sustainable growth will remain elusive.

Successive governments have also taken steps to put a stop to the exuberant women abuse. The Constitution of Pakistan ensures women’s security against any form of violence in its Articles 3 and 11. Besides, the National Commission on the Status of Women Bill 2012, the National Policy for Development and Empowerment of Women (NPDEW) 2002, and the Punjab Protection of Women against Violence Act (PPWVA) 2016 are among the measures adopted to protect women from domestic violence in the last decade. PPP Senator Sherry Rehman tabled the Domestic violence Bill on the floor of the Senate for debate, in July 2020. Under the bill, offenders were to be punished by domestic violence which was criminalized. In recent times Shireen Mazari, the Human Rights Minister in the PTI government, started a helpline to enable women and children to report instances of domestic violence.

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