Domestic Violence as a Significant Concern Worldwide

Domestic violence (DV) is a significant medical, public health, and societal concern worldwide. Total annual healthcare costs related to domestic violence run into the billions in the USA. An understanding of the relationship between physical violence during pregnancy, its adverse effects on fetal and maternal conditions, and birth outcomes are very important. Its early diagnosis, measures, and interventions can reduce adverse pregnancy outcomes.

Understanding the causes of domestic violence is substantially more difficult than studying a disease. The disease usually has a biological basis and occurs within a social context but domestic violence is entirely a product of social context. Consequently understanding the causes of such violence requires research in many social contexts. Most diseases can be investigated with various objective measures, but the measurement of intimate partner violence has posed a challenge. Furthermore, measurement of social conditions thought to be risk factors, such as the status of women, gender norms and socioeconomic status poses difficulties, especially cross-culture. Although a consensus has emerged on the need to explore male and female factors and aspects of the dynamics of relationships, this has been done in very few studies.

Many researchers have discussed domestic violence as a learned social behavior for both men and women. The intergenerational cycling of violence has been documented in many settings. The sons of women who are beaten are more likely to beat their wives and in some settings, the daughters of women who are beaten are more likely to be beaten as adults. Women who are beaten in childhood by their parents are more likely to be abused by their intimate partners as adults.

Experience of violence in the home in childhood teaches children that violence is normal in certain settings. In this way, men learn to use violence and women learn to tolerate it or at least tolerate aggressive behavior. Cross-cultural studies of domestic violence suggest that it is much more frequent in societies where violence is usually in conflict situations and political struggles. An example of this is South Africa, hare not only is there a history of violent state repression and community insurrection but also violence is deplored frequently in many situations including disputes between neighbors and colleagues at work. Verbal and physical violence between staff and patients in health settings also vary common and contributes to violence being accepted as a social norm.

Many cultures Condon the use of physical violence by men against women in certain circumstances and within certain boundaries of severity. In these settings so long as boundaries are not crossed, the social cost of physical violence is low. The tolerance may result from families or communities emphasizing the importance of maintenance of the male, and female union at all costs, police trivializing reports of domestic strife, or lack of legislation to protect women. Violence against women is a demonstration of male power juxtaposed with the lesser power of women. Where women have low status they often lack the necessary perception of self-efficacy and the social and economic ability to leave a relationship and return to their family or live alone and thus are severely curtailed in their ability to act against an abuser. Women might also have no legal access to divorce or redress for abuse. Conversely, at higher levels, the empowerment of women protects against violence. Domestic violence is increased in settings where sanction against abusers is often also low. Childhood experiences of violence in the home reinforce for both men and women the normative nature of violence, thus increasing the likelihood of male perpetration and women’s acceptance of abuse.

Only recently recognized as a major woman's health issue, domestic violence has a long, dark past and is firmly entrenched in many societies. DV is identified as a global human right issue against women.

The percentage of women who were physically victimized by their partner or husband in Barbados is 30 percent. In the USA 25 percent of women are sufferers of violence by their intimate partner every year. Domestic violence prevalence in Canada is 29 percent, New Zealand 35%, Switzerland 21%, Egypt 34%, Tanzania 41%, South Africa 42%, Australia 15%and in Spain it is 32%. Some surveys in specific places report figures as high 50-70% of women who were ever physically assaulted by an intimate partner. In Mbeya, more than 56% of women are victims of domestic abuse by their partners. In Ethiopia, the prevalence is 71%.

There are cases of bride burning occurs after every two hours in India due to a small dowry or so that their husband can remarry. In Bangladesh, beating is common and often justifiable and it is up to 76%. In the Pakistani male dominant society, the prevalence is as high as 90 percent. Four women daily are killed due to dowry-related issues by their husbands or in-laws in Pakistan and there are a number of cases which are under reported(HRCP). Stove burning is a popular form of domestic violence in Pakistan. Pakistan is home to the possessed stove which burns only young housewives (Progressive woman Association). Other frequent form of domestic violence are assault/battering, acid throwing, Vani, Swara, child marriages, incest, illegal confinement, and murder. Another common form of violence against women in Pakistan is acid burning. Fifteen thousand cases of acid burns in the last ten years in Pakistan. 

There are many dangerous effects that domestic violence can produce upon the physical, mental, and social life of women. Domestic violence during pregnancy can be missed by medical professionals because it is often present in a non-specific way. Research conducted in a number of countries to statistically calculate domestic violence in pregnant women shows a number of presentations such as delay in seeking care for injuries, late booking, self-discharge, frequent attendance, vague problems, and aggressive or over solicitous. Partner, burns, pain, tenderness, injuries, vaginal tears, bleeding, STDs and miscarriage. The prevalence of domestic violence in pregnant women in the UK is 3.4%, in USA 3.2-33.7% in Ireland 12.5%. Studies conducted in the Arab countries show that about. One out of three women is beaten by her husband. Domestic violence can also affect the fetus and subsequent child. Physical violence is associated with neonatal death.

The experience of violence and abuse during pregnancy deserves special attention. In spite of the prevalence of violence experienced by women, and its damaging impact on women's health and mental health, few studies have attempted to identify the factors associated with violence during pregnancy. Minimal research on mental health outcomes of DV from a reproductive health perspective in Pakistan. Feedback to healthcare personnel to screen DV and Stress during antenatal visits. Evidence-based information for reviewing policies and implementing policies related to DV

Research on the psychological effects of domestic violence on women extensively documented the harm such violence causes. Battered women experience increased levels of depression, low self-esteem, and higher levels of psychological distress when compared with nonbattered women.

Herman focused on the traumatizing aspects of violence and trauma symptoms exhibited by battered women. She theorized that many battered women suffer from a complex traumatic syndrome that is similar to the diagnosis of PTSD(APA) but includes additional symptoms, including anxiety, depression, idealization of the perpetrator, and dissociation due to the chronic nature of trauma. Thus, this conceptualizing of trauma argues for a much broader understanding of traumatic symptoms than the DSM-IV suggesting that all aspects of psychological distress seen in trauma survivors are part of a trauma syndrome.

Herman also describes the dynamics of the abusive situation. While suggesting that battered women suffer character logical changes in personality which leave them vulnerable to repeat harm. She emphasized the perpetrator’s action rather than the women’s pre-morbid psychological functioning as the reason for these changes. She argued that typically the perpetrator gains control over the women’s body through deprivation of sleep, food, or shelter. He then becomes the potential source of solace when he grants small indulgences. Herman reported that this dynamic greatly diminishes the women's ability to initiate action. The women‘s traumatic reaction to the physical and psychological abuse may be the mechanism through which many aspects of the battered women‘s functioning may become impaired. Herman argues that strong social support can protect women’s functioning in traumatic situations. She also argued that a history of abuse from childhood makes women more psychologically vulnerable.

Several studies have demonstrated the relationship between violence and mental health among women in general. For example, Kumar et al. (2005) reported that physically violent behaviors (e.g., ‘slap,’ ‘hit,’ ‘kick,’ or ‘beat’) doubled the relative risk of poorer mental health of abused women compared with women who had not reported any IPV. As in earlier studies (McCauley et al., 1995; Flanzer, 1993), Kumar et al. also observed that women who (a) experienced dowry harassment or harsh physical punishment during childhood, (b) witnessed their father beating their mother, (c) whose husbands regularly consumed alcohol, and (d) experienced physical violence at home were at increased risk of poor mental health. High school education for both the woman and husband and more social support served as protective factors. An earlier study from India has also reported that women faced with enormous social, physical, and economic stressors in association with IPV were more likely to have higher levels of depression in the postpartum period.

Few studies have assessed the relationship between IPV and depression during pregnancy. Smith et al. (2004) reported on psychiatric morbidity among women attending prenatal clinics and found that women with a lifetime history of IPV were more likely to present with a psychiatric disorder. Leung, et al., (2002) described an association between IPV and postnatal “blues”/depression in China. Patel et al. (1999)conducted a community study in India and found that domestic violence was a strong predictor of antenatal and postnatal depression. Mezey et al. (2005) assessed 200 women receiving postnatal or antenatal care at a South London maternity service, and reported that 121 (60.5%) women reported at least one traumatic event, two-thirds of these had experienced multiple traumatic events and, of the latter, 23.5% had experienced domestic violence. They also found that physical and sexual abuse co-occurred: 13 (10.7%) women with a trauma history had current PTSD. Severe PTSD symptoms were associated with physical and sexual abuse histories and repeat victimization.

The evidence suggests an association between IPV violence and adverse mental health outcomes and a relationship between pregnancy and IPV, as well as some suggestions that culture might influence IPV. That is, pregnant women in traditional societies — where gender inequalities are evident — might be even more vulnerable to IPV. Research is needed to clarify the relationship between the different forms of IPV (i.e., psychological, physical, and sexual violence) and mental health outcomes, especially in the developing world where relatively little research is available. Therefore, this study provides evidence regarding (a) the prevalence of IPV during pregnancy, and (b) the relationship between IPV and mental health outcomes (i.e., depressive, somatic, and PTSD symptoms) in a sample of pregnant Indian women.

Physical violence during pregnancy is the second leading cause of trauma during pregnancy, after motor vehicle accidents. 

Domestic violence during pregnancy can be missed by medical professionals because it often presents in non-specific ways. A number of countries have been statistically analyzed to calculate the prevalence of this phenomenon. From a public health perspective, an important question is that of risk. If being pregnant increases the risk for violent victimization, then certain interventions are warranted. For the most part, however, the majority of the researchers examining pregnancy-related violence use small samples of either postpartum women or women attending a prenatal clinic without a comparison group of women who are not pregnant.