The prevalence of violence against women and some related factors in Sanandaj city (Iran) in 2015.

BACKGROUND AND AIM: Violence against women is considered as one of the social problems of all countries in the world. The aim of this study was to determine the prevalence of violence against married women referring to health centers, and determining its related factors in Sanandaj, Iran, in 2015.
METHODS: This cross-sectional study was conducted on 700 married women referred to health centers in Sanandaj, Iran in 2015. A researcher made questionnaire was used to collect data. To perform sampling, the city was divided into 5 regions and from each region, one health center was selected randomly. Data were analyzed by SPSS 18 and using descriptive statistics, independent-samples t-test, chi-square test and ANOVA. Significance level of .05 was considered.
RESULTS: The results of this study showed that all women in the study had been subjected to violence at least once. In 11.7% of cases, the violence was moderate and severe. A total of 9.6% had been subjected to physical violence, 42.2% to verbal and psychological violence, 52.4% to sexual violence and 53.4% to economic violence. It was a statistically significant correlation between violence and following variables; education (p=0.0001), occupation (p=0.0001), history of domestic violence in family (p=0.0001), and having a boy in the family (p=0.0001). There was no statistically significant relationship between the number of girls in the family and violence against women (p=0.19).
CONCLUSION: Although Physical violence against women has decreased, other forms of violence including; verbal, sexual and economic were used against women. It seems that the problem of violence against women would not be solved without improving women's socio-economic status.

1. Introduction

Violence against women is generally recognized as a serious public health problem. As established by the Declaration on the Elimination of Violence against Women, which was released by the General Assembly of United Nations, the term “violence against women” means any form of gender-based violence that brings about, or is likely to bring about sexual, physical, or psychological harm or suffering to women, including any form of threat of such acts, coercion or arbitrary deprivation of liberty, whether in public or in private (1). There are various types of acts of violence against women including; verbal, psychological, emotional, economic, physical, sexual and even death (2). Domestic violence against women has been reported from all countries, but it is very difficult to achieve data, because in many cultures, women have poor socioeconomic conditions, and violence against them, especially in the family environment, has not been identified and in some cases, is even justified as legitimate (3). Studies show the wide prevalence of this health problem in the world. The WHO multi-country study on women’s health and domestic violence against women which was conducted on 24,000 women from 10 countries showed that 13% to 61% of women had been abused physically and 10% to 50% had been sexually abused (4). A national project in Iran which was conducted in 2001 showed that the prevalence of domestic violence is on average 66.3% (5). The prevalence of violence against women in Iran was estimated as 61.8% by Adineh et al. (6). Based on geographical classification the prevalence of domestic violence in Iran was 70% in the east of Iran, 70% in the south, 75% in the west, 62% in the north and 59% in the central parts of Iran (7). There are factors related to the risk of violence against women in Iran. Saffari et al. showed that education, employment status, and lower number of children lowered the risk, whereas history of previous marriage, unstable marriage, substance abuse, crowded family situation, and lower socioeconomic status increased the risk of domestic violence (8). Although in North America, by law, women have equal rights, but 40% to 50% of them have experienced physical violence, rape and domestic violence and 25% to 30% have been beaten at least once by their husbands (9). In Hong Kong, one in five women had experienced violence since age sixteen (10). In Palestine and Tunisia, one in every three women have been beaten by their husband (11). A study by Mavrikiou showed that from 1,107 Greek-speaking women living in Cyprus who took part in the study, 28% have suffered domestic violence from their partner or husband at least once in their lives (12). Inami et al. in a study, identified the prevalence of intimate partner violence against Japanese women. The results showed that the prevalence rate of intimate partner violence against Japanese women was 31.4 % (13). Walsh revealed in a study that 25% of US women reported lifetime exposure to gender-based violence (14). According to the World Bank report, violence against women is widely prevalent across high-, middle- and low-income countries (15). It has significant economic costs in terms of expenditures on service provision, loss of income for women and their families, decreased productivity, and negative impacts on future human capital formation, also rape and domestic violence threatens the health of women of 15 to 44 years old, more so than diseases such as breast and uterus cancer (15). Deyessa et al. reported that violence against women is more prevalent in rural communities (16). Violence against women is widespread around the world. It is a fundamental violation of women’s human rights, and is also a significant public health problem, with significant economic and social costs. Victims of violence suffer physical and psychological distress, they may suffer isolation, experience a decline in labor productivity and loss of wages, with consequences on children’s health and education (17). Violence as a learned behavior, would transfer from generation to generation. Children under the influence of the family’s experiences transfer violence to society, this called “the cycle of violence”, and in fact domestic violence is the root of all social violence (18). Those who witnessed parental violence during childhood were victims of family violence (19) and “the cycle of violence” never stops. Considering the importance of violence against women as a global issue and the effect of violence on the life quality of women and the family, also the future of a new generation, the aim of this study was to determine the prevalence of violence against married women referring to health centers and determining its related factors in Sanandaj, Iran in 2015.

2. Material and Methods

2.1. The study design and sampling

This cross-sectional study was conducted on 700 married women referred to health centers in Sanandaj, Iran, in 2015. To increase the power of the study, 700 married women were selected. Multi-stage sampling was performed. The city was divided into 5 regions based on socioeconomic characteristics and from each region, one health center was selected with simple random sampling, the selected health centers included; Baharan, Jalalizadeh, Ibn Sina, Farabi and Velayat Faghih. Share of each center was 140 cases (Married women) that were selected using systematic sampling. The inclusion criteria included; at least one year of marriage, residence of Sanandaj and literacy. Exclusion criteria included; unwillingness to participate in the study, being divorced and marked mental or physical disorder.

2.2. Instrument

A researcher made questionnaire was used to collect data. Considering the research objectives, similar studies, ethnic and cultural conditions of Kurdistan province, the initial questions of the questionnaire were designed. In the next stage, the relevance, simplicity and clarity of each of the questions, as well as their necessity in the questionnaire, were verified by content validity method. Four experts including; a psychologist, a sociologist, a gynecologist and a reproductive health specialist confirmed the final version of the questionnaire. Its reliability was also determined by pre-test study, and Cronbach’s alpha coefficient was calculated as 0.82. The first part of the questionnaire contained 8 questions related to demographic characteristics and the second part contained 15 questions relating to the determination of violence; 5 questions were related to verbal and psychological violence, 2 questions related to physical violence, 4 questions related to sexual violence and 4 questions related to economic violence. Responses were two choices (Yes and No) that were scored as (1) and (0). Score range was between zero and 15. Higher score indicated a high degree of violence and vice versa. Score 1–5 indicated mild domestic violence; score 5–10 indicated moderate domestic violence and a score of 10 or higher was defined as severe domestic violence. Five questions related to measurement of other variables were placed at the end of the questionnaire.

2.3. Data collection and ethics

This study was approved by the Ethics Committee of Kurdistan University of Medical Sciences, and its registration code was Muk.rec.1393.8. In order to observe ethical issues, informed consent was taken from participants. Questionnaires were distributed and completed in self administered method. The questionnaires were distributed among participants by two trained and experienced interviewers and necessary explanations were given to the participants. After introducing themselves, they communicated with women cordially, and gained their confidence.

2.4. Data Analysis

Data were analyzed by SPSS .18 and using descriptive statistics, independent-samples t-test, chi-square test and ANOVA. Significance level of .05 was considered.

3. Results

The mean age of women in this study was 32.6±10.9 years ranging from 13 to 50 years and the mean age of their spouses was 36.7±10.8 years ranging from 20to 65 years. The mean duration of marriage was 5.6±1.5 years. The mean of age difference between women and men was 4.1±3.3 years.

The mean age of marriage for men and women was 26.1 and 30.2 years respectively. In terms of education level, 35.5% of women had academic education and for their spouses it was 47.3%. In terms of occupation, the majority of women were housewives (70.1%) and men were self-employed (57%). The frequency of domestic violence in women’s families was 23.4% and for men was 18.3%. Women had no history of crime, while 1.7% of men had a history of crime. In total, 92.4% were middle class economically (Table 1). The results of this study showed that all women in the study had been subjected to violence at least once. A total of 9.6% had been subjected to physical violence, 42.2% to verbal and psychological violence, 52.4% to sexual violence and 53.4% to economic violence. Regarding the severity of domestic violence, one case was severe, 11.6% were moderate and 88.3% were faced with mild violence (Table 2). There was no statistically significant difference between severity of violence with women’s age, men’s age and duration of marriage, but there was a statistically significant difference between severity of violence with couples’ age differences (p=0.0001) (Table 3). There was a statistically significant correlation between violence and the following variables; education (p=0.0001), occupation (p=0.0001), history of domestic violence in family (p=0.0001), and having a boy in the family (p=0.0001). There was no statistically significant relationship between the number of girls in the family and violence against women (p=0.19) (Table 4).

Table 1

The frequency distribution of demographic variables in studied women

Variables		n	%
Women’s education level	Primary	17	2.4
	Secondary	77	11
	High school	231	33
	Academic	371	53
	Not defined	4	0.6
Men’s education level	Primary	50	7.1
	Secondary	127	18.1
	High school	192	27.4
	Academic	331	47.3
Number of boys in Family	0	407	58.1
	1	231	33
	2	62	8.9
Number of girls in Family	0	336	48
	1	290	41.4
	2	74	10.6
Violence Witnesses	Nobody	648	92.6
	Children	14	2
	Couple’s Families	3	0.4
	Other	35	5
Women’s occupation	Housewife	487	69.6
	Self-employed	66	9.4
	Employee	142	20.3
	Not defined	5	0.7
Men’s occupation	Jobless	113	16.1
	Self-employee	399	57
	Employee	188	26.9
Acquaintance	Own	488	69.7
	Family	144	20.6
	Other	68	9.7
Economic status	Poor	12	1.7
	Middle	647	92.4
	High	41	5.9

Table 2

The frequency of violence type in studied women

Type of Violence		Yes		No
		N	%	N	%
Physical violence	With injury	16	2.3	684	97.7
	Being hit Without injury	53	7.6	647	92.4
Sexual violence	Unwanted sex	126	18	574	82
	Persecuted during sex	151	21.6	549	78.4
	Not caring to satisfy the woman	231	33	469	67
	Relationship with another woman ground out of revenge	7	1	693	99
Economic violence	Financial control	231	33	469	67
	Preventing financial independence	62	8.9	638	91.1
	Assets belonging to women	269	38.4	431	61.6
	Not providing requirements despite financial power	43	6.1	657	93.9
Psychological violence	Insulting in public	68	9.7	632	90.3
	Contempt and ridicule	37	5.3	663	94.7
	Disregarding feelings	134	19.1	566	80.9
	Abusiveness	19	2.7	681	97.3
	Shouting	130	18.6	570	81.4

Table 3

Comparing the quantitative variables in terms of violence against studied women

Variable	Degree of Violence	No	Mean and SD	t	p-value
Woman’s Age	Mild	618	32.8±10.8	1.49	0.13
	Moderate	82	30.9±11.6
Man’s age	Mild	618	36.7±10.8	0.33	0.74
	Moderate	82	36.3±10.8
Duration of marriage	Mild	618	6.3±5.1	1.6	0.1
	Moderate	82	7.3±5.3
Age difference	Mild	618	3.9±3.1	3.9	0.0001
	Moderate	82	5.4±3.9

Table 4

The relationship between the severity of violence with demographic variables of studied women

Variables		The severity of violence				p-value*
		Mild		Moderate
		n	%	n	%
Women’s education level	Primary	17	100	0	0	0.0001*
	Secondary	58	75.3	19	24.7
	High school	178	77.1	52	22.9
	Academic	362	97.6	9	2.4
	Not defined	5	100	0	0
Men’s education level	Primary	45	90.00	5	10	0.0001*
	Secondary	98	77.2	29	22.8
	High school	153	79.7	39	20.3
	Academic	322	97.3	9	2.7
Number of boys in Family	No	337	82.8	70	17.2	0.0001*
	1	223	96.5	8	3.5
	2	58	93.5	4	6.5
Number of girls in Family	No	293	87.2	43	12.8	0.19
	1	255	87.9	35	12.1
	2	70	94.6	4	5.4
Women’s occupation	Housewife	407	83.6	80	16.4	0.0001*
	Self-employee	66	100	0	0
	Employee	141	99.3	1	0.7
	Not defined	5	100	0	0
Men’s occupation	Jobless	94	83.2	19	16.8	0.0001*
	Self-employee	342	85.7	57	14.3
	Employee	182	96.8	6	3.2
A history of violence in women’s family	Yes	155	94.5	9	5.5	0.005*
	No	463	86.4	73	13.6
A history of violence in men’s family	Yes	105	82	23	18	0.015
	No	513	89.7	59	10.3

One way ANOVA

4. Discussion

The results of this study showed that all women in the study had been subjected to violence at least once and regarding the severity of domestic violence, one case was severe, 11.6% were moderate and 88.3% were faced with mild violence. The lifetime prevalence of intimate partner violence in Iran was reported as 38.7% by Rasoulian et al. (20). Also, a study by Yari showed that about 32.8% of women had experienced severe intimate partner violence (21). Vakili et al. reported that the prevalence of physical violence against women was 43.7% (22). Nikbakht Nasrabadi had reported physical violence against women as 34.4% (23). In a study by Fidan and Bui, physical violence against women in Zimbabwe was reported as 32.7 % (24). Nguyen has reported 47% of lifetime physical violence in Vietnam (25). In our study, the prevalence of physical violence was 9.6 %, therefore it seems that physical violence in Sanandaj is likely lower than other parts of Iran and the world. In a previous study by Ghazizadeh, which was also conducted in Sanandaj, 15 % of women had suffered physical violence (26). In his study, 18% of the husbands were illiterate and only 10 % had higher degrees of education. In our study, 47% of men and 53 % of women had academic education and there were no illiterates among our population. It seems that the level of education in men and women affected the rate of violence. Perhaps the reason is that in our study, more than 50% of women and their spouses have an academic education level. According to this finding, it is necessary to educate and raise the level of knowledge of women as well as men to protect women from violence against them. Women whose level of education was low had a 1.59 times greater risk of becoming a victim of domestic violence in comparison to more educated women. This could be because educated people may be more effective when coping with, adapting to and anticipating problematic situations and trying to avoid them (19). In a study in Egypt, it was found that the prevalence of violence against women was lower only when both partners were educated, and women who were more educated, suffered less severe acts of violence than less educated women (27). In our study 42.4% of women were exposed to verbal and psychological violence. In a study by Nikbakht Nasrabadi, psychological violence had been reported as 58.8% (23). Vakili et al. also reported the high prevalence of psychological violence against women as 82.7% in Kazeroon, Iran (22). Fidan and Bui have reported 27.4% of emotional violence in Zimbabwe (24). Shuman et al. showed 46.4% of emotional violence against women in Abidjan, Côte d’Ivoire (28). In our study, psychological violence was also lower than that reported in Iran and other parts of the world except for the Fidan and Bui study (24). Similar studies showed that the most common type of violence against women was psychological and verbal violence. This finding also re-emphasizes the importance of the level of knowledge and education of women. As mentioned previously, there were no illiterate women among our population. Usually, women with higher education are economically independent and less likely to be brutalized.

In our study, 52.4% of women had experienced sexual violence. In a study by Yari et al., 32.9% of women experienced sexually intimate partner violence (21). A study by Vakili et al. showed 30.9% of sexual violence against women (22). Nikbakht Nasrabadi also, has reported sexual violence against women as 34.2% (23). In the Fidan and Bui study, the reported sexual violence was 14% (24). In all the above studies (21–24), the prevalence of sexual violence was less than our study and their findings are not inconsistent with ours. Although more than 50% of our participants had academic education level, the prevalence of sexual violence against women was more than previous studies (21–24). Women who had primary education were more likely to report physical and emotional violence than those who had secondary or higher education; however, in our study, as in the study of Nikbakht Nasrabadi, education was not significantly associated with sexual violence (24). Although a national survey in South Africa found that women with no education were to be much less likely to experience sexual violence than those with higher levels of education (29). In terms of sexual violence, our study was inconsistent with this survey. In our study 53.4% of women were subjected to economic violence. A study in India showed that socioeconomic statuses of women have a significant association with domestic violence (30). The importance of socioeconomic status in the rate of intimate partner violence was confirmed in a study by Rasoulian et al. (20). Also, a study showed that socio-economic status of women influenced domestic violence (31). On other hand, Dalal concluded that economic empowerment is not the sole protective factor. Economic empowerment, together with higher education and modified cultural norms against women, may protect women from violence (32). Although, in our study, more than 50% of women had an academic education level and were perhaps economically independent, but the rate of economic violence was 53.4%. It seems that in addition to education level and economic empowerment there are other factors that affect violence against women.

In our study, women with less age difference to their husbands were less subjected to violence. The age difference of couples is among factors affecting the incidence of domestic violence. Vakili et al. found a significant correlation between violence and age of couples (22). Nikbakht Nasrabadi also confirmed that there was a significance between age difference of couples and violence (23). Another study which was conducted in the city of Babol, Iran found a significant correlation between violence and woman’s age (33). It seems that the less age difference between spouses the less violence there is. Our finding was inconsistent with previous studies (22, 23, 33). In this study, there was a significant relationship between education and violence. Women with academic education were less subjected to violence than women with primary school and high school level of education. Previous studies also confirmed that there is a relationship between violence against women and couples’ education level (20–23, 25, 27). In our study, almost all women subjected to moderate violence were housewives, and in jobless men, violence against women was more than employed men. This finding confirmed the socioeconomic status of family and violence. Rasoulian et al. found that the husbands’ type of employment was strongly associated with the level of violence (20). Nikbakht Nasrabadi et al. clarified that employment is effective on women’s experience of violence (23). Bostok et al. declared that the economic condition and young women are more exposed to violence (34). Aghakhani et al. also showed that there was a significant relationship between physical violence and husband’s employment; that is, those husbands who did not have a permanent job showed more physical violence (35). The results of a study showed that male partner employment plays a major role in the risk of physical violence, while female employment only lowers it when her partner was employed too (36). Based on the statistics center of Iran, the unemployment rate in Kurdistan province was 20.5% at the end of 2016, and Kurdistan was among three provinces in the country with the highest unemployment rate. Therefore, solving the problem of unemployment can affect the level of violence against women in Sanandaj which is the capital city of Kurdistan. In this study, women who had no sons were more subjected to violence, but there was no statistically significant relationship between the number of girls in the family and violence against women. Given the patriarchal culture in the community, women who had no sons are more subjected to violence. The limitation of our study was married women who had no desire to answer the questionnaire and did not participate in the study voluntarily who were excluded from the study. Perhaps there were some cases of severe violence among them, not evaluated in this study, because cases of violence are considered as personal and family confidential.

5. Conclusions

In conclusion, the results of this study showed that all women in the study had been subjected to violence at least once and they experienced moderate and severe violence. Also, the results showed that there was a statistically significant correlation between violence against women and education, occupation and history of domestic violence in family. The practical significance of these findings was that we showed most effective variables on violence, so it is recommended they be taken into consideration by those who are responsible in Iran. It is recommended that supporting organizations such as the Welfare Organization and the Ministry of Health do their best to improve the knowledge and also the economic situation of families, particularly women. Conducting a supplementary research on violence against women with greater study population could be an interesting way for future investigations in this field.