Domestic violence : profile of married women availing institutional help

1PhD Scholar, Department of Psychiatric Social Work, NIMHANS, Bangalore-29, Karnataka, India, 2Supervisor, Integrated Child Development Services (ICDS), Kozhikode Urban No. 3, Kozhikode, Kerala, India, 3Psychiatric Social Worker, Department of Psychiatric Social Work, NIMHANS, Bangalore-29, Karnataka, India, 4Additional Professor, Department of Psychiatric Social Work, NIMHANS, Bangalore-29, Karnataka, India


Introduction
Over the last few years, violence against women in developing countries is becoming a major concern among researchers and policymakers interested in women's empowerment and health.[1] Violence against women is a major public health issue in both the developed and less developed countries.[2] A study on domestic violence (DV) conducted by World Health Organization (WHO) revealed that intimate partner violence is the commonest form of violence in women's lives -may be more than the abuse or assault or rape by others.[3] The WHO study revealed that women face enormous physical and sexual violence by husbands and partners, and this has an impact on the health and well-being of women around the world.[3] Also, the partner violence is still largely hidden in most of the countries.[3] In India, a study on 90,303 married women indicated presence of widespread of DV (21%, since age 15) and another study showed 39% of women undergoing DV. [4,5] A study among Asian women showed that reasons for not seeking help were social stigma, rigid gender roles, marriage obligations, expectations of silence from women, loss or lack of social support after migration, limited knowledge about available resources, and myths and misconceptions about intimate partner abuse.[6] DV victims usually turned for help only after experiencing or developing significant mental and physical health problems.[6] A study conducted in India showed that women accessing external support systems such as the police or nongovernmental organisations (NGOs) was viewed as both socially inappropriate and infeasible.[7] On the contrary, another study revealed that many women approach NGOs or police to get help.[8] The profile of women sought or availed help to address DV and the outcome of institutional help is minimal in Indian literature.In this context, the current study made an attempt in profiling married women undergoing DV, who received any kind of institutional (counselling centres, police, etc.) help from various agencies to address DV.

Methods
The data were collected from Calicut (Kozhikode) district of Kerala state, India.Authors approached various government (police/family counselling centres/court etc.) and NGOs.With the permission from organisations, researchers approached the clients.The purpose of research was explained to the clients and those who were ready to give consent were included in the study.All participants were allowed to withdraw their consent at any point.Institute ethical clearance was obtained to conduct the study.
The study had adopted descriptive research design.Data were collected from 60 married women aged between 18 and 50; who were experiencing DV from their husbands.An interview schedule was prepared by the authors and validated by professionals (social worker, sociologist, lawyer, and psychiatrist) for the purpose of collecting data.The interview schedule covered socio-demographic data of respondents and their husbands, nature of violence, perceived reasons for violence, services related information, and their response to DV. Descriptive statistical analysis was done.

Results
With regard to the demographic details (Table 1) of women who experienced DV, they belonged to the age group of 25-45 years.Majority were from semi-urban (61%) background.Only 30% were staying with their husbands and others were at their own house or shelter homes or relative's homes.With regard to the education, 46.67% were educated up to tenth standard, five per cent were illiterate.Majority were unemployed (60%).Sociodemographic details of husbands (Table 2) showed that they were in the age group of 25-65 years, 51.66% were educated up to tenth standard, mainly were doing daily wage works (36%), and 55% abused alcohol or drugs.
With regard to the DV experienced (Table 3), 60% of them faced DV for more than five years.All of the participants have faced at least one form of DV (physical, emotional or verbal, sexual, and financial).Majority (63.33%) had faced DV from husband's family members also.Their children (58.33%) also have witnessed DV.Perceived causes of DV were (Table 4) husband's exposure on parental violence (58.34%), extramarital relationship in spouse (58.34%), presence of wife-beating member in husband's family (56.66%), and other reasons.With regard to the responses towards DV (Table 5), majority remained submissive (46.67%) when DV happened and 66.66% had attempted suicide.With regard to the knowledge about legal aid services (Table 6), 53.33% did not have awareness on laws or services to protect women's rights, majority (50%) approached NGOs for support, and 75% considered legal/formal support was inadequate to solve the DV related problems.

Discussion
The current study focused on profiling of married women who were undergoing DV and of those who have sought or availed any kind of institutional help from various sources (NGOs/police/family counselling centres/court etc.) to deal with DV.The study showed that majority of the victims were young, from low socioeconomic strata (LSES), and belonged to nuclear family.The majority of the respondents were not highly educated and employed also.These findings go along with findings in other studies.[4,9,10] All these factors may be maintaining factors for DV and this may worsen DV, as women may avail less social, legal, and emotional support.
With regard to religion, most of them were Muslims.This is contrast to a report in an electronic media that DV is high in Hindu family.[11] The children also have witnessed DV.It may adversely affect the development of children.This has been established in few studies that the children and adolescents living with DV are at high risk of undergoing emotional, physical, and sexual abuse and of developing emotional and behavioural disorders.[12][13][14] This reminds health professionals that the children of women undergoing DV also require attention.
With regard to the perpetrators of DV, most of them were young, abused alcohol or other psychoactive substances, and had extramarital relationships.These findings are similar to the other studies also.[4,[15][16][17][18] Most of the respondents were undergoing DV in terms of physical, sexual, emotional or verbal, and economic violence.This finding has been established in a few other studies conducted in different countries including India.[19][20][21] Many studies have revealed that physical violence and forced and unprotected sex has major impact in physical health and reproductive health of women.[22][23][24][25][26] Majority of the respondents have experienced DV from husband's family members also.Same findings have been found in other few Indian studies and this may worsen the condition of women further.[18,27] Current study has explored respondents' perceived factors of DV, such as husband's exposure on their parental Most of the study participants responded to DV in unhealthy manner.Many became submissive and felt it is their fate.In a study conducted in India revealed that woman prefers to be submissive during DV.[27] This may be because the cultural beliefs and gender disparity exist and one common custom is women should be submissive to men.Current study revealed that majority of them has made suicide attempts due to DV.Many studies showed that DV has greater role in developing mental illnesses in women, such as anxiety, depression, posttraumatic stress disorders (PTSD), and suicide.[25,[31][32][33][34][35][36] This is an alarming situation that mental health consequences are high in women because of DV and this needs immediate attention.
The Protection of Women from Domestic Violence (PWDV) Act was passed in 2005 in India.[37] But, legal awareness (about legal protection for women and DV as crime) was low among respondents.Poor legal knowledge may increase the risk of living in a hostile environment and associated psychosocial, health, mental health risks.In the current study though most of them sought help including legal help from various sources, at the same time they felt legal interventions are inadequate to address DV.These findings go along with another study conducted in India which claims that the PWDV Act could neither guarantee any reduction in the extent of such violence, nor could they expedite the justice delivery system in India.[38] Here, most of the perpetrators abuse psychoactive substances and women had poor coping skills and this has caused to force them even attempting suicide.The current study findings alarm health professionals and policy makers about the importance of approaching DV in mental health perspective.Evaluation and treatment of mental health condition of both perpetrators and the victims are essential.Physicians, nurses, counsellors, social workers, and psychologists working with the DV victims should be trained how to provide psychological first aid to the women who experienced DV.This may reduce suicide rate among the victims.Along with community awareness programme, extension of legal awareness and legal aid interventions, mental health services including individual counselling or psychotherapy, family counselling or therapy, de-addiction services, etc. should be available to both victims and perpetrators.The children who witnessed DV also require special attention.They also require screening for emotional and behavioural disorders.Police and lawyers also need to be to be sensitised about this issue and may require training on how to approach DV in mental health perspective.So, these professionals can refer DV cases to appropriate professionals and minimise the impact of DV.

Conclusion
DV is a major public health issue and it is not openly discussed by the victims in Indian society even now.In the current study, most of the participants who were undergoing DV were young, from LSES, not well educated, and were unemployed.The perpetrators abused psychoactive substances and had extramarital relations.Lack of awareness about laws and women's rights and unhealthy way of coping with DV worsened the situation and it had an impact on their mental health.Victims perceived that the legal measures did not help them adequately.Multi-level interventions are required to address the issue.Political, legal, social, and mental health interventions are essential.A greater amount of attention is required from health professionals, especially mental health professionals as the impact of DV is long lasting and severe among women as well as among their children.Police and lawyers also need to be trained to manage DV.

Table 2 :
Socio-demographic details of husbands

Table 3 :
Domestic violence related details [29,30] conducted in India, found dowry as a major reason for DV.[29,30]It could be because of that, people in Kerala while compared to other states of India, are aware of legal consequences of giving or accepting dowry.

Table 4 :
Perceived causes of violence

Table 5 :
Responses to domestic violence

Table 6 :
Services related information