Abstract
Eleven South Asian women were recruited from three domestic violence agencies in the United States and interviewed to examine their experiences with intimate partner violence (IPV). The interviews were analyzed using a grounded theory approach. Themes included detailed barriers and facilitators to disclosure of the abuse and leaving the abusive relationship. Findings suggest that families of origin and in-laws play a significant role in the process of leaving the relationship. Children are often cited as a source of strength for the women. The process of healing and recovery after leaving a relationship with IPV was also discussed by women enrolled in this study. Pragmatic approaches to addressing IPV among South Asian women in health care settings are also considered.
South Asian female immigrants—those from India, Pakistan, Sri Lanka, Bangladesh, Nepal, and Bhutan—residing in the United States have particularly high rates of intimate partner violence (IPV) and may have socio-cultural circumstances that pose challenges to identifying those at risk so that appropriate resources can be offered. The prevalence of IPV among South Asian women has been reported to be as high as 40% (Mahapatra, 2012; Raj & Silverman, 2003). When including psychological abuse, other studies have found even higher rates of abuse, with 77% prevalence and 71% incident rates (Adam & Schewe, 2007). While immigrants have been found to have lower rates of crime overall compared with native-born Americans, less research has been conducted around IPV in immigrant populations. The most recent large scale study (n = 19,073) that examined the relationship between immigration status and the incidence of IPV found that immigrants, when compared with native-born Americans, are more likely to perpetrate some forms of IPV in the aggregate, including being “50% more likely to threaten a spouse with a knife or a gun, and approximately twice as likely to force sex and injure a spouse or partner to the extent that medical care is required” (Vaughn, Salas-Wright, Cooper-Sadlo, Maynard, & Larson, 2015, pp. 1899-1900). The IPV rates varied for different immigrant groups, with those from Mexico (13.3%), the Caribbean (9.0%), and Central America (9.4%) showing higher 1 year incident rates than those born in the United States (7.3%), and lower rates for those from Africa (3.5%), Europe (3.3%), and Asia (5.7%), suggesting a complex picture. This study points to the heterogeneity of immigrant populations and the importance of research that examines the role of different factors (acculturation stress, gender roles, patriarchy in country of origin, isolation, language barriers, etc.) within and between immigrant groups and not just compared with native-born Americans.
South Asian immigrant women who have experienced IPV are also at higher risk for poorer physical health outcomes (Hurwitz, Gupta, Liu, Silverman, & Raj, 2006) and have greater sexual health concerns compared with community peers without a history of IPV (Raj, Liu, McCleary-Sills, & Silverman, 2005). There is also a clear link between experiences of IPV and common mental disorders, suicidal ideation, and suicide attempts, including a documented increased risk of suicide for South Asian women (Bhui & McKenzie, 2008; Hunt et al., 2003). These discrepancies highlight the significance of understanding, preventing, and providing culturally tailored interventions for this group of women (Singh, 2009; Tummala-Narra, Satiani, & Patel, 2015).
Employing a comparative approach to studying IPV rates and help-seeking behaviors, research has found significant differences between South Asian, Hispanic, and Vietnamese immigrant populations (Yingling, Morash, & Song, 2015; Yoshioka, Gilbert, El-Bassel, & Baig-Amin, 2003). These studies found that South Asian female samples were more educated and had more work experience, often coming to the United States after a male partner arrived first. Yoshioka et al.’s (2003) study also showed that South Asian women were more likely to turn to family members (fathers, brothers, and also siblings of the abuser) for support or to resist IPV than other immigrant groups. They conclude that this is due to a heavy reliance on “the kinship network for assistance” and “reluctance to take their problems outside of the family,” as well as “culturally based family roles” that require brothers to care for sisters (p. 177).
Examining the specific experiences and needs of particular immigrant subpopulations is important not only due to significant cultural differences among immigrants but also because many services and advocacy programs for IPV that are available in the United States are developed for specific immigrant subgroups. This is particularly true for South Asian immigrant women who have experienced IPV, as there have been a number of community-based services focused exclusively on South Asian women, especially in large cities (Abraham, 2000b; Dasgupta, 2011; Merchant, 2000; Pan et al., 2006; Preisser, 1999).
Indeed, significant socio-cultural factors related to South Asia and the immigration experience have been noted as contributors to IPV in this population. One study showed that enculturation (behaviors, values, and community participation in culture of origin practices) was most related to a view of condoning IPV in a mixed-gender sample (Yoshihama, Blazevski, & Bybee, 2014). In addition, the link between marriage practices in South Asia, immigration status, and patriarchal norms are the most frequently reported contributors, with some studies connecting patriarchal cultural norms to perceptions of abuse (Ahmad, Riaz, Barata, & Stewart, 2004). Religion and family not only play important roles but also may be linked to experiences of abuse (Abraham, 2006), as may views of gender and sexuality (Venkataramani-Kothari, 2007).
There has been a significant body of qualitative research that has been conducted in the last two decades that examines the experience of IPV among South Asian women immigrating to a Western context, such as the United Kingdom or the United States. Notably, Finfgeld-Connett and Johnson (2013) conducted a systematic review of this topic and reviewed 30 research reports that involved qualitative investigation of South Asian immigrant women located in Western countries. At the broadest level, they highlighted issues of paternalism, perceptions of abuse, issues related to reluctance to take action, and the process/strategy of resistance to abuse. However, a systematic review approach may conceal heterogeneity and important differences among the included studies. This type of summary of qualitative studies that tend to take a narrative or “giving voice” has both strengths and limitations.
In the existing qualitative research on South Asian women, particular forms of control are highlighted, particularly control of reproductive rights and sexual control (Hague, Gangoli, Joseph, & Alphonse, 2010). Abraham (2000a) has also noted how isolation can be a form of IPV with a spouse isolating a partner from family, friends, and community members, in addition to isolation from formal institutions. Others have noted the important roles of insecure immigration status and economic abuse as contributors to IPV (Anitha, 2011), as well as financial dependence (Hyman et al., 2011).
South Asian women who have experienced IPV often feel “unnoticeable” and rely on prayer and faith (Chaudhuri, Morash, & Yingling, 2014), and also engage in what has been labeled “rumination” and “rewinding” (Kallivayalil, 2010) as a form of processing their experiences. Some research has focused on the help-seeking process (Raj & Silverman, 2007) and noted a reliance on family and friends, including family of the partner, in seeking help. The help-seeking process is complex due to the complicated roles of in-laws, as research has also suggested that in-laws are significantly more emotionally abusive in situations where women are experiencing IPV (Raj, Livramento, Santana, Gupta, & Silverman, 2006; Wasim, 2014). Often, motivation to leave abusive relationships comes from willpower, concern for children’s well-being, influence from family/friends, and the aging process (Ahmad, Rai, Petrovic, Erickson, & Stewart, 2013). In addition, some research has focused on men and contributing factors to IPV, such as their experience of “forced marriage” (Anitha, 2011) and some of their individual attributes and behaviors (Hague et al., 2010).
Many of the existing qualitative studies on South Asian immigrant women who have experienced IPV are confined to a local setting or single agency, with a few notable exceptions (Abraham, 1999, 2000a; Chaudhuri et al., 2014). Some work has also focused on particular national origin, such as women from Nepal (Thapa-Oli, Dulal, & Baba, 2009) or from Bangladesh (Rianon & Shelton, 2003). Other work (e.g., Kallivayalil, 2010) draws heavily from a particular theoretical lens (e.g., feminist analysis) in understanding and interpreting these women’s experiences.
The aim of this qualitative study is to describe the experience with IPV among South Asian women living in the United States. The authors collected data at three urban domestic violence agencies in the United States, and interviewed women with a broad range of religious, cultural, and community backgrounds to understand South Asian women’s diverse experiences of abuse and the process of leaving such relationships. This study adds to the literature by describing factors that influence the disclosure of abuse, decisions to leave the relationship, and the healing process after leaving the relationship.
Method
Sample
Eleven South Asian women were recruited through three domestic violence agencies in Georgia, New York, and North Carolina for in-person interviews by one of the authors (F.A.). The agency in New York served women of any culture who experienced IPV, while the other two agencies focused on South Asian women who experienced IPV. Inclusion criteria included being a South Asian female (self-identified as from or with ancestors from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, or Sri Lanka) who was at least 18 years old and has had at least one relationship in which there has been some level of abuse (emotional, physical, or sexual). Participants had to be able to communicate in English given the qualitative methodology of the research. Participants also had to be eligible for support services at the agency at the time of the interview, as all participants, per the study’s institutional review board (IRB) protocol, had the option of meeting with a counselor at the agency immediately after the interview.
All 11 women who consented to participate in the study completed their interviews. A description of participants’ demographics can be found in Table 1. The majority of the participants were of Indian origin (n = 7) with other participants being of Pakistani (n = 3) or Bangladeshi (n = 1) origin. All but one of the participants immigrated to the United States. All but one of the women reported having had an arranged marriage, though with varying degrees of involvement in the arrangement. The participants were generally highly educated and ranged from a 12th grade education to master’s and nursing level of training. Participants ranged in age from 24 to 49 years old and lived in the United States for a range from 2 to 24 years. Participants identified as Muslim (n = 5), Hindu (n = 3), Sikh (n = 1), Christian (n = 1), or spiritual without identifying with any specific religion (n = 1). Only two of the participants did not have any children. Almost half were currently employed at the time of the interview.
Participant Demographic Characteristics.
Note. Y = yes; N = no.
Procedures
A semistructured interview guide was developed by two authors (F.A., S.N.) and pilot-tested with a woman who matched the inclusion criteria above, but was a descendant of a country outside of South Asia. The interview involved questions around demographics, relationships involving IPV, contributing or protective factors to any past suicidal ideation/attempts, help-seeking behaviors and barriers, and the process of recovery. Participants were told in advance that the interview would involve questions about their abusive relationships and possible suicidality that they might have experienced. The participants were compensated with a US$50 gift card for their time. All participants were informed that they would be compensated even if they decided to end the interview early. This study received IRB approval at Widener University (Chester, PA).
Analysis
Interviews were recorded and transcribed, identifying information was removed, and the written transcripts were analyzed and coded by three authors (F.A., N.K., and H.H.) via Dedoose software (2017) using consensual coding from a grounded theory approach (Strauss & Corbin, 1998). A minimum of two coders reviewed each of the interviews line by line. Proposed codes were mutually agreed upon. Once all the transcripts had been coded, the codebook was reviewed and codes were identified that were present in more than four different transcripts. When codes were present in fewer than four transcripts, they were evaluated by the authors with discussion around whether they reflected an isolated experience or were part of a broader existing category. Categories were collapsed, refined, and themes agreed on by all authors. A higher order of analysis (Strauss & Corbin, 1998) involved comparing the developing themes and codes between the different transcripts to see if a more comprehensive theory emerged from the data. For example, the coding group attempted to understand how axial codes related to relationship history, characteristics of their families, and perceptions of the effect of children of witnessing abuse connected or disconnected to axial codes for disclosure facilitators and barriers. The higher order selective coding categories across transcripts were also examined to see which factors best accounted for the process of leaving the relationship.
Throughout this process, emergent themes were also examined to ensure that themes were being captured that went beyond the larger categories that were specifically asked about via the semistructured interview questions.
Results
Emerging from the coding and consistent with topics explored by the interview, themes related to barriers and facilitators to disclosing abuse were prominent, as well as barriers and facilitators to leaving the relationship. A number of factors influenced the staying/leaving process, and most women eventually reached a “tipping point” where concerns about leaving were outweighed by the psychological and emotional costs of staying. Finally, our participants elaborated on both adverse long-term effects and healing as part of the longer term process of recovery.
Views on Early Relationship and Abuse
Some participants reported feeling a sense of initial wariness toward their future husbands even before the start of any abuse because of early behaviors identified in retrospect, such as being controlling, jealous, or self-absorbed. Women noted expectations that these behaviors would change once they were married or that what they observed was not enough to terminate a relationship, especially once the engagement process had started. The women in our sample described various types of abuse that they experienced from their partners (and frequently, from their in-laws) including physical, sexual, emotional, and restriction of financial resources and basic needs.
Participants described ways that they reacted to the abuse by their husbands, naming common emotions of anger, fear, and depression, as well as rationalization of partners’ violent behaviors. Many participants also expressed feeling helpless, hopeless, and isolated from others, often including their families of origin. Some women felt so hopeless that they had thoughts of death or suicide. Women spoke about conflicting thoughts about suicide: I was feeling . . . helpless and just like my life doesn’t make sense. I’m just in so much misery and pain and I would rather not live. To die is better than to live like this every single day-every moment of your life-and taking so much physical pain-and so much insults.
Another participant described, I mean, I had a knife in my bathroom to slit myself. But then, every time I would sit and just talk myself that, “You have it, but don’t do it. Because life can be much better. If you can go ahead and slit [yourself], then might as well go out of this situation the other way.”
Children and religion were often cited as reasons not to act on suicidal thoughts or were the reasons that some women reported not having any suicidal thoughts: “I cannot do nothing, because of my son. If I don’t have the son then I hurt myself, it’s true.” Some participants coped with abuse by engaging in positive activities, such as self-care or physical activity. One participant stated that, when the abuse was occurring, she would “just sit down and Google how to handle the stress of a relationship [and found] if you go for a sprint or a long run, or go for a workout, endorphins kick in and you feel better.”
Extreme Isolation as a Barrier to Disclosing Abuse
Women cited multiple reasons for deciding to leave the marital relationship, a process that often began with disclosing abuse to in-laws, family members, or people in the community. Participants described numerous barriers to seeking help and disclosing the abuse. In particular, women noted obstacles to talking about the abuse with their families of origin. A contextual barrier included being physically cut off from their families of origin, given that after marriage, most participants moved to a different country from their families. One woman described her extreme social isolation and her reaction to ongoing abuse (staying silent), as well as how it related to physical distance from her family of origin: I didn’t have any other choice. I didn’t have any other place to go to. I didn’t have any family here. I didn’t have any friends here. So whatever he did, I kind of had to take it. So that’s how . . . I just kept quiet.
This isolation was exacerbated for some women by their partners and in-laws restricting access to contacting family, either by discouraging contact or sometimes by directly forbidding or withholding means of contact. The fear of burdening their families of origin with the knowledge that they were suffering abuse was another significant barrier noted and was related, in many cases, with the perceived (or actual) inability for their families to intervene given their distance: “My family, even if they knew . . . they couldn’t do anything. It was like I was suffering bad over here and they were equally suffering over there and they couldn’t do anything about it.” In this context, most participants described fear of escalation of abuse by their partners as one significant barrier to disclosing abuse and seeking help. One participant observed how her parents’ helplessness given their distance did increase her risk of escalating abuse after her disclosure: “[Father] just kept calling every 2 hours . . . every 3 hours. My husband got suspicious that I had told them something because they were calling so much.”
Another barrier to disclosure and means of enforcing isolation included restrictions on mobility. Women reported not being able to leave the house without the abuser present or not being allowed to have a driving license. These restrictions increased social isolation and contributed to fewer relationships for disclosure to happen. Women in our sample did not disclose the abuse to health professionals or counselors prior to leaving their abusive relationships. Reasons for this included being told by an abuser that the professional would report back to him, limited knowledge or familiarity with these helping systems, and a feeling of distrust or a fear of being misunderstood. Many participants expressed beliefs that health care professionals either could not understand or would not address the root cause of their suffering. When counseling was suggested to one Muslim participant, she feared seeing someone who did not understand South Asian culture and expected a response such as “oh you guys are Muslim women, you’re oppressed anyway.” One participant recalled that her imam told her that a counselor would just suggest that she get a divorce. Another woman observed, If I went to some psychologist or if I went to some psychiatrist, what are they going to do? They’re going to tell ME to take this pill—pop this pill and go to sleep and not get depressed. They would only tell me to . . . just change MY ways . . . I knew that the problem is not ME—the problem is HIM.
Family as Source of Support and/or Pressure to Stay in an Abusive Relationship
Participants reported restricted access to supports, most prominently family, as reason to stay in their marriages. In addition, they noted limited access to financial and legal resources, as well as psychological fears and concern for breaking cultural expectations. Many women also reported prominent legal fears related to losing custody of children, which sometimes included misinformation supplied by their abusive partners (e.g., that custody would likely be granted to the father).
Disclosure to family members, in-laws, or friends was sometimes used as a means to cope with ongoing abuse, seek support, and remind individuals of their self-hood. This often led to a process of considering whether or not to leave the marriage. In some cases, families were key to helping the survivor to recognize that she should no longer endure the abusive relationship and to overcome psychological barriers to leaving. One participant shared how she felt it was important for women to talk about their relationships with their families and friends because this had changed her own understanding of her relationship: But [my parents] told me that this is not supposed to happen to you. And they gave me that sense of feeling which I didn’t have before, like this is wrong, this is wrong. No one can do that to you. No one should do that to you. That, of course, was very, very supportive . . .
However, support around leaving at the time of disclosure did not always lead directly to a decision to leave and could involve complicated feelings about the arrangement of the marriage: Hearing that, they were like “just come over—you don’t need to take that.” . . . I was like, first of all, you get us married and then you tell me to leave. I mean, I’m not doing that. It’s my life. I need to work it out.
While some families facilitated the decision to leave the relationship, others offered mixed advice. Women had to go through a process which often included prioritizing herself, her children, or her parents. For example, participants spoke about their decisions to leave, sometimes despite the advice that they were given: Nobody thought that leaving him is a good idea. And nobody suggested [it to] me. But it’s me who knows the pain, living with him. So I just decided for myself that I have to.
Another participant described, I’ve had mixed opinions both ways like some wanting—some thinking it should have worked out, but they don’t matter. I mean, it’s just my parents that matter.
Prominent cultural considerations included familial and self-stigma against divorce, with both participants and families weighing pressure to make marriages work against the alternative of perceived limited options for a divorced woman in society: In our religion, we are not supposed to marry another guy. I mean, we are supposed to but there will be less chances . . . And there will be no good future. I mean, in my culture . . . I have to marry to a 70 year old, 80 year old guy. So [my parents] were thinking of that. If she wants to get married again, what kind of a guy . . . they were thinking of my future, what could be my future? I told them clear: no need to worry about me.
In-Laws’ Roles in Prolonging or Perpetuating the Abusive Relationship
In-laws also played a role in maintaining the abuse cycle for many women. Indeed, in-laws and families of origin influenced all aspects of the participants’ experiences, including the staying/leaving process. For all but one woman in our sample, marriages had been arranged; thus, family was involved from the beginning of courtship. Most of the participants lived with or close to their in-laws at some point in their marriage. One woman described the importance of the extended family in her perceptions of marriage: Marriage is not just for the body, marriage [is], you know, for the soul. Your soul is marriage for him, you know, and the family, you know the relationship of two families. You are attached for two families so more you need to be careful for the family.
Another participant observed, “Ending relationship means ending with everyone. Because with my family it would end too because it’s like, ‘Oh, couldn’t you get along?’”
Relationships of participants to their in-laws were complicated and multi-dimensional. Sometimes, the in-laws sided with the participant, encouraged the abuser to behave better toward her, and encouraged the participant to leave the relationship or even directly helped her leave. More commonly, however, in-laws witnessed, normalized, and encouraged staying in the abusive relationship, and/or they participated in control/abuse. This included in-laws reporting back to the abuser about their displeasure toward their daughter-in-law’s actions in the household. Many in-laws also placed or enforced restrictions around food, freedom, money, access to health care, and other resources. In addition to normalizing their sons’ behaviors, at times, in-laws were also a part of emotional abuse in treating their daughter-in-law as if she were invisible or nothing more than a servant for the household. For example, one participant shared, “I mean, his parents came here to take care . . . to take care of my son. But they were not. All three became one and they were torturing me.” Another described, “I had gone for separation, and then his family barged in. And they’re like, ‘Yeah. Yeah. He’s a changed person. Give it another try.’”
In some of the relationships between participants and their mothers-in-law, the mother-in-law conveyed the message that the participant should preferentially come to her to seek advice about the marriage—rather than “burdening” her own parents. For some women, this contributed to a normalization of the abuse and, at times, a sense of betrayal when their requests for help and advice went unmet. The notion that the in-laws were aware of behavioral problems with their sons but still arranged the marriage also contributed to this: She would never tell him to change his behavior or anything . . . anything that I told her, she somehow twisted it around and made it look like, oh, I need to work on it more and I need to change it. I need to change the situation. Everything somehow, came down to how I have to change myself. How I have to be more patient. How I have to be more tolerating. It was just that I hated her.
Although families of origin were often physically distant from the women in this study, it was not unusual for abusers and participants to call each other’s families, even if the abuse was not disclosed, to complain about each other’s role in an argument. Participants’ parents would sometimes try to negotiate with the in-laws about their daughter’s experience of abuse, in-laws might call to complain about their daughter-in-law, and sometimes all parties became involved. One woman described, It just became everybody’s fight. His parents started defending him—well his parents started calming me down because I was angry by that time. I was yelling at him. He was yelling at me . . . his parents started yelling at my mom . . .
Facilitators to Leaving the Relationship
Overcoming isolation through family and resourceful means
When participants decided to leave their partners, the support of their families of origin was often central to the process. As described above, this could include affecting how women understood what was acceptable in a relationship or having support to overcome expected societal judgment. When a woman decided to leave, examples of support included family helping her to overcome barriers of social isolation and restrictions of mobility/finances by traveling to help the participant physically leave the situation. Sometimes a confrontation between family and in-laws and/or abuser led to the termination of the relationship. When participants lacked the presence of their families or other supports in the immediate vicinity, they often found creative solutions to leave their abusive relationships. For example, one woman disclosed the abuse to her “eyebrow girl” when seeking help. Another went to the leasing office in her apartment to make a call to the police, as she was unable to make calls in her apartment due to restrictions placed by her abuser. In the face of tight control imposed by her abuser and difficulty contacting her family of origin, one woman created a second email account, of which the abuser was not aware.
Higher stakes: Intensification of abuse and/or involvement of children
Intensification of abuse was a prominent reason and facilitator in ultimately leaving their relationships for many participants, and this could include abusers perpetrating violence in front of family and children. For one participant, escalating abuse while she was pregnant was the event that led her to leave. In addition, growing fears about the long-term adverse effects of abuse on their children was a key factor for multiple women. One participant talked about leaving when her young sons began trying to defend her from their father. Another participant discussed her concern for her daughter: I don’t care what my father would feel or what my mother would feel if I’m not in a relationship with him. I only care about one thing. That is what can I do for my daughter because I’m solely responsible for her.
Long-Term Effects of Abusive Relationship
Adversity in regaining sense of self and community
Many of the women in this study expressed their advice that women in abusive relationships should decide about staying or leaving more quickly than they had because of negative consequences that they experienced following protracted experiences of abuse. For one participant, Such a harm . . . physical or emotional harm . . . it stays with you for a long time. So, if they are in an abusive relationship, it can change them. It can change who they are . . . It can just affect them in such a negative way and the effect won’t go away for years and they shouldn’t put themselves through this for a long time.
Some of these negative effects included longer lasting medical (e.g., broken bones or requiring surgery) and psychological consequences of the abuse. Participants talked about a significant amount of fear related to their recent traumas and current situations including, for some, becoming single parents and fear about what the future held for them even after they left their abusers. One participant relayed her persisting fear: the dreams, the nightmares . . . I was in a totally another state at that time. The fear of him coming and taking the kids away. The fear of I don’t know what legal issues. I had no idea what was going to happen . . .
Other adverse effects included reduced self-confidence and feeling behind in the world, such as not understanding changes in technology that occurred during an isolative period. Some of the participants spoke about struggling with a reduced sense of confidence which some attributed to a feeling that they had lost a part of themselves. In addition, participants described feeling mistrustful after the relationships ended. For some participants, this was related to a mistrust of men in general. One participant shared, It has made me super-cautious. I would not trust any man, I guess. So also, it has made me super-believe in myself even more. But the bad thing is that it has made me very negative. Like anytime there is even the slightest of a problem, I think of the WORST that could happen. I’m not a positive person anymore.
For others, especially if their experiences was of being ignored by people in their communities during or after leaving their abusive relationships, this mistrust could also extend to members of their own culture or religion. Some participants described hesitation with returning to social and religious events because of fear of judgment.
Resilience and healing: A process of re-finding strength
Women also consistently reported a process of healing that was important to their recovery. Main factors of this identified in our interviews included the importance of children, self-care, and re-finding and strengthening self-confidence. Just as children were often mentioned as reasons to finally leave the relationships, they also played a significant role in women’s healing in the recovery process. Women identified being needed by their children as a top reason that they continued their struggle even when it felt difficult. As one women noted, “I have to be more strong and I have to show [daughter] I am strong. She makes me strong every day of my life. When I sleep, I sleep for her and when I awake for her. That’s my life now.”
Others saw themselves as previously strong individuals who had been given positive messages in their upbringing and described this as important in their healing process. States one woman, “my upbringing and strong mind helped me see there is always hope even when you feel hopeless.” Another woman reflected, Nothing gave me hope . . . it just went on and on and on and on. Unless until I decided to take the action. That’s when I was like, no. I cannot let things just go and someone just come and spoil my life and just go like that. And I’m not allowing. I mean, my parents had worked so hard for me and I’ve worked hard for my life too.
The resilience and strength of the participants were also demonstrated in the ways that many of the women were able to identify that they had not done anything to deserve the abuse and ascribed the blame to their abusive partners. Women also shared the idea that they would not allow what had happened to them to ruin their lives. Women expressed identifying as people who did not give up and who kept fighting. Seeing positive changes and growth since leaving their relationships was also viewed as a source of hope. One woman shared, I thank Allah every day alhamdulillah. I’ve come . . . I’ve come really far. [Counselor at DV agency] has seen it. [Another counselor] has seen it. Everyone has seen it. I can’t back down and . . . after all the help I’ve received from my family and friends. I can’t give up now. I can’t . . . no matter how hard it gets.
Finally, women described multiple self-care avenues that helped them heal, such as engaging in exercise, centering themselves, going to church to “find peace,” and watching TV. Prioritizing oneself over the role of wife and mother was also described as an important part of the healing process. One participant said, Even Oprah helped me because—you know, they always tell, “Put yourself first.” And “put yourself first” is a good phrase, but how do you define putting yourself first? I should put myself first so I should give food to my husband, and he should be helping . . . And then when they say, “Put yourself first,” is that – firstly manage yourself and then your daughter and then your husband? So that . . . how you understand [that]—the understanding changed.
Another woman notes on her process of healing and recovery, I feel the mind has a lot of power over the body and that’s what I’ve been using after what happened last year, you know, just controlling my emotions and my heart through the mind, so—at the end of the day, I just want—I want to be centered—I was my—I want no, you know, upsetting thoughts in my mind. It all comes down to a state of peace over here up in my head.
Women were also able to envision a future, including looking for a new relationship or not, depending on newly formulated life goals. One woman reflected on a new understanding of what she needed out of a partner: “Before I don’t know how marriage goes, because I never dated anybody. I don’t know what is a relationship is…” Some women enjoyed their time being single while others expressed their hopes and uncertainties around re-marriage: I’m hoping like if I marry second, you know, second marriage, hopefully it’s could be better. Better than me and my daughter but whoever, you know, it’s hard to find somebody to marry because I have a daughter . . . So it’s okay. We just hoping. I’m just hoping. I don’t know.
In addition, many women described a process of gaining hope through action, including seeking support and community at the domestic violence shelters they were recruited from, as well as sharing their stories and feeling less alone. For some, it helped to meet women of other cultures who had also experienced abuse to realize that their experiences were more universal. The process of sharing stories of IPV was healing for these women, and helped them to rebuild an important sense of community. This process led the women to feel more able to change their lives and to re-gain a sense of agency. Importantly, women also described sharing their stories with others as a way to find community and heal. Several women offered that they agreed to the interview or found comfort in participating in the study because they felt that telling their stories might help other South Asian women who were in abusive relationships.
Because I thought that, see, it’s me, it’s only me who got hurt in this world, and later when I came—when I realized, when I went to the support group meetings, there were a lot of people worse than me. So then I thought, okay, if you share, if we got to know some information, if we share some information, that helps you . . . And my information might help somebody like their information helps me. So then I just thought of okay, let me come out, speak. That’s the way we get healed.
Discussion
This qualitative study reflects the voices and experiences of a mixed sample (e.g., religion, country of origin) of educated South Asian immigrant women who presented at three urban U.S. community domestic violence programs. The study describes how these women experienced the process of ongoing and escalating IPV that led to disclosure and/or help-seeking and eventually leaving the abusive relationship. Importantly, the study was also able to examine salient factors that served as barriers and facilitators to the women leaving their relationships, and to highlight long-term adverse effects, as well as their process of healing and resilience. At a broad level, the results are consistent with prior work that suggested factors that affect a woman’s reluctance to take action as well as the process of resisting abuse (Finfgeld-Connett & Johnson, 2013).
Many aspects of these women’s experiences map onto general findings that are consistent with the broader domestic violence literature: fears of intensifying abuse and concerns about children. However, there were also some culturally specific findings, particularly in terms of beliefs about professionals, as well as culturally mediated shame and fear about approaching their families of origin and disclosing abuse. Women often found themselves worried about their ability to trust professionals or had their contact with physicians mediated or controlled by their abusers. Some of these aspects of abuse were related to the experience of being a new immigrant and the by-product of arranged, patriarchal marriages. These findings are consistent with prior work on the experience of South Asian women who have encountered IPV, including Raj, Liu, McCleary-Sills, and Silverman’s (2005) work that addressed reproductive health access issues or Ahmad, Riaz, Barata, and Stewart’s (2004) work on how patriarchal beliefs related to abuse.
This study was able to describe both barriers and facilitators to help-seeking, and a prominent finding was the central role of in-laws in this process. This is not only consistent with prior research (Raj et al., 2006; Wasim, 2014) but also very significant in terms of understanding the central role that in-laws play in emotional and sometimes physical abuse. In-laws normalizing or minimizing the abuse also led to further difficulties women faced in leaving their relationships. In-laws often had more physical proximity to women than women’s families of origin and were engaged in extending or perpetuating the partners’ isolation or control. The extent of in-laws’ influence as a complicating factor for whether and when women left or stayed was a telling indicator; it indicates a need for professionals to inquire about in-laws and their influence when assessing IPV risk.
Families of origin also had an important role to play in these women’s process of negotiating their relationships and eventually leaving. When some women reached out to their families of origin, it led to their parents negotiating with in-laws and brokering a way to leave; in fact, support from the family of origin was central to seeking help. These findings are consistent with a “family marriage” model where parents and in-laws are important brokers in decisions regarding marriage and the self, and consistent with a collectivist culture that prioritizes larger family ties over individualized goals or needs (Triandis, 2001). This finding suggests the importance of professionals assessing family relationships and cultural views related to staying or leaving in assessing a woman’s readiness to leave an abusive relationship.
This study adds to the literature on IPV by highlighting these women’s recovery processes, including elaborating their self-hood after the abuse and looking toward the future, both psychologically and pragmatically in terms of new relationships and family configuration. Longer term effects that these women experienced after the abuse were ongoing concerns about custody and a process of attempting to restore well-being for their children. For many women, healing involved moving toward hope via restoring a sense of agency and self-efficacy. Children served as a vehicle to introduce a sense of purpose, and women reported the importance of finding self-care practices and communities of healing. Of note, women often felt particularly aided by being able to share their experiences at agencies with other women with the same background religion/culture. For areas where such culturally specific services are not available, fostering such connections outside the service setting may be very important.
One significant limitation of our study is that participants were recruited from domestic violence agencies, which limits the generalizability of the findings. Whether results would be similar with women who either remain in abusive relationships or leave via nonformal means remains unknown. The study, like many qualitative approaches, also used a convenience sample, albeit one that was geographically and religiously diverse. The sample was also highly educated, reflective of a subgroup of South Asian immigrants, and possibly reflective of interviews being conducted in English. Lower educational level and/or class status South Asian immigrants may have very different outcomes, processes, and challenges. Another potential bias was that the interviewer’s last name (Ahmad) is a common Muslim name. One participant directly commented on this as being a reason that she almost canceled the interview, given that she had a lot mistrust for Muslims following her experience of IPV. An additional caveat is that the study was developed with an initial focus on assessing experiences of suicidality in women who experienced IPV (consistent with prior research) but became a more open-ended process of capturing the women’s experiences broadly. As having suicidal ideation was not a requirement to participate, the number of women who spoke about certain themes was too limited to ascertain if it was reflective of broader experiences by women in abusive relationships. Questions were asked about disclosure and help-seeking around suicidal ideation/behaviors and point to an area of potential future research as some women reported not wanting to disclose their histories of depression or suicidality due to concern it might bring others down or not wanting to be the first to bring this topic up in groups, even in those that involved other women who had experienced IPV. As one participant stated regarding her suicidal ideation, “It’s one of the—you want to say ‘dark secrets.’ Like a dark secret, you don’t want to tell that you were bad or to that level.” Suicidal ideation may be more prevalent but may have more stigma around disclosure, even among women who have shared their experiences of their abusive relationships.
Practical implications of the findings include culturally sensitive health care services that take into account the possibility of IPV for South Asian immigrant women. The results suggest ways in which health care professionals may be cognizant of the larger process of family negotiation, the possible involvement (and potentially abusiveness) of in-laws, hopelessness and suicidality, and access to care; incorporating this knowledge into clinical practice can help to build constructive alliances with women who have experienced IPV (Battaglia, Finley, & Liebschutz, 2003). Women are likely to be nontrusting of traditional Western care (Campbell, Ramsay, & Green, 2001), and agencies and practices may want to consult with or utilize community-based services that are focused on South Asian populations whenever possible (Merchant, 2000).
This study provides a window into the experiences of South Asian immigrant women who have suffered IPV. Given the complex factors that impact their experience, the present study adds to a growing literature by further elaborating the impact of familial relationships and in-laws, how women negotiate the staying/leaving tension and reach a tipping point, and how women are impacted in the long term. This study adds to the current knowledge with a nuanced and rich portrait of the shared lived experiences of South Asian immigrant women who have encountered IPV. Further research may want to either explore subgroup differences in this population not addressed here (class background, focus on one religion, etc.) or examine similarities and differences with other Asian immigrant groups or non-Asian immigrant groups. Such studies would add to a more comprehensive picture of these women’s experiences.
Conclusion
This qualitative study of South Asian women immigrant survivors of IPV highlights specific barriers and challenges that they face in the help-seeking process. The women in this sample represented diverse national backgrounds and state domestic violence agencies, but all had received support through these agencies. Consistent with previous IPV work, children were often cited as an important factor in leaving an abusive relationship and were also cited as important sources of strength for these particular women. Significant barriers included their particular isolation as immigrants and women living in homes far from their families of origin. In addition, the important roles that their in-laws played in perpetuating abuse and increasing isolation may be important to consider when working with a woman in these circumstances. Health care professionals may want to actively explore the possibility of IPV in this population during their visits and inquire about social supports and in-law involvement. Women who have disclosed about their IPV may still have significant barriers to bringing up and obtaining support around any of their suicidal thoughts. For women in our sample, regaining a sense of self and reestablishing trust and connection to a larger community played a large role in their long-term healing. This process is important to consider in program development and resource mobilization for women who have experienced IPV and successfully left their abusers.
Footnotes
Acknowledgements
This study was made possible by the Lindback Career Enhancement Minority Junior Faculty Grant (S.N.), the Albert Einstein Medical Center Research Fellow Program (F.A.), the National Institute of Health (MH20021-14) (H.H.), and the Fulbright Scientific Mobility Scholars Program (H.H.). The authors gratefully acknowledge Shireen Cama, MD, for her helpful suggestions on the article.
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.