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Original Article

Domestic violence against women in Shiraz, South-

western Iran
Bahareh Moazena, Alireza Salehib,*, Maryam Soroushc, Hossein Molavi Vardanjania, Amir
Zarrinhaghighid
a
Department, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
b
Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz,
Iran.
c
Academic Center for Education, Culture, and Research (ACECR)-Fars Branch, Iran.
d
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract:
KEY WORDS Background: Domestic violence against women can lead to short and long term health-related
issues. We aimed to estimate the prevalence of domestic violence against married women and
Domestic violence its correlates in southwestern, Iran.
Methods: A population-based survey was carried out from February 1st to May 30th, 2018 in
Public health Shiraz, Iran. Currently married or recently separated/divorced women who visited healthcare
Women’s health centers were voluntarily interviewed. World Health Organization (WHO) standard domestic
violence questionnaire was used to measure domestic violence. Hence, its prevalence and
correlates were assessed. Data were analyzed using multivariable logistic regression.
Results: Lifetime prevalence of overall, mental, physical, and sexual domestic violence were
54.5% (95% CI: 49.6, 59.4), 52.0% (95% CI: 47.1, 57.0), 18.2 % (95% CI: 14.4, 22.0) and
14.0 % (95% CI: 10.6, 17.4), respectively. Living separately, increasing spouse’s age, the
higher number of children, rental housing, middle to low monthly income, and history of domestic
violence in the family of husband and/or wife had a positive correlation with domestic violence
in some categories.
Conclusions: More than half of the married women in southwestern Iran are experiencing
domestic violence, and mental domestic violence is the most common type. Economic instability
and witnessing domestic violence in childhood are the most correlates of domestic violence.
Family violence preventive services and other population-based measures are highly necessary
Received: 2019-05-07 for this region.
Accepted: 2019-06-25

* Corresponding Author at:

Alireza Salehi: MD, MPH, PhD, Associate Professor of Epidemiology, Director of MPH Department, Shiraz University of Medical Sciences,
Shiraz, Iran. Tel: +987132337589, Fax: +987132338476; Email: [email protected] Salehi A.).

Introduction harm, resulting in her suffering or forced deprivation of

her individual or social freedom2. The psychological

D omestic Violence

Domestic violence (DV) has been defined as the

injuries associated with violence can be feelings, such as
helplessness, lack of confidence, anxiety, depression,
and suicide. Also, physical disabilities, chronic
violent and dominant behaviour of a family member headaches, drug use, and mental disorders are
against other members of the same family. Usually, expected 3, 4.
women and girls are the first victims of DV.1 Violence Domestic violence is mainly categorized into three
against women is any act of gender-based violence that groups: Mental, Physical and Sexual Violence 5.
leads to a woman's physical, sexual or psychological

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Literature Review age of 10, 60.53% of men are married, 1.46%

In a large population study by the World Health divorced, 0.78% widowed, and 37.21% are single.
Organization (WHO) in 15 regions of 10 countries Also, 60.89% of women are married, 2.68% divorced,
2000-2003, on 24096 women, DV rate was 15-71%. 7.24% widowed, and 29.18% bachelorette 11.
According to this study, physical and sexual violence in
the world is widespread 5. Participants
In a meta-analysis study conducted in Iran, April Currently married or recently separated/divorced
2017 on 31 articles on DV against women (from 2000 women who visited health centers for a routine check-
to 2014), it was estimated that DV prevalence in Iran is up, neonatal, child or maternal healthcare or as patient
66%. Prevalence rate in the Eastern region of Iran was companion voluntarily participated in this study.
70%, West 75%, North 62%, South 70%, and in the Bachelorettes were excluded from the survey. All the
Central region 59%, respectively6. women who entered the study gave their informed
In a study by Kargar Jahromi et al. in Jahrom city consent verbally. The study was approved by the local
(Fars province), the prevalence of physical, sexual and Ethics Committee of Shiraz University of Medical
emotional violence against women was 16.4%, 18.6% Sciences (Approval Code: IR.SUMS.MED.REC.1398.77).
and 44.4%, respectively. In this study, domestic violence
against women was positively associated with factors Sampling
such as younger women and men, low duration of In this study the sample size was estimated at least
marital years, and low level of education amongst men 430 participants using the Cochran sample size formula
and women7. by assuming 6% precision, 5% type 1 error, 75%
In the study by Shayan et al. in Shiraz, on 197 prevalence and a response rate of 80%.
women who had referred to Shiraz Forensic medicine, In this study, a multistage cluster sampling was done.
more than 50% were subjected to DV, and had general All 10 Shiraz municipality districts (only urban) are
health problems. They were also suffering from listed as sampling stratum. Public and private sectors
depression and anxiety 8. were considered as sampling districts to provide a
representative sample of people with high or low
Aim of the study socioeconomic status. From each district, 1 public and 1
Considering the significant effects of DV on familial private clinic was randomly selected, of which clinic 20
and social health, as well as lack of sufficient evidence in women were interviewed.
Fars province, especially Shiraz, situation analysis might
facilitate evidence-based health policy making. Variables
Considering higher prevalence of DV among families DV and marital status, age, spouse’s age, years of
with lower economic condition in several previous studies marriage, number of children, housing (own or not own),
as well as the current economic instability due to work status (housewife or employed), spouse working
economic sanctions in Iran,9,10 this study can provide an status (full-time, part-time and unemployed), level of
update on the prevalence of DV.. This study was education (diploma or lower, associate or bachelor,
conducted to determine the prevalence of domestic master or higher), spouse’s level of education (diploma
violence, and its correlates against married women who or lower, associate or bachelor, master or higher)
visited health centers in Shiraz, 2018. monthly income, age difference between spouse and
wife, history of DV in the women and/or spouse’s
Materials and methods parental family (often, sometimes, never) were
Setting measured during the interview.
The study was a population-based survey, carried
out from February 1st to May 30th, 2018, in Shiraz., the Data collection
capital city of Fars province, located in the southwestern The adopted and standardized Persian version of
part of Iran (29.5929° N, 52.5836° E) with a population the WHO standard DV questionnaire was used 12, 13.
of 1869000, according to the Population and Housing The questionnaire includes 15 demographic questions,
Census report from the Statistical Center of Iran in 2016. 11 mental DV questions, 6 physical DV questions, and 3
Based on this census, 50.43% of Shiraz’s inhabitants are sexual DV questions (Appendix 1) (7 questions in terms
men and 49.57% women. Also, among people over the of controlling behavior were considered as mental
age of 6, 94.83% of men and 91.43% of women are violence).
literate. Furthermore, among the population over the

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The questionnaire probes the participants’ DV in the past 12 months, which was the highest frequency
experience during their life as well as the last 12 months. in mental violence, as well as amongst all the questions
Also, in the case of physical DV, the severity of violence asked. The second most frequent mental violence
is assessed by the type of violence (moderate or severe). experienced, was being insulted and felt bad about
Being slapped, pushed, shoved or something thrown at themselves more than 3 times within the past 12 months
them, which is defined as moderate violence, and actions (57 (14.2%) women). The least answered question in
like being punched or other things, kicked, dragged, the mental violence was given by 34 women (8.5%)
beaten up, choked or burnt on purpose, threatened with about their husband often feeling suspicious of them
a weapon or the actual use of a weapon against them being faithful during their lifetime.
where categorized as severe physical violence. Being pushed or shoved and also being slapped or
Data were collected by two trained female had something thrown at more than 3 times in the last
healthcare nurses. Participants were oriented on how to 12 months, was the most frequent answers among
answer the questions and then the questionnaires were physical violence questions (22 (5.5%) and 19 (4.8%)
filled out in a private room via face-to-face interviews. women), respectively.
Each form was completed in approximately 10 minutes. The least answered questions were being choked or
burnt on purpose with a frequency of 6 (1.5%) during
Statistical Analysis their lifetime.
Data were prepared using methods presented by A total of 21 (5.3%) women were forced to have
Molavi et al. 14. The mean and standard deviations (SD) intercourse without their consent more than 3 times in
were used for quantitative variables and relative the last 12 months, and 25 (6.3%) had this experience
frequency for qualitative variables. Chi-square test was 2-3 times in the past 12 months, which was the highest
used for bivariate analysis. Variable selection for in sexual violence. The participants’ answers to the
multivariate analysis was done based on a conceptual questions are shown in Appendix 2.
framework, and P value lower than 0.25. Binary logistic According to the multivariable analysis, women who
regression was applied for multivariable analysis by were not living with their partner (divorced, separated)
backward elimination approach. Adjusted odds ratio experienced overall DV 6.5 (95%CI: 2.1, 20.2) times,
(OR) and its 95% confidence interval (CI) were mental 5.6 (95%CI: 1.8, 16.9) times, and physical DV
estimated. P values of less than 0.05 were considered to 5.2 (95%CI: 2.2, 12.4) times more than women who
be statistically significant. All statistical analysis was were living with their spouses. Wives, whose spouses
done using SPSS software version 14. were in their 30-49 or older than 50 years
experienced mental violence 2.7 (95%CI: 1.3, 5.6),
Results and 3.8 (95%CI: 1.7, 8.8) times more than those
younger than 30 years. Women from families with 3 or
In this study, response rate was 93.0%. Wives’ mean more children reported to have experienced 3.8
age ± SD was 38.29 ± 11.18 years, and spouses’ mean (95%CI: 1.8, 7.9) and 4.6 (95%CI: 1.8, 11.9) times
age was 42.69 ± 11.83 years. Mean marital life ± SD more DV in general and physical violence compared to
was calculated 14.01 ± 11.18 years. Majority of both those from families without children, respectively (Table
women and men educational level was diploma with 2).
134 (33.5%) and 111 (27.8%), respectively. Also, 264
women (66.0%) were housewives. Discussions
The lifetime prevalence of overall, mental, physical,
and sexual DV were estimated at 218 (54.5%, 95%CI: In this study, in Shiraz, southwestern Iran, more than half
49.6, 59.4), 208 (52.0%, 95%CI: 47.1, 57.0), 73 of the women had experienced DV at least once in
(18.2%, 95%CI: 14.4, 22.0), and 56 (14.0%, 95%CI: their lifetime. This was similar to the prevalence
10.6, 17.4), respectively. Lifetime experience (at least reported by a previous study in Shiraz and Rafsanjan 8,
one time) of moderate and severe physical DV was 15. According to the findings from the WHO multi-

reported by 68 (17.0%, 95%CI: 13.3, 20.7) and 37 country study conducted by Garcia-Moreno et al.
(9.2%, 95%CI: 6.3, 12.1) participants (Table 1).
Among all participants, 61 (15.3%) women reported
being ignored or treated indifferently more than 3 times

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Table 1: Frequency and analysis results of qualitative parameters.

Experienced DV in total Mental violence
Variables n
n (%) %95CI n (%) %95 CI
Overall 400 218 (54.5) 49.5 – 59.5 208 (52.0) 47.0 – 57.0
Together 369 192** (52.0) 46.8 – 57.2 182** (49.3) 44.1 – 54.6
Marital status
Separated 31 26 (83.9) 66.3 – 94.5 26 (83.9) 66.3 – 94.5
< 30 108 52 (48.1) 38.4 – 58.0 51 (47.2) 37.6 – 57.0
Wife’s age 30 – 49 227 127 (55.9) 49.2 – 62.5 119 (52.4) 45.7 – 59.0
> 50 65 39 (60.0) 47.1 – 72.0 38 (58.5) 45.6 – 70.6
< 30 46 18* (39.1) 25.1 – 54.6 17* (37.0) 23.2 – 52.4
Spouse’s age 30 – 49 252 141 (56.0) 50.0 – 62.1 134 (53.2) 46.8 – 59.5
> 50 99 57 (57.6) 47.2 – 67.5 55 (55.6) 45.2 – 65.5
< 10 200 104 (52.0) 44.8 – 59.1 101 (50.5) 43.4 – 57.6
Marital years 10–19 95 56 (58.9) 48.4 – 68.9 50 (52.6) 42.1 – 63.0
> 20 105 58 (55.2) 45.2 – 65.0 57 (54.3) 44.3 – 64.0
0 87 37* (42.5) 32.0 – 53.6 37* (42.5) 32.0 – 53.6

Number of 1 child 117 67 (57.3) 47.8 – 66.4 63 (53.8) 44.4 – 63.1

children 2 children 126 70 (55.6) 46.4 – 64.4 68 (54.0) 44.9 – 62.9
>3 70 44 (62.9) 50.5 – 74.1 40 (57.1) 44.7 – 68.9
Diploma and
202 112 (55.4) 48.3 – 62.4 103 (51.0) 43.9 – 58.1
lower
Wife’s Associate/
education 140 79 (56.4) 47.8 – 64.8 78 (55.7) 47.1 – 64.1
Bachelors
Masters or higher 58 27 (46.6) 33.3 – 60.1 27 (46.6) 33.3 – 60.1
100**
House Owning 216 39.5 – 53.2 94** (43.5) 36.8 – 50.4
(46.3)
ownership
Not owning 184 118 (64.1) 56.7 – 71.1 114 (62.0) 54.5 – 69.0
Diploma and
194 110 (56.7) 49.4 – 63.8 104 (53.6) 46.3 – 60.8
lower
Spouse’s Associates/
education 133 74 (55.6) 46.8 – 64.2 70 (52.6) 43.8 – 61.3
Bachelors
Masters or higher 72 34 (47.2) 35.3 – 59.3 34 (47.2) 35.3 – 59.3
Full–time 241 118** (49.0) 42.5 – 55.5 112** (46.5) 40.0 – 53.0
Spouse’s
Part–time 112 72 (64.3) 54.7 – 73.1 68 (60.7) 51.0 – 70.0
occupation
Not-working 44 27 (61.4) 45.5 – 75.6 27 (61.4) 45.5 – 75.6
Wife’s Housewife 264 141 (53.4) 47.2 – 59.5 134 (50.8) 44.6 – 56.9
occupation Employed 136 77 (56.6) 47.9 – 65.1 74 (54.4) 45.7 – 63.0
< 10MR 100 61* (61.0) 50.7 – 70.6 55* (55.0) 44.7 – 65.0
10–20MR 138 78 (56.5) 47.8 – 64.9 77 (55.8) 47.1 – 64.2
Monthly wage
20–50MR 102 54 (52.9) 42.8 – 62.9 52 (51.0) 40.9 – 61.0
> 50MR 60 25 (41.7) 29.1 – 55.1 24 (40.0) 27.6 – 53.5
Never 152 64**(42.1) 34.2 – 50.4 60**(39.5) 31.6 – 47.7
Argument in
Sometimes 193 117 (60.6) 53.3 – 67.6 113 (58.5) 51.3 – 65.6
wife’s family
Often 54 37 (68.5) 54.4 – 80.5 35 (64.8) 50.6 – 77.3
Never 126 46**(36.5) 28.1 – 45.6 42**(33.3) 25.2 – 42.3
Argument in
Sometimes 218 127 (58.3) 54.4 – 64.9 124 (56.9) 50.0 – 63.4
spouse’s family
Often 55 45 (81.8) 69.1 – 91.0 42 (76.4) 63.0 – 86.8
* means P-value < 0.25, ** means P-value <0.05 (significant variables are indicated by star signs in the first row). P–value < 0.25 is assumed as the
level of selection for logistic regression analysis.
MR = Million Rial

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Table 1 (Cont.): Frequency and analysis results of qualitative parameters.

Physical violence Sexual violence
Variables
n (%) %95 CI n (%) %95 CI
Overall 73 (18.2) 14.6 – 22.4 56 (14.0) 10.8 – 17.8
Together 59** (16.0) 12.4 – 20.1 50 (13.6) 10.2 – 17.4
Marital status
Separated 14 (45.2) 27.3 – 64.0 6 (19.4) 7.6 – 37.5
< 30 11** (10.2) 5.2 – 17.5 9* (8.3) 3.9 – 15.2
Wife’s age 30 – 49 43 (18.9) 14.1 – 24.7 40 (17.6) 12.9 – 23.2
> 50 19 (29.2) 18.6 – 41.8 7 (10.8) 4.4 – 20.9
< 30 4* (8.7) 2.4 – 20.8 6 (13.0) 4.9 – 26.3
Spouse’s age 30 – 49 46 (18.3) 13.7 – 23.6 37 (14.7) 10.6 – 19.7
> 50 23 (23.2) 15.3 – 32.8 13 (13.1) 7.2 – 21.4
< 10 29* (14.5) 9.9 – 20.2 26 (13.0) 8.7 – 18.4
Marital years 10–19 20 (21.1) 13.4 – 30.6 18 (18.9) 11.6 – 28.3
> 20 24 (22.9) 15.2 – 32.1 12 (11.4) 6.0 – 19.1
0 9** (10.3) 4.8 – 18.7 8* (9.2) 4.1 – 17.3
Number of 1 child 20 (17.1) 10.8 – 25.2 15 (12.8) 7.4 – 20.3
children 2 children 24 (19.0) 12.6 – 27.0 17 (13.5) 8.1 – 20.7
>3 20 (28.6) 18.4 – 40.6 16 (22.9) 13.7 – 34.4
Diploma and lower 38* (18.8) 13.7 – 24.9 29 (14.4) 9.8 – 20.0
Wife’s education Associate/ Bachelors 29 (20.7) 14.3 – 28.4 21 (15.0) 9.5 – 22.0
Masters or higher 6 (10.3) 3.9 – 21.2 6 (10.3) 3.9 – 21.2
Owning 38 (17.6) 12.8 – 23.3 22** (10.2) 6.5 – 15.0
House ownership
Not owning 35 (19.0) 13.6 – 25.4 34 (18.5) 13.1 – 24.9
Diploma and lower 36 (18.6) 13.3 – 24.8 28 (14.4) 9.8 – 20.2
Spouse’s
Associates/ Bachelors 27 (20.3) 13.8 – 28.1 21 (15.8) 10.0- 23.1
education
Masters or higher 10 (13.9) 6.9- 24.1 7 (9.7) 4.0 – 19.0
Full–time 39 (16.2) 11.8 – 21.5 27** (11.2) 7.5 – 15.9
Spouse’s
Part–time 26 (23.2) 15.8 – 32.1 24 (21.4) 14.2 – 30.2
occupation
Not-working 8 (18.2) 8.2 – 32.7 5 (11.4) 3.8 – 24.6
Housewife 45 (17.0) 12.7 – 22.1 35 (13.3) 9.4 – 18.0
Wife’s occupation
Employed 28 (20.6) 14.1 – 28.4 21 (15.4) 9.8 – 22.6
< 10MR 21 (21.0) 13.5 – 30.3 21**(21.0) 13.5 – 30.3
10–20MR 26 (18.8) 12.7 – 26.4 21 (15.2) 9.7 – 22.3
Monthly wage
20–50MR 20 (19.6) 12.4 – 28.6 12 (11.8) 6.2 – 19.6
> 50MR 6 (10.0) 3.8 – 20.5 2 (3.3) 0.4 – 11.5
Never 14** (9.2) 5.1 – 15.0 15** (9.9) 5.6 – 15.8
Argument in wife’s
Sometimes 46 (23.8) 18.0 – 30.5 27 (14.0) 9.4 – 19.7
family
Often 13 (24.1) 13.5 – 37.6 14 (25.9) 15.0 – 39.7
Never 8** (6.3) 2.8 – 12.1 12** (9.5) 5.0 – 16.0
Argument in
Sometimes 45 (20.6) 15.5 – 26.6 30 (13.8) 9.5 – 19.1
spouse’s family
Often 20 (36.4) 23.8 – 50.4 14 (25.5) 14.7 – 39.0

Bangladesh, Peru and the United Republic of Tanzania women (from 2000 to 2014) estimated that the total
had similar prevalence, while Ethiopia had a total prevalence of this phenomenon in Iran was 66% while
prevalence of 70%5, 16. However, a meta-analysis study DV prevalence in the southern regions of the country
conducted on 31 articles on domestic violence against was reported to be 70% in the same study 6. These

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Table 2: The results of the logistic regression analysis.

Adjusted OR Unadjusted OR
Type of violence Status
(95% CI up., low.) (95% CI up., low.)

Living together Reference

Marital status
Living separated 6.4 ** (2.1–20.2) 4.8 ** (1.8–12.8)
0 Reference
1 child 2.3 ** (1.2–4.4) 1.8 * (1.0–3.2)
Number of children
Total 2 children 2.7 ** (1.5–5.1) 1.7 (1.0–2.9)
> 3 children 3.8 ** (1.8–7.9) 2.3 * (1.2–4.4)
Owning Reference
House ownership
Not owning 2.6 ** (1.6–4.0) 2.1 ** (1.4–3.1)
Never Reference
Argument in spouse’s
Sometimes 2.2 ** (1.4–3.5) 2.4 ** (1.5–3.8)
family
Often 8.5 ** (3.8–19.2) 7.8 ** (3.6–17.0)
Living together Reference
Marital status
Living separated 5.6 ** (1.8–16.9) 5.3 ** (2.0–14.2)
< 30 Reference
Spouse’s age 30 – 49 2.7 ** (1.3–5.6) 1.9 * (1.0–3.7)
> 50 3.8 ** (1.7–8.8) 2.1* (1.0–4.4)
Mental Owning Reference
House ownership
Not owning 2.7 ** (1.7–4.3) 2.1 ** (1.4–3.2)
Never Reference
Argument in spouse’s
Sometimes 2.3 ** (1.4–3.7) 2.6 ** (1.7–4.2)
family
Often 6.9 ** (3.2–14.8) 6.5 ** (3.1–13.3)
Living together Reference
Marital status
Living separated 5.2 ** (2.2–12.4) 4.3 ** (2.0–9.3)
0 Reference
1 child 2.1 (0.9–5.2) 1.8 (0.8–4.1)
Number of children
2 children 2.8 * (1.2–6.8) 2.0 (0.9–4.6)
> 3 children 4.6 ** (1.8–11.9) 3.5 ** (1.5–8.2)
Physical Never Reference
Argument in wife’s family Sometimes 2.3 * (1.1–5.2) 3.1 ** (1.6–5.9)
Often 1.5 (0.6–4.0) 3.1 ** (1.4–7.2)
Never Reference
Argument in spouse’s
Sometimes 2.2 (0.9–5.5) 3.8 ** (1.7–8.4)
family
Often 6.6 ** (2.3–18.7) 8.4 ** (3.4–20.8)
<10 M 9.0 ** (2.0–40.8) 7.7 ** (1.7–34.2)
10M – 20M 6.089 * (1.4–27.3) 5.2 * (1.2–23.0)
Monthly wage
20M – 50M 4.551 (1.0–21.5) 3.9 (0.8–17.9)
>50M Reference
Sexual
Never Reference
Argument in wife’s family Sometimes 1.6 (0.8–3.1) 1.5 (0.8–2.9)
Often 3.7 ** (1.6–8.6) 3.2** (1.4–7.2)
OR, odds ratio; Dash marks are insignificant factors in previous chi-square analysis. * means
P–value < 0.05 and ** means P–value < 0.01.
MR = Million Rials

different fin dings could be due to different cultures and are some studies in favor of physical violence, having a
traditions by illustrating men superiority across different greater burden on public health. A study by Coker et
regions 6, 16. al. reported 77.3% physical or sexual and 22.7 %
The highest prevalence in this study was found in non-physical abuse 19. Moreover, in a study by Bonomi
mental violence with 52%. Despite the differences in et al., depression rates from physical and sexual abuse
cultural, religious, economic and ethnic factors, the were higher than non-physical abuse compared to
evidence is in favour of mental violence as the major never abused women 20. Accordingly, more studies
domestic violence experienced all over the world 7, 17, 18. should be conducted to clarify the most detrimental
The number of individuals in the present study who only type of violence to implement preventive programmes
experienced sexual and/or physical violence without and reduce its possible negative impacts.
any mental harm was scarcely low. Nonetheless, there

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WHO multi-country survey also showed that from all to families who owned a house. Moreover, those with
injured women, 86% had experienced at least one monthly low and low-middle income compared to high-
severe physical violence, and only 14% experienced income families experienced sexual violence more than
moderate violence. Whereas, compared to our study, 9 and 6 times, respectively. Previous studies also
moderate and severe violence in injured women was reported increasing significant effects of different
49% and 51%, respectively. This shows that women socio-economic related variables on DV 16, 17.
suffering from domestic violence experienced moderate According to a survey conducted in sub-Saharan Africa,
and severe physical violence equally. This could be due women living in rich families in Zambia and
to cultural and traditional gender norms, which supports Mozambique experienced more partner violence
beating up women in some regions 5, 16. whereas, in Zimbabwe and Kenya, it was higher among
Additionally, it was concluded that the majority of women coming from poor households. In the same study,
women were ignored or treated indifferently by their women from the middle class in Nigeria and Cameroun
husbands. Similarly, a study in Esfahan, Iran reported this experienced more partner violence compared to poor
action as the highest violence experienced by women 21. and rich families 32. This is in contrast with a survey
Our finding concludes that women in Shiraz are mostly conducted in Eastern India, reporting less DV in families
harmed by being ignored by their husbands, and this with higher income 33. Accordingly, socio-economic or
characteristic might be acquired during life through the better said, family income is a correlate of DV, but the
family and society. Thus, public health organizations direction of its effect seems to be cultural dependent.
should implement strategies to improve family However, financial issues should be addressed by
communication and relationship via public awareness responsible organizations by providing more
educational programs at workplaces as well as the affordable housing to families as well as supplemental
society namely, public transport advertisements and food assistance programs. In addition, families should
billboards 19, 20, 22, 23. be well educated to manage their routine financial
According to this study, living separately significantly matters more efficiently 34, 35.
increased the risk of domestic violence (above 5 times). One of the most effective factors worth mentioning
Similarly, a study conducted in Sweden indicated that is the husbands who had often witnessed their parent’s
pregnant women living separately were more likely to arguments. It can be said that DV was approximately 6
experience domestic violence 24. Nonetheless, a study in to 8 times more prevalent in these families. In the same
Portugal, revealed intimate partner violence in dating manner, women who experienced or witnessed DV in
couples compared to married couples, and reported their parents’ house were more susceptible to this
general disapproval of violence as well as increased phenomenon during their marital life. Our study is in
support among the married participants25. line with a study by Holt et al., 2008 revealing an
As it was stated, spouse age was related to mental increase in behavioural and emotional problems of
violence in this research. Similarly, a study in Egypt children who had witnessed DV throughout their lives 36.
revealed more violence in men over 40 years 26. The study conducted by Krug et al. reported that
However, studies by Izmirli 2014 in Turkey and children witnessing DV were more likely to develop
Adebowale 2018 in Nigeria showed that violence was various mental problems and engage in interpersonal
higher among younger men 27, 28. violence as they grow older. It was also reported that
In line with most previous studies, it was revealed that childhood exposure to violence is a risk factor for many
women in families with more children were more likely to behavioural disorders37. Also, surveys by Locascio M. in
experience physical DV 29-31. Whereas, a study by 2018 and Yount et al., 2006 revealed a positive
Ahmadi et al. (2016) revealed that more partner relationship between women being victims of childhood
violence was experienced by women in families with no psychosocial abuse and domestic violence 31, 38. It can
children 17. This could be due to increase in family be suggested that by monitoring youth mental health
management problems and challenges for a satisfying regularly during their education, early approach could
life, which can contribute to spouse confusion and anger, be implemented in order to reduce the negative effects
leading to violence against their wives. Consequently, of family arguments on their behavioral development.
educational strategies should be considered by Moreover, incorporating wellness activities in the school
organizations to aid families tackle stressful challenges, curriculum will certainly have beneficial impacts on this
by prioritizing their needs 22, 23. issue 19, 20, 23.
Total and mental DV against women approximately Also, a study in Jahrom, Iran showed that younger
doubled in families who lived in rented houses compared women and marital years less than 5 years tend to

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8 Injury & Violence J Inj Violence Res ××× (2019) ×××-××× ARTICLE IN PRESS

experience DV more, which might be due to their reports, early childhood interventions and family
disorientation on how to cope with family problems and therapy can reduce the long-term effects of DV on
confront their husbands’ violent behaviour. Ahmadi et al. children, with a significant effect on their future lives 36.
also concluded that younger women experience more Also, economic security can significantly affect men's
physical violence than older women 17. Similarly, a study behaviour towards their wives, which should be
in 34 countries, 2017 showed increased DV among considered 40. Ultimately, considering these essential
younger women 39. elements and implementing preventive strategies for all
family member are highly necessary in this region.
Limitations As it was mentioned above, DV has a significant
Due to the sensitivity of some questions, the time role in reducing each family member’s personal
spent on each question was approximately 10 minutes, capabilities, since it can lead to depression, anxiety,
but collecting data on some confounding variables was physical and mental abnormalities, and suicidal
not possible. Nevertheless, efforts were made to obtain thoughts 8. The outcomes can contribute to a poor social
data for important variables. and public performance of family members, leading to
In terms of sampling, a door-to-door survey was not an insecure and harmful society 36. Thus, this research
feasible since many families live with their husband’s was developed, and different variables were
parents, especially in low socio-economic areas. examined to help improve family and public health by
However, although public and private clinics in all focusing on finding out the related elements. Finally, it
municipality districts were considered in this study, can be said that such studies play a crucial role in
women visiting healthcare centres might not completely developing public health strategies with aim to improve
be a representative of the total population. family relationships and child development.
Additionally, due to recall and prestige bias, some
answers might not be fully truthful. However, efforts Acknowledgements
were made to maintain confidentiality by providing We gratefully acknowledge the 400 participants
private rooms for answering the questions as well as who shared their experiences with us, which can surely
closed boxes for placing questionnaires. Moreover, the help society’s health to a great extent. Also, we would
necessity of these studies in reducing the prevalence of like to thank all the staff and healthcare workers who
DV was explained with details to participants, and many dedicated their time to the present study.
were interestingly grateful for being asked about their Funding: The authors acknowledge Shiraz University of
situation. Medical Sciences for financial support. This article is
extracted from the Mater of Public Health (MPH) thesis
Conclusion written by Bahareh Moazen.
Competing interests: None declared
According to multiple research, public mental health has Ethical approval: The study was approved by the local
a significant dependency on people's behaviours and Ethics Committee of Shiraz University of Medical
their roles in the environment, which can mainly be Sciences (approval code: IR.SUMS.MED.REC.1398.77).
achieved through family mental health 5, 37. As WHO

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Appendix 1: Questionnaire used in the study.

Number Type of question Question

Question 1 Mental Restricts contact with family

Question 2 Mental Insists on knowing where she was

Question 3 Mental Ignores or treats indifferently

Question 4 Mental Gets angry when spoken with other men

Question 5 Mental Is often suspicious of wife’s faithfulness

Question 6 Mental Expects permission for seeking health care

Question 7 Mental Keeps away from seeing friends

Question 8 Mental Insults or makes her feel bad about herself

Question 9 Mental Belittles or humiliates in front of others

Question 10 Mental Scares or intimidates on purpose

Question 11 Mental Threatens to hurt wife or her beloveds

Question 12 Physical Slaps or throws something at her

Question 13 Physical Pushes or shoves

Question 14 Physical Hit with a fist or something else

Question 15 Physical Kicks, drags or beaten up

Question 16 Physical Choked or burnt on purpose

Question 17 Physical Threaten or used a weapon

Question 18 Sexual Physically forced to have sexual intercourse

Question 19 Sexual Ever had unwanted sexual intercourse from fear of partner’s actions

Question 20 Sexual Forced to do humiliating sexual activities

1. Questions asked from participants which included 11 mental, 6 physical and 3 sexual items.

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Appendix 2: Answers received from participants.

More than three

Answers Yes but not within Once (recent 2–3 times (recent
Never times (recent
Questions 12months 12months) 12months)
12month)
Question 1 332 (83.0%) 7 (1.8%) 5 (1.3%) 26 (6.5%) 30 (7.5%)

Question 2 321 (80.3%) 10 (2.5%) 12 (3.0%) 19 (4.8%) 38 (9.5%)

Question 3 295 (73.8%) 11 (2.8%) 5 (1.3%) 28 (7.0%) 61 (15.3%)

Question 4 319 (79.8%) 11 (2.8%) 14 (3.5%) 26 (6.5%) 30 (7.5%)

Question 5 366 (91.5%) 5 (1.3%) 7 (1.8%) 6 (1.5%) 16 (4.0%)

Question 6 320 (80.0%) 12 (3.0%) 14 (3.5%) 20 (5.0%) 34 (8.5%)

Question 7 338 (84.5%) 3 (0.8%) 6 (1.5%) 24 (6.0%) 9 (7.2%)

Question 8 299 (74.8%) 5 (1.3%) 5 (1.3%) 34 (8.5%) 57 (14.2%)

Question 9 320 (80.0%) 4 (1%) 14 (3.5%) 25 (6.3%) 37 (9.3%)

Question 10 319 (79.8%) 9 (2.3%) 10 (2.5%) 27 (6.8%) 35 (8.8%)

Question 11 366 (91.5%) 4 (1.0%) 6 (1.5%) 10 (2.5%) 14 (3.5%)

Question 12 345 (86.3%) 9 (2.3%) 15 (3.8%) 12 (3.0%) 19 (4.8%)

Question 13 344 (86.0%) 9 (2.3%) 6 (1.5%) 19 (4.8%) 22 (5.5%)

Question 14 370 (92.5%) 5 (1.3%) 4 (1.0%) 5 (1.3%) 16 (4.0%)

Question 15 374 (93.5%) 4 (1.0%) 7 (1.8%) 4 (1.0%) 11 (2.8%)

Question 16 394 (98.5%) 0 (0.0%) 2 (0.5%) 1 (0.3%) 3 (0.8%)

Question 17 390 (97.5%) 0 (0.0%) 4 (1.0%) 1 (0.3%) 5 (1.3%)

Question 18 347 (86.8%) 2 (0.5%) 5 (1.3%) 25 (6.3%) 21 (5.3%)

Question 19 383 (95.8%) 1 (0.3%) 2 (0.5%) 7 (1.8%) 7 (1.8%)

Question 20 383 (95.8%) 2 (0.5%) 3 (0.8%) 8 (2.0%) 4 (1.0%)

1. Frequency and percentages of participants’ answers are considered in this table.

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