Prevalence and Experiences of Intimate Partner Violence Against Women With Disabilities in Bangladesh

Abstract

This study was aimed to estimate the prevalence of intimate partner violence (IPV) in a sample of 226 women with disabilities living in four different districts of Bangladesh. It also explored the physical and psychological suffering of women experiencing violence and their various coping strategies. A cross-sectional survey was carried out with 226 women with disabilities to measure the prevalence of IPV, and 16 in-depth interviews were conducted to document in detail the experiences of violence encountered by the abused women. Among the 226 women interviewed in the survey, about 84% reported ever having experienced at least one act of emotional abuse, physical, or sexual violence from their partner during their lifetime. Women who were older (aged above 32 years), separated, and members of economic/savings group were more likely to report ever having experienced any IPV than women with disabilities who were younger (aged 32 years and less), married, and not members of economic/savings group. Most of the women experiencing violence reported sufferings from physical and psychological problems. Of all the women who experienced violence, less than half (45%) reported seeking support to minimize or avoid violence experiences. However, seeking support from informal network such as family and relatives was commonly reported by many (81.4%) of them. Study findings suggest that women with disabilities who possess poor socio-economic status coupled with economic dependency on husbands’ income and wide-spread social stigma against disability make them vulnerable to IPV. Future interventions to address IPV against women with disabilities should include building community knowledge of disability and IPV, countering the pervasive social stigma against disabilities, and improving the socio-economic conditions of women with disabilities through education and employment.

Keywords

women with disabilities intimate partner violence Bangladesh

Introduction

Existing research findings suggest that intimate partner violence (IPV) against women with disabilities is prevalent in many different countries. Although IPV constitutes serious threats to the mental and physical well-being of women with disabilities, very little research has been conducted on this issue.

Some previous studies have shown that women with disabilities are in general at increased risk of experiencing IPV compared with women without disabilities (Barrett, O’Day, Roche, & Carlson, 2009; Brownridge, 2006; Martin et al., 2006; Smith, 2008). They are vulnerable to experiencing violence for multiple reasons, such as dependency on a partner for daily living (Nosek, Foley, Hughes, & Howland, 2001). While it is common that women with disabilities experience verbal, physical, and sexual abuse on grounds of their disabilities, oftentimes violence itself leads to disabilities. A study by Coker, Smith, and Fadden (2005) in the United States has found that women who have ever experienced IPV are more likely to report a disability due to generalized chronic pain and mental illness compared with those who never experienced IPV. A few other studies (Hathaway et al., 2000; Plichta & Falik, 2001; Thomas, Joshi, Wittenberg, & McCloskey, 2008) have also reported that women who are victims of IPV are at increased risk of disability.

Many studies examined the association between women’s experience of IPV and their health consequences (Bonomi et al., 2006; Campbell et al., 2002; Fanslow & Robinson, 2004; Martin et al., 2008; Plichta & Falik, 2001). Compared with women who never experienced IPV, women who experienced IPV are more likely to suffer from depression and sleeping problems (Hathaway et al., 2000) and to attempt suicide (Davidson, Hughes, George, & Blazer, 1996; Ellsberg, Jansen, Heise, Watts, & Garcia-Moreno, 2008; Fanslow & Robinson, 2004; Kaslow et al., 2000; Wingood, DiClemente, & Raj, 2000). They are also more prone to define their health as poor (Bonomi et al., 2006; Ellsberg et al., 2008; Plichta & Falik, 2001; Weinbaum et al., 2001). A study conducted by Barrett et al. (2009) found that women with disabilities who experience IPV are less likely to report their health as good or excellent as compared with women with disabilities who have not experienced IPV.

Previous research conducted in Bangladesh has examined the prevalence of IPV against women within the general population (Ahmed, 2005; Hadi, 2000; Naved, Azim, Bhuiya, & Persson, 2006; World Health Organization [WHO], 2005). In a study of 1,305 poor rural women aged less than 50 years, Schuler, Hashemi, Riley, and Akhter (1996) reported that 47% of the women were ever beaten by their husbands during their lifetimes. In another study, the prevalence of lifetime physical violence was found to be 61% among 79 women who were admitted in two hospitals due to violence-related injuries (Azim, 2000). The most comprehensive study on violence against women (WHO, 2005) also reported the prevalence of physical and sexual violence against women by an intimate partner—the lifetime prevalence of physical violence was found to be 42% in the provinces and 40% in the cities, the lifetime prevalence of sexual violence was found to be 50% in the provinces and 37% in the cities.

The prevalence of IPV against women with disabilities is presumed to be high in Bangladesh; however, lack of reliable information and limited research in this area makes it difficult to conclude whether or not women with disabilities are actually more at risk of experiencing partner violence. To date, only one study has been conducted by Naved et al. (2012) that explored violence against women with chronic mental disabilities in Bangladesh. Out of 17 women who participated in this study, 8 reported having experienced sexual violence from their partner. However, this particular study lacked generalizability as it utilized only a small number of participants recruited through purposive sampling.

The present study aims to fill the knowledge gap on IPV against women with disabilities in Bangladesh. It describes the prevalence of IPV against women with disabilities, the sufferings of the women who experienced violence, and their coping strategies. The data have been collected from women living in four districts of Bangladesh. The study also examines the association between experiences of IPV and women’s socio-economic characteristics. The study defines violence as follows: The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development, or deprivation (WHO, 1996).

Method

This study is based on the information of a sub-sample of women (226 women who were ever partnered) from a larger study conducted in India, Nepal, and Bangladesh which explored experiences of violence by women with disabilities, sex working women, and women who engaged in same-sex relationships (CREA, 2012). Although the larger study (CREA, 2012) gathered information on experiences of violence from 368 women with disabilities, this article uses information from only 226 of those 368 women with disabilities who were ever partnered. The study followed WHO multi-country study’s definition of “ever-partnered women” in Bangladesh and included women who were or had ever been married or in a common-law relationship (WHO, 2005).

The study adopted an explanatory sequential mixed-method design (QUAN → qual; Creswell & Clark, 2011). The initial quantitative survey was followed by a second phase of qualitative research based on in-depth interviews. The quantitative survey measured the prevalence of IPV among a representative sample of women. However, this approach alone does not address questions related to the detailed processes of violence, life experiences, support systems, and women’s expectations. Preliminary analysis of the quantitative survey helped the researchers formulate research questions to explore in detail during the qualitative phase. In addition, it also helped in sampling, by selecting appropriate individuals for the qualitative segment of the study. This explanatory sequential mixed-method study design combined both quantitative and qualitative approaches to provide a more comprehensive view of IPV among women with disabilities, taking into account the breadth and depth of the problem.

Participants were recruited through the National Council of Disabled Women (NCDW), a national network of disabled people’s organizations (DPOs) working for the rights of women with disabilities in Bangladesh. This organization (NCDW) is supported by Action on Disability and Development (ADD) Bangladesh to build a broader network for boosting the rights of the population with disabilities. ADD is a U.K.-based development agency working in multiple countries within Asia and Africa to facilitate activities of DPOs. There are many independent local organizations/DPOs working for women with disabilities at the union/upazila level (The upazilas are the second-lowest tier of regional administration in Bangladesh. Clusters of unions make an upazila and cluster of villages make a union). Many of these local organizations are member of NCDW. As most women with disabilities were likely to be members of the local organizations, we developed sampling frame by collecting membership lists of these local organizations through NCDW. The inclusion criteria of the participants was defined as (1) women who have a physical disability or sensory disability (visual or hearing impairment) or both of these types, (2) who were above 15 years of age, (3) capable of giving informed consent, and (4) members of any of these local organizations. Due to the last clause of the criteria, the study excluded women with disabilities who were not members of NCDW. Furthermore, ethical considerations and the lack of protection for non-NCDW members also compounded the final decision in excluding non-NCDW participants. Finally, recruiting other local disability organizations into the research was not possible due to the time and resource constraints on the research team.

The initial quantitative survey was carried out in four districts (Dhaka, Rajshahi, Natore, and Sirajganj) from August 2010 to October 2010 to measure the prevalence of violence. These four districts were selected due to the large number of women with disabilities identified encompassing both rural, slum, and urban respondents. Rural areas in Bangladesh are usually characterized by low population density, lack of employment opportunities and located in the periphery of the country. Rich landowners are few in number and most villagers have a low income. Urban areas are characterized by high population density and city life. Slum areas are located in the city and characterized by poor living conditions in spite of temporary work opportunities and prone to evictions and social insecurities. The questionnaire used involved questions related to socio-demographic characteristics of women, their experiences of violence, their mental and physical health sufferings, coping strategies, perception regarding empowerment, and expectation of support/justice.

For the qualitative component, 16 in-depth interviews were conducted with ever-partnered women with disabilities. Participants were purposively selected based on their violence experiences. Some of them participated in the quantitative survey and others were referred by organizations. Interviews started with broad, generic questions about themselves and then graduated to specific questions related to the type of violence experiences, reasons/triggers for violence, formal and informal support sought, experiences with service providers, disclosure concerns, health sufferings, and expectations of violence prevention and seeking justice (wish list).

On average, each survey interview took 30 to 45 min and each qualitative in-depth interview took approximately 2 hr. The qualitative interviews were followed by a short de-briefing session conducted by trained interviewers to avoid re-traumatization among the participants addressing and validating their thoughts and feelings to bring appropriate closures to the interviews (adopted from Tehrani & Westlake, 1994). Almost all the interviews (survey interviews and qualitative interviews) took place at the field offices of ADD Bangladesh. In some cases, due to unavailability of ADD offices, interviews were conducted in local DPO offices or in nearby upazila health complexes or in nearby schools, where the respondents felt comfortable.

The ethical approval of the study was obtained from the ethical review committee of the James P. Grant School of Public Health (JPGSPH), BRAC University. Researchers also maintained ethical norms while conducting interviews. Informed consent was obtained from all the survey and in-depth interview participants. They were also informed about the anonymity and confidentiality, the nature of the research, the types of questions, and the length of the interviews. The participants were also provided with additional information on support services depending on their experiences and if they asked/felt they required support services.

Quantitative data were analyzed using SPSS; a data analysis software (version 11.5, SPSS Inc., Chicago, IL). Logistic regression analysis was used to investigate association between lifetime experience of violence and socio-demographic characteristics. Qualitative data were analyzed through thematic categorization and computer-assisted coding (Atlas.ti 6.1). Quantitative data analysis was followed by qualitative data analysis. While the analysis of quantitative data provided the extent of violence, analysis of the qualitative interviews provided comprehensive details of experiences of violence. Integration of the mixed-method data analysis was done during the interpretation of the study findings.

Results

Characteristics of the Participants

Table 1 provides characteristics of 226 women with disabilities interviewed in the survey. Among the 226 women who were interviewed, about 33% were aged 50 years and above. Majority of them were from rural areas (85%) and 38% reported having no education.

Table 1.

Characteristics of the Survey Participants.

Background Characteristics	Frequency	Percentage
Age in years
14-19	3	1.3
20-29	42	18.6
30-39	53	23.5
40-49	54	23.9
50 and above	74	32.7
Area of residence
Rural	192	85
Urban	28	12.4
Slum	6	2.6
Education
No education	85	37.6
1-5 years education	46	20.4
6-10 years education	22	9.7
Non-formal education	73	32.3
N	226

All the participants identified themselves as disabled and 37% reported congenital or birth problem as the possible cause of their disabilities. Only a small percentage (3%) reported experiencing disability after being subjected to violence. Of the 226 women, 20.4% reported that they had moderate disability and 29.2% reported that they had severe disability.

Of the 16 women who participated in the qualitative phase, 10 were from the age group 25 to 39 years. Most of them were married and were residents of rural areas. Table 2 shows the characteristics of the 16 participants interviewed in the qualitative phase.

Table 2.

Characteristics of the Qualitative In-Depth Participants.

Background Characteristics	Frequency
Age in years
15-24	6
25-34	7
35 and above	3
Area of residence
Rural	9
Urban	6
Slum	1
Education
No education	1
Can give signature	7
1-5 year education	1
6-10 year of education	5
Information missing	2
n	16

Experience of Violence

Among the 226 participants questioned in the survey, about 84% reported experiencing at least one act of emotional abuse, physical or sexual violence from their partner during their lifetime. Qualitative data revealed that violence was in the form of emotional abuse (belittling their disabilities, not giving them new clothes, preventing them from having children, and so on), verbal abuse (name calling), physical (severe beatings, including slaps, kicks, punches, and so on), and sexual abuse (forced sex, etc.).

Table 3 shows the prevalence of different kinds of violence experienced by the 226 participants from current partner/ex partner. Our qualitative findings revealed that participants experienced violence because of their disabilities, incapacity of paying satisfactory dowry to husbands/in laws, or lower economic status. Dowry is a traditional informal contract of paying money, cash in kind, or property by bride’s family to prospective groom for marriage. Many participants interviewed in the qualitative phase reported that their families had to pay generous amounts of dowry to prospective husbands. A few participants mentioned that men opted to marry women with disabilities in expectations of higher dowries. As a result, these husbands tended to become violent with their wives post marriage.

Table 3.

Different Forms of Violence Experienced by the Ever-Partnered Women With Disabilities.

	Total Number of Ever-Partnered Women	Ever Experienced Violence		Violence Experienced in the Past 12 Months
Types of Violence	N	Frequency	%	Frequency	%
Emotional abuse
Insulted you or made you feel bad about yourself	226	160	70.8	63	39.4
Belittled/humiliated you in front of other people	226	148	65.5	62	41.9
Done things to scare/intimidate you on purpose	226	125	55.3	46	36.8
Threatened to hurt someone you care about	226	51	22.6	14	^a
Any type of emotional abuse	226	168	74.3	69	41.1
Physical violence
Slapped or thrown something at you	226	154	68.1	44	28.7
Pushed or shoved or pulled hair	226	119	52.7	32	26.9
Hit with fist or with something else	226	119	52.7	32	26.9
Kicked/dragged/beaten up	226	105	46.5	28	26.7^a
choked or burnt on purpose	226	52	23.0	12
Threatened to use a gun, knife, or other weapons against you	226	44	19.5	10	^a
Any type of physical violence	226	159	70.3	45	28.3
Sexual abuse
Physically forced to have sex	226	103	45.6	18	^a
Experienced something sexual when you were afraid of what your intimate partner might do	226	81	35.8	16	^a
Experienced something sexual that you found degrading or humiliating	226	40	17.7	11	^a
Any type of sexual abuse	226	110	48.7	20	18.2

Percentage based on fewer than 20 participants suppressed.

Emotional abuse

Table 3 shows the high prevalence of emotional abuse experienced by the 226 participants from current partner or ex-partner. The most common act of emotional abuse ever experienced by these women was having been insulted (70.8%). A large proportion (65.5%) also reported that they had been humiliated by their partners during their lifetime. Regarding experiences of emotional abuse in the past 12 months, 42% of the women reported having been humiliated by their husbands in front of other people.

Our qualitative data revealed similar findings regarding experience of emotional abuse. Almost all of the ever-partnered women reported experiencing verbal abuse from their partners ranging from belittling to humiliation. A 21-year-old participant from a rural area shared her experience of emotional abuse as follows:

My husband told me “I won’t keep you, it is not possible, and you are disgusting.” He said “Your father is bad, your mother is bad and that is why you also have become bad.”

Some participants also mentioned that they experienced tremendous pressure from their husbands to handover their properties to them. A 35-year-old participant from a rural area stated that her volatile relationship with her husband resulted from pressures to transfer her property under his name:

“Give me your property and whatever you have, and then I will behave nicely with you.” He asked me to sell my cow and sell my land and give him money. He does like this always. (35-year-old participant from rural area)

Physical violence

Table 3 shows that the most common form of physical violence ever experienced by the 226 participants was slapping or having something thrown at them by their partners (68.1%). This was followed by being pushed or shoved or having their hair pulled (52.7%) and being hit with the fist or with something else (52.7%). Regarding experiences of violence in the past 12 months, more than one fourth of the women (28.7%) reported being slapped or having something thrown at them, followed by being pushed or shoved or having their hair pulled (26.9%), and being hit with the partner’s fist or with other objects (26.9%).

Our In-depth interviews revealed that participants often experienced severe forms of physical violence from their husband. The physical violence manifested in beatings ranged from no apparent reasons to mere infractions or due to lack of settlement of dowries, or failure to follow the partners’ instructions properly. One of our participants said,

He used to beat me always and he used to beat me for nothing (for no reason). He used to beat me if I didn’t listen to any of his instructions. He used to beat me if I didn’t do as he said. One day I went to the kitchen to cook rice. Then my husband told me “Come, give me a massage.” I told him “I will cook now.” Then he kicked me on my back and threw away all the rice. (30-year-old participant from an urban area)

Sexual violence

The prevalence of sexual violence experienced by the 226 participants was found low, as compared with physical violence and emotional abuse. Table 3 shows that the most common form of sexual violence ever experienced by the women was being physically forced by their partners to have sex (45.6%). Our qualitative findings revealed that participants experienced sexual violence for multiple reasons ranging from their inability to fulfill husband’s sexual desires to aggressive sexual overtures by their husbands, and so on. One of our participants said how she was sexually abused by her husband:

I used to feel suffocated in doing such thing. Yes, it gave me lot of trouble. He would refrain from doing so when I insisted. He wanted to do it every day. My body was unable to tolerate such a thing daily. (30-year-old participant from an urban area)

A few of the participants also reported experiencing forced sex when they were pregnant. A 25-year-old participant from a rural area said,

My husband forced me to be with him when I was pregnant. My stomach used to hurt doing this but he did not listen to me.

She further stated that her husband berated her for her physical disabilities and insisted that due to his generosity in marrying her she must yield to all his demands:

He said, you are lame and yet I married you. Did I marry you so that you can just sit around? You have to fulfill my wants. I cannot skip days and do it as your wish. Then I can go to the Bazaar (market) and do it.

Women’s Lifetime Experience of Violence in Relation to Socio-Demographic Characteristics

Logistic regression model was used to investigate the association between women’s lifetime experience of IPV and different socio-demographic characteristics. Participants were categorized into two groups—ever experienced violence and never experienced violence. Among the ever-partnered women (n = 226), about 84% reported ever experienced at least one act of physical, sexual, or emotional abuse by an intimate partner. Logistic regression results in Table 4 shows that women aged more than 32 years were about 4 times more likely to report ever having experienced any IPV as compared with women who were less than or equal to 32 years. Women who were members of economic/savings group, such as a micro-credit organization (micro-credit organizations are non-government institutions that provide small-scale loans to the poor who cannot qualify to borrow from traditional financial institutions, for example, private and state-sponsored banks) or a local co-operative, were found 3 times more likely to report a violence experience, as compared with women who were not members of economic/savings group. Women who were separated were found more likely to report a violence experience, as compared with women who were married and lived with their husband.

Table 4.

Association Between Women’s Lifetime Experiences of Violence by an Intimate Partner and Specific Demographic Characteristics.

Independent Variables	Odds Ratio	p-Value for Logistic Regression
Age group
Below median age (Age ≤ 32 years) (reference category)
Above median age (Age > 32 years)	3.67	0.010*
Area of residence
Rural area (reference category)
Urban and slum	0.809	0.715
Education
No education (reference category)
1-5 years of education	0.379	0.088
6-17 years of education	0.534	0.390
Non-formal education	0.602	0.317
Member of economic or savings group
No (reference category)
Yes	3.43	0.016*
Marital status
Married (reference category)
Separated	10.821	0.028*
Divorced	9.30	0.998
Widowed	0.718	0.505
Degree of disability
Mild/moderate (reference category)
Severe/profound	0.762	0.564

p < .05.

Physical and Psychological Sufferings of Women

Table 5 shows the physical and psychological problems ever suffered by women with disabilities after experiencing partner violence. A majority of the participants reported suffering from fear (88.3%). More than half of them (53.8%) reported having suicidal feelings at least once and 11% reported that they tried to take their lives. Many of them also reported having suffered from physical injuries such as swelling (88.4%) and bruises (83.3%).

Table 5.

Commonly Mentioned Physical and Psychological Problems Ever Suffered by the Participants.

	Percent of Women Reported
Psychological problems
Fear	88.3
Tension	80.7
Depression	82.5
Suicidal feeling	53.8
Tried to take own life	11.1
Physical problems
Cut	47.1
Sprain	13.8
Broken bone	12.3
Broken teeth	1.4
Pregnancy loss	4.3
Swelling	88.4
Bruise	83.3
Pain	44.2

Our qualitative findings revealed that violence perpetrated by husbands led many participants to harm themselves. Sometimes they tried to commit suicide. A 35-year-old participant who was severely beaten by her husband shared her feelings as follows:

I felt very bad at that time. I felt like killing myself but I did not do it looking at the faces of my children. I also thought that committing suicide was a great sin. Then I thought that perhaps it was better to get killed through the beating of husband and get a place in the heaven.

Our qualitative data also explored the physical sufferings of women. In many cases, participants’ injuries resulting from physical violence were so severe that they had to go to a doctor or had to seek medical treatment from facilities. Two of the participants mentioned that they became disabled after experiencing severe physical violence from their husbands. A 25-year-old participant from a rural area described her sufferings as follows:

I had pain all over the body. A black scar developed on the hand from beating by shoes and it was deep. There was swelling all over.

Seeking Support

Among the 189 women who reported ever having experienced at least one act of emotional abuse, physical, or sexual violence from their partners, less than half (45%) reported that they had used any strategy to minimize or avoid violence experiences. Seeking support from informal networks (family, friends, and relatives) was commonly reported by many of them. Some of them also reported seeking help from formal networks such as police, local political leaders, NGO counsellors, and so on. Figure 1 shows the percentage of women who reported seeking support from different individuals after experiencing partner violence.

Figure 1.

Percentage of women who reported ever sought help.

Similar to survey findings qualitative data revealed that women usually received support from their family members. Many of our qualitative participants reported receiving help from parents and siblings and sometimes even from parents-in-law.

He went out after beating me. He returned after 3-4 hours. My mother told him “Don’t come to my home as long as I am here. You keep beating my daughter and you want to stay in my home? This will not be allowed.” (24-year-old participant from rural area)

Our qualitative findings also indicated that local influential people such as community leaders and political leaders play a key role in settling disputes between the survivor and her husband. However, deliberation of the case by the local community members often resulted in encouraging the women to return to their husbands. Sometimes participants also received help from disability rights organization. A 35-year-old participant from an urban area said:

I returned home from the hospital after nine days [after being beaten by husband]. The arbitration was called the next day . . . everyone in the village came to the arbitration. The village headmen, the members, my uncles, my brothers, my husband, his brothers and sisters, his first wife, my mother-in-law . . . everyone came. They heard from my husband and me what had happened. After this, the village headmen went to beat my husband with a stick, questioning why he beat me. Then, my husband touched the hand and feet of my mother, and begged for forgiveness. He admitted that he was at fault. The arbitration ended like that. Afterwards, I was taken home.

Although many of the participants reported seeking support from different individuals, not all of them sought support from others. Out of 183 women who had ever experienced violence, 103 reported that they did not share their violence experiences with others. Among these 103 women, 28.2% reported that they found it shameful to share their experiences with others. A small percentage (6.8%) feared that they would face further violence from their husbands for disclosure. Qualitative data also found similar reasons hindering women from seeking support. Some of them reported receiving no support even after they sought it from someone. One of our participants, who was physically challenged, discussed her vulnerability after she was severely beaten by her husband:

I did not tell anyone. I did not tell my mother even. I just cried. I called the land lord. He did not come; his door was locked. (30-year-old participant from an urban area)

Discussion

Our survey findings revealed that more than two third of the participants had experienced at least one act of emotional abuse and physical violence from their partners during their lifetime. About 46% had ever experienced sexual abuse. These rates are quite high in comparison with the prevalence rates found in other studies in Bangladesh where participants were women from the general population (Naved et al., 2006; WHO, 2005). Qualitative findings revealed that participants experienced abuse mainly because of dowry or because of their disabilities. Our finding on dowry payment echoes the findings of Naved and Persson (2005) that payment of dowry is associated with IPV in rural and urban Bangladesh. Although dowry is legally banned in Bangladesh, it is still a common occurrence in rural areas. Brides’ families give dowry for their daughters, especially when daughters are not beautiful by conventional and cultural norms. Women with disabilities are often considered less beautiful; moreover, they are often seen as a burden in the family and parents want to get rid of them by getting them married. A study conducted by Hosain, Atkinson, and Underwood (2002) in rural Bangladesh found that any form of disability had devastating effects on the marriage prospects of people, especially for females. Females were found more likely to suffer from problems, such as “cannot marry” and “breakdown of marriage” than their male counterparts. Thus, possessing a disability increases women’s vulnerability of getting married.

We found statistically significant association between women’s lifetime experience of IPV and various socio-economic characteristics. Women who were older (age > 32 years) and separated from their partners were found more likely to report any IPV compared with women who were younger (age ≤ 32 years) and married. This might be due to the fact that older women lived longer with their partners and faced more risks of lifetime violence compared with the younger women. Barrett et al. (2009) also found that separated/divorced women were more likely to experience IPV compared with their disabled counterparts not experiencing IPV; however, his other study finding that younger women are more likely to experience IPV contradicts with our study findings. The most likely reason for the inconsistency between these two study results is that, in our study we categorized age into two groups (age >32 years and age ≤ 32 years), whereas in Barrett et al.’s (2009) study age was categorized into six groups. Brownridge (2006) also found a negative association between experience of IPV and age of women. Each year of increase in age was associated with 4% reduction in odds of violence. However, this study explored association between IPV and age considering 5-year prevalence of violence. We also found that women who were members of economic/savings group were more likely to report any IPV as compared with those not involved in any economic/savings group. Some previous studies conducted in Bangladesh revealed inconsistent relationship between women’s experience of IPV and their involvement in economic/savings group. Schuler et al. (1996) found that women’s involvement in micro-credit organizations makes them more vulnerable to experience IPV, whereas Hadi (2000) found that women’s involvement in micro-credit programs reduces their chances of experiencing IPV.

Our study revealed that majority of the participants suffers from physical and psychological problems. More than half of them reported ever having suicidal feelings and many reported suffering from physical injuries. These findings are consistent with those of Forte, Cohen, DuMont, Hyman, and Romans (2005) who found that women who have activity limitations and also experience IPV suffered from physical injuries, guilt feeling, anxiety, and depression. Many other studies also documented that IPV may worsen physical and mental health of women (Bonomi et al., 2006; Plichta, 2004; Thomas et al., 2008). These results highlight the adverse effect of IPV on the health of women with disabilities and underline the need of ensuring health services for them.

Previous research conducted in Bangladesh has shown that many of the women remain silent about their experiences of violence (Naved et al., 2006; WHO, 2005). Our study findings suggest women with disabilities are not different in this aspect. More than half of our sample participants reported that they had never shared their experiences of violence with others. Possible explanations of why women with disabilities remain silent about their experiences of violence might be because they internalize that they deserve abuse due to the existence of their disabilities or they consider husbands’ violence a normal phenomenon, given the existence of a patriarchal and male-dominant society in Bangladesh. Other possible reasons as noted by Milberger, Israel, and LeRoy (2003) could be the feeling that they are capable of handling the trauma of violence themselves, having other forms of support, being unaware of where to go, feeling embarrassed, feeling guilty about being a burden or at fault, fear that abuser would come after them, fear of not being believed, or concern about lack of accommodation at shelter.

Our study findings revealed that women with disabilities who disclosed their violence experiences and tried to prevent future violence, most often received help from family members/relatives. Qualitative findings revealed that members of husband’s family (parents-in-law, brother-in-law) sometimes acted as the perpetrator while in other cases they provided support to the women. Sometimes unexpected support came from neighbors or friends. In many cases, women also received support from local influential people such as community leaders, local political leaders, and also from police when violence was too extreme. In majority of the cases, these people helped women in getting justice. Sometimes participants also received help from local NGOs working for and with the disabled people. These findings highlight the need of joint effort of local influential people (local political leader and local community leader), administration, community people, and NGOs to work together to address severe violence against women with disabilities from the society.

Social exclusion and marginalization is commonly experienced by many women with disabilities in Bangladesh. Many of our participants interviewed in the qualitative phase reported that they had experienced unequal access to education, employment, and other forms of social services. Some of them mentioned that they experienced problem while crossing roads or accessing public transport. All these factors make them vulnerable of experiencing abuse. Moreover, their disabilities may also serve as an additional vulnerability factor (Nosek et al., 2001). Physically impaired women may perceive themselves as sexually inadequate and unattractive (Phillips & McNeff, 2005). Their low self-esteem, poor socio-economic status, and dependency on husbands’ income may also minimize the power of self-defence. Thus, any future interventions on reducing IPV should consider improving socio-economic conditions of disabled women and also increase awareness about their rights, their body, and sexuality.

However, there are several limitations of this study. The study interviewed women with disabilities from four districts of the country. Therefore, the findings cannot be generalized for the overall population of women with disabilities in the country. It is also important to note that because of the sensitivity of the issue, some participants may not have shared their violence experiences in detail, resulting in an incomplete picture. We were also unable to assess and control the history of physical and mental health that may not be due to IPV. Another important limitation of this article is that it presents findings only on IPV against women with disabilities. It is well-recognized that women with disabilities experience violence not only from their intimate partners but from different types of perpetrators (from family members, relatives, schoolteachers, friends, etc.), an issue that was not explored in this article.

The issue of IPV against women with disabilities has been little explored by scholars and researchers. Moreover, violence research in Bangladesh to date has been conducted among women from the general population. To our knowledge, there has been only one study published on violence against women with disabilities (Naved et al., 2012) except this present study. Therefore, more research is required on issues related to IPV against women with disabilities. A future research that is urgently required is a prevalence study of IPV with a nationally representative sample of women with disabilities. The results from this type of study would help the policy makers and the program planners to develop effective intervention programs to minimize the prevalence and consequences of IPV against women with disabilities.

Footnotes

Acknowledgements

The authors greatly acknowledge the support from CREA (Creating Resources for Empowerment and Action Inc.) and University College London in conducting the research in Bangladesh. We thank Dr. Sarah Hawkes, Institute of Child Health, University College London, for her guidance in conducting the research and for providing useful comments on the Bangladesh country report on “violence against marginalized women in Bangladesh”. We also thank Ms. Geetanjali Misra, CREA, for her input to the project. We thank all the institutions for facilitating the research process in Bangladesh, particularly the members and staff of ADD International, National Council of Disabled Women (NCDW), Natore Zila Protibhandi Sangstha Nandon, PIACT Bangladesh, Bangladesh Women’s Health Coalition (BWHC), and Tangail brothel. We also thank all the research participants who shared personal experiences with us to make this research possible. This research was part of the “Count Me In: Learn About Me”

Research project (CREA), which addressed violence against marginalized women in India, Nepal and Bangladesh

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This study received grant from the MDG3 Fund of the Dutch Government, entitled Count me In! Addressing violence against women in South and Central Asia.

Author Biographies

Md. Tanvir Hasan, MS, is a lecturer at James P. Grant School of Public Health (JPGSPH), BRAC Institute of Global Health (BIGH), BRAC University. He has more than 4 years of experience in research and teaching. His research area of interest includes quantitative research methods, Biostatistics, and Public Health Informatics. In the past 4 years, he has worked as a research co-investigator in a number of research studies that were focused on violence against marginalized women, HIV/AIDS-related stigma and discrimination, and so on. He earned his master of science degree in Applied Statistics from the University of Dhaka.

Tisa Muhaddes, MA, worked as a research and communication officer at the JPGSPH, BRAC University. She contributed to the Violence Against Marginalized Women in Bangladesh research project as a qualitative interviewer and a co-coordinator of the management of the research. She completed an MA in Gender Studies from School of Oriental and African Studies, University of London.

Suborna Camellia, MSS, has 10 years of hands on experience in both qualitative and quantitative research and had done extensive fieldwork both in rural and urban areas on highly sensitive issues like violence against children, men and women, and religion. Some of her works are already published in peer-reviewed journals. Currently she is working as a senior anthropologist at JPGSPH, BIGH, BRAC University. Prior to that, she worked at icddr,b, Bangladesh Institute of Development Studies, BRAC University Institute of Educational Development and Save the Children-Bangladesh. She earned her master’s and bachelor’s degree in anthropology from Jahangirnagar University. Her areas of interest are sexual and reproductive health and rights, gender-based violence, and urban poverty.

Nasima Selim, MBBS, MPH, MSc, works at JPGSPH, BIGH as senior lecturer. She teaches anthropological approaches to public health, qualitative research methods, methodology workshop, and scientific writing for MPH students as well as short-course participants. She has been a research co-investigator of a number of research projects. She completed her bachelor of medicine and bachelor of surgery (MBBS) degree from Sir Salimullah Medical College, Dhaka University in 2000. Later In 2007, she completed her MPH securing the highest GPA from JPGSPH and in 2011, she did her master’s in medical anthropology (AMMA) in the University of Amsterdam, the Netherlands. Her research interests include health promotion, self-care and meditation practices, social determinants of health, positive mental health, health professional education, public health epistemologies, qualitative research methods, mixed methods as well as the interface of public health with social sciences specially the field of medical anthropology.

Sabina Faiz Rashid, PhD, MA, is the dean and professor at JPGSPH, BIGH, BRAC University. She has extensive experience in conducting qualitative research on gender, violence, community-based maternal health, reproductive and sexual health and rights, and service delivery (informal sector) and the health of urban slum populations. She has led a number of collaborative research grants with national and international partners (Institute of Development Studies, UK; African Population Health Research Centre, Kenya; UNAIDS, WHO, Geneva; CREA, India; and Guttmacher Institute, New York).

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