Abstract: Background and Objective: A domestic violence victim who believes of justifying reasons for wife beating, would be a target for continuous violence and abuse in addition to significantly reduced reporting and help seeking. This study was conducted to explore the factors involved in women’s attitudes toward accepting wife beating in the southern region of Saudi Arabia. Material and Methods: A cross sectional survey was conducted in 2014 among 151 women in the Obstetrics and Gynecology clinics at the Armed Forces Hospital in the southern region of Saudi Arabia. The research setting was chosen because it serves the inhabitants of the southern region. Results: This study revealed that 51.7% of women in our sample believed that wife beating was justified in at least one situation out of 6 situations. The highest number of respondents accepted wife beating in scenarios described as "if a wife insults her husband" and " if she disobeys him" (43.0% and 32.5, respectively). The researcher also conducted interviews with the participants regarding household decision-making, the results of which are outlined in the relevant section in this study. Conclusion: Education and empowerment for women can help changing women’s attitudes towards wife beating and further comparative studies is recommended in different regions.
INTRODUCTION
Wife beating victim who believes of justifying reasons for wife beating, would be a target for continuous violence and abuse in addition to significantly reduced reporting and help seeking wife beating is considered a social, cultural and public health problem that can have much health, psychological and physical consequences, some of which can affect pregnancy outcomes1-3. Globally women are still blamed for domestic violence incidents due to not complying with their expected roles as wives or not seeking permission when they go out or visit relatives. Moreover, most wives consider themselves as disconnected from societal support structures and regulation as domestic violence is considered to be a private matter1,4-6. According to The World Health Organization (WHO)1, 35% of women globally have reported physical or sexual abuse by an intimate partner.
Previously, little was known about wife beating in Arab and Muslim countries. However, surveys conducted by Douki et al.7 in Egypt, Palestine, Tunisia revealed that at least one in three women is beaten by her husband due to the perception that such behavior is instigated by the woman's misbehavior and disobedience, a belief that is based on religious misinterpretations as well as Arab cultural values.
Studies conducted in the Arab countries reported that the prevalence of wife beating is relatively high. For example, one study in Jordan, taking a sample from 12 regions in Jordan, found that almost all (98%) of the sampled women had experienced at least one type of violence in their lifetime relationship with their husbands8. While in Palestinian territory the results of Haj-Yahia and Clark9 study, showed that 50% of women reported minor psychological violence and 12 reported severe and in terms of physical violence 17% reported minor and 6% severe. Similarly, an Egyptian study aimed at measuring wife beating over a period of 10 years via demographic health surveys (1995-2005), revealed that the prevalence of wife beating remained high despite the improvement in educational status among women10.
Thus, in the Gulf countries wife beating is still a hidden problem. Studies have shown that in Iraq, 21.1% of women reported physical violence during a 12 months period11. Bahrain the Batelco Care Center for Victims of Domestic Violence reported that there were 6061 cases of women battered by their husbands between 2007 and 2009 and that on average there are between 100-200 cases of battered women seen/month12. Furthermore, a survey conducted by The Qatar National Development Strategy (2011-2016) in 2011 indicated that 28% of married women have, at some point, experienced domestic violence perpetrated by their husbands13. In addition, Ba-Obaid and Bijleveld14 in their study conducted in Yemen, found that about half of the women who participated in the study reported having experienced domestic violence during their relationship with their husbands. As for the studies conducted on domestic violence in Saudi Arabia, one study conducted in Jeddah revealed a 34% prevalence of life time domestic violence15. while a study conducted in Medina found that 25.7% of women who have ever been married and were attending primary health care centers reported physical abuse16 and in the Eastern Province of Saudi Arabia, particularly in Al-Ahsa Oasis, a community based study showed that 22.8% of women reported physical abuse17. Barnawi18 found in one study conducted in 2011 in Riyadh that 20% of women reported being exposed to any forms of domestic violence during the previous year.
Wife beating can be perpetuated by the wife's perception and justification of such acts. Based on social and psychological theories (self-blame theory and the Imagination of hypothetical of still worse world)19, if the victim of domestic violence believes that she causes her own problems and that she deserves what she gets, help seeking and violence reporting would significantly be reduced and she would be a target for continuous battering and abuse5,20-22.
Moreover, several studies in developing countries indicated high acceptance levels of wife beating among women. For example, a study conducted in Uganda indicated that almost all women in that country (90%) readily accepted wife beating23. While another study showed that three quarters of women in Uganda thought that wife beating was acceptable under certain circumstances particularly if the women neglects the children (57%) and in the case when women goes out without informing their husbands (54%)24. Similarly, a study in Zimbabwe revealed that more than half (53%) of women in that country justified wife beating in certain scenarios, the highest was in the case when women argue with their husbands (36%) and neglect the children (33%)25.
Moreover, wife beating seems to be interpreted based on cultural perspectives and misinterpretations of religious values in the Arab world and Middle Eastern countries. Thus, national studies in Jordan and Egypt showed that women readily accept at least one reason for wife beating (70 and 39.3% respectively)26,27. Furthermore, a similar study conducted in Palestine (measuring the same scenarios measured in the above-mentioned national studies) revealed that 64.7% of women accepted wife beating as justifiable for at least one reason28. Furthermore, in an unpublished study in Qatar the primary results revealed that 28.9% of women justify wife beating under certain reasons29.
Previous studies revealed that certain factors were found to be associated with women’s acceptance of wife beating. These are: patriarchal culture, age at first marriage, women’s low level of education, women’s unemployment, duration of marriage and household decision making9,25,28,30-32.
Hence, against this background, the aim of this study was to explore the signifiers involved in women’s attitudes toward accepting wife beating in the southern region of Saudi Arabia. The study hypothesized that women in the southern region might generally be accepting of wife beating.
MATERIALS AND METHODS
Study design: A cross-sectional survey of 151 Saudi women, in their 36th+week of pregnancy, was conducted in 2014 (commencing in October and ending in December). The study was conducted at the Obstetrics and Gynecology out-patient clinic at the Armed Forces Hospital in the Southern Region (AFHSR). These institutions were selected as they provide reproductive health services to the entire southern region of Saudi Arabia (including antenatal care, high-risk pregnancy, postnatal care, infertility treatment and family planning) and they are also connected to the Obstetrics and Gynecology ward in the hospital. Furthermore, the daily rate of patients seen in the clinic was on average 370 patients at that time. The average daily number of appointments meeting the research criteria was 36 women. The hospital itself is considered the largest tertiary hospital in the southern region with 700 000 active patients’ files.
Assessment Instrument: The researcher conducted face-to-face interviews, using a structured questionnaire. The questionnaire covered all aspects of reproductive health and socio-demographic data. The questionnaire was adapted from previous studies like Demographic and Health Surveys (DHS), some of which had been conducted in Arabic26-28. The author made use of questions to measure the women's attitudes towards wife beating, similar to questions previously used by the researcher in another closely related study28, these questions were also previously used in studies conducted in Zimbabwe and the DHS in Jordan and Egypt25-27.
A pilot study was first conducted among 10 women in the clinic mentioned, these results are not included in the main analysis. Based on the results of the pilot study, the researcher adapted some wording in the questionnaire in order to accommodate cultural understanding which seemed to be lacking at the time.
Sampling and data collection: The clinic was visited five days a week from Sunday till Thursday and the study was conducted from October-December, 2014. The data was collected by both the article author and one other data collector (nursing lecturer) who was trained prior to data collection in interviewing methods and approaches to questions. Women were approached after reported to the clinic, during their waiting time. On average the 36th+week of pregnancy clinic received visits from 36 women/day at that time. Given the duration of the interview and the mean duration of visit of 8 min, approximately every 4th or 5th eligible woman was interviewed. A consent form was signed prior to the interview and the women were informed about the purpose of the study. A total number of 160 women were approached to participate and only nine women refused to participate, which yields a response rate of 94.3%. Initially, a sample size of 160 women was planned, assuming a 75% response rate. Thus it was expected that a total sample of 120 respondents would allow estimating proportions with +/-5% accuracy for the 95% confidence interval. However, given the excellent response rate, the sample of 151 provides 80% power to detect differences of 16% or more.
Dependent variable: To assess women's attitudes towards wife beating the following 6 questions were asked towards the end of the interview after ensuring rapport with the women: “Sometimes a husband is annoyed or angered by things which his wife does. In your opinion, is a husband justified in beating his wife in the following situations:
| • | If she goes out without telling him? |
| • | If she neglects the children? |
| • | If she argues with him? |
| • | If she burns the food? |
| • | If she disobeys him? |
| • | If she insults him?” |
Those who answered "yes" to any of those situations were classified supporting and accepting violence, while those who answered "no" for all the situations were classified as rejecting violence.
Independent variables: Several reproductive health variables and socio-demographic variables were assessed for their association with the acceptance of each reason for wife beating: whether participants had any children (in 2 categories, namely ‘yes’ or ‘no’), the total number of living children (in 3 categories: 0-1, 2-3, 4+), whether respondents used contraceptives for family planning (have ever used, have never used), number of years married (in 2 categories: <10 or >10), respondent’s age at first marriage (in 3 categories: <16, 17-20, >21), respondent’s current employment status (unemployed or employed), respondent’s highest level of education obtained (< secondary- or >secondary school), husband's highest level of education obtained (< secondary- or >secondary school), difference of level of education achieved between husband and wife (in 3 categories: wife has higher education, same educational level and husband has higher educational level), respondent’s age (in 3 categories: <24, 25-29, >30 years) and total of household decisions made solely by the wife (in 3 categories: 0, 1-2, 3+).
The woman’s status and empowerment in the family was assessed through the wife’s participation in household decision-making. This variable was included in the analysis. Women were asked: “Who in your family usually has the final say on the following decisions?”
| • | your own health care |
| • | your children's health care |
| • | large household purchases |
| • | daily household purchases |
| • | visits to family, friends or relatives |
| • | what food should be cooked each day |
Response options for each question were: "The woman herself, her husband, the woman and husband jointly". Two new variables were created for the purpose of the analysis: the sum of all decisions made solely by the woman and categorized into 0, 1-2 and 3 or more and the sum of decisions made solely by the woman excluding the decision regarding the food cooked each day and categorized into 0, 1-2 and 3 or more. These variables were added in order to avoid social desirability bias that was detected during the data collection. That is, cooking is seen as the woman’s responsibility in Saudi culture, whereas decision-making powers within the marriage can vary considerably.
Statistical analysis: The PASW statistics 18 software was used to enter and analyze the data. Cross tabulation and the Pearson chi-square test were used to compare proportions for variables. Two-sided tests with significance level of p<0.05 were used for all analyses. A multi-variable analysis was conducted using logistic regression, first checking correlations and significant differences between the women's characteristics and the variable of accepting wife beating in at least one situation and then for each scenario separately.
RESULTS
All the respondents were pregnant women in their 3rd trimester (36+weeks). Table 1 describes the demographic characteristics of the study sample, 80% of the respondents were women who had living children at the time, the majority of respondents were older than 25 years of age, 35% of the respondents were women who had no education or less than secondary education, only 12% of the women were employed.
Women’s attitudes towards accepting wife beating: Overall, a total of 51.7% of the respondents perceived wife beating as justified in at least one situation, while 48.3% rejected the justifiability of wife beating in all of the situations mentioned. The highest percentage of respondents perceived wife beating as justified if a wife insults her husband (43.0%), followed by disobedience to her husband (32.5%), if she neglects her children (19.9%), if she goes out without telling her husband (12.6%), if she argues with her husband (9.9%) and lastly, if she burned the food (0.7%) (Fig. 1).
| Table 1: | Sociodemographic characteristics of the sample |
| Fig. 1: | Percentage of women's acceptance of wife beating per situation |
| Fig. 2: | Percentage of women's solely making household decisions |
Women’s participation in household decision-making: Overall, the majority of women indicated that they make joint decisions with their husbands in terms of general household decision-making. However, the women made more final decisions with respect to daily cooking (49.7%), their own health care (23.8%) and daily house purchasing (21.2%) and least decisions made was for large household purchasing (6.6%). The number of respondents who made no household decisions totaled 33.8% (excluding the daily cooking decision) and the percentage of women who made no final household decisions was represented by 62.9% of the respondents (Fig. 2).
Factors associated with women’s acceptance of wife beating: Based on the cross tabulation and the associations of sociodemographic characteristics with the acceptance of wife beating in at least one situation, there was no significant association detected in any of the variables therefore, a multivariate regression model was utilized for each of the reasons separately, in order to try and find some associated factors. Regarding the acceptance for wife beating in the case of insulting the husband and in the case of women arguing with their husbands, there were no significant associations detected with any of the sociodemographic variables. In the case of accepting wife beating if the woman goes out without permission from her husband and in the case of neglecting the children, there was a significant association with the variable of ever having used family planning contraceptive methods. In that those respondents who had ever used family planning were less accepting of wife beating compared to those respondents who had never used family planning methods (p = 0.005, OR = 5.66) and the same variable was found to be associated with the case of going out without permission and in the case of negligence of the children (p = 0.05, OR = 2.85).
| Table 2: | Associations of socioeconomic, demographic factors and women’s status inside the family with women’s believe towards accepting wife beating (AWB) (Q: Husband has the right to beat his wife if wife disobey Him). All data. (Multivariable Analysis) |
OR: Odds ratio, CI: Confidence interval, aNumber of women in each stratum, bPercentages of women who justified wife beating within each stratum, cFinal logistic regression model included only those variables listed in column, dSignificant p = <0.005 | |
Table 2 presents the associations between the respondents who accept wife beating in the case of disobedience to the husband and several socio-demographic factors like the woman's use of family planning methods as well as the woman’s status based on a logistic regression model. Respondents who had ever used family planning methods showed less likelihood of accepting wife beating compared to those who had never used family planning methods (p = 0.023, OR = 3.21). Those women who were married for <10 years were more likely to be less accepting of wife beating compared to those women who had been married for >10 years (p = 0.014, OR = 3.33). Women who had received less than secondary education or had no education were more likely to accept wife beating compared to those who had received a higher education (p = 0.009, OR = 0.14). Respondents who were married to men who had received basic education only were less likely to accept wife beating compared to those married to men who had received a higher level of education (p = 0.04, OR = 3.66). However, in the case where the woman's educational level was higher than that of her husband, she was less likely to accept wife beating compared to the case where husbands received higher education levels than their wives (p = 0.015, OR = 0.09). Women's household decisions were not significantly associated with any of the reasons.
DISCUSSION
The study reveals that about half of the respondents in this study conducted in southern Saudi Arabia believe that wife beating is justified in at least one of the scenarios presented. However, the proportion of acceptance was different for the various scenarios. The highest levels of acceptance were found in the scenarios where the wife “insults her husband", “disobeys her husband” and “neglects her children”.”. Only one woman replied that wife beating can be acceptable if the wife “burns the food”. More associated factors were found when a wife disobeys her husband and if the wife ever uses contraceptive methods, lower levels of education, when the woman's level of education is higher than her husband and with longer duration of marriage, however, there were no significant associations with the household decision making factor.
Several previous studies measured the relationship between domestic violence, particularly wife beating and the use of contraceptive methods. Some studies conducted in developed and developing countries have found that the use of contraceptives increases when domestic violence is present33-35. On the other hand, Zakar et al.36 conducted a study in Pakistan and found less use of contraceptives and less support from husbands in the use of contraceptives among women who reported physical violence in the marriage.
In our study, the researchers found an association with acceptance of wife beating in the case of wife disobedience, negligence of the children and going out without permission with never having used contraception. The same result was found in one study which included 25 sub-Saharan countries, with the aim to measure the link between attitudes towards wife beating and the use of contraceptives. That study showed less use of contraceptives among those respondents who accept wife beating in general37. However, family planning and the use of contraceptives have different implications and interpretations in Saudi Arabia and that is not the concern of our study.
Our multivariate analysis did not show any significant association with any of the demographic factors and justification of wife beating under at least one of the scenarios. This can be related to the fact that Saudi Arabia is considered as an ultraconservative country, adhering very strictly to Islamic interpretations and cultural traditions. In that Saudi women are required to have consent from their close male relatives (muhrum) in every aspect of their lives, including leaving the house, obtaining permission to go out and study and getting married38. Respect of and obedience to the husband probably derives from the religious interpretation of the Qur'an wherein it is stated that "Men are in charge of women by right of what Allah has given one over the other and what they spend from their wealth…" (Quran-Al-Nisa-34) along with the teachings of the Prophet Mohammed (PBUH) Hadeeth "…If I ordered to bow down to anyone I will order the woman to bow down to her husband"39. However, the percentages of respondents accepting wife beating under the scenario of "going out without telling the husband" and " arguing with your husband " were significantly less than of the results found in Egypt26 and very similar to what was found in Jordan27. Therefore, further analysis was made for each of the scenarios in order to try to find associated factors influencing women's attitudes. The results indicate the associated factors to be that educated women were less likely to accept wife beating compared to less educated women in the case of the wife disobeying her husband. This was supported by many studies measuring women's attitudes toward wife beating25,28,37,40. These attitudes can be related to women's empowerment inside families with higher levels of education and the fact that complying to the man's status inside the family and obeying the husband might not be a justification for wife beating in such instances. However, many studies showed that women with a higher education or those who have achieved higher educational levels than their husbands might be at a higher risk of wife beating, especially in more patriarchal societies with fundamental gender inequalities as husbands in such instances might feel threatened and undermined by the women's increased status41,42.
Pertaining to the result that indicated higher levels of acceptance of wife beating for disobedience to husbands in marriages of longer duration, results of studies conducted in Zimbabwe and Palestine revealed opposite results25,28. This result may be due to the fact that Arab women tend to commit themselves more readily to the cultural roles and religious interpretations of those roles as well as to the importance of family unity and boundaries after many years of marriage. Moreover, the gender roles of the Saudi community are defined by total dependency of women on men. In addition, the honor and reputation of the family become very important with more years of marriage as these factors can affect the overall status of the woman and her family in the region38,39. This matter was investigated extensively among the Saudi Arabian, Jordanian and Palestinian cultures, with findings indicating that Jordanian women had very similar responses to those of the southern Saudi women8,43-48.
Household decision making was studied as a major indicator of a woman’s level of empowerment as there seems to be a direct correlation between household decision making and the acceptance of wife beating by women as revealed in studies conducted in Zimbabwe and Palestine25,28. However, in the study under current discussion no significant relationship was found between these factors. This might be due to the fact that women in the Saudi culture have minimal responsibility and decision making roles outside their homes as men are responsible for earning money, buying all the necessary domestic necessities as well as negotiating all the issues outside of the home. Women are also dependent on their husbands for decisions regarding even their own health or their children's health as well as transportation - all of these factors limiting their participation in decision-making. This dependence is further reinforced by the social values and norms of a patriarchal society38,39,49-51.
Based on all of the above, future studies is highly recommended to measure the prevalence of violence among women with specific operational definition of violence. So as for women to be able to identify violence and to get close to reality figures. This study can also serve all those who is interested in women’s health and women’s rights and empowerment to work on further encouraging empowering women at both community and family level.
This study got a very high response rate as a major strength. There was also some limitations as despite the fact that the questions regarding women’s acceptance of wife beating were asked towards the end of the survey in order to ensure that rapport had first been established and furthermore, the interview was conducted in a private setting in order to reduce the chances of social desirability bias. Nevertheless, acceptance of wife beating is a very sensitive issue especially in conservative and traditional societies like Saudi Arabia and therefore women in the study may have under reported their acceptance of violent behavior in their husbands. Looking to the sensitivity of the issue, the history of family violence was not assessed at this study level
CONCLUSION
Wife beating in Saudi Arabia is still a hidden problem. Although this study explores women's attitudes and acceptance of wife beating in the southern region of Saudi Arabia, further studies need to be conducted in the other regions to compare results and discuss associated factors. Based on the results of this study, which shows that there is high acceptance of wife beating among married women in at least one given situation, the empowerment of women through education and participation in decision making is essential. Furthermore, a better understanding of the cultural values and differences in various regions might provide more insight into the necessary measures required for the empowerment of women.
SIGNIFICANCE STATEMENT
This study discovers that there is high acceptance of wife beating among women in the southern region even if that is under special circumstances, since wife beating is not well covered and studied in Saudi Arabia, this study will be beneficial in drawing the attention that wife beating might be significantly high is the country. Therefore, further research is highly recommended in other regions in Saudi Arabia as well as at the national level and comparative studied among other regional with similar culture countries.
ACKNOWLEDGMENT
The study was facilitated by the Obstetrics and Gynecology out-patient clinics by the general staff and nurse-in-charge. Special acknowledgment to Ms. Rona Marx for the English editing of the manuscript.