Abstract
Domestic violence is a serious threat to the health of women in the world and derives from several factors. Therefore, due to the importance of this issue, this study aimed to determine domestic violence against women in four educational hospitals in Iran as a Muslim country. The study employed a cross-sectional design and was conducted in four educational hospitals supervised by the Kerman University of Medical Sciences in 2016. Using a researcher-made questionnaire, we assessed factors associated with domestic violence in female employees using a census method (N = 400). Data were analyzed using descriptive statistics including mean and SD and analytic statistics such as Kolmogorov–Smirnov, ANOVA, t test, and Pearson and multivariate regression tests using SPSS 16 and p ≤ .05. This study showed that most common types of violence against women are psychological/verbal (58%), physical (29.25%), and sexual (10%), respectively. There was a significant relationship between couples’ age gap, forced marriage, husband addiction, income, and history of violence experienced by the husband with domestic violence against women. This study examines the basic prevalence of partner violence victimization among Iranian women who work in hospitals in southeast Iran. Findings suggest that national and local policies in Iran may need to examine factors that contribute to violence against women as well as focusing on how to reduce partner violence.
Introduction
Domestic violence against women is the cause of many of physical injuries, psychological illnesses, and other undesirable consequences, and it is considered as a major health problem and a hidden and continuous epidemic for women (Güleç Öyekçin, Yetim, & Sahin, 2012). Violence against women is a phenomenon in which force is used against them and their rights are violated because of their gender by the other males. When this type of behavior is within the family and between the wife and the husband, it will be called domestic violence. However, for the purposes of this study, the many forms of violence against women are referred to by the general term “domestic violence” (Gates, Gillespie, & Succop, 2011). As domestic violence has a close association with the regional, social, and cultural background, it is essential to collect the related information in various geographical and social contexts (Watts & Zimmerman, 2002).
Islamic instruction prohibits men from violence against woman and prohibits women from acting and/or presenting themselves in such ways that increases violence against them which could somehow be interpreted wrongly as she brought it on herself without judging the nature of the behavior (Salarifard, 2011). The holy Quran also says that man and woman are equal in nature and identity, and it states, “O people! Fear your Lord, who created you from a single cell, and created from it its mate” (Ahmed, 1990). This concept has also been stated in Chapter 7: “It is he who created you from a single person, and made from it its mate, that he may find comfort with her” (Ahmed, 1990). As stated above, the maintenance of the family depends on woman as the woman is the source of comfort for the man and the children in the family. This idea also may lead someone to justify aggression when she is seen as no longer fulfilling this traditional role.
Despite the high importance of the dignity of the woman in the Islamic, there are still different kinds of violence such as physical and verbal violence against women (Hajian, Vakilian, Najm-abadi, Hajian, & Jalalian, 2014; Salari & Nakhaee, 2008). The studies about domestic violence against women in Iran have classified contributing factors about domestic violence in three groups: (a) communication and interactional factors including gender type, marriage type, interference of the family members of the man and the woman, and communicational problems; (b) individual and personality factors such as addiction and drug abuse, educational level, disappointment, moral problems, and different characteristic features; and (c) socioeconomic and cultural factors such as occupation, lack of participation of the women in social activities, economic status of the family, patriarchy, limited women’s participation in political system, and ignoring domestic violence by the authorities (Alhabib, Nur, & Jones, 2010; Ansari, Noruzi, Yadegari, Javaheri, & Ansari, 2011; Derakhshanpour & Mahboobi, 2014; Hesami, Dolatian, Shams, & Majd, 2010; Kamali, Rahimi Kian, Mir Mohamad Ali, Mehran, & Shafiei, 2015; Latifi, Taghdisi, Estebsari, & Rahimi, 2014; Sarichloo, Ghafelehbashy, Kalantari, Bagloei, & Jahani-Hashemi, 2010).
The Islamic system also tries to decrease domestic violence against women by legislating different rules. The goal is to prevent men from looking at women as an instrument and to decrease high-risk-stimulating behavior of the women which paves the way for violence against them. The necessity of hijab for women with code of civil laws 638 and preventing establishment of the brothel houses as places to abuse women with code of civil laws 639 and 640 are some examples of these prophylactic measures. It has also tried to decrease violence against women by legislating impinging rules and setting sanction (Islamic Parliament Research Center of the Islamic Republic of IRAN, 2011).
In Iran, there are many social, psychological, and spiritual supportive sources for people exposed to violence to consult with such as friends, neighbors, clergies, other trustworthy individuals, welfare organization telephone consultancy with phone numbers 123 and 148, police force telephone consultancy with phone number 110, and judiciary telephone consultancy with phone number 129. Based on Iranian code of civil laws 1115, if the husband causes a serious physical, emotional, and financial danger to his wife, she can leave him temporarily without any court order. In this case, the woman can leave the house and the husband has to provide her with alimony, and this situation has to be confirmed by the court as soon as possible (Salarifard, 2011).
Domestic violence is not happening in a specific area or group of people, and all social economic groups and levels may be involved (Ansari et al., 2011). Although various studies have been conducted on violence against women in Iran, there is no study on female hospital workers in terms of domestic violence. As most of female hospital workers in Kerman city are women and their physical and psychological health affect the development of the health system and the society, investigation of domestic violence against women is important in this group of professionals. These results of this study could be helpful in effective decision making of public health officials and health services organization managers to provide community and organizational education regarding promotion of good relationship culture and reduction of violence against women for families and society in general.
Method
Design
This study was approved by the Ethical Committee of the Kerman University of Medical Sciences prior to the collection of data. A cross-sectional design was employed in 2016. The ethical approval code is IR.KMU.REC.1395.920.
Respondent Characteristics and Setting
The target population of this study was women who work in the healthcare field. The population sample included 354 women in direct clinical roles (medical and nursing) and162 in nonclinical roles (clerical and administrative) using a census method. The sample was recruited from inpatient, outpatient, surgical departments; emergency departments; and administration in four educational hospitals. 1 Confidentiality was kept by putting no name or other personal information in the questionnaires. Questionnaires were handed out by research assistants and distributed to the participants in the hospitals. The participants filled in the questionnaire during their daily work hours. In total, 516 questionnaires were distributed; 437 questionnaires were returned from which 37 were excluded due to being incomplete and 79 were not returned, which is an overall response rate of 77.5% for inclusion in the analyses.
Inclusion and Exclusion Criteria
Inclusion criteria for participants consisted of Iranian nationality, no specific physical or psychological disease, no use of psychotropic drugs, married and living with their husband and not being divorced. Exclusion criteria included lack of consent for participation in the study and incomplete questionnaires.
Data Collection
For data collection, research team initially developed a questionnaire in two parts after an extensive review of the relevant literature to achieve good content validity. We developed the questionnaire in Farsi to reconcile study issues and concepts culturally and linguistically for Persian-speaking study participants and also due to lack of a current validated questionnaire. The first part included questions about demographic characteristics of employees including age, employment status, organizational positions, educational level, work experience, forced marriage, spouses’ age gap, familial relationship with wife, husband job, husband income, husband addiction, and history of violence experienced by the husband. The second part contained 26 questions to investigate domestic violence including of physical, psychological/verbal, and sexual violence sections. Physical violence had 10 questions including pushing, punching and aggression, slapping, burning, pulling hair and clothes, beating, bruising, and injuries such as limb fractures; sexual violence had five questions including coercive sex, compulsory abortion, unusual intercourse, dissatisfactory marital relations, and sadism. Psychological/verbal violence had 11 questions including yelling, belittling, humiliation, threatening to divorce or second marriage, pejorative view about women, indifference, battery, aggressive behavior, insulting to wife and family, restriction, and possessiveness. The number of each act of violence was based on a 5-point Likert-type scale (0 = never, 1 = once, 2 = twice, 3 = 3-5 times, and 4 = more than 5 times). In the present study, domestic violence means the act of violence against the woman by her husband during the past year; the response of violated person who has had at least one positive response to each physical, psychological/verbal, and sexual violence questions of the questionnaire was acceptable.
The content validity of the questionnaire was approved by 10 professors of the Kerman University of Medical Sciences (including psychiatrist, social health nurse, psychological health nurse, social medical experts). Also the reliability of the questionnaire was determined with internal consistency and intraclass correlation coefficients (ICCs). The Cronbach’s alpha coefficient was .87, and ICC was used to establish the test–retest reliability of the questionnaire over an interval of 2 weeks using two-way mixed ICCs for absolute agreement at the level of individual items. Its results were interpreted as follows: 0.0-0.2 as low, 0.21-0.40 as fair, 0.41-0.60 as moderate, 0.61-0.80 as substantial, and 0.81-1 as almost perfect (Landis & Koch, 1977). To assess the suitable sample size for the test–retest reliability, power analysis was performed. The power analysis identified that a sample of 30 women was required to have a power of 0.80 to detect a test–retest correlation of .90.
Data Analyses
To analyze data, descriptive tests including frequency, percentage, mean, and standard deviation and analytical tests including the Kolmogorov–Smirnov test were conducted to indicate that the data were sampled from a population with a normal distribution. The correlation between demographic data and domestic violence mean score was examined by the Pearson correlation coefficient, t test, and one-way ANOVA. The multivariate regression was used to determine the impact of demographic variables on domestic violence using the SPSS 16 software. There was a significant difference at the level of p < .05.
Results
A total of 400 women were included in the study, most participants (59.25%) were clinical staff, mean age of the participants was 30.23 ± 4.00 years, and most participants (64%) had BS degrees. Other demographic characteristics are shown in Table 1. Most participants (97.5%) have experienced domestic violence at least once, and 2.5% reported no violence. The results showed that the most common types of violence against women are psychological/verbal (58%), physical (29.25%), and sexual (10%), respectively (Table 2). The ANOVA test showed a significant difference between the age gap variable and physical violence (p = .018), psychological/verbal violence (p < .001), and sexual violence (p = .018). The t test showed statistically significant difference in the mean score of physical violence (p < .001), psychological/verbal violence (p < .001), and sexual violence (p < .001) in terms of husband addiction. Statistical t test showed a significant relationship between mean score of different domestic violence in terms of husband income (p = .24) and compulsory in marriage (p < .001) independently. Pearson correlation coefficient showed significant correlation between history of violence experienced by the husband and psychological/verbal violence (p = .032), physical violence (p = .028), and sexual violence (p = .042), respectively. Statistically no significant difference was found between other demographic variables of the participants and various types of domestic violence. Multiple regression models showed that increased age gap, low income, husband’s addiction, and history of violence experienced by the husband increased violence against female employees. Among all factors influencing violence against women based on β coefficient, violence experienced by the husband had the most impact on violence against women (Table 3).
Demographic Characteristics of Research Sample.
Frequency of Types of Domestic Violence Against Women Staff.
Coefficients of the Regression Model Factors Related to Domestic Violence (Physical, Psychological, and Sexual) Against Female Employees (N = 400).
Discussion
As domestic violence has a close association with the regional, social, and cultural background, it is essential to collect the related information in various geographical and social contexts (Watts & Zimmerman, 2002). In this study, the most common type of domestic violence against women was psychological/verbal violence followed by physical and sexual violence. These findings are consistent with the results of studies conducted by Derakhshanpour and Mahboobi (2014) and Narimani and Agha Mohammadian (2005) who reported psychological/verbal violence as the most common type of domestic violence. Ninety-seven percent of the participants in this study have experienced at least one kind of violence. This is in line with the findings of Clark, Bloom, Hill, and Silverman (2009) who reported 73% of the participants have experienced at least one kind of violence and the most frequent types of violence were verbal, physical, and sexual, respectively. Eighty percent of the Brazilian women reported household psychological aggression toward them; 30% experienced physical violence (Moraes & Reichenheim, 2002). In a study performed in India in 2012, it was shown that 37.2% of women suffered from domestic violence by their husbands after marriage (Sinha et al., 2012). The prevalence of violence has been reported with different frequencies; this difference is due to method of the study, sampling, tendency of the participants in sharing their experiences, and cultural differences. In Iran, high prevalence of domestic violence against women by their husbands is due to different cultural factors such as patriarchy and dominance of male physical power, social belief about gender, and acceptance of violence as a tool for solving problems.
The results of the present study showed a significant difference between age gap between spouses and domestic violence against women. These results are in line with study conducted by Alhabib and Jones (2010) and Mohseni Tabrizi, Kaldi, and Javadianzadeh (2013). They stated that most violence against women occurs when the age gap between couples is more than 15 years. The lower age of couples is associated with immaturity, and this variable paves the way for violence by man or woman against the other sex. On the contrary, when the age gap between couples is too high, the possibility of agreement and compatibility among them will be lower because of the lower mutual understanding (Abramsky et al., 2011).
The findings of this study also indicated significant correlation between the income of the husbands and domestic violence against women. This finding is in line with study conducted by Boonzaier and van Schalkwyk (2011) and Klomegah (2008) as they also showed that when husbands have high income, their violence against their wives would be less. However, this finding is not in line with the study conducted by Ahmadi, Rahnavardi, Kiyani, Purhoseingholi, and Asadzadeh (2015). They found that there is no correlation between husbands’ income and violence against women. In Iran, the man is responsible for family financial providence, and insufficient salary for supporting the financial providence will worsen the relationship between family members so that this stressful conditions cause to more violence incident provided (Fourozan, Dejman, Baradaran-Eftekhari, & Bagheri-Yazdi, 2007; Latifi et al., 2014).
Our findings also showed significant correlation between forced marriages and domestic violence against women. This finding is consistent with the study conducted by Klomegah (2008) and Siddiqui (2013). In context and culture of Iran does not exist law to prevent from forced marriage in family for women and most who are forced to marry under their parents pressure are usually affected with psychological disorders and their mental health is endangered, especially if there is a great age gap between husband and wife which leads to maladaptive behaviors by the wife and consequently creation of violent behavior by the husband (Ansari et al., 2011).
Study results also showed a significant relationship between drug addiction of the husband and domestic violence against women, which is in line with studies conducted previously (Haskell, Graham, Bernards, Flynn, & Wells, 2016; Hayati, Högberg, Hakimi, Ellsberg, & Emmelin, 2011; Mohseni Tabrizi et al., 2013; Shorey, Stuart, Moore, & McNulty, 2014). Drug abuse and alcohol addiction weaken morality and behavioral power, change characteristic, and decrease self-confidence in the man; therefore, man commits violence against his family members.
Our study results also showed that there is a significant correlation between a history of violence experienced by the husband and domestic violence against women. This finding is consistent with the result of studies conducted by Pahl (2016) and Rahmatian (2009). According to the social learning theory, experience of violence or learning to be violent takes place by viewing and imitating violent acts of the family members. According to this view, behavior is acquired both through imitating family members or other people’s action and through direct experiences (Bandura, 1971). If during his childhood, a man has lived in a chaotic family where parents always had conflict, the willingness for insultation and violence against his spouse would increase (Dolatian, Zahiroddin, Velaie, & Majd, 2012; Fourozan et al., 2007).
Limitations
Potential limitations of the present study were lack of cooperation of the participants and not responding to the questions truly due to embarrassment and fear of revealing information. These limitations were partially overcome by communicating to the participants properly and explaining that their participation is optional, their responses will be kept confidential, and they can fill it without writing their names on it.
Practice and Policy Implications
According to the results of this research, different approaches to factor in adjustment and improvement related to domestic violence against women could include establishment of professional counseling, training courses, and workshops through in-service training of the employees. Also for couples, confirming physical and psychological health of the man and woman before marriage, informing parents about the consequences of forced marriage, and advising them not to have argument and fights in front of their children to prevent implications for their children in the future, in addition to social support and establishment of appropriate agencies providing addiction counseling and employment opportunities for men as the head of the family so that they could afford their life expenses, are recommended.
There are different approaches to prevent domestic violence against women in Islamic point of view. Some of these approaches are preparation of choosing the right spouse, training the good relations among family members, training how to deal with tension and stress of life, religious and moral training of the children, changing and modifying the behavior of violent men, reforming the attitudes of violent men, identifying the reasons and signs of violence in the husband, helping the husband to manage anger, and cooperation of the people and social institutions in decreasing domestic violence against women (Salarifard, 2011).
Conclusion
The present study showed that most of the participants have experienced psychological/verbal and physical violence. Important factors such as a history of violence experienced by husband, husband’s low income and addiction, big age gap between the man and woman, and forced marriage can pave the way for domestic violence against female employees of the hospital. As hospitals are one of the main parts of health system which give health services to people, physical and psychological health of hospital personnel has an important role in maintaining and development of these services. So public health officials must be concerned about women’s health and perform effective actions to reduce domestic violence, and these actions may include identifying risk factors and reasons of domestic violence, performing education and long-term follow-up, establishment and development of counseling or family guidance centers, establishment of self-aid groups among women, and educating skills to husbands which are the main factors in violence against women. At the end for more accurate investigation into the issue of domestic violence, this research suggests to implement qualitative research on women undergoing domestic violence and their husbands.
Footnotes
Acknowledgements
The authors thank the hospital officials and women employees in four educational hospitals (Shahid Bahonar, Shafa, Affzalipour, and Shahid Beheshti) for participation in this research.
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) received no financial support for the research, authorship, and/or publication of this article.
