In Egypt, Beaten Wives Are Less Likely to Use Prenatal Care or Contraceptives
Egyptian women who have been beaten by their spouse are less likely than other women to use modern contraceptives or to have received professional prenatal care during their last pregnancy, according to an analysis of data from the 1995 Demographic and Health Survey (DHS).1 When compared with women who reported no domestic violence, those reporting that they had ever been beaten by their husband were significantly less likely to have received prenatal care when pregnant with their last child (odds ratio, 0.2). Moreover, women reporting three or more incidents of abuse in the past year were significantly less likely than those reporting one or two incidents to be current users of female contraceptives (0.5).
Analyses were based on 6,566 currently married women aged 15–49 who completed the women's status module of the DHS as well as the main questionnaire. Participants provided data on their socioeconomic and demographic characteristics; knowledge, attitudes and practice regarding family planning; access to health information and services; and attitudes related to domestic violence and family planning. Information was also collected on their husbands and on couple dynamics. In addition, women were asked whether they had been beaten since they were married, who had perpetrated the vio-lence, and how many times they had been beaten in the past year. The researchers examined whether women had received prenatal care for the last child born in the past 12 months; the average number of prenatal visits during that pregnancy (1–3 vs. four or more); and current use of female contraceptives. Univariate and multivariate logistic regressions were used to identify relationships between women's experience of domestic violence and use of prenatal care and contraceptives.
The majority of respondents were aged 25–39, lived in rural areas and had not completed secondary school (53–68%). Ninety-five percent were Muslim, and 82% did not work for cash. The women had a mean of 3.6 births, and more than one-half were married to men aged 30–44. Nearly six in 10 husbands had less than a secondary education. Thirty-four percent of respondents reported that they had ever been beaten by their husband; of these, 47% had been beaten in the past 12 months. Among women who reported violence during the past year, 38% had experienced three or more beatings in that period. Moreover, 54% of women who had ever been beaten reported that they had never talked to anyone about the abuse; of these, 52% said they kept quiet because it was "no use," and 8% said that being beaten was "part of life."
Substantial proportions of all respondents reported that their freedom of movement outside the home was restricted. Yet compared with women who had not been abused, significantly higher proportions of those reporting domestic violence were limited in their ability to go to the doctor (36% vs. 33%), visit relatives or friends (43% vs. 41%) or go into the neighborhood for recreation (90% vs. 83%).
Univariate analyses revealed several correlations between women's experience of domestic violence and use of prenatal care and contraceptives. Having ever been beaten and having been beaten in the past year were associated with decreased odds of having received prenatal care (odds ratios, 0.5 each). Among women who had experienced violence in the past year, those who had been beaten three or more times had higher odds of having received prenatal care than those who had been beaten once or twice (2.6), but were less likely to use contraceptives (0.7).
Multivariate analysis confirmed only one of the three bivariate associations between having been beaten and prenatal care: Women who had ever been beaten were less likely than those who had not to have received prenatal care when pregnant with their last child (odds ratio, 0.2); however, among women who had received prenatal care, those who had ever been beaten had higher odds of having made four or more visits (36.5). The association between the frequency of being beaten and the use of contraceptives remained as well: Women who reported three or more beatings during the past year had lower odds of current contraceptive use than did those reporting one or two incidents (0.5). The number of reasons women gave to justify wife beating was negatively associated with their odds of reporting four or more prenatal visits (0.7).
The researchers acknowledge that the lack of information on the respondents' husbands and the larger socioeconomic and political environment in which the women live limited the study's ability to examine contextual factors. However, they note that their findings indicate "that wife beating is associated with negative health outcomes, and that controlling behaviors play as important a role in abusive relationships in Egypt as they do in more industrialized societies." They recommend that campaigns be undertaken to increase knowledge and change attitudes about wife beating as well as to decrease the behavior itself. Moreover, they maintain that "it is crucial that specialized health services be provided in public as well as private institutions, and that the availability of such resources be made known to all women."—R. MacLean
1. Diop-Sidibé N, Campbell JC and Becker S, Domestic violence against women in Egypt—wife beating and health outcomes, Social Science & Medicine, 2005, 62(2006):1260–1277.