Domestic
violence which is also called battering, abuse, intimate partner violence and
spousal abuse is a pattern of abusive behavior by a partner against the other
in a close relationship1. There are many types of domestic violence,
including verbal, psychological, physical and sexual. Physical abuse may be
defined as ‘hitting, kicking, biting, shoving, restraining, slapping, and
throwing objects2. Physical form of domestic violence is very common
in Pakistan. According to Ali et al every second a female faces physical abuse
at domestic level in Pakistan. Domestic violence is primarily a crime affecting
women3. Where there are chances of men being the victim of domestic
abuse, they are usually the perpetrators against women (as high as four times
more)4, especially in Pakistan. Literature suggests that most
commonly the injuries occur in head and neck regions of the victim, out of
which ocular injuries are frequent consequence of such violent acts5.
In countries like Pakistan, we need to have three fold agenda as far as
domestic violence is concerned. We need to create awareness in women so that
they themselves recognize domestic violence in their homes and neighborhood. We
need to train our doctors to recognize and identify victims of domestic
violence. We need to do quantitative studies in order to know the full extent
of this social evil. The purpose of the current paper is to find the frequency and causes of
domestic violence at THQ Hospital Ahmedpur.
MATERIAL AND METHODS
This is a cross
sectional study which was carried out at Tehsil Head Quarter Hospital Ahmedpur
East. Data collection and analyses was done during 3 months starting from May
2018 till end of July 2018. During
this study observation of physical trauma on the face especially related to
eye, orbit and adnexa were used as inclusion criteria. Wound due to road
traffic accidents and wounds older than two weeks were not included. Whenever, a female patient reported to eye OPD with wounds
including lacerations, hyphemas, swollen eyes and serious injuries like ruptured
globes, retinal hemorrhages, subarachnoid or
intra-cerebral bleeding, subdural hematoma and orbital bone fractures,
they were examined with the help of slit-lamp, ophthalmoscope and radiological
studies. Serious injuries were immediately referred to Bahawalpur Victoria
Hospital, being the tertiary care hospital of the division. Simple wounds were
treated and patients were advised for follow up visit. Another issue faced by
the Ophthalmologist during history taking was that many a times victim was accompanied
by the very abuser which made history taking difficult.
RESULTS
There
were 156 female patients identified as victims of domestic violence out of 4368
total female patients checked during three months period. Out of these 156 female patients 39 reported
to have faced violence while rest of 117 cases were of suspected domestic
violence where abuse was not admitted nor was abuser identified. The patients
ranged from 14 to 88 years old females. The abusers were mostly husbands and
in-laws including mother-in-law, father-in-law, brothers-in-laws and
sister-in-laws. Surprisingly in several cases even own sons were batterers of
their own mothers. Wounds included lacerations, hyphemas, swollen eyes and
serious injuries like ruptured globes, retinal
hemorrhages, subarachnoid or intra-cerebral bleeding, subdural hematoma
and orbital bone fractures. Out of these 156 cases 23 of serious injuries were
referred to Bahawalpur Victoria Hospital, rest were treated and recommended for
follow-ups. In 39 reported cases, infertility, giving birth to daughters,
financial issues, domestic politics and substance abuse were reported as causes
of domestic violence. Following tables and figures show the break-up of the
data with respect to age-group and causes of domestic violence.
Table 1
and figure 1 clearly shows that younger females were subject to more physical
domestic violence. 41% of the total violence cases were seen in the age bracket
of 14 to 29 years old females. It dropped to 23.72% as the age group advanced to
30-45 years. It further fell to 17% for females older than 45 years of age.
However, it was saddening to see that females even beyond 60 years of age were
not safe from domestic violence. One case was seen where an 88 year old female
was beaten by her son.
Age and
frequency of domestic violence cases was tested for association by running two
slightly different versions of the chi-square in Minitab version 14, which gave
results for the age and domestic violence prevalence. Results reported by
Minitab are:
Pearson Chi-square = 54,367, DF = 1, P-Value = 0.000
Likelihood Ratio Chi-Square = 51.277, DF = 1, P-Value =
0.000
The p-value,
0.000, is below 0.05
so the result is statistically significant. This means that age and domestic
violence are related in a larger population.
Table
1: Age-Wise
Percentage Distribution of Violence Cases.
|
Age
|
Total Injuries
|
Percentage of Cases
|
|
14-29
|
64
|
41.02%
|
|
30-45
|
37
|
23.72%
|
|
46-60
|
28
|
17.95%
|
|
>60
|
27
|
17.30%
|
A more
zoomed in picture of types of injuries is presented in Table 2 and figure 2. It
is evident that as compared to serious injuries like ruptured globe, retinal
hemorrhage, intra-cerebral bleeding or orbital fractures, simple injuries like
lacerations, hyphemas, swollen eyes and eyelid tears were more commonly reported.
However, almost all type of injuries was again more common in younger age
groups. Taller blue columns of age group 14-29
depict the higher frequency of violence cases in the youngest group.
On categorizing the
causes of domestic violence we found that financial stress, lack of male heir,
infertility all seemed to be equally strong causes or in other words any of the
excuses could be used to control a female by her family. Although after
marriage cases of battering and violence increased, still even before marriage
females faced domestic violence by her family. One of the major causes of such
domestic violence after marriage included local social customs of ‘wattasatta’
(exchange) marriages or bride purchase. Marriages in very young age were also
identified as the cause of domestic abuse during history taking.
Fig. 1: Age-Wise Percentage
Distribution of Violence Cases.
Descriptive analysis showed that social causes
were the strongest cause of all domestic violence however, rest of the causes
were not very low as well. There was no significant difference in the
contribution of these causes in domestic violence, which is also evident from
figure 3.
DISCUSSION
Ocular injuries in domestic violence can
range from minor lacerations on the eyelid to major tears, fractures and
ruptures in ocular and orbital regions, sometimes even losing an eye. Again it
is supported by literature that in females mostly these ocular injuries are a
result of domestic violence6. These injuries are mostly a result of
physical attack, blow or fight. Many a time problems aggravate due to
continuous battering. This issue of domestic violence is not limited to
underdeveloped countries rather it is very common even in developed countries.
However, in developed countries the statistics on violence especially against
women are well-known and social systems are well in place, whereas in
developing countries the situation is very different7. Very small
number of women dare to report against their spouses8&9. Due to
lack of education or even awareness of their basic rights, many females do not
even recognize this as an abuse or violence against them. Due to shame, emotional
black mailing, coercion or threat, many prefer not to tell anyone about what
happens to them10,11,12. According to several reports more than
20-30% of Pakistani females suffer from domestic violence13. Some of
these self-admit that these statistics are low reported, as many of these
crimes go unreported14. This is because due to psychological
violence victims mind and emotions are also under the control of the abuser.
Victims are so scared and confused that it is hard for them to rationalize the
situation and report it to anyone coherently15. It may be easy to
assess if a female is victim of domestic violence but less than one in 20
doctors do so routinely. This wrong tendency is compounded by the
non-cooperation of the victims with the doctors16. However, if there
is mismatch of explanation of injury by the victim with the nature of the
injury a doctor must be alert to pick it up and report. For doctors online
information is available on how to assess if a victim has faced domestic
violence16. Furthermore, in developed countries there are organized
trainings for doctors to recognize the signs of domestic violence17.
Social and health aspects of domestic violence victims are highly related18.
For effective management of domestic violence combined efforts of law
enforcement agencies, social welfare department and health care services are required19.
Need of the time is to emphasize to the doctors the importance of mandatory
reporting of suspected domestic violence cases to police20. Causes
of domestic violence included financial stress, lack of male heir, infertility,
local social customs of ‘wattasatta’ (exchange) marriages or bride purchase.
Marriages in very young age were also identified as the cause of domestic abuse
during history taking.
Lack of training, social
services and legal mode of action, multiple and frequent suspected domestic
violence cases which can be easily identified by medical practitioners
especially ophthalmologists go unrecognized and unidentified. Many of the
abusers become bold and the victims suffer more and more as time passes,
sometimes even resulting in deaths. In rural areas of Pakistan, due to lack of
education and awareness and patriarchal social system, domestic violence
prevails. Due to consideration of these issues as private family matters it is
mostly left uninterrupted where no one comes to the rescue of the poor victims.
Ophthalmology OPD can be one place to identify and report such cases whether
reported or suspected in order to stop this crime and to save lives.
CONCLUSION
It is evident from the
results that domestic violence is commonly faced by the females in Ahmedpur
East. This domestic violence is negatively related to age. As the age
progressed there was a reduction in percentage of cases of domestic violence.
However, it is disturbing to know that females in all ages are subject to
domestic violence.
Author’s Affiliation
Dr. Muhammad
Yasser Nisar
MBBS, DOMS
Consultant Ophthalmologist
THQ Hospital, Ahmedpur East
Dr. Taseer Salah-ud-Din
PhD Economics
CEO, TS Women Empowerment agency
Role of Authors
Muhammad Yasser Nisar
Examination of the patients, collection of data, partial
literature review.
Dr. Taseer Salah-ud-Din
Data analysis, interpretations.
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