Intimate partner abuse (IPA) or intimate partner violence (IPV) is historically known as spouse abuse or domestic violence. All four expressions talk of violence posed to a person or people, to simplify for readers I am going to use the term intimate violence abuse (IPA), however I will interchangeably use other expression like domestic violence or spouse abuse when necessary. To understand IPA let us look at the word Violence. Violence is the physical force or power threatened intentionally against oneself, another person, a certain group or community, often violence results to injuries, death, psychological damages (Allen, M 2013).
Interpersonal or domestic violence is between individuals often in-home settings, it occurs over a period, it is done with the intention to coerce or dominate. Therefore, IPA refers when a person in a relationship intentionally hurts the partner either physically, sexually or emotionally, often in a domestic setting such as marriage or cohabitation, the relationship can be a heterosexual or of same-sex couple. IPA is often caused by the husband or ex-husband, the current boyfriend or ex-boyfriend, at times it can be the woman who is the abuser in a relationship (Wallace & Roberson 2015), The two authors gives further description of physical, sexual and emotional abuse as described below.
Physical abuse is when using physical aggressive behaviour intentionally with the potential to cause disability, injury, death or physical harm. Physical abuse can be kicking, biting, shoving or throwing things, choking, shaking, slapping, use of weapon, punching burning or restraints, holding the victim hostage, pulling hair, in the worst scenario it can be acid attack as it is well known in Pakistan, study shows that acid-attack victim are 70% women and 30% men and boys (Zia, T 2013)
Emotional/Psychological violence can be controlling what the partner does, threatening to cause harm and destructions or yelling, humiliating the victim, isolating her from the family and friends to gain full control of her, withholding information, threatening to kill or kidnap the children, looking at the phone calls to investigate whom she spoke to.
Sexual abuse is categorized into three categories: The first one is to use force to make a person to engage in sexual act against his/her consent. The second one is to take advantage of a person who is unable to understand and engage him/herself willingly in a sexual act, example can be if the victim is ill, influenced by alcohol or drugs. The third type of sexual abuse is using words/gesture/weapon to cause disability, death, injury or physical harm through sexual violence (Wallace & Roberson 2015).
We must look back into the Pakistan history and find out how the social structure came to be today.
In south Asia religions like Buddhist, Hindu, Islam, and Christian has shaped the personalities of women and social status in societies. As for Pakistan an Islamic nation women had high status and were respected, they had a status like men. They excelled in Scholarship, medicine, and warfare. There was a blend of Moslem and Hindu in the Mughal Era. This Era lasted for 600 years in this part of South Asia. Many women had professions such as eminent scholar, Philosophers, writers, poets. Education was for all regardless of gender (Hasan, 1982). but the rigid culture and patriarchal attitudes devalued the position and role of women. British rule saw a turning point to Mughal Era, Closure of Maktabs (elementary school) affected many women especially in the rural area, skill training was discontinued, Cheaper man-made products came into the market such as cotton clothes and rubber. A vast majority of women became unemployed and were confined of their homes According to some historians, in 1847 there was 90% literacy among women which was reduced to 12% in 1947.
In most of the country today Islam is misinterpreted by a semi or uneducated maulanas (Islamic priests). Maulanas interpretation leads to inequality and subjugation of women. It denies women their rights of inheritance, divorce, and marriage. All these interpretations are completely contrary to Islamic teachings. This led to women being totally marginalized. Today there are many treaties endorsed by the United Nation (UN) to enhance women’s right, the equal right of men and women. Some example is the Vienna Declaration, 1993, Declaration of Beijing 1995 all these treaties were signed because women’s economic, social and cultural rights were neglected. Women in Pakistan face multiple types of violence such as sexual violence, domestic abuse, honour killings, torture, and custodial abuse (Niaz, U 2003)
Pakistan an Islamic country in South Asia sub-continent, bordered by India, Afghanistan, China and Iran. It has a population of 197 Million people (2017), Majority being Moslem (95%), there are minority religion such as Hinduism, Christianity and Sikhism. Karachi is the largest city in Pakistan which comprises of 9,3 million people. Nearly 40% of its population living below poverty line, Karachi presents a heterogenous population with various classes (working class, jobless, business people, millionaires) and ethnic groups.
Women across the planet face different demanding situations based totally on the country, religion and tradition of the very country they live in, challenges are greater complex and trickier in the growing countries. Pakistan is one of the countries wherein cultural stereotype and discrimination towards women and girls is widely practiced, that is wherein men are the authority and ladies are subordinate to follow and obey rules of the men.
Pakistan a patriarchal society dominated with gender inequality and human proper violation towards girls and women in all levels, the narrow-minded society offers no chance for women to expand or prosper, the extent of education amongst women is extensively low dwelling in a terrible health scenario as compared to privileged men, more than 50% of the whole women in Pakistan lack basic education while vast majority are confined at home to do household work (Ali & Bustamante Gavino 2007). Example, the social constrain makes it impossible for the inclined women to do commercial enterprise since she should get permission from the male to qualify for a loan. Pakistan one of the least gender equitable country in South Asia vicinity, out of 169 countries, Pakistan is ranked as 125th, on Gender Development Index (GDI), and out of 109 countries Pakistan is ranked 99 on Gender Empowerment.
Gender-based violence is a critical practice cutting across Pakistan, setting women in a mental and bodily problems. Gender discrimination is implemented all the way from pre-natal sex choice to dowry abuse to intimate partner abuse and marital rape. (Ali et al. 2011).
Just like any other part of the world there is a wide spread of domestic violence in this community, domestic violence is common in all societies across the planet despite religion, ethnicity or location. As a person responsible to stop this inhuman violence in Karachi I will work hard along with other authorities such as the local government, police force, neighbourhood and human right to make a holistic approach for a smooth and effective solution.
First and foremost, we must see how this phenomenon is spread in this city, by looking at earlier studies carried by practitioners and other disciplines. We will look at three different studies. Two studies show how exposed women are and one shows the attitude of men towards domestic violence.
A study was conducted in Karachi on women before and during pregnancy to find out if there was domestic violence. There was various type of women, educated, illiterate, those working outside home and those who were at home, also there were those with children and those without. The method used was, questionnaire was structured and administered to 300 women in a public tertiary hospital (Fikree et al. 2006). The study showed that 44% of women suffered marital physical abuse, 132 women were physically abused, of 300 women 36% reported sexual coercion and 23% suffered from domestic violence during pregnancy, talking about pregnancy it was stated by (Wallace & Roberson 2015; Allen, M. 2013) that pregnancy may contribute to domestic violence, moreover (Mezey et al. 2006) confirmed the theory that during pregnancy domestic violence might commence and escalate since the male partner may feel neglected to some extent, however, in some cases women might experience a decrease level of violence during pregnancy. 55% of the 300 women experienced antenatal care clinic as a good place to source and inquire information about domestic violence. It is estimated that about one million Pakistani pregnant women are abused at least once during the period of pregnancy.
A survey conducted on 1000 women in Punjab showed that 35% of women were beaten by the husband. The report showed that at least two women were burned daily, 90% of women were abused. 282 cases of burn were reported from one province in 1998. 65% of the 282 victims died from the injuries, while in the same year 1998 1974 women including 885 cases was reported from one province of Pakistan. Between 1998-2004 about 4000 people among others 2800 women were killed due to honour killings. Before 1998 in Larkana, Sindh there were 86 honour killings and 53 of the victims were women. The figures disclose how enormous violence against women is. Pakistan is the third most dangerous country for women after Afghanistan and Democratic Republic of Congo (Ali & Gavino 2008).
Another study was carried on 176 men who were married 5 years and more, over 50% of the men had been a little more educated than their wives. Majority of the men were poor. 94% had abused the wife verbally during domestic dispute, 49.4% had used physical violence towards their spouse, some of physical abuse were hitting, slapping and punching. Among 176 men 45 of them reported injuries that their wives sustained, such as bruises and fractures. 76 men reported engaging in non-consensual sex with their wives, 55% of men were subjected to violence during their childhood and 65% had witnessed their mother being beaten by the father. The study further revealed that men who are poor were three times more to abuse their wives compared to those who are not poor, similarly illiterate wives were five times at risk of being abused by their husbands compared to their educated peers. Close related couples had higher chance of experiencing physical abuse in their marriage, Men who has experienced violence during their childhood are five times more likely to abuse the spouse (Fikree & Bhatti 1999).
The magnitude of domestic violence in Karachi is a public health problem in an epidemic level and has been practised over the centuries just like any other cities across Pakistan and the world. Initially it was not considered as a problem and it was expected to be resolved within the family or community, however more and more attention is now given to domestic violence at the same time it is now recognized as a social and public health and human right issue. Now even the government is fully aware and can intervene when necessary because it is an obligation (Fikree et al. 2006). Domestic violence is slowly emerging as a public health problem around the world, yet in developing world there is a lack or poor documentation regarding data focused on domestic violence, today people begin to recognize and pay high attention to it as a negative trend. (Ali, 2007)
There are some factors that may entail to domestic violence in Karachi and Pakistan as a whole, such as vast majority of women having low educational level. Women and girls are less or not empowered, Pakistan politics is mainly man dominated not letting in female politicians in the arena, Misconception about religion, honour misconception, poverty, dowry system, male superiority and alcohol & drugs. I will briefly explain these concepts to understand the whole mechanism.
Studies found that poverty is one reason which leads to domestic violence, often it is the male family member who are bread earners, more often the expenses exceeds income in the family and this economic stressor may lead to abuse because the provider may get depressed and frustrations. It is even more likely to happen if the family lives in an extended family fashion. Another study shows that out of 400 women 65% had conflict with their husbands due to financial issues, the men are frustrated because they could not meet the house hold needs (Fikree & Bhatti, 1999).
Misconception between cultural, tradition and Islamic teachings also causes domestic violence, to avoid shame and humiliation of the society many families are strict to their daughters, therefore women and girls are restricted from outside activities by their parents and partners. Often it is said they provide security to the girl/woman according to Islam; however, Islam does not prohibit girls/women to achieve education and empowerment (Ali 2007).
Studies show women are suppressed by the husband and the society, women have significant limited chances of attending education and getting employment. The Pakistan traditional norms such as Purdah (Purdah means curtain and this tradition segregate women by keeping them within home settings) which limits the mobility of women and their basic rights (Ali 2007)
Despite Pakistan being an Islamic nation, a vast majority of people drink alcohol to relieve the tension, often drunk men are more likely to become angry easily. Due to poverty and economic stress many men who are bread earner choose to do drugs to numb the pain, this makes their wives and family prone to abuse act by the addicted men. Consumption of alcohol and drugs entails to the man becoming aggressive violent toward the wife and the children, Pg 30
Dowry is an amount of money or expensive material such as Jewellery that is given to the bride by the groom as a gift and symbol of unity between the two partners, at times the groom might mistreat the women because the money paid is a lot, yet the women is not fulfilling the expected performance such as house hold work. The woman is trapped in a hopeless situation because her parents would not encourage her to return home fearing stigmatizing as a divorcee. If she leaves the abusive husband her parent would be forced to repay back husband’s loss, often it is difficult for the parents due to poverty and shame. This situation can escalate into harassment and physical abuse to the woman who cannot leave the batterer behind. Dowry related issues is wide spread across Pakistan, Pg31.
Vast Majority of the abused victims in Pakistan do not have legal recourse, and there is no law enforcement authority to conduct justice for victims, since the law enforcement does not consider domestic violence as a crime, for that reason the law enforcement does not register cases of these types. Moreover, most women are reluctant to report domestic violence to the police or responsible authority because they find it difficulties to disclose the abuse due to the perception of shame, blame, and fear, some women feel disloyal to their husband. Poor economy is another factor that makes many women not to leave violence relationship, even if they dare to, there is no shelter they can turn to and the family she comes from are not willing to take her back since she belongs to another family and it is big shame to have a divorcee at home (Jewkes et al, 2002).
According to World Health Organization (WHO) a Multi-Country study showed that abused women have poorer self-esteem and health, they had significant emotional distress and at times suicidal thought compared to women who have not been abused, Women who experience domestic violence during pregnancy are likely to have postnatal depression and they risk to encounter complication when giving birth (Madhani et al, 2017). Further studies reveal that domestic violence can cause even more and severe injuries such as, gastro-intestinal problems, fractures, vaginal lacerations, sleeping disorders, sexual dysfunction, genital infections, skeletal deformation, post-traumatic stress disorders (PSTD) depression and anxiety, (Ali 2007). How does domestic violence affect children? Explanation to come.
Daniel et al. 2010 stated that Children who witness marital violence at home are more likely to become more vulnerable, they can develop emotional and behavioural issues such as anxiety, low self-esteem, depression, they perform poorly at school, they experience nightmares and can be disobedient. Battered women in domestic violence can develop depression, significant longstanding psychiatric problems which can in turn affect parent-child relationship. Studies show that Children under 12 years growing up in marital violence environment can develop learn, emotional and behavioural problems 6-7 times more compared to children who do not experience abusive parents.
As mentioned earlier that studies show pregnancy can trigger violence from men, and when a child is born, the battered woman/mother must take care of the child in a violence home setting. Risk is therefore bigger that she develops psychological problems which makes her unfit to care for the baby. An emotionally neglected baby not getting a secure attachment the first two years, can have difficulties to develop relationship with other children, family member, teachers. That child can grow up emotionally and psychologically unstable. If nothing is done, after they grow up, they can have difficulties to trust their spouse after marriage and they can become aggressive against their children (Daniel et al. 2010; Parrish, M 2010). As social workers we must therefore break this vicious circle. Intervention follows.
After accounting all the devastating wide spread social problem in Karachi and Pakistan as a whole, it is about time to come up with a holistic approach to get the best information out of victimized women, the multi-agency working with the domestic violence in Karachi should be given correct awareness, willingness and knowledge, this will make our intervention more effective when attending potential victims who are mainly girls, women and pregnant women. A good example can be during visit to midwife it would be good to screen pregnant women to find out if they have been subjected to any type of violence. Screening routine which mainly is to pose questions professionally has shown to be accepted and welcomed by many women (Gazmararian et al, 1996). But all these multi-agencies such as social services, Voluntary agencies, health professionals, legislation, victim support service and criminal justice system should be supportive, non-bias, non-judgemental and honest towards the victim. Interventions is now to follow.
Another method is to use an intersectional lens to identify how women experience trauma and difficulties to enjoy the resources. With a good analytical framework, we can organize and give service to meet the multiple forms of oppressions and structural violence. All victims are not same therefore approach and service given to victims will be specific. Through intersectionality approach we would be able to distinguish the problems and intervention.
Public health interventions for domestic violence may be given through three characterised tiers of prevention. The first prevention in which positive steps are taken to prevent violence from taking place, this can encompass awareness applications both for girls, women and other society members to avoid domestic violence. Second prevention is focused on immediately reaction to violence, which also includes care given by the nurses before gaining access to hospitals and emergency room. Nurses specifically can play the vital role inside the preliminary evaluation and presenting mental support to buttered women to save them from psychiatric disorders such as depression. The third type is further prevention which is focused on long-term care of the sufferers, this includes rehabilitation and reintegration, and measures to lower the possibilities of reoccurrence of any kind of similarly abuse on women. Over all, there are 3 types of preventive measures related to assist victims in their critical situation which are subjected to domestic violence. in addition, more, interventions ought to be designed to work with girls and women who know themselves better and their choices (Ali & Khan 2007).
All health programme across Pakistan should customized in a uniformly proper screening system to detect all kind of domestic violence at all levels. There should be availability of adequate emergency treatments to meet the victim’s needs and along there should be good rehabilitation facilities. Domestic violence should be a well-known phenomenon by all health professionals, that includes preventive measures, treatment and facts about IPA. Crisis centres should be present across the nation including Rural Health Centre (RHC), Basic Health Units (BHU) and tertiary hospitals. All the facilities suitable for domestic violence should be easily accessible and there should always be specialized health care professionals to all the victims (Ali & Khan 2007).
The government should organize and conduct an awareness programmes for men, women and girls through the help of nurses, doctors and psychologists, regardless if the health professionals work under the government or non-governmental organizations NGO’s. The awareness can either be done directly or indirectly. Further explanation of direct and indirect is: the personnel can have a one to one counselling, teaching or can organize a group-based teaching to several participants, while indirect method can be using the media, role plays, pamphlets, talk shows or drama (Ali & Khan 2007).
The local government backed with the government should have a central committee that includes religious leaders, and scholars who should give religious definition of the basic right of women and girls, for instance freedom and autonomy. All local government through Pakistan should ensure that all the citizens follow and practice the main themes defines by religious committee (Ali & Khan 2017; Zia, T 2013)
A family-based model is a good program to terminate domestic violence, men should be involved in the gender violence program to curb violence. It is good to make men understand that they are also an important element of the situation and they can work as a family. In Honduras, Nicaragua and Bolivia male were included in the program and it showed significant improvement. Family model approach will make the whole family cooperate for a peaceful future (Zia, T 2013).
Nurses and doctors should work together with the police force at the police centres to offer a good complete service to the victims of IPA, there should be female police officer to handle victims of domestic violence both at home settings and at the police station as this would create
a sense of safe, trust and protection to the victims. Recreational centres should be available for the women who spent a great deal of their time indoors, (Ali & Khan 2017)
Domestic violence is significantly high in Pakistan, women are subjects to various abuse such as physical, sexual and psychological either by the husband, in-laws and in a few instances by brothers or parents. Factors leading to domestic violence such as the women having low-economic status and there is a lack of domestic violence awareness, lack of education, male dominancy, issues based in imbalance, lack of help from the government, these factors keep women in an intersecting barrier. In respond to these factors one must combat the problems by integrating several social players to reinforce the interventions and programs. Gender equality mentality and Gender empowerment is a new concept in south Asia therefore resistance is to be expected and the social workers must be persisted. Women must get a chance to have group therapy where they can share the experience. Activities should be available for girls and women as protective factors at the same time to reduce vulnerability.
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