Sunday February 05, 2023

Intimate partner violence

January 17, 2022

Intimate partner violence (IPV) is one of the most common forms of violence against women and girls. It includes psychological, emotional, physical, and sexual abuse and controlling behaviours by an intimate partner. IPV undermines women’s personal freedom, autonomy, and fundamental human rights and is a major public health issue throughout Pakistan. It has massive social and economic impacts on women, adolescent girls and the wider community.

Pakistan has a patriarchal society where women’s lives are often controlled by male family members. Husbands attempt to closely control and monitor their wives through the use of IPV. The latest Pakistan Demographic and Health Survey reveals that almost 34 percent of ever-married women aged 15-49 have experienced IPV.

IPV is rooted in widely accepted harmful social norms including: ‘sexual intercourse (including rape) is the right of men in a marriage’, ‘husbands have a right to assert power over their wives’, and ‘girls are responsible for controlling a man’s sexual urges’. Women’s reproductive health and rights continue to be violated due to these deeply ingrained harmful social norms.

Women in Pakistan are often expected to have children as soon as they are married and are unable to time their first pregnancy, practise birth spacing and decide on a certain number of children. Women are also ‘valued’ based on their ability to reproduce due to patriarchal concepts of their roles within the family. According to UN Women: “Early marriage and pregnancy, or repeated pregnancies spaced too closely together in efforts to produce male offspring because of the preference for sons – has a devastating impact on women’s health with sometimes fatal consequences.’’

IPV is perpetrated against women and girls to control their sexual and reproductive health and has been significantly associated with unintended and unwanted pregnancies and unsafe abortion. According to UN Women, Pakistan has the highest population growth rate – 2.4 percent – with the lowest contraceptive prevalence rate – 35 percent – in South Asia. The fertility rate stands at 3.6 births per woman and four million unwanted pregnancies in a year. Women often lack the status and knowledge to negotiate for safe sex and contraceptive practices, increasing the probability of unintended and unwanted pregnancies. This also puts women at the risk of acquiring sexually transmitted infections including HIV, pregnancy complications, pelvic inflammatory disease, urinary tract infections and sexual dysfunction.

This is seen more significantly in adolescent girls who are married to older male spouses with more sexual experience. A Unicef report revealed that 21 percent of girls are married before the age of 18 in Pakistan. As per Girls Not Brides, girls who marry before age 15 are 50 percent more likely to suffer from IPV than those who marry later. It has also been revealed that child marriages are also closely linked to female genital mutilation/cutting (FGM/C), which negatively affects their sexual and reproductive health and rights (SRHR).

Adult spouses can significantly control and exert power on child brides through the use of IPV. Also, child brides are physically and mentally unprepared to engage in sexual activity. Children have limited knowledge about their SRHR and limited access to sexual and reproductive health (SRH) services. According to the World Health Organization (WHO), complications from pregnancy and childbearing are the leading causes of death among girls aged 15–19 years. A WHO multi-country study revealed that adolescent mothers were at higher risk of several adverse outcomes including low birth weight, preterm delivery eclampsia and infections, compared to adult mothers.

Various studies have indicated high levels of physical IPV during pregnancy throughout the world. As per data revealed by the Center for Disease Control of the United States (CDC), IPV affects as many as 324,000 pregnant women each year in the US. However, this has not been studied or researched in Pakistan, leaving a significant gap in the protection of women and girls. Physical IPV during pregnancy can affect women’s reproductive health and may also account for a proportion of maternal mortality. Moreover, IPV during pregnancy may result in miscarriage, late entry into prenatal care, stillbirth, premature labour and birth, etc. However, the WHO notes that this association is often left unrecognised by policymakers.

According to the CDC, pregnancy may represent a unique opportunity for women and girls to have contact with healthcare providers. It is important to ensure that healthcare providers are trained to regularly screen for the signs of IPV.

Healthcare providers should educate couples about the risk of adverse birth outcomes due to exposure to IPV along with immediate-, medium- and long-term effects on their SRH. Hospitals and clinics must have strong referral mechanisms and should refer women and girls who screen positive to IPV to intervention services, such as shelter homes, police stations, women protection cells, etc with the consent of patients/survivors.

The Sindh Reproductive Healthcare Rights Act 2019 is a progressive piece of legislation that was enacted to facilitate reproductive healthcare and promote reproductive health rights in Sindh. Article 4 specifically grants the right to be free from ill-treatment and to be protected from sexually transmitted diseases such as HIV/AIDS, rape, sexual assault, sexual abuse, sexual harassment and other forms of gender-based violence.

There is no denying that the role of IPV as an underlying factor in women’s SRHR in Pakistan remains an area that lacks robust data. This association has not been researched or studied in Pakistan even though the country has a high prevalence of maternal mortality and morbidity and gender-based violence, including IPV.

There is a need to study the link between IPV and SRHR; this will help policymakers look at the issue at the grassroots level and address the issue through evidence-based information that appropriately responds to the problem. This includes the establishment of intervention programmes that work, such as raising awareness on IPV and SRHR in newlyweds and young couples, building the capacity of health providers and integrating SRHR into the existing healthcare training curricula.

As per Article 7 (1) of the 2019 Act, the health and population departments of the Sindh government are made responsible for overseeing the act and implementing it efficiently. However, it is unfortunate that the 2019 Act remains unimplemented and women and children continue to suffer.

The writer is a barrister. She tweets @RidaT95 and can be reached at: