Samuel Ojima Adejoh, Bether Glory Anozie, and Abolaji Awodein
Abstract
This chapter presents reviewed research findings and case studies presented. The
findings from the case studies were the results from a study conducted among
25 participants who were survivors of domestic violence in Lagos, Nigeria.
Research studies found that the lifetime prevalence of physical or sexual partner
violence, or both, varied from 15% to 71% in 10 low- and middle-income
countries. Causes of domestic violence identified include being a smoker/alcoholic,
low level of education, type of occupation, financial dependency, temperament,
and childhood history of observing and experiencing abuse. Other factors
are being married more than once as a woman, divorced or separated, marriage at
a young age, larger family size, and psychoactive substance use. Consequences of
domestic violence include physical, psychological, mental health disorder, and
health and reproductive health emergencies. The different types of domestic
violence experienced by women include physical abuse/violence, sexual violence,
verbal and emotional violence, spiritual violence or cultural violence,
social violence, and economic or financial violence. The effects of domestic
violence on women’s health include bowel disorders, pelvic pain and several
reproductive tract infections, unhappy sexual life, unintended pregnancy, inability
to use contraceptives, maternal mortality, and risk of pregnancy complications,
induced abortion, miscarriage, and low birth weight.
The universality of domestic violence against women makes it an urgent social
problem that must be addressed holistically as it affects not just the health of the
woman but also that of the unborn child, those who might be pregnant, those
nursing children, their family relationships, the community, and the society.
Advocacy, continuing education, and research are the engine room for addressing
domestic violence against women and the effects on their reproductive health.
Keywords
Domestic violence · Health · Women · Effect · Consequences
Introduction
The chapter is structured into three main sections. The first section presents findings
from reviewed studies and this begins with the introduction, forms of domestic
violence and their prevalence rates, causes of domestic violence, consequences of
domestic violence, and types of domestic violence. The second section presents
findings on domestic violence and women’s reproductive health, specific issues are
physical violence, low birth weight, unwanted pregnancy, abortion and malnutrition,
physical violence and premature birth and loss of pregnancy, domestic violence and
mental health of women, sexual violence, and contraction of sexually transmitted
diseases. The third section presents lived experiences in the form of case studies and
finally, the conclusion.
Domestic violence is defined as “physical violence occurring within intimate
relationships and in a domestic setting” (Morgan & Chadwick, 2009). Although
domestic violence is a neutral term, in most cases, it is a gender-specific situation of
men perpetrating violence against women and when women strike out against men
within relationships or families, it is usually in self-defense (Ogbuji, 2004). Men who had more controlling power were more likely to be violent against their partners
(Garcia-Moreno et al., 2006).
Prevalence
TheWorld Health Organization’s (WHO) multicountry study on women’s health and
Violence Against Women (VAW) found that the lifetime prevalence of physical or
sexual partner violence, or both, varied from 15% to 71% in 10 low- and middleincome
countries (Garcia-Moreno et al., 2006). Similar studies of antenatal clinic
attendees in tertiary hospitals in Nigeria reported prevalence of domestic violence
ranging from 7.8% in Port Harcourt (Jeremiah et al., 2011), 14.0% in Jos (Gyuse &
Ushie, 2009), and 14.2% in Abeokuta (Fawole et al., 2008). In Nigeria, which is the
most populated country in sub-Saharan Africa, a previous study has reported a
lifetime prevalence of physical violence against women as 52.1% in the south–south
zone, 31.0% in the north-central, 29.6% in the south–east, 28.9% in the south–west,
19.7% in the north–east, and 13.1% in the north–west zone (National Population
Commission, 2009).
A WHO study reported that lifetime prevalence of physical or sexual partner
violence or both in 15 countries varied from 15% to 71% (Garcia-Moreno et al.,
2006). In New Mexico, 58.7% of women experienced lifetime physical and/or
sexual IPV, and 40.1% of women reported partner-perpetrated injuries. In
Pakistan, 44% of women reported “lifetime marital physical abuse” and 23% of
women reported abuse during pregnancy. These physically abused women also
reported verbal abuse and 36% of them reported sexual coercion. The wife’s education,
consanguinity, and duration of marriage were significant risk factors, similar for
lifetime marital abuse and abuse during pregnancy (Fikree et al., 2006). A study
showed that 15.9%of women in Minneapolis reported physical abuse by their partners
and 52% of them reported abuse during pregnancy. According to the Australian
Bureau of Statistics (2006) Personal Safety Survey, approximately one in three
Australian women have experienced physical violence during their lifetime, nearly
one in five women have experienced some form of sexual violence and nearly one in
five have experienced violence by a current or previous partner (Tables 1 and 2).
Causes of Domestic Violence
Studies have identified predictors of domestic violence, and these being social
determinants that encompass both social conditions and social relations. Social
conditions range from education and economy to position in the family and society,
whereas social relations include relationship with husband, interaction and support
from immediate and distant family members, neighbors, friends, and coworkers
(WHO, 2005). Risk factors related to husband may include age, being a smoker/
alcoholic, low level of education, type of occupation, financial dependency, health,
temperament, and childhood history of observing abuse, especially those who saw their mothers being victims of domestic violence (Somach & AbouZeid, 2009;
Fageeh, 2014). Kishor & Johnson (2004) identified several risk factors associated
with domestic violence against women that operate at the level of relationship. Their
study revealed that women, who had married more than once, divorced or separated,
tend to report experiencing domestic violence more than those who had married only
once. Women who married at a young age and those who have larger family sizes
with many children were also reported to be likely to have higher rates of domestic
violence experience. Alcohol misuse among men has particularly been identified as
an associated risk factor for wife beating in Nigeria (Fawole et al., 2005).Women who
engaged in harmful use of alcohol and other psychoactive substances were also likely
to be victims of domestic violence. Obi and Ozumba (2007) found that domestic
violence was significantly associated with financial disparity in favor of the female,
influential in-laws, educated women, and couples within the same age group. Consequences
Survivors of sexual violence can suffer both immediate and prolonged psychological
and mental problems (Josse, 2010), the most common being post-traumatic stress
disorder (PTSD), anxiety, depression, insomnia, low self-esteem, perceived loss of
control, and psychosis (García-Moreno et al., 2005; Moosa et al., 2012).
Amoakohene (2004) found a variety of psychological and emotional consequences
of violence, including fear, stress, depression, tension, and low self-esteem among
married women. Similarly, Adu-Gyamfi (2014) reported mental and emotional
effects of sexual abuse, including loss of sense of dignity, lack of respect, confidence,
and self-esteem. The cumulative effect of repeated sexual violence may cause
substance abuse, despair, low self-esteem, and perceived loss of control (García-
Moreno et al., 2005; Moosa et al., 2012). The severe health problems, coupled with
the emotional ones, may lead married women to develop suicidal death as the only
means of thoughts and thinking escape (Luce et al., 2010). Throughout the world, at
least one in three women (nearly one billion) has been beaten, forced to have sex, or
harassed in some manner. About 70% of female murder victims were killed by their
male partners. Every 2.5 min, one woman is exposed to sexual abuse in the United
States (Turla & Özkanli, 2006). Amnesty international (2007) reported that a third
(and in some cases two-thirds) of women are believed to have been subjected to
physical, sexual, and psychological violence carried out primarily by husbands,
partners, and fathers, while girls are often forced into early marriage and are at
risk of punishment if they attempt to escape from their husbands. It has serious
consequences on women’s mental and physical health, including their reproductive
and sexual health. These include injuries, gynecological problems, temporary or
permanent disabilities, depression, and suicide, among others. Domestic violence on
women’s reproductive health is linked most times with their intimate partners, and
intimate partner violence during pregnancy and the postpartum period may have
negative consequences for the health of the mother, fetus, and child. In such cases,
the violence is not just directed against the woman; it also involves the newborn
child or one that is within its first year of life and growing up in an environment of
violence (Ramirez-Baen et al., 2019).
Types of Domestic Violence
Domestic violence is not just about physical violence but extends to other forms of
abuse such as sexual, social, psychological, economic, and spiritual abuses. Domestic
violence against women is a common worldwide social and health problem.
Domestic violence is perpetrated by, and on, both men and women (Susmitha, 2016).
However, most commonly, the victims are women, especially in Nigeria. Although
physical violence is repeatedly recognized by the public as the core form of domestic
violence, there are equally damaging nonphysical behavior that must be categorized
as abusive and these are identified as:
- Physical Abuse: This includes openly hitting a victim by a perpetrator like
punching, kicking, pushing, slapping, shaking, inflicting burns, choking, biting,
hair pulling; using a weapon, for example, flogging with a stick, stoning, belting,
spearing, etc. Physical violence refers to the use of physical force to inflict pain,
injury, or physical suffering on a victim. Slapping, beating, kicking, pinching,
biting, pushing, shoving, dragging, stabbing, spanking, scratching, hitting with a
fist or something else that could hurt; burning, choking, threatening, or using a
gun, knife, or any other weapon are some examples of physical violence (García-
Moreno et al., 2005).
- Verbal and Emotional Violence: Verbal violence includes the intent to humiliate,
degrade, demean, threaten, force, or intimidate, and includes the use of
derogatory language or continual “put-downs” to highlight a particular part of a
person’s being or their societal role. Consequently, the person may experience
this violence as an attack on their identity resulting in psychological harm. As a
result, verbal violence is closely related to emotional violence. Emotional or
psychological violence can leave a person feeling that they are to blame for the
problems in the family or in a relationship. Psychological abuse may result in
depression, anxiety, stress, low self-esteem, and in the long run may lead to risktaking
behaviors. - Sexual Violence: This involves trying to force either a male or female to have sex
or take part in sexual acts against their will. Or using an object or body part to
penetrate the vagina, mouth, or anus without consent or permission, injuring
sexual organs, intentionally hurting someone during sex, forcing someone to have
unsafe sex, without protection against pregnancy or sexually transmitted diseases,
forcing someone to take their clothes off or remain naked against their will, being
made to pose for pornography or being made to look at pornography against their
will, being forced to watch, observe, or take part in sexual activities, voyeurism or
exhibitionism, criticizing sexually or making sexually degrading comments or
names, and any other types of sexual harassment. Sexual abuse refers to physically
forcing a partner to have sexual intercourse who does not want it, forcing a
partner to do something that she found degrading or humiliating (García-Moreno
et al., 2005), harming her during sex or forcing her to have sex without protection
(World Health Organization, 2014). - Spiritual or Cultural Violence: It is when power and control is used to deny a
partner or family member their human, cultural, or spiritual rights and needs. It
can also include using religion or culture as an excuse to commit abuses to justify
the behavior. - Social Violence: Social abuse and isolation is commonly used by perpetrators to
separate the victim from supportive friends, family, and community agencies.
This has particular relevance for women in rural and remote areas where there is
limited access to cheap transportation and where firearms are more common;
there is increased isolation from neighbors and support services, and communities
are small. This abuse may also be more prevalent for women from culturally and
linguistically diverse communities. - Economic or Financial Violence: Involves the unequal control of finances in a
relationship or family and the deprivation of necessities. - Intimate Partner Violence: Intimate partner violence is marked by violent
behavior perpetrated by one’s spouse or partner through physical aggression,
sexual aggression, or emotional abuse. Manifestations of intimate partner violence
appear to be different across cultures. The World Health Organization
(2010) defined intimate partner violence (IPV) as “behaviour within an intimate
relationship that causes physical, sexual or psychological harm, including acts of
physical aggression, sexual coercion, psychological abuse and controlling
behaviours.”
In the context of intimate partner violence (IPV), IPV can be classified into
five qualitatively different types. These include coercive controlling violence
(CCV), violent resistance, situational couple violence (SCV), mutual violent
control violence, and separation-instigated violence (Beck et al., 2013). CCV
refers to a pattern of emotionally abusive intimidation, coercion, and control
combined with physical violence perpetrated against an intimate partner (Kelly &
Johnson, 2008: 478). The coercive partner keeps the victim under surveillance,
and failure to follow the rules established by them often results in punitive action
(Kelly & Johnson, 2008; Tanha et al., 2009; Beck et al., 2013). Johnson maintains
that the abuser may use one or a combination of several tactics to keep the victim
under control. In heterosexual relationships, CCV is most often perpetrated by
men. Johnson (2006), for instance, found that 97% of the CCV in the Pittsburgh
sample were male-perpetrated. Violent resistance is the type of violence used by
the victim of violence to resist violence from a coercive controlling partner.
Various terms that have been used to describe this type of violence include female
resistance, resistive/reactive violence, and self-defense (Kelly & Johnson, 2008;
Beck et al., 2013).
Situational couple violence (SCV) is a type of violence between partners when
an individual is violent and noncontrolling in a relationship with a nonviolent
partner or a violent but noncontrolling partner (Johnson, 2006). It is the most
common type of violence in the general population and can be perpetrated by men
or women against their partners. The intention behind this type of violence is not
power, control, or coercion; it arises from situations, arguments, and conflicts
between partners, which then escalates into physical violence (Kelly & Johnson,
2008). Mutual violent control violence occurs when both partners are violent and
controlling towards each other (i.e., two intimate terrorists) (Beck et al., 2013).
In separation-instigated violence, couples do not normally have a history of
violence in their intimate relationship, and the violent episodes are triggered in
response to traumatic experiences at the time of separation. Such violence is
typically limited to one or two mild to more severe forms of violence episodes
during the separation period (Kelly & Johnson, 2008). The various ways a person
may react include lashing out, throwing objects at the spouse, destroying property,
and trying to intimidate the spouse or new partner through various actions
such as sideswiping (to strike along the side in passing) or damaging their car
(Kelly & Johnson, 2008).
One of the most significant problems associated with domestic violence is how it
affects women’s reproductive health. Female victims of domestic violence experience
a wide range of injuries and medical problems. Several studies have found a
cause-effect relationship between domestic violence and reproductive health problems.
As the life expectancy of women grows longer, “adding health and meaning to
life” becomes a significant dimension of health for everybody who understands (Kök
et al., 2006). WHO (2013) argued that women in violent relationships are often
cowed by fear and, as a result, may be unable to freely exercise their right of choice
to have sexual intercourse or to protect themselves from unwanted pregnancies by
using contraception. Studies have shown that sexual violence is a causal factor of
chronic headaches, bowel disorders, pelvic pain, and several reproductive tract
infections. Some unexplainable physical symptoms and lower health standards are
observed among the women exposed to physical and sexual violence (Tomasulo &
McNamara, 2007). The reproductive health of women experiencing violence is
affected negatively due to an unhappy sexual life. Linares et al. (2005) reported
that while women who are not experiencing violence “love” their spouses, women
experiencing violence usually “hate” or “fear” their husbands. It is obvious that
women with negative feelings toward their spouses cannot live a happy family and
sexual life. Indeed, Akyüz et al. (2008) found that women exposed to violence
defined their sexual life as unhappy and found it hard to share their sexual problems
with their partners. A study conducted in Uganda (Kaye et al., 2006) showed that
men often believe that a woman’s clandestine use of contraceptives is a justifiable
reason for beating her. In Estonia, Laanpere et al. (2013) found that women with
experience of both physical and sexual violence were significantly less likely to have
used contraception during their most recent sexual encounters. They were also less
likely to have used condoms and more likely to have undergone repeated induced
abortions. Using demographic and health data from Columbia, Pallitto and
O’Campo (2004) found elevated risks of unintended pregnancy for women who
had been physically or sexually abused by their current or most recent sexual
partners. In some cultures, women are less likely to discuss the use of contraception
with their husbands because it may lead to accusations of infidelity and may lead to
physical violence and/or abandonment, because some men believe that the use of
contraception is associated with infidelity on the woman’s side. Violence during
pregnancy can also cause maternal mortality. Many of the maternal deaths related to
traumas are caused by head traumas or intra-abdominal bleeding. Abdominal injury
may cause a secondary bleeding risk due to the separation of the placenta and
maternal and fetal deaths may be seen because of this (Öztürk & Sevil, 2005).
Among married women, reproductive coercion is common; although it is common,
it is also an understudied form of gender-based violence. The National Sexual
and Intimate Partner Violence Survey (NISVS), first conducted in the United States
in 2010, found that nearly 1 in 10 women reported having partners who refused to
use condoms and/or were trying to get them pregnant when they did not want to be
(Black et al., 2011). In Boston, women reported that partners had limited their ability to choose whether to have children; they often described that their partners used
tactics to get them pregnant or forced them to undergo abortion and sterilization
(Hathaway et al., 2005).
Silverman and Raj (2014) posited that violent men could control the reproductive
behavior of their partners, preventing them from accessing important family planning
and reproductive health services. Reproductive coercion often includes the
prevention of a woman from obtaining birth control, as well as the manipulation
of a woman to get pregnant. Nikolajski and colleagues (2015) further divided
pregnancy coercion into pregnancy pressure and control of pregnancy outcomes;
direct interference with a woman’s contraceptive efforts (birth control sabotage),
pressuring a female sexual partner to become pregnant when she does not want to be
(pregnancy pressure), and using pressure or threats to coerce women to either
continue or terminate a pregnancy (control of pregnancy outcomes). Miller et al.
(2010) measure includes items under the “pregnancy coercion” section, which
focused on removing or sabotaging condoms during sexual activity. For instance,
if a woman consented to sexual activity with a condom, but would not have
consented without a condom, this partner behavior could be both sexual assault
and reproductive coercion. Indeed, survivors of stealthing describe stealthing as
“a disempowering, demeaning violation of a sexual agreement” (Brodsky, 2017).
Domestic violence affects women’s reproductive health as conceptualizations of
reproductive coercion, typically including birth control sabotage, or active attempts
to prevent women from using birth control, and pregnancy coercion, or attempts to
pressure them into becoming pregnant and/or to control the outcome of a pregnancy.
Batterers who are sabotaging or preventing birth control use are coercing pregnancy.
Over the last decade, reproductive coercion has emerged as a widespread but
understudied form of gender-based violence. Some studies do not separate out
physical assault from sexual assault when examining their relationship to reproductive
health.
Studies from the United States and Norway have linked battering during pregnancy
to increased risk of pregnancy complications, miscarriage, and to delivering a
low birth weight infant. Studies from the United States also suggest varying patterns
of abuse during pregnancy with some women at higher risk of assault during
pregnancy and others being abused less often while pregnant. Studies of women
presenting to prenatal care clinics in the United States suggest that between 3.9% and
15.2% are being beaten during their present pregnancies. Women’s anxiety following
emotionally violent experiences (e.g., intimidation, fear, and ridicule) could limit
their ability to control their fertility and may be harmful to their experiences in
pregnancy (Tiwari et al., 2008). Demographic and health data from Columbia,
Pallitto and O’Campo (2004) found elevated risks of unintended pregnancy for
women who had been physically or sexually abused by their current or most recent
sexual partners. According to WHO, intimate partner violence is one of many
barriers to accessing sexual reproductive health services in both developed and
developing countries. In Kenya, family planning workers reported that women
regularly forge their partners’ signature on spousal consent forms for contraception
rather than ask their partners’ permission. When family planning clinics in Ethiopia removed their requirement for spousal consent, clinic use rose to 26% in a few
months. Violence not only causes physical injury, but it also undermines the social,
economic, psychological, spiritual, and emotional well-being of the victim, the
perpetrator, and the society as a whole. Domestic violence is a major contributor
to the ill health of women.
However, Katz et al. (2017) pointed out and explored the co-occurrence of sexual
assault and reproductive health. For instance, forced sexual activity without contraception
could be considered sexual assault. That is, if a woman consented to sexual
activity with a condom, but would not have consented without a condom, but her
partner went ahead without a condom, the partner’s behavior could be translated as
sexual assault. Different forms of intimate partner physical violence are linked to
different risks and outcomes for survivors. For instance, weapon threats, sexual
assaults, and strangulation are, not surprisingly, more strongly linked to higher future
lethality risks.
Women may have problems like unwanted pregnancies and serious pregnancies
related complications as a result of different kinds of violence. Taft and Watson
(2008) reported that women exposed to violence from their partners have many more
unwanted pregnancies, abortions, and pregnancy-related complications. Akyüz et al.
(2008) showed that women who experienced more violence did not plan their most
recent pregnancies and, therefore, terminated those pregnancies by means of abortion.
Unwanted pregnancies among women experiencing violence have a higher rate
of being terminated through induced abortion. Furthermore, these unwanted pregnancies
can lead to unsafe abortions in countries where abortion is illegal. This
situation causes many risks of serious health complications and even death for
women exposed to violence. In addition, physical and sexual violence continues
during pregnancy for many women if the pregnancy continues. This may affect both
the health of the woman and the baby (Khan & Hussain, 2008). Some complications,
such as prenatal bleeding, fetal fractures, maternal infections, uterus, lung, or spleen
rupture, abortion, stillbirth, and premature birth, may appear due to exposure to
violence or due to being beaten during pregnancy. Violence during pregnancy can
also cause maternal mortality. Many of the maternal deaths related to traumas are
caused by head traumas or intra-abdominal bleeding. Abdominal injury may cause a
secondary bleeding risk due to the separation of the placenta, and maternal and fetal
deaths may be seen because of this.
Risk factors for domestic violence in pregnancy have been identified from various
studies. These are: teenagers, late bookers and women with unwanted pregnancies,
unmarried or divorced women, and of greater parity, low socioeconomic class,
together with high consumption of tobacco and alcohol (Khan & Hussain, 2008).
Domestic violence in pregnant women is well recognized as an important health
issue and has been associated with increased rates of adverse pregnancy outcome or
fetal risk, although the magnitude of this risk is not well established. By detecting
domestic violence during pregnancy, there would be an opportunity to intervene and
protect two lives from a dangerous environment.
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