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 Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار (Re: Mohamed E. Seliaman)
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DOMESTIC VIOLENCE IN THE SUDAN: OPENING THE PANDORA’S BOX
By
Awad Mohamed Ahmed, MD. Professor of Medicine, University of Bah Elghazal, Khartoum, Sudan.
Introduction
According to the World Health Organization (WHO) violence is defined as ‘intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that is either result in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation’1 Violence is divided into three categories, self-directed violence, interpersonal violence and collective violence. The interpersonal violence is further divided into two subcategories: family or domestic violence (DV) and community violence (violence between individuals who may not know each other).2 The violent acts can be physical, sexual or psychological or involve deprivation or neglect.1 In this chapter we are concerned only with DV.
Domestic violence is defined as violence exerted toward the women by a family member (most commonly the husband or the intimate male partner). 3 It can be seen as a pattern of psychological, economical and sexual coercion of one partner in an intimate relationship by the other that is punctuated by physical assaults or credible threat of bodily harm.4 Historically DV is an old phenomenon. English sources from the preindustrial era revealed six broad categories of social harms associated with abuse of alcohol. 5 The judiciary records of Portsmouth, UK, in the period 1690-1781 had included 356 cases of wife beating.6 DV most often refers to violence between married or cohabiting couples although it sometimes refers to violence against other members of the household such as children or elderly relatives. Some studies indicate that the incidence of DV among homosexual couples is approximately equivalent to that found among heterosexual couples. 7 DV carries serious consequences on the health and social well-being of the abused women. DV negatively affects the self-esteem of the victims rendering them vulnerable to sustainable physical and psychological disorders. In addition to physical injuries such as burns, fractures and wounds the abusees tend to frequently complain of unexplained chronic problems such as backache and headache.8 Psychologically the abused woman tend to have high rates of depression and even suicide attempts. The reproductive health is not exempted from the harmful effects if DV such as miscarriage, unintended pregnancies, low birth weight and sexually transmitted diseases including the AIDS.8 Not only the woman is the sole victim of DV, as in many parts of the world approximately ten millions of children are exposed to some forms of abuse during assaults on their mothers, either deliberately or accidentally. 9 They may also suffer emotional traumas or behavioural problems as a result of witnessing abuse such as sleep disorders, enuresis and substance. 9
There are three types of violence that occur in domestic settings, physical, sexual and psychological or emotional. The physical violence is the intentional use of physical force with the potential for causing harm, injury, disability or death e.g. hitting, shoving, biting, or use of a weapon. The sexual violence includes use of force to compel a person to engage in a sexual act or to attempt or complete a sex act involving a person who is unable to understand the nature or condition of the act. The psychological or emotional violence involve trauma to the victim caused by acts, threats of acts or coercive tactics. It can include humiliating the victim, controlling what can the victim do and can not do, withholding information from a victim, deliberatively do something to make victim embarrassed or diminished. Isolating victims from friends and family and denying victims’ access to money or other basic resources.
Violence against women is a product of interaction of factors at different levels, the individual, the family, the community and the society.3 At the individual level these factors include being abused as a child, witnessing violence at home, having an absent or rejecting father and frequent use of alcohol or drug. At the family level the marital conflicts and the dominant male control of wealth and family issues are considered as strong predictors of abuse.10 At the community and society levels the factors interplay to produce violence include poverty, unemployment, lack of support and isolation of family and women, linkage of the concept of masculinity to male honor or dominance, acceptance of violence as a way to resolve conflicts and social tolerance of physical punishment of women.10 Violence may evolve from the socially acceptable gender norms. Men are the families’ masters (or even women’s owners!) because they provide financially. Women are expected to tend the house, mind children and show obedience for husbands. A breach in the women’s role or challenging the men’s rights may produce violence.
Domestic violence affects women in all social strata and ethnic groups in both developed and developing nations. Worldwide, 20-50% of women are affected by DV at some stage in their lives in most populations surveyed.11 In the United Kingdom (UK) 23% of women aged 16-50 years had been physically assaulted by a current or former partner and two women killed weekly.8 In the United States and Australia 5-20% of women attending general practice settings reported experiencing DV in the year previous to the year of survey.12 In a Canadian study performed in 1993 involved 12300 women, 29% reported that they had been subjected to DV. 13 They had been pushed, grabbed, shoved, slapped, hit with an object or had a gun or knife used against them by their partners. 13 In California, USA, DV causes one of every three homicide deaths among women. 14 In Islamic and African countries the studies on DV had reported similar or higher figures for women’s assaults. In Egypt, a prevalence of DV of 22% was reported and 2.5% of victims reported attempting suicide as a reaction to abuse.15 In Turkey a study among women attending a health centre reported a prevalence of DV of 58%.16 The male partner was the primary abuser followed by mother and or father.16 In Bengladish the prevalence of DV was found to be 40% in both rural and urban areas.17 DV was also found to be an important cause of maternal mortality in Bengladish.18 DV in Bengladish is particularly associated with dowry and other demands of marriage19 In Nigeria the prevalence of DV was found to be 31% in a sample of 430 women.20 The associated factors with DV identified by the Nigerian study included alcohol consumption and young age of the wife.20 In Uganda a study among 5000 women reported a prevalence of DV of 30% with alcohol consumption was the commonest risk factor.21 Other African studies on DV had reported incidences of 43% in Zimbabwe,22 25% in South Africa23 and 20% in Rowanda. 24
Sudan is located at the heart of Africa, of a surface area of 2.5 square kilometres (roughly 10% of the total landmass of Africa and 1% of the total earth surface area). It is populated by 35 million of 19 ethnic groups and 600 subgroups, and more than 100 languages and dialects. The current Sudanese are, ethnically, a product of Hamites, Samites and Negros following the Arab invasion of Nubia Kingdom in the seventh century. Therefore the Sudanese culture is diverse including African, Arabic, Islamic and Christian elements. In the Northern part (site of our study), the Islamic religion plays a dominant role in the people’s life. The orthodox Muslims believe that Islamic teachings should control every aspect of their lives (great or small) including family matters. Sudan’s women constitutes 50% of the population. They are jeopardized by the highly drastic socioeconomic conditions currently affecting the country due to economic collapse and civil wars. The maternal mortality is one of the highest in the world (509 per 100000 live births). The illiteracy rate among women is about 60% (40% among men). Around 90% of Sudanese women are prone to dangerous genital mutilations that seriously affect their reproductive health. In both the public and private sectors our women suffer biased working conditions. The political participation is so limited with no significant impact on the national decision-making process. Despite the deep history of DV and other types of violence against women it is only recently come the public interest. The author had done two large studies on DV, one on patterns and determinants of DV among a group of women attending a health centre, and the other on the attitudes of doctors toward DV as a public health.25,26 In the first study of 492 eligible women, 394 gave their consent to participate in the study, giving a response rate of 86.8%.25 Of these, 164 women were abused to give a prevalence rate of domestic violence of 41.6%. For the abused women the average age was 29 ±11 years, duration of marriage was 6 ± 4 years, 133 of the (81.1%) had annual household income below 2500 dollars (poverty line), 122 women (74.4%) were unemployed and 74(45.1%) spent educational period of 6-8 years.25 The abused women were subjected to 525 violent episodes in the last year, classified into controlling behaviours (194), threatening behaviours (169) and physical violence (162).25 Frequency of violent episodes varied from one episode in 41 women (25%) to more then 6 episodes in 34 women (20.7%). Twenty seven women (16.5%) reported violence during pregnancy. More than a third of the abused group gave a history of abuse before marriage. The immediate provoking events for violence included suspicions of illicit relations, taking back and inadequate home care.25 The common reactions reported by the abused women included staying quite, 81 women (54.3%); crying, 32 women (19.5%) and resistance, 18 women (11%).25 The other study on response of doctors to DV involved 142 doctors who received the questionnaires, 102 of them returned it to give a response rate of 71.8%.26 The respondents’ ages ranged from 25 to 54 years; 53 were female (51.9%); and 32 (31.3%) had experience of more than 10 years. forty three doctor (42.1%) had fair knowledge of the concept of domestic violence, 28 (27.4%) viewed it as a worthwhile health problem and 21 (20.5%) reported encountering 1-2 cases in the last year.26 Barriers to screen women for a possibility of being abused included lack of knowledge and training, insufficient time at clinics and fear of problems with perpetrators. The female gender and long professional experience had positive correlations with the better knowledge about violence and the desire to intervene beyond physical treatment (P<0.005).26
Subjects and methods
The aim of our study was to investigate the problem of domestic violence in the Sudan in regard to its occurrence, types and causes. The study was done at the outpatient department of Elribat University Hospital (EUH). The EUH is the training centre for the medical students of Elribat University comprises. 250 beds and the entire major and most of the minor specialties. It run both inpatient and 24-hour emergency service. We opted to use this place for our study as the health settings are the best place for routine enquiries because they have the most frequent contact with the population. The study period was 1-10 April 2006. The subjects eligible for the study were all married women seen consecutively during the study period. Women who were too ill and need to lie down to complete were excluded as they can not be interviewed in a private room. The eligible women provided oral consents after fully describing the nature and procedures of the study; we avoided written consents so as to prevent a link to identify subjects to the questionnaires administered. We made it clear to the potential respondents that their participation in the study was totally voluntary, and that they can quit at any phase of the study, and that their choice of to participate would not affect the quality of their care anyway. We clearly explained to the participants that they would be asked sensitive questions about their relationship with their husbands and other family issues. The respondents were assured that any data obtained would be treated with strict confidentiality, and would be used for the purpose of research.
The next step in our study was that each eligible women after giving her consent to participate was given an anonymous questionnaire, in a private setting with strict confidentiality been assured. Three research assistants helped the authors in recruiting the women, and to answer queries raised by women in regard to completion of the questionnaire. Up to now there is no one universally agreed upon method of defining and measuring DV, but for the purposes of our study it was defined as an assault, threat or intimidation by a husband.27 The abusive behaviors were categorized into threats, controlling behaviors and physical assaults. The physical assaults were classified into minor (e.g. throwing objects, shoving), moderately severe (e.g. beaten up, contusion) and severe (e.g. head and internal injuries). In the questionnaire we required the following information:
1. Age.
2. Employment.
3. Educational level
4. Duration of marriage
5. Wife previous marriage
6. Number of children.
7. Husband age
8. Consanguinity.
9. Husband occupation.
10. Husband educational level
11. Husband previous marriage.
12. Husband current polygamy.
13. Overall socioeconomic status of the family; the average family in Sudan at the time of study needed 2500 dollars per annum to meet the very basic requirements of living, families of income below this were considered poor.
14. Husband bad habits: alcohol consumption, drug abuse.
15. Husband leisure time: e.g. at home, outside.
16. Overall rating of marital life: stable, in disharmony
17. Couple living: alone, with a spouse family.
18. If the woman during the three months been subjected to the following assaults by her
Husband: e.g. hit, kicked, thrown with an object, slapped, pushed, injured with a weapon, shoved, punched her (body), punched her (face), forced to do something, try to be choked, burned, physically hurt in some other way.
19. What is the immediate provoking event for the violence, e.g. suspicions of illicit relations, talking back, not obeying husband, not having food prepared on time, refusal of sex, failure to care home or children adequately, going out of home without permission, questioning the husband about his money or illicit relations, others
20. Reactions of wife to violence: e.g., staying quiet, crying, resistance, telling a relative, deciding to ask for divorce, contacting the police, others.
21. Controlling behaviors usually adopted by the husband: e.g. shouting at her, criticizing her at public, restriction her social life, checking her movements, keeping her short of money, others.
22. Threatening behaviors usually adopted by the husband: e.g. throwing things, threatening by a fist, threatening children, threatening by a weapon.
23. If she had sought medical help for husband assaults, and if her doctor ever asked her if
been assaulted by her husband.
24. If ever been assaulted during pregnancy.
25. If been assaulted by other family members: e.g. father, mother, brother, son, husband’s relatives.
26. If ever had assaulted her husband in any way.
The questionnaire was piloted with 12 subjects in the same research settings for organization, clarity and ease of completion. Questions on violence related to sexual issues were perceived to be offensive by the first ten women and then deleted from the survey. The data were analyzed using statistical software (SPSS version 11.5; SPSS, Chicago, IL). The analysis of the interval variables of the characteristics of both abused and non-abused women was done on frequency data using the Student’s t-test. The significant levels were determined at p<0.005.
Results
We recruited 254 women as eligible for our study, 146 of them gave their consent to participate, thus giving a response rate of 57.4%. Of the respondents, 67 women (45.8%) gave a history of one or more forms of abusive behaviors by their husbands in the last three months. The rest, 79 women (54.2%) served as a control group for our study in regard to the socio-demographic characteristics of the study group.
The socio-demographic characteristics of the abused women and the controls (the non-abused group) are shown in Table 1. The abused group was significantly younger than the control group. The range of ages of the abused group was 16-53 years, whereas the range of other group was 20-57 years. On the educational level, the abused group had a statistically significantly lesser educational status. The socioeconomic status as determined by the annual income determined that the majority of the families of abused women suffered poverty. The abused group had a shorter duration of marriage (the younger age of this group confirmed this finding). Both groups had somewhat similar rate of consanguinity. Only a small minority of both groups had a previous marriage. There is a statistically significantly difference in self-rating of their marital life, with more women of the abused group were living in disharmony with their husbands. The non-abused group had a larger number of kids (this might be explained by their longer duration of marriage.
The socio-demographic characteristics of the husbands of both the abused and non-abused groups are shown on Table 2. The husbands of the abused group were younger than the other group. The husbands of the abused group were of lesser educational and employment status. Only a minority of both groups had a previous marriage and only two of them were in current polygamy. The majority of the husbands of abused group were consuming alcohol or using illegal drugs.
Table 3 shows the patterns of controlling and threatening behaviors, and distribution of the episodes of physical violence among the abused group in a period of three months prior to our study. The most common controlling behaviors were shouting, criticizing at public and restriction of social life and activities. The commonest threatening behaviors were throwing things, threatening by a fist and threatening children. The abused women reported 123 episodes of physical violence (i.e. 1.8 per capita). The most common violent episodes were shoving and punching both body and face. The majority of these episodes were of mild and moderate severity. The immediate provoking events for violence included suspicions of illicit relations, talking back, not obeying husband, not having food prepared on time, refusal of sex, failure to care home or children adequately, going out of home without permission. In a few of the violent episodes there were no evident reasons. The women who had injuries that needed a medical treatment did not mention the real cause of injury to their treating doctors. As well none of these doctors had asked them specifically about a possibility of a husband assault.
Apart from their husbands, 12 of the abused women (17.9%) mentioned other perpetrators commonly the father and brother. Eight women (11.9%) reported different episodes of violence during pregnancy, but no complications were stated. The victims reported several reactions to the violent behaviors including staying quiet (25 women, 37.3%), crying (19 women 28.3%), resistance (12 women, 17.9%), telling a relative (9 women, 13.5%), contacting the police (2 women, 3.0%).
Discussion
Prevalence of DV
This study confirms the sensitivity of the issue of domestic violence as evident from the relatively low response of recruited women (146 out of 254) to participate in our investigation. It is needless to mention that we informed the potential participants that questionnaires were to be completed in private rooms, and that most of the research assistants were female, and we assured them that the collected data were to be treated with strict confidentiality. The response rate in this study is lower than in a similar study by the same author.25 The difference is that the investigated women in that study were familiar to the author as they had been followed up by him for chronic diseases for several years. We think that use of new communication methods such as telephone and e-mail may encourage more women to participate in such studies.
The prevalence rate in our study (45.8%) is one of the high in the world. It is nearly similar to studies done in African and Islamic countries (e.g. 40% in Bengladish, 31% in Nigeria, 30% in Uganda).7,20,21 But our prevalence is lower than Western studies, (e.g.23% in UK).8 Most of these studies were done in health settings in conditions similar to our study. It is useful here to remind the readers that our operational definition for DV encompassed in addition to physical violence both controlling and threatening behaviors. If the definition involved physical violence alone the prevalence was to be lower. There is a possibility of under-representation due to the cultural sensitivity of the issue, thus some people could not speak openly. The questionnaires, by their nature, depend on self-reporting and then were subject to recall and reporting bias.
Dynamics and patterns of DV
In this section we are concerned with discussion of types, frequency and reactions of victims to DV. All the spectrum violent acts are present in our study sample (from shouting and yelling to use of simple weapons such as sticks) were reported. But use of acts that result in severe injuries is rare in our country. This might be because such acts usually result in severe injuries that necessitate intervention of other parties such as doctors or police. This usual pattern of assault is controlling or threatening behaviors with or without mild or rarely moderately severe injuries. Our society, in general, is tolerant to controlling behaviors. Even more, the lesser educated sectors of our society link the concept of manhood to control and restrict the social and professional roles of their families’ women. The ‘natural history’ of DV is that there is usually an initial phase of controlling behavior and then, depending on her empowerment and or reaction of the wife it may or not escalate to more severe abuse.
Domestic violence is never an event which occurs once in life. It is a recurrent event. In our study physical assaults alone occurred at a rate of 1.8 per capita in a period of three months. The controlling and threatening behaviors were nearly ‘uncountable’, so we referred to them in the section of results as ‘usual behaviors’. The repetition of the abusive acts is facilitated by that DV occurs in atmosphere dominated by controlling behaviors toward women. Also the women as victims to DV are readily to their abusers.
It is of utmost importance to discuss the possible reactions of the victims to DV (especially to implement support programs). In our study the majority of abused women reacted in a passive and useless way. They usually stay quiet (fearing of stigma) or crying (even this with a low voice not audible even to neighbors). Unfortunately some women may adopt the societal indifference to DV been considered as a private matter, or even a justifiable response to misbehavior on the part of the wife.28 The situation is similar to that in Bengladish where 60% of women were silent about their abuse.15 They prefer to continue in an abusive relationship stating reasons such as high societal acceptance of DV, fear of stigma, financial dependence, fear of further abuse and difficulty of getting divorced.13 In Uganda it was found that the majority of women viewed beating as justifiable in some circumstances, thus posing a central challenge to prevent DV.21 But in a few circumstances the abused woman approach a source of help especially when she could not endure any more, or when violence becomes life-threatening.29 Even in a Western country like Canada, where women are more aware of their rights, victims rarely report to the police except if a weapon is used or fear for their lives. 13 A question may arise, why victims remain in such an abusive relationship. There are two possible reasons. Such women, due to their low educational and employment status can only obtain marginal (and low-income), or illegal jobs. Divorce seems, theoretically, as a definitive solution to put an end to family assaults. Due to the sharia (Islamic laws code) the decision to divorce is almost exclusively reserved for the husband. Only under certain few conditions the woman can file a case in the court for divorce (where she has to follow borrowsome and prolonged court procedures, that might take several years). Some women reuse the divorce option considering it as a social stigma, or not wanting their children to suffer when they lose the financial support of their fathers, or hoping that their husbands will change to the better.20
Some of our study sample reported that they had been abused by family members other than the husbands. They specifically named the father, brother, and even some of the close relatives of the husbands. In an Indian study 7% of victims of DV had been assaulted by multiple perpetrators.30 These included the father, brother, or other close relatives.30 Matters are complicated when some societies view some acts such as beating or verbal abuse as are not violent when committed by a father or a brother.
In rare instances there are reports of men being abused by their wives.8 Even more DV can be a problem in the same sex relationships.7 No one of our sample admitted that they ever abused their husbands, verbally or physically. We know that this pattern of abuse might rarely occur in our society. In the UK in a study one in seven men had reported being physically assaulted by their wives.8 Even in African societies there are reports of men being abused. In Uganda 18% of surveyed women had reported verbally or physically abusing their current male partners.21 However, such incidents are less serious than those reported by women.
Reasons and risk factors of DV
Our study indicates a clear association of DV to certain socio-demographic and personal characteristics such as poverty, young age and low educational and employment of the wife and husband’s abuse of alcohol or drugs. Going through different studies on DV we find a long list of other causes and immediate provoking factor of DV. Examples, patriarchal family structure, difference in ethnic, religious and socioeconomic backgrounds of spouses, pregnancy, suspect on immoral behavior, disobedience, talking back, witnessing DV in childhood, sexual impotence, jealousy, sex refusal, use of contraceptives without permission, neglect of house or children, difference in approach to child upbringing, argument over money.
Socio-cultural contexts Numerous studies have indicated that the possible determinants of DV are salient across diverse cultural and societal contexts.31 In this section we will discuss the impact of three factors on DV, the societal perception of violence, and the religious and marriage institutions.
The perception of violence is primarily a function of knowledge received and the socio-cultural and economic setup in which the violence takes place. Violence is understood by many people as only limited to actions that cause physical traces on the body and does not include psychological and social impacts. Thus practices such as polygamy or restriction of woman’s movements are not considered as violence! In many societies the current socioeconomic power relationships render the woman a property of some male. This ‘ownership of women’, predisposes them to abuse by linkage of masculinity to male honor, and acceptance of violence or female chastity to resolve conflicts. These norms are not peculiar to Sudan and may prevail in many cultures worldwide.32,33 Thus DV occurs in an atmosphere that favors violence against women in the society at large (at work, at street, etc).
The issue of DV is closely related to the institution of marriage. Marriage is an important site for expression of gender roles and relationships.34 Some Muslim husbands socialize their wives to believe that what ever he wants the family to do is the same as what the God wants them to do.34 He, in effect, make himself something of a god.34 Men often use violence to enforce their dominating gender role particularly in the early years of marriage.31 Young women at time of marriage know little or even nothing about sex and aspects of home care. Then DV is often used to establish the new norms for the future partner who is then rendered powerless and vulnerable to abuse. The understanding of some men of the requirements of the Islamic marriage may further aggravate the family violence. The husband provides mahr (dower) which is an amount of money or a property intended to provide wife to-be with some economic security. Unfortunately some men may understand this (dower) as they buy a slave, thus paving the road to violence, and wife subordination. A relevant issue is divorce. In our society, divorce (or even being unmarried) is socially unacceptable especially when asked by the wife. As we discussed above divorce on the will of the wife is difficult to be obtained. The divorcees suffer social isolation or even further violence from other members for the family (as she is not allowed to liver independently in a separate home).
The religion plays an important role in the life of the Sudanese, where Islam is the religion of the majority. Many Muslims believe that the Islamic teachings should control all the aspects of their lives. And in the foremost the family issues. Some Muslims believe that Islam favors male supremacy and require the total obedience of a woman (a wife, a sister, a daughter) to desires and orders of the men of the family. They use selective excerpts from Koran (the holy book of Muslims) to prove that men who beat their wives are following the God’s commands.28 Even more some fundamentalist Muslims (as in all religions) believe that women are the source of all the sins in the world and thus paving the way to violence against women. However some enlightened religious men are trying to provide innovative and fair reading of Koran as to indicate that wife abuse is a result of culture rather than religion.28
Poverty and empowerment Although women from all socio-economic groups suffer DV, many studies provide some evidence that women from poor families disproportionately experience violence.35 Poverty increases vulnerability to violence through increasing relationship conflicts. Being associated with reduced educational and economic power, it reduces the ability of men to live in a manner they regard as successful.36 The loss of role of financial provision to family generates more tensions in the domestic atmosphere. Some men vent their own frustrations at their poverty and their inability to fulfill their role as provider by battering their wives. Some studies have suggested that battered women may remain in abusive relationships because of financial dependence.37 There may be other causes for their position. In a study performed by the author we found some women were not dependant financially on their abusers but they were reluctant to leave such a relationship because of psychological dependence and fear of further injuries, the stigma of divorce and failure to obtain it.25
There are variable views on effects of economic empowerment on the women’s possibilities of being abused. In Bengladish a study had suggested that women participated in a micro-credit program, on virtue of giving more public and social role, were protected to some extent against DV.36 Thus economic empowerment can be seen as entailing a departure from the traditional gender norms mandating women’s seclusion.31 At the same time some researchers had suggested that women’s increased bargaining power might threaten the men’s inherent sense of control and superiority.38 To detail, the new role of women as financial provider, especially in a context of deprivation, may undermine male authority and increases the risk of violence. 31 Some studies indicated the protective role of the women’s high social status as measured by education and degree of autonomy or control over resources may be context-specific and that such women in conservative societies may actually be at an increased risk of violence.21 One study had suggested that these empowered women are only vulnerable to violence in the near future, but they become protected after a critical threshold of empowerment has been reached and gender role, then, has substantially shifted 31
Education Our study clearly indicates an association between women’s educational level and their vulnerability to abuse. Similarly a Turkish study indicated that DV is significantly associated with low educational level, with illiterate and semi-illiterate women reported marital abuse 2.6 times the more educated ones.39 The low level of education is linked to unemployment and poor income.40 The poor education may be an indicator of poor communication skills, which have been linked to domestic violence (especially in a context of high gap of education between the couple).41
Employment Unemployment (recent or long-term) and the stress of finding a work increase the risk a man will physically abuse his wife.40 Employment in itself does not protect couples from marital violence. Stressful work experiences have also been associated with violence.42 The professional rivalry may generate marital tension. In a conservative society like ours the work of the wives and the unemployment of the husbands breach the latter’s cultural role as family supporters, and then generate family conflicts.
Alcohol More than half of the husbands of abused women consume alcohol or abuse some drugs, mostly cannabis. Some studies indicated that 25-50% of perpetrators of DV were drinking during the event and that history of problem drinking was obtained in 60-70% of them.43 It was also found that half of the binge drinkers were drinking before an episode of violence, and that they are three times more likely to abuse their wives than abstainers.43 In particular the victims of DV in many African studies had reported that alcohol was the commonest cause.20,21 Some studies had investigated the exact role of alcohol in DV. The alcohol may aggravate marital difficulties leading to separation and divorce. Some studies had suggested that structural factors such as unemployment and disrupt communities and social relationships lead to alcohol consumption.44 In some instances there is a combination of alcohol consumption and drug abuse, adding greater risks to family violence.
Pregnancy In comparison with international studies only a few of our respondents reported assaults during pregnancy, this might be due to that a pregnant lady in Sudan is used to be cared by her mother or elder sister and then her contact with her husband is reduced. The pregnant women are thought to be twice as likely to experience physical violence. In the UK 12% of maternal deaths had reported DV during their pregnancy.31 Up to 41% of antenatal attendees in American studies report a history of violence at some point in their past pregnancies.45 Pregnancy in virtue of its hormonal and psychological changes may trigger violent assaults by minor events such as sex refusal or inadequate home care, or even missing fixing a missed button in a husband’s shirt. Violence during pregnancy is a health and social problem that poses particular risks to women and their embryos. It has been associated with increased risks of abortion, preterm labor and low birth weight.
Conclusions
Our study indicates that domestic violence is a serious and common problem in our society. A prevalence of 45.8% puts Sudan as one of countries of high prevalence. As in other countries DV is associated with some socio-demographic and negative personal behaviors on the part of the male partner. The subordinate status of women, worldwide, resulting from long-acting cultural and socioeconomic factors renders them easy victims for violence.
There are some factors that challenge combating DV (and other types of violence against women). The roots of DV can be traced in the culture and religion which sustain and stereotype gender relationship that favor male supremacy and women subordination. Women themselves are less aware to their human rights. Even more, as we discussed above some African women agreed that men are justified in beating their wives. There is a lack of a clear policy that directs the efforts of government and non-governmental organizations to alleviate women’s abuse. Sudan government did not yet ratify the convention on Elimination of all forms of Discrimination Against Women (CEDAW) which was adopted by the United Nation’s General Assembly in 1993. Currently there are no laws to punish the perpetrators of DV. As well there are no available supportive services for the victims, even in form of counseling or legal assistance. What is available, are infrequent and ill-prepared seminars and workshops performed by few organizations of the civil society that only produce unproductive recommendations. Lack of information, financial deficits and lack of skills of intervention are responsible of this situation.
There is a need to implement a national multidisciplinary programme to deal with this problem, with the share of health workers, non-governmental organizations, governmental departments of health and social care, universities and other concerned bodies. This programme should aim at augmenting the professional, public and government awareness to the problem and to provide medical service, social support, protection and legal assistance to the abuse victims. We should be aware that unless evidence of benefit exists, many women might hesitate to cooperate with the programmes addressing domestic violence.
On our part, the health system should awake up to the idea that DV is more than a private matter, and health professionals should get involved in it. It is important to educate and train clinicians and heath workers in promoting disclosure of abuse. This can be accomplished through development of knowledge and skills of identifying and treating DV victims and to display the associated cultural, ethical and legal considerations. As an emergency, comprehensive guidelines for identification and medical management of the abused women are to be issued. Although the doctors alone can not change the cultural and social norms that may give rise to violence but can have a much to offer beyond the physical treatment of injuries. They must be aware of the societal (and professional) misconcepts that lead to, or aggravate violence and to correct them. Doctors should acknowledge the injustice of violence and give a clear message to the abusers, victims and community that battering is a public health problem and not at all, a private matter. Some reform in the curricula of medical schools is needed to introduce specific courses to impart knowledge and develop awareness and intervention abilities in the further doctors.
References
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| العنوان |
الكاتب |
Date |
 {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-04-08, 07:52 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-04-08, 07:53 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-04-08, 07:54 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-04-08, 07:55 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-04-08, 07:56 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-04-08, 08:44 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-05-08, 07:50 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Mohamed E. Seliaman | 03-05-08, 08:32 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | عوض محمد احمد | 03-05-08, 02:38 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | ibrahim kojan | 03-05-08, 08:05 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-05-08, 08:10 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Abdel Aati | 03-05-08, 08:12 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-06-08, 11:10 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-06-08, 11:07 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-06-08, 11:01 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | بله محمد الفاضل | 03-05-08, 08:17 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | بدر الدين الأمير | 03-05-08, 10:01 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-06-08, 01:29 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-06-08, 11:17 AM |
 Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | AMNA MUKHTAR | 03-06-08, 00:18 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-06-08, 02:01 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Safia Mohamed | 03-06-08, 11:59 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-06-08, 02:12 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | أبو ساندرا | 03-06-08, 12:00 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | أبنوسة | 03-06-08, 01:29 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | أبو ساندرا | 03-06-08, 02:22 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-07-08, 08:02 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-08-08, 12:25 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | azhary awad elkareem | 03-08-08, 01:06 PM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Safia Mohamed | 03-09-08, 11:21 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Ishraga Mustafa | 03-12-08, 11:10 AM |
| Re: {طق الحنك} وسياسة قهر النساء....... الى كل سناء خلف الجدار | Mohamed E. Seliaman | 03-12-08, 12:16 PM |
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