Domestic violence against women in Egypt—wife beating and health outcomes
Introduction
Attention to the issue of violence against women, of which domestic violence is a component, has been growing over the past few decades. Research all over the world has consistently indicated that a woman is more likely to be injured, raped or killed by an intimate partner than by any other person (Heise, Ellsberg, & Gottemoeller, 1999; UNICEF, 2000; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002).
Domestic violence, or intimate partner violence (IPV), is an important cause of morbidity and mortality for women in every country where these associations have been studied. It results in acute medical conditions such as multiple injuries to the face, head, neck, breast, or abdomen, and in chronic conditions such as headaches, abdominal pain, pelvic pain and sexual dysfunction (Campbell, 2002; Ellsberg, 1997; Gelles & Straus, 1998; Goodman, Koss, & Russo, 1993; Karol, Micka, & Kuskowski, 1992; Martin & Younger-lewis, 1997; Nduna & Goodyear, 1997). Intimate partner violence is also associated with lowered self-esteem and lowered self-perception of health by the victims (Amoakohene, 2004; Baker, 1997; Ellsberg, Caldera, Herrera, Winkvist, & Kullgren, 1999; McCauley et al., 1995; Skupien, 1998).
Domestic violence has serious reproductive health consequences, including inability to use a contraceptive method at all or consistently, unwanted pregnancy, and increased levels of sexually transmitted infections and HIV/AIDS. Even the period of pregnancy is not protective (Blaney, 1998; Diop-Sidibé, 2001; Gazmararian et al., 2000; Jejeebhoy, 1998; Maman, 2000; Letourneau, Holmes, & Chasedunn-Roark, 1999; Martin et al., 1999; Parsons, Goodwin, & Petersen, 2000; Rickert, Wiemann, Harrykissoon, Berenson, & Kolb, 2002; Sharps & Campbell, 1998). Of course the most extreme physical consequences of this type of violence are death of the victim, by suicide or homicide, and homicide against the perpetrator (Breiting et al, 1989; Wilson & Daly, 1994). Although the associations of IPV and detrimental health outcomes have been well established in research from industrialized countries, they have seldom been studied in developing countries. Similarly, despite the fact that IPV against men is known to occur in the USA, there is almost no research on the phenomenon in developing countries. In addition, the research has been almost entirely cross sectional, with the pathways from violence to chronic physical health and reproductive problems poorly understood.
The consequences of domestic violence do not affect the victims alone. Studies have found that children who grow up in families with such violence are more likely to have strong feelings of helplessness, anger, shame or guilt (Davidson, 1994; Ellsberg, 1997). They are also more likely to be victims of abuse and to become abusive themselves. In fact, the cost is high and borne by the whole society (Day, 1995; Friedman, Tucker, Hartman, & Stark, 1997; Heise et al., 1999; (The) Hesperian Foundation, 1998; Karol et al., 1992; MacCulloch, 1997; Michau & Naker, 2003; SADC, 1998; UNICEF, 2000). First, it may cause people to believe that violence is a reasonable way to solve problems. Second, it can sustain the false belief that men are better than women, and that women deserve to be beaten. Third, everyone's quality of life suffers because the participation and productivity of abused women in social and economic activities are lessened. And fourth, the monetary costs are very high. For example, UNICEF (2000) reports annual estimates of 5–10 billions dollars for the USA, and these are only for direct service-related costs. Significant costs are also estimated in developing countries (World Bank, 1993).
Despite the importance of the problem, the number of studies with nationally representative samples in either North or Sub-Saharan Africa is limited. One exception is the Egyptian Demographic and Health Survey (EDHS-95) conducted in 1995 by the country's National Population Council and Macro International Inc (El-Zanaty, Hussein, Shawky, Way, & Kishor, 1996).
There are many types of domestic violence against women, including psychological (e.g. controlling behavior, economic abuse, social isolation), physical, and sexual abuse (Counts et al., 1999; Haj-Yahia, 2000; Heise et al., 1999; Michau & Naker, 2003). However, EDHS-95 only addressed wife beating (physical abuse). While the prevalence of wife beating1 was analyzed and published in the EDHS-95 report, the associated health consequences were not examined. The present study used the EDHS-95 data to examine the association among currently married women between wife beating and contraceptive use, pregnancy management, and report of health problems and illnesses requiring a visit to the doctor.
Section snippets
Data and methods
EDHS-95 was a nationally representative household survey of ever-married women age 15–49 selected using a multistage sampling technique. Survey questionnaires were administered face-to-face by female interviewers. The overall response rate to EDHS-95 for eligible women exceeded 99% in all areas (El-Zanaty et al., 1996).
In addition to the main survey instrument, a special module on women's status was administered to a sub-sample of women in one-third of the households in 24 of the 26
Results
Table 1 presents selected background characteristics of the women in the research sample. Most of them were rural Muslim women age 25 to 39 with an average of four children ever born. They had generally no or little formal education and did not work for pay. Their husbands were also generally middle-age men with no or little formal education. Table 1 also compares the women in the research sample to those who only responded to the main survey. Despite some statistically significant differences
Discussion
This research is the first to examine the association between wife beating and health outcomes in Egypt from a nationally representative sample of currently married women. It confirms that, as elsewhere, wife beating is prevalent in Egypt. For example, compared to available data from North and Sub-Saharan Africa, the prevalence of beating in the past year among currently married women in Egypt (16%) is lower than the 52–54% reported among Palestinian women in the West Bank and Gaza (Haj-Yahia,
Acknowledgements
This work was supported by the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. The authors thank Dr Andrea Gielen and Dr Michael Koenig for their comments and suggestions, the National Population Council of Egypt, the staff of Macro International Inc., and the thousands of Egyptian women who spent time sharing the details of their lives.
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