Journal of Obstetrics and Gynaecology, November 2005; 25(8): 772 – 775

Gender and sufferings

S. CHHABRA

Department of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India

Summary
The World Health Organization describes violence against women, as the most pervasive yet least recognised human rights
abuse which cuts across geographical, racial, social and economic boundaries in the world. In the present study of the 2000
women interviewed, nearly 50% reported having been physically assaulted. Age, education or socioeconomic status did not
change anything but more women from nuclear families were assaulted (52%) compared with other group. Some 68% of
women were assaulted by husbands and 7% by multiple perpetrators. The reasons for assault varied. Nearly 60% of those
assaulted had informed someone and in around 65% of cases someone had tried to help, but in only 50% of those where help
was offered, was the situation improved. The complex problem of gender violence needs to be remembered while providing
healthcare because it is common. Women need to be aware of their rights and possible help. We need to progress towards a
civilised society with gender equality and no violence.

Introduction The questionnaire had mostly direct yes or no questions,

The World Health Organization (WHO) describes violence
against women as the most pervasive yet least recognised
human rights abuse which cuts across geographical, racial,
social and economic boundaries in the world (Heise and
Garcia-Moriers 2002). The recent results of 10 studies from
10 countries have confirmed that gender-based violence is a
serious public health problem and is an extreme manifesta-
tion of gender inequity (Velzeboer et al. 2003). The problem
breeds in silence and finds legitimacy through cultural
norms. It is believed to be as common as many diseases for
which routine screening is offered.
In the UK, the lifetime prevalence of domestic violence is
one in three to four women with annual prevalence rate of 1
in 9 – 10 women (Bacchus et al. 2001).
Violence is increasingly being recognised in India as a
major public health problem with serious consequences. We
have tried to look into this issue. The aim was to know the
extent of physical violence and its relation to variables such
as age, education, socioeconomic status, type of family and
action taken.
Materials and methods
A total of 2000 female health seekers (excluding women
who were seriously ill or reporting with emergency obstetric
or gynaecological problems), with their accompanying
friends and relatives, were the study subjects. They were
selected randomly. It took nearly 10 months to collect the
information. The women were asked questions by the
social worker assigned to the task, with the help of a
pre-designed and pre-tested proforma, in the local
language. The interviewer explained the reasons for
collecting the information and confidentiality was assured.
followed by reasons, as open ended questions.
The subjects were aged between 15 and 65 years and
represented all socioeconomic groups. Socioeconomic
class was graded into five using information about job/
profession and income. The broad classification was as
follows: daily wage labourer (class V); labourer on annual
contract or other occupation with a similar income (class
IV); land-owner or technical skilled worker or other
occupation with similar income (class III); those running
a small business or class II type occupation, or business or
class I occupation, using national definitions.
Observations
Out of the 2000 women interviewed, 993 (49.6%) reported
having been physically assaulted. Age, education or socio-
economic status of women did not make any difference.
However, more women from nuclear families were
assaulted (52.1%) compared with other groupings 37.3%
(Table I).
A total of 670 (67.47%) women were assaulted by their
husbands; 40 (4%) by the mother-in-law; 183 (18.3%) by
the father-in-law; 68 (6.8%) by a sister-in-law; 33 (3.3%)
had been assaulted by others, and 68 (6.8%) had multiple
perpetrators. Out of the total assaulted, 424 (42.69%) had
to be taken to a health facility, for physical injury, for
example bruising, cuts, burns or fractures.
The reasons for violence varied. A total of 111 (11.17%)
women said violence related to their low economic status;
188 (18.93%) said it related to arguments about dowry;
240 (24.16%) women were just disliked by their husbands
and/or her family members (136 husbands and 104 family
members and 53 by husbands as well as family members).
Infertility was the reason for violence in 187 (18.8%);

Correspondence: S. Chhabra, Department of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram 442 102, Wardha,
Maharashtra, India. Tel: 91-7156-284341-55. Fax: 91-7152-284286. E-mail: chhabra_s@rediffmail.com
ISSN 0144-3615 print/ISSN 1364-6893 online Ó 2005 Taylor & Francis
DOI: 10.1080/01443610500328033
 Gender and sufferings 773

Table I. Age, literacy, socioeconomic status, type of family and violence

Assaulted Not assaulted

Total women
(n) n (%) n (%)

Age
519 42 20 47.62 22 52.38
20 – 29 1,082 524 48.40 558 57.60
30 – 39 458 248 54.15 210 45.85
40 – 49 344 159 46.22 185 53.78
50 – 59 46 32 69.57 14 30.43
460 28 10 35.72 18 64.28
Total 2,000 993 49.65 1,007 50.35
Literacy
Illiterate 229 100 43.66 129 56.34
Primary school 239 161 67.37 78 32.63
Middle 261 145 55.60 116 44.40
High school and higher secondary 919 465 50.60 454 49.40
Undergraduate 274 85 31.03 189 68.97
Postgraduate 78 37 47.44 41 52.56
Total 2,000 993 49.65 1,007 50.35
Socioeconomic status
Upper 19 8 42.11 11 57.89
Upper middle 130 61 46.92 69 53.08
Middle 305 129 42.30 176 57.70
Lower middle 1,048 538 51.33 510 48.67
Lower 498 257 57.60 241 48.30
Total 2,000 993 49.65 1,007 50.35
Type of family
Nuclear 977 509 52.10 468 47.90
One generation joint family 969 464 47.88 505 52.12
Two generation joint family 54 20 37.03 34 62.97
Total 2,000 993 49.65 1,007 50.35

30 (3%) women’s husbands had extra-marital relations and
were also alcoholics. A total of 100 (10.07%) women said
they were assaulted because they had no male child; and
suspicion about infidelity was the reason in 137 (13.79%)
cases.
A total of 601 (60.5%) women said they had talked to
someone about the violence. The reasons for not talking to
anyone varied: 315 (69%) because of fear; 171 (28.5%)
embarrassment; 76 (12.6%) did not believe that any
change would occur; 43 (7.15%) thought that the situation
would worsen; 123 (20.5%) felt that they did not have
anyone to confide in and 23 (3.82%) women did not give
any reason for not having talked to anyone. Many women
gave multiple reasons.
A total of 640 women assaulted said some help was
attempted by someone: 402 (62%) by the women’s
parents; 128 (19.75%) by the husbands’ parents; 86
(13.27%) by elders of the village, and 32 (4.9%) obtained
help from friends. The actions taken included: 274
(42.28%) talking to the husband or his parents; 46
(7.09%) making the husband’s family aware of women’s
rights; 70 (10.8%) threat of police action and 258 (39.8%)
because the women were taken to a hospital due to physical
injury helped. However, only in 324 (50%) of the 648
women where attempts were made, did the situation
improve.
Discussion
Violence affects a woman’s physical, mental, economic
and social well-being and is associated with significant
consequences. Documenting this sensitive issue is an
extremely difficult task, with many dilemmas. Most of the
studies are either from places of social support or from
places where victims of violence had reported the problem
and therefore often, the studies excluded many women.
The task was rendered particularly difficult owing to the
women’s reluctance to report for a variety of reasons.
Ignorance, fear and insecurity played a major part. A recent
study published by the Center for Health and Gender
Equity at John Hopkins University reveals that one in three
women worldwide suffer from gender-based violence
(Ashfored 2001). There has been a rise in cases of sexual
harassment by 40%; dowry issues by 15%, and smuggling
of girls by 87% in 1998. These are indicative of women’s
traumatised existence (Jejeebhoy 1998). In the present
study, women of all ages reported having been assaulted.
Both less educated and highly educated women had
suffered, irrespective of socioeconomic class. The studies
suggest that in most countries, younger women are more at
risk of being abused than older women. This is borne out
not just by the current rates but also by the fact that rates of
experience of violence do not increase consistently with
age. In Colombia, the Dominican Republic, Haiti,
India, Nicaragua and Peru, women who reported that
they were currently working and earning cash also report
significantly higher levels of violence than do women
who are not currently working. In countries such as
Cambodia, Colombia, the Dominican Republic, India
and Nicaragua, the relationship between education and
violence was negative and monotonic (Kishor and Johnson
2004).
774 S. Chhabra
While most literature associates petrilocal extended
family living arrangements with less autonomy and
empowerment for women, it may also be that women
living within an extended family receive a degree of
protection from domestic violence, given the regular
presence of other family members in the household. The
results of the study by Kishor and Johnson (2004) indicate
that experience of violence does not vary between women
living in non-nuclear and nuclear (married couple) house-
holds in Nicaragua. In Colombia, the Dominican Republic
and Zambia, it is women who are in non-nuclear house-
holds that report higher levels of abuse than women in
nuclear households. Only in Cambodia, India and Peru is
the expectation borne out that women who live in nuclear
households have higher rates of violence (Kishor and
Johnson 2004). In the present study, it was revealed that
living on their own or with many people did not change
many things but statistically significantly more women
from nuclear families had been assaulted (52%) compared
with joint families (37%) (p value 5 0.001). It may be the
case that the presence of many people acts as an inhibiting
factor for the perpetrators. Visaria (1999) reported that
about 53% of women in joint families faced some form of
abuse compared with 73% in nuclear families.
Around the world, the events that trigger violence are
remarkably consistent: unemployment, economic depen-
dence, lack of information on legal rights and poverty are
recurring features (Chatterjee 2001). The present study
reveals that some women were assaulted because of dowry
problems (188; 18.9%); others because their husbands had
extra-marital relations or because husbands were suspi-
cious of wife’s infidelity, and some others suffered because
of infertility or had no male child. The risk factors in China
were also similar to those in the rest of the world. Women’s
lack of financial autonomy, low male socioeconomic status
and alcohol consumption are associated with partner
violence (Parish et al. 2004). Russo et al. (1997) have
reported that lower-income women are more likely to
experience partner-violence. A total of 111 (11.2%) women
in the present study had said violence was because of
poverty.
Visaria (1999) confirms that the husband was the
perpetrator in 42% cases. This was also the finding of an
American study (O’Campo et al. 1994). Martin et al.
(1999) reported that 18 – 45% of men admitted having
physically abused their wives. One other study revealed that
30 – 65% of wives are physically assaulted by their
husbands at some point in time (Aggarwal 1998; Daga
et al. 1999). Rates of spousal/intimate partner violence
among married women were found to be similar across
countries, with the rates being highest at 48% in Zambia,
44% in Colombia and 42% in Peru; the lowest being 18%
in Cambodia, with 21% from India (Kishor and Johnson
2004). The first national estimates of partner assault in
China using data from a population-based probability
sample of adults aged 20 – 64 revealed that one-third of
women had been hit by their current partner (Parish et al.
2004). In nearly 50 population-based surveys from around
the world, 10% to over 50% of women reported being hit
or otherwise physically harmed by an intimate male partner
at some point in their lives (Population report 2000).
In every country where large-scale studies have been
conducted, the results indicate that between 16% and
52% of women have been assaulted by an intimate partner
(WHO 1997).
A large proportion of women who experience violence
sustain significant injury. In Colombia, 28% of women
had reported going to a health facility as a consequence
of something the husband had done to her. This
proportion was 21% in the Dominican Republic and
9% or less in the remaining countries (Kishor and
Johnson 2004). In the present study, 43% of women who
had suffered had to be taken to a healthcare facility, for
physical injury.
Embarrassment was the reason for not seeking help in
20% of our cases. The person who had assaulted was not
ashamed, but the person who had suffered was ashamed to
speak. A total of 9% of women had not talked to anyone
because they believed that no improvement would occur
and another 11% thought that it would worsen the
situation.
In India, as in many other countries, violence occurs in
families of all social class and educational level. Findings of
the study of ‘Domestic violence in India’, by Martin et al.
(1999), indicated that factors which enhance stress increase
the chances of physical abuse. These factors include low
socioeconomic status and low educational levels (Martin
et al. 1999).
Physicians and other healthcare providers know that
victims of violence need medical attention. Thus,
integration of violence prevention into health, social
and educational policies is necessary. This complex
issue must be presented to healthcare providers, so
that not only medical attention is given, but also
information should be given to help women become
more aware of their rights and possible sources of help
and support.
Generally speaking, the complexities of violence are not
well understood. There is a long way to go in terms of
causes, and therefore interventions which could deter
violence against women and support services for those
affected. It is essential to try to construct a network
where women can mutually empower each other, address
the roots of violence and transform the past century’s
legacy.
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