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COMMENTARY
Year : 2012  |  Volume : 56  |  Issue : 2  |  Page : 140-145  

Domestic violence in India: Need for public health action


1 Junior Resident, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Additional Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication21-Aug-2012

Correspondence Address:
Sanjeev Kumar Gupta
Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Charlette SL, Nongkynrih B, Gupta SK. Domestic violence in India: Need for public health action. Indian J Public Health 2012;56:140-5

How to cite this URL:
Charlette SL, Nongkynrih B, Gupta SK. Domestic violence in India: Need for public health action. Indian J Public Health [serial online] 2012 [cited 2019 Aug 25];56:140-5. Available from: http://www.ijph.in/text.asp?2012/56/2/140/99906


   Introduction Top


Domestic violence is an age old social evil which remained hidden from the eyes of the society for long. In India, it was recognized as a human rights issue in the 1980s due to the increasing number of dowry deaths. This resulted in the addition of section 498-A for cruelty against women in the Indian Penal Code. [1] With further research in the field, it is now being recognized as a public health issue; first, because of the myriad health issues associated with it, and second, that some of the prevention strategies lie in the hands of practitioners of public health.

Domestic violence occurs in all countries, irrespective of social, economic, religious or cultural group. Although women can be violent in relationships with men, and violence is also sometimes found in same-sex partnerships, the overwhelming burden of partner violence is borne by women at the hands of men. The fact that women are often emotionally involved with, and economically dependent on those who victimize them, has major implications for both the dynamics of abuse, and the approaches to dealing with it. [2]


   Definitions Top


Various terms, viz., "violence against women", "domestic violence" and "intimate partner violence" are often being used synonymously. However, there are subtle differences in what they convey, as is evident from the following definitions:

Violence against women: The United Nations Declaration on the Elimination of Violence against Women defines "violence against women" as any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women. The act of violence may occur in family, general community, or even being perpetrated and condoned by state. [3]

Domestic violence: The term "domestic violence" includes violence against women and girls by an intimate partner, including a cohabiting partner, and by other family members, whether this violence occurs within or beyond the confines of the home. [4]

As per The Protection of Women from Domestic Violence Act, 2005, omission or commission or conduct of the respondent shall constitute domestic violence in case of the following:

  1. Harms or injures or endangers the health, safety, life, limb or well being, whether mental or physical, of the aggrieved person or tends to do so, and includes causing physical abuse, sexual abuse, verbal and emotional abuse and economic abuse; or
  2. Harasses, harms, injures or endangers the aggrieved person with a view to coerce her, or any other person related to her, to meet any unlawful demand for any dowry or other property or valuable security; or
  3. has the effect of threatening the aggrieved person or any person related to her by any conduct mentioned in clause (a) or clause (b); or
  4. Otherwise injures or causes harm, whether physical or mental, to the aggrieved person. [5]
Intimate partner violence : In order to improve the quality of data available, the Centers for Disease Control and Prevention undertook a project to standardize the definition of "intimate partner violence" according to which "intimate partner violence" is described as physical, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples, and does not require sexual intimacy. "Intimate partners" include current spouses, current non-marital partners, dating partners, divorced or separated spouses, former non-marital partners, former boyfriends/girlfriends (heterosexual or same-sex). [6]


   Forms of domestic violence Top


Violence against women can be physical, sexual, psychological, and threat of physical or sexual violence. Physical violence includes acts of physical aggression such as slapping, hitting, kicking and beating. The common sexual abuses women endure are forced intercourse, and other forms of sexual coercion. Psychological abuse includes acts like intimidation, constant belittling, humiliating and various controlling behaviors such as isolating a person from their family and friends, monitoring their movements, and restricting their access to information or assistance. [6] When abuse occurs repeatedly in the same relationship, the phenomenon is often referred to as "battering". [2]


   Burden of domestic violence Top


Various factors affect the quality and comparability of data on domestic violence. First, there are inconsistencies in the way violence is defined. For instance, not all studies report violence as physical, sexual or psychological; also the time periods studied vary. Second, there are differences in the inclusion criteria of participants. For example, many studies on partner violence include all women within a specific age range, while other studies interview only women who are currently married or who have been married. The prevalence of violence varies based on the population studied. Third, prevalence estimates are also likely to vary based on the source. National surveys tend to under-estimate the prevalence compared to smaller in-depth studies. Smaller in-depth studies tend to concentrate more on the interaction between interviewers and respondents, and also tend to cover the subject matter in much greater detail than most national surveys. Prevalence also depends on the willingness of respondents to talk openly and honestly about experiences with violence because of its sensitive nature. [2]

Domestic violence occurs in all countries, though the magnitude varies. The Multi-country Study on Women's Health and Domestic Violence against Women by the World Health Organization was a landmark research project. In this project, specially trained teams collected data from over 24,000 women from 15 sites in 10 countries representing diverse cultural settings: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania. According to this study, the proportion of ever-partnered women who had ever experienced physical or sexual violence, or both, by an intimate partner in their lifetime, ranged from 15% to 71%, with most sites falling between 29 and 62%.The results indicated that violence by a male intimate partner was widespread in all countries covered by the study. However, there was a great deal of variation from country to country, and from setting to setting within the same country. [7]

In India, according to the National Family Health Survey III carried out in 29 states in 2005-2006, the prevalence of domestic violence was 37.2%. However, it was not uniform across the country, with the prevalence ranging from 59% in Bihar, to 6% in Himachal Pradesh. [8] Several studies have reported on the prevalence of domestic violence in India. [9],[10],[11],[12],[13],[14],[15],[16] Their results are summarized in [Table 1].
Table 1: Burden of domestic violence in India

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   Determinants of domestic violence Top


From available published literature, it is observed that there are marked regional differences in the prevalence of domestic violence. There are determinants of domestic violence at individual level, and factors which modify the prevalence at societal and community levels. According to the World Report on Violence and Health, [2] the factors associated with a woman's risk of being abused by her partner can be individual factors (young age, heavy drinking, depression, personality disorders, poor academic achievement, etc.), relationship factors (marital conflict, marital instability, male dominance, economic stress, etc.), community factors (weak community sanctions against domestic violence, poverty, low social capital), and societal factors (gender norms, and social norms supportive of violence).

Various socioeconomic conditions, viz., husband's lower education, [15],[16] poverty and economic pressure, [13],[16] household overcrowding, [15] husband's alcohol abuse, [13],[17] and women who grew up witnessing violence in their homes, are more likely to report experiencing domestic violence. [18] Although better socioeconomic conditions were found to be protective, studies indicated that a gender gap complicates the picture; women who are better educated, who are at better employment, and earn better than their husbands, are at greater risk of domestic violence. [18],[19] A study conducted across seven sites in India, viz., Bhopal, Chennai, Delhi, Lucknow, Nagpur, Thiruvananthapuram, and Vellore found that gender gap in employment status was a significant factor for violence. [20]

As far as relationship factors are concerned, husband having an affair, [15] being issueless, [13] and families having multiple children are at greater risk. [15],[16] Also, certain issues like 'dowry system', [10],[15] and 'love marriages' [10] remain as possible causes for violence. Women who participate in social groups or vocational training are reported to be more at risk. [10] The societal and community factors which influence violence include residing in communities where murder rates are high, and in those where wife beating is socially condoned. [13] Inconsistent associations of violence were found with other factors like age, place of residence (urban/rural), age at marriage, and duration of marriage. [11],[21] Though studies have identified the association between various factors and violence, the gender norm expected of a woman to be more submissive to the husband and elders, and forbidding her to bring out problems to outside world, may influence her reporting and interpreting the causes of violence.


   Health consequences of domestic violence Top


The ill-effects of abuse can be discussed under four broad categories, viz, effects physically related to abuse, gynecological problems due to forced sexual intercourse, the psychological effects, and the effects of violence on pregnant women.

1) Physical effects : Apart from the direct effects of violence like physical trauma, fractures and blunt trauma, studies have also linked violence to multiple somatic syndromes, pelvic pain, increased number of surgeries and irritable bowel syndrome. [22] Of considerable interest is the economic loss due to violence. It can result in loss of days of work both to the victim and the perpetrator, thus resulting in loss of wages and direct losses in seeking health care. According to a study from Nagpur, the mean number of days that a woman could not work for wages was 6.88 days; it was 9.84 days for the perpetrator. Taking into account the loss of income from waged work only, the average cost per household was 759.30 per incident, which is a fairly significant proportion of monthly income for laborer households in the slum and rural communities. If the cost of women being unable to complete housework was added, the loss per incident comes to 974.10. The average cost per incident was 1084.50, with a range of 10,000-20,000 for medical care. [20] 2) Psychological hazards: Studies have indicated that women experiencing violence have more chances of suffering from anxiety, depression, post-traumatic stress disorder, suicide, somatic pain syndromes, phobias and panic disorder. [17],[23] Another study indicates that women who are unemployed and experience domestic violence resort to practices like smoking and chewing tobacco. This observation in India is consistent with those in developing countries. Substances present in tobacco, e.g. nicotine, elevate mood and relieve stress. [24]

3) Gynecological: Women whose husbands engage in both physical and sexual abuse have higher odds of reporting gynecologic symptoms like blood after intercourse, vaginal discharge, burning micturition, pain during intercourse, and symptoms suggestive of sexually transmitted infections like foul smelling discharge, lower abdominal pain, and vaginal itching or irritation. This may reflect, in part, the important role of sexually transmitted infections, with husband transmitting infection to his wife through coercive sexual relations; forced sex may lead to vaginal trauma, through direct physical force or a lack of lubrication, which increases the risk of transmission of sexually transmitted infection. The finding that the highest risk of gynecologic symptoms was associated with a combination of physical and sexual violence is consistent with this interpretation. Another possible explanation is that perceived gynecologic symptoms may represent an expression of underlying depression or mental distress. [25] According to a study based on the secondary data analysis of National Family Health Survey III, a higher prevalence of HIV was found among those women who experienced both physical and sexual abuse. [26]

4) Violence in pregnant women: According to a population-based study in Uttar Pradesh, both perinatal and neonatal mortality rates were almost twice as high among women who experienced domestic violence than among women who did not. The association between domestic violence and childhood mortality risks weakens as children age, with both post-neonatal and early-childhood mortality rates no longer significantly associated with mother's exposure to violence. Overall, the risk for infant mortality was 36% higher among mothers who experienced domestic violence compared with mothers who did not. One plausible way of how domestic violence might influence childhood mortality is the effect of violence on maternal health care behaviors during and immediately after pregnancy. [12]


   Available services and challenges Top


Various laws have been enacted for the protection and empowerment of women in India. These include:

  1. The Dowry Prohibition Act, 1961 [27]
  2. The Criminal Law (Second Amendment) Act, 1983 [1]
  3. The Dowry Prohibition (maintenance of list of presents to the bride and bridegroom) Rules, 1985 [28]
  4. The Indecent Representation of Women (Prohibition) Act, 1986 [29]
  5. The Commission of Sati (Prevention) Act, 1987 [30]
  6. The National Commission for Women Act,1990 [31]
  7. National Policy for the Empowerment of Women, 2001 [32]
  8. The Protection of Women from Domestic Violence Act, 2005 [5]
  9. Prevention of Offences (by acids) Act, 2008 [33]
Most services currently available for victims of domestic violence are on the legal front. The main focus is on the secondary and tertiary levels of prevention. The victim faces numerous health problems, which not only affect her, but also the immediate family. Yet, there is a lack of public health-oriented approach. There is also a relative lack of recognition of the problems faced by these women among health care professionals.

A couple of challenges pose difficulties in identifying solutions for domestic violence. First, there is inaccuracy in identifying and quantifying the victims of domestic violence because of the absence of operational definitions adapted for India, incomparability of existing data, and the gender norms preventing women from seeking help. Second, the situation is complicated by the multi-factorial determinants of domestic violence, viz., individual, community and societal factors.


   Recommendations Top


A public health approach emphasizes the primary prevention of domestic violence, i.e. stopping them from occurring in the first place. Until recently, this approach has been relatively neglected in the field, with the majority of resources directed toward secondary or tertiary prevention. Perhaps the most critical element of a public health approach to prevention is the ability to identify underlying causes and determinants, rather than focusing upon more visible "symptoms". This requires development of uniform operational definitions adapted for India and dedicated surveys on the ethical lines suggested by the World Health Organization. [34] Advocacy campaigns should also be built with specific emphasis around high-profile events on the global calendar, such as the International Day for the Elimination of Violence against Women (25 November) [35] and the annual 16 Days of activism against gender violence campaign (25 November-10 December). [36]

Some factors responsible for domestic violence can be prevented by socioeconomic development like female literacy, employment, and by adapting gender equitable policies. This requires an inter-sectoral approach. School-based programs should be evaluated and corporal punishment banned in schools, since witnessing violence as a child has major implications in future.

The public health sector can foster an environment for primary prevention by sharing knowledge and raising awareness about the various issues related to domestic violence. Health providers need to be sensitive to the needs of the victims of domestic violence. Support groups and men's groups should me mobilized for developing a society free of domestic violence.

 
   References Top

1.The Criminal Law (Second Amendment) Act, 1983. Available from: http://www.498a.org/contents/amendments/Act%2046%20of%201983.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 1
    
2.WHO. Geneva: World report on violence and health. Available from: http://www.who.int/entity/violence_injury_prevention/violence/world_report/en/introduction.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 2
    
3.United Nations Declaration on the elimination of violence against women. New York: United Nations General Assembly, 1993. Available from: http://daccess-ddsny.un.org/doc/UNDOC/GEN/N94/095/05/PDF/N9409505.pdf?OpenElement. [Last accessed on 2011 Sep 26].  Back to cited text no. 3
    
4.UNICEF. Innocenti Research Centre. Italy: Domestic violence against women and girls. Available from: http://www.unicef-irc.org/publications/pdf/digest6e.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 4
    
5.The Protection of Women from Domestic Violence Act, 2005. No 43 of 2005. Available from: http://wcd.nic.in/wdvact.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 5
    
6.Centers for Disease Control and Prevention. Georgia: Intimate Partner Violence Surveillance Uniform Definitions and Recommended Data Elements. Available from:  Back to cited text no. 6
    
7.http://www.cdc.gov/Ncipc/pub-res/ipv_surveillance/Intimate%20Partner%20Violence.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 7
    
8.WHO Multi-country Study on Women's Health and Domestic Violence against Women. Initial results on prevalence, health outcomes and women's responses. A summary report. Available from: http://www.who.int/gender/violence/who_multicountry_study/summary_report/summary_report_English2.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 8
    
9.National Family Health Survey III, India. Factsheets. Available from: http://www.nfhsindia.org/factsheet.html. [Last accessed on 2011 Sep 26].  Back to cited text no. 9
    
10.Vachher AS, Sharma A. Domestic violence against women and their mental health status in a colony in Delhi. Indian J Community Med 2010;35:403-5.  Back to cited text no. 10
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11.Rocca CH, Rathod S, Falle T, Pande RP, Krishnan S. Challenging assumptions about women's empowerment: Social and economic resources and domestic violence among young married women in urban South India. Int J Epidemiol 2009;38:577-85.   Back to cited text no. 11
    
12.Babu BV, Kar SK. Domestic violence against women in eastern India: A population-based study on prevalence and related issues. BMC Public Health 2009;9:129.  Back to cited text no. 12
    
13.Ahmed S, Koenig MA, Stephenson R. Effects of domestic violence on perinatal and early-childhood mortality: Evidence from north India. Am J Public Health 2006;96:1423-8.  Back to cited text no. 13
    
14.Koenig MA, Stephenson R, Ahmed S, Jejeebhoy SJ, Campbell J. Individual and contextual determinants of domestic violence in North India. Am J Public Health 2006;96:132-8.   Back to cited text no. 14
    
15.Kumar S, Jeyaseelan L, Suresh S, Ahuja RC. Domestic violence and its mental health correlates in Indian women. Br J Psychiatry 2005;187:62-7.   Back to cited text no. 15
    
16.Peedicayil A, Sadowski LS, Jeyaseelan L, Shankar V, Jain D, Suresh S, et al. IndiaSAFE Group. Spousal physical violence against women during pregnancy. BJOG 2004;111:682-7.  Back to cited text no. 16
    
17.Martin SL, Tsui AO, Maitra K, Marinshaw R. Domestic violence in northern India. Am J Epidemiol 1999;150:417-26.  Back to cited text no. 17
    
18.Varma D, Chandra PS, Thomas T, Carey MP. Intimate partner violence and sexual coercion among pregnant women in India: Relationship with depression and post- traumatic stress disorder. J Affect Disord 2007;102:227-35.   Back to cited text no. 18
    
19.Chandra PS, Satyanarayana VA, Michael P, Carey MP. Women reporting intimate partner violence in India: Associations with PTSD and depressive symptoms. Arch Womens Ment Health 2009;12:203-9.   Back to cited text no. 19
    
20.International Clinical Epidemiologists' Network. Domestic violence in India. A summary report of a multisite household survey. Available from: http://www.icrw.org/files/publications/Domestic-Violence-in-India-3-A-Summary-Report-of-a-Multi-Site-Household-Survey.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 20
    
21.Martin SL, Moracco KE, Garro J, Tsui AO, Kupper LL, Chase JL, et al. Domestic violence across generations: Findings from northern India. Int J Epidemiol 2002;31:560-72.  Back to cited text no. 21
    
22.Dalal K. Does economic empowerment protect women from intimate partner violence? J Inj Violence Res 2011;3:35-44.  Back to cited text no. 22
    
23.Sarkar M. A study on domestic violence against adult and adolescent females in a rural area of West Bengal. Indian J Community Med 2010;35:311-5.  Back to cited text no. 23
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24.Drossman DA. Abuse, trauma, and GI Illness: Is there a link? Am J Gastroenterol 2011;106:14-25.  Back to cited text no. 24
    
25.Ackerson LK, Kawachi I, Barbeau EM, Subramanian SV. Exposure to domestic violence associated with adult smoking in India: A population based study. Tob Control 2007;16:378-83.  Back to cited text no. 25
    
26.Stephenson R, Koenig MA, Ahmed S. Domestic violence and symptoms of gynecologic morbidity among women in North India. Int Fam Plan Perspect 2006;32:201-8.   Back to cited text no. 26
    
27.Silverman JG, Decker MR, Saggurti N, Balaiah D, Raj A. Intimate partner violence and HIV infection among married Indian Women. JAMA 2008;300:703-10.   Back to cited text no. 27
    
28.The Dowry Prohibition Act, 1961 (28 of 1961). Available from: http://wcdhry.gov.in/Women_Acts/Dowry_Act.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 28
    
29.The Dowry Prohibition (maintenance of list of presents to the bride and bridegroom) rules, 1985. Available from: http://indianchristians.in/news/images/resources/pdf/dowry_prohibition_rules_1985.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 29
    
30.The Indecent Representation of Women (Prohibition) Act, 1986. Available from: http://www.womenstudies.in/elib/legal_resources/lr_the_indecent.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 30
    
31.The Commission of Sati (Prevention) Act, 1987. No 3 of 1988. Available from: http://indianchristians.in/news/images/resources/pdf/commission_of_sati_prevention_act_1987.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 31
    
32.The National Commission for Women Act, 1990. Available from: http://ncw.nic.in/PDFFiles/NCWACT.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 32
    
33.National Policy for the Empowerment of Women, 2001. Available from: http://wcd.nic.in/empwomen.htm. [Last accessed on 2011 Sep 26].  Back to cited text no. 33
    
34.Prevention of Offences (by acids) Act, 2008. Available from: http://ncw.nic.in/pdffiles/offences_by_acids.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 34
    
35.WHO. Geneva: Putting women first. Ethical and safety recommendations for research on domestic violence against women. Available from: http://www.who.int/gender/violence/womenfirtseng.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 35
    
36.United Nations. Resolution adopted by the general assembly [on the report of the third committee (a/54/598 and corr. 1 and 2)] 54/134. International day for the elimination of violence against women. Available from: http://www.uneca.org/daweca/conventions_and_resolutions/Resolution%20international%20day.pdf. [Last accessed on 2011 Sep 26].  Back to cited text no. 36
    



 
 
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