Socio demographic determinants of violence among school-going adolescent girls in a rural area of North India: A cross-sectional study.

Background: The United Nations defines violence against women as "any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life".[1] Violence can take many forms, including physical, sexual or emotional and varies in its severity. Gender discrimination, norms and practices mean that adolescent girls are likely to experience certain forms of violence, such as sexual violence, at much higher rates than boys.
Methods: This cross-sectional study was conducted in a rural block of North India. A total of 500 adolescent girls in the age group of 13-19 years studying in class VIII to class XII in 10 government and private senior secondary schools of the Lakhanmajra block were included in the study. A pre-designed pre-tested semi-structured interview schedule was used.
Results: In this study, we found the prevalence of physical, sexual and emotional violence among adolescent girls as 6.6, 5.4 and 5.2%, respectively. The most frequent perpetrator of physical violence was the parent and of sexual violence was the neighbour followed by friends or relatives. Higher emotional violence was experienced by adolescent girls from middle-class families (P < 0.05). The prevalence of physical violence among adolescent girls was maximum in the younger age group 13-14 years (10.2%), followed by 15-17 years (4.0%). This association was found statistically significant (P < 0.05). Conclusions: There are several restrictions on free communication about violence-related topics in our highly conservative society. Blaming the victim is the rule rather than the exception and sexual abuse is usually linked to a loss of virginity and family honour in our patriarchal society. Hence, girls may be more reluctant to disclose their experience of violence. Copyright:

Introduction

The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”.[1]

Research nowadays has been mostly focused on violence against women and children but the same issues faced by adolescent girls are being overlooked. There are 1.2 billion adolescents across the world or one in six of the world’s population are adolescents aged 10–19.[2] According to the census 2011 report, 20.9% of the population in India comprise of adolescents.[3] Adolescent girls constitute a vulnerable group as they are facing physical, psychological and hormonal changes in their body along with gender inequality, social taboos in the outside world due to our highly conservative Indian society. Gender inequality and norms on the acceptability of violence are the root cause of violence against teenage girls.

Violence can take many forms, including physical, sexual or emotional and varies in its severity. Gender discrimination, norms and practices mean that adolescent girls are likely to experience certain forms of violence, such as sexual violence, at much higher rates than boys. This may further predispose the adolescents to the brim of developing mental health problems like depression which is of utmost importance to be addressed by primary care physicians. Globally, 1 in 10 girls under the age of 20 years reports experiencing sexual violence.[2]

Methodology

Study design and sampling

A school-based descriptive cross-sectional study was conducted in the senior secondary schools of block Lakhanmajra, District Rohtak, Haryana (India). CHC Chiri, which provided health services in this area, is the rural field practice area attached to the Department of Community Medicine, Pt. BD Sharma PGIMS Rohtak. This study was conducted from April 2019 to Jan 2020.

Taking the prevalence of 26.6% from a previous study and allowable error of 15% at 95% level of significance, using the formula N = 4 pq/E2, the sample size was calculated as 491. So, a total sample of 500 students was included in the study.

Participants

Adolescent girls in the age group of 13–19 years, studying in class VIII to class XII in government and private senior secondary schools of the Lakhanmajra block were included in the study.

Inclusion criteria

Students who gave assent to participate in the study.

Exclusion criteria

Students who were not available in the respective schools on the days of the visits (maximum three visits), were not enrolled in the study.

Study objectives

Objective 1

To estimate the prevalence of violence among adolescent girls in a rural area of North India.

Objective 2

To determine the association between violence and sociodemographic factors.

There were 12 government and 9 private senior secondary schools in the block Lakhanmajra according to the data collected from the office of the Block Education Officer (BEO), Lakhanmajra. Out of these, one was exclusively a boys’ school, which was excluded. The adolescent girls aged 13–19 years studying in classes VIII to XII in these 11 government and 9 private senior secondary schools were included in the study population.

Data collection

From these 20 schools, 5 government and 5 private schools were selected randomly; 50 students from each school and 10 students from each class were selected. Thus, a total sample size of 500 was taken. One day before the data collection, permission was obtained from the concerned in charge of the selected school. After obtaining consent from the parents of the selected students, each student was interviewed separately in a different classroom. The investigator tried to develop a good rapport with the student and confidentiality was ensured. A pre-designed pre-tested semi-structured interview schedule was used and the responses were recorded by the investigator herself. A simple random sampling technique was used to select students from each class. Prior permission from the District Education Officer was taken.

Data compilation and analysis

The data were entered in the MS Excel spreadsheet and was presented in the form of tables, proportions, mean and standard deviation. The Chi-square test of association was used to determine the associations in the SPSS (Statistical Package for Social Sciences) software 20.0 version as per the study objectives.

Ethical consideration

The study was started after getting ethical clearance from the Institutional Ethical Committee of Pt. BD Sharma PGIMS Rohtak, India.

Results

In the present study, the mean age of the study subjects was 14.73 ± 1.736 years; 50.6% of the study subjects were in the age group of 15–17 years, followed by 13–14 years (37.2%) and 18–19 years (12.2%). Most of the respondents’ fathers and mothers were educated up to the secondary level (30.4 and 33%). respectively. Nearly half of the study subjects’ fathers were farmers (47.2%), followed by government employees (16.6%) and a majority of the study subjects’ mothers were homemakers (93.6%); 25.4% of the study subjects belonged to the middle class and 23.6% to the upper-middle class. The upper class constituted the least of the cases (7.0%). Half of the study subjects (50.6%) belonged to the nuclear family, followed by 33.6% who belonged to a three-generation family and nearly half of the study subjects (51.6%) belonged to families with 7–10 family members as described in Table 1.

Table 1

Sociodemographic profile of the study subjects (n=500)

	Frequency	Percentage
Age
13-14	186	37.2
15-17	253	50.6
18-19	61	12.2
Type of family
Nuclear	253	50.6
Joint	79	15.8
Three generation	168	33.6
Category of socioeconomic status
Upper class (>Rs. 7008/-)	35	7.0
Upper-middle (Rs. 3504-7007)	118	23.6
Middle class (Rs. 2102-3503)	127	25.4
Lower-middle (Rs. 1051-2101)	117	23.4
Lower class (<Rs. 1051/-)	103	20.6

The prevalence of physical, sexual and emotional violence among the adolescent girls was 6.6, 5.4 and 5.2%, respectively, as described in Table 2. The most frequent perpetrator of physical violence was the parent (54.5%) and of sexual violence was the neighbour (44.4%), followed by a friend (22.2%) or relatives (11.1%); 38.5% of the adolescent girls responded that the perpetrator of emotional violence was a family relative as described in Table 3.

Table 2

Prevalence of violence among adolescent girls (n=500)

	Frequency	Percentage
Emotional violence
Present	26	5.2
Absent	474	94.8
Physical violence
Present	33	6.6%
Absent	467	93.4
Sexual violence
Present	27	5.4
Absent	473	94.6

Table 3

Distribution of the study subjects based on the perpetrators of violence

	Frequency	Percentage
Perpetrator of emotional violence
Parent	7	26.9
Family relative	10	38.5
Friend	6	23.1
Others	3	11.5
Total	26	100
Perpetrator of physical violence
Parent	18	54.5
Siblings	1	3.0
Friend	8	24.2
Others	6	18.2
Total	33	100
Perpetrator of sexual violence
Friend	6	22.2
Neighbour	12	44.4
Family relatives	3	11.1
Others	6	22.2
Total	27	100

There was no association between sexual violence and age group or socioeconomic status of the study subjects. This shows that adolescent girls across all income families were equally vulnerable to sexual violence. However, there was a significant association between the type of family and sexual violence (P < 0.05).

Higher emotional violence was experienced by the adolescent girls from middle-class families (P < 0.05). The maximum prevalence of physical violence was present in the lower socioeconomic class (10.7%), followed by the middle class (7.1%). However, there was no significant association between socioeconomic status and physical violence among the study subjects.

In contrast, there was a significant association between the type of family and physical violence (P < 0.05); 10.1% was the prevalence of physical violence among the study subjects belonging to the three-generation family, followed by joint (7.6%) and nuclear families (3.2%).

Discussion

In this study, we found the prevalence of physical, sexual and emotional violence among adolescent girls as 6.6, 5.4 and 5.2%, respectively. Malhotra S, et al.[14] in their review in 2010 reported that sexual violence was reported by 3% of the Indian girls which is almost comparable to our study.

In contrast, a higher prevalence of physical, sexual and emotional violence was reported by Daral S, et al.[5] and Patel R, et al.[4] in their study conducted in Najafgarh, Delhi (2016) and Bihar (2021), respectively, among adolescent girls. In their study, the most frequent perpetrator of physical violence was the parent and of sexual violence were neighbours, friends or relatives which is similar to our study. The reason for the higher prevalence in the above study could be due to the use of a questionnaire in their study instead of an interview schedule. In a national survey conducted in the UK,[6] it was observed that mothers and fathers were most often responsible for physical violence which was similar to our study, although violence by siblings was also reported. However, the incidence of physical violence in some other countries is found to be much higher. For example, in a survey of students aged 11–18 years in the Kurdistan Province of the Islamic Republic of Iran, 38.5% of the subjects reported experiences of physical violence at home that had caused mild-to-severe physical injury.[7]

Parents with poor impulse control, low self-esteem and mental health problems are more likely to use physical violence against children.[8] Parents who use violence against their children may well have experienced violence as children themselves.[9] The prevalence of violence against children by parents and other close family members as well as deliberate neglect of children has been reported across the world.[10]

The World Health Organisation (WHO) estimates that 150 million female children and 73 million male children under 18 have experienced forced sexual intercourse or other forms of sexual violence involving physical contact, though this certainly is an underestimation.[11] A good number of children worldwide also experience violence within educational institutions.[12]

In the present study, regarding the socioeconomic status of the study participants, data show that higher emotional violence was experienced by adolescent girls from middle-class families (P < 0.05) [Table 4]. In middle-class families, parents have high expectations of their children in regard to their academic performance, for which sometimes they taunt, humiliate them in front of others, which can lead to psychological trauma. However, there was no association between sexual and physical violence with the socioeconomic status (P > 0.05). This was in consonance with the study conducted by Deb et al.[10] in Tripura (2010), where it was observed that there was no association between sexual violence and socioeconomic status of the adolescents. This shows that adolescent girls across all income families were equally vulnerable to sexual violence. In general, adolescent girls across different social strata in India are treated as incapable of knowing what is best for them, and that, there is a need to control their decisions and behaviour by others in every aspect of their life. In our study, there was no significant association between sexual and emotional violence with age. It shows that adolescent girls from every age group were equally vulnerable to sexual and emotional violence (P > 0.05).

Table 4

Association of violence with socio-demographic factors

Socio-demographic factors		Sexual violence				χ 2	df	P
		Yes		No
		n	%	n	%
Age categories (years)	13-14	12	6.5%	174	93.5%	1.111	2	0.574
	15-17	11	4.3%	242	95.7%
	18-19	4	6.6%	57	93.4%
Socio-economic status	Upper class	1	2.9%	34	97.1%	5.302	4	0.258
	Upper Middle	9	7.6%	109	92.4%
	Middle	8	6.3%	119	93.7%
	Lower middle	2	1.7%	115	98.3%
	Lower	7	6.8%	96	93.2%
Type of family	Nuclear	9	3.6%	244	96.4%	8.547	2	0.014*
	Joint	2	2.5%	77	97.5%
	Three-generation	16	9.5%	152	90.5%
Socio-demographic factors		Physical violence				χ 2	df	P
		Yes		No
		n	%	n	%
Age categories (years)	13-14	19	10.2%	167	89.8%	8.248	2	0.016*
	15-17	10	4.0%	243	96.0%
	18-19	2	3.3%	59	96.7%
Socio-economic status	Upper class	1	2.9%	34	97.1%	6.207	4	0.184
	Upper Middle	6	5.1%	112	94.9%
	Middle	9	7.1%	118	92.9%
	Lower middle	4	3.4%	113	96.6%
	Lower	11	10.7%	92	89.3%
Type of family	Nuclear	8	3.2%	245	96.8%	8.716	2	0.013*
	Joint	6	7.6%	73	92.4%
	Three-generation	17	10.1%	151	89.9%
Socio-demographic factors		Emotional violence				χ 2	df	P
		Yes		No
		n	%	n	%
Age categories (years)	13-14	12	6.5%	174	93.5%	1.155	2	0.561
	15-17	12	4.7%	241	95.3%
	18-19	2	3.3%	59	96.7%
Socio-economic status	Upper class	1	2.9%	34	97.1%	12.997	4	0.11
	Upper Middle	6	5.1%	112	94.9%
	Middle	14	11.0%	113	89.0%
	Lower middle	3	2.6%	114	97.4%
	Lower	2	1.9%	101	98.1%
Type of family	Nuclear	9	3.6%	244	96.4%	2.923	2	0.232
	Joint	6	7.6%	73	92.4%
	Three-generation	11	6.5%	157	93.5%

There was a significant association between the type of family with sexual and physical violence (P < 0.05). The prevalence of sexual and physical violence among the study subjects was maximum in the study subjects belonging to the three-generation family, followed by nuclear and joint families. However, there was no significant association between the type of family and emotional violence. In contrast, a study conducted by Deb S, et al.[10] in Tripura (2010) observed that adolescents were more likely to experience physical and sexual violence in single/nuclear families. In their study, a disturbed family environment along with the type of family was also taken into consideration which might be the reason for dissimilar findings.

It should be pointed out that the low prevalence of sexual violence in our study does not necessarily mean that sexual abuse of girls is less in our society. As there are several restrictions on free communication about sexual abuse-related topics in our highly conservative society, open discussion of sexuality and sexual behaviour is taboo in our Indian culture. Hence, girls may be more reluctant to disclose their experience of sexual abuse. Reporting of cases of sexual abuse is low worldwide.[13]

Conclusion and Recommendation

To conclude, we found that girls are not safe even in their homes, not even from the people who are supposed to make them feel safe and cared for. This is a sad and worrisome fact. Age and family type being significant determinants need to be addressed. We need to make sure that more people are educated, especially young girls, about the laws regarding violence and the help they can get if they report it. Programmes and strategies need to be made to create awareness about violence among the public on a large scale in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.