According to health professionals, domestic violence against women is a major public health problem in the world that affects the individuals, families, and society (1). Globally, 40%-70% of the female victims have been murdered by their husbands. According to World Health Organization, domestic violence varied from 15% in Japan to 71% in rural regions of Ethiopia (1, 2). Based on the results of a study conducted on married women residing in Rasht, Iran, it was revealed that in 2,091 cases, 57.1%, 27.6%, 26.6%, and 6.9% of women suffered from psychological violence, physical abuse, sexual abuse, and physical injury, respectively (3).
A review of literature was carried out on a study population consisted of 15,514 women in Iran from 2000 to 2014. The prevalence rates of domestic violence in the mentioned study were reported as 66% (95% confidence interval: 55-77), 62% in the north (95% confidence interval: 37-86), and 70% in the south (95% confidence interval: 32-100) (4).
According to the literature, the prevalence of violence against women was announced lower during pregnancy than that in other periods. For instance, 68.8% of married women endured one form of violence and 11.4% of the cases experienced physical violence in pregnancy (5). Furthermore, in another survey conducted in the post-partum period, the prevalence of domestic violence among all participants was estimated as 40.1% (38.5% of adolescents, 41.7% of adults) (6). In addition to the physical injuries regarding violence, long-lasting psychological consequences, such as chronic depression, suicide attempts, panic attacks, anxiety, low self-esteem, and sexual problems should be considered. Real understanding of the situation, causes, and consequences seem to be necessary to prevent and control the violence against women in families besides personal and social effects related to violence (7(.
Contemporary research publications indicate the influence of culture and religion on health behaviors and its application in health care. According to the evidence, regular religious affiliation was inversely associated with abuse and violence among women and men (8). The role of religious and spiritual factors in domestic violence has been investigated in recent studies; however, it is not certain that such factors could affect the violent behaviors (9). With this background in mind, this study aimed to investigate the relationship between religious attitudes and domestic violence against women of reproductive age in Shiraz Urban Health Centers.
Materials and Methods
This descriptive-analytical study was conduct on a total of 210 women referred to Shiraz Urban Health Centers. The inclusion criteria were residency in Shiraz at least for one year, Iranian nationality, being a Muslim, ability to read and write, and age range between 15-45 years. The exclusion criteria were the lack of cooperation and willingness to continue the study. The sample size was estimated as 210 cases according to the statistical consultation and consideration of previous studies (10). The cluster sampling method was used in this study.
Firstly, among health centers in Shiraz, 4 cases were selected from the northern, southern, eastern and western parts of the city. Out of all subjects, 52 to 53 cases were selected using convenience sampling method in each health center. The demographic survey questionnaire and Religious Attitude Scale were utilized to collect the data. Furthermore, informed consent forms were obtained from the participants. The researcher-made questionnaire was used to measure the violence against women. The research team along with some of the faculty members of the Faculty of Nursing and Midwifery School in Shiraz University of Medical Sciences approved the content validity of the questionnaire, including the questions related to demographic information and violence.
Verbal Violence included the use of bad, worthless, insulting, and inappropriate words and titles. Psychological violence consisted of the lack of attention, silence, no continual speech. Physical violence included pushing and hitting parts of the body (by hand or tools). The revised version of Religious Attitude Scale contained 25 questions covering six domains in this regard. The subjects with the scores of d≥100, d=51-99, and d≤50 have high, moderate, and low religious attitudes. According to the results of a study carried out by Ebrahimi et al. in Iran, Cronbach's alpha coefficient was equal to 0.954, which has been used in other studies in Iran. Religious Attitude Scale can be used as a valid criterion for the determination of religious attitudes in patients and general population (11-14). Chi-square test was applied to investigate the relation between religious attitudes and domestic violence against women of reproductive age. The data were analyzed using SPSS software (version 16). P-value less than 0.05 was statistically considered significant.The cases were assured that their information would remain confidential.
This project was approved by the ethics committee of Shiraz University of Medical Sciences, Shiraz, Iran (Code: 93-01-85-8837). The informed consent was obtained from all the subjects. In addition, the participants were informed about the possibility to leave the project at any stage of the study.
The educational levels of the participants were reported as 4% (n=9), 21.4% (n=45), 7.6% (n=16), 28% (n=58), and 39% (n=82) with illiteracy, elementary education, high school education, diploma, and university degree, respectively. Moreover, 79% and 21% of the cases were housewives and employees, respectively. The results of the present study revealed that 62.9% (n=132), 35.2% (n=74), and 1.9% (n=4) of the participants had moderate, high, and low levels of religious attitudes, respectively. According to the findings, 21% (n=44) of the subjects suffered from verbal violence, 2.6%, 13.3%, and 1.4% of whom had high, moderate, and low levels of religious attitudes, respectively. Moreover, 3.3% (n=7) of the cases were reported to experience non-verbal violence, 3.8% of whom had moderate level of religious attitudes.
About 9.6% (n=20) of the participants suffered from physical harms, 10.8% and 9% of whom had high and moderate religious attitudes. It was noticed that 4.3% (n=9) of the cases experienced all types of violence, most of whom (6.1%) had moderate religious attitudes. Among all the subjects, 61.9% (n=130) underwent no violence, while 68.9% of the cases had high religious attitudes. There was a significant relationship between violence against women and religious attitudes (P≤0.004) (Table 1). Regarding the violence duration, it was observed less than a week for 16.2% (n=34) of the participants, while for 21.1%, of the cases (n=44) it was lasted more than a week to six months. There was a significant relationship between the duration of violence and religious attitude (P=0.019) (Table 2).
According to the results of this study, religious attitude resulted in less violence and violence duration against women. The results of the studies conducted on both Christian (11, 15) and Muslim subjects (16) revealed the effects
of religious instructions regarding martial satisfaction and less violence against married women. Therefore, in a study carried out by Berkel et al., religion and spirituality were considered as predictors of violence against women on a study population of 316 white students. Religious beliefs played a very important role in the incidence of domestic violence .The results of the mentioned study showed that gender-role attitudes were the best predictors of domestic violence beliefs. Furthermore, the implications and intervention strategies of spirituality to men and women helped to regulate violence (17).
However, Kim studied the role of religious affiliations and frequency of religious ceremonies, such as going to church, Bible studies, and religious unequal relationship between couples in intense partner violence (IPV) among Korean immigrant women in the United States. Based on the results of Kim's study, it was revealed that a high frequency of religious service attendance was associated with higher IPV victimization in Korean immigrant women, while their partners' high religious service attendance correlated with lower IPV victimization (18). Therefore, religious attitudes can be a fundamental concept in marriage (15).
Such attitudes cause the couples to move toward marriage (19) in a safe environment with less violence and martial conflicts (20). The majority of couples with common religious beliefs have rational or realistic attitudes toward their marital challenges. Moreover, religion represents guidelines for a better life in order to increase empathy (21). The practice of religious beliefs increased verbal participation, happiness and dramatically decreased verbal aggressions, marital conflicts, and ultimately increased marital satisfaction (22).
The only limitation of this study was no chance of expressing the real religious attitudes, which was resolved to some extent by coding the questionnaires. According to the results, there was a relation between religious attitudes and low frequency and duration of domestic violence against women. Violence is considered as a serious threat for women’s health besides other family members, exposing the members at risk of social harms, such as suicide. In addition, it is recommended to conduct further studies on legal, cultural, and religious aspects.
According to the results, it was revealed that religious attitudes had a meaningful relationship with the reduction and duration of domestic violence against women. In other words, in cases with high levels of religious attitudes, the violence was reported at a lower level. Moreover, the most severe violence was observed against subjects with moderate religious attitudes. It is suggested that further studies should be conducted on the ways through which religious values can affect martial life.
This article is a part of a research project with the number of 93-01-85-8837. The authors would like to appreciate Research and Technology Department of Shiraz University of Medical Sciences and Student Research Committee for their financial support. In addition, the authors would like to thank Clinical Research Development Center of Nemazee Hospital and Dr. Nasrin Shokrpour for the editorial assistance.
Conflicts of interest
The authors declare no conflicts of interest.