VIOLENCE in the home is perhaps the most pervasive and endemic form of violence in Pakistan despite several laws designed to protect women. The United Nations defines it as “any act of gender-based violence that results in physical, sexual or mental harm or suffering to women including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”.

The same definition has been approved by Pakistan’s Ministry of Law, Justice and Human Rights. Nevertheless, domestic violence remains the least-attended and most under-reported form of violence as it is considered a private matter in the country.

Fortunately, a domestic violence module was included in the Pakistan Demographic and Health Survey (PDHS) for the first time in 2012-13. This has made domestic violence a suitable focus for assessment and further in-depth analysis. According to the survey, domestic violence is highly prevalent in Pakistan with varying levels among provinces. The report shows that 39pc of women experienced physical and/or emotional violence at the hands of their husbands. Moreover, 11pc of women have experienced physical violence during a pregnancy.

The survey shows that socio-economic and demographic factors are key in determining domestic violence, which in turn affects pregnancy outcomes through physical and/or psychological trauma. These factors enforce unequal power relations, fear of and control over female sexuality, belief in the inherent superiority of males based on misinterpretation of Islamic teachings.

Domestic abuse affects pregnancy outcomes.

Consequently, 43pc of women age 15-49 agree that a husband is justified in violence. Nevertheless, women with improved socio-economic factors are less likely to experience domestic violence. Four out of 10 women who are employed for cash are likely to have experienced physical violence, which increases from 34pc among women in the lowest wealth quintile and then decreases to 19pc among women in the highest wealth quintile. In addition, experience of physical violence shows a decrease with educational attainment.

The evidence further shows that intermediate factors directly influence pregnancy outcomes. Contraceptive use is positively associated with women’s empowerment. The use of modern methods is more prevalent among women who take part in several household decisions (33pc) than among women who partake in none of the decisions (19pc). Moreover, women who participate in no household decisions have a higher unmet need for family planning than women who participate in the decisions.

Importantly, the survey reveals that incidence of experiencing foetal loss or having ever had an unintended pregnancy is higher (four out of 10) among women who have experienced domestic violence. Furthermore, underweight births are substantially higher among ill-treated women compared to their counterparts (three women out of 10 compared to two). The survey reflects that domestic violence substantially reduces a woman’s chances to access and use contraception. This lower use of contraceptives among ill-treated women reflects Pakistani women’s low control over reproductive decisions, especially accessing contraceptive services.

The evidence forms a strong basis for the federal and provincial governments, NGOs, INGOs, UN agencies and civil society partners to take pertinent action. The findings highlight the need to address the economic and sociocultural factors that foster a culture of violence against women by engaging of community organisations, men, activists, and leaders to promote an enabling environment.

The government should establish integrated services by incorporating issues of domestic violence into service delivery by linking family welfare centres with community workers to identify such cases to encourage contraceptive use and birth spacing. The service delivery should also build on mental health so that women may seek a variety of healthcare options with­­out necessarily disclosing the violence. Healthcare providers and outreach workers should be trained to help them understand and respond appropriately to avoid negative pregnancy outcomes.

The new WHO clinical and policy guidelines (2013) are recommended to be integrated with undergraduate medical curricula for all healthcare providers and in-service training for domestic violence case management. Helplines, referral networks, legal systems of protection and shelter homes should be established to protect victims as well as women at risk. This will help women to rebuild, recover and protect their lives after violence.

Though the evidence generated by the study is wide-ranging and covers most pertinent aspects, there is room for further research as data related to complications during pregnancy and physical trauma including deaths and injury due to domestic violence is missing from it. It would be a valuable addition to the study.

The writer works with a reproductive health organisation.

Published in Dawn, August 2nd, 2015

On a mobile phone? Get the Dawn Mobile App: Apple Store | Google Play