Barriers to Leaving a Relationship From the Perspective of Married Abused Iranian Women: Secondary Analysis of the Interviews With Abused Women

Abstract

Violence has a heavy impact on the physical and mental health of women in developed and developing countries; however, most of the violence victims would suffer in silence and never leave their relationship. The aim of the present study was to identify the barriers to leaving a relationship from the perspective of married abused Iranian women. The present study was a secondary analysis of the interviews conducted in a primary study. The primary study that was conducted using the grounded theory approach has assessed the coping process with domestic violence in 24 married abused Iranian women. These women were selected from local parks, health centers, and universities of Tehran city using a purposive sampling method. Qualitative secondary analysis of the interviews was conducted, in accordance with the goal of this study, using content analysis. Four categories emerged through the analysis of the data including “fear,” “lack of resources,” “beliefs and attitudes,” and “dependence” and the common theme between these categories was “deterrents to leaving an abusive relationship.” Results indicated that contextual factors such as fear, lack of resources, attitudes and beliefs, and dependence were the reason for not leaving a relationship. Interventions for enriching women’s resources (improving the condition of education and employment, and improvement of the formal and informal support systems), education about domestic violence and its management methods, and modification of the existing attitudes and beliefs in this regard could keep abused women from experiencing more violence.

Keywords

Iran domestic violence barriers wife abuse leaving intimate partner violence

Introduction

Intimate partner violence (IPV) is a public health, preventable, and serious problem that has affected millions of women around the world (Domenech del Rio & Sirvent Garcia del Valle, 2016). Decreasing the rate of IPV is the aim of Healthy People 2020 (Coffin-Romig, 2015; Sutherland, Fantasia, & Hutchinson, 2016). World Health Organization/London School of Hygiene and Tropical Medicine (2010) has defined IPV as the occurrence of behaviors in an intimate relationship that would lead to physical, sexual, or mental damage and includes physical attacking, sexual coercion, mental violence, and controlling behaviors. Based on this definition, the one who commits IPV could be the current or previous spouse or partner (Heise & Garcia-Moreno, 2002; Jewkes, Sen, & Garcia-Moreno, 2002; World Health Organization/London School of Hygiene and Tropical Medicine, 2010).

IPV has a negative effect on the health of women and is associated with outcomes such as chronic pain syndrome, gastrointestinal disorders (Chang et al., 2010), depression, feeling of frustration (Baly, 2010), post-traumatic stress disorder (Baly, 2010; Scheffer Lindgren & Renck, 2008), low self-esteem (Scheffer Lindgren & Renck, 2008), anxiety, drug abuse, suicidal thoughts or attempted suicide (Haarr, 2010), and more use of medical services (Chang et al., 2010). The longer a woman is exposed to IPV, the higher the chance of suffering from adverse health consequences (Baholo, Christofides, Wright, Sikweyiya, & Shai, 2015).

Living with violence is painful and leaving a relationship is difficult (Enander & Holmberg, 2008); but the main question is that why women do not leave the relationship or why leaving a relationship is so difficult. Leaving a violent relationship is mostly the last option and requires courage and determination (Baholo et al., 2015). Most of the times, women would temporarily leave the relationship a few times before the final leave (C. E. Murray, Crowe, & Flasch, 2015). Bermea et al. believed that leaving an abusive partner is a complicated, non-linear, and potentially threatening process. For example, if women leave the relationship or try to leave, the chance of being killed by their partner would be increased three times more than the time they stay in the relationship and if they were controlled by their abusive partner; this risk would be increased to nine times (Bermea, Khaw, Hardesty, Rosenbloom, & Salerno, 2020). Other consequences of leaving could be increased frequency and severity of physical, psychological, and sexual violence, losing one’s mental and physical safety and of their loved ones, losing social support and financial stability, losing their home, losing freedom and children, and being stalked or murdered (Thomas, Goodman, & Putnins, 2015). However, except for rare cases, the only way that an abused woman could gain empowerment is to leave the relationship and staying is always an unhealthy method (Anderson & Saunders, 2003).

Some researchers have conceptualized leaving an abusive relationship as a process and believed that for abused women, violence is not the only effective factor in making the decision to leave (Sabri et al., 2016). For abused women, leaving is the continuity of a process that has started in cognitive and emotional levels while they are still in the relationship and would continue until after physical leaving (Anderson & Saunders, 2003). Intrapersonal factors such as personality characteristics, personal resources, and interpersonal factors such as social support, having children, and sociocultural factors (such as cultural norms and social attitudes) are related to the decision of abused women for staying in the relationship (Estrellado & Loh, 2014). These factors (intrapersonal and interpersonal factors) are described below.

Personality characteristics such as having a dependent personality, self-devotion, and being submissive and inactive would make women vulnerable to violence and make them tolerate violence. However, following the experience of violence, women’s perception of themselves might be destroyed which consequently could decrease their self-esteem and self-efficacy. So, a false sense of dependence might be created and women would believe that they could only survive if they live with their abusive partner (Estrellado & Loh, 2014). Although it has been determined that some women would make efforts for leaving the relationship, they eventually decide to stay with their partner, because they would realize that they do not have the facilities to build an independent life. Therefore, the lack of personal resources is an important intrapersonal factor that prevents women from leaving their relationship (Estrellado & Loh, 2014). Lack of an appropriate residence (Khoury & Wehbi, 2016) and lack of an independent income (Baholo et al., 2015) are some of these intrapersonal factors.

Lack of social support is another important barrier to leaving a relationship among women (Baholo et al., 2015). In the study of Estrellado and Loh (2014), lack of supportive and encouraging people in life and lack of access to help and services from governmental and non-governmental institutions would prevent abused women from leaving the relationship. Since the well-being of children is an important issue for women, they do not leave the relationship if they would realize that staying is the best choice for their children and might create a traditional family environment for the growth of their children (Domenech del Rio & Sirvent Garcia del Valle, 2019; C. E. Murray et al., 2015). Women may decide to leave when they realize leaving the relationship creates a safer environment for their children’s growth (Domenech del Rio & Sirvent Garcia del Valle, 2019).

Other barriers to leaving a relationship are fear of retaliation (C. E. Murray et al., 2015), fear of increased violence, low self-esteem, lack of information about services, experience of discrimination and previous negative interactions with the judicial system (Amanor-Boadu et al., 2012), being an immigrant (Khoury & Wehbi, 2016), the feeling of commitment and love (Amanor-Boadu et al., 2012; Smith, Murray, & Coker, 2010) and attachment to the partner (C. E. Murray et al., 2015; Thomas et al., 2015), having hope for husband’s change, feeling shame and guilt (Scheffer Lindgren & Renck, 2008), having external control locus (Baholo et al., 2015), lingered duration of the relationship (Estrellado & Loh, 2014), and sociocultural attitudes that would assign supportive caring and child-bearing roles for women (Baly, 2010).

Identifying the barriers to leaving a relationship and then performing interventions for resolving them is effective in decreasing IPV-related mortality and morbidity (Baholo et al., 2015). In this regard, social and cultural factors are of significant importance because not only they could affect the decision of abused women for staying in or leaving the relationship but also they would affect women’s perception of violence (Taherkhani, Negarandeh, Simbar, & Ahmadi, 2014). Few and Rosen (2005) believed perception, accepting or rejecting domestic violence, is dependent on the culture and domestic violence could be perceived variously in different cultures. Most of the studies on the barriers to leaving a relationship have been conducted in other societies, especially western societies and the United States, and sufficient information is not available about the Iranian context.

Following modernism in Iran, family values and roles have been transformed. On one hand, some are still committed to the traditional family values and roles (Farahmand, Khorampoor, Parsaian, & Mandegari, 2014); in this group, tolerating violence by women in marital life is considered a virtue. Women are expected to prioritize the needs of the husband and children over their own needs and maintain the family from the danger of collapsing by all means. Family and familialism are of significant importance and divorce is considered a stigma for the woman and her family (Garrusi, Nakhaee, & Zangiabadi, 2008; Sadeghifasai, 2010). On the other hand, some other has tended toward the modern family values such as individualism, equality, and independence (Farahmand et al., 2014). The dynamic nature of the family values in Iran has made it necessary to conduct a study on the barriers to leaving a relationship. Moreover, In Iran, still, no law exists that comprehensively and specifically addresses domestic violence or violence against women. The available services for abused women include shelters and phone consultation (hotlines). These services are mainly provided at urban centers by non-governmental organizations (NGOs) or the welfare organization. A team including social workers, psychiatrists, legal advisors, and psychologists is ready at the shelters to provide essential consultations (Nasr, 2016). But since no plans exist at the community level for informing and preventing domestic violence, majority of the women are not aware of these centers.

Most of the performed Iranian studies on abused women have had the quantitative approach and have indicated the high prevalence of domestic violence against women and the low rate of leaving the relationship (Taherkhani, Negarandeh, Simbar, & Ahmadi, 2015, 2016, 2017). Therefore, the present study was designed to identify the barriers to leaving a relationship in this less studied group.

Method

Primary Study

The primary study was a grounded theory study titled “exploration the process of coping with domestic violence among abused women” that was conducted with Corbin and Strauss’ (2008) approach. The primary study was a research project at Shahid Beheshti University of Medical Sciences in 2015 (No. 1392-1-86-12534).

In the primary study, 24 married abused women were selected from local parks, health centers, and universities of Tehran city using purposive sampling method. The inclusion criteria were having experienced domestic violence during the married life, being Iranian and married, being able to speak Farsi, being older than 18 years, and not being pregnant or during the postpartum period (up to 6 months after delivery). Since an individual’s perception of domestic violence is of significant importance, therefore in the primary study, women who believed they had experienced abuse from their husband during their married life were enrolled in the study. This method of recruiting abused women has been used in other qualitative studies (Wuest & Merritt-Gray, 2008).

Data were gathered over the course of 17 months (June 2012 to November 2013) using semi-structured interviews. After attending the research field (local parks, health centers, and universities in Tehran city), the first author introduced herself to women. She explained to them her specialty and the goals of research and asked about their violent relationship experiences. Then, she invited the women to participate in the study if they said their husband had abused them and also had other criteria to enter the study. If the woman wishes to participate in the study, after obtaining informed written consent, the time and place of the interview will be determined by the woman’s preference.

The interviews lasted for 25 to 106 min (mean: 60 min). Interview’s questions were about the experiences of the participants of violence and the manner of coping with it. The interview guide is included in the appendix. The study was confirmed by the Ethics Committee of the Shahid Beheshti University of Medical Sciences (400/4834). When conducting and designing the study, the ethical guidelines recommended for the study on domestic violence against women were observed (Taherkhani, 2016; World Health Organization, Family and Community Health, Department of Gender and Women’s Health, 2001).

Secondary Data Analysis

In the present secondary analysis study, data from the primary study were used to identify the barriers to leaving a relationship among married abused Iranian women. The aim of the secondary analysis is to find answers to the new research questions using data that have been gathered previously. In cases where the subject of the study is sensitive and access to the studied population is difficult, secondary analysis is specifically helpful (Long-Sutehall, Sque, & Addington-Hall, 2010). Secondary analysis of qualitative studies is a new approach to creating new knowledge in the field of health care and it is especially recommended when the researchers are re-examining their data (S. A. Murray et al., 2010).

Sample

Participants were 24 married women who have experienced physical, sexual, and psychological violent behaviors during their marriage. They were 22 to 72 years old. The duration of the marriage of the participants was 3 to 58 years. Seven of the participants had a high school diploma, five had a bachelor’s degree and higher, and the rest had a degree of lower than high school diploma. Six of the participants were employed and the rest were housewives. Most of the participants had one to two children. Twelve of the participants reported their economic status as somehow desirable, eight as desirable, and four as undesirable. Except for one of the participants, the rest were living with their husband at the time of the interviews.

Analysis

To perform secondary analysis, the texts of the interviews, audio tapes, and field notes were read again and analyzed according to the question of this research (identifying the barriers to leaving a relationship). Data were analyzed using Graneheim and Lundman’s (2004) five-step method as follows:

Verbatim transcribing of the interviews and repeatedly rereading them to gain a comprehensive understanding of their content;

Dividing the texts into condensed meaning units;

Abstracting the condensed meaning units and coding them;

Comparing the codes based on their similarities and differences and classifying them into categories and subcategories (that would represent the manifest content of the text);

Determining the themes of the categories (that would represent the latent content of the text).

In the present study, the interviews were not transcribed verbatim and the pre-prepared texts of the interviews were analyzed. To facilitate the analysis, OpenCode software was used (Department of Public Health and Clinical Medicine, 2009). The first author performed the initial analysis. The other authors examined the interviews and the results of the analysis by the first author and in the case of disagreements, discussions were made to reach an agreement. Examples of meaning units, condensed meaning units, codes, subcategories, and category are shown in Table 1.

Table 1.

Examples of Meaning Units, Condensed Meaning Units, Codes, Subcategories, and Category.

Meaning Unit (From the Transcripts)	Condensed Meaning Unit (Description Close to the Text)	Code	Subcategory	Category
I feel like I have been tied up by my children for a long time. If one day I would realize that the law is supporting me and gives me the right to custody of my children, I won’t hesitate for a second.	Not leaving the relationship due to the fear of losing the children	Fear of losing the children after divorce	Fear of losing the children and compromising their well-being	Fear
I not leaving just because of my daughter. I do not want her to be raised by a stepmother or her grandmother.	Not leaving for the fear of her child being raised by others	The fear of causing harm to children after divorce
I gave it up because of my daughter. I told myself that she wants to get married one day and she might feel ashamed against her husband’s family so that they won’t say her parents are divorced.	Giving up on divorce for the fear of making her daughter ashamed at the time of her marriage	The fear of making children ashamed in the future due to divorce

Trustworthiness

Lincoln and Guba’s criteria for credibility, dependability, transferability, and confirmability were used to approve the trustworthiness of the data (Polit & Beck, 2012). To increase the credibility of the results, the extracted categories and codes from the data were examined and approved by expert co-authors (peer debriefing). The external audit was applied to increase dependability and confirmability.

During the external audit, the accuracy of the analysis was approved by two experts in the field of qualitative research who were not a part of the research team. Furthermore, transferability of the results was confirmed by approving the accuracy of the extracted categories and subcategories of the data by six abused women who did not participate in the primary study. These women had referred to forensic medical centers after experiencing physical violence from their husband. The first author attended in forensic medical centers and identified these women through their cases. Then she asked women to comment on the findings of this study. They also approved the accuracy of the data about themselves.

Results

During data analysis, a theme “deterrents to leaving an abusive relationship” and four categories were identified. The categories included “fear,” “lack of resources,” “beliefs and attitudes,” and “dependence.” The categories are explained in the following with direct quotes from the participants.

Fear

Participants’ statements showed that fear is an important factor in not leaving a relationship. This category contained three subcategories of “fear of losing the children and compromising their well-being,” “fear of compromising the husband’s well-being,” and “fear of the divorce’s outcomes.”

Fear of losing children and compromising their well-being

Participants were afraid that after the divorce, they would lose their children, their children would be displaced, their future might be ruined, their peace and comfort could be threatened, and they would suffer physical and mental problems. The fear was more when children were younger. Fear of losing the children and compromising their well-being prevented women from leaving the relationship and they preferred themselves being in pain and suffering if they could stay with their children, support them, and create a good future for them. In fact, the love for children could give women strength to tolerate violence.

In this regard, a participant said:

Whatever he would do to me, I will not leave. If I went, he would throw our children out, and they will become homeless. I know that my presence could not make the situation better for them, and he would not do anything for them but at least, it will not get worse. (55 years, 5 years of schooling, housewife)

Fear of compromising the husband’s well-being

Some of the participants were afraid that after they would leave, their husband’s condition might worsen and they will feel guilty in the future for leaving him. This fear existed in women who had a relationship based on love. A participant who had a drug-abusing husband stated: “I felt sorry for him. I knew that if I left, he would destroy himself and its guilt would never leave me” (33 years, high school diploma, housewife).

Fear of the divorce’s outcomes

In the Iranian society, divorce is considered shameful. Participants described the post-divorce life as difficult and unbearable. They mentioned the consequences of divorce and described it as equal to losing the children and joint property; starting over with poverty and difficulty; losing respect, value, and social security; losing relatives’ support and being isolated; and losing their reputation, and even their relatives’ and children’s.

Participants believed that divorced women do not have an appropriate situation for remarrying, especially if they are not that beautiful. They stated that society is widely pessimistic and distrustful toward divorced women. Participants’ statements revealed that the presence of the divorced women is considered a threat to the stability of the married life of their female friends and relatives and so, others would try to stay away from them. They mentioned post-divorce problems including loneliness, being overly controlled by the relatives, and job and social insecurity. Being abused, rejected and humiliated, and even pitied were some other mentioned outcomes of divorce. In this regard, a participant said: “divorce has no place in this country; if hypothetically, I will mention being divorced in my workplace, everyone would hang on to me or whenever there is a chance, they want to abuse me for being divorced” (41 years, Bachelor’s degree, civil servant).

All of these factors would make women prefer staying with their abusive husband; or even if the violence gets intolerable, they prefer living separately over getting a divorce. In this regard, a participant stated:

My family does not agree to divorce, for example, encourage me to get a divorce. They agreed that we will live separately. I still tell my colleagues that I am in contact with my husband, and he comes to me. Even if I would get a divorce I will not tell anybody, I will keep wearing my ring, and eventually would say there are no problems in my life; even educated people might look at you differently, for example, they might say pity her, she does not have a husband. Perhaps they would look at you with sympathy. (47 years, Master’s degree, faculty member)

Lack of Resources

Another effective factor in not leaving a relationship was lack of resources. This category contained two subcategories of “lack of personal resources” and “lack of social resources.”

Lack of personal resources

Participants mentioned a lack of personal resources for starting an independent life such as independent income or residence. Most of the participants were financially dependent on their husband. They did not have access to necessary financial resources to start a new life after divorce and this was one of the barriers to leaving a relationship. In this regard, a participant said: “you should tolerate because you have no other way. If you had an income you would leave but when you have nothing, you should suffer and say nothing” (55 years, 5 years of schooling, housewife).

Lack of health was another factor that would make the participants more dependent on their husband. Some of the participants had spent all of their power and energy in their marital life and now, after years of suffering and developing various diseases, they did not have sufficient health for working. A participant mentioned: “now I have varicose veins and lumbar disc. I cannot work even if I want to” (50 years, 6 years of schooling, housewife).

Lack of social resources

Lack of social support was one of the important reasons for not leaving a relationship. Not only the participants mentioned lack of relatives’ support in providing financial resources and helping for starting an independent life, but they also mentioned lack of relatives’ support of women’s decision for getting a divorce.

A participant said: “once I tried to speak and said that I would get a divorce. My father said that it is your own fault; you accepted him and now you should stay in this life” (27 years, 8 years of schooling, housewife).

Another participant also mentioned: “if my father supported me, perhaps now I was in my father’s house” (38 years, high school diploma, housewife).

However, most of the participants believed that the existing laws regarding the rights of divorce, custody, and alimony have major flaws and considered them injustice against women. According to the Iranian civil laws, man is the head of the family and women should obey their husband (Salarifar, 2009). After the divorce, the custody of children would be given to the husband after a certain age (Garrusi et al., 2008). Divorce is the husband’s right (Salarifar, 2009) and he could divorce his wife at any desired time. But when a woman files for divorce, she should get her husband’s consent for divorce by any means (even by sparing all of her rights).

In this regard, a participant stated:

When it comes to the children’s custody, they say it is father’s right. When it comes to the alimony and your rights, they say you have not been submissive and so, you have no rights. These are all injustice of laws. Now, if a woman wants to get a divorce, she cannot do it easily, unless it would be a settlement. I should beg my husband for a settled divorce; first, his condition was that I should not work. The day before yesterday, when I started talking about divorce again, he said that if you do not want the children and you will give written permission that you would not want to see them and would not want them to live with you; so I will give you a divorce. (46 years, Bachelor’s degree, civil servant)

The lingered and time-consuming process of divorce in the judicial system and non-supportive and even humiliating behaviors of the judicial system’s staff were some other reasons for not leaving a relationship. A participant said: “courts do not grant divorce easily. You should spend a few years in the courtrooms. It really destroys you. You should wear iron shows in these courts. It is really annoying. That is why I gave up on divorce” (47 years, Master’s degree, faculty member).

Beliefs and Attitudes

According to the results, beliefs and attitudes of the participants were a major barrier to leaving the relationship. Most of the participants had beliefs and attitudes based on the necessity of maintaining the marital life, the condemned nature of divorce, improvement of husband’s behavior over time, relative acceptance of aggression and husband’s violence and being soft and surrendered against the husband, tolerating the conditions and ignoring husband’s behavior and considering violence normal in marital life. Some of the participants believed that they should not reveal the experience of violence to others and seek help. They considered women to be responsible for controlling their husband’s violence and believed that a woman should not leave her house in any condition. In this regard, a participant said:

I did not want to get a divorce. Divorce is not usual in our family. They say that you marry with a white dress and you should leave the husband’s house with a white dress (shroud); that is what we believed. (50 years, 6 years of schooling, housewife)

Also, another participant stated:

I told myself that he is a man, a family man should be like this, we should tolerate. For example when he gets angry, screams, curses, I should back off. Men have an ego. He should be respected; God has said that you should respect your husbands after me, that is what I have heard and believed. (72 years, illiterate, housewife)

Dependence

Dependence on the husband was another reason for not leaving the relationship. Besides financial dependency, which was resulted from the lack of financial resources participants mentioned emotional, sexual and security dependence on the husband as well. As women’s access to their required resources for resolving their needs decreased, the dependence was increased. The higher the dependence on the husband, the more limited the choices of women and consequently, the more difficult leaving the relation. This dependence could create or intensify fear and concern. Dependence category contained three subcategories of “emotional dependence,” “sexual dependence,” and “security dependence.”

Emotional dependence

Emotional dependence on the husband and having feelings for him would make it difficult to leave the relationship; love for the husband could increase women’s tolerance and make it easier to cope with difficult conditions.

A participant mentioned: “I threaten him that I will get a divorce; but when I think about it I tell myself no, I cannot do it. I cannot be separated from my children, and I love him too” (36 years, 7 years of schooling, housewife).

Sexual dependence

Some of the participants stated that they are dependent on their husband to meet their sexual needs. Since these women have predicted that fulfilling this need might be almost impossible after getting a divorce, they would prefer to stay in the relationship. In this regard, a participant said:

I told myself that if I will get a divorce I cannot stay single in this society; this is also a need and so, I should find another person. I am afraid that I might find someone for myself, but my situation would be worsened. So I would get along with this life, and this life is better than life after getting a divorce. (51 years, 6 years of schooling, housewife)

Security dependence

Some of the participants mentioned that their physical and mental security, whether in the house or the society, depends on their husband. They believed that their husband was the main factor in controlling and supervising children’s behavior and believed that if their husband was out of the picture, the children might not obey their mother and the environment of the house will get tense. Even the mother might be disrespected by the children.

In this regard, a participant said:

I feel that his presence in the house is a kind of security for me. He does not do anything for me but I feel like I have no place in the house if he is not there. When a man is not present in the house, your child would mistreat you more; they would do things that they should not. (72 years, illiterate, housewife)

Participants’ statements indicated that women who have a husband are freer and more secured in the society, and their limitations would be decreased in different aspects such as putting on make-up, communicating with others, and being present in the society and workplace, due to having a husband. Having a husband would protect women from being abused, harassed, and any other inappropriate behaviors that lonely or divorced women are usually subjected to in the society. Therefore, the participants preferred to stay in the relationship instead of getting a divorce and even losing their current freedom and security.

A participant mentioned: “Right now, I am living with a man; of course he misbehaves, hits me, but at least I have his name, No one would bother me when I go out, no one would dare to” (38 years, high school diploma, housewife).

Obviously, for women who are dependent on their husband for fulfilling all of their needs, from financial to sexual and security, the world of divorce is so dark and they are forced to pay a heavy price for getting a divorce. The higher the level of dependence on the husband, the more difficult the decision of getting a divorce.

Discussion

The study results showed that fear, lack of resources, attitudes and beliefs, and dependence were the barriers to leaving a relationship among the participants. One of the main reasons for not leaving a relationship among the participants was fear. Participants mentioned the fear of losing the children and compromising their well-being, the fear of compromising husband’s well-being, and the fear of the divorce’s outcome. This result was in line with the results of other studies.

In the study of Ruiz-Pérez et al. (2013), children had a determinant role in women’s decision for leaving their partner, in a way that concerns for children would prevent women from leaving the relationship (Fanslow & Robinson, 2010; Hayati, Eriksson, Hakimi, Högberg, & Emmelin, 2013; Ruiz-Pérez et al., 2013). However, Enander and Holmberg (2008) showed that the fear of risking the safety of one’s self, their children, and other’s could make women leave the relationship. Fear of compromising husband’s well-being was also reported as a barrier to seeking help in other studies (Nash, 2005; Vives-Cases, Espinar-Ruiz, Castellanos-Torres, & Coe, 2017). In the study of Zakar et al., women were fully aware of the divorce’s consequences and knew that should pay a high price for getting a divorce. So, the fear of worsening their condition after divorce and returning to their father’s house would prevent them from leaving the relationship (Zakar, Zakar, & Krämer, 2012).

The fear of losing the children and compromising their well-being and fear of the divorce’s consequences which had a high rate among the participants could be explained according to the Iranian context. Based on the Iranian civil laws, the custody of children would be granted to the husband after a specific age (Garrusi et al., 2008). However, most of the Iranian population is Muslim and maintaining the family is of great importance in Islam and divorce is considered condemned (Salarifar, 2009). In the society also, divorce is considered a failure for the woman, her family, and even her children (Sadeghifasai, 2010; Taherkhani, Negarandeh, Simbar, & Ahmadi, 2017). In this context, women who would file for getting a divorce might be blamed in the future by their relatives and even children and might be considered as the reason for the family’s breakdown.

Results indicated that lack of personal resources, such as independent income, and residence and health, was one of the important barriers to leaving a relationship among the participants. In other studies, unemployment and low educational level (Ruiz-Pérez et al., 2013), inability in gaining independent income (Kulwicki, Aswad, Carmona, & Ballout, 2010; Zakar et al., 2012), not knowing English language for immigrant women, lack of knowledge about the provided social and legal services in the community, being an immigrant (Kulwicki et al., 2010), and having poor health (Sabri et al., 2016) were the barriers to leaving a relationship. However, having access to the resources that would decrease dependence on the partner such as job opportunities (Ruiz-Pérez et al., 2013), health (Ruiz-Pérez et al., 2013; Sabina & Tindale, 2008), and independent income or residence (Fanslow & Robinson, 2010) considered as effective factors in leaving a relationship.

Participants mentioned lack of social resources, such as lack of support from the relatives and lack of support from the law and legal organizations, as a barrier to leaving a relationship. Ruiz-Pérez et al. believed that lack of financial, social, organizational, and family support would make it difficult to identify the violence and leave the relationship. Other studies showed that social isolation, lack of a strong support network, receiving desperate responses from the organizations in the past (Ruiz-Pérez et al., 2013), and insufficient response of the judicial system to women (Enander & Holmberg, 2008) would prevent them from leaving an abusive relationship. In general, having access to external support is considered an important turning point for leaving a relationship (Enander & Holmberg, 2008; Sabri et al., 2016; Scheffer Lindgren & Renck, 2008) because it would change women’s perspective from the sense of being trapped and isolation to the feeling of hope for change and being released from violence (Sabri et al., 2016).

Another barrier to leaving the relationship among the participants was their attitudes and beliefs that forced them to tolerate husband’s aggressive behaviors such as condemning divorce, considering violence a normal issue in marital life, improvement of husband’s behavior over time, and the necessity of being soft and surrendered against the husband. In other studies also, attitudes and beliefs had an important role in not leaving a relationship such as the belief in acceptability of violence against women (Vives-Cases, La, Parra-Casado, Gil-González, & Caballero, 2018), the believe in or hope for the change in partner’s aggressive behavior and decrease in the violence in the future (Amanor-Boadu et al., 2012; Fanslow & Robinson, 2010; Ruiz-Pérez et al., 2013; Scheffer Lindgren & Renck, 2008; Silva, Araújo, Valongueiro, & Ludermir, 2012; Zakar et al., 2012), perceiving violence as a normal issue (Amanor-Boadu et al., 2012; Fanslow & Robinson, 2010; Hayati et al., 2013), believing that women are responsible for maintaining the marriage (Khoury & Wehbi, 2016), and beliefs that would prevent women from seeking help from outside the family or prevent them from working or going to school (Amanor-Boadu et al., 2012). These attitudes and beliefs indicate the existence of a kind of cognitive distortion in which women would consider their husband less guilty, thinking that they could stop the violence themselves and believing that their husband will change (Heim, Tapia, & Gonzáles, 2015).

Participants’ belief and attitudes are rooted in society’s cultural norms; in fact, the norms had an important role in tolerating violence by abused women. Other researchers also showed that traditional expectations of the gender role such as expectation from women to tolerate the adversities in marital life, being obedience and self-giving (Estrellado & Loh, 2014), cultural norms about the sacredness of family, social stigma of divorce (Kulwicki et al., 2010; Zakar et al., 2012), and the norms that would hold women responsible for maintaining the family’s cohesion and wants them to be an obedient wife and a good mother (Estrellado & Loh, 2014; Hayati et al., 2013; Vives-Cases et al., 2017) make women surrender and tolerate violence.

Results showed that in case of emotional dependence on the husband and having a feeling for him, leaving the relationship would become difficult for women. Other researches also showed that love for the partner was the main reason for staying in or returning to a relationship (Amanor-Boadu et al., 2012; Enander & Holmberg, 2008; Fanslow & Robinson, 2010; Silva et al., 2012). In the study of Ruiz-Pérez et al. (2013), intense emotional dependence on the partner would lead to returning to the relationship and taking back their complaint a short while after filing; women were feeling guilty for reporting to the police.

In the present study, some of the participants mentioned that they would need their husband to fulfill their sexual needs and considered this dependence an important factor in not leaving the relationship. Probably, one of the important reasons for this finding is that sexual relationship is only acceptable in the frame of marriage in the traditional society of Iran. In the Iranian society, divorced women have an unstable position and usually do not have an appropriate condition for marrying again. However, in Islam, which is the official religion in Iran, fulfilling sexual needs is only permitted within the framework of marriage.

Participants mentioned security dependence on the husband in the house and the society as another reason for not leaving the relationship. Some of the participants believed that their physical and mental security in the house depended on the presence of their husband because they considered their husband the main factor for controlling and supervising the children’s behavior. In Iran, the dominant pattern for family relationships is patriarchy pattern. In this pattern, father is the head of the family, makes the important decisions for the family members and other family members, including the wife and the children, are obedient, submissive, and afraid of him. Therefore, the strength of the family would be guaranteed (Malakotinia, 2016). Obviously, in such conditions, if the father is not present, it is possible that the children would rebel and the house would be out of order.

Participants also mentioned security dependence on the husband outside the house as a factor for not leaving the relationship. In the study of Khoury and Wehbi that was about the experience of leaving an abusive relationship among Lebanese women, marriage was a social necessity which was placed in the center of their lives. They have considered marriage as a social institution that will protect them from unwanted sexual attentions that usually unmarried or divorced women would encounter. Therefore, marrying and maintaining it, in any condition, was of great importance to them (Khoury & Wehbi, 2016). It seems that people in society would recognize the husband as the owner of the woman and so, they think that they could easily get involved with unmarried or divorced women.

Implication

The diversity in the demographic characteristics of the participants in the primary study including age, educational level, and economic status was helpful in achieving more aspects of the barriers to leaving a relationship. Results could be helpful in future policy-making and designing context-dependent interventional programs (Taherkhani et al., 2015). Also, the results could be applied in the educational content of health care providers and social workers so that, by having this information, they would be able to provide better care for abused women and not use a similar approach for dealing with them (Taherkhani et al., 2014, 2015, 2016). This means that they should not encourage all women to leave or stay in a relationship regardless of their contextual factors (e.g., fear, lack of resources, attitudes and beliefs, and dependence).

Health care providers, social workers, and counselors should not be judgmental against women who would not leave their relationship and consider them inactive individuals. Instead, they should empower these women for decision-making for safety or decreasing risk for IPV while they are still in the relationship (Estrellado & Loh, 2014).

Limitations

Since the present study was a secondary analysis that was conducted on the transcripts of the interviews that were done in a primary study, we did not have access to the same participants for member check.

Although diversity in this sample was observed, it is recommended that a qualitative study with a more diverse sample would be conducted. Also, it is recommended that qualitative studies should be conducted to examine the ways of overcoming the barriers to leave a relationship, facilitators of leaving a relationship, and the outcomes of leaving a relationship in women who have been successful in doing so.

Conclusion

Results of the present study extended our comprehension of the barriers to leaving a relationship among abused women. Results showed that contextual factors such as fear, lack of resources, attitudes and beliefs, and dependence were the barriers to leaving a relationship among married abused Iranian women.

Educational programs for schools, community, government, and health care providers to promote changes in overall attitudes, norms, and behaviors that encourage IPV against women and gender inequality, empowering women to improve their occupational and educational status, and legal and social support for abused women could keep abused women from experiencing more violence.

Footnotes

Appendix

Interview guide: The axial questions were as follows, but the questions changed according to the interview circumstances.

Please talk about the mistreatment of your husband. How did you feel when your husband was being abusive?

Has that feeling changed over time? What was the impact of the mistreatment of your husband on you? Has that impact changed over time?

What was your reaction to the misbehavior of your husband? And why did you react to that? What were the consequences of your reaction?

Do you always deal the same way with your husband’s mistreatment? If no, why?

What changes in your reactions occurred over time? Why? What were the consequences of these changes?

What was your feeling to your reactions? What changes in your feeling to your reactions occurred over time?

Acknowledgements

The authors express their appreciation to all the women who participated in the primary study.

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.

ORCID iD

Sakineh Taherkhani

Author Biographies

Sakineh Taherkhani, PhD in Reproductive Health, is an assistant professor in the School of Medicine, Arak University of Medical Sciences, Arak, Iran. Her research interests include domestic violence, coping with domestic violence, women’s health, and qualitative research methodology.

Reza Negarandeh, PhD in nursing, is a full professor and the Director of Nursing and Midwifery Care Research Center at Tehran University of Medical Sciences, Tehran, Iran. His research interests include community-based nursing, nursing ethics, patient advocacy, coping, and spirituality.

Fatemeh Farshadpour is an assistant professor in the School of Medicine and a member of the research council in the Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran. She is interested in qualitative research and women’s health.

References

Amanor-Boadu

Messing

J. T.

Stith

S. M.

Anderson

J. R.

O’Sullivan

C. S.

Campbell

J. C.

(2012). Immigrant and nonimmigrant women factors that predict leaving an abusive relationship. Violence Against Women, 18, 611-633.

Anderson

D. K.

Saunders

D. G.

(2003). Leaving an abusive partner: An empirical review of predictors, the process of leaving, and psychological well-being. Trauma, Violence, & Abuse, 4, 163-191.

Baholo

Christofides

Wright

Sikweyiya

Shai

N. J.

(2015). Women’s experiences leaving abusive relationships: A shelter-based qualitative study. Culture, Health & Sexuality, 17, 638-649.

Baly

A. R.

(2010). Leaving abusive relationships: Constructions of self and situation by abused women. Journal of Interpersonal Violence, 25, 2297-2315.

Bermea

A. M.

Khaw

Hardesty

J. L.

Rosenbloom

Salerno

(2020). Mental and active preparation: Examining variations in women’s processes of preparing to leave abusive relationships. Journal of Interpersonal Violence, 35(3-4), 988-1011.

Chang

J. C.

Dado

Hawker

Cluss

P. A.

Buranosky

Slagel

Scholle

S. H.

(2010). Understanding turning points in intimate partner violence: Factors and circumstances leading women victims toward change. Journal of Women’s Health, 19, 251-259.

Coffin-Romig

(2015). Ending intimate partner violence among Latinas: Aguantando no mas. Hispanic Health Care International, 13(4), 186-196.

Corbin

Strauss

(2008). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: Sage.

Department of Public Health and Clinical Medicine. (2009). OpenCode 3.6 B1. Retrieved from https://www.umu.se/en/department-of-epidemiology-and-global-health/research/open-code2/

10.

Domenech del Rio

Sirvent Garcia del Valle

. (2019). Influence of intimate partner violence severity on the help-seeking strategies of female victims and the influence of social reactions to violence disclosure on the process of leaving a violent relationship. Journal of Interpersonal Violence, 34(21-22), 4550-4571.

11.

Enander

Holmberg

(2008). Why does she leave? The leaving process (es) of battered women. Health Care for Women International, 29, 200-226.

12.

Estrellado

A. F.

Loh

(2014). Factors associated with battered Filipino women’s decision to stay in or leave an abusive relationship. Journal of Interpersonal Violence, 29, 575-592.

13.

Fanslow

J. L.

Robinson

E. M.

(2010). Help-seeking behaviors and reasons for help seeking reported by a representative sample of women victims of intimate partner violence in New Zealand. Journal of Interpersonal Violence, 25, 929-951.

14.

Farahmand

Khorampoor

Parsaian

Mandegari

(2014). The effect of modernization components in the kinship support of Yazd families. Cultural Research, 7, 149-177. (In Persian)

15.

Few

A. L.

Rosen

K. H.

(2005). Victims of chronic dating violence: How women’s vulnerabilities link to their decisions to stay. Family Relations, 54, 265-279.

16.

Garrusi

Nakhaee

Zangiabadi

(2008). Domestic violence: Frequency and women’s perception in Iran (IR). Journal of Applied Sciences, 8, 340-345.

17.

Graneheim

U. H.

Lundman

(2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112.

18.

Haarr

R. N.

(2010). Suicidality among battered women in Tajikistan. Violence Against Women, 16, 764-788.

19.

Hayati

E. N.

Eriksson

Hakimi

Högberg

Emmelin

(2013). ‘Elastic band strategy’: Women’s lived experiences of coping with domestic violence in rural Indonesia. Global Health Action, 6, 1-12.

20.

Heim

E. M.

Tapia

L. T.

Gonzáles

R. Q.

(2015). “My partner will change”: Cognitive distortion in battered women in Bolivia. Journal of Interpersonal Violence, 33, 1348-1365.

21.

Heise

Garcia-Moreno

(2002). Violence by intimate partners. In Krug

E. G.

Dahlberg

L. L.

Mercy

J. A.

Zwi

A. B.

Lozano

(Eds.), World report on violence and health (pp. 87-121). Geneva, Switzerland: World Health Organization.

22.

Jewkes

Sen

Garcia-Moreno

(2002). Sexual violence. In Krug

E. G.

Dahlberg

L. L.

Mercy

J. A.

Zwi

A. B.

Lozano

(Eds.), World report on violence and health (pp. 149-181). Geneva, Switzerland: World Health Organization.

23.

Khoury

Wehbi

(2016). Leaving a violent domestic relationship: Experiences of women in Lebanon. International Social Work, 59, 73-85.

24.

Kulwicki

Aswad

Carmona

Ballout

(2010). Barriers in the utilization of domestic violence services among Arab immigrant women: Perceptions of professionals, service providers & community leaders. Journal of Family Violence, 25, 727-735.

25.

Long-Sutehall

Sque

Addington-Hall

(2010). Secondary analysis of qualitative data: A valuable method for exploring sensitive issues with an elusive population? Journal of Research in Nursing, 16, 335-344.

26.

Malakotinia

(2016). Management of the father in the family from the perspective of Islam. Retrieved from https://www.pasokhgooyan.ir/node/49635 (In Persian)

27.

Murray

C. E.

Crowe

Flasch

(2015). Turning points: Critical incidents prompting survivors to begin the process of terminating abusive relationships. The Family Journal, 23, 228-238.

28.

Murray

S. A.

Kendall

Boyd

Grant

Highet

Sheikh

(2010). Archetypal trajectories of social, psychological, and spiritual wellbeing and distress in family care givers of patients with lung cancer: Secondary analysis of serial qualitative interviews. British Medical Journal, 340, c2581.

29.

Nash

S. T.

(2005). Through black eyes African American women’s constructions of their experiences with intimate male partner violence. Violence Against Women, 11, 1420-1440.

30.

Nasr

(2016). Establishing the shelters in 18 provinces of Iran. Retrieved from https://www.mehrnews.com/news/3714874 (In Persian)

31.

Polit

D. F.

Beck

C. T.

(2012). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Lippincott Williams & Wilkins.

32.

Ruiz-Pérez

Rodriguez-Madrid

Plazaola-Castaño

Montero-Piñar

Escribà-Agüir

Márquez-Herrera

Nevot-Cordero

(2013). Inhibiting and facilitating factors to end a violent relationship: Patterns of behavior among women in Spain. Violence and Victims, 28, 884-898.

33.

Sabina

Tindale

R. S.

(2008). Abuse characteristics and coping resources as predictors of problem-focused coping strategies among battered women. Violence Against Women, 14, 437-456.

34.

Sabri

Holliday

C. N.

Alexander

K. A.

Huerta

Cimino

Callwood

G. B.

Campbell

J. C.

(2016). Cumulative violence exposures: Black women’s responses and sources of strength. Social Work in Public Health, 31, 127-139.

35.

Sadeghifasai

(2010). A qualitative study of domestic violence and women’s coping strategies in Iran. Iranian Journal of Social Problems, 1(1), 107-138. (In Persian)

36.

Salarifar

M. R.

(2009). Khanevadeh az didgahe Islam va ravanshenasi [Family from the viewpoint of Islam and psychology]. Tehran, Iran: SAMT. (In Persian)

37.

Scheffer Lindgren

Renck

. (2008). Intimate partner violence and the leaving process: Interviews with abused women. International Journal of Qualitative Studies on Health and Well-being, 3, 113-124.

38.

Silva

R. A.

Araújo

T. V. B.

Valongueiro

Ludermir

A. B.

(2012). Facing violence by intimate partner: The experience of women in an urban area of Northeastern Brazil. Revista de Saúde Pública, 46, 1014-1022.

39.

Smith

P. H.

Murray

C. E.

Coker

A. L.

(2010). The coping window: A contextual understanding of the methods women use to cope with battering. Violence and Victims, 25(1), 18-28.

40.

Sutherland

M. A.

Fantasia

H. C.

Hutchinson

M. K.

(2016). Screening for intimate partner and sexual violence in college women: Missed opportunities. Women’s Health Issues, 26, 217-224.

41.

Taherkhani

(2016). Ethical considerations in domestic violence related researches. Journal Medical Ethics, 10(35), 141-175. (In Persian)

42.

Taherkhani

Negarandeh

Simbar

Ahmadi

(2014). Iranian women’s experiences with intimate partner violence: A qualitative study. Health Promotion Perspectives, 4, 230-239.

43.

Taherkhani

Negarandeh

Simbar

Ahmadi

(2015). Effect of contextual factors on women coping strategies against domestic violence: A qualitative study. Koomesh, 16, 581-594. (In Persian)

44.

Taherkhani

Negarandeh

Simbar

Ahmadi

(2016). Iranian women’s strategies for coping with domestic violence. Nursing Midwifery Studies, 5(4), e33124.

45.

Taherkhani

Negarandeh

Simbar

Ahmadi

(2017). Barriers to seeking help among abused Iranian women. Journal of Adult Protection, 19, 261-273.

46.

Thomas

K. A.

Goodman

Putnins

(2015). “I have lost everything”: Trade-offs of seeking safety from intimate partner violence. American Journal of Orthopsychiatry, 85(2), 170-180.

47.

Vives-Cases

Espinar-Ruiz

Castellanos-Torres

Coe

A.-B.

(2017). Multiple struggles in fighting violence against women: Implications among Romani women leaders in Spain. Global Health Action, 10(Suppl. 2), 1317084.

48.

Vives-Cases

La Parra-Casado

Gil-González

Caballero

(2018). Acceptability of violence against women among the Roma population in Spain. Journal of Interpersonal Violence. Advance online publication. doi:10.1177/0886260518807910

49.

World Health Organization, Family and Community Health, Department of Gender and Women’s Health. (2001). Putting women first: Ethical and safety recommendations for research on domestic violence against women. Geneva, Switzerland: World Health Organization.

50.

World Health Organization/London School of Hygiene and Tropical Medicine. (2010). Preventing intimate partner and sexual violence against women: Taking action and generating evidence. Geneva, Switzerland: World Health Organization.

51.

Wuest

Merritt-Gray

(2008). A theoretical understanding of abusive intimate partner relationships that become non-violent: Shifting the pattern of abusive control. Journal of Family Violence, 23, 281-293.

52.

Zakar

M. Z.

Krämer

(2012). Voices of strength and struggle: Women’s coping strategies against spousal violence in Pakistan. Journal of Interpersonal Violence, 27, 3268-3298.