Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Spousal Violence Real Experiences of Victimized Women Attending Family Court: A Qualitative Study

Aliaa Mohammed Othman El-Afandy, Fatma Mohammed Ahmed*

Lecturer of Community Health Nursing, Faculty of Nursing, Zagazig University, Egypt

Abstract: Background: Spousal violence is an international problem of prevalent magnitudes. It incorporates physical or psychological harm between husbands and wives. The health significances of spousal violence can be severe, leading to physical, emotional or mental health consequences. Aim: the aim of the present study was to explore spousal violence real experiences among victimized women attending Family Court. Design: a descriptive exploratory qualitative research design was used. Setting: the study was conducted at Samanood family court (Gharbia governorate, Egypt). Sampling: a purposive sample of 12 divorced women who were willing to participate in interactive interviews, they were 12 divorced woman. Tools: in-depth interviews were used to collect data where a topic guide included open ended questions about spousal violence was used. Results: After thematic analysis, six main themes illustrating the cycle of violence were emerged: violence predictors; as relationship strain & maltreatment. Violence types; commonly reported verbal & physical. Causes; customs & traditions played a major role. Reaction to violence; women reaction was mainly seeking help from family member. Health consequences; were mostly psychological. And finally, with the escalation of danger women became more hopeless, until the occurrence of crucial event which gave them the power to take the decision of escaping violence. Conclusion: Women described the begging of relationship as ordinary or very good (pre-contemplation), then the appearance of predictors & occurrence of partner violence (contemplation), after that the women reaction (preparation), and finally with the negative health consequences and escalation of danger women decided to escape violence (action and maintenance). Recommendation: Prevent cycle of violence from ever starting by preparing young couples for healthy marital relationships, and raising public awareness /families about consequences of spousal violence on future community.

Keywords: spousal violence, qualitative study, real experiences, victimized women, Egypt

Received June 25, 2018; Revised August 12, 2018; Accepted August 24, 2018

Citation: Aliaa Mohammed Othman El-Afandy, Fatma Mohammed Ahmed, Spousal Violence Real Experiences of Victimized Women Attending Family Court: A Qualitative Study. American Journal of Nursing Research, 6 (5). 335-343. January 2018. doi:10.12691/ajnr-6-5-16

1. Introduction

Violence against women is an overpriced and widespread public health issue and an infringement of human rights. It is regularly alluded to as "gender based violence" since it comes from women's subordinate status in the family and society. [1] Violence against women is a worldwide epidemic. A demographic health survey conducted in Egypt revealed that approximately half of married women aged between fifteen and forty nine had been slapped, hit, kicked, or exposed to some other form of physical abuse at some point after their fifteenth birthday. [2]

The expressions “domestic violence” and “spousal violence” are frequently used alternately and denote husbands as the most common perpetrators. Domestic violence is a serious public health and human right issue that concerns all community sectors. Many studies illuminated that violence is an alarming problem in terms of its prevalence and incidence. Moreover, the results of multi-country research by the World Health Organization (WHO) on violence against women showed that fifteen percent to seventy one percent of ever-married women were victims of domestic violence in their marital lives at least once. [3]

With the involvement of more than 80 countries, the WHO in collaboration with London School of Hygiene and Tropical Medicine conducted global analysis of violence problem and the analysis results indicated that 35% of women have experienced either intimate partner violence or non-partner sexual violence in their lifetime. Partner physical and sexual violence was reported by 30% of women in relationship, meanwhile 38% were victims of murder by their intimate partner. Ultimately, the existing forms of violence may exacerbate to present new forms as a result of conflict and displacement. [4]

Research results either in Egypt or internationally indicated that violence against women is both various and widespread. A demographic health survey conducted in Egypt clarified that nearly half of ever-married women stated that they continually experience physical violence since the age of fifteen. Additionally, the majority of women identified an intimate partner as the perpetrator of at least one incident of violence. [5] Intimate partner violence is highly widespread problem touching millions annually in the United States (U.S). A recent survey revealed that in the U.S approximately twenty three percent of adult women compared to fourteen percent of men reported having severe physical violence from an intimate partner in their lifetime as kick, beating, choking, or being burned on purpose etc. Additionally, about half of all women and men were exposed to psychological hostility, such as humiliating or controlling behaviors. [6]

Domestic violence causes are varied. Gender discrimination based violence concept was used as an umbrella that labels any violence type used to perpetuate, establish or impose gender inequalities and keep in place unequal gender-power relations. Economic causes include contradicting a woman access to and control over basic resources as funds denial, snub to financially contribute, controlling access to health care, and food and basic needs denial, etc. Emotional or psychological causes are any omission or activate that harms personal identity, self-esteem and respect or individual development. It includes but is not limited to degradation, threatening loss custody children, family or friend's forced isolation, individual or someone they care about threatening to harm, repeated yelling, persuading fear through threatening words or gestures, behavior controlling and possessions destruction. [7]

As a member of the health care team, nurses conventionally have been reluctant to study domestic violence as a health issue, favoring instead to consider it to be the field of social workers, psychologists and psychiatrists. Despite this, nurses have an important role to play in their work community settings, to assist women (and their children) who are victims of abuse/violence in a domestic situation. While domestic violence remains a severe and common feature of women's intimate relationships, and women and children hurt health concerns as a result, nurses have a significant role to play in working toward the prevention and early intervention of domestic violence. [8]

1.1. Significance of the Study

Violence against women is a defilement of Egypt’s cultural and religious values though; this crime is committed and has been committed for many years. However, movements calling for fighting this crime have increased in the past 5 years, where discourse on this issue has converted from being a taboo to an issue of community belief. Percentage of ever-partnered women aged fifteen to forty nine years experiencing intimate partner physical and/or sexual violence at least once in their lifetime constitute approximately twenty six percent. [9]

Although the limitation of statistics about the frequency of domestic violence against women, studies revealed that 25% of the women worldwide have witnessed whatever form of domestic violence in their lifetime. For example a recent Iranian study clarified that, 41% and 20.2% of women reported being exposed to psychological and physical violence respectively at any given point of time. [10] Somewhat an old study, carried out in Alexandria, Egypt revealed that 77% of women stated experiencing spousal violence during their marital life regardless of socioeconomic strata, where, emotional violence was commonly reported followed by physical, economic, and sexual violence (71%, 50.3%, 40.8% & 37.1% respectively). [11]

A history of experiencing violence is therefore a contributing factor for many illnesses and disorders. Violence affects women’s physical and mental health through direct ways (harm), and indirect pathways (chronic health problems that rise from continued stress). Recent research proposes that the effect of abuse can persevere long after the violence has stopped. The more severe the abuse, the more its influence on a woman’s physical and mental health, and the impact over time of different types and many episodes of abuse seems to be accumulative as clarified by the Centers of Disease Control and Prevention. [12] For the reason that women in Egypt are often subjected to spousal violence, also one of the researchers observed the recurrence of spousal violence cases in her neighborhood in Gharbia Governorate. Moreover, no similar researches were carried out in this area, and many quantitative studies were conducted on this problem in Egypt. Henceforth, it was imperative to conduct qualitative research to explore the experiences of those victimized women regarding spousal violence.

1.2. Research Question

What are the real experiences of spousal violence among victimized women attending family court?

1.3. Aim

The purpose of the current study was to explore spousal violence real experiences among victimized women attending Family Court.

2. Participants and Methods

2.1. Research Design

A descriptive exploratory design was used which was achieved by using a qualitative approach that added personal descriptions in context and women voices, which demonstrated how the nature of relationships are very complicated and can involve many harmful aspects that make married females victims of partner violence. Creswell [13] stated that qualitative research is an analysis process of understanding, constructed on discrete methodological backgrounds of inquiry that discover a social or human problem. The researcher builds a compound, whole picture, analyses words, reports comprehensive views of informants, and performs the study in a natural setting.

2.2. Setting

The current study was conducted at Samanood Family Court, Gharbia Governorate, Egypt.

2.3. Sample and Sampling

A purposive sampling method was used taking into account only those women who were willing to participate in interactive interviews, they were 12 divorced women. In this context, Polkinghorne [14] clarified that the goal of qualitative research is enriching the understanding of lived experience; hence, selecting fertile exemplars is of utmost importance. Information-rich cases are those from which one can learn a great deal about issues of central importance to the purpose of the research, thus the term “purposive sampling”. The sample size was determined by theoretical saturation (completeness of data), where recruitment and data collection continued until no new themes emerged from the interviews.

2.4. Tool

The tool used to collect data was in the form topic guide (semi structured questionnaire), which was prepared beforehand, it included some personal questions as current age, age at marriage, education, number of children and duration of marriage. Besides, open ended questions about partner violence as the predictors, types, causes, impact on victim health, reaction to partner violence, crucial event triggered divorce, and decision of divorce. An example of questions used is; could you describe the nature of the life with your husband, from the beginning to the end of the relation, in your opinion, what are the causes of spousal violence?, could you tell me why you decided to get divorce?, and how violence affected your life?.

2.5. Field Work

After the final letter of authorization was gained from the Family Court President in Sammanoud City, the data collection phase started. Firstly, the researcher visited the court to be familiar with the place, and to coordinate for the place of conducting the interviews inside the court. Then, since there was no official permission for video or audio tapping, and for keeping anonymity of participated women, the researcher played the role of the facilitator, a social specialist from the court was the assistant to be more attentive in note taking. The sessions started with a brief introduction about the aim of the interview and an ice-breaker activity to make participants ready to engage in the discussion. Seeking the informant’s permission before the interview was appropriate way of finding suitable and reliable informants. Twelve women agreed to participate in the interviews had experienced spousal violence. Probe questions were used to take the discussion into still deeper territory as “Please tell me more about that” or “I don’t think I know what you mean, can you explain?”. In an effort to obtain detailed responses, the researcher responded to the interviewee by utilizing active listening, and silence to distill participants’ responses. The researcher conducted 30 minutes to one hour in-depth interviews, where each woman was interviewed once. Recruitment and data collection continued until no new themes emerged from the interviews. Data collection ran over three month period (from end of August 2017 to the end of November 2017).

2.6. Ethical Considerations

Participants were informed that research results will be anonymous to assure secrecy of their data, their participation is voluntary, and there is no penalty for refusing to take part in the research. Finally they were assured that they may refuse to answer any question or stop the interview at any time. Also, to guarantee privacy, an alias (Eve) was used for describing their stories.

2.7. Pilot Study

Prior to the beginning of the actual data collection, the researcher conducted in-depth interviews with the participation of three women to test the clearness of questions. Those who participated in the pilot study were excluded later, since there were minor modifications in questions.

2.8. Administrative Design

A letter containing the aim of the study was issued to Elmahala Court President (Gharbia governorate) from whom the first agreement was taken, and then the second letter of approval was gained from Family Court President in Sammanoud City.

2.9. Analysis

Upon gathering the data, the researcher established a permanent written record of the discussions (Transcription) to facilitate further analysis. Data were coded and categorized; then, the researcher spent much time reading and re-reading transcripts searching for a pattern. Next, ongoing comparison of the participants’ responses with each other was performed. After that, the data were subjected to a thematic analysis (the extraction of the common themes emerging from the interviews). The next step was to divide the data into subcategories, which were formulated by interpreting the contents of the data, and then into main categories. All those reflecting things concerning a same certain area belonged to the same group. In this way, main categories were formulated. Finally, the emergent themes were revised many times.

2.10. Validity

At the end the researchers revised the emergent themes to be sure that all participants agreed about their experiences.

3. Results

Real lived stories as perceived by the 12 divorced women mainly attributed to partner abuse were taken into consideration. The results revealed that, age at marriage ranged from 17 to 25 years, and duration of marriage ranged from 7 months to 7 years except one participant whom her marriage lasted for 44 years, most of them had higher educational level except one of them had primary educational level. Themes were developed from in-depth interview through careful analysis of transcriptions of participants’ experiences. Open ended questions were asked during the individual interviews and were structured to explore their experience from the beginning of the abusive relationship to leaving and living abuse free lives. Six main themes and their subthemes are labeled in the following matrix.

Five stages of the process of change in battered women were identified as pre-contemplation, contemplation, preparation, action and maintenance. [15] As reflected in women stories in the current study, women reported taking or going away many processes and times to leave and many challenges or difficulties were faced to take decision to leave. Where women described the beginning of relationship as ordinary or very good (pre-contemplation), then the appearance of predictors and occurrence of partner violence (contemplation), after that the women reaction (preparation), and finally with the negative health consequences and escalation of danger women decided to escape violence (action and maintenance).

Table 1. Emergent Themes And Subthemes Matrix

3.1. Predictors

As the women discussed their relationship experiences, they provided a clearer picture of how these relationships slowly unfolded from what they thought was a loving relationship to the point that they became manipulated, controlled, and abused.

3.1.1. Relationship Strain with Wife's Family

In the earlier stages of relation formation, most women described positive relationship that included fun, caring, and high level of attention. Some participants described their marriage as very good at first where there were no problems and they understand each other, whereas the rest of them described it as ordinary relation.

Eve 1, 2 and 3: “The first few months were very good”

Eve 4 -12: “It was ordinary relation, he asked to marry me and I accepted”

After the first months of marriage which witnessed the couple's stable relation, the honey moon period started to dissolve. The situation soon changed with the onset of some behaviors from the husband denoting strained relations with the wife's family. Then something wrong started to happen prefigure the relationship strain with wife's family.

Eve 1: “He prevented me from calling my family”

Eve 2: “He began to change toward my family and prevented me from visiting them”

Eve 5: “He was jealous from my family because of the scientific level difference between us and him”

3.1.2. Maltreatment

Nearly all women were treated badly and roughly in a way or another. Women described the predictors of violence as maltreatment which started with carelessness, anger, shouting, another marriage, and end with physical violence.

Eve 4: “Neglect and carelessness”

Eve 7: “He did not sit with me at home and was always with his friends”

Eve 1: “His quick anger at everything”

Eve 10: “Nervous for no reason”

Eve 6: “Arrogance and snootiness; he never gave me a gift, he was wearing a mask in the early months”

Eve 12: “He married another woman, and took my gold and everything I have”

Eve 9: “Beating, indignity and insult”

3.1.3. Husband's Family Intrusion

Only three participants pointed to husband's family mix in herown life as an indicator of the beginning of marital tension.

Eve 1: “Shared life with his family, and the work in the house day and night”

Eve 2: “His mother storms the house and does whatever she wants”

Eve 3: “He is directed by his family”

3.1.4. Financial (Tight- Fisted)

To many families the financial aspects are a nuisance, but to the current study participants it was prominent spark of the starting sparks of the violence cycle.

Eve 1: Described this early part of the relationship as “parsimony, insofar he took my gold and mortgaged it without telling me”

Eve 2 & 4: “He refused to give me the house expenses”

Eve 3 & 6: “He was tight-fisted”

3.2. Types

In the current study all women were exposed to partner violence. The reported types were physical and psychological (verbal & emotional).

3.2.1. Psychological

It was the commonly reported form especially the verbal violence, where all women except Eve 5 tell about their exposure to verbal violence.

3.2.1.1. Verbal

“Insult, indecent words and expelling me from home”

3.2.2.2. Emotional

Eve 3: “Sarcasm and disrespect of anything I do because I am not working woman”

Eve 5: “Brusqueness, neglect, antagonism and disregard; I felt that I am a servant at home”

3.2.2. Physical

This type too was commonly reported, where all women except Eve 5 & 8 informed being physically abused.

“He was usually beating me”

3.3. Causes of Partner Violence

The causes of partner violence are complex, however, the findings of the current study pointes to customs & traditions, meddling of couples' parents, husband personality and the woman herself as main causes of partner violence.

3.3.1. Customs & Traditions

Depending on the context we live in, customs and traditions can play an important role in guiding our live and decisions. Regardless of civilization or modernization level some communities still stuck to retrograde customs and traditions which can have negative consequences and even destroy the future of its generation. As in some areas in Egypt the early and traditional marriage; also, although women hold leadership positions, society remains a male (masculine) society; besides the society view of the divorced woman. All these factors played a pivotal role in triggering partner violence.

3.3.1.1. Early Marriage

Some families are keen to marry their daughters as early as possible because they believe that the society become unsafe and a way to get rid of the financial burden so they want to get rid of this heavy responsibility, for others they have other kids so they also need their share of care, additionally, other families see that their daughters already finished their education so there is no reason for waiting especially when the bridegroom is evaluated by the family as "Good chance" and the girl is not mature enough to choose wisely.

Eve 1: “Families rushing to marry daughters early”

Eve 9: “I get married when I was little, I didn't complete my education, and I don't have a job”

3.3.1.2. Traditional Marriage

The traditional marriage is not bad or unsuccessful; on the contrary for many it is fruitful way of marriage. But the drawback here is that, traditional marriage usually requires the families of the future bride and groom meetings, and in many instances both the girl and the future groom is never met before the matter which creates great influence of family on the girl's decision to accept marriage. In other words it is "families' marriage".

Eve 9: “A normal traditional marriage”

Eve 7: “A normal relationship, he requested to marry me from my parents and I agreed, since I was living in Sinai and have no relationship with anyone”

Eve 5: “A traditional marriage, I did not know him enough before marriage”.

3.3.1.3. Masculine Society

In spite of the change in the role of woman in the Egyptian society today, the society is still to a great extent masculine. The man is in a superior state as the common tongue in Egypt, “Se-Elsayed or Mr. Sayed”; a cinematic personality that reflects the power and domination of the Egyptian man over his wife and children, he was looking for his pleasures outside the house while his wife was oppressed and oblivious. Also, when any problem occurs as harassment for example, the society say the girl is the responsible she must be out home late , her cloth were short or tight, ….etc.

Eve 3: “Male superior status in society as he wants to be as a lord (Se Elsayed) and me as a servant. Also, the wife is a follower to her husband in everything; doesn't have any opinion or decision in her life or children's life”.

Eve 6: “He wanted to revoke my personality and he always wanted to hurt me without any reaction from my side”

Eve 1, 2 & 11: “Discrimination in treatment between girls and boys”

Eve 8: “We are a society that always makes the girl erring even if she is not a mistaken”

3.3.1.4. Society's View of the Divorced Woman

Sometimes the society blames the woman and holds her accountable for the occurrence of divorce, and looks at her as there is always something wrong with her, so many women who become divorced seek second marriage as soon as possible even if it is non-equivalent marriage to escape such stigma "absolute title". Additionally, her future fears of being divorced for the second time gives the husband extra chance to exploit such point and accordingly an abusive relation can start easily.

Eve 8: “The community's view of the divorced woman, I was married before that, but my first husband died which means I am not divorced, and after that, my second husband is the one who asked to marry me so I agreed immediately”

Eve 3: “I was afraid from the term divorced women as it is described by community as bad reputation”

3.3.2. Meddling Of Couples' Parents (In-Laws)

It is important that parents (father/mother in law) transfer their decades of experience to their offspring, but with consideration of not violating the private life of their sons and daughters. Unfortunately, 8 out of the 12 participants confirmed that the problems emerged with her spouse stem from meddling of in-laws (either her or his family). The in-laws did not let the couples live their own life as they wish, instead tried to govern the couple's life. It might be intentional or accidental, but the outcome was destroying their sons and daughters marriage.

Eve 2: “When my mother-in-low asked me to go to a gynecologist, I refused and she overridden my wish and forced me to go”

Eve 9: “One day we got a disagreement and his mother governed him not sleep in my apartment with me”

Eve 7: “Father and mother who interfere in the life of their son on the basis that they fear for his welfare, but they destroy his life”

Eve 12: “His mother intervenes in our life and he listens to her, and tells her about the special relationship between us”

Eve 1: “The words of my family about him (insult), made him come down from my eyes”

3.3.3. Husband Personality

Some participants described husbands personality as playing an important role in divorce or exposed her to violence as H12: “He was liar and did not keep his promises”

Eve 10: “He was always nervous even without causes, also he was psychopath”

Eve 6: “He was wearing mask in early marriage months”

Eve 12:“Weakness and negativity and that my husband does not solve nor bind”

Eve 4: “Drug abuse continuously”

3.3.4. The Woman Herself

Fear and passivity; fears is a feeling which can destroy the person him/her-self not only the relations. The woman fear from her husband hanged her back for no good reason; also fears of being alone with no support made her didn't improve the choice of her partner. Consequently she becomes an easy prey of partner violence.

Eve 3: “I was afraid of my husband very much, that makes me a humiliating personality”

Eve 8: “Loneliness, because my parents are dead and my brothers are traveling abroad that forced me to remarry without conviction to escape the feeling of loneliness”

Eve 7: “Fear of becoming a spinster was what prompted me to rush into marriage and fear of divorce”

3.4. Reaction to Partner Violence

In the current study abused women have gone through many steps before divorce decision as ; seeking family help, react with violence , give chance and take time to assess.

• Seeking family help: all of the studied women sought help whether from their family members, husband's family or friends.

• React with violence: in the current study reaction take many forms as:

Eve 6 & 2: “Response with the same violent manner or sometimes respond with the same expletive or tirade”.

Eve 1: “I preferred silence”

• give chance and take time to assess through:

Eve 3: “Firstly I cried, and then I tried with my husband to solve our problems through understanding with each other, seek help from family members and friends, recourse to Allah. Ultimately, I asked divorce”.

Eve 10: “Possess or become patiently and not telling anyone in my family, when there is no change or response beefed to my father and then divorce”

3.5. Victim's Perceived Negative Health Consequences of Violence

3.5.1. Physical

Half of the participants reported the occurrence of physical health problems as a result of spousal violence ranging from bruise and contusion to wounds, and fractures.

Eve 1, 2, 4 & 10: “Bruise, contusion and wounds”

Eve 12: “Bruise, contusion and fracture”

3.5.2. Psychological

All the participants reported suffering from psychological health problems due to spousal violence.

Eve 1: “Psychological pressure, depression and I tried to commit suicide once”.

Eve 3: “Internal conflict and torment, and all the time I was scared and worried”

Eve 5: “Psychological pressure, loss of confidence in myself and others, sense of loneliness and alienation”

Eve 9: “Depression and all the time I was sad due to beating effects”.

3.6. Decision to Escape Partner/Spousal Violence

In Islamic law, the husband has the exclusive right to divorce or talaq, i.e., the husband can simply say, ‘I divorce you’, and the divorce is carried out. This divorce does not require the intervention of a judge or the wife's approval. In special circumstances, Islam makes allowances for a woman to seek divorce for one of three reasons: khul (divorce for monetary redemption), ta'liq (divorce for breach of a condition in the marriage contract), and fasakh (divorce by the kadi [judge] for justifiable reasons proven by the wife). [16]

Walking away from a relationship can be a painful and difficult choice for anyone. Regardless of the type of relationship (e.g., healthy/unfulfilling, abusive/non abusive) there are factors that play a role in staying (e.g., commitment, personal values) and factors that contribute to and facilitate the decision to eventually leave the relationship (e.g., unmet needs, support systems). As with most major life choices, leaving a relationship is a process and is likely not immediate, as it may take days, weeks, months, or years to come to a final decision to permanently end the relationship. The process of ending an abusive relationship can be described as complex and nonlinear; since it can involve many leaving attempts for various reasons. [17]

3.6.1. Crucial Event (Triggering Situation For Divorce)

Crucial event or turning points can be specific events that serve as catalysts for change. Continuing the cycle of violence against women as reflected in their stories, the women in this study did not leave after the first incident of abuse. As time passed, events unfolded in such a way that woman either became ready to leave (hopelessness) because there was no hope of changing him “the straw that broke the camel’s back”. For other women the level of danger escalated to a point where women needed to flee.

Eve 1: “The increase of humiliating and assaulting me, and taking my money and stealing my gold; which confirms the lack of gregariousness between the spouses”.

Eve 4: “I tried with him a lot, and our families tried; I have despair and had no hope to change him”.

Eve 6: “Multiple beating and humiliation”.

Eve 7: “I felt that I was not making any difference with him, my existence is like my absence”.

Eve 11: “When he told everything to his family even our private matters, I felt that our house was built from glass”.

Eve 12: “When my husband drove me out of home again and I found myself & my children in the street. Neither had he wanted us, nor my father's wife”.

As reported by Eve 3: “The boiled oil spilled on my hands when I was preparing food and I cried. Although he was with me in the apartment he didn't care about me, and instead quarreled with me because the food was not finished yet”.

Eve 5: “I was pregnant and he did not want children at all, and that's what I discovered after being pregnant. He did not welcome pregnancy and refused to bear both my and child's expenses. So, I have already confirmed that he is not fit to be a husband or a father”.

4. Discussion

Violence against women is a significant public health issue with significant health and human rights implications. Domestic violence is an international problematic issue; women in developed countries mainly face more challenges, traditionally denoted to as domestic or intimate partner violence (IPV) which refers to physical, sexual, or psychological harm by existing or previous intimate partner or spouse [18].

Concerning early relationship nature the women in the current study portrayed their relationship experiences, they provided a clearer picture of how these relationships slowly extended from what they believed a loving relationship to the point that they became influenced, controlled, and abused, where, in the beginning stages of relationship formation, most women described positive relationship that included enjoyment and high level of kindness and caring. In the same line, Cordero [19] in Logan Utah, USA conducted study entitled: “understanding experiences of female survivors of domestic violence: Stories of strength, resilience, and mechanisms that assist in leaving violent relationships”, and reported that in the beginning stages of relationship formation, women described optimistic experiences that included “wooing,” delightful, and high levels of attention. They were made to sense special at the same time there was steady increase of behaviors that abusers operated to safeguard survivors became dependent on them.

Regarding causes of spousal violence, it is well known that the causes of violence are complex and the findings of the current study denoted that the commonly reported causes were family intrusion and male superior status in society (masculine society). These results are in agreement with that of Osulah [20] in western part of Kenya who studied: Causes, consequences and response to intimate partner violence: A qualitative study of Kakamega central sub-country”, and reported that the common aspects linked to violence against women are factors related to the male partner, such as his superior status in society and as the significant decision maker and control of family funds and resources. As well, Laisser et al. [21] in Tanzania, who studied: Community perceptions of intimate partner violence – a qualitative study from urban Tanzania”, and Taft et al. [22] in USA, who studied “Intimate partner violence against African American women: An examination of the socio-cultural context”, and explained the suffering of intimate partner violence as a result of masculinity which plays a key factor in intimate partner violence (IPV) and maintenance of patriarchy within a society.

In the same context, Khurram et al. [23] who conducted a qualitative study about: Factors that contribute to the violence against women: a study from Karachi, Pakistan”, and reported that three different classes of women existing in Karachi revealed information that helps in concluding different factors of violence presently prevalent in three classes; interference of in-laws and other family members, male dominance, and restrictions. The widespread violence against women domestically and publicly is because of the patriarchal society still transmitting male dominance in the form of abuse and restriction on women. Other factors like education, poverty, the influence of family were additional prevalent factors of violence.

As well, Muchane [24] who studied the: Experiences of women victimized by domestic violence in Kenya”, and denoted that cultural beliefs were considered as a major cause. Gender differences that sometimes have been set by some beliefs and lead to VAW considered from the most prevalent issues. The participants sensed that the gender distinctions avoid participation, joining and relating spouses, which in most cases will lead to the men using domestic violence as a means of attaining control.

Regarding types of spousal violence against women the current study results revealed that all women were exposed to partner violence. The reported types were physical and psychological (verbal & emotional). This finding agreed with those of Osulah [20] in Kenya, and Sabria et al. [25] in Maryland, USA which reported that result of IPV differs from physical to emotional and sometimes sexual and economical. The women stated on the consequences of daily and long term IPV such as emotional and physical injuries as experienced by the survivors.

Regarding women response to partner violence the current study described that the process of ending an abusive relationship can be described as complex and nonlinear; since it can involve many leaving attempts for various reasons. In the current study abused women took many steps before divorce decision as keeping silence, patience, seeking family help, react with violence and give chance and take time to assess. Congruently, Sabria et al. [25] in Maryland, USA studied: The cumulative violence exposures: black women’s responses and sources of strength, and clarified that some women extradite support from family members and friends who assisted them survive with the violence they experienced.

In the same context, Fanslow and Robinson [26] studied: Help-seeking behaviors and reasons for help seeking” reported by a representative sample of women victims of intimate partner violence in New Zealand, and mentioned that informal support systems were another important source of support for IPV victims. Women sought informal support through extended family, rather than seeking support through formal institutions. In Nepal, Puri et al. [27] studies: Suffering in silence: consequences of sexual violence within marriage among young women in Nepal”, and suggested that, many women chosen to remain silent about IPV experiences. This mirrors global findings, in which more than half of battered women have never told anyone about the violence.

In India, Michele et al. [28] conducted a study to: Identify violence-related coping, help-seeking and health care based intervention preferences among perinatal women in Mumbai”, and reported that participants reflected a variety of responses and coping mechanisms that did not involve other individuals or formal institutions. Silence as a main coping response to maltreatment and abuse defined by participants was one of responses. Informal help was the dominant method of help established by women, most commonly from family members and neighbors in close nearness. Informal help was often encouraged by cases of violence that were exclusively severe or public, such that members were unable to hide what they were experiencing.

However, in Kenya Odero et al. [29] studied the: Responses to and resources for intimate partner violence: Qualitative findings from women, men, and service providers in rural Kenya”, and recognized nine types of actions that women frequently take in response to intimate partner violence, preliminary with their families, moving along to community organizations, hospitals, and sometimes moving to legal or non-governmental structures. Some of them choose to share with their friends but most of them opt to hurt in silence, a few can select to run back to their parents. Other women take some action, but tend to reach out to informal support systems such as relatives and elders.

The current study specified some situations considered as a crucial event which bring up women to leave the abusive relationship. Often in their stories, there was a critical incident where the level of abuse escalated to a point at which they needed to make an immediate escape. Regarding crucial event/turning points, Chang et al. [30] stated that it is a minor event that tip the scale in a process that has escalated over time; time-related factors that refers to realization that the remaining time for changing an abusive partner is becoming more and more limited; excuses, through which a woman can place the responsibility of breaking up on someone else who insists that breaking up is necessary; and either/or alternatives, in which a woman perceives that she has to make a choice between two alternatives, and that the no chosen will be lost.

In the same line, Sabria et al. [25] clarified that although women described going back and forth in terms of leaving and returning, there were some turning points where women decided to finally break free from the abusive relationship (robbery for one participant, the turning point was when her partner robbed her). Moreover, Sukeri and Normanieza [16] in Kelantan, Malaysia, carried out a study to identify: Escaping domestic violence: A qualitative study of women who left their abusive husbands, and reported that some of these women were hurt years of emotional violence, but lastly reached the breaking point when they were physically abused.

5. Conclusion

The current study results and research question bring about the conclusion that most women who were exposed to spousal violence lived a happy life full of sympathy and kindness until the emergence of alarming predictor as relationship strain and maltreatment. These predictors reemerged again and again to the degree that it became a pattern of life. The spousal violence took many forms ranging from verbal to emotional and physical. The customs and traditions were the mostly reported causes of spousal violence against women, which included early marriage and traditional marriage, as well as the distinction (masculine society) between men and women in rights and duties, which made men the guardians of women. Although being victims and suffering from physical and psychological health problems due to violence, women seek many methods to solve problem, such as asking for help from close family, relatives and friends, or interacting with violence, and giving opportunity for change to the best. However, all these means failed until they were exposed to an event which led to the end of marital life such as gross exposure to humiliation, theft, frequent physical assault and then divorce became the only solution for women to come through this dilemma and start a new life.

6. Recommendations

In the light of the current study results it is recommended that,

• Offer awareness programs in different community setting attempting to prevent cycle of violence from ever starting by preparing young couples for healthy marital relationship.

• Victims of spousal violence must be subjected to physical and psychological rehabilitation.

• Educational programs directed to families and all community members about spousal violence and its consequences.

• Research to be conducted to identify men's perspective of spousal violence.

• Further studies to be directed to other settings with large sample for generalization of the results.

7. Limitations

It was planned for the current study to take in consideration both couples perspectives by conducting in-depth interviews with the two couples separately, but none of the husbands accepted to take part in the study with his wife and share his experience.

Conflicts Of Interest Disclosure

The author declares that there is no conflict of interest.

References

[1]   | Kharboush, I.F., Roudi-Fahimi, F., Ismail, H.M., Mamdouh, H.M., Muhammad, Y.Y., Tawfik, M.M., El Sharkawy, O.G., & Sallam, H.N. Spousal Violence in Egypt:Population Reference Bureau. [Online]. 2010 [Cited 2018 Jan 3rd]; Retrieved from: www.prb.org/pdf10/spousalviolence-egypt.pdf.
[2]   | Marroushi, N. Violence against women in Egypt: Prospects for improving police response. [Online]. 2015 [Cited 2018 Mar 21st]; Retrieved from, https://www.files.ethz.ch/isn/191657/violence-against-women-inegypt.pdf.
[3]   | World Health Organization [WHO]/ London School of Hygiene & Tropical Medicine (LSHTM). Preventing intimate partner and sexual violence against women: Taking action and generating evidence. Geneva/London, World Health Organization/ London School of Hygiene and Tropical Medicine; 2010.
[4]   | World Health Organization [WHO]. Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. [Online]. 2013 [Cited 2018 Mar 5th]; Retrieved from: http://apps.who.int/iris/bitstream/handle/.
[5]   | El-Deeb, B. Study on ways and methods to eliminate sexual harassment in Egypt. [Online]. 2013 [Cited 2018 Feb 25th]; Retrieved from: https://www.euromedwomen.foundation/pg/en/documents/.

[6]  
Niolon, P.H., Kearns, M., Dills, J., Rambo, K., Irving, S., Armstead, T., & Gilbert, L. Preventing intimate partner violence across the lifespan: A technical package of programs, policies, and practices. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Atlanta, Georgia. [Online]. 2017 [Cited 2018 Mar 30th]; Retrieved from: https://www.cdc.gov/violenceprevention/pdf/ipv-technicalpackages.pdf.

[7]   | McGinn, T., Taylor, B., McColgan, M., & Lagdon, S. Survivor perspectives on IPV perpetrator interventions: A systematic narrative review. Trauma Violence Abuse 2016; 17 (3): 239-255.
[8]   | Da Silva, L.A., França, T.D., Ferreira, D.S., Dos Santos, W.M., & Da Silva, C.R. The nurse's role in the care of women victims of violence. American Journal of Medical and Biological Research 2015; 3 (3): 78-81.
[9]   | Ministry of Health and Population & ICF International. Egypt Demographic and Health Survey 2014. Cairo, Egypt and Rockville, Maryland, USA: Ministry of Health and Population and ICF International, 2015.
[10]   | Mohamadian, F., Hashemian, A., Bagheri, M., & Direkvand-Moghadam, A. Prevalence and risk factors of domestic violence against Iranian Women: A Cross-Sectional Study. Korean J Fam Med 2016; 37(4): 253-258.
[11]   | Mamdouh, H.M., Ismail, H.M., Kharboush, I.F., Tawfik, M.M., El Sharkawy, O.G, Abdel-Baky, M., & Sallam, H.N. Prevalence and risk factors for spousal violence among women attending health care centers in Alexandria, Egypt. Eastern Mediterranean Health Journal 2012; 18 (11): 1118-1126.
[12]   | Centers for Disease Control and Prevention. Intimate partner violence: risk and protective factors. [Online]. 2016 [Cited 2018 Apr 13th]; Retrieved from: https://www.cdc.gov/violenceprevention/intimatepartnerviolence/riskprotectivefactors.html.
[13]   | Creswell, J.W., & Miller, D.L. Determining validity in qualitative inquiry. Theory into practice 2010; 39 (3): 124-130.
[14]   | Polkinghorne, D.E. Language and meaning: Data collection in qualitative research. Journal of Counseling Psychology 2005; 52 (2): 137-145.
[15]   | Brown, J. Working toward freedom from violence: The process of change in battered women. Violence against women 2005; 3, 5-26.
[16]   | Sukeri, S., & Normanieza, N.N. Escaping domestic violence: A qualitative study of women who left their abusive husbands. Journal of Taibah University Medical Sciences 2017; 12(6): 477-482.

[17]  
Karim, N. Exploring the process of leaving: Experiences of intimate partner violence survivors with children. Published dissertation Submitted to Michigan State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Psychology, Michigan State University; USA; 2011.

[18]   | World Health Organization [WHO]. Understanding and addressing Violence against women: intimate partner violence. [Online]. 2012 [Cited 2018 Jan 15th]; Retrieved from, http://apps.who.int/iris/bitstream/handle/10665/77432/WHO_RHR_12.36_eng.pdf.

[19]  
Cordero, A. Understanding experiences of female survivors of domestic violence: Stories of strength, resilience, and mechanisms that assist in leaving violent relationships. Published dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology Utah State University: Logan, Utah, USA; 2014.

[20]  
Osulah, W.T. Causes, consequences and response to intimate partner violence: A qualitative study of Kakamega central sub-country. A project report submitted to the Institute of Anthropology Gender and Africans studies in partial fulfillment of the requirements for the degree of Master of Arts in Gender and Development Studies of the University of Nairobi; 2014.

[21]   | Laisser, R.M., Nystrom, L., Lugina, H.I., & Emmelin, M. Community Perceptions of intimate partner violence – A qualitative study from urban Tanzania. BMC Women’s Health 2011; 11 (13): 1-12.
[22]   | Taft, C.T., Bruant-Davis, T., Woodward, H.E., Tillman, S. & Torres, S.E. Intimate partner violence against African American women: An examination of the socio-cultural context. Aggression and violent behavior 2009; 14(1): 50-58.
[23]   | Khurram, E., High, C., & Fritz, H. Factors that contribute to the violence against women: A study from Karachi, Pakistan. Published Master Thesis Linnéuniversitetet Kalmar Vaxjo: Sweden; 2018.
[24]   | Muchane, G. Experiences of women victimized by domestic violence in Kenya. Published Bachelor Thesis, Bachelor of Health Care Degree Program in Nursing, School of Health and Social Studies, Jyväskylä University of Applied Sciences: Kenya; 2011.
[25]   | Sabria, B., Huerta, J., Alexander, K.A., StVil, N.M., Campbell, J.C., & Callwood, G.B. Multiple intimate partner violence experiences: Knowledge, access, utilization and barriers to utilization of resources by women of the African Diaspora. J Health Care Poor Underserved 2015; 26(4): 1286-1303.
[26]   | Fanslow, J.L. & Robinson, E.M. Help-seeking behaviors and reasons for help seeking reported by a representative sample of women victims of intimate partner violence in New Zealand. J Interpers Violence 2010; 25(5):929-951.
[27]   | Puri, M., Tamang, J., & Shah, I. Suffering in silence: consequences of sexual violence within marriage among young women in Nepal. BMC Public Health. 2011; 11: 29.
[28]   | Michele, R., Saritha, N., Niranjan, S., Bushra, S., Meghna, J., Anita, R., Balaiah, D., & Jay, G. Violence-related coping, help-seeking and health care–based intervention preferences among perinatal women in Mumbai, India. Journal of Interpersonal Violence 2013; 28(9) 1924-1947.
[29]   | Odero, M., Hatcher, A.M., Bryant, C., Onono, M., Romito, P., Bukusi, E.A., & Turan, J.M. Responses to and resources for intimate partner violence: Qualitative findings from women, men, and service providers in rural Kenya .J Interpers Violence 2014; 29(5): 783-805.
[30]   | Chang, J.C., Dado, D., Hawker, L., Cluss, P.A., Buranosky, R., Slagel, L., & Scholle, S.H. Understanding turning points in intimate partner violence: Factors and circumstances leading women victims toward change. Journal of Women’s Health. 2010; 19 (2): 251-259.