Violence Against Women and Its Consequences on Women’s Reproductive Health and Depression: A Jordanian Sample

Abstract

The aims of this study were to investigate the women’s current reproductive health (RH) status, depression levels, and to clarify the relationships between the violence against women and depression and the RH components. Three hundred women participated in the study. Data were collected from the Women Health Center (WHC) in Prince Faisal hospital in Rusaifa, Jordan. The findings revealed that around 25.9%, 13.1%, 83.2%, and 65.1% of the participant women had been exposed to physical, sexual, control, and psychological violence, respectively. Around 77.7% of women were using contraceptives; oral contraceptives and intrauterine devices (IUDs) were the most common family planning methods used. In addition, the results revealed that 50% of women were suffering from significant levels of depression. A positive relationship between exposure to all violence types and women’s depression levels was found but not for all RH components.

Keywords

violence against women reproductive health depression Jordan

Introduction

Violence against women (VAW) is a global phenomenon, which has serious health consequences. It could be found in every civilized society regardless of the country (Cook & Bewley, 2008). The United Nations defines VAW as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life” (World Health Organization [WHO], 2002, p. 4). VAW is a global public health crisis because of its high prevalence and its association with deleterious physical, mental, and reproductive health (RH) outcomes (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2005).

Domestic violence (DV) in general and against women specifically is a persistent problem in the Jordanian local community (National Council for Family Affairs [NCFA], 2008). Even though there has been an increased awareness of the implications of key demographical, social, and behavioral factors on women’s health status, the phenomenon needs to be clearly addressed in Jordan (Colarossi, Breitbart, & Betancourt, 2010). The Jordanian community, as in many other Middle Eastern communities, still lacks the significant and detailed data on VAW (Nasser, Belbeisi, & Atiyat, 1998).

VAW is considered to be a health risk factor and a public health problem, due to its consequences for a woman’s health and her quality of life and RH (Emenike, Lawoko, & Dalal, 2008; Johri et al., 2011; Pallitto & O’Campo, 2004; Parish et al., 2004; Salam, Alim, & Noguchi, 2006; WHO, 2002).

A review of the literature on VAW in Jordan indicates that the size of the violence problem ranges from 7.7% to approximately 78%, regardless of the types and forms (NCFA, 2008). Clark, Bloom, Hill, and Silverman (2009) argued that there are different types of violence with different prevalence in Jordan (control, 97.2%; psychological violence, 73.4%; physical violence, 31.2%; and sexual violence, 18.8%). Furthermore, Al-Badayneh (2012) has found that there were differences in VAW prevalence based on women educational levels, employed–unemployed, experiencing violence during childhood, and women’s propensity to leave the marital relationship.

The VAW figures in Jordan could be considered within the international ones. For example, an international survey of 48 countries revealed that between 10% and 69% of women around the world reported being physically assaulted by male partner at some point in their lives (WHO, 2010). The VAW problem became significant for Jordan in light of the results of Population and Family Health Survey [PFHS] in 2012, which found that around 70% of Jordanian women accepted at least one reason as a justification for wife beating. Where, relatively few believed that a man was justified in beating his wife if she burned the food or argued with him and if she insulted him, and around one out of four Jordanian women believed that wife beating is justified if a wife did not feed her husband (Department of Statistics & ICF International, 2013). All forms of violence can be justified, which could be reflected in the use of violence to solve and deal with different marital issues within the family. The VAW problem in Jordan, as in other countries, can interfere with the women’s RH and other psychological and mental health aspects (Nasser et al., 1998).

Learning more about attitudes toward women was essential for understanding and preventing VAW in a country such as Jordan. In some cases, DV and even the murder of one’s wife or daughter, which is called “honor killing” (Faqir, 2001, p. 66), have been justified by ideas about family honor and what was required to keep it intact.

Victims of VAW experience significant mental health problems, which manifest as symptoms of psychological and physical distress. Major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and anxiety have emerged as the most frequently diagnosed mental health problems related to VAW (Gilchrist, Hegarty, Chondros, Herrman, & Gunn, 2010; Torres & Han, 2000). Studying the relation between VAW and other health and psychological problems (e.g., RH, depression) could help the Jordanian community to address VAW problem from different and newly perspectives, to plan appropriately the solutions. This could be reflected on women’s health and wellness as well as the public health.

Rossman (2001) claimed that VAW has negative effects on the women’s RH and sexual health (such as, unwanted pregnancy, abortion, and sexually transmitted disease [STD]), which can negatively affect their mental health. However, the available data indicated that most women who received RH care services in Jordan were not being screened for violence in routine RH care visits (Clark et al., 2009; Damra et al., 2015). Such screening could clarify and justify some RH and mental health problems for the women. Evidence suggests that having these potential screening facilities for VAW at the family planning and Women Health Centers (WHC) may have double positive outcomes. First, they can provide wide opportunities to identify, refer, and consequently help abused women to obtain interventional services. Second, they interpret the possible actual reasons behind the different RH complaints (Damra et al., 2015; Parsons, Goodwin, & Petersen, 2000).

Having new regular procedures for VAW screening at different RH and other, WHCs will help to prevent VAW problems in Jordan (Damra et al., 2015). On the contrary, studying the relationship between the VAW and some women’s RH dysfunctions and mental health may help the health care practitioners (HCPs) to extend their responsibility in working against DV and other forms of VAW in Jordan.

Based on others findings (Emenike et al., 2008; Gilchrist et al., 2010; Johri et al., 2011; Parsons et al., 2000; Torres & Han, 2000), we hypothesized that women who experience violence have higher prevalence of RH problems and higher scores of depression than women who do not. The main questions posed in this study were as follows: (a) Are there any statistical correlations between VAW and the RH aspects of women? and (b) Are there any statistical correlations between VAW and the depression levels of women?

Study Operational Definitions

For this study purposes, the RH could be operationally defined within the framework of WHO’s definition. The RH addresses the reproductive processes, functions of systems at all stages of one’s life. RH addresses that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so (WHO, 2018a); in this study, we considered that RH has different four components (current use of family planning, abortion, planning for pregnancy, and sexually transmitted infections [STIs]). While, depression could be defined as; a common mental disorder, characterized by persistent sadness and a loss of interest in activities that person normally enjoy, and accompanied with an inability to carry out the daily activities for at least 2 weeks (WHO, 2018b). Operationally, depression was measured with Beck Depression Inventory (BDI; Beck & Steer, 1984). Moreover WHO’s operational definition (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006) of current prevalence of VAW was adopted, which is “the proportion of ever-partnered women reporting at least one act of physical or sexual violence during the 12 months before the interview” (p. 1262).

Method and Procedures

Study Variables and Design

We considered that the exposure to violence is an independent variable, with four different types (physical, psychological, control, and sexual). On the contrary, RH components (current use of family planning, abortion, planning for pregnancy, and STIs) and depression were the dependent variables. For the study design, a descriptive, comparative design was used, as it is applicable and convenient for the study variables.

Study Sample

A convenience sample was recruited from a population of women who were receiving gynecology and obstetrics services at the Prince Faisal Ben al Hussein (PFBH) in Rusaifa, Al Zarqa governorate. The total sample was 300 women, aged between 18 and 49 years (M = 32, SD = 6.4). Their educational level ranged from elementary school (n = 13, 4.5%) to graduate students (n = 3, 1%). Around 77.1% of them were educated to secondary school and bachelor degree level (n = 118, 104; 41%, 36.1%, respectively). All the participants were married and living with their husbands in the urban area. Around two thirds of the respondents were house wives (n = 177, 65.3%), while 123 (n = 34.7%) of them were working. Twenty-two percent (n = 66) of the respondents were married to their first-degree relative, while more than half of them (n = 167, 55.7%) were married to nonrelatives. Around 22% (n = 67) of them were married to second- and third-degree relatives. Fifteen women (5%) had a polygamous husband. The majority of the respondents (n = 207, 70.2%) were not pregnant, while around 30% (n = 88) of them were pregnant during the study. All of the women had at least one child (M = 3, SD = 1.7), with the range being between 1 to 13 children. For more details, see Table 1.

Table 1.

Sociodemographic Characteristics of the Participants.

Demographical Variables	n	%
Education level
None	1	0.3
Elementary	13	4.5
Secondary	118	41
Diploma	49	17
Bachelor	104	36.1
Master	3	1
Employment
House wife	177	65.3
Public work	91	33.6
Private	3	1.1
Place of residency
City	293	99
Village	3	1
Relative to husband
No	167	55.7
First-degree relative	66	22
Second-degree relative	33	11
Third-degree relative	34	11.3
Husband married to another woman
No	285	95
Yes	15	5
Are you pregnant
No	207	70.2
Yes	88	29.8

Procedure

Recruitment

All the women who visited WHC in PFBH between September 21, 2013 and March 30, 2014 and matching the study eligible criteria (aged 18 years and above, married, being able to give the consent on her behalf, having the ability to understand the Arabic language, and having had previous experience with pregnancy and delivery) were assessed to participate in this study. These eligible criteria could be justified based on cultural perspectives and limitations. In Jordanian culture, it is not allowed for a female to be sexually active or having any sexual activity before getting married, and the majority of clients in the gynecology and obstetrics clinics are married women who seek for help for their reproductive health problems. Women who matched the inclusion criteria were invited to participate in the study. The assistant researchers explained the study’s main purpose, procedures, and its ethical considerations for the women. After that, the participant women signed the study consent form. Then they were asked to answer the study questionnaires provided by the research assistants.

Ethical considerations

This study has the Ministry of Health (MOH) (No. IRB\3828) and Hashemite University (HU) (No. R\Q\1300389) IRB approvals. The human rights of the participants were protected by asking them to sign the consent form.

Instruments

Domestic Violence Questionnaire (DVQ)

Violence was measured by using the Arabic version of WHO’s Domestic Violence Questionnaire (WHO-DVQ; Garcia-Moreno et al., 2005), which was modified by Clark et al. (2009) based on the results of focus group discussions conducted in Jordan. This tool was originally developed by WHO (Garcia-Moreno et al., 2005) and is known as an accredited tool for identifying intimate partner violence (IPV) in different cultures. It contains 26 items distributed on four different violence types: control, psychological, physical, and sexual violence. The DVQ has different answering choices (never, one time, sometimes, and all times) with total scoring between 26 and 104. It was modified for the Jordanian culture by previous study (Clark et al., 2009). For this study’s purposes, this tool had an accepted content validity, and having been reviewed by some Jordanian physicians, psychologists, and counselors (Clark et al., 2009), and the participants who answered one time, sometimes, and all times were grouped together and compared their depression and RH with women who answered never.

Reproductive Health Checklist (RHC)

The RHC covered the women’s backgrounds, RH aspects, access to reproductive facilities, fertility preferences, child care and nutrition, child mortality, adult mortality, awareness of and precautions against STIs, marriage and sexual behavior, and DV (Akyüz, Şahiner, & Bakir, 2008; Pallitto & O’Campo, 2004; Salam et al., 2006; Santhya et al., 2010). For the purpose of this research, four subdimensions of the RHC were used. The first dimension was about family planning preference, which included close-ended questions about the type of family planning used, reasons for not use, and whether husband or family members interfered with women’s use of the family planning. The second dimension was about abortion, which included a close-ended question about number of abortions and an open-ended question about the reasons for the abortions if known. The third dimension was about STIs, which included close-ended questions about the occurrence of STIs and the type if happened. The fourth dimension was about planning for pregnancy, which included a close-ended question about whether she planned for her previous pregnancies or not. The RHC has a good content validity for the Jordanian culture (Clark et al., 2008).

BDI

The women were screened for depression symptoms by using the modified BDI for the Jordanian culture (Beck & Steer, 1984). This inventory uses cutoff levels for depression symptoms in the general population as follows: less than 9, no depressive symptoms; 10 to 15, mild depressive symptoms; 16 to 23, moderate depressive symptoms; and above 23, severe depressive symptoms (Cohen, Norris, Acquaviva, Peterson, & Kimmel, 2007). The Jordanian version of the BDI was used for its good psychometric properties and accessibility in the Jordanian culture. The BDI has a very good internal consistency and was highly reliable (α = .96) for the Jordanian women (Hamid et al., 2004).

Data Analysis

Initially, the descriptive statistical methods (means, percentages, standard deviations, chi-square, and Pearson r correlation) were used for general analysis to answer both study questions. For the purpose of the study, the respondents were divided into two groups, women who experienced physical, sexual, control, or psychological violence and women who did not experience such violent acts. Each type of violence (physical, sexual, control, and psychological) was treated separately during the analysis of the data.

Checking the normality of the total BDI’s scores within the comparative groups indicated that the scores were not normally distributed. For that, the authors have used a Mann–Whitney U test to compare the depression symptoms scores for women according to the violence exposure variable. To examine the effect of violence types on RH components, the chi-square test was conducted for each RH component separately.

Results

Prevalence of VAW

The findings indicated that around 76 (25.9%) women had been exposed to physical violence, 39 (13.1%) to sexual, 237 (83.2%) to control, and 185 (65.1%) to psychological violence. See Table 2.

Table 2.

Violence Frequency According to Violence Type.

Violence Type	Yes	No
Physical	76 (25.9%)	218 (74.1%)
Psychological	185 (65.1%)	99 (34.9%)
Control	237 (83.2%)	48 (16.8%)
Sexual	39 (13.1%)	259 (86.9%)

RH Components

Current use of family planning

The results showed that 77.6% of the study participants were using different types of contraceptives. Oral contraceptives and intrauterine devices (IUDs) were the most commonly used methods among respondents (n = 135, 113; 45%, 37.7%, respectively). Around one quarter of the women (n = 74, 24.7%) used male condoms, while they were using coitus interruptus, the lactation amenorrhea method, and fertility awareness methods less frequently (16%, 13.3%, 10%, respectively).

Only seventy-six women (56.7%) mentioned the reasons why they did not use the family planning service during their lives. The main two reasons were wanting more children (n = 25, 11.8%) and the husband asked her not to use any (n = 18, 8.5%). On the contrary, the results indicated further different reasons: menopause (n = 4, 1.9%), not having a regular sexual intercourse (n = 9, 4.2%), infertility (n = 7, 3.3%), sick husband (n = 2, 0.9%), and husband’s sexual dysfunction (n = 1, 0.5%)

Abortion

Around one third of the respondents (n = 95, 31.6%) had a history of abortion with a mean of 1.6 times (range from 0 to 6). Only 19 of them (6.3%) had answered the question about the reason for the abortion. The participants mentioned two reasons for their previous abortion: God’s wishes (n = 1), infection (n = 1), immune reaction (n = 1), and unknown reasons (n = 16).

Planning for pregnancy

More than half of the respondents (n = 163, 59.3%) planned for their current or previous pregnancies, while the rest (n = 112, 40.7%) did not. Only 16 women (5.5%) mentioned that they had not received any kind of antenatal care in their last pregnancies. On the contrary, most of the respondents (n = 273, 94.5%) mentioned that they had received antenatal care with a mean of 10.7 gynecology and obstetrics visits.

STIs

Only 32 women (10.6%) mentioned that they had suffered from STIs before. Twenty-one (67.7%) suffered from a fungal infection, four (12.9%) suffered from viral infection, and the rest (n = 6, 19.4%) did not mention the type of infection. Seventy-two women (24.7%) mentioned that they had suffered from non-STIs, and 67 (93%) of them received medication for the infection.

Depression Symptoms

The results indicated that around 51.3% of the sample (n = 154) did not suffer from depression symptoms, 19.3% suffered from mild depression symptoms (n = 58), 21.6% suffered from moderate depression symptoms (n = 65), and around 7.6% suffered from severe depression symptoms (n = 23).

Violence effects on depression symptoms and RH components

Violence effects on depression symptoms

Checking the normality of the total Beck’s Depression Inventory scores within the comparative groups indicated that the scores were not normally distributed. For that, a Mann–Whitney U test was conducted to compare the depression symptoms scores for women who experienced violence and women who did not experience violence. The following are the results for each type of violence separately. There was a significant difference in depression scores for women who experienced all violence types and women who did not. Physical violence, Z(274) = −3.9, p = .00; sexual violence, Z(278) = −3.3, p = .00; control violence, Z(266) = −5.5, p = .00; and psychological violence, Z(266) = −6.4, p = .00.

Violence effects on RH components

Violence effect on family planning use

A chi-square test of independence was calculated comparing the frequency of each type of family planning with each type of violence separately. A significant interaction was only found between control and psychological violence on one hand and fertility awareness method on the other hand, $χ^{2}$ (1) = 10.3, 2.8, respectively, p ≤ .05. Women who experienced control violence and psychological violence were less likely to use fertility awareness methods (2.5%, 0.8%, respectively) than women who did not experience (12.1%, 6%, respectively). The proportion of women who experienced physical, psychological, control, and sexual violence who were using other types of family planning methods was not significantly different from women who did not experience violence (p > .05).

The effect of violence on the occurrence of abortion

A chi-square test of independence was calculated comparing the frequency of abortion occurrence with each type of violence separately. Our findings showed that, on one hand, a significant interaction was only found between abortion occurrence and psychological violence, $χ^{2}$ (1) = 5.7, p = .017. Women who experienced psychological violence were more likely to have abortion (n = 68, 38%) than women who did not experience (n = 23, 23.2%). On the other hand, the proportion of women who experienced physical, sexual, and control violence that had abortion was not significantly different from women who did not experience such types of violence that had abortion (p ≥ .05).

Effect of violence on the women’s plans for their previous pregnancies

The findings showed that there were no significant differences in the planning of pregnancies according to violence exposure and violence types; physical violence: no VAW sample (n = 122, 60.7%), VAW sample (n = 40, 58%), $χ^{2}$ (1) = 0.66, p = .8; psychological violence: no VAW sample (n = 58, 66.7%); VAW sample (n = 100, 57.5%), $χ^{2}$ (1) = 1.7, p = .19; sexual violence: no VAW sample (n = 144, 59.5%), VAW sample (n = 18, 56.3%), $χ^{2}$ (1) = 0.03, p = .87; control: no VAW sample (n = 29, 72.5%), VAW sample (n = 127, 57.5%), $χ^{2}$ (1) = 2.6, p = .1.

Discussion

The aim of this study was to investigate the women’s current RH status, depression levels, and to clarify the relationships between the VAW and depression and the RH components. The findings revealed that there was a sound percentage of women had been exposed to different type of violence. These results are consistent with previous related research (Al-Badayneh, 2012; Al-Nsour, Khawaja, & Al-Kayyali, 2009; Department of Statistics & ICF International, 2013), which found that all types of violence were common in Jordanian families in the last 12 months.

Therefore, the VAW should be seen from the Jordanian cultural perspective, which can help to explore it. For many Jordanians, violence within a family is considered to be a private matter and is rarely discussed beyond the household due to shame and fear of social disclosure (Al-Badayneh, 2012; Gharaibeh & Al-Ma’aitah, 2002). These values influence interpersonal relationships at the family and community levels, which serve to perpetuate the unequal status of women in Jordanian society. In Jordan, we found a high acceptance of VAW in Jordanian families regardless to the reasons (Department of Statistics & ICF International, 2013; McCleary-Sills, 2013).

The results indicated that a sound percentage of women were suffering from different levels of depression, and there was a significant relationship between the women’s depression levels and their exposure to violence. All violence types had a significant effect on developing significant levels of depression. This result is consistent with the findings of previous studies (Devries et al., 2013; Gilchrist et al., 2010; Lipsky, Field, Caetano, & Larkin, 2005; Rodriguez et al., 2008), in that we found a significant relationship between VAW and the development of depressive symptoms. The relationship between depression and VAW can be understood through the battered woman syndrome (BWS; Salam et al., 2006). The violence can cause different maladaptive symptoms to develop, such as feelings of guilt, self-blaming, loneliness, disrupted interpersonal relationships, body image distortions, sexual intimacy problems, powerlessness, and different anxiety symptoms. It is well known that leaving the woman to suffer without any appropriate intervention might increase these symptoms. Also all these maladaptive symptoms could increase in such Jordanian reticent community for helping the VAW victims. According to the last PFHS (2012) study results, only 41% of VAW cases have sought help from any source, 13% did not seek help but told someone about their experience, and 47% did not either seek help or inform anyone about the abuse. The same survey demonstrated that in a few cases they asked for help from professional sources, but the majority of them asked for help from unprofessional sources (e.g., police departments, friends, neighbors, and their original family; Department of Statistics & ICF International, 2013). The PFHS results are supported by Damra et al.’s (2015) study findings, as they have called VAW victims as a silent victims, which indicated that 60% of women who visited the maternity and gynecological clinics and WHCs had never previously discussed violence with their general practitioner (GP). Eighteen percent said that they were too embarrassed or afraid to raise the issue of IPV directly by themselves with their GPs. However, they said they would be willing to discuss their experiences if the GP initiated the discussion. The abused Jordanian women’s trends for asking for help from unprofessional sources might be linked with some depressive symptomatology (e.g., sadness, loneness, low levels of self-worth and feelings of worthlessness or guilt).

Concerning RH, the results showed that 77.7% of the women used contraceptives. Oral contraceptives and IUDs were the most widely adopted family planning methods. Around one third of the sample had had a previous experience with abortion, more than half had planned for their previous pregnancies, and around one third of the sample had suffered from STIs before. These results are consistent with PFHS’s results, which indicated that around 61% of Jordanian women were using at least one family planning method. The different PFH surveys (2002, 2007, 2009, and 2012) results indicated that there has been a substantial increase in the use of family planning methods among Jordanian Women in the last two decades, which could explain the increased rate in using contraceptives in our results compared with the PFH survey (Department of Statistics & ICF International, 2013). All these results could indicate the reason for the decline of fertility rates from 3.8 children per woman in 2009 to 3.5 children per woman in 2012. In the same time, different factors could affect the fertility rates in the community (e.g., income rates, security situations, educational, and cultural levels and country stability) in addition to the use of family planning methods, but we think that the increase of the use of these methods during the last two decades has been accompanied by a decrease in fertility rates. The two main reasons for not using the contraceptives were that they wanted more children or that the husband had asked her not to use such methods, which might reflect the sociocultural constructs of masculinity in the Jordanian community (McCleary-Sills, 2013).

Some significant results between the psychological and control violence and woman’s awareness family planning method could be discussed and justified according to the current cultural attitudes in the Jordanian families. It is well known that getting children in Jordanian culture is a personal issue for men. Men usually control the pregnancy process, in light of the encouraging culture of having a big family size. For example, in religious and conservative culture as Jordanian one, woman who does not use the fertility methods will faced with rejection and lack of approval by her husband. This woman behavior could be justified by her willingness not to have children from her husband, and this could be reflected to expose her to threats of divorce, violence, or polygamy (Kridli & Libbus, 2001).

Research in other regions has provided strong evidence of the impact of partner violence exposure on the women’s ability to work out her RH, including through direct and deliberate interference by her partner on her attempts to avoid or delay pregnancy (McCleary-Sills, 2013; Salam et al., 2006).

Some contradictive results were found regarding the relationships between the violence exposure and RH components comparing with other studies’ results (Fleming, Mullen, Sibthrope, & Bammer, 1999; Salam et al., 2006). The current study results indicated that the psychological violence had a significant relationship with the occurrence of abortion but not all other violence types had the same relationship with RH components. On one hand, the significant result could be explained through knowing that women reporting psychological violence had significantly higher mean scores of anxiety (Al-Modallal, 2012) and anxiety, in early pregnancy, results in loss of fetus (Shahhosseini, Pourasghar, Khalilian, & Salehi, 2015). On the other hand, the nonsignificant result could be explained based on Damra et al.’s (2015) findings that the health facilities in Jordan were not prepared to manage such sensitive discussions (violence) between the HCPs and the women. This might lead to have falsely positive or negative results. Even so, a growing body of research has begun to document the associations between the experience of violence and the RH status of women. The collected data are still largely preliminary, but it suggests a need for further inquiry into these relationships (Moore, 1999).

The results of this study had some limitations. Our findings were not generalized to all Jordanian women because of the sampling type (convenience sample), which made our study results limited. In this study, we have some enrolment criteria (e.g., aged 18 years and above, married, being able to give the consent on her behalf, having the ability to understand the Arabic language, and having had previous experience with pregnancy and delivery), which might affect our results; for example, according to HFH surveys (2009, 2012), there are many females below 18 years of age were excluded from study sample suffer from RH, depression, and DV problem, also the RH, violence, and depression problems are not restricted for married women or who have children. Moreover, falsely negative results through pretending woman’s life without violence were a possibility as VAW is considered to be a private family issue in Jordan.

In the light of this, we have the following recommendations. Health educators should focus on improving the student’s communication skills with VAW victims to improve their disclosure of experiencing violence. In practice, the screening of violence and depression should be included with all women’s caring plans, to detect and treat such problems early, when necessary.

Further research is necessary with a simple randomized sample to improve the generalizability of the results to the Jordanian population. Qualitative and quantitative studies might enrich our understanding of the Jordanian women’s experience of violence and its related attitudes and roots.

Conclusion

VAW is common and justified among Jordanian women. It has affected the women’s psychological status and increased their level of depressive symptoms. However, it has not affected the women’s RH as reported in other countries. We suggest that the government should focus on improving violence screening and disclosure to improve women’s physical and psychological health.

Footnotes

Acknowledgements

Many thanks for the Hashemite University’s Scientific Research Support Fund for funding the research and to the women who participated in the study for their friendly cooperation with the data collectors.

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: This research was funded by the Hashemite University’s Scientific Research Support Fund.

Author Biographies

Jalal K. Damra is an assisstant professor in counseling and mental health at HU, with long clinical experience in providing support and specialized therapy for trauma survivals.

Sanaa Abujilban is an assistant professor, working at Hashemite University in Jordan, with research interest in violence againest women, evaluation of antenatal education and antenatal depression. She Holds BSc in nursing, MSc in nursing education, higher diploma in midwifery, and a PhD in Midwifery from University of Ulster.

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