Gender-Based Violence in Rural Uttar Pradesh,India

Abstract

This study explores the prevalence of different forms of domestic violence and their impact on women’s reproductive health behavior in rural Uttar Pradesh (UP), India. Data were collected as a part of a large household survey carried out in 2009-2010. A multistage stratified systematic sampling design was used. A total of 4,223 married women aged 15 to 49 years and 2,274 husbands of these women were interviewed. Data were analyzed using bivariate and multivariate analyses. More than one third of married women in rural UP had experienced one or more forms of violence, such as verbal abuse, physical manhandling, and sexual abuse by their spouse. Nearly 47% of the women had experienced some form of violence during their last pregnancy. Significant associations were found between violence and incorrect reproductive health behaviors, pregnancy complications, poor birth preparedness, poor likelihood of institutional delivery, limited postnatal care, and limited spousal communication for family planning. After controlling for socio-economic variables in multivariate analysis, only pregnancy complications (odds ratio [OR] = 1.62, 95% confidence interval [CI] = [1.40, 1.85]) and lack of delivery preparedness (OR = 0.79, 95% CI = [0.68, 0.93]) were found to be significantly associated with violence. Husband’s attitude and reporting of violence by their wives in different situations were not significantly associated. This study provides evidence of the association of violence on the reproductive health behavior of married women in rural India. The results argue for frontline health workers to identify and counsel pregnant women experiencing violence during antenatal check-up to reduce maternal morbidity and mortality.

Keywords

gender-based violence reproductive behavior husband’s attitude violence reproductive health

Introduction

Gender-based violence (GBV) is a common form of domestic violence, done against women by their husbands (Singh, Singh, & Singh, 2014). GBV has serious consequences for women’s mental and physical health, including their reproductive and sexual well-being (Bailey, 2010; Chandra, Styanarayna, & Cary, 2009; Chowdhary & Patel, 2008; Golding, 1999).

Numerous studies have documented the prevalence of GBV and its effects on women (Ahmed, Koenig, & Stephenson, 2006; Bailey, 2010; Khan, Rob, & Hossain, 2000; Plichta, 2004; Sarkar, 2008). A study by García, Jansen, Ellsberg, Heise, and Watts (2005) in 15 sites from 10 countries estimated that lifetime prevalence of intimate partner violence experienced by women varied from 15% to 71%. In India, the National Family Health Surveys (NFHS) showed an increasing trend in GBV experienced by married women in the last 12 months, from about 9% in 1998 to about 16% in 2006 (International Institute for Population Sciences [IIPS] & ORC Macro, 2000; IIPS & Macro International, 2007). There is a significant variation in the prevalence of GBV across various states in India (IIPS & Macro International, 2007). Reports showed that in Northern India 25% of husbands reported having perpetrated physical violence against their wives during the preceding year whereas 30% reported sexual violence (Koenig, Stephenson, & Ahmed, 2006).

Although GBV cuts across all socio-economic groups, certain socio-economic factors put some women at higher risk of experiencing GBV than others (Babu & Kar, 2009). Women belonging to lower castes, who are illiterate, and from poor economic backgrounds are more at risk of experiencing violence than others (Babu & Kar, 2009; Dalal & Lindqvist, 2010). In addition, cultural factors are also associated with GBV; cultural approval of wife-beating in the community, and the acceptance of wife-abuse as “legitimate” have also been reported as important determinants of GBV in India (Khan & Aeron, 2006; Simister & Mehta, 2010). Furthermore, GBV is manifested in culturally perceived gender roles and women are at risk of experiencing violence if they deviate from the expected role pattern (Khan & Aeron, 2006). In many cultural settings, violence is considered as a husband’s right to bring his wife into the “right way” (Heise, Ellsberg, & Gottemoeller, 1999). Studies outside India reported that husband’s attitude toward GBV is often associated with violence toward their wives (Luke, Schuler, Mai, Vu, & Minh, 2007, Yigzaw, Berhane, Deyessa, & Kabra, 2010).

GBV has been increasingly recognized as a public health problem, yet it is one of the major public health problems that has been widely ignored and little understood (Babu & Kar, 2009; Ravneet & Suneela, 2008). Violence during pregnancy or in the normal course of a woman’s life has adverse health consequences. Reducing physical violence against pregnant women can reduce adverse pregnancy outcomes (Pool, Otupiri, Owusu-Dabo, de Jonge, & Agyemang, 2014). Although several studies in India have highlighted the negative impact of domestic violence on women’s reproductive health behaviors (Bailey, 2010; Mahapatro, Gupta, Gupta, & Kundu, 2011, Purwar, Jayaseelan, Vahadpande, Motghare, & Pimplakute, 1999, Sarkar, 2008; Singh et al., 2014), few studies have explored the consequences of GBV on reproductive behaviors and health.

In view of the above, the objectives of this study were to explore (a) the prevalence of different forms of domestic violence in rural Uttar Pradesh (UP), India; (b) husband’s attitude toward GBV and its association with GBV reported by their wife; and (c) association of GBV with reproductive health behaviors of pregnant women. In this study, it is hypothesized that husband’s attitude toward GBV will influence their GBV behavior. It is also expected that occurrence of GBV will lead to poor reproductive health practices.

Method

Data were collected as a part of a larger household survey on reproductive, maternal, neonatal, child health, and nutrition conducted in UP, the largest state in India with a population of 200 million. The study covered 225 villages from 12 districts representing all three major regions of UP. Participants were selected using multistage sampling. In the first phase, four districts were randomly selected from each of the three major regions of UP—Eastern, Central, and Western. In the next phase, from the 12 districts 225 villages were selected using implicit stratification based on the scheduled caste (SC) and scheduled tribe (ST) population and female literacy in the state. The allocation of sample size in each village was done through probability proportional to size technique. Within a village, households were selected using systematic random sampling. In each household all eligible women were listed. The eligibility criteria were married women aged 15 to 49 years having a child below 2 years. From each household, one eligible woman was selected for interview using the Kisch table. In all, 4,472 women were interviewed for the larger study; of these 4,223 women were living with their husbands for the last 6 to12 months and were therefore, included in our sample for this study on GBV.

As the larger study focused on women’s reproductive health, about half of the husbands of the interviewed women were asked to participate in a separate interview. For this, a husband from every alternate household was invited to participate in the study. If the husband in any household was not available for the interview or refused to participate, the husband in the next household in the list was requested to participate. In all, 2,274 husbands were interviewed on GBV.

Respondents were interviewed by trained investigators using a semi-structured questionnaire. Seven indictors of GBV were assessed based on the World Health Organization (WHO) GBV framework (García et al., 2005) perpetrated by a husband on his wife, broadly classified as humiliation (emotional violence), physical assault (physical violence), and forced sex (sexual violence). Experience of GBV was assessed by asking eligible women whether they had experienced any of the seven violence indicators perpetrated by their husbands in last 12 months. Emotional violence indicators were (a) husband said or done something to humiliate his wife in front of others and (b) husband insulted or made his wife feel bad about her. Physical violence indicators were (c) slapping, (d) twisting of arm or pulling of hair, and (e) punching with fist or something that could physically hurt. Sexual violence indicators were (f) physically forcing the wife to have intercourse against her wish and (g) forcing her to perform any sexual act that she did not want to. GBV during pregnancy was measured by asking women whether they had experienced any of the seven violence indicators from their husband during their last pregnancy and whether severity of violence was more or less or similar to experiences when they were not pregnant.

Data on husband’s attitude toward GBV were collected using an 18-item questionnaire that focused on four domestic situations: (a) justification for hitting or beating wife, (b) justification of wife to refuse having sex, (c) husband’s right to GBV if his wife refuses to have sex, and (d) agreement to have perpetuated violence on their wives. Husband’s attitude toward GBV was considered as a mediator variable to understand the relationship between GBV and reproductive health behavior. To assess the mediation effect of husband’s attitude, its association with GBV was examined before considering the variable as a controlling factor to explain the relationship between GBV and reproductive health behaviors.

The study was conducted in compliance with the ethical review committee of the first author’s organization. All the statistical analyses were conducted using SPSS for Windows software (Version 18.0).

Results

The mean age of woman was 26 years (SD = 4.25 years) and the husband’s was 29 years (SD = 5.42 years). Nearly half the women (45%) were below the age of 25 years and about 85% of husbands were above 25 years (Table 1). More than 35% of women and husbands belonged to SC/ST families and more than 40% belonged to “other backward classes” groups, showing that the participants were from poor and marginalized population. The majority of women (59%) had no formal education but only 26% of husbands had similar educational status. More than twice the percentage of husbands (58%) had at least secondary education, that is, at least sixth standard or higher of schooling than the women (28%), showing less education among women compared with their husbands. Only 14% women were working in addition to household work; however, almost all husbands (94%) were working.

Table 1.

Background Characteristics of Study Participants.

Background Characteristics	Women (n = 4,223)	Husbands (n = 2,274)
Age groups (years), %
15-19	5.4	0.3
20-24	39.6	14.9
25-29	34.3	37.0
30-34	20.7	26.4
35+	—	21.2
Religion, %
Hindu	83.8	85.4
Non-Hindu	16.2	14.6
Caste, %
Scheduled caste/scheduled tribe	35.9	35.2
Other backward classes	43.1	43.4
General caste	20.2	20.6
Educational status, %
No education	58.7	25.5
Primary (1-5 years of schooling)	13.6	16.6
Secondary (6-12 years of schooling)	24.7	49.8
Higher education (college or above)	3.0	8.1
Standard of living index, %
Low	37.4	33.8
Middle	30.2	30.0
High	32.4	36.2
Working status, %
Working	14.1	93.7

The analysis in the present article is based on 4,223 women who reported living with their husbands in last 6 to 12 months, preceding the survey. Overall 37% of women reported they had experienced any form of GBV during the last 12 months. Of the three types of violence, emotional violence was the most commonly reported (31%), followed by physical violence (28%) and sexual violence was least common, reported by only 6% of women. Nineteen percent of women reported at least two types of violence and 5% reported experiencing all three types of violence.

Table 2 shows the prevalence of different types of violence with respect to women’s background characteristics. The highest prevalence of all forms of violence was reported by women in the 25 to 29 years age group. Women from non-Hindu families, SC/ST communities, those without any formal education, from families with a low standard of living index (SLI), and working outside the home reported experiencing more violence compared with their counterparts. Similar prevalence of violence was reported among different categories of age difference between husband and wife.

Table 2.

Prevalence of Various Forms of Violence Reported by Women of Different Background Characteristics.

		Types of Violence
Background Characteristics	n	Emotional	Physical	Sexual	Any Type
All	4,223	30.80	28.40	6.30	36.7
Age groups, %
15-19 years	227	30.4	32.6	9.7	38.3
20-24 years	1,674	27.7	25.2	6.1	34.1
25-29 years	1,449	33.9	30.8	6.0	40.0
30-34 years	873	32.0	29.3	6.2	36.8
Religion, %
Hindu	3,539	30.2	27.9	6.0	36.5
Non-Hindu	684	33.9	31.1	7.9	39.0
Caste, %
Scheduled caste/scheduled tribe	1,518	33.5	32.9	7.0	40.9
Other backward classes	1,822	30.5	26.7	6.1	36.2
General caste	852	27.3	24.3	5.4	31.9
Educational status, %
No education	2,478	33.5	32.0	7.2	39.9
Primary (1-5 years of schooling)	574	32.1	28.9	8.2	37.8
Secondary (6-12 years of schooling)	1,044	25.4	31.3	3.6	31.1
Higher education (college or above)	127	18.1	13.4	1.6	22.0
Standard of living index, %
Low	1,579	34.7	32.9	7.7	41.0
Middle	1,274	31.9	28.6	6.6	38.1
High	1,370	25.4	23.1	4.4	31.1
Working status, %
Worker	596	36.2	34.7	7.6	42.8
Non-worker/household work	3,627	29.9	27.4	6.1	36.0
Husband-wife age difference categories, %
0-5 years	3,168	30.3	28.4	6.4	36.5
6-10 years	852	32.7	28.9	6.2	38.7
11 or more years	203	31.5	25.6	3.9	35.5

The association between violence and women’s background characteristics were examined by calculating both unadjusted and adjusted models of logistic regression. In the unadjusted model, the experience of violence was considered as the dependent variable and women’s background characteristics were considered as independent variables. The adjusted models were calculated by multivariate analysis; for each background characteristic, the remaining characteristics of the women were considered as covariates. The unadjusted model revealed that women aged 20 to 29 years reported significantly less sexual violence as compared with the youngest group of 15 to 19 years (Table 3). However, in the adjusted model, women aged 25 to 34 years reported significantly less violence compared with the youngest group. No significant association was found between any form of violence in the unadjusted model; however, reporting of emotional and physical violence was significantly less among Hindu women than non-Hindu women, after controlling for other background characteristics. Women from SC/ST families were significantly more likely to report more emotional, physical, or “any type” of violence, however, after controlling for other background characteristics, caste was found to be significantly associated only with physical and “any form” of violence.

Table 3.

Results of Unadjusted and Adjusted Models of Logistic Regressions Showing the Association of Different Types of Violence With Selected Background Characteristics of Women.

	Types of Violence
	Emotional		Physical		Sexual		Any Type
	OR (95%CI)		OR (95% CI)		OR (95% CI)		OR (95% CI)
Category	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted
Age groups
15-19 years	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
20-24 years	0.88	0.92	0.70	0.73	0.61*	0.64	0.83	0.87
25-29 years	1.17	1.19	0.92	0.92	0.60*	0.60*	1.07	1.08
30-34 years	1.08	1.01	0.86	0.77	0.61	0.56*	0.94	0.87
Religion
Hindu	Ref.	0.83*	Ref.	0.82*	Ref.	0.77	Ref.	0.87
Non-Hindu	0.84	Ref.	0.85	Ref.	0.74	Ref.	0.90	Ref.
Caste
Scheduled caste/scheduled tribe	1.34**	1.20	1.53**	1.34*	1.32	1.10	1.48**	1.32*
Other backward classes	1.16	1.08	1.14	1.03	1.15	1.00	1.21*	1.12
General caste	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Educational status
No education	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Primary (1-5 years of schooling)	0.94	1.02	0.86	0.93	1.15	1.23	0.92	0.99
Secondary (6-12 years of schooling)	0.68**	0.81*	0.57**	0.68*	0.49**	0.59*	0.68**	0.80*
Higher education (college or above)	0.44**	0.55*	0.33**	0.39	0.27*	0.28	0.43**	0.52*
Standard of living index
Low	1.56**	1.28*	0.98	1.20	1.81**	1.47*	1.54**	1.24*
Middle	1.37**	1.20*	1.06	1.08	1.54	1.30	1.54**	1.17
High	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Working status
Working	1.33**	1.18	1.41**	1.22*	1.27	1.12	1.33**	1.19
Non-worker/household work	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.

Note. In adjusted model remaining background characteristics were used as covariates (n = 4,223). OR = odds ratio; CI = confidence interval.

p < .05. **p < .01.

Educational status was significantly associated with violence both in the unadjusted and adjusted models of logistic regression. In both the models, the women with a secondary or higher level of education were significantly less likely to report all forms of violence compared with women with no formal education (Table 3). Women with higher education were even less likely to report violence compared with women with secondary level of education. Women of families with low and middle SLI were significantly more likely to report violence as compared with women from families with high SLI. However, in the adjusted model women from families with low SLI only were significantly more likely to report violence in comparison with women from families with high SLI. Women working outside their household work were more likely to report violence than “non-working” women. However, in the adjusted model only the physical violence was significantly associated with working status of the women.

Experience of emotional violence was more strongly associated with physical violence (odds ratio [OR] = 28.49, 95% confidence interval [CI] = [23.84, 34.03]) than sexual violence (OR = 11.36, 95% CI = [8.28, 15.57]). However, experience of physical violence was strongly associated with reporting of sexual violence (OR = 90.94, 95% CI = [46.60, 177.50]).

Nearly half the husbands (46%) did not justify use of physical or sexual violence against their wives. However, 36% of husbands reported that they had perpetrated violence against their wives in the last 12 months. One third of husbands justified the use of physical violence if their wife showed disrespect to his parents. Nearly 80% of husbands agreed that women had the right to refuse sex in case her husband had a sexually transmitted disease or was sexually unfaithful. Few husbands justified refusing financial support (4%) or using force if their wife refused to have sex (2%; Table 4).

Table 4.

Husband’s Attitude Toward Gender-Based Violence in Certain Domestic Situations (n = 2,274).

Husband’s Attitudes	%
Husband justified in hitting or beating wife if
she shows disrespect for her in-laws	34.3
she argues with him	28.6
he suspects of her being faithful	20.9
she neglects the house and children	16.0
she goes out without telling him	15.0
she does not cook food properly	10.9
she refuses to have sex	4.3
Wife is justified to refuse sex with her husband if
husband has sexually transmitted infection (STI)	81.5
he has sex with another woman	77.0
she is tired and not in the mood	76.2
If wife refuses to have sex husband has right to
get angry and reprimand	16.0
use force and have sex with her	4.7
refuse to give her financial support	3.9
have sex with another woman	1.8
Husband agreed to have perpetuated violence on their wives
Slapped	26.4
Humiliate	15.5
Twisted her arm or pulled hair	11.0
Forced to have sex	5.1

Logistic regression analysis examined the association between husband’s attitude toward violence and the experience of any form of violence reported by their wives. In this analysis, the husband’s attitude toward violence was an independent variable and the reporting of any form of violence by their wives a dependent variable. The results do not show a significant association between husband’s attitude and violence reported by their wife for most situations. Moreover, wives of husbands who justified violence if their wife did not cook properly, reported significantly less violence (Table 5). As husband’s attitude did not have a significant relationship with GBV, it was excluded from further analysis to assess its mediation effect on association of GBV with reproductive health behaviors.

Table 5.

Results of Logistic Regression of Showing the Association of Husband’s Attitude Toward Gender-Based Violence With Any Form of Violence Reported by Their Wives (n = 2,274).

	Any Type of Violence
Husband’s Attitudes	OR (95% CI)
Husband justified in hitting or beating wife if
she goes out without telling him	0.870 [0.682, 1.110]
she neglects the house and children	0.985 [0.779, 1.244]
she argues with him	1.107 [0.917, 1.336]
she refuses to have sex	0.675 [0.429, 1.061]
she does not cook food properly	0.660* [0.493, 0.884]
he suspects of her being faithful	1.078 [0.875, 1.329]
she shows disrespect for her in-laws	0.943 [0.787, 1.130]
Wife is justified to refuse sex with her husband if
husband has sexually transmitted infection (STI)	1.015 [0.804, 1.284]
he has sex with another woman	0.783 [0.509, 1.205]
she is tired and not in the mood	1.401 [0.902, 2.146]
If wife refuses to have sex husband has right to
get angry and reprimand	0.985 [0.779, 1.244]
stop financial support	1.277 [0.830, 1.963]
have forced sex	0.714 [0.466, 1.094]
have sex with another woman	1.025 [0.504, 1.947]
Husband accepted to have perpetuated violence on their wives
humiliate	0.989 [0.780, 1.253]
slapped	0.980 [0.806, 1.190]
twisted her arm or pulled hair	1.059 [0.807, 1.390]
forced to have sex	0.801 [0.535, 1.199]

p < .05.

Women were asked to report the severity of different forms of violence as defined earlier whether it increases, decreases, remains same, became less, or no violence during their last pregnancy and compare it with when they were not pregnant. Findings show that 47% of women experienced violence during their last pregnancy. Approximately one third of women mentioned that violence decreased during pregnancy. Among women who had experienced any form of violence during their last pregnancy, 34% reported pregnancy complications. However, among women who did not experience violence during pregnancy, 24% had experienced complications (z test, p < .05).

Table 6 shows the association between reporting of violence and reproductive health behaviors among women. A significantly higher proportion of women who reported violence also experienced pregnancy complications, were less prepared for delivery, less likely to have an institutional delivery, less likely to seek postnatal care within 7 days of delivery, and less likely to have spousal communication family planning.

Table 6.

Association of Violence With Reproductive Health and Practices (n = 4,223).

	Reporting of Any Type of Violence
Reproductive Health and Practices	Reported	Not Reported	Chi-Square Test
Any pregnancy complication	33.5	22.9	59.52**
Received three or more antenatal check-ups	73.0	72.0	0.38
Birth preparedness^a	76.4	82.5	24.17**
Institutional delivery	42.0	45.7	5.81*
Received postnatal check-up (n = 4,166)	13.6	14.1	0.18
Lack of spousal communication on family planning use	37.4	39.2	1.4
Use family planning modern methods	43.1	44.5	0.84

Birth preparedness includes discussion of delivery plan with family members to identification of health facility, provider, arrangement of transportation, delivery kit, saving money for emergency expenses.

p < .05. **p < .01.

The association between violence and reproductive health behaviors were further examined by calculating two models of logistic regression. Model 1 is the unadjusted model where reproductive health behaviors were dependent variables and reporting of violence the independent variable. As many reproductive health variables are correlated with socio-economic conditions, in Model 2, that is, the adjusted model (multivariate analyses), women’s background characteristics were considered as covariates in addition to dependent and independent variables in Model 1. The results of both unadjusted and adjusted models showed a significant association between violence and increased pregnancy complications, poor birth preparedness, and poor institutional delivery (Table 7).

Table 7.

Results of Logistic Regression of Showing the Association of Reproductive Behaviors and Any Type of Violence: Model 1 Unadjusted Model and Model 2 Adjusted Model Controlling for Background Characteristics (n = 4,223).

	Model 1 Unadjusted		Model 2 Adjusted
Reproductive Behaviors	OR	CI	OR	CI
Complication during pregnancy	1.702**	[1.486, 1.949]	1.749**	[1.532, 2.008]
Received >3 antenatal check-ups	1.043	[0.911, 1.195]	1.039	[0.905, 1.193]
Pregnancy preparedness	0.686**	[0.590, 0.798]	0.650**	[0.557, 0.758]
Institutional delivery	0.861**	[0.762, 0.972]	0.867*	[0.763, 0.985]
Received postnatal check-up	0.963	[0.809, 1.147]	1.006	[0.837, 1.208]
Lack of spousal communication on family planning use	0.928	[0.819, 1.050]	0.905	[0.796, 1.208]
Using family planning method	0.942	[0.829, 1.071]	0.908	[0795, 1.037]

p < .05. **p < .01.

Discussion

More than one third of married women in rural UP experienced some form of violence; this finding corroborates the findings of NFHS 2005-2006 on the prevalence of domestic violence in UP (IIPS & Macro International, 2007). Although presence of GBV cuts across all sections of society, the findings indicate a stronger association between GBV and lower socio-economic strata, that is, women of low SLI, SC/ST, with no education, and who work outside household. Younger women (15-19 years) are more likely to experience sexual violence as compared with older women (above 20 years). This finding is similar to those of Raj, Saggruti, Lawrence, Balaiah, and Silverman (2010), where women, married below 18 years, experienced more GBV compared with women who married later.

The study also shows that each form of violence cannot be seen in isolation; all forms of violence were experienced together. This study shows that nearly half the women experienced GBV during last pregnancy, similar to findings of other studies (Ahmed et al., 2006; Ravneet & Suneela, 2008) including a multicountry study by WHO (García et al., 2005).

The study’s findings show that GBV is associated with pregnancy complications and lack of delivery preparedness. The results of multivariate analyses indicate that GBV alone can increase the chances of serious reproductive morbidity and mortality among women, sometimes leading to abortion and stillbirths. In view of this finding, the role of health care providers becomes critical.

Frontline health workers (FHWs) are often the only health care providers for pregnant women in rural India. Antenatal services provided by FHWs could be used as a window of opportunity to address the issue of domestic violence (Interagency Gender Working Group/Change, 2002). It requires a little effort by the FHWs to identify high-risk women and advise them on how to protect themselves from GBV during pregnancy. Yet FHWs expressed their inability to discuss GBV with their clients, perhaps because this issue has not been recognized as health issue. Therefore, health care providers require training to identify women who experience GBV during pregnancy for further counseling.

This study of GBV has some methodological limitations. GBV in the family is a sensitive topic and women of rural India generally do not want to discuss this subject (Amoakohene, 2004; Senanayake, 2011). It might be because a certain level of violence within married life is culturally acceptable (Simister & Mehta, 2010). This leads to underreporting of GBV in all strata of society. Women who belong to low SLI may consider certain acts of violence as part of their routine life and socially acceptable. Similarly, women of high SLI and highly educated women also underreport GBV due to stigma of disclosing violent behavior of their partners to outsiders as this put the status and reputation of their families at stake within the community. Further reporting or disclosing of domestic violence to outside family members may cause embarrassment to the family members. To overcome these limitations, methodological research is necessary to develop standardized methods to assess the GBV with more validity. Another limitation of this study is the lack of information on the severity of violence at different stages of pregnancy. The nature and extent of violence at different stages of pregnancy may have differential effect on reproductive health behaviors during pregnancy and that in turn may have differential pregnancy outcome.

Conclusion

This study explores GBV among a representative sample of women from UP, India. The findings of the study will be useful to plan different reproductive health programs addressing GBV-based problems, especially among women of low socio-economic groups. The association of GBV with reproductive health-related behaviors indicated the importance of counseling for GBV by the FHWs to reduce maternal morbidity and mortality.

Footnotes

Acknowledgements

The authors are grateful to the participants of this study. They are also thankful to Ms. Deepika Ganju for editing the manuscript.

Authors’ Note

Logistic support for this study was provided by the Population Council, New Delhi, India.

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, authorship, and/or publication of this article: Data of this study were collected as part of a large-scale study on reproductive maternal neonatal child health and nutrition funded by Bill and Melinda Gate Foundation.

Author Biographies

Jaleel Ahmad is a senior program officer at the Population Council, New Delhi. He has master’s degrees in social work and public administration. He has been actively involved in various research studies for more than 8 years in diverse areas such as reproductive, maternal and child health (MCH), behavior change communication (BCC), HIV/AIDS, and measuring quality of services. Earlier, he worked with the National Commission for Women (Government of India) for 5 years on gender-based violence. He has presented many research papers in various forums and published articles in reputed journals and books. His area of interest includes action-based research on MCH issues.

M. E. Khan, PhD, is a senior program associate at the Population Council, New Delhi, India. He has more than 37 years of research experience with expertise in undertaking operations research to improve service delivery in maternal and childcare, family planning, safe motherhood, and abortion. Scaling up of successful interventions and capacity building of young professionals are his other passions. Earlier, as regional director, Asia and Near East counties, of the FRONTIERS Program, Population Council, he has worked in many countries. He is a member of various national and international committees, including committees of the World Health Organization (WHO), Geneva. He has written/edited 16 books and published numerous papers in peer-reviewed journals.

Arupendra Mozumdar, PhD, is a program officer in the Reproductive Health Division of the Population Council, New Delhi, India. He is an anthropologist with an experience of 15 years in population-based health researches. Prior to joining the Council he worked at the Tata Institute of Social Sciences, Mumbai, India, as a research associate and as a visiting scientist in the Indian Statistical Institute, Kolkata. He received his PhD and MSc in anthropology from the University of Calcutta, Kolkata, India. For his doctoral research, he was awarded research fellowship from the Indian Statistical Institute, Kolkata, India. He did his postdoctoral research in the North Dakota State University, Fargo, ND, USA, to evaluate “Go Red for Women in North Dakota” program conducted by American Heart Association. He has published a number of research articles in different scientific journals of national and international repute and has presented his work in various scientific conferences throughout India and the United States. His publication history indicates a diverse research interest with a focus on bio-social study of health and adaptation at population level.

Deepthi S. Varma is a freelance consultant in the United States. At the time of this study, she was working as a program officer at the Population Council, New Delhi, on reproductive health issues. She holds a PhD in psychiatric social work from the National Institute for Mental Health and Neuro Sciences (NIMHANS, Bangalore, India) and an NIH-Fogatory International Post-Doctoral Fellowship in psychiatry from Washington University, USA. She has also worked as research associate with the Centre for Mental Health Services Research at George Warren Brown School of Social Work of Washington University at St. Louis, USA. Her expertise is in qualitative research and her other research interests include sexuality, HIV/AIDS, and mental health. She has authored several papers in the area of HIV/AIDS and sexuality with specific focus on women.

References

Ahmed

S. A.

Koenig

M. A.

Stephenson

R. B.

(2006). Effects of domestic violence on early childhood mortality: Evidence from North India. American Journal of Public Health, 96, 1423-1428.

Amoakohene

M. I.

(2004). Violence against women in Ghana: A look at women’s perceptions and review of policy and social responses. Social Science and Medicine, 59, 2373-2385.

Babu

V. B.

Kar

S. K.

(2009). Domestic violence against women in Eastern India: A population based study on prevalence and related issues. BMC Public Health, 9, 129.

Bailey

A. B.

(2010). Partner violence during pregnancy: Prevalence, effects, screening, and management. International Journal of Women’s Health, 2, 183-197.

Chandra

P. S.

Styanarayna

V. A.

Cary

(2009). Women reporting intimate partner violence in India: Association with PTSD and depressive symptoms. Archives of Women’s Mental Health, 12, 203-209.

Chowdhary

Patel

(2008). The effects of spousal violence on women’s health: Findings from the Stree Arogya Shodh in Goa, India. Indian Journal of Postgraduate Medicine, 54, 306-312.

Dalal

Lindqvist

(2010). A national study of the prevalence and correlation of domestic violence among women in India. Asia-Pacific Journal of Public Health, 24, 265-277.

García

M. C.

Jansen

H. A. F. M.

Ellsberg

Heise

Watts

(2005). World health organization multi-country study on Women’s health and domestic violence against women: Initial results on prevalence, health outcomes, and women’s responses. Geneva, Switzerland: World Health Organization.

Golding

J. M.

(1999). Intimate partner violence as a risk factor for mental disorder: A meta-analysis. Journal of Family Violence, 14, 99-132.

10.

Heise

Ellsberg

Gottemoeller

(1999). Ending violence against women (Population reports series L, number 11). Baltimore, MD: Johns Hopkins School of Public Health, Population Information Program.

11.

Hollander

(2006). Domestic violence in India is linked to individual and community factors. International Family Planning Perspectives, 32, 53.

12.

Interagency Gender Working Group/Change. (2002). Gender based violence and reproductive health and HIV/AIDS: Summary of technical update. Washington, DC: Population Reference Bureau. Retrieved from http://www.prb.org/pdf/genderbasedviolence.pdf

13.

International Institute for Population Sciences & Macro International. (2007). National Family Health Survey (NFHS-3), 2005-06: India (Vol. 1). Mumbai, India: International Institute for Population Sciences.

14.

International Institute for Population Sciences & ORC Macro. (2000). National Family Health Survey (NFHS-2), 1998-99: India. Mumbai, India: Author.

15.

Khan

M. E.

Aeron

(2006). Prevalence, nature and determinants of violence against women in Bangladesh. Journal of Family Welfare, 52, 33-51.

16.

Khan

M. E.

Rob

Hossain

S. M.

(2000). Violence against women and its impact on women’s lives-some observations from Bangladesh. Journal of Family Welfare, 46, 12-24.

17.

Koenig

M. A.

Stephenson

R. B.

Ahmed

S. A.

(2006). Individual and contextual determinants of domestic violence in North India. American Journal of Public Health, 96, 132-138.

18.

Luke

Schuler

S. R.

Mai

B. T.

T. P.

Minh

T. H.

(2007). Exploring couple attributes and attitudes and marital violence in Vietnam. Violence Against Women, 13, 5-27.

19.

Mahapatro

Gupta

R. N.

Gupta

Kundu

A. S.

(2011). Domestic violence during pregnancy in India. Journal of Interpersonal Violence, 26, 1-18.

20.

Plichta

S. B.

(2004). Intimate partner violence and physical health consequences: Policy and practice implications. Journal of Interpersonal Violence, 19, 1296-1323.

21.

Pool

M. S.

Otupiri

Owusu-Dabo

de Jonge

Agyemang

(2014). Physical violence during pregnancy and pregnancy outcomes in Ghana. BMC Pregnancy and Childbirth, 14, 71.

22.

Purwar

M. B.

Jayaseelan

Vahadpande

Motghare

Pimplakute

(1999). Survey of physical abuse during pregnancy GMCH, Nagpur, India. Journal of Obstetrics and Gynaecology Research, 25, 165-171.

23.

Raj

Saggruti

Lawrence

Balaiah

Silverman

J. G.

(2010). Association between adolescent marriage and marital violence among young adult women in India. International Journal of Gynecology & Obstetrics, 110, 35-39.

24.

Ravneet

Suneela

(2008). Addressing domestic violence against women: An unfinished agenda. Indian Journal Community Medicine, 33, 73-76.

25.

Sarkar

N. N.

(2008). The impact of intimate partner violence on women’s reproductive health and pregnancy outcome. Journal of Obstetrics and Gynecology, 28, 266-271.

26.

Senanayake

(2011). Gender-based violence and sexual and reproductive health and rights: Looking at the health sector response in the Asia-Pacific Region. Arrows for Change, 17, 1-2.

27.

Simister

Mehta

P. S.

(2010). Gender based violence in India: Long term trends. Journal of Interpersonal Violence, 25, 1594-1611.

28.

Singh

B. P.

Singh

K. K.

Singh

(2014). Couple interaction and predicting vulnerability to domestic violence in Uttar Pradesh, India. Journal of Interpersonal Violence, 29, 2304-2324.

29.

Yigzaw

Berhane

Deyessa

Kabra

(2010). Perceptions and attitude towards violence against women by their spouses: A qualitative study in Northwest Ethiopia. Ethiopian Journal of Health and Development, 2010, 39-45.