Association of various reproductive rights, domestic violence and marital rape with depression among Pakistani women

Abstract

BackgroundDepression among women is common in developing countries. Gender inequality can contribute to women's risk for depression. Lack of reproductive and sexual rights is an important marker of gender inequality and women do not have the freedom to express their reproductive and sexual needs in many parts of the world. Therefore we designed this study to determine the association of depression with lack of various reproductive rights and domestic violence among married women in Karachi, Pakistan.MethodsA case-control study with 152 cases and 152 controls, which included women 15-48 years, recruited from two teaching hospitals from 1st June 2007 through 31st August 2007. The SRQ was administered to all subjects. A cut off score of 8 was used to confirm cases of depression diagnosed by physicians, and to exclude cases of depression from the controls. Self-administered questionnaire was used to assess the risk factors.Results61% of the cases and 43% of the controls were ever abused by spouse and the frequency of marital rape was 33% in cases and 13% in controls. After adjusting for the effects of other variables in the model, less than 18 years of age at marriage (OR 2.00; 95% CI = 1.07, 3.7), decision for marriage by parents (OR 3.51; 95% CI = 1.67, 7.37), abuse by in laws (OR 4.91; 95% CI = 2.66, 9.06), ≤ 3 hours per day spent with husband (OR 2.33; 95% CI = 1.34, 4.08), frequency of intercourse ≤ 2 times per week (OR 1.85; 95% CI = 1.06, 3.22) and marital rape (OR 3.03; 95% CI = 1.50, 6.11) were associated with depression among women.ConclusionIn our study depression in married women was associated with younger age at marriage, lack of autonomy in marriage decisions, marital rape and domestic abuse by in-laws. Efforts should be directed towards creating awareness about the reproductive and sexual rights of women in Pakistan. Physicians should be trained to screen and identify women who may be at risk for psychological distress as a result of denial of reproductive rights so that they can support positive mental health outcomes through individual, family or marital counseling.

Intimate Partner Violence in Pakistan

“…Slapping and pushing were the most commonly reported forms of physical abuse (Fikree & Bhatti, 1999).The prevalence of physical IPV was reported in 20 studies (Ali et al, 2009;Ali et al, 2005;Ali, Asad et al, 2011;Ali, Mogren et al, 2011;Asif et al, 2010;Farid et al, 2008;Fikree & Bhatti, 1999;Fikree et al, 2006;Fikree et al, 2005;Kapadia et al, 2010;Karmaliani et al, 2008;Niaz et al, 2002;Rabbani et al, 2008;Shaikh, 2000Shaikh, , 2003Shaikh et al, 2008;Zareen et al, 2009). The lifetime prevalence of physical IPV, defined as experiencing physical IPV at least once during the marital period, ranged from 16%-80% with the six studies reporting a life time prevalence of physical IPV between 28%-35% Farid et al, 2008;Fikree & Bhatti, 1999;Fikree et al, 2004;Niaz et al, 2002;Shaikh, 2000).…”

“…Shouting, yelling and the use of abusive language were the most frequently reported acts perpetrated by husbands (Fikree et al, 2005). Only nine studies (Ali et al, 2009;Ali et al, 2005;Ali & Bustamante-Gavino, 2007;Fikree & Bhatti, 1999;Fikree et al, 2006;Fikree et al, 2005;Karmaliani et al, 2008;Rabbani et al, 2008;Shaikh, 2000Shaikh, , 2003Zareen et al, 2009) specifically reported verbal abuse, the prevalence of which varied between 31% (Karmaliani et al, 2008) and 100% (Rabbani et al, 2008;Shaikh, 2000). The frequency of verbal IPV was reported to decrease in pregnancy in two studies -Karamaliani et al…”

“…Acts of psychological IPV included repeated yelling and degradation (Kapadia et al, 2010), humiliation, threats to harm the individual's loved ones and inducing fear through intimidating words or gestures (Ali, Asad et al, 2011;Farid et al, 2008;Kapadia et al, 2010;Zareen et al, 2009), suspected or actual infidelity by the husband, emotional blackmailing, character assassination, social isolation or perceived neglect of the basic needs of the wife by the husband (Rabbani et al, 2008). The prevalence of psychological IPV -reported by 11 studiesranged between 48% and 84% (Ali et al, 2009;Ali, Asad et al, 2011;Ali, Mogren et al, 2011;Farid et al, 2008;Fikree & Bhatti, 1999;Kapadia et al, 2010;Niaz et al, 2002;Rabbani et al, 2008;Shaikh, 2003;Shaikh et al, 2008;Zareen et al, 2009). The prevalence of psychological IPV was reported to decrease during pregnancy in one study (Farid et al, 2008).…”

“…The majority of the studies (n =13) were conducted in only one province in Pakistan and more specifically in only one of the country's cities, Karachi. The majority of studies were conducted in hospital environments such as post-natal wards (Fikree et al, 2006;Fikree, Jafarey, Korejo, Khan, & Durocher, 2004;Kapadia et al, 2010), outpatient departments of family medicine (Ali, Israr, Ali, & Janjua, 2009;Fikree & Bhatti, 1999;Fikree et al, 2005), outpatient departments of psychiatry (Ali et al, 2009;Niaz, Hassan, & Tariq, 2002) and antenatal clinics (Fikree & Bhatti, 1999;Karmaliani et al, 2008;Shaikh et al, 2008;Zakar et al, 2011;Zareen, Majid, Naqvi, Saboohi, & Fatima, 2009) or in primary care physicians' practices (Ayub et al, 2009;Naeem et al, 2008), with only six studies undertaken in community settings (Ali, Asad et al, 2011;Ali & Bustamante-Gavino, 2007;Ali, Mogren et al, 2011;Asif et al, 2010;Rabbani et al, 2008). The majority of the studies (n =19) involved interviews with women, with seven of these focusing on pre-or post-natal women.…”

Dowry practices and their negative consequences from a female perspective in Karachi, Pakistan <br>—A qualitative study

“…Suicidal thoughts were reported by 65% -74% of women exposed to physical, sexual or psychological violence [23]. Similarly, another study showed that depression in married women in Pakistan was strongly associated with domestic abuse by in-laws (OR 4.91; 95% CI = 2.66, 9.06) and marital rape (OR 3.03; 95% CI = 1.50, 6.11) when compared with a control group [24].…”