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Intimate Partner Physical Violence Experiences of Saudi Arabian Women

INTRODUCTION

• To Estimate the incidence rates of IPPVAW in women frequenting PHC’s

• To explore IPPVAW-injuries

• To Analyze the ecological framework factors associated with IPPVAW

METHODS

FREQUENCY OF IPPVAW & IPPVAW ACTS

CONCLUSION

• IPPVAW was prevalent in our study & rates were similar to reported rates in EM

regional studies

• Husband’s-related factors were significantly associated with IPPVAW than those

related to women at all measured levels of the ecological model

• Most women were unemployed (75%) and dependant on husbands, which explained

the significant effect of male dominance in reported IPPVAW

• Most women (80.5%) believed in family privacy, which may explain reluctance to report

IPPVAW-related injuries to healthcare professionals

• Most women did not accept a husband’s right to beat his wife at any given scenario,

except in a wife’s infidelity, where half of the women accepted beating

• Social & Legislative restrictions on women’s autonomy contribute to their risk for

IPPVAW in Saudi Arabia

• PHC services as first-point of contact in a healthcare system are not well-equipped to

respond to women’s needs in cases of IPPVAW

REFERENCES

CONTACTS

Halah M. Eldoseri, PhD, MSc

Health Researcher, National Guards Health Affairs, Ministry of Health, Saudi Arabia

heldo001@gmail.com

Kimberly Adams Tufts, DNP, WHNP-BC, FAAN

Associate Chair & Director of Community & Global Initiatives, School of Nursing

Old Dominion University

ktufts@odu.edu

• Department of Primary Healthcare at the Saudi Ministry of Health

• Dr. Mustafa Al-Shebl, Professor of Statistics, Alexandria University,

mkshebl@yahoo.com

Intimate partner physical violence against women (IPPVAW) is prevalent in the Eastern

Mediterranean (EM) region, ranging between 16% and 52%, compared with 1.3% to

12% in Europe and North America1. The variation observed reflect not only the

difference in methods and data collection but also the difference in the populations

studied. Studies addressing IPPVAW in Saudi Arabia are limited with variable

methodology and definitions used. Prevalence of IPPVAW in primary healthcare clinics

(PHC’s) settings ranged between 17.9% and 25.7% respectively 2, 3. Spousal violence is

embedded in the beliefs on gender roles. The ratio of Saudi men who supported the use

of violence against women in case of misconduct was 52.7%, and 32% of men have

actually used violence against their wives4. Heise (1998) suggested the use of an

integrated, ecological framework to capture multiple levels of variables that influence the

experience of intimate partner violence against women (IPV) (Figure -1-)5.

The Adverse Health Effects of IPPVAW

The health outcomes of IPPVAW are well-documented. Adverse health outcomes of

IPPVAW range from temporary or direct effects to long term or indirect, prolonged

effects6. The long term effects of violence range from lower health status, lower quality

of life, and higher utilization of health services6. Annual increase of healthcare costs was

found to be higher in women with a history of violence compared to women who did

not report violence 7, 8.

Studies in EM region showed that women who were beaten were more likely to have

unwanted or mistimed pregnancies, to commence antenatal care later, and to terminate a

pregnancy. Infant and child mortality rates in children born to abused mothers are

significantly higher compared to the mortality in children of non-abused mothers9-11.

Mental health consequences, injuries, disability and death of abused women are well

documented in several EM studies12-14. In Saudi Arabia, IPPVAW resulted in mild and

severe injuries, ranging from scratches and bruises to abortion and preterm labor 2,3,15.

This study aimed to explore the frequency of IPPVAW, the associated risk factors, and

the adverse health outcomes in Saudi women within PHC’s setting.

Halah M. Eldoseri, PhD, MSc. and Kimberly Adams Tufts, DNP, WHNP-BC, FAAN

ACKNOWLEDGMENT

GENDER ATTITUDES & ACCEPATNCE OF BEATING

FIGURE 1: Ecological Model Factors & IPPVAW

ABSTRACT

RESULTS

OBJECTIVES

PERSONAL FACTORS:

• Husband’s history of a childhood abuse (ρ=0.048), Husband’s alcohol use (ρ≤0.000),

& husband’s drug use (ρ=0.001) were significantly associated with IPPVAW

INTERPERSONAL FACTORS:

• Increased marital conflicts (ρ≤ 0.0000) & male dominance (ρ≤0.000) were

significantly associated with IPPVAW

COMMUNITY-RELATED FACTORS:

• Husband’s unemployment (ρ=0.008) & husbands aggression towards other men

(ρ=0.013) were significantly associated with IPPVAW

SOCIETAL FACTORS:

• Reported IPPVAW did not differ significantly in women based on gender attitudes and

acceptance of physical chastisement.

ADVERSE HEALTH EFFECTS ASSOSIATED WITH IPPVAW

• Perceived recent pain & discomfort (ρ=0.046), antidepressants use (ρ=0.009) &

suicidal thoughts (ρ≤0.000) were significantly associated with reported IPPVAW

• Women who reported IPPVAW were more likely to report antidepressant use

(OR=11.5) and suicidal thoughts (OR=10.7) than women who did not report IPPVAW

• Among women who reported IPPVAW, 18% sustained IPPVAW-related injuries

• A total of 16% women required medical attention out of 18% of women who

reported IPPVAW

• Only 6.5% of women disclosed to a healthcare professional the cause of injuries

Intimate partner physical violence against women (IPPVAW) is a serious public

health concern with global implications. The Ecological Model provides a

comprehensive framework for the investigation of factors associated with IPPVAW.

Studies addressing IPPVAW in Saudi Arabia are limited and have not explored risk

and protective factors for IPPVAW. Our study aimed to investigate the association

of personal, interpersonal, community, and societal factors with IPPVAW, as well as

perceived health outcomes.

Methods: Cross-sectional study design in six PHC’s in Jeddah city. Convenience

sampling was used to recruit 200 ever-married Saudi women. We used structured

personal interviews to explore IPPVAW-related factors using an adapted version of

WHO VAW survey. Data were analyzed using univariate & bivariate analysis. Chi-

Square, Mann-Whitney, Kruskal-Wallis, & BLR tests were used to measure the

significance of IPPVAW association with the measured factors and adverse health

effects, ρ<0.05 was considered significant.

Results: Nearly 46% of women reported IPPVAW, while 18% of those reported

IPPVAW-related injuries. Approximately, half of the women held traditional gender

attitudes and agreed on a husband right to hit his wife in at least one condition.

Husband’s alcohol & drug use, increased marital conflict, male dominance,

husband’s unemployment, and husband’s involvement in physical aggression with

others were significantly associated with reported IPPVAW. Women who reported

IPPVAW were more likely to report increased antidepressants use (OR 11.5) and

more likely to think of suicide (OR 10.7) than women who did not report IPPVAW.

Only 6.5% of women who reported IPPVAW-related injuries disclosed the reason

of their injuries to a healthcare professional.

Conclusion: IPPVAW in Saudi Arabia requires better management in PHC settings

to identify victims of abuse and to improve services provision.

• The Study is cross-sectional, quantitative one in 6 PHC’s

• 200 ever-married Saudi women were included

• Personal, structured interviews were conducted (WHO VAW 9.9 Survey)

• Physical violence construct showed a good reliability (Cronbach’s α = 0.82)

• Descriptive statistics, Chi-Square, non-parametric tests (Mann-Whitney & Kruskal

Wallis), & BLR test were used to analyze data, ρ ≤ 0.05 was considered significant

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