Intimate Partner Violence and the Relation Between Help-Seeking Behavior and the Severity and Frequency of Physical Violence Among Women in Turkey

Abstract

This study explores the severity and frequency of physical violence from an intimate partner experienced by 15- to 59-year-old women and their help-seeking behavior by using data from the “National Research on Domestic Violence Against Women in Turkey.” Chi-square tests and logistic regression analyses were conducted to compare the relationship between severity and frequency of violence and women’s characteristics. Of all ever-partnered women, 36% have been exposed to partner violence; almost half of these experienced severe types of violence. Women used informal strategies to manage the violence instead of seeking help from formal institutions. Help-seeking behavior increases with increased severity and frequency of violence.

Keywords

help-seeking intimate partner violence severity and frequency of physical violence

Introduction

Intimate partner violence (IPV) is one of the most important violations of women’s human rights worldwide and does not appear to have regional distinctions. Research shows that IPV is pervasive in developed and developing countries (Ellsberg, Pena, Herrera, Liljestrand, & Winkvist, 2000; Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2005; Heise, Ellsberg, & Gottemoeller, 1999; Heise & Garcia-Moreno, 2002; Kishor & Johnson, 2006). Prevalence of IPV in the Middle East and North Africa (MENA) region does not differ from that observed in other regions of the world (Boy & Kulczycki, 2008).

The World Health Organization (WHO) study, which produced internationally comparable statistics through standardized survey methods, showed that reported lifetime prevalence of intimate physical partner violence against women varied between 13% and 61% (Garcia-Moreno et al., 2005). However, despite the global pervasiveness of IPV, help-seeking behavior of abused women is an area that still needs further, detailed exploration, especially in developing countries.

The WHO study showed that between 55% and 95% of women who had been physically abused by their partners had never sought help from formal services or from individuals in a position of authority (Garcia-Moreno et al., 2005). With regard to the MENA region, there are few studies on IPV; Boy and Kulczycki’s (2008) review reveals the lack of knowledge about IPV in this region. Their review indicated that among 25 countries in the region, only 8 had carried out research on the prevalence of IPV. Furthermore, the prevalence of “ever experienced physical violence” in the region ranged from 8.1% to 64.6%, but the methodologies and definitions used in the studies were different and thus not comparable. There were, however, characteristics that were common to abused women from all age groups in the region, namely, living in a rural area, lack of financial support, and low levels of education (Boy & Kulczycki, 2008; El-Zanaty, Hussein, Shawkey, Way, & Kishor, 1996; Mayda & Akkus, 2005; Maziak & Asfar, 2003; Sahin & Sahin, 2003). Despite the high prevalence of IPV in the MENA region, the percentage of women seeking help from formal institutions is not high (Boy & Kulczycki, 2008; Cwikel, Lev-Wiesel, & Al-Krenawi, 2003). In the region, women in general had a tendency not to seek help (Boy & Kulczycki, 2008); less than 50% of women in Egypt sought help and only 8% of women in Israel sought help from institutions or organizations (Cwikel et al., 2003; El-Zanaty et al., 1996).

Generally, abused women may continue to stay with their abusive partners for a variety of reasons, including fear of more violence, lack of economic independence and social support from family and friends, concerns about their children, emotional dependence on their partners, and fear of stigmatization. This is particularly true in developing countries (George, 1998; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). In some studies, fear of isolation or being shunned is given as the reason for underreporting and hiding IPV in the MENA region (Haj-Yahia, 2000; Sahin & Sahin, 2003). However, in many countries around the world, when women seek help they prefer informal social networks to formal institutions or organizations (Garcia-Moreno et al., 2005; Hyman, Forte, Du Mont, Romans, & Cohen, 2009; Kaukinen, 2002).

The Setting

Within the MENA region, Turkey was the first country where women acquired political rights, as well as legal and social equality. Women in Turkey have had the right to vote and to stand for election for 77 years. However, these formal legal rights have not been reflected in practice; currently, for example, only 14.4% of parliamentary seats are held by women. Unequal gender ratios at various educational levels and low levels of female participation in the labor force are indicative of other areas where women occupy a subordinate position. It should be noted that legal achievements are not always sufficient to ensure the practice of rights. Turkey is one of the leading countries in the MENA region in combating IPV (United Nations Women [UN-Women], 2011). The struggle against domestic violence in Turkey first appeared on the agenda of the women’s movement in the late 1980s and was followed by the enactment of laws at the government level in the late 1990s. The national mechanism on women’s issues was established in the 1990s and, as a result, the first government-run shelter was established. In the process of establishing legal protection for women against domestic violence, the “Protection of Family Law” was enacted in 1998 and amended in 2007. In 2006, a circular to eliminate domestic violence was issued by the Prime Ministry. Moreover, legal regulations were amended to ensure the principle of gender equality in the civil and penal codes as well as the Constitution.

In spite of the social and political rights of women in Turkey and the progress in terms of legislation, IPV remains widespread (Altinay & Arat, 2009; Directorate General on the Status of Women [DGSW], 2009). There have been a limited number of studies on IPV in Turkey and of these, only a few have focused on the help-seeking patterns of women. The first study that gave the prevalence of IPV was conducted by a government institution in the early 1990s. In that study, physical violence from an intimate partner was defined as the act of hitting, and prevalence levels were reported as 30% by married women and 34% by married men. Help-seeking information in this study was collected through in-depth interviews and the results revealed that women generally did not seek help, but instead tolerated violence reluctantly and showed passive resistance such as keeping silent, staying calm, as well as being respectful and obeying the abusive husband (Aile Arastirma Kurumu, 1995).

Another study conducted in 2008 gave the prevalence of ever experienced IPV as 35% (Altinay & Arat, 2009). In this study, violence was measured by physical acts such as “slapping, shoving, and beating,” and help-seeking information was obtained through attitude-type questions. Women were asked how they would have reacted and what they would have done if they had been beaten by their husbands. Individual strategies of ever-married women included staying inactive, reacting physically or verbally, getting divorced, leaving home, and crying. Only 5% of ever-married women said that they would go to the police (Altinay & Arat, 2009). However, the results were analyzed only as overall frequencies without a breakdown of results by the background characteristics of the women. This study lacks detailed information about how women’s development of help-seeking strategies differs on the basis of their social, economic, or demographic characteristics. In addition to the countrywide studies, findings from province-based studies show variations. Prevalence of ever experienced IPV ranges from 27.5% to 41.4% in different provinces (Kocacik & Dogan, 2006; Kocacik, Kutlar, & Erselcan, 2007; Mayda & Akkus, 2005). The above-mentioned studies, in which definitions of IPV vary considerably, focused mainly on the prevalence and type of violence experienced rather than the help-seeking behavior of women. Another province-based study found the prevalence of physical violence to be 34% and less than half of these women went to the police (Tokuc, Ekuklu, & Avcioglu, 2010).

Help-seeking behavior of women in Turkey has received scant attention and this article seeks to address this gap in knowledge by exploring patterns of help-seeking behaviors among physically abused women, particularly by severity and frequency of lifetime physical partner violence. We have focused on characteristics such as women’s age, educational level, working status, and region, which are assumed to impact women’s help-seeking behaviors. Questions on women’s experience-based strategies rather than their attitudes have been used to gather data on help-seeking. Furthermore, the operational definition used for physical violence is from the WHO, which is a comprehensive definition in which six acts were used to measure physical violence. The data for this article come from the most recent nationwide survey in Turkey (DGSW, 2009). This survey, besides providing lifetime and current prevalence of violence types from intimate partners and nonpartners, also explores the help-seeking behavior of women who are exposed to physical violence by their husband(s) or partner(s). In this article, we use the term IPV to mean physical violence from an intimate partner.

Method

Quantitative data from the “National Research on Domestic Violence Against Women in Turkey (NR-DVAW-TR)” were used for the analyses in this article. This is a nationally representative cross-sectional survey and it provides the most recent, as well as the most comprehensive, data on domestic violence against women in Turkey. The data were collected in face-to-face interviews, with women aged 15 to 59 years, using a structured questionnaire, between July and September 2008. The quantitative survey was designed to obtain prevalence data for different types of IPV, by region, as well as by urban and rural settlement, with a defined 95% confidence interval (CI). The Ethical and Safety Guidelines formulated by the WHO were followed throughout the research (Jansen, Watts, Ellsberg, Heise, & Garcia-Moreno, 2004; WHO, 2001).

Sample Design

The sample design of the survey was a weighted, stratified, and multistaged cluster sample. There are 81 provinces and 12 regions in Turkey. The sample selections were performed using the PPS (probability proportional to size) method within the strata. Settlements with a population of more than 10,000 are considered urban, whereas those with fewer than 10,000 are rural. There was a total of 542 clusters, of which 378 were urban and 164 rural. The clusters comprised 48 households in urban settlements and 36 in rural settlements. The target sample size of the quantitative survey was 24,048 households and the household response rate was 88%. One woman per household was selected for interview using the Kish method (Kish, 1949 cited in DGSW, 2009). In total, 12,795 face-to-face interviews were conducted with women aged 15 to 59 years. The response rate for the women’s questionnaire was 86.1% and only 2.1% of women refused to participate. Separate weights were calculated for households and women to correct the complexity of the sampling design (DGSW, 2009).

Questionnaire

Two questionnaires were used for data collection: one for households and one for individual women. These were designed based on the questionnaires of the WHO multicountry study on domestic violence (Garcia-Moreno et al., 2005) with some modifications related to the specific needs of the country. Information about the household population such as age, education, and marital status of the household members and housing characteristics was collected using the household questionnaire. Information on the woman and her partner’s background characteristics, general and reproductive health of the woman, experience(s) of partner and nonpartner violence, and the impact of violence on the woman’s life was collected from the women’s questionnaire. The questionnaire also included a consent form.

Outcome Variable: Severity and Frequency of Physical Violence

NR-DVAW-TR used the same questions as the WHO study for measuring physical violence, that is, ever having experienced physical violence was measured by asking women whether any of their husbands or intimate partners had ever “slapped or thrown something at her that could hurt her”; “pushed or shoved her or pulled her hair”; “hit her with his fist or something else that could hurt her”; “kicked her, dragged her, or beaten her up”; “choked or burnt her on purpose”; and “threatened to use or actually used a gun, knife, or other weapon against her.” Women were also asked whether these acts had happened in the 12 months preceding the survey. Frequency (once or twice, a few times, or many times) of acts of physical violence was obtained for lifetime and for the 12 months preceding the interview.

WHO classifies physical violence as “moderate” or “severe” based on the likelihood of causing injury. According to this classification, “slapping or throwing something that could hurt” and “pushing or shoving” were considered as “moderate”; the other acts were considered as “severe” physical violence (Garcia-Moreno et al., 2005).

The outcome variable of this study, ever experienced physical violence, is divided into three categories¹ according to the severity and frequency of physical acts of violence. The first category, specified as “moderate only once,” comprised any of the moderately violent acts experienced only once. The second category, “moderate more than once,” comprised moderately violent acts experienced more than once. The third category, “severe,” comprised any of the severe acts, regardless of frequency. If a woman experienced “moderate more than once” and “severe” types of violence, she was included in the “severe” category of violence. Therefore, these three categories were mutually exclusive (Table 1).

Table 1.

Categories of Physical Partner Violence by Severity and Frequency as Used in This Article.

Categories of physical violence	Acts of physical violence included	Frequency of physical violence
Moderate only once	Either one or both of the following two acts only:	One or both of these acts only once in her life
	Slapping her/throwing something at her that could hurt her
	Pushing/shoving her or pulled her hair
Moderate more than once	Either one or both of the following two acts only:	One of both of these acts more than once in her life
	Slapping her/throwing something at her that could hurt her
	Pushing/shoving her or pulled her hair
Severe	At least one of the following acts:	Any of these acts at least once in her life
	Hitting her with his fist or something else that could hurt her
	Kicking or dragging her or beating her up
	Choking or burning her on purpose
	Threatening to use or actually use a gun, knife, or other weapon against her

Explanatory Variables

Seven background variables were used to determine the relationship between severity and frequency of IPV and women’s help-seeking behavior in Turkey. These variables were place of residence (urban, rural), region (West, South, Central, North, East), household wealth level (low, middle, high), age group (15-24, 25-34, 35-44, 45-59), educational level (none/primary incomplete, first-level primary, second-level primary, high school and above), individual income (yes, no), and marital status (never married, ever married).

Place of residence and region reflect the heterogeneous structure of the country. Three quarters of the population of Turkey live in urban areas. Regional breakdown indicates the diverse geographical, cultural, social, and economic characteristics within the country. The West region is the most densely settled, industrialized, and socioeconomically advanced, while the East region is the least developed part of the country.

Primary education (5 years of first level and 3 years of secondary level) is compulsory in Turkey (Hacettepe University Institute of Population Studies [HUIPS], 2009).

The wealth level variable indicated the wealth of the household where the woman lives and was classified according to the wealth scores that were constructed based on household assets. The index value was subsequently ranked and divided into three groups to measure wealth status. Of the wealth scores, the lowest 40% constituted the “low” group, the next 40% constituted the “middle” group, and the highest 20% formed the “high” group (DGSW, 2009).

In NR-DVAW-TR, women were asked whether they sought help from institutions or organizations. In this analysis, a public prosecutor or lawyer was considered a “legal institution,” while nongovernmental organizations (NGOs), local governments, and government offices (such as social centers) were considered as “social services.”

Data Analyses

The Pearson chi-square test of statistical significance was conducted to compare the relationship between severity and frequency of IPV and women’s background variables. When asked about the causes of violence, women reported multiple reasons. Information on disclosing the violence to their family, friends, or neighbors and getting help from these people was also collected. Coping strategies such as applying to formal institutions or seeking informal strategies were analyzed by the severity and frequency of violence. The informal strategies were defined as disclosing violence, leaving home, and fighting back.

To indicate the determinants of applying to any formal institution, a logistic regression analysis was performed. Bivariate regression models were constructed to explore the crude relationship between help-seeking from any institution or organization and women’s selected characteristics such as age, individual income, education level, household wealth level, region and urban–rural residence, as well as severity of physical violence. Multivariate logistic regression was used to determine the factors that would remain significant in seeking help from formal institutions.

Results

Of 12,795 women interviewed, 4,552 (36%) reported ever having experienced any type of physical violence in their lifetime. The physical violence prevalence showed variation by women’s characteristics such as age, education level, marital status, household wealth level, region, and urban–rural settlement. All explanatory variables were found to be statistically significant, except individual income (Table 2).

Table 2.

Prevalence of Physical Partner Violence Among Ever-Partnered Women by Level of Severity and Frequency of Physical Violence and by Background Characteristics, Turkey 2008.

				Severity and frequency of violence
	Any type of physical violence			Moderate only once (n = 1,011)	Moderate more than once (n = 1,392)	Severe (n = 2,139)
Background characteristics	%	n	χ²	%	%	%	χ²
Type of place of residence			21.33**				12.3**
Urban	34.8	3,279		8.5	10.8	15.4
Rural	39.6	1,273		7.8	12.4	19.4
Region			149.31**				57.6**
West	30.4	894		8.2	9.7	12.5
South	37.6	405		7.0	9.9	20.8
Central	41.1	1,186		8.4	13.6	19.1
North	35.7	494		10.1	12.5	13.0
East	44.3	1,573		9.2	12.9	22.2
Household wealth level			272.43**				52.9**
Low	43.8	2,070		8.7	12.4	22.6
Middle	36.1	1,911		8.7	12.2	15.1
High	23.9	571		7.0	7.6	9.3
Age groups			332.14**				85.8**
15-24	22.0	454		7.4	6.3	8.3
25-34	35.5	1,443		9.4	11.3	14.7
35-44	39.4	1,265		9.1	11.8	18.4
45-59	45.1	1,390		7.3	14.6	23.2
Education			548.61**				88.2**
None/primary incomplete	51.2	1,458		8.2	16.4	26.6
First-level primary	39.2	2,229		9.1	12.2	17.8
Second-level primary	26.1	331		7.1	8.8	10.1
High school and above	21.6	534		7.5	6.1	8.0
Individual income			0.48				12.2**
Yes	21.8	881		9.8	10.0	16.7
No	78.2	3,666		7.9	11.5	16.3
Marital status			442.10**				43.8**
Never married	9.0	72		4.4	2.1	2.5
Ever married	39.3	4,480		8.8	12.3	18.1
Turkey	36.0	4,552		8.3	11.2	16.4

Note. Percentages are based on weighted and numbers are based on unweighted cases.

The associations are statistically significant with p < .01.

Women who live in the rural settlements and in the East and Central regions reported more IPV than their counterparts in urban settlements and other regions. Experience of physical violence for women with a low education level was higher compared with women in other educational categories. As expected, a cumulative effect of time was observed when the age of women was considered: Older women were more likely to report lifetime experience of physical partner violence than their younger counterparts. Moreover, women who lived in households with lower wealth categories were more likely to experience physical violence.

Prevalence for severe physical violence in all explanatory variables was found to be statistically significant. Of 4,552 women who were exposed to any type of physical violence, 46% experienced severe violence, 31% experienced moderate violence more than once, and 23% experienced moderate violence only once.

With regard to the severity and frequency of physical violence, some variation among the categories of physical violence was observed. Severity and frequency of physical violence categories were statistically significant for all explanatory variables. However, the statistical significance of individual income was different for “any type of physical violence.” In all categories of severity and frequency of physical violence, more violence was reported by women who were ever married, in the 45 to 59 age groups, with a low education level, who lived in rural settlements, in the East region, and in households with low wealth levels.

Reasons for Violence: The Women’s Perspectives

Our findings showed that women’s help-seeking behavior is very much linked to their perceptions of the reasons for the physical violence they experienced. The eight most frequently mentioned reasons were “partner’s family-based problems,” “partner’s bad habits,” “partner’s behaviors,” “women’s behaviors,” “women’s family-based problems,” “children-based problems,” “economic problems,” and “no specific reason” (Figure 1). “Economic problems,” “partner’s behaviors and bad habits,” “women’s behaviors,” and “children-based problems” were statistically significant in relation to the severity categories; the more severe the physical violence, the more these reasons were mentioned.

Figure 1.

Causes of violence from women’s point of view by severity of physical violence.

In the “moderate only once” category, 21% of women reported “women’s behaviors” as the main reason for physical violence. “Women’s behaviors” included refusing sex, not obeying the partner, delaying household chores, and being jealous of the partner, as well as blaming themselves without giving any reason. “Partner’s behaviors,” which covered jealousy, being nervous or irresponsible, spending too much time out of the home, and wishing to divorce/separate and/or to have another wife, was reported by 15% of women. “Children-based problems” was reported by 15% of women and was also found to be significant.

In the “moderate only once” category, partner’s family-based problems was the most frequently reported reason. However, despite being reported by 29% of women, it was not statistically significant.

In the “moderate more than once category,” 22% of women cited economic problems, which also included being unemployed, partner’s problems at work, and/or insufficient food at home, appeared as one of the significant reasons for IPV.

In the “severe” category, 29% of women cited economic problems and 29% cited partner’s behaviors as reasons for physical violence.

First Step for Help-Seeking: Disclosing the Violence

Our study revealed that almost half the women in the study population who had experienced physical violence disclosed their experience(s) for the first time to the interviewers. Among women who experienced any type of physical violence, 35.2% reported that they had disclosed IPV to their birth family members, in particular to sisters or mothers, followed by friends or neighbors (23.1%). It is noteworthy that 11.9% of women disclosed the violence to their mother-in-law or to female members of the partner’s family. Severity of violence was one of the determining factors for disclosing IPV. Findings indicated that as severity and frequency of physical violence increased, disclosure also increased. For example, 61.7% of women who were exposed to severe types of physical violence disclosed it compared with 44.1% in the “moderate only once” category (Figure 2).

Figure 2.

Disclosing violence by severity and frequency of physical violence.

Disclosing violence was significant for region of residence, household wealth level, age and education level of the women, and marital status. Among women who were exposed to “moderate only once,” those who live in the West region (44.4%) and wealthier households (53.8%), who were in the 15 to 24 age group (57.9%), who have secondary-level education (58.3%), and who were single (63.6%) were more likely to disclose violence than their counterparts. In fact, with regard to background variables, the pattern for disclosing IPV did not differ in the other two categories of severity and frequency. Among women who were exposed to severe types of physical violence, findings reveal that those who live in the North region (67.0%), in wealthier households (71.3%), who were in the 15 to 24 age group (63.9%), who have secondary-level education (80.2%), and who were single (65.6%) were more likely to disclose IPV (Table 3).

Table 3.

Proportion of Women Getting Support Among Women Who Experienced Physical Partner Violence by Level of Severity and Frequency of Violence, Turkey 2008.

				Severity and frequency of violence
	Any type of physical violence (n = 4,552)			Moderate only once (n = 1,011)		Moderate more than once (n = 1,392)		Severe (n = 2,139)
Persons who tried to help women	%	n	χ²	%	n	%	n	%	n	χ²
No one	55.0	2,520	0.005	60.5	641	58.1	803	50.1	1,076	3.7**
Birth family	17.3	783	1,275.4**	9.4	95	14.3	183	23.4	505	99.3**
Friends or neighbors	8.5	343	571.4**	5.5	37	6.8	78	11.3	228	9.4**
Mother-in-law and women in partner’s family	7.7	397	607.9**	5.9	69	7.2	110	9.0	218	35.5**
Others	4.4	211	294.7**	2.0	22	3.0	41	6.7	148	42.8**

Note. Percentages are based on weighted and numbers are based on unweighted cases.

The associations are statistically significant with p < .01.

However, 55.0% of women who experienced IPV reported that no one had ever helped them, even though members of their social network knew about or witnessed the violence they had experienced. Women’s birth families (17.3%) followed by friends or neighbors (8.5%) were the first two groups who tried to help. Receiving help increased with the severity and frequency of the violence. For example, 60.5% of women in the “moderate only once” group did not receive help, but this decreased to 50.1% in the “severe” group. The percentage of women receiving help from birth family members rose from 9.4% in the “moderate only once” category to 23.4% when they were exposed to severe types of physical violence (Table 4).

Table 4.

Proportion of Women Who Had Disclosed Violence to Someone Among Women Who Experienced Physical Partner Violence by Severity and Frequency of Violence and by Background Characteristics of Women, Turkey 2008.

	Severity and frequency of physical violence
	Moderate only once (n = 1,011)		Moderate more than once (n = 1,392)		Severe (n = 2,139)
Background characteristics of women	%	n	%	n	%	n	χ²
Place of residence							4.7
Urban	45.7	346	52.2	487	65.1	966
Rural	38.8	91	37.8	144	53.5	332
Regions							35.5**
West	44.4	102	54.9	142	63.2	239
South	36.9	27	52.1	55	64.8	143
Central	52.1	115	48.0	178	63.4	360
North	41.3	68	35.4	77	67.0	114
East	38.3	125	36.8	179	52.8	442
Household wealth level							64.94**
Low	36.2	135	39.8	216	57.2	618
Middle	46.5	206	50.2	314	64.0	528
High	53.8	96	63.6	101	71.3	152
Age groups							76.8**
15-24	57.9	76	52.9	65	63.9	117
25-34	45.1	176	56.4	245	62.4	377
35-44	43.5	115	45.5	168	63.8	385
45-59	31.8	70	41.3	153	58.8	419
Education							70.9**
No education/primary incomplete	26.7	63	34.2	136	50.5	380
First-level primary	42.6	220	48.8	325	60.4	665
Second-level primary	58.3	52	60.5	71	66.9	94
High school and above	57.3	102	70.0	99	80.2	159
Individual income							4.6
Yes	46.7	111	62.2	127	68.8	275
No	43.3	326	44.9	504	59.6	1,022
Marital status							30.4**
Never married	63.6	23	88.5	14	65.6	12
Ever married	42.9	414	47.4	617	61.6	1,286
Turkey	44.1	437	48.2	631	61.7	1,298

Note. Percentages are based on weighted and numbers are based on unweighted cases.

The associations are statistically significant with p < .01.

Informal Strategies to Manage IPV

The findings indicate that few women sought help from formal institutions; rather, they used informal strategies to manage IPV. Respondents were asked about two informal strategies: fighting back and leaving home.

Fighting back

Of the women who experienced IPV, 30.9% fought back as an informal strategy. When the effect of fighting back was considered in terms of the level of IPV, physical violence remained at the same level or worse for 16.5% of women and it either stopped or decreased for 13.8% of women. The effects of fighting back varied according to the severity of physical violence. When women fought back in cases of moderate types of violence, it resulted in decreasing or stopping violence. The effect was different in cases of severe types of violence. Of the women who had been exposed to any type of severe violence, 24.3% reported that if they fought back, the violence stayed at the same level or worsened. However, 12.6% of this group said that the violence either decreased or stopped (Table 5).

Table 5.

Proportion of Women Fighting Back, Leaving Home, and Applying to Formal Institutions Among Women Who Experienced Physical Partner Violence by Severity and Frequency of Violence, Turkey 2008.

				Severity and frequency of violence
	Any type of physical violence (n = 4,552)			Moderate only once (n = 1,011)		Moderate more than once (n = 1,392)		Severe (n = 2,139)
Informal and formal strategies	%	n	χ²	%	n	%	n	%	n	χ²
Fighting back			^a							168.0**
Fighting back	30.9	1,258		21.4	188	28.6	348	37.2	722
Fighting back resulting in same or worse	16.5	684		7.2	58	12.1	161	24.3	465
Fighting back, resulting in decreased or stopped	13.8	551		13.4	124	15.8	178	12.6	249
No answer	0.6	23		0.8	6	0.8	9	0.4	8
Leaving home			42.7**							401.8**
Leaving home at least once	27.1	1,171		12.6	106	16.5	220	41.6	845
Left home once	13.1	586		8.6	74	9.9	137	17.6	375
Left home more than 2 times	14.0	585		4.0	32	6.0	83	24.0	470
Application to formal institutions
At least one application to any institution	8.4	361	587.7**	2.2	22	2.0	27	15.9	312	256.9**
Police or gendarmes	4.7	199	352.2**	0.4	6	0.8	10	9.6	183	186.3**
Legal institutions	4.2	170	289.9**	1.1	11	0.8	11	8.0	148	130.0**
Health facility	3.8	172	1.2	0.9	9	0.4	5	7.6	158	137.8**
Social service, NGOs, and municipalities	0.8	25	55.21**	0.0	0	0.2	1	1.6	24	30.3**

Note. Percentages are based on weighted and numbers are based on unweighted cases. NGOs = nongovernmental organizations.

As only respondents who exposed to physical violence are considered, chi-square values cannot be calculated.

The associations are statistically significant with p < .01.

In terms of the severity and frequency of physical violence, household wealth level, age, education level, and women’s marital status were statistically significant variables in the case of fighting back. Being young and single, living in a wealthier household, and having secondary-level education were the characteristics associated with women fighting back as a response to IPV. For example, fighting back increased to 60.4% for women with a higher education level in the severe violence category (Table 6).

Table 6.

Proportion of Women Who Fought Back Among Women Who Experienced Physical Partner Violence by Severity and Frequency of Violence and by Background Characteristics of Women, Turkey 2008.

	Severity and frequency of physical violence
	Moderate only once		Moderate more than once		Severe
	%	n	%	n	%	n	χ²
Place of residence							3.7
Urban	21.7	147	32.6	285	40.8	563
Rural	17.9	38	16.9	59	28.5	161
Regions							10.5
West	23.3	54	33.5	80	41.1	155
South	24.3	19	34.7	38	44.6	97
Central	18.6	41	25.6	93	35.0	190
North	20.3	25	24.2	50	45.6	81
East	14.2	46	17.6	83	24.6	201
Household wealth level							21.1**
Low	15.9	52	21.0	104	29.8	301
Middle	23.0	92	30.1	173	40.9	315
High	24.7	41	40.4	67	53.3	108
Age groups							58.6**
15-24	30.1	40	37.7	50	40.5	81
25-34	24.7	85	37.2	139	41.5	222
35-44	18.1	41	25.4	84	34.3	186
45-59	10.6	19	18.9	71	35.0	235
Education							39.4**
No education/primary incomplete	11.8	23	16.3	61	26.3	178
First-level primary	17.4	78	28.5	171	37.3	370
Second-level primary	33.3	27	39.5	42	48.5	64
High school and above	31.7	57	47.2	70	60.4	112
Individual income							1.3
Yes	23.8	49	37.2	78	49.2	185
No	19.8	136	26.1	266	33.9	539
Marital status							18.8**
Never married	35.2	13	42.3	9	51.6	10
Ever married	20.0	172	27.9	335	36.9	714
Turkey	20.8	185	28.2	344	37.1	724

Note. Percentages are based on weighted and numbers are based on unweighted cases.

The associations are statistically significant with p < .01.

Leaving home

Around 27.1% of women left home overnight, at least once, as another informal strategy. This finding revealed that about 3 out of 10 women who experienced IPV left their home at least once. The percentage of women leaving home temporarily also increased with the severity of physical violence (Table 5).

Women, who left home at least once due to IPV, had similar background characteristics to women who used “fighting back” as a strategy to overcome violence. Leaving home was more common among women who experienced severe types of physical violence (41.6%) compared with those in the moderate categories (16.4% and 12.6%, respectively). Leaving home temporarily due to violence was also more common among women living in wealthier households. Younger, single women with higher education levels more commonly left home as a strategy than older, married women with lower education levels (Table 7).

Table 7.

Proportion of Women Who Left Home Due to Violence Among Women Who Experienced Physical Partner Violence by Severity and Frequency of Physical Violence and by Background Characteristics of Women, Turkey 2008.

	Severity and frequency of physical violence
	Moderate only once (n = 1,011)		Moderate more than once (n = 1,392)		Severe (n = 2,139)		Number of women who left home
Background characteristics of women	%	n	%	n	%	n	n	χ²
Place of residence								8.8
Urban	13.7	85	18.4	173	43.1	611	869
Rural	9.2	21	11.5	47	38.1	234	302
Regions								19.3
West	14.1	33	17.4	44	40.1	149	226
South	18.2	13	18.6	20	44.5	97	130
Central	11.3	23	16.0	61	42.2	235	319
North	10.3	12	16.3	35	48.0	76	123
East	7.7	25	14.0	60	39.2	288	373
Household wealth level								19.2**
Low	11.7	38	13.6	74	38.0	399	511
Medium	12.2	48	14.9	103	43.8	345	496
High	15.6	20	29.3	43	48.5	101	164
Age groups								24.7**
15-24	17.0	18	21.3	27	37.0	62	107
25-34	11.7	44	18.2	80	46.0	259	383
35-44	12.5	25	17.3	60	42.9	248	333
45-59	11.0	19	12.6	53	38.8	276	348
Education								46.8**
No education/primary incomplete	7.5	11	7.9	39	32.6	242	292
First-level primary	10.9	50	17.0	116	43.5	438	604
Second-level primary	20.2	17	31.6	32	47.7	58	107
High school and above	19.4	28	23.9	33	56.0	107	168
Individual income								3.9
Yes	15.9	35	18.8	44	48.8	187	266
No	11.5	71	15.9	176	39.8	658	905
Marital status								33.1**
Never married	43.8	3	0.0	0	30.8	4	7
Ever married	12.1	103	16.5	220	41.7	841	1,164
Turkey	12.6	106	16.4	220	41.6	845	1,171

Note. Percentages are based on weighted and numbers are based on unweighted cases.

The associations are statistically significant with p < .01.

Seeking Help From Formal Institutions

The percentage of women seeking help from formal institutions was much lower than the percentage of women disclosing violence, fighting back, and leaving home. Only 8.4% of women who experienced IPV sought help from institutions or organizations. Help-seeking from formal institutions or organizations included reporting IPV to the police or gendarmes, seeking medical care from hospitals or health facilities, asking for help from public prosecutors and lawyers with legal issues such as divorce, and seeking social and psychological support from women’s NGOs, social services, and municipalities. Among these institutions, police or gendarmes (4.7%) was the most frequently mentioned institution among women who experienced IPV. Seeking help from the formal institutions was significantly higher among women who experienced severe physical violence (15.9%) compared with women who experienced moderate types of violence (2.2% and 2.0%, respectively; Table 5).

Women were asked about their reasons for seeking help from formal institutions. The most frequently reported response was that women could not endure the violence any longer (42.7%). This was followed by needing legal advice about divorce or how to be protected from violence. One out of four women who sought help applied to health facilities because they were badly injured due to violent acts. Another frequently mentioned reason was that the woman had been threatened with death, or she was afraid that her intimate partner would kill her or someone from her family (18.6%). The findings of this study reveal that women did not apply to formal institutions until they were injured or their lives were endangered. Moreover, the need for psychological support for some women (11.1%) indicated the harmful effects of partner violence on women’s mental health (Table 8).

Table 8.

Main Reasons for Seeking Help and Not Seeking Help Among Women Experiencing Physical Partner Violence by Severity and Frequency of Violence, Turkey 2008.

	Severity and frequency of violence
	Moderate only once (n = 22)		Moderate more than once (n = 27)		Severe (n = 312)			Number of women who applied to any formal institutions (n = 361)
	%	n	%	n	%	n	χ²	%	n
Most reported reasons for seeking help
Could not endure more	13.6	3	38.5	8	45.4	139	8.7*	42.7	150
Badly injured	28.6	5	4.0	1	25.8	92	6.2	24.4	102
Afraid of being killed	0	0	0	0	9.6	56	12.4	18.6	56
Get legal support	42.9	9	30.8	9	27.2	85	2.5	28.4	48
Get psychological support	9.5	3	19.3	4	10.6	30	1.8	11.1	37
Encouraged by family or friends	4.5	1	3.8	2	8.9	30	4.9	8.1	33
Children related	0	0	0	0	9.6	26	9.5	7.2	26
	Moderate only once (n = 989)		Moderate more than once (n = 1,365)		Severe (n = 1,825)			Number of women who did not seek help from any formal institutions (n = 4,191)
	%	n	%	n	%	n	χ²	%	n
Most reported reasons for not seeking help
No serious problem	84.7	868	76.3	1,057	32.1	653	983.2**	58.1	2,578
Fear from violence and threats	8.5	78	17.1	255	40.7	928	421.6**	25.9	1,261
Reasons related to partner	13.2	145	13.8	193	13.7	320	0.2	13.6	658
Reasons related to institutions	3.0	27	7.4	94	19.3	391	199.0**	11.8	512

Note. Percentages are based on weighted and numbers are based on unweighted cases. Categories have been calculated independently of each other, the summation may exceed 100.

The associations are statistically significant with *p < .05. **p < .01.

Women were also asked why they did not seek help from any available service providers. Many women who did not apply to any formal institutions considered the violence they were exposed to as “not serious” (58.1%). With regard to the severity categories of physical violence, women who did not consider the violence as a serious problem had generally experienced moderate types of violence. In the severe physical violence category, considering violence as “not a serious problem” was significantly lower (32.1%). Some women reported that they would not seek help due to fear and threats of more violence (25.9%). The “fear and threat of more violence” category included the following reasons: “being afraid to be blamed,” “embarrassed/ashamed to seek help,” “afraid of shaming her family name,” “afraid that her children would be unhappy,” “partner threatened her or her children,” or “partner’s family threatened her.” Another commonly mentioned reason was related to the institutions. Some reported that they “didn’t know where to apply” or there were “no institutions in their living area,” while others reported that they “didn’t believe that they would be helped” (11.8%). Among the most reported reasons for not seeking help, “not considering the act as a serious problem” was the highest in the moderate categories of violence (84.7% and 76.3%, respectively). However, “fear of and threats of violence” was the highest (40.7%) among women who experienced severe physical violence (Table 8).

Determinants of Seeking Help From Formal Institutions

Results of the multivariate logistic regression models indicate that seeking help from formal institutions was highly associated with women’s educational level, the region they lived in, and the severity and frequency of physical violence. The likelihood of seeking help among women who experienced severe physical violence was 10.5 times higher than among women who experienced moderate types of violence. Seeking help was 3.6 times higher for women who had secondary-level education and 2.45 times higher in the higher education group compared with the no education/primary incomplete education group. In terms of region, levels of seeking help from institutions were higher in all regions compared with the East region. Women who had an individual income were 2.21 times more likely to seek help from formal institutions than women who did not have an individual income, and women who live in urban areas were 1.44 times more likely to seek help than their counterparts in rural areas. After controlling for all characteristics of women, household wealth level was no longer associated with help-seeking from formal institutions even though it was associated at the bivariate level (Table 9).

Table 9.

Crude and Adjusted Logistic Regression Models Ever Applying to Any Institutions/Organizations to Overcome With Intimate Partner Violence.

	Crude		Adjusted
Variables	OR	95% CI	OR	95% CI
Age groups
15-24	1.00		1.00
25-34	1.09	[0.74, 1.60]	1.05	[0.69, 1.60]
35-44	1.23	[0.83, 1.81]	1.11	[0.72, 1.69]
45-59	1.25	[0.86, 1.82]	1.14	[0.74, 1.74]
Education
None/primary incomplete	1.00		1.00
First-level primary	1.84*	[1.35, 2.50]	1.85*	[1.32, 2.59]
Second-level primary	3.08*	[2.06, 4.62]	3.60*	[2.23, 5.80]
High school and above	2.55*	[1.76, 3.68]	2.45*	[1.55, 3.86]
Individual income
No	1.00		1.00
Yes	2.44*	[1.94, 3.07]	2.21*	[1.71, 2.85]
Household wealth level
Low	1.00*		1.00
Middle	1.14	[0.89, 1.46]	.99	[0.72, 1.56]
High	1.62*	[1.19, 2.19]	1.06	[1.06, 1.96]
Region
West	1.84*	[1.25, 2.70]	1.45*	[0.96, 2.20]
South	2.47*	[1.60, 3.80]	1.57*	[0.98, 2.50]
Central	1.95*	[1.30, 2.91]	1.56*	[1.01, 2.40]
North	1.97*	[1.16, 3.35]	2.43*	[1.37, 4.31]
East	1.00		1.00
Type of place of residence
Urban	1.54*	[1.18, 2.03]	1.44*	[1.06, 1.96]
Rural	1.00		1.00
Severity of physical violence
Moderate only once	1.00		1.00
Moderate more than once	0.89	[0.50, 1.59]	1.01	[0.56, 1.81]
Severe	8.36*	[5.35, 13.06]	10.48*	[6.65, 16.54]
Nagelkerke R²			.21*

Note. All figures are based on weighted data. OR = odds ratio; CI = confidence interval.

p < .05.

Discussion

This study reveals the relationship between severity and frequency of physical violence and the help-seeking behavior of women. The results show that IPV is widespread in Turkey and that severe types of physical violence are more common than the moderate types. The findings are similar to those from other studies in showing that the vast majority of physically abused women do not seek help from formal institutions or organizations (Ellsberg, Winkvist, Pena, & Stenlund, 2001; Fugate, Landis, Riordan, Naureckas, & Engel, 2005). Instead, like the women in other studies, women in Turkey use informal strategies to manage violence (Ansara & Hindin, 2010; Ellsberg et al., 2001; Garcia-Moreno et al., 2005; Heise & Garcia-Moreno, 2002).

Other researchers have suggested that disclosing the experienced violence can be considered as the first step in seeking help from formal and/or informal networks (Brown, 1997; Ellsberg et al., 2001; Postmus, Severson, Berry, & Yoo, 2009). As almost half the women in Turkey who experienced IPV said they had not talked about it to anybody before, their reporting of the IPV during the interview might be interpreted as the first disclosure (Altinay & Arat, 2009; Ellsberg et al., 2001; El-Zanaty et al., 1996; Garcia-Moreno et al., 2005).

As was seen in studies of other countries, when abused women in Turkey disclose IPV, their first choice is to talk to their birth family, followed by their friends and neighbors, although not all of them receive help from their close circle (Garcia-Moreno et al., 2005; Moe, 2007). In Turkey, the family is the source of women’s primary relationships and is thus pivotal in their lives. Despite legislative advances in combating IPV, it remains a family issue and our findings indicate that women can be trapped by the family and familial concerns. Although the family can be an important source of support for women, it can also be an unsafe place. Thus, raising family awareness of IPV and providing gender equality in public and private life would help women’s empowerment in developing support strategies to cope with IPV. This, in turn, would contribute to the overall goal of eradicating IPV.

The results of our study show that leaving home temporarily and fighting back as a response to physical violence are among the informal strategies that women most frequently use to manage violence, despite the fact that these strategies are not always effective in decreasing or stopping violence. However, even informal strategies were found to be more commonly used in cases of severe physical violence than in moderate cases.

Women who use informal strategies have distinctive features in terms of their background characteristics—they are more likely to be young, never married, more educated, and living in wealthier households. This highlights the fact that not all women have opportunities that will enable them to use informal strategies and underlines the importance of living in developed regions and having more education as factors that improve women’s power to overcome IPV.

Not seeking help from formal institutions is a major concern of our study. The results indicate that reasons for not seeking help differ according to the severity and frequency of physical violence. Women who are exposed to moderate IPV are less likely to consider it as a serious problem, while more than two thirds of women who are exposed to severe IPV perceive it as serious. However, in cases of severe violence, the fear of more violence or threats by the partner and partner’s family emerges as the common reasons for not seeking help from formal institutions.

Another important finding regarding the reasons for not seeking help is related to the institutions. In spite of the fact that women’s NGOs, local governments, and social service institutions can, in principle, play a vital role in empowering women through their programs and activities, they were the least mentioned among the formal organizations. Women cited inadequate numbers of institutions and lack of belief in such institutions’ ability to help them. Thus, these findings indicate the need for increasing the number of institutions and organizations that provide legal, psychological, and other support to women. Women’s counseling centers and shelters run by NGOs, municipalities, and government are few in number relative to the population of the country. Although the number of institutions and organizations has increased in the past two decades, there are only 103 women’s shelters for a population of 75.6 million (Republic of Turkey Ministry of Family and Social Policies, 2012).

Although about one third of women use informal coping strategies, seeking help from formal institutions was rare. Reaching a breaking point at which the IPV can no longer be tolerated appears to be the trigger for women to seek help from formal institutions. Being badly injured and afraid of being killed by their partner and/or their partner’s family were other commonly mentioned reasons for seeking help from formal institutions.

In terms of legislation relating to IPV, Turkey emerges as a leader among the MENA countries (UN-Women, 2011). In the past decade, legislative advances, such as revisions to the Constitution as well as civil and penal codes, aimed at combating IPV have been accomplished in Turkey. However, despite these advances, our study indicates that IPV remains high and few women seek help from legal institutions. This would suggest that empowerment of women through such legislative advances is not enough, in and of itself, to substantially reduce IPV.

Studies show that even though some women want to leave their abusive intimate partners, social, economic, and cultural conditions compel them to stay in that relationship (Ellsberg et al., 2000; Heise et al., 1999; Heise & Garcia-Moreno, 2002). Our findings show that besides the social and economic conditions that prevent women from seeking help, experiencing less frequent and less severe physical violence was also a deterrent to seeking help and thus not leaving the partner. Gelles (1976) observes that “the less severe and less frequent the violence, the more a wife remains with her husband.” (p. 659)

It is important to understand the perceptions of abused women about the causes of IPV to develop preventive strategies. Also knowing women’s views of the reasons for violence will help to understand how the issue is perceived at the societal level. For instance, in our study, issues relating to women’s behavior were frequently mentioned by women in the “moderate only once” category. However, as the frequency and severity of violence increased, economic problems and partner’s behaviors gained importance as reasons for IPV. This may imply that women blame themselves when the violence is less severe or less frequent, but with an increase in frequency and severity of violence, women cite other reasons, in particular those that are partner-related.

Seeking help as an active process to manage IPV includes disclosing violence and using informal and/or formal strategies. In our study, even in the most severe cases of physical violence, informal strategies are much more commonly used than approaches to formal institutions. Having an individual income and a high education level gained importance in seeking help from formal institutions to manage IPV.

One of the limitations of this study is that there is no information on the timing of the IPV and seeking formal or informal help. Collecting information only from women appears to be another limitation of the study. Despite these limitations, this study was the first in Turkey to explore the help-seeking behavior of women in response to IPV by focusing on the severity and frequency of physical violence, using a large, comprehensive, population-based, representative sample.

Footnotes

Acknowledgements

We would like to generously thank the many thousands of women, who agreed to be interviewed, as well as the research and project assistants, and the field and data entry staff, who all made this study possible.

Authors’ Note

An earlier version of this article was presented at the “Gender-Based Violence in the MENA Region” workshop of the European University Institute in Florence, Italy, March 24 to 27, 2010.

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 study was conducted by the consortium of ICON-Institute Public Sector GmbH, Hacettepe University Institute of Population Studies (HUIPS), and BNB Consulting Ltd. Co., with the financial support of the European Commission. The Republic of Turkey Ministry Directorate General on the Status of Women was the beneficiary institution and the Central Finance and Contracts Unit the contracting authority. The research team consisted of the key experts Henrica A. F. M. Jansen, Sunday Üner, and Filiz Kardam, and of the experts Sabahat Tezcan, Banu Akadlı Ergöçmen, A. Sinan Türkyılmaz, İlknur Yüksel, İsmet Koc, Elif Yiğit, and Yadigar Coşkun.

Notes

Author Biographies

Banu Akadlı Ergöçmen is an associate professor at the Hacettepe University Institute of Population Studies (HUIPS). Her research areas include demographic issues—mainly reproductive health, fertility, abortion, and population policy.

İlknur Yüksel-Kaptanoğlu is an assistant professor at HUIPS. Her research interests include demography, domestic violence, reproductive health, poverty, and qualitative research techniques.

Henrica A. F. M. (Henriette) Jansen is a doctor, epidemiologist, and a renowned expert on violence against women research. She worked for the WHO Multi-Country Study on Women’s Health and Domestic Violence and was the team leader for domestic violence research in Turkey in 2008.

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