In Turkey, Pregnant Women's Risk of Domestic Abuse Is Linked to Education, Income, Number of Children
The presence and level of physical, emotional and sexual abuse during pregnancy varies according to the characteristics of women and their husbands, according to a 2003–2004 cross-sectional survey of pregnant rural and urban women in Malatya, Turkey.1 Overall, 32% of women had experienced at least one type of abuse from their spouse or his family during pregnancy. The odds of experiencing any abuse during pregnancy were elevated among women whose pregnancy was unwanted and who had a low family income, as well as among those whose husband had little or no education.
Study participants included 824 women (70% from urban areas and 30% from rural areas) who had completed at least one trimester of their current pregnancy and were recruited systematically from 60 population clusters within Malatya province. Data on demographic, behavioral and fertility characteristics of these women were collected, with a response rate of 92%. Researchers defined physical violence as having been hit, pushed, kicked or otherwise hurt; emotional abuse as having been humiliated, insulted, threatened with violence or separated from one's children; and sexual violence as having been physically forced or verbally coerced into having sex. The husband was the most common perpetrator (97% of physical, 81% of emotional and 100% of sexual incidents); in all other cases, women were abused by their husband's family.
In all, 261 women had experienced some type of violence during pregnancy, and 75% of those women had also been abused earlier in their marriage. Among women who had not been abused prior to their current pregnancy, 7% experienced abuse during pregnancy. Thirty-eight percent of women who had experienced physical violence prior to pregnancy, compared with 2% of those who had not, experienced physical violence during pregnancy. Those proportions for emotional abuse were 78% and 4%, respectively, and for sexual abuse, 59% and 5%.
In the bivariate analysis, the level of overall abuse was negatively associated with the educational level of the woman and her husband, the husband's occupation and the family's income, and was positively associated with the number of living children. For example, the proportion of women who had experienced any type of abuse ranged from 13% among those who had graduated from college to 44% among those who were illiterate, and from 16% among women whose husband had graduated from college to 64% among those whose husband had not finished primary school. Overall abuse had a U-shaped relationship to duration of marriage, with the highest level occurring at 4–5 years (45%).
Women in their second trimester of pregnancy were more likely to be abused than those in their third trimester (35% vs. 26%), and those whose pregnancy had been unwanted were more likely to experience abuse than were those with a wanted pregnancy (46% vs. 28%). Abuse was more common among women who smoked regularly during pregnancy than among those who did not (43% vs. 29%).
The patterns for individual types of abuse were generally similar to those for overall abuse. However, physical violence had a U-shaped relationship to the husband's education, and was not associated with the woman's education. The associations of being in the second trimester of pregnancy and having a higher number of living children with overall abuse were due entirely to their associations with emotional abuse. Sexual abuse was not associated with the duration of marriage.
In the multivariate analysis, the odds of overall abuse and each individual type of abuse were elevated among women who smoked regularly during pregnancy (odds ratios, 1.6–1.9). Unwanted pregnancy was associated with overall abuse and with emotional and sexual abuse (1.6–1.8). Women whose husband was illiterate or had less than eight years of education were significantly more likely to experience any type of abuse, physical violence and emotional abuse (1.7–2.4). Urban residence and low family income were associated with elevated odds of overall abuse (1.5 and 1.9, respectively) and emotional abuse (1.7 and 2.0). The risk of overall abuse was elevated among women who were in the second trimester of pregnancy, and the risk of physical violence was raised among women whose husband was unemployed (2.4).
The authors point out that just 38% of the women who had experienced violence either before or during pregnancy had discussed their experience prior to their interview. Given that only 2% of women had talked about their situation with a health care worker, the authors emphasize the importance of initiating health-based interventions to identify and help women who are being abused. They conclude that, in conjunction with other medical and social service programs, "the golden opportunity of antenatal care should be used to diagnose, assess and prevent domestic violence."—H. Ball
1. Karaoglu L et al., Physical, emotional and sexual violence during pregnancy in Malatya, Turkey, European Journal of Public Health, 2005, 16(2):149–156.