case study on domestic violence in india

• Open access
• Published: 21 April 2022

Domestic violence in Indian women: lessons from nearly 20 years of surveillance

• Rakhi Dandona 1 , 2 ,
• Aradhita Gupta 1 ,
• Sibin George 1 ,
• Somy Kishan 1 &
• G. Anil Kumar 1  

BMC Women's Health volume  22 , Article number:  128 ( 2022 ) Cite this article

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Prevalence of self-reported domestic violence against women in India is high. This paper investigates the national and sub-national trends in domestic violence in India to prioritise prevention activities and to highlight the limitations to data quality for surveillance in India.

Data were extracted from annual reports of National Crimes Record Bureau (NCRB) under four domestic violence crime-headings—cruelty by husband or his relatives, dowry death, abetment to suicide, and protection of women against domestic violence act. Rate for each crime is reported per 100,000 women aged 15–49 years, for India and its states from 2001 to 2018. Data on persons arrested and legal status of the cases were extracted.

Rate of reported cases of cruelty by husband or relatives in India was 28.3 (95% CI 28.1–28.5) in 2018, an increase of 53% from 2001. State-level variations in this rate ranged from 0.5 (95% CI  − 0.05 to 1.5) to 113.7 (95% CI 111.6–115.8) in 2018. Rate of reported dowry deaths and abetment to suicide was 2.0 (95% CI 2.0–2.0) and 1.4 (95% CI 1.4–1.4) in 2018 for India, respectively. Overall, a few states accounted for the temporal variation in these rates, with the reporting stagnant in most states over these years. The NCRB reporting system resulted in underreporting for certain crime-headings. The mean number of people arrested for these crimes had decreased over the period. Only 6.8% of the cases completed trials, with offenders convicted only in 15.5% cases in 2018. The NCRB data are available in heavily tabulated format with limited usage for intervention planning. The non-availability of individual level data in public domain limits exploration of patterns in domestic violence that could better inform policy actions to address domestic violence.

Conclusions

Urgent actions are needed to improve the robustness of NCRB data and the range of information available on domestic violence cases to utilise these data to effectively address domestic violence against women in India.

Peer Review reports

The Sustainable Development Goal (SDG) target 5 is to eliminate all forms of violence against women and girls, and the two indicators of progress towards this are the rates of intimate partner violence (IPV) and non-partner violence [ 1 ]. The World Health Organization (WHO) estimated a 26% prevalence of IPV in ever-married/partnered women aged 15 years or more globally in 2018, and this prevalence is higher at 35% for southern Asia region in which India falls [ 2 ]. The self-reported domestic violence (majority by an intimate partner) in any form is reported between 33 to 41% among ever-married women from India [ 3 , 4 , 5 , 6 , 7 , 8 ]. Furthermore, the suicide death rate among women in India was reported to be twice the global rate [ 9 ], and housewives account for the majority of suicide deaths, the reasons for which are documented as “personal/social” [ 10 ].

Domestic violence was first recognized as a punishable offence in India in 2005 with the passing of the Protection of Women from Domestic Violence Act (PWDVA) [ 11 , 12 ]. A significant focus of domestic violence against women in India has been on dowry-related harassment. Dowry is the transfer of goods, money and/or property from the bride’s family to the groom or his family at the time of marriage [ 13 ], initially meant to provide funds to women who were unable to inherit family property [ 14 ]. Dowry is very prevalent in India [ 15 ], and it has propagated domestic violence as means to extract money or property from the bride and her family [ 13 , 16 ]. While earlier sections of the Indian Penal Code (IPC) criminalized only dowry-related domestic violence, PWDVA expanded legal recourse for domestic violence beyond dowry harassment for more effective protection of the rights of women guaranteed under the Constitution who are victims of violence of any kind occurring within the family [ 11 ].

The major official source of surveillance for domestic violence in India are the reports compiled by the National Crime Records Bureau (NCRB) [ 17 ]. Though under-reporting in NCRB reports is well documented for certain types of injuries [ 9 , 10 , 18 ], it remains the most comprehensive longitudinal source of domestic violence available at the state-level for India. We undertook a situational analysis for the years 2001 to 2018 using the NCRB reports to highlight the trends in the reported magnitude of domestic violence over time, to highlight the variations within country that could facilitate prioritization of immediate actions for prevention, and to discuss the limitations of the available NCRB reports for surveillance.

The primary source of the NCRB data is the First Information Report (FIR) completed by a police officer for any domestic violence incident which is compiled at the state level and provided to NCRB. FIR is a document prepared by police when they receive information about the commission of a cognizable offence either by the victim of the cognizable offence or by someone on their behalf [ 19 , 20 ]. It captures the date, time and location of offence, the details of offence, the details of victim and person reporting the offence, and steps taken by the police after receiving these details. The NCRB reports provide summary data based on these FIRs, which we utilized from 2001 to 2018 available in the public domain for this analysis. The details of data extracted and utilized are described below.

Type of data

Four crime headings corresponding to domestic violence related crimes against women were considered after consultation with legal experts who dealt with domestic violence cases based on the crime headings under which these are registered in India —cruelty by husband or his relatives, dowry death, abetment of suicide of women, and cases registered under PWDVA (Additional file 1 : Table S1). A case is filed under ‘cruelty by husband or his relatives’ (Section 498A of the IPC) when there is evidence of violence causing grave injury or of harassment to fulfil an unlawful demand for property [ 21 ]. Case of death of a woman within 7 years of marriage with evidence of dowry harassment is filed under dowry death (IPC Section 304B) [ 22 ]. As domestic violence is known as a risk factor for death by suicide among married women, we also considered the cases registered under abetment of suicide of women [ 23 ]. The cases under the PWDVA act criminalize perpetrators of domestic violence, defined to include physical, verbal, sexual, emotional and economic abuse in addition to dowry-related violence [ 11 ]. The NCRB reports data based on the “Principal Offence Rule,” which means that regardless of the number of offences under which a case of domestic violence is legally registered, it is reported only under the most serious crime heading by the NCRB [ 24 ].

Data extraction

NCRB reports included the number of cases filed as well as the number of victims under each of the four crime headings for 2014–2018 but reported only the number of cases filed from 2001 to 2013. The ratio of the number of cases to victims was 1.0 for 2014 to 2018, and hence we use the number of cases filed for this analysis from 2001 to 2018. Individual level-data is not published in the NCRB report.

Data for cruelty by husband or his relatives and for dowry death were available from 2001 to 2018, while data for abetment of suicide of women and PWDVA were available only from 2014 to 2018. We extracted the number of cases filed under each of the four domestic violence crime heads for each year for each state and for India. We also extracted data on the number of persons arrested under each crime category, which were available from 2001 to 2015 for the states and until 2018 for India. Here too, the data on abetment of suicide and PWDVA was available from 2014 to 2018 only. Lastly, we extracted data on the number of legal cases filed for these crimes and their current status in the judicial system. This legal data was available cumulatively for only India, and since it could not be extrapolated for each year from the tables, we analyzed this only for 2018.

Data analysis

Our analysis was aimed at understanding trends in the rate for each type of domestic violence crime heading. We calculated the rate of cruelty by husband or his relatives and dowry deaths from 2001 to 2018, and the rate of abetment of suicide of women and PWDVA from 2014 to 2018. As the NCRB reports do not specify the age of women who had reported these crimes, we assumed the age group of women to be 15–49 years to estimate the rates as the previous reports on domestic violence in India are predominately for women aged 15–49 years [ 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. We used the Global Burden of Disease (GBD) study 2019 state-wise annual population estimates for women aged 15–49 years as the denominator [ 32 ], and report the rates per 100,000 women aged 15–49 years with 95% confidence intervals (CI) estimated for these rates. We report these rates across three administrative splits: nationally, by groups of state and individual state. The state groups were populated based on the Socio-demographic Index (SDI) computed by the GBD study, which uses lag distributed income, average years of education for population > 15 years of age, and total fertility rate [ 9 , 32 ].

To assess the trends in arrests related to domestic violence crimes, we computed the mean number of people arrested under each crime heading by dividing the number of people arrested with the total number of cases. The statistical analysis was done using MS Excel 2016, and maps were created using QGIS [ 33 ]. As this analysis used aggregated data available in the public domain, no ethics approval was necessary.

Cruelty by husband or his relatives

A total of 1,548,548 cases were reported under cruelty by husband or his relatives in India from 2001 to 2018, with 554,481 (35.8%) between 2014 and 2018. The reported rate of this crime in India was 18.5 (95% CI 18.3–18.6) in 2001 and 28.3 (95% CI 28.1–28.5) in 2018 per 100,000 women aged 15–49 years, marking a significant increase of 53% (95% CI 51.7–54.3) over this period (Table 1 ). This rate was 37.9 (95% CI 37.5–38.3) for the middle SDI states as compared with 27.6 (95% CI 27.4–27.8) in the low- and 18.1 (95% CI 17.8–18.4) in the high-SDI states in 2018 (Table 1 ). This reported crime rate remained higher in the middle SDI states between 2001 and 2018 as compared with the other states, reaching its highest levels between 2011 and 2014 (Fig.  1 ). Wide variations were seen in the rate for reported cruelty by husband or his relatives in 2018 at the state-level, which ranged from 0.5 (95% CI -0.05 0–1.5) in Sikkim to 113.7 (95% CI 111.6–115.8) in Assam (Table 1 and Fig.  2 ). The state of Delhi, Assam, West Bengal, Arunachal Pradesh, Meghalaya and Jammu and Kashmir documented > 160% increase in this reported crime rate during 2001–2018 (Table 1 ). The greatest decline in the rate of this reported crime was seen in Mizoram, 74.3% from 2001 to 2018 (Table 1 ).

Yearly trend in the rate of cruelty by husband or his relatives per 100,000 women of 15–49 years, 2001–2018. SDI denotes Socio-demographic Index

Crime rate for cruelty by husband or his relatives per 100,000 women aged 15–49 years in 2018 in India, by state

Interestingly, the 53% increase in this reported crime rate between 2001 and 2018 for India was accounted for by increased rates for only a few states, and the rate remained stagnant in most states (Additional file 2 : Fig. S1, Additional file 3 : Fig. S2, Additional file 4 : Fig. S3). Only the states of Assam and Rajasthan among the low SDI states (Additional file 2 : Fig. S1), Andhra Pradesh and Tripura among the middle SDI states (Additional file 3 : Fig. S2), and Kerala and Delhi among the high SDI states (Additional file 4 : Fig. S3) showed increased reporting of this crime over the study period. The mean number of persons arrested under this crime in India decreased from 2.2 in 2001 to 1.1 in 2018, and the numbers were similar across the state SDI groups (Additional file 5 : Fig. S4).

Dowry deaths

A total of 137,627 crimes were reported as dowry deaths between 2001 and 2018, with 38,342 (27.9%) cases between 2014 and 2018. The rate of this reported crime in India was 2.0 (95% CI 2.5–2.7) in 2018 per 100,000 women aged 15–49 years (Table 1 ). This rate in 2018 was 3.1 (95% CI 3.0–3.2) in the low-SDI states as compared to 1.2 (95% CI 1.1–1) in the middle- and 0.7 (95% CI 0.60–0.8) in the high-SDI states, and this trend was seen throughout the period studied (Table 1 ). At the state level in 2018, this rate ranged from 0.11 (95% CI 0–0.32) in Meghalaya to 4.0 (95% CI 3.8–4.2) in Uttar Pradesh; no cases were reported in Arunachal Pradesh, Manipur, Mizoram or Nagaland (Table 1 and Fig.  3 ). The largest decline in this rate was seen in the states of Tamil Nadu and Gujarat over the study period (Table 1 ).

Rate of dowry deaths per 100,000 women aged 15–49 years in 2018 in India, by state

The mean number of persons arrested for dowry deaths in India declined from 3 in 2001 to 2.3 in 2018. In 2001, this mean was markedly higher in the high-SDI states (4.9) than the low- (2.7) and middle- (2.6) SDI states. However, by 2015 this rate was higher in the low-SDI states (2.9) than high- (2.2) and middle- (1.8) SDI states (Additional file 5 : Fig. S4).

Abetment of suicide of women

Data under this crime head was available from 2014 to 2018, during which 22,579 cases were reported. The average rate of this crime was 1.27 (95% CI 1.25–1.29) per 100,000 women aged 15–49 years over this period. Overall, relatively higher rates were recorded in middle-SDI states (2.2; 95% CI 2.1–2.3), followed by high- (1.7; 95% CI 1.6–1.8) and low- (0.73; 95% CI 0.69–0.77) SDI states (Table 1 ). Notably, the middle- and high-SDI groups recorded a similar rate in 2014, after which the middle-SDI states recorded a steady increase in rate until 2017, while the high-SDI states saw an initial dip in 2015 and then an increase till 2017. The rate in the low-SDI states remained low throughout this period (Table 1 ).

At the state-level in 2018, this rate ranged from 0.07 (95% CI 0.02 to 0.12) in Odisha to 4.0 (95% CI 3.6–4.4) in Telangana; no cases were reported in Bihar, Meghalaya, Mizoram, Sikkim and Nagaland (Table 1 and Fig.  4 ). While some states did not record any case, other states recorded significant changes between the 2014 and 2018. This rate in Tamil Nadu increased by 450% from 2014 to 2018, and West Bengal and Gujarat recorded an increase of over 100%, while this rate declined the most in Telangana, by 31% (Table 1 ). The mean number of persons arrested for this crime in India recorded a small increase from 1.4 in 2014 to 1.7 in 2018, and was similar across the state SDI groups (Additional file 5 : Fig. S4).

Rate of abetment of suicide of women per 100,000 women aged 15–49 years in 2018 in India, by state

PWDVA, 2005

A total of 2,519 cases were reported under PWDVA between 2014 and 2018, with an average crime rate of 0.14 (95% CI 0.13–0.15) per 100,000 women aged 15–49 years during this period (Table 1 ). Majority of the states did not report any case under this Act (Table 1 ). The mean number of persons arrested in India for this crime decreased from 1.6 in 2014 to 1 in 2018 (Additional file 5 : Fig. S4).

Status of the legal cases

A total of 658,418 cases were sent for trial in India in 2018, of which trial was completed in only 44,648 (6.8%) cases. Among the cases in which trial was completed, the offender(s) was convicted in only 6,921 (15.5%) cases.

In India between 2001 and 2018, the majority of domestic violence cases were filed under ‘cruelty by husband or his relatives’, with the reported rate of this crime increasing by 53% over the 18 years. However, it is important to note that only some states recorded change in the reported rate with the almost stagnant reported rate of domestic violence in many states over time. Significant heterogeneity was seen in the pattern of the four types of crimes at the state-level. Overall, the mean persons arrested decreased irrespective of the crime during the period studied, and less than 7% of the filed cases had completed legal trial in 2018. We discuss the gaps identified in the reported data which unless addressed have major implications in the facilitating action to reduce domestic violence against women in India.

The rate of reported crime under all the considered categories excluding dowry deaths in 2018 in India in the NCRB was close to the 33% self-reported domestic violence reported by women in the national survey in 2015–16 [ 3 ], though there is an indication that the prevalence of domestic violence could be as high as 41% in India [ 4 ]. The NCRB data provides passive surveillance with the source being the FIR filed by family/kin/community member with the police for a crime, and hence is dependent on the reporting from the community, which is known to be selective as women report less to the police for domestic violence due to various reasons including lack of social support, shame, and stigma [ 34 , 35 , 36 , 37 ]. These differences could account for differential rates of domestic violence between the police records and self-reporting of domestic violence in the surveys [ 3 , 4 ]. Recently, it is also shown that how women are asked about domestic violence in surveys can also result in different estimates [ 38 ]. Furthermore, the Principal Offence Rule followed by NCRB "hides" many cases of domestic violence as according to this Rule, each criminal incident is recorded as one crime. If many offences are registered in a single case, only the most heinous crime—one that attracts maximum punishment—is considered as counting unit [ 39 , 40 ]. For example, an incident involving dowry death and cruelty by husband or relative will be reported in NCRB as dowry death as it warrants the maximum punishment, thereby, underreporting the number of cases with cruelty by husband or relative.

The cases under cruelty by husband or his relatives accounted for the majority of reported cases, and the rate of this reporting was comparatively higher in the middle-SDI states over the years studied. Previous research using field notes from cases reported to police indicate that victims are often in an environment that condones violence through active encouragement or tacit approval by the husband’s family members; and that many women lack social support as they experience violence from multiple perpetrators at home [ 34 , 41 ]. It is plausible that this rate is higher in the middle-SDI states because material wealth is highly prized among the Indian middle class, and dowry is seen as an easy path to greater wealth and social status [ 12 ]. A higher dowry demand, and a greater dissatisfaction from inability to meet these demands could possibly result in more domestic violence in these states [ 12 , 42 , 43 ]. Another possible factor in these states could be that the increasing female literacy in these states may be perceived as a threat to the prevalent power structures, prompting violence against women as a means to reinstate control [ 12 , 44 , 45 , 46 , 47 ].

The middle-SDI states also had a higher rate of reported cases under abetment to suicide. The link between abuse and suicidal behaviour is well established, with research indicating that three out of ten women who undergo domestic violence are likely to attempt suicide [ 5 ]. Furthermore, a significantly higher suicide death rate is reported in Indian women than their global counterparts [ 9 ], and housewives account for the majority of these suicide deaths [ 10 ]. Wide state-level variations in the suicide death rate for women are also reported [ 9 ], and the relationship between the prevalence of domestic violence and suicide death rate needs to be explored further.

In contrast to the increased reporting of cases of cruelty over time, the rate of dowry death cases decreased from 2001 to 2018, with the low-SDI states recording the highest rate of dowry deaths. The dip in these cases may have resulted from the 2010 judgment requiring prior harassment of the victim associated with a dowry shortfall which made it harder to register a dowry death but presumably also harder to prove beyond a reasonable doubt that it was a dowry death, and not in fact.[ 48 ] Furthermore, qualitative research has shown that the families of dowry death cases deter from accusing the husband or his family due to fear of issues with up-bringing of the children of their daughter [ 47 ]. Also dowry deaths or related suicide deaths are less likely to be reported by the natal family, who fear social stigma and negative impact on marriages of their other daughters [ 42 , 49 ]. In this context, it is not easy to interpret the decreased number of cases of dowry deaths in India as actual fewer dowry deaths, for which more evidence is needed.

Very few cases were filed under PWDVA with the middle-SDI states reporting no cases during the period studied. While PWDVA defines domestic violence to include coercive behaviour as well as physical, sexual, emotional and economic abuse [ 11 ], in actuality only extreme forms of physical violence with evidence of injury are seen to evoke a legal response [ 12 ]. Interviews with victims indicate that unless they were able to offer a dowry claim or show evidence of grave physical violence, the police were either reluctant to file an FIR or offer PWDVA as a legal recourse to them [ 12 ]. It is also documented that the police, acting as social brokers, attempt to fit the reported domestic violence cases into ‘normal constructs’ frequently focusing on dowry harassment despite the broadened scope of the law as a recourse for domestic violence beyond dowry harassment [ 5 ]. Thus, data under this crime heading is unlikely to reflect the true picture of domestic violence against women in India.

The poor response of formal system to domestic violence is also reflected in the legal recourse as only 6.8% of the cases filed completed trials in 2018, with the majority of accused being acquitted. This bleak state of waiting, extended trials and low conviction is known to further discourage women from reporting [ 50 ]. The legal process is also influenced by the patriarchy driven attitudes of the police and people in the legal systems [ 44 ], and their unwillingness to act on domestic violence cases which they view as “private matter,”[ 13 , 44 ] such that many cases are not investigated, or dropped due to delay in filing [ 5 ]. In other cases, the investigation is based on the statement of the husband or relatives rather than fingerprints [ 13 ], with the perpetrator of violence not even recorded in over 90% of the cases [ 5 ]. Notably, little empirical research is available on the perceptions of abusive husbands and families on domestic violence that can facilitate intervention programs for abusive husbands [ 34 ].

Limitations and way forward

There are limitations to the data presented and the interpretation. The NCRB data depend on the availability and quality of data recorded by the police at the local level, which is known to have varied quality [ 9 , 10 , 18 ]. The findings have to be interpreted within in this limitation as it is not possible for us to comment on the extent of underreporting of data or the pattern of underreporting by type of crime, year or state. The heterogeneity in the NCRB data at the state level highlighted by the noisy trends or stagnant trend for certain states do not allow for a meaningful interpretation, and calls for a robust assessment of the reporting practices by the police and judiciary at state level to identify the gaps for inadequate documentation and underreporting that can facilitate appropriate corrective measures to improve data quality [ 18 ]. We assumed the age group of affected women to be 15–49 years. Though majority of the cases are likely to be in this age group given the other available information, the unavailability of age of women affected by the type of crime, year and state restricts understanding of the target women for prevention and action. Currently, the data are available in heavily tabulated fixed formats that limit the extent of disaggregated analysis. Because of non-availability of data on number of victims for some years, we assumed the ratio of the number of cases to victims based on the available data for other years. More informative analyses may also be possible if the NCRB reports allow for anonymized individual level data to be available in the public domain, including repeat reports of domestic violence by individual women.

Despite NCRB being a passive surveillance source, efforts can be made to improve the quality of information collected by the police during their routine tasks to improve utilisation of these data for planning action. The World Health Organization injury surveillance guidelines could provide practical advice on collecting systematic data on domestic violence, which can be more comparable over time and location [ 51 ]. Training and sensitisation of the police to address gender violence should also include standardisations in capturing of the data and the quality of data captured.

Disasters, natural or otherwise, disproportionately impact women and girls with some evidence suggesting that violence against women increases in disaster settings, however, there is a lack of rigorously designed and good quality studies that are needed to inform evidence-based policies and safeguard women and girls during and after disasters [ 52 ]. There has also been suggestion of an increase in domestic violence against women during the Covid-19 pandemic, globally [ 53 ] and in India [ 54 , 55 ]. In this context, the urgency to address the gaps highlighted in the NCRB data is even more for India to protect its women against domestic violence.

India needs to address the gaps in the administrative data to effectively respond to the SDG target five to eliminate all forms of violence against women. This longitudual analysis of the reported cases of domestic violence of nearly 20 years across the Indian states has highlighted the under-reporting and almost stagnant data, which hinders formulating of well-informed public health intervention strategies to reduce domestic violence in India.

Availability of data and materials

The domestic violence related data used in these analyses are available at NCRB website ( https://ncrb.gov.in ) and from the authors on request. The GBD population data used in these analyses are available at GBD Results Tool | GHDx (healthdata.org).

Abbreviations

Confidence interval

First information report

Global burden of disease

Indian penal code

National Crimes Records Bureau

National Family Health Survey

Protection of women from domestic violence act

Quantum geographic information system

Sustainable development goal

Socio-demographic index

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Acknowledgements

We thank Amit Kumar Chetty and Parijat Singh for help with downloading and formatting of the data.

This work was supported by the Bill & Melinda Gates Foundation [INV-004506]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission

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RD and GAK conceptualised this paper. RD drafted the manuscript with contributions from AG and GAK. SG, SK and GAK performed data analysis. All authors contributed to the interpretation and agreed with the final version of the paper. RD and GAK had full access to all the data in the study and had the final responsibility for the decision to submit for publication. All authors had access to the estimates presented in the paper. RD and GAK verified the data underlying this study. All authors read and approved the final manuscript.

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Supplementary Information

Additional file 1.

. Definitions of crime headings considered under domestic violence. IPC denotes Indian Penal Code.

Additional file 2

. Crime rate for cruelty by husband or his relatives per 100,000 women aged 15-49 years in the Indian states categorised as having low Socio-demographic Index, 2001-18.

Additional file 3.

Crime rate for cruelty by husband or his relatives per 100,000 women aged 15-49 years in the Indian states categorised as having middle Socio-demographic Index, 2001-18. Telangana state not shown as it was formed in 2014.

Additional file 4.

Crime rate for cruelty by husband or his relatives per 100,000 women aged 15-49 years in the Indian states categorised as having high Socio-demographic Index, 2001-18.

Additional file 5.

Mean numbers of persons arrested under cruelty by husband or his relatives and dowry deaths for the years 2001-2018, and under abetment of suicide of women and PWDVA for the years 2014-2018. SDI denotes Socio-demographic Index. The state wise data for mean number of persons arrested was available until 2015 only.

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Dandona, R., Gupta, A., George, S. et al. Domestic violence in Indian women: lessons from nearly 20 years of surveillance. BMC Women's Health 22 , 128 (2022). https://doi.org/10.1186/s12905-022-01703-3

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Trends and correlates of intimate partner violence experienced by ever-married women of India: results from National Family Health Survey round III and IV

• Priyanka Garg 1   na1 ,
• Milan Das 2   na1 ,
• Lajya Devi Goyal 1 &
• Madhur Verma 3  

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The study aims to estimate the prevalence of Intimate partner violence (IPV) in India, and changes observed over a decade as per the nationally representative datasets from National Family Health Surveys (NFHS) Round 3 and 4. We also highlight various socio-demographic characteristics associated with different types of IPV in India. The NFHS round 3 and 4 interviewed 124,385, and 699,686 women respondents aged 15–49 years using a multi-stage sampling method across 29 states and 2 union territories in India. For IPV, we only included ever-married women (64,607, and 62,716) from the two rounds. Primary outcomes of the study was prevalence of the  ever-experience of different types of IPV: physical, emotional, and sexual violence by ever-married women aged 15 to 49 years. The secondary outcome included predictors of different forms of IPV, and changes in the prevalence of different types of IPV compared to the previous round of the NFHS survey.

As per NFHS-4, weighted prevalence of physical, sexual, emotional, or any kind of IPV ever-experienced by women were 29.2%, 6.7%, 13.2%, and 32.8%. These subtypes of IPV depicted a relative change of − 14.9%, − 30.2%, − 11.0%, − 15.7% compared to round 3. Significant state-wise variations were observed in the prevalence. Multivariate  binary logistic regression analysis highlighted women's and partner’s education, socio-economic status, women empowerment, urban-rural residence, partner’s controlling behaviours as major significant predictors of IPV.

Conclusions

Our study findings suggest high prevalence of IPV with state-wise variations in the prevalence. Similar factors were responsible for different forms of IPV. Therefore, based on existing evidences, it is recommended to offer adequate screening and counselling services for the couples, especially in health-care settings so that they speak up against IPV, and are offered timely help to prevent long-term physical and mental health consequences.

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Strengths and limitations of the study

One of the very first comprehensive assessment of the different types of IPV using data from the third and fourth rounds of the National Family Health Survey India.

Predictors of IPV were estimated through a weighted analysis, that helped in highlighting certain feasible actionable points

Large and nationally representative data on violence were analysed from India.

Appropriate sampling during the survey makes the results generalisable, and recommendations can be adopted by other Lower Middle Income countries.

The use of only the predetermined variables to predict IPV is the key limitation to this analysis as there are many other variables apart from those included in the NFHS that affect IPV.

Lastly, self-reporting may under-estimate the overall prevalence of the IPV, owing to the fear, economic dependence, humiliation, and the feeling of severe confinement by the women.

Introduction

Spousal or Intimate partner violence (IPV) is one of the most common forms of domestic violence (DV), and refers to any physically, psychologically, sexually, or economically harmful behavior in an intimate relationship [ 1 ]. The three levels of IPV are Level I abuse (pushing, shoving, grabbing, throwing objects to intimidate, or causing damage to property and pets), Level II abuse (kicking, biting, and slapping), and Level III abuse (use of a weapon, choking, or attempt to strangulate) [ 2 ]. IPV takes place across different age groups, genders, sexual orientations, economic, or cultural status. The World Health Organization (WHO) recently estimated that almost one-third of women who have been in a relationship have experienced IPV [ 3 ]. Other studies have depicted the prevalence of IPV in the range of 13 - 61% in women (15–49 years old) [ 3 ]. As per the National Family Health Survey (NFHS) round 4, the prevalence of IPV ranges between 3 - 43% in different states of India. Marital violence acceptability is amongst the highest in the world (52% women, and 42% men) [ 4 ]. The magnitude of IPV is underestimated as many studies indicate the difficulty of obtaining clear figures about prevalence of IPV in general population [ 5 , 6 ]. This is because of the under reporting which can be attributed to the fear of reprisal by the perpetrator, economic dependence on the spouse, a hope that IPV will stop, humiliation, loss of social prestige, and the feeling of severe confinement. However, there are anecdotal evidences which suggest that approximately nine out of ten of victims of IPV don’t disclose such mis-happenings and suffer all alone.

Ecological model has been preferred by many scientists around the world to understand IPV, according to which violence is an outcome of interaction between multiple causal agents operating at individual, relationship, community and societal levels [ 3 ]. There are various culturally specific norms that exist at these levels. These norms offer social standards of appropriate and inappropriate behavior that may favor or discourage IPV [ 7 ]. For instance, India had a deep-rooted patriarchal society, with preference to male child. It has been observed that Indian states with anisometric sex-ratios of first births favouring males, women with first born sons are less likely to experience IPV than those with first born daughters and, among those who have experienced IPV once, are more likely to experience it again [ 8 ]. Then, there are societal issues that act as perpetrators of IPV like dowry, inequities in education, and decision making powers. Spousal factors like alcohol, and other substance abuse, unemployment, challenges to masculinity norms are significant factors. At individual levels, IPV is more pronounced among less educated and poor women. High level of IPV and its acceptability in society corroborates with other factors that point towards gender discrimination and other social inequalities [ 9 ]. All these factors depicts the link between sex-discrimination and IPV at the household level, which is bolstered in an environment where females are regularly downplayed [ 10 , 11 ].

There is a substantial evidence suggesting that IPV may act an causal agent to a plethora of acute and chronic physical, mental, and sexual health problems [ 12 ]. Abused women commonly suffer from chronic gynecological problems, including chronic pelvic pain, sexually-transmitted diseases and vaginal bleeding, and present very frequently to healthcare services and require a wide range of medical services [ 13 ]. Other conditions affecting abused women include chronic pain such as back pain and headaches, neurological symptoms such as fainting and seizures, and gastrointestinal disorders such as irritable bowel disease [ 14 , 15 ]. IPV is also a significant risk to pregnant women and their unborn children. The WHO recently reported that abused women have two times higher chances of having an abortion, miscarriage, premature birth, fetal injury, and low birth weight baby [ 16 , 17 , 18 , 19 ]. Apart from physical injuries, abused women have a lot of mental health problems like depression, anxiety, post-traumatic stress disorder and substance abuse [ 20 , 21 , 22 ]. Such women also suffer from low self-esteem and hopelessness [ 23 ]. These problems impact upon women’s ability to parent their children [ 24 ]. In addition, there are also wider economic societal implications of IPV that needs to be considered.

Around the world, considerable attention is being given to IPV. For instance, European Union Agency for Fundamental Rights affirmed in 2015 that IPV can be perceived as an infringement of human rights and dignity [ 25 ] . On similar lines, the United States Department of Justice stated that IPV has a considerable impact on victim, as well as family members, and other acquaintance of both the abuser and the victim [ 26 ]. In this sense, children who witness violence while growing up can be severely emotionally damaged. In India, IPV has been recognized since 1983 as a criminal offense under Section 498-A of the Indian Penal Code, and is comprehensively defined in the Protection of Women from Domestic Violence Act (PWDVA) 2005, which came into effect in 2006 [ 27 ]. Even after the enactment of the Act, over the last decade, the rate of decline in IPV prevalence has remained abysmally low in India.

Management of IPV demands a need for multi-pronged collaboration between different stakeholders at various levels of the ecological framework. Though, individual-level interventions are comparatively easy to assess, evaluation of multi-component programmes and institutional-wide reforms is more challenging, and are also the most under-explored [ 12 ]. The existing literature describes all kind of violence comprehensively, and doesn’t attempt to explain the differences in the socio-demographic variations observed in the various forms of violence like physical, sexual and emotional type. Each type of IPV may have  its own correlates, and management strategies. Hence, they need to be studied separately. For instance, similar counselling sessions cannot be given to women experiencing sexual violence by alcoholic husband and emotional violence instigated by the non-earning husband. Health care providers can play a pertinent role in identifying women who are experiencing IPV and halting the agonizing cycle of abuse through screening, timely support, and offering suitable prevention and referral options [ 28 ]. They are often the first professionals to offer care to women facing IPV. Therefore, this study attempts to explain the experience of IPV in India, and changes observed in the prevalence of various forms of IPV after the enactment of the PWDVA 2005, through the use of nationally representative datasets from NFHS round 3 and 4. We will also attempt to highlight various socio-demographic characteristics associated with physical, sexual and emotional type of IPV in India. The results of such analysis using a national survey holds merits compared to a sub-national estimates, to give a comprehensive picture about the IPV, and deduce meaningful interpretations for advocacy, and policy making.

Methodology

Study design.

A repeated, independent, cross-sectional ecological study design was used in the present study.

Data source

The present study uses data from the third and fourth rounds of the NFHS conducted in 2005–06 and 2015–16. The NFHS is India’s version of the Demographic and Health Survey (DHS). In NFHS-3, all 28 states and New Delhi were covered, while NFHS included all 29 states and all union territories using a multistage stratified cluster sampling procedure for data collection. The NFHS-3 and 4 included women and men aged between 15–49 and 15-54 years in the primary sample. The design of the study, sampling strategy, and other details of the NFHS-3 and 4 can be found in the NFHS report (IIPS & ICF International, 2007,2017). The surveys collected information on child and maternal health, family welfare and domestic violence including  IPV.

The NFHS follows both Indian and international guidelines, e.g. WHO ethical guidelines for research on domestic violence against women, 2001, for the ethical collection of data on violence. NFHS-4 sample size was approximately 699,686 women, up from about 124,385 women of NFHS-3. Domestic violence related questions were included in the state module, where about 68% in NFHS-3 and 15% in NFHS-4 of the total sample was selected for the interview. It should be noted that to assess DV, a total of 84,703 women (never-married 14,219, ever-married 64,607, others 5877) were interviewed during NFHS-3 survey, while a total of 79,729 women (never-married 13,716, ever-married 62,716, others 3297) were interviewed during NFHS-4 survey.

Study participants

From each household, only one woman was  invited to complete the DV module, and sample weights, specific to the estimation of DV, were calculated to adjust for the selection and ensure that the DV subsample is nationally representative. Of all the women who were invited for the DV module, we only included 64,607 and 62,716 ever married women from the round 3 and 4 in our analysis.

Study variables

Dependent variables.

The main dependent variables for this analysis are the ever-experience of different types of IPV: physical, emotional, and sexual violence by a partner of ever-married women aged 15 to 49 years. In both the NFHS-3 and-4, DV is defined to include violence by spouses as well as by other household members [ 29 , 30 ]. However, it is well documented that IPV is one of the most common forms of violence experienced by married women [ 3 ].

The set of questions in NFHS survey attempts to capture detailed information on physical, sexual and emotional IPV. Information is obtained from ever-married women on violence by husbands and by others, and from never married women on violence by anyone, including boyfriends. In NFHS-3 & 4 surveys, spousal physical, sexual and emotional violence for ever-married women is measured using the following module of questions.

Physical violence

Physical IPVs was defined as any type of physical violence experienced by a woman at the hands of husband/partner, which includes: (a) ever having been slapped; (b) ever having had arm twisted or hair pulled; (c) ever having been pushed, shaken or had something thrown at them; (d) ever having been punched with fist or hit by something harmful; € ever having been kicked or dragged; (f) ever having been strangled or brunt; (g) ever having been threatened with knife/gun or other weapon.

Sexual violence

The Sexual IPVs was captured by three questions: a) ever having been physically forced you to have sexual intercourse with him even when you did not want to; b) ever having been physically forced you to perform any other sexual acts you did not want to c) ever having been forced you with threats or in any other way to perform sexual acts you did not want to.

Emotional violence

(a) ever having been said or done something to humiliate you in front of others b) ever having been threatened to hurt or harm you or someone close to you c) ever having been insulted you or make you feel bad about yourself.

The expected responses to all the above questions were coded as either ‘never’, ‘often’, ‘sometimes’, ‘yes but not in the last 12 months’. Of these, all response except ‘never’ to the questions related to IPVs implied experience of physical, sexual and emotional violence respectively. For the ease of analysis, all responses except ‘never’ were coded as Yes = 1, while never was coded as No = 0.

Independent variables

The independent variables were categorized as per the women’s individual, partner, family level factors. The selection of these variables were based upon extensive literature review. All those variables that have been highlighted in previous studies from India and abroad, and were available in the DHS datasets were included in our study [ 11 , 27 , 31 , 32 , 33 , 34 ]. Individual level factors included her age, education status, age at first marriage, parity, and economic empowerment status; and partner level factors included his education status, controlling behavior, and history of substance abuse like alcohol. Family factors included duration of cohabitation in years, number of co wives, and history of witnessing parental violence, while the household and community level factors included the wealth status, religion, place of residence, and region of the country.

These variables were categorized as age (15–19, 20–24, 25–34, 35+), educational attainment (no education, primary, secondary and higher), wealth quintile status (poorest, poorer, middle, richer, richest), religion (Hindu, non-Hindu), place of residence (urban, rural), region of India classified as North, Central, East, Northeast, West, and South. The North region includes Jammu & Kashmir, Himachal Pradesh, Punjab, Chandigarh, Uttarakhand, Haryana and Delhi; the Central region includes, Rajasthan, Uttar Pradesh, Chhattisgarh and Madhya Pradesh; the East region includes West Bengal, Jharkhand, Odisha and Bihar; the North-east region includes Sikkim, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Tripura, Meghalaya and Assam; the West region includes Gujarat, Maharashtra, Goa; and finally, Andhra Pradesh, Telangana, Karnataka, Kerala, Tamil Nadu and Puducherry belong to the South region. Parity was categorized as 0 = None, 1 = 1–2 parity,2 = 3+ parities. Economic empowerment was considered if women had ownership of property (house and land) or was gaining earnings from her work. It was obtained by merging women responses to questions: does a respondent: a) own a house? b) own land [either alone or jointly with a partner for both questions a) and b)] and c) type of earning from her work. The analysis dichotomized question c into paid (cash only, cash and in kind, and in kind only) and not paid. Any one of the three questions a, b, or c indicated a ‘yes’ that a woman is considered empowered and ‘no’ meant non empowerment. Responses to these questions were recorded into two categories (0 = Not empowered, 1 = Empowered).

The variable ‘Age at marriage’ was categorized as 0 = less than or equal to 18 years, 1 = more than 18 years. ‘Witnessing parental violence’ was measured by a question that asked- ‘whether the respondent’s father had ever beat her mother’, which was recorded dichotomously (0 = NO, 1 = Yes). ‘Duration of cohabitation in years’ was categories as 0 = 0–4, 1 = 5–9, 2 = 10–14,3 = 15–19 and 4 = 20 + years. ‘Number of co-wives’ were categories as 0 = None, 1 = One and more.

To measures the partner’s controlling behavior, respondents were asked- “Does your partner ever or did; a) Prohibit you to meet female friends? b) Limit you contact your family? c) Insist on knowing where you are at all times? d) Is jealous if you talk with other men? And e) Frequently accuses you of being unfaithful?” These questions were merged into one variable the “partner’s controlling behaviors”. Any positive response (yes) to any of the above questions implies the existence of such behavior and no to all the questions implied nonexistence of such behaviors. The partner’s alcohol consumption was measured by responses to the questions, “Does your partner drink alcohol?” and it had a binary outcome (0 = No, 1 = Yes). Frequently of a partner being drunk was follow-up question to those respondents whose partners indicated that the partner drank alcohol.

Patient and public involvement

No patients were involved in the study.

Data analysis

Due permissions were sought from the Demographic and Health Survey program for data access and analysis after submitting the protocol and study objectives [ 35 ]. NFHS-3 and 4 datasets were imported into Stata version 14 for analysis. We calculated the weighted prevalence of each type of IPVs ever experience by the female respondents by doing univariate analysis separately for NFHS rounds 3 and 4 to get nationally representative estimates. Logistic regressions were used to estimate the unadjusted (OR) and adjusted odds ratio (aOR) with 95% confidence interval (CI) to depict the association of ever experience of different types of IPVs by the respondent with the independent variables. We used the domestic violence weighting variable (d005) included in the NFHS data and the Stata survey (svy) command to weight the data during the analysis in order to account for the complex survey design. We also explored the relative change in the different types of IPVs between two rounds of NFHS surveys in India.

Ethics approval and consent to participate

This is a secondary analysis of a nationally representative survey dataset NFHS-4 (2015–16) which is in public domain. The Institute Ethics Committee of All India Institute of Medical Sciences, Bathinda waived off the need for ethical clearance for this study wide letter no. IEC/AIIMS/BTI/032.

Table  1 depicts the socio-demographic characteristics of the 64,607 and 62,716 ever married females who consented to respond to the domestic violence module of NFHS-3 and 4. The sample in both the rounds was comparable in terms of age distribution, region of country they belong to, wealth status, religion, parity, and duration of cohabitation after marriage. However, a higher number of respondents were educated in round 4 (54.2%), while non-educated group was prevalent as per the 3rd round (47.2%). Most of the respondents from round 4 were economically empowered (55.8%). Nearly four-fifth of the them had witnessed parental violence, and more than half were experiencing partners controlling behavior. Age of marriage of the respondents had shifted primarily from < 18 Years in round 3 to > 18 years in round 4.

Physical violence was the most common form of IPV (29.2%) experienced by the respondents. Over all, the proportion of the respondents who ever experienced physical form of IPV (Table  2 ) decreased from round 3 to round 4 (Relative change of − 14.9%). The physical form of IPV continues to be reported from the highest age groups, uneducated, poorest respondents from Eastern part of India, who were mostly multiparous, married at a young age and were economically empowered. Also, the weighted prevalence was high among the respondents whose partners either had a controlling behavior, or were addicted to alcohol. Only southern region of the country depicted a relative increase in prevalence of IPV in round 4 compared to round 3. State-wise, maximum prevalence was observed in Manipur (50%), while minimum prevalence was seen in Sikkim (1%) as per the NFHS Round 4 (Supplementary Table  1 ; Fig.  1 a). Multiple binary logistic regression analysis, depicted all the variables depicted in Table 1 as the significant predictor of physical form of domestic violence as per NFHS-4 datasets except older age groups, and less years of education.

a - d State-wise variations in the prevalence of physical, sexual, emotional and anyform of IPV among the married women as per the fourth round of the National Family Health Survey, India (2015–16)

Sexual form depicted minimum weighted prevalence amongst all types of IPV, and decreased (− 30.2%), from round 3 (9.6%) to round 4 (6.7%) (Table  3 ). The weighted prevalence as per the round 4 of NFHS is maximum in the 25–34 years age group, uneducated, poorest respondents from Eastern part of the country who were married at a younger age, were multiparous, and economically empowered. State wise weighted prevalence of Sexual IPV ranged between (14% in Bihar and Manipur to 0% in Sikkim) (Supplementary Table  1 ; Fig. 1 a). Similar to physical form of IPV, weighted prevalence was more among the respondents, whose partners had a controlling behavior, or were consuming alcohol, and had increased in Southern region of the country. Binary logistic regression depicted all the independent variables as significant predictors of sexual IPV except age, less years of education of respondents and their partners, parity, more than 20 years of cohabitation, and age of marriage of the respondents.

Emotional violence was more common than sexual violence but less than the physical form with a national prevalence of around 13% (Table  4 ). The weighted prevalence was nearly similar in all age groups as per NFHS 4, but highest in uneducated, and poorest quintile of respondents belonging to the eastern region of India, who were multiparous and economically empowered similar to other forms of violence. State wise weighted prevalence of emotional IPV ranged between (21% in Tamil Nadu to 1% in Sikkim) (Supplementary Table  1 ; Fig. 1 c). More number of co-wives, early age of marriage, controlling behavior of partners, and alcohol also increased weighted prevalence of emotional form of IPV. Binary logistic regression depicted that there were higher odds of experiencing emotional violence when the respondents were young, uneducated, belong to the poorest quintile, and southern region of India, multiparity, history of witnessing parental violence, more duration of cohabitation after marriage, controlling behaviours of the partner, and alcohol consumptions.

The weighted prevalence of any type of IPV ever faced by a woman decreased from 38.9% in third round to 32.8% in the fourth round. Maximum relative % decrease was seen in youngest age group, uneducated (− 10.9%), middle quintile (− 17.4%), Northern region (− 30.9%), nulliparous female respondents (− 26.4%), amongst those who did not witness any kind of parental violence (− 22.7%), who were coinhabiting for less than 5 years (− 21.5%), and were not living with any co-wives of their partners (− 16.5%). State wise weighted prevalence of any type of IPV ranged between (56% in Manipur to 2% in Sikkim) (Supplementary Table  1 ; Fig. 1 d). Significant predictors of any type of IPV as per the fourth round of NFHS are depicted in Table  5 . It was seen that economic empowerment of women, and age at first marriage could not predict exposure to IPV among the respondents.

There are some major findings of our study. First, there was a decrease in any form of IPV from NFHS round 3 to 4. Maximum reduction was observed in sexual IPV, followed by physical and emotional form. But still, around 7 out of 100 women reported history of sexual IPV. Second, IPV was reported more amongst the poorest and uneducated respondents. Third, contrary to our belief, urban areas depicted a higher chance of IPV. Fourth, we observed that certain factors like economic empowerment that were considered to act as a shield against IPV were of no help, but increased the probability of violence episodes. Lastly, we observed that most of the factors predicting the exposure to different kinds of violence were same. Decrease in IPV in NFHS-4 can be attributed to improvement in education and societal status, decrease in witnessing family violence, improved sense of gender equality, more awareness among women, improved community norms regarding domestic violence, and enforcement of the PWDVA after 2006 .

We observed that sexual IPV has depicted maximum decrease in India as per the two rounds, compared to other forms of IPV. Coerced sex as seen in sexual violence may result in sexual gratification on the part of the perpetrator, though its underlying purpose is to dominate the spouse through force. Also, such men feel that their actions are in accordance with the law as they are married the victim. However, sexual violence has a profound impact on physical and mental health because it also leads to physical injuries, a plethora of acute and chronic sexual and reproductive health problems [ 36 ]. To our dismay, it is a neglected area of research, the available data is scanty and fragmented as many women do not report sexual violence due to emotional embarrassment, or fear of being blamed. Also, only a very small proportion of women seek medical services for immediate problems related to sexual violence.

We observed a higher incidence of IPV among the poorest and uneducated respondents [ 37 ]. It is well documented that people from the under-privileged sections of the society are at increased risk of IPV [ 38 ]. Low economic status also has many associated stressors like economic stress, that are linked with marital conflicts [ 39 , 40 ]. According to the family stress model , lack of money or increased expenditure, induces frequent emotional outbursts and, conflicts among family members, including conflict between spouses [ 40 ]. Also, the women who is a victim to IPV, experience several negative outcomes like decreased economic productivity in addition to poor psychosomatic health as a vicious cycle.

We also observed a higher chance of having IPV in urban areas compared to rural areas. On bivariable logistic regression, there was higher chances of violence in rural areas, but this was reversed during the adjusted analysis. This contradictory pattern has also been noted in Bolivia, Haiti and Zambia, where women living in urban areas were more likely to report partner violence than women living in rural areas [ 41 ]. There are several factors that can explain such trend. Some men may find economically independent and educated female partners threatening. There is evidence that increase in women’s empowerment, abates men’s feelings of control over their spouses that leads to increased violence to exert their control and power [ 42 ]. Further, urban areas provide women with greater opportunities to report violence, contrary to the rural areas, where access to appropriate health care services including the counselling of the victims and management of IPV injuries is more limited [ 43 ]. Also, interpersonal relations are more compromised and strenuous in urban areas due to pressures of urban living, such as poverty, engagement in certain types of occupation, poor quality living conditions and the physical configuration of urban areas, which can lead to greater incidence of violence [ 44 ]. On the other hand, rural areas in India depict better social support compared to the urban [ 45 ]. However, some studies depict higher chances of IPV in rural areas and it attributed to patriarchal ideology, and traditional gender roles [ 46 ]. Women with more children tend to be a higher risk of IPV similar to our observations and it was more in urban areas compared to rural [ 46 ]. This may be indirectly linked to increased economic stress in families with more children.

Economic empowerment was not seen to be protective against IPV in our study. Similar observations were reported in various sub-national analysis from India and abroad [ 47 , 48 , 49 , 50 , 51 ]. A longitudinal study of married women in Bangalore found that women who were unemployed but began employment subsequently had an 80% higher odds of violence, as compared to women who maintained their unemployed status [ 49 ]. Another study for a violence against women and girls reduction programme in India found that women who earned and controlled their own income were more likely to report violence experienced both at home [ 50 ]. One of the study also reports that till the time women’s income is less than her male spouse, empowerment is protective, and as the scenario changes with increase in her income, violence increase [ 51 ]. This increase in risk is related to ‘male backlash’ – as women gain more economic autonomy, men feel that their authority is being challenged and thus increase their use of violence as a means of reasserting their control [ 49 , 51 ]. It is hypothesized that in less developed settings, where women are not independent economically, their entry into work may initially increase marital tensions and risk of IPV, but the tussle gradually settles down as their male counterparts start recognizing the benefits of additional household income [ 52 ]. This theory is supported by cross-country analysis [ 53 ]. However, the relationship between economic empowerment and violence is not universally the same. Studies from our neighbouring countries like Pakistan, Nepal, and Bangladesh depicted that the lifetime experience of IPV was high among the women with low empowerment [ 54 , 55 ]. Another study from Jordan reported that the women who can take decision independently in the household matters and income related issues are less likely to suffer from IPV [ 56 ]. The relationship between women empowerment and violence is complex, and hence further investigation is required to understand which factors drive such findings in Indian context.

As noted, acceptability of IPV remains high in India, and in fact have seen little changes between the last two rounds of NFHS [ 10 ]. Furthermore, the impact of parental violence on their children was highlighted through our study. Families where parental violence was witnessed, or husbands exerted a controlling behavior depicted a higher risk of IPV [ 57 ]. Unfortunately, each form of family violence begets interrelated forms of violence, and the “cycle of abuse” is often continued from exposed children into their adult relationships, and finally to the care of the elderly [ 57 ]. Mothers should encourage daughters to engage in a relationship with responsible men, while fathers’ communication should be directed towards young boys and aimed at inculcating values against dominant traditional masculinity, objectifying girls and chauvinist values.

There are certain strength and limitations of this study that should be acknowledged. The study was done using the national data collected following a robust methodology that increases the reliability of data generated. The use of complex weighted analytical design to obtain results allow us to generalize the results for projection at national level. However, the use of secondary data in itself is a limitation of the study, as the results will contain only the predetermined variables. There are a lot more number of variables apart from those included in the NFHS that affect IPV and its effects on a female experiencing it. Lastly, if the data is self-reported, the overall true prevalence of the violence may actually be higher than estimated, owing to various reasons discussed earlier in the manuscript.

There are a few policy implications of this study. Given a high prevalence of physical and mental health problems in women exposed to IPV, there is a potential for cognitive behavioral interventions to improve women’s mental health. Advocacy related to IPV is necessary. It should be implemented through a multifaceted approach in the form of legal, housing and financial advices. Awareness should be aimed about the access to existing community resources such as shelters, hostels and psychological interventions and provision of legal support. Informal counselling is another intervention that may be offered to women [ 58 ]. However evidence from a Cochrane review regarding the effect of advocacy for women exposed to IPV has been equivocal [ 58 ]. Therefore, the future research should try to look for the best options that can be offered to such women who are seeking help. Also, the role of screening for IPV has been debated over recent years. The routine screening of women for IPV in health settings, in the absence of structured intervention, was to have limited impact upon health outcomes and re-exposure to violence and hence not recommended [ 18 , 59 ]. However, some other studies from different study setting are in favor of offering screening services, and hence this also needs to be evaluated in different socio-cultural settings [ 60 ]. Finally, exposure to violence has significant impacts. Longitudinal studies are needed to understand the temporal relationship between recent IPV and different health issues, while considering the differential effects of recent versus past exposure to IPV [ 60 ]. Healthcare providers and IPV organizations should be aware of the bidirectional relationship between recent IPV and psycho-somatic symptoms. This will also improve our understanding of the immediate and long-term health needs of women exposed to IPV.

We observed different patterns of IPV and their risk factors through this comprehensive assessment, and concluded that much needs to done in this regards. Our concepts of decreasing IPV through empowerment of women has been challenged, and so it the urban-rural divide. We must understand that in order to decrease IPV, we need to think beyond women, and focus more on challenges emerging from increase in women’s empowerment, and increase in urbanization. Interventions to empower women must work with couple as a unit, and at the community-level, to address equal job opportunities, and gender specific roles.

Availability of data and materials

This study analyses a nationally representative survey database which is available freely in public domain.

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Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India

Priyanka Garg & Lajya Devi Goyal

International Institute for Population Sciences, Mumbai, India

Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India

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PG, LDG, MV conceived the idea, MD and MV performed data analysis, and interpreted the data; PG, and MV prepared the manuscript. All the authors have read and approved the submitted version of the manuscript.

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State wise trends in the different types of Intimate partner violence as per NFHS Round 3 & 4.

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Garg, P., Das, M., Goyal, L.D. et al. Trends and correlates of intimate partner violence experienced by ever-married women of India: results from National Family Health Survey round III and IV. BMC Public Health 21 , 2012 (2021). https://doi.org/10.1186/s12889-021-12028-5

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13 Case Study Number 4: Sonali and Ravi

*At the time of the Family Court application 

Pre-Migration History  

Sonali was twenty-seven years old and Ravi was twenty-nine when they were married. At the time of the wedding, Sonali was living in India.  Ravi, a Canadian citizen, lived in a large city in Ontario and had a full-time job in the automotive industry. Along with his job, Ravi also had a motor freight business. The arranged marriage took place in India in October 2013 and it was the first marriage for both. Sonali continued to live in India for two years after their marriage as Ravi delayed applying for the Spousal Sponsorship Program which would allow her to immigrate to Canada. Sonali landed in Canada in October 2015, as a Conditional Permanent Resident .

Settlement in Canada  

Upon Sonali’s arrival to Canada, she lived with Ravi, his parents and his two sisters in a house that was co-owned by Ravi, his father, and the sisters. During this time, Ravi’s family was verbally abusive towards Sonali. In addition, her mother-in-law would inappropriately interfere with the couple, not allowing them privacy. For example, the mother-in-law would often come into their bedroom and insist on sleeping between the couple. On one occasion, she barged into the washroom, without knocking, when the couple was showering together.

Domestic Violence 

Sonali suffered violence from both Ravi as well as her in-laws. Her mother-in-law would physically and verbally abuse her. Once, when Sonali was on the phone with her mother in India, her mother-in-law was listening to the conversation on another line. When Sonali confronted her, her mother-in-law became angry and slapped Sonali. She began to cry and called Ravi at his place of employment and he came home and took her back to his office with him.

After this incident, Sonali would go to Ravi’s office with him every day because she did not want to be alone with her mother-in-law. Eventually, the mother-in-law and sisters-in-law, stopped speaking to her.

One day in winter, when Sonali was in the car with Ravi, he started arguing with her, slamming his hand into the steering wheel, and yelling at her. He told her to get out of his car and dropped her off on the side of the road. She asked a passing couple for help. The couple agreed and dropped her off at a police station. The police took Sonali back to the house as part of their investigation. The officers spoke to the mother-in-law, who stated she had no problem with Sonali living with them, but the officers gave Sonali the option of being taken to a shelter.  Sonali did not want to separate from her husband and decided to go to Ravi’s office. She eventually went back to the house.

Tensions continued to increase and there was another argument between Sonali and her mother-in-law. Sonali had stepped outside of the house for a moment and was locked out by the mother-in-law. Sonali and Ravi left his family’s home after the incident. After obtaining permission from Ravi’s employer, they stayed at Ravi’s office for three nights. They had no change of clothes and ate at a local temple. Eventually, Ravi’s boss took them to his home and allowed them to use his facilities. He advised them to move out on their own to start over.

Later that winter (March 2016), Sonali and Ravi moved into a condominium that he owned, it had been purchased before the couple married but had been rented out as an income-generating

Sonali started working part-time in a large drug store chain as she never received money from Ravi.  Ravi directed her to purchase all the necessary items for the condo (bed, mattress, TV, etc.) from her own account. Sonali had come to Canada with extremely limited money and once that was spent, her mother would sporadically send her money from India. Sonali was also told that she was responsible for groceries and her own cell phone bills.

Sonali suffered verbal, physical, financial and sexual abuse at the hands of her husband. He was unpredictable and had intense mood swings, becoming angry for reasons that were not clear to Sonali. He would drink excessively and frequently exhibited strange behaviours. For example, he would drive Sonali around the city, drop her off at a random location, and then report her missing to the police. On numerous occasions, Sonali was physically assaulted by Ravi. In the spring of 2016, after an assault resulted in a bruise on her arm, Sonali went for treatment and disclosed to her family doctor she was being abused. The doctor advised her to report the abuse to the police and go to a shelter, but she refused stating that she wanted to try and save her marriage. Some time passed and once again Ravi assaulted her and caused her arm to bleed. He went with her to the hospital emergency department and forced Sonali to tell the doctors that she cut herself while washing dishes. She required stitches for the lacerations.

Ravi’s behaviour was erratic, he would often do and say hurtful things to her and then apologize. During a trip to the shopping mall, he left her and approached a nearby police officer saying that Sonali was mentally unstable, and suicidal; that her lacerations were self-inflicted. Sonali spoke to the officers herself and clarified the situation. The officers asked Sonali if they should arrest and charge her spouse, to which she answered, “No”. The officers dropped Sonali off at the condo. During this time, Ravi stayed with his sisters for a few nights then returned to the condo.

In January 2017 the couple went to India to attend a wedding and visit family. At the wedding, Ravi got extremely drunk and insulted her in front of family members. While visiting a neighbouring country on a tour, Ravi became angry and asked Sonali for his passport and told her not to return to his house in Canada.  He then returned to the place they were staying and acted as nothing had happened. Sonali was becoming increasingly scared of his erratic behaviour.

Upon return to Canada, Ravi was fired from his job. Soon after, he assaulted Sonali again but this time she called 911. Ravi was criminally charged with three counts of assault. He was released on bail with a no direct or indirect contact with her and he was not allowed to visit their home.  However, her mother-in-law consistently attempted to contact her, wanting them to reconcile. Ravi went to Criminal Court in May 2018 where he pleaded guilty to the charges. Sonali was fearful for her life and sought a restraining order . As a result of the abuse, Sonali developed anxiety, constantly feels stressed, and has difficulty concentrating. She has trust issues and difficulties forming relationships. She also suffers from headaches, which impair her day-to-day functioning.

During their separation proceedings , Ravi did not disclose his full financial status. He did not disclose the fact that he was self-employed, as he did not want this income to be computed for the purposes of spousal support.  Prior to marriage, he had incurred high debts which he was unable to repay. He had a consumer proposal in January 2013 which he was paying off throughout their marriage. Sonali found out about these financial issues at the time of separation.

Resolution 

The condominium was sold and, after paying off the mortgage and taxes, Sonali got a lump sum settlement. Sonali is safe, in receipt of a substantial financial settlement and restraining order from Family Court.  Ravi and Sonali eventually got divorced. She is currently working two jobs and is financially self-sufficient. She owns a condominium, which she was able to purchase, in part, with help from her family in India.

Click on the links below to access Case Study questions related to the following:

Intersectional Vulnerabilities

Practitioners’ Subjectivity and Social Location

Social Policy and the Law 

Migration and Transnationalism

Providing Supports to Victims of DV

Media Attributions

• Image of a sad woman hugging herself is licensed under a CC0 (Creative Commons Zero) license

In October 2012, the federal government introduced Conditional PR which meant that the sponsored partner or spouse is mandated to live with their immigration sponsoring partner for a duration of two (2) years. This was applicable if, at the time of application the partner fit into the following categories:

The relationship was less than two years; and There are no children in common.

Failure to meet this condition would revoke the PR status and the sponsored immigrant could be deported. However, as of April 28, 2017, the Canadian government eliminated this requirement ; meaning conditional permanent residence no longer applies to any applicants seeking spousal sponsorship (Immigration, Refugees and Citizenship Canada, 2017). The two-year conditional PR has increased the vulnerability of many sponsored newcomers, particularly victims of domestic violence, who were often women.

A citizen of a country other than Canada who has been given the right to immigrate to Canada and stay  in the country permanently

A form of marriage where the choice of groom and bride is largely made by the families of the couple.

A program  that allows Canadian permanent residents/citizens and persons registered as Indian under the Canadian Indian Act to sponsor their spouses/common law partners to immigrate to Canada.

A restraining order can be requested from a family court if there is fear that a former spouse/partner could potentially cause harm to another member of the family.  This is completed within a Family Court and must be mandated by a judge to be considered binding. Typically, it lists a number of conditions in which the spouse/partner must adhere to and obey and can either be broad or detailed, depending on the situation. An example of a general restraining order would be the instruction that the partner/spouse “cannot come near you or your children.” Alternatively, a more detailed order would stipulate that a partner/spouse cannot come to a place of employment, must maintain a specific distance, cannot visit children at school, or try to initiate communication at locations often frequented. It is applied for by way of a court application or a court motion (if urgent) (Ministry of Attorney General, 2009).

A Consumer Proposal is a formal process provided under the Bankruptcy and Insolvency Act which stipulates that an individual (debtor) who borrowed and owes money (known as debt) and are facing financial difficulty to repay it to (creditors) e.g. a person, credit card company(ies) or financial institutions. With assistance of a licensed Insolvency Trustee, the debtor makes an offer to pay off the debt within a certain timeframe. There are many conditions that apply to such consumer proposals.

Domestic Violence in Immigrant Communities: Case Studies Copyright © 2020 by Ferzana Chaze, Bethany Osborne, Archana Medhekar and Purmina George is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License , except where otherwise noted.

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A comprehensive approach to ending violence against women in rural spaces in India

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With the support of UN Women, women and men in the rural communities of Assam State in India have found new ways to work together to prevent and respond to violence against women, youth, and children in their neighbourhoods.

“I tell my husband that I am not the same woman whom he can ill-treat and subdue. He now helps me out at home”, proudly exclaims Kiara Devi*, a tea plucker on a tea estate in Assam in the northeast of India, and a member of a local Jugnu Club.

Jugnu Clubs, formed with support from UN Women in several tea estates in Assam, are women’s empowerment groups that are helping to break the silence on violence against women and mobilize action for the safety and equality of all women and girls. Beginning in January 2017, the clubs were formed as part of a comprehensive approach to preventing and responding to sexual harassment and other forms of violence against women and girls in the region. It was UN Women’s first prevention of violence against women programme to be implemented in rural spaces in Assam.

“[At club meetings] we encourage girls and mothers to not be silent if someone is experiencing harassment in the community, and to come to us”, says Devi. “We are now more aware about not accepting domestic violence and to not stand for discrimination between men and women, and the ways we can address this—this is what I have learned”.

Creating safe and supportive workplaces

Six million people in Assam State are estimated to be employed in the state’s 765 tea estates and 100,000 small gardens, producing more than half of India’s tea and 13 per cent of tea globally . Women represent half of the workforce in Assam tea estates, with most working as tea pluckers, and many experience violence at home, while at work, and in public spaces. In 2015, in Assam there were a reported 11,225 cases of cruelty by husbands or relatives against women, with alcohol abuse by men reported to have a significant role in the violence ( “Crime in India 2015: Compendium” ).

As part of UN Women’s prevention programme developed in the Udalguri district of Assam, hundreds of tea estate managers, welfare officers, workers, and Jugnu Club members received training about India’s Sexual Harassment of Women at Workplace Act, women’s rights, and the legal obligations around domestic violence and child labour. Training sessions used local folk songs and dialects, skits, and other user-friendly education materials. Among the training participants, 95 per cent had been unaware of the legislation and its provisions before the training; after, 80 per cent of participants reflected that the training had improved their understanding of the Act.

Jugnu Club participants in the programme are now aware of their rights and are more vocal about their needs. Through a process of safety audits piloted in the programme—where women identify safe and unsafe spaces—women have demanded streetlights be placed in dark public areas and safe transport to work, including two buses to ferry women from nearby villages to the tea gardens. These steps have also helped strengthen the relationship between management and the women workers.

Raising awareness and educating communities

Under the programme, raising awareness about how to prevent and respond to violence against women, youth, and children extended beyond the tea estate setting to the wider rural community, including schools. Mass campaigns about gender equality using community-led performing arts and crafts, such as interactive theatre shows, dance, and music, reached more than 6,000 community members, and 371 children participated in early intervention programmes focused on preventing violence.

When the COVID-19 pandemic hit in 2020, and campaign activities could not be conducted in person, an online Facebook campaign was launched that reached close to 300,000 people.

“I have observed that after UN Women’s work on the tea estate, more families are permitting their daughters to enrol in computer training classes. My sister goes to computer classes too”, says 20-year-old Mohammed Mondal*, who lives on one of the tea estates and participated as an actor in one of the interactive theatre shows.

“Earlier, families would not allow their daughters to enrol. The moment girls turn 17 or 18 years old they are married off. My parents want my sister to be married at 18 years old. But a girl can have her dreams and wishes. I have argued with my family that my sister should be allowed to complete her education and then marry”, exclaims Mondal.

Long-term legal support

In June 2020, with the technical support of UN Women, a Legal Aid Centre was opened in Udalguri district, the first centre of its kind on a tea estate in Assam. The holistic service centre provides legal consultation to women and information on a wide range of issues. One tea company provided a mobile van to enable the centre’s services to be accessed in the six tea estates. As part of this comprehensive model, UN Women also trained 67 lawyers from the region about laws on domestic violence and sexual harassment in the workplace to enable them to provide legal services to women in these communities.

“The interactions with UN Women have had positive outcomes, and so such interactions need to be conducted on a larger scale in the sector”, requests Ramesh Patel*, a welfare officer who works in the tea estates. “UN Women’s engagement is the first time that such measures have taken place at an institutional level. When a trusted external entity engages with the workers, it is more effective, since people pay more attention”.

*Names and personal information have been changed to protect the identities of the individuals.

• Anti-violence interventions
• Domestic violence/interpersonal violence
• Gender power relations
• Men and boys (masculinity)
• Rural women
• Economic empowerment
• Ending violence against women and girls
• Gender equality and women’s empowerment

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Affiliations.

• 1 a Division of Infectious Diseases , Emory University School of Medicine , Atlanta , GA , USA.
• 2 b Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA.
• 3 c Department of Behavioral Sciences and Health Education , Emory University Rollins School of Public Health , Atlanta , GA , USA.
• 4 d Center for Sexuality and Health Disparities , University of Michigan School of Public Health and School of Nursing , Ann Arbor , MI , USA.
• 5 e General Internal Medicine , Temple University School of Medicine , Philadelphia , PA , USA.
• 6 f Department of Social and Behavioral Sciences , National AIDS Research Institute , Pune , India.
• PMID: 26886155
• PMCID: PMC4988937
• DOI: 10.1080/17441692.2015.1119293

Domestic violence (DV) is prevalent among women in India and has been associated with poor mental and physical health. We performed a systematic review of 137 quantitative studies published in the prior decade that directly evaluated the DV experiences of Indian women to summarise the breadth of recent work and identify gaps in the literature. Among studies surveying at least two forms of abuse, a median 41% of women reported experiencing DV during their lifetime and 30% in the past year. We noted substantial inter-study variance in DV prevalence estimates, attributable in part to different study populations and settings, but also to a lack of standardisation, validation, and cultural adaptation of DV survey instruments. There was paucity of studies evaluating the DV experiences of women over age 50, residing in live-in relationships, same-sex relationships, tribal villages, and of women from the northern regions of India. Additionally, our review highlighted a gap in research evaluating the impact of DV on physical health. We conclude with a research agenda calling for additional qualitative and longitudinal quantitative studies to explore the DV correlates proposed by this quantitative literature to inform the development of a culturally tailored DV scale and prevention strategies.

Keywords: India; Intimate partner violence; domestic violence; review; spouse abuse.

Publication types

• Systematic Review
• Domestic Violence / statistics & numerical data
• Domestic Violence / trends*
• India / epidemiology
• Middle Aged
• Prevalence*
• Spouse Abuse / statistics & numerical data
• Spouse Abuse / trends*

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Domestic violence cases in India increased 53% between 2001 and 2018: Study

The data analysed by the researchers was extracted from the annual reports of the national crimes record bureau (ncrb) under four domestic violence crime headings..

A longitudinal research study by BMC Women’s Health analysing trends and lessons on domestic violence faced by Indian women from 2001 to 2018 has highlighted that India needs to focus on efforts to reduce the gaps in the administrative data which includes underreporting and almost stagnant data over the time.

Between 2001 and 2018, the majority of the domestic violence cases were filed under ‘cruelty by husband or his relatives’, with the reported rate of this crime increasing by 53% over 18 years.

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The study has also highlighted that the rate of cases of cruelty by husbands or relatives was 28.3 per 1,00,000 women in 2018, which is an increase of 53% from 2001. The rate of reported dowry deaths and abetment to suicide was 2% and 1.4%, respectively, in 2018. The data analysed by the researchers was extracted from the annual reports of the National Crimes Record Bureau (NCRB) under four domestic violence crime headings – cruelty by husband or his relatives, dowry deaths, abetment to suicide, and protection of women against domestic violence act.

A total of 1,548,548 cases were reported under cruelty by husband or his relatives in India from 2001 to 2018, with 554,481 (35.8%) between 2014 and 2018. The reported rate of this crime in India was 18.5 in 2001 and 28.3 in 2018 per 1,00,000 women aged 15–49 years, marking a significant increase of 53% over this period. Wide variations were seen in the rate for reported cruelty by husband or his relatives in 2018 at the state-level.

Delhi , Assam, West Bengal, Arunachal Pradesh, Meghalaya and Jammu and Kashmir documented more than 160% increase in this reported crime rate during 2001–2018.The greatest decline in the rate of this reported crime was seen in Mizoram, 74.3% from 2001 to 2018.

“However, it is important to note that only some states recorded changes in the reported rate with the almost stagnant reported rate of domestic violence in many states over time,” said Prof Rakhi Dandona, the lead researcher of the study and a professor at the Public Health Foundation of India.

The study also underlined that the non-availability of anonymised individual level data of the cases registered in the public domain limits the exploration of patterns in domestic violence that can enable evidence-based policy action. The Sustainable Development Goal (SDG) target 5 is to eliminate all forms of violence against women and girls and the two indicators of this progress are rates of intimate partner violence (IPV) and non-partner violence. The WHO has estimated a 26% prevalence of IPV in ever-married /partnered women aged 15 years, this prevalence is at 35% for southern Asia.

“Data and Information systems must be strengthened for better evidence- informed policy to address the issue of domestic violence in India. The lessons from nearly 20 years of surveillance of domestic violence in Indian women points out that the change in the reported rate of domestic violence cases is seen only in some states while some had an almost stagnant rate. This underlines the importance of understanding the under-reporting of cases by women and by police, thereby, increasing robustness of available data. More standardisation in data recording and increase in the range of data by the police will strengthen utility of this data more effectively to inform policy and prioritise prevention strategies to reduce the cases of domestic violence against women in India,” Dr Dandona said.

The poor response of a formal system to reduce domestic violence is also reflected in the legal recourse as only 6.8% of the cases filed completed trials in 2018, with the majority of accused being acquitted. “This bleak state of waiting, extended trials and low conviction is known to further discourage women from reporting cases,” Dr Dandona added.

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ORIGINAL RESEARCH article

A global study into indian women’s experiences of domestic violence and control: the role of patriarchal beliefs.

• School of Psychology, Deakin University, Melbourne, VIC, Australia

Domestic violence (DV) is a serious and preventable human rights issue that disproportionately affects certain groups of people, including Indian women. Feminist theory suggests that patriarchal ideologies produce an entitlement in male perpetrators of DV; however, this has not been examined in the context of women from the Indian subcontinent. This study examined Indian women’s experiences of abuse (physical, sexual, and psychological) and controlling behavior across 31 countries by examining the relationship between the patriarchal beliefs held by the women’s partners and the women’s experience of DV. This study uses an intersectional feminist framework to examine the variables. Data from an online questionnaire was collected from 825 Indian women aged between 18 and 77 years ( M  = 35.64, SD  = 8.71) living in 31 countries across Asia (37.1%), Europe (18.3%), Oceania (23.8%), the Americas (16.1%) and Africa (3.2%) and analyzed using a hierarchical linear regression. A majority of participants (72.5%) had experienced at least one form of abuse during their relationship, and over a third (35.1%) had experienced controlling behavior. In support of the central hypotheses, after controlling for potential confounders, women whose partners showed greater endorsement of patriarchal beliefs were less likely to have access to freedom during their relationship ( ß  = −0.38, p  < 0.001) and were more likely to have been abused by their partner or a member of his family ( ß  = 0.34, p  < 0.001). The findings of this study highlight the need to engage with men in Indian communities through culturally-tailored intervention strategies designed to challenge the patriarchal ideologies that propagate, justify, and excuse DV.

Introduction

Domestic violence (DV) is the most common form of violence against women, and occurs in every country around the world, transgressing social, economic, religious, and cultural divides ( García-Moreno et al., 2005 ; Violence Against Women Prevalence Estimates, 2018 ). Although men can be abused by female partners and violence also occurs in non-heterosexual relationships, the vast majority of DV victims are women, and their perpetrators are a current or former male partner ( World Health Organization, 2019 ). In the context of this study, DV includes physical, sexual abuse, or emotional abuse and controlling behaviors such as enforced isolation, excessive jealousy, and limiting access to economic resources or support ( Our Watch, 2015 ; World Health Organization, 2019 ). In research, the terms, domestic violence, intimate partner violence, family violence, sexual violence and spousal abuse are used interchangeably. For the purposes of the present study, ‘domestic violence’ is used to refer to the violence women experience from their current or former intimate partner.

In addition to representing the leading cause of death for women around the world, with more than 50,000 women being killed by a partner or family member each year ( UNODC, 2018 ), the physical, psychological, and social effects of DV are profound and enduring. Along with physical injuries, women who have been subjected to DV report higher rates of depression, anxiety disorders, post-traumatic stress disorder, cognitive impairment, substance abuse, and are more likely to have thought about or attempted suicide ( Ellsberg et al., 2008 ; Chandra et al., 2009 ). They are also at a heightened risk of experiencing sexually-transmitted infections, gynecological problems, unwanted pregnancies, and miscarriages ( Ellsberg et al., 2008 ; Stephenson et al., 2008 ; Dalal and Lindqvist, 2010 ). Moreover, violence in the home places women at significant risk of homelessness, unemployment, and poverty ( Specialist homelessness services annual report, Summary, 2021 ). Although some men also experience violence from their female partners, prevalence rates from across the world show that women experience violence at three times a greater rate than men; the risk factors for men and women could also vary and therefore, these need to be clearly delineated for each group. Given the deleterious outcomes associated with DV, understanding the factors that drive it is vital in research, policy, as well as in clinical practice ( Ellsberg et al., 2008 ).

A landmark study by the WHO which collected data from over 24,000 women in 10 countries about the extent of domestic violence they experienced found that depending on country and context (e.g., rural versus urban locations), between 15 and 71% of women had been physically or sexually assaulted by an intimate partner during their lifetime ( García-Moreno et al., 2005 ). These findings raise three pertinent points: first, that the apparent universality of DV confirms that its occurrence is not a random aberration, but instead a reflection of gender inequalities that are deeply entrenched and systemically enacted in many cultures and societies around the world. Second, that in addition to gender, factors such as socioeconomic status, ethnicity, and immigration status intersect with gender to shape women’s experiences of abuse. Third, that high rates of violence against women are not inevitable, nor intractable, and therefore should be the aim of global prevention efforts. In sum, it is clear that the harmful effects of DV are universal, but not experienced by all women equally. As such, identifying how diverse groups of women experience DV in their particular cultural context is essential for designing culturally relevant interventions for both victims and perpetrators ( Bhuyan and Senturia, 2005 ). Studies have shown that the experiences of migrant and refugee women can vary significantly to their non-migrant counterparts, therefore, we need a clearer understanding of the nuances of these differences and the impacts of their experiences.

Indian women are one group of women that remain at high risk of DV with or without migration from India ( Natarajan, 2002 ; Ahmed-Ghosh, 2004 ; Bhuyan and Senturia, 2005 ) compared to women from Europe, the Western Pacific or North America ( Violence Against Women Prevalence Estimates, 2018 ). However, the largely Western-centric feminist discourse surrounding DV means there is a dearth of Indian-specific research. In addition, common methodological limitations such as the lack of psychometrically-validated, culturally-appropriate DV measurement tools, small and single-location sample sizes, and a failure to recognize forms of abuse other than physical abuse means that the voices of Indian women remain both under-and mis-represented in the extant literature ( Yoshihama, 2001 ; Kalokhe et al., 2016 ).

While much progress has been made toward gender equality in India ( Bhatia, 2012 ), the prevalence of DV is high. Data from the 2015–2016 Indian National Family Health Survey indicated that 33% of the 67,000 women surveyed in India had experienced DV during their marriage, with the most common type being physical violence (30%), followed by emotional (14%) and sexual violence (7%) ( National Family Health Survey, 2017 ). A recent systematic review of 137 quantitative studies examining DV in India by Kalokhe and colleagues ( Kalokhe et al., 2016 ) also found high rates of these types of violence along with a 41% prevalence of multiple types of abuse. The impact of physical, sexual, and psychological abuse on women’s mental, physical, sexual, and reproductive health is severe and leads to greater levels of depression, suicide attempts, post-traumatic stress disorder, and somatic symptoms and a decreased quality of life ( Kalokhe et al., 2016 ). Research also shows that Indian women who have migrated from India to the United Kingdom, the United States, and Canada experience higher rates of DV than the general population ( Raj and Silverman, 2002 ; Ahmad et al., 2004 ; Mahapatra, 2012 ). Little is known about the DV rates among Indian women who migrate to other countries. Taken together, these findings suggest that Indian women across the globe experience high rates of DV. As such, it is important to understand the sociocultural factors that contribute to its occurrence.

While there is no single cause of DV, feminist theories emphasize how the circulation and espousal of patriarchal ideologies in society contribute to, create, and maintain DV ( Pagelow, 1981 ; Smith, 1990 ). Although variously defined, patriarchy refers to the hierarchical system of social power arrangements that affords men more power and privilege than women, both structurally and ideologically ( Smith, 1990 ; Hunnicutt, 2009 ) with the origins of the word ‘patriarchy’ coming from the Greek word Πατριάρχης ( patriakh͞es ), meaning male chief or head of a family.

According to an ecological framework ( Heise, 1998 ), patriarchal control, exploitation and oppression of women occurs within all levels of social ecology, including the macrosystem (e.g., government, laws, culture), mesosystem (e.g., the media, workplaces), microsystem (e.g., families and relationships), and at the level of the individual. Through social learning, patriarchal structures are internalized as patriarchal ideologies, which are a set of beliefs that legitimize and justify the expression of male power and authority over women, including DV ( Smith, 1990 ; Yoon et al., 2015 ). More specifically, patriarchal beliefs include notions about the inherent inferiority of women and girls, men’s right to control decision-making in both public and private spheres, traditional and proscriptive gender roles, and the condoning of violence against women ( Our Watch, 2015 ; Yoon et al., 2015 ). Such ideologies preserve and strengthen the structural gender inequalities that set the necessary social context for DV to occur, by giving men the cultural, legal, and social mandate to use varying degrees of violence and control against women ( Our Watch, 2015 ; Yoon et al., 2015 ; World Health Organization, 2019 ).

Research from the United States indicates that positive attitudes toward violence against women and beliefs in traditional gender roles is associated with perpetration of DV ( Sugarman and Frankel, 1996 ; Stith et al., 2004 ). Similarly, Hah-Yahia ( Haj-Yahia, 2005 ) found that Jordanian men who subscribed to patriarchal ideologies were more likely to justify DV, blame women for violence against them, believe that women benefit from beating, and believe that men should not be punished for hurting their wives. Furthermore, a study of South Asian women living in the United States found that women who endorsed patriarchal beliefs were more likely to have experienced DV ( Adam and Schewe, 2007 ), and men in Pakistan who adhered to patriarchal ideology were more likely to use physical violence against their partners ( Adam and Schewe, 2007 ).

Despite its clear theoretical underpinnings, the relationship between patriarchal beliefs as a single construct and DV perpetration in Indian communities has, to the best of the authors’ knowledge, not been quantitatively examined. This is important, as although patriarchy is omnipresent in all societies on earth, culture shapes its manifestation through values, norms, beliefs, traditions, and familial roles that perpetuate patriarchal structures and ideologies ( Duncan, 2002 ).

In Indian families, power and authority is transmitted from father to the eldest son, meaning that females are expected to be subservient to males throughout their lifetimes; in childhood, to their fathers; upon marriage, to their husbands; and in old age (on occasion of the death of their husband), to their sons ( Bhuyan and Senturia, 2005 ). The impact of a father’s violence on children’s development can last a long time. Research suggests that the effects of this violence against girls in childhood are much more serious and deleterious than the effects of violence used by other men, or even a mother, against women such that women who suffer violence by their father have low levels of resilience in adulthood – even though they might report other perpetrators (such as the husband) as committing greater violence ( Tsirigotis and Łuczak, 2018 ). Therefore, women, as adults, can continue to be affected by patriarchal behaviors of men. In the Indian context, historically too, the hierarchy between men and women prevailed. For example, in ancient India, Smriti, Kautilya, and Manu philosophers demanded total subservience of women to their husbands ( Kumar, 2017 ). In spite of advances in society about gender equality and gender roles, such attitudes still exist in India. For instance, the Indian National Family Health Survey found that less than two-thirds, that is, 63% of married women participated in decision-making about major household matters, and less than 41% were allowed to go to places such as the market, a health facility, or visit relatives alone ( National Family Health Survey, 2017 ).

Prescriptive gender roles contribute to the incidence of domestic violence by positioning women as subordinate, with men therefore tasked with ‘protecting’ women and ensuring they uphold the gendered expectations and moral standards imposed on them ( Haj-Yahia, 2005 ; Satyen, 2021 ). Indeed, physical violence is viewed as a common and acceptable response to women’s “disobedience,” or failure to meet her husband’s expectations ( Jejeebhoy and Cook, 1997 ). For example, 42% of men and 52% of women believed that a husband is justified in beating his wife if she goes outside without telling him, neglects the house, argues with him, refuses to have sex, does not cook properly, is suspected of being unfaithful, or is disrespectful. This demonstrates that women have possibly internalized their “inferior” status in society and are more accepting of the inequality they face in the household. Honor killings, where women are killed by male family members for bringing shame to their families, still occurs in India and may represent the most extreme example of such attitudes ( Kumar and Gupta, 2022 ).

Taken together, the aforementioned findings clearly outline the broad links between DV and elements of patriarchal ideology including ideas about the inherent inferiority of women, men’s right to control decision-making, traditional gender roles, and condoning of violence against women ( Our Watch, 2015 ; Yoon et al., 2015 ). However, lacking from this literature is a culturally-specific, comprehensive assessment of the role of individual-level patriarchal beliefs in influencing Indian women’s experiences of DV. Understanding this relationship is vital in order to develop culturally tailored DV interventions and policies.

While cultural expressions of patriarchy provide the necessary context for DV to occur, according to intersectionality theory ( Kumar and Gupta, 2022 ), gender oppression intersects with other forms of inequality, such as poverty, racism, and migration status to increase the risk of DV for certain groups of Indian women ( Sokoloff and Dupont, 2005 ). For example, those who are younger, have more children, live in rural locations, have fewer years of schooling, or who are unemployed are more likely to experience DV during their lifetime ( Sokoloff and Dupont, 2005 ), and may be less likely to seek help for DV ( Leonardsson and San, 2017 ). Furthermore, migration has been identified as a key risk factor for DV ( Satyen et al., 2018 ; UNODC, 2018 ; Satyen, 2021 ), through practical and cultural barriers to accessing help and support ( Raj and Silverman, 2002 ; Colucci et al., 2013 ), as well as so-called ‘backlash’ factors, whereby men increase their use of violence and control following migration to more egalitarian locations, in response to the threatened loss of status and authority ( Dasgupta and Warrier, 1996 ; Zavala and Spohn, 2010 ). In examining DV, it is therefore important to acknowledge the compounding effects of such factors, while underscoring the central role of patriarchy ( Gundappa and Rathod, 2012 ).

The objective of this study was to examine Indian women’s experiences of abuse (physical, sexual, and psychological) and controlling behavior across 31 countries by examining the relationship between the patriarchal beliefs held by the women’s partners and the women’s experience of DV. Given our understanding of how patriarchal beliefs relate to DV, it was hypothesized that a greater endorsement of patriarchal beliefs by a woman’s partner would predict greater occurrence of abuse and controlling behavior during their relationship.

Research design

We examined the relationship between women’s partners’ patriarchal beliefs (as reported by the women) and the women’s experiences of DV using an intersectional feminist lens. This study used a quantitative, cross-sectional design using an online survey, which explored the impact of partners’ patriarchal beliefs on Indian women’s experiences of DV. The inclusion criteria for partaking in the study included: women who identified culturally as belonging to or having origins in the Indian sub-continent. They needed to have been in the past or currently be in an intimate partner relationship. They could be living in the Indian sub-continent or have migrated elsewhere in the world. They needed to also be 18 years and over to take part in the study and have minimal English language skills to comprehend the questionnaires.

Participants

Participants for this study were recruited from across the world via social media and culturally relevant organizations. Through targeted recruitment, Indian women 18 years or over who were currently in or had previously been in an intimate relationship with a male were asked to participate in the study. In addition to recruiting from India and Australia, data from the Government of India’s Ministry of External Affairs ( Population of Overseas Indians, 2018 ) was used to identify the 15 countries with the highest population of people of Indian origin and these were targeted for recruitment in addition to promoting the study across other countries. Target countries included: the United States, United Arab Emirates, Malaysia, Saudi Arabia, Myanmar, the United Kingdom, Sri Lanka, South Africa, Pakistan, Canada, Kuwait, Mauritius, Qatar, Oman and Singapore. In total, 349 organizations and community groups were contacted by email and provided details of the study. Further, A Facebook page was set up for the project, and a recruitment advertisement was posted to 1,167 public groups relating to Indian women’s interests. In all, 825 participants aged between 18 and 77 years ( M = 35.64, SD = 8.71) from 31 countries across Asia (37.1%), Europe (18.3%), Oceania (23.8%), the Americas (16.1%) and Africa (3.2%) took part. The majority of them were born in India ( n = 720, 87.3%), but 59.3% had migrated from their country (India or other) of birth. See Table 1 for a detailed summary of their demographic characteristics.

Table 1 . Demographic characteristics of the sample ( N = 825).

Participants completed an online questionnaire that assessed demographic information, their experiences of domestic violence, and their partners’ patriarchal beliefs.

Demographic information

Participants’ age, country of birth, country of residence, migration status, religion, marital status, and educational attainment were collected.

Domestic violence

Experiences of abuse including physical, sexual, and psychological and controlling behaviors perpetrated by women’s partners and/or his family members were measured using the 63-item Indian Family Violence and Control Scale [IFVCS; ( National Family Health Survey, 2017 )]. The IFVCS was designed for use in the Indian population, with items being derived from informant and expert interviews with an Indian sample to ensure it captured culturally-specific forms of DV ( Kalokhe et al., 2015 , 2016 ). Preliminary validation of the IFVCS suggested that the scale has strong internal consistency, and good concurrent and construct validity ( Kalokhe et al., 2016 ). Cronbach’s alphas were calculated for the current sample, indicating that both the control and abuse subscales had very good internal reliability (0.94 and 0.97 respectively).

The control subscale consisted of 14 items which asked women to rate their access to various freedoms during their entire relationship (e.g., “freedom to spend my own money on personal things”) on a 4-point scale, ranging from 0 ( never ), to 3 ( often ). Total scores for this subscale ranged from 0 to 42, with lower scores indicating lower access to freedom, or more frequent controlling behavior. The 49-item abuse subscale comprised of statements relevant to psychological (22 items), physical (16 items), and sexual violence (11 items) domains and asked women about the frequency of abusive behaviors (e.g., “burnt me or threatened to burn me with a cigarette”) on a 4-point scale, from 0 ( never ) to 3 ( about once a month ). Higher scores indicated greater frequency of abuse, with the total possible abuse score ranging from 0 to147.

Partner’s patriarchal beliefs

Women’s partner’s patriarchal beliefs were measured using 10 items derived from the 5-item Husband’s Patriarchal Beliefs Scale, which was originally developed by Smith (1990) and later adapted by Ahmed-Ghosh (2004) , with the addition of 5 items from the 37-item Patriarchal Beliefs Scale ( Yoon et al., 2015 ). The 10 resultant items captured each of the core dimensions of patriarchal ideology identified by Yoon ( Yoon et al., 2015 ); these include beliefs about the institutional power of men, the inherent inferiority of women, and gendered domestic roles. The scale asked women to rate their perception of their partner’s level of agreement to various patriarchal beliefs (e.g., “men are inherently smarter than women”) on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 ( strongly agree ). Scores ranged from 10 to 70, with higher scores indicating greater endorsement of patriarchal ideology. Cronbach’s alpha was calculated as.96, indicating this new scale had very high internal consistency.

This study was guided by the WHO’s ethical and safety recommendations for DV research ( Ellsberg and Heise, 2002 ) and received approval from the institutional ethics committee in compliance with American Psychological Association (2017) ethical standards ( American Psychological Association, 2017 ). All persons who saw an advertisement or accessed the online link received a plain language statement, as well as information about DV support services in their country, regardless of whether or not they completed the survey. To protect the safety of participants, a Quick Escape button was programmed into the survey. The survey (in English) was anonymous and took approximately 20 min to complete.

Data screening and cleaning

Data cleaning was conducted prior to analysis. Cases missing more than 50% of their data were removed from the sample. For the remaining cases, random missing values were replaced with the series mean. All items across the three abuse subscales, and the control subscale of the IFVCS were summed to obtain a total abuse, and total control score, respectively. For the purposes of regression analyses, employment was dichotomised as employed versus not employed, and education as tertiary education versus non-tertiary education. Each nominal independent variable was treated as a set of dummy variables, with one variable serving as the reference group. For the regression analyses, only women who had reported some form of abuse were included in the analysis; thus, the 15.9% of the sample that reported no abuse were excluded from the analyses.

Analytical strategy

First, descriptive analyses were undertaken to determine the extent of DV and partners’ patriarchal beliefs in the sample and these are presented in Table 2 . As control and abuse were measured on different scales, two hierarchical multiple regression analyses (as seen in Table 3 ) were conducted to test the central hypothesis. For each regression analysis, a three-stage hierarchical regression, and bottom-up model building strategy was used. In model 1, a univariate model including patriarchal beliefs, and either abuse or control as the outcome measure was tested. This provided a baseline estimation of the variance in abuse or control predicted by patriarchal beliefs, enabling estimation of the contribution of the variables added hierarchically in subsequent models. In Model 2, demographic variables (age, marital status, educational attainment, employment status, migration status, and continent of residence) identified in the literature review as potential confounders were entered into the model; all demographic variables were entered into the model together. Two-way interaction effects between patriarchal beliefs and each of the demographic characteristics were examined to exclude potential moderation effects.

Table 2 . Descriptive statistics for abuse ( N = 729), control ( N = 825) and partners’ patriarchal beliefs ( N = 729).

Table 3 . Summary of hierarchical regression analysis for variables predicting control ( N = 579).

Descriptive analyses

Abuse and control.

Results (seen in Table 2 ) demonstrated that 72.5% of women reported having experienced at least one instance of abuse in their lifetime, while 15.9% reported no abuse. Across the different subscales, 69.9% had experienced some form of psychological abuse, 45.2% had experienced physical abuse and 21.7% had experienced sexual abuse. Over a third of participants (35.1%) had on at least one occasion had an aspect of their freedom denied by their partner.

Patriarchal beliefs

The descriptive statistics for patriarchal beliefs are also presented in Table 2 . The Mean scores ( M = 26.27, SD = 16.28) indicated an overall tendency for partners to disagree with patriarchal beliefs.

Multiple regression analyses

A detailed summary of the hierarchical regression is presented in Table 3 .

In Model 1, the univariate model, patriarchal beliefs was associated with a statistically significant 14.4% of the variance in controlling behavior. Women whose partners endorsed stronger patriarchal beliefs had less access to freedom in their relationship ( ß  = −0.38, p  < 0.001). Introducing demographic variables in Model 2 using the Stepwise method was associated with a statistically significant additional 10.3% of variance in control. Specifically, women experienced significantly more control (<0.05) with increasing age and significantly less control (<0.01) when they were separated compared to women who were married. The beta value for patriarchal beliefs remained statistically significant and largely unchanged with the addition of the demographic variables ( ß = −0.35, p  < 0.001). Patriarchal beliefs alone accounted for 11.49% ( sr 2  = 0.12) of the total variance in controlling behavior. In addition to patriarchal beliefs, two of the 11 demographic variables were significant predictors of control. Inspection of two-way interaction effects between PBS and each of the demographic characteristics indicated no evidence of moderation occurring. The final model accounted for 23.3% of the variance in control F (12, 566) = 15.61, p  < 0.001, which is considered a large effect ( Cohen, 1988 ).

A detailed summary of the hierarchical regression is presented in Table 4 .

Table 4 . Summary of hierarchical regression analysis for variables predicting abuse ( N = 577).

For Model 1, the univariate model, partners’ patriarchal beliefs was associated with a statistically significant 11.4% of the variance in experience of abuse. Women who perceived their partners held stronger patriarchal beliefs were more likely to have been abused ( ß  = 0.34, p  < 0.001). The addition of demographic variables was associated with a statistically significant additional 5.7% of the variability in abuse (Model 2). This final model explained 15.5% of the variance in abuse, adjusted R 2  = 0.155, F (12, 564) = 9.79, p  < 0.001, which is considered a medium effect ( Cohen, 1988 ). The beta value for patriarchal beliefs remained a significant independent predictor of abuse ( ß  = 0.31 , p  < 0.001). Patriarchal beliefs contributed the highest amount of variance in abuse, independently contributing 9% (sr 2  = 0.09). Inspection of two-way interaction effects between PBS and each of the demographic characteristics indicated no evidence of moderation.

This study is the first to examine the relationship between domestic violence and a partner’s adherence to patriarchal ideology in the global Indian context. The findings support the hypothesis that women who perceived their partners to endorse greater patriarchal beliefs were more likely to have been abused and subjected to controlling behavior.

The finding that partners’ patriarchal beliefs predicted DV victimization lends support to the longstanding feminist propositions that DV occurs mainly in contexts where patriarchal ideologies are dominant ( Jejeebhoy and Cook, 1997 ; Haj-Yahia, 2005 ; Satyen, 2021 ). In this study, women who believed that their partners viewed women in general as inherently inferior to men, legitimized male authority in public and private arenas, endorsed prescriptive gender roles, and condoned the use of violence for gender-role violation were more likely to be abused or controlled by their male partners. This finding is consistent with the limited existing studies that have demonstrated the relationship between male patriarchal ideologies and DV perpetration across three countries including the United States ( Sugarman and Frankel, 1996 ; Stith et al., 2004 ; Haj-Yahia, 2005 ; Adam and Schewe, 2007 ; Watto, 2009 ). By contributing to the understanding of the experiences of Indian women globally, this study highlights the pervasive and enduring negative influence of the patriarchal ideology on women.

The relationship between patriarchal beliefs and DV persisted after controlling for a range of factors such age, educational attainment, marital status, migration status, employment, and geographical location that have been previously used to explain DV victimization in Indian populations [(e.g., Sabri et al., 2014 ; Gender, 2015 ; Kalokhe et al., 2018 )]. It further emerged as the strongest independent predictor of women’s experiences of both abuse and control. Such a finding cautions against any theory of DV in Indian communities that overlooks or minimizes gender as an explanatory factor. It also suggests that merely focusing on the individual characteristics of DV victims is problematic in that it conceals the ways in which DV is embedded in broader sociocultural structures including the violence committed in childhood by a father [(e.g., Tsirigotis and Łuczak, 2018 )]. This finding removes some of responsibility and shame from both victims of DV and from individual cultural groups, by firmly situating their experiences within a patriarchal framework. This finding also has fundamental practical implications for understanding and preventing DV in Indian communities, by identifying patriarchal beliefs and practices as targets for intervention that are amenable to effecting social change in the continuance of DV.

An unexpected finding was that age, educational attainment, marital status, geographical location, migration status, and employment status did not moderate the relationship between patriarchal beliefs and DV experiences. These findings could be considered in light of the universal phenomenon of gendered violence in women and the significant role of patriarchal beliefs. This is in contrast to an intersectional framework ( Crenshaw, 1991 ) which suggests that different social factors interact and intersect with gender oppression to place certain groups of women at increased risk of DV. While it is possible that this finding may be an artefact of the specific sample included in this study, we did not measure structural patriarchy, for example, casteism and classism, which may be a better proxy for the macro-level gender oppressions and inequalities referred to in intersectionality theory ( Heise, 1998 ). In support of this explanation, one salient finding from the present study was that continent of residence was not an independent predictor of either abuse or controlling behavior and did not moderate the relationship between patriarchal beliefs and DV. This suggests that patriarchal beliefs can prevail despite structural gains in women’s empowerment or through migrating to more egalitarian locations ( Hunnicutt, 2009 ). However, the findings also demonstrated that women experienced greater controlling behavior as they became older and, in contrast to women who were married, those who were separated experienced less control. The latter findings could relate to lower levels of control because the women had separated from their partner. It is also possible that as women are older, they are more invested in their relationships and less likely to challenge greater levels of control by their partners. In sum, women’s specific social context does not appear to specify the appropriate conditions for the translation of patriarchal ideas about gender relations and, in particular, DV ( Yoon et al., 2015 ). The findings of this study highlight the need to engage with men at the individual level to challenge the patriarchal beliefs and norms that propagate, justify, and excuse DV.

Based on the findings of this study, it is clear that interventions should use a ‘gender transformative’ approach ( Gupta and Sharma, 2003 ) which acknowledges that DV is inherently gendered and a product of patriarchal ideologies. These interventions could be provided in group or individual formats, should be culturally-tailored, and work with men to promote women’s access to authority and decision-making, as well as challenge traditional gender roles and acceptance of DV ( Violence against women in Australia An overview of research and approaches to primary prevention, 2017 ). Encouraging evidence from the international literature suggest that such programs can lead to short-term changes in both attitudes and behavior, including decreased self-reported use of physical, sexual, and psychological DV ( Whitaker et al., 2006 ; Barker et al., 2010 ). However, the literature does not reveal if such programs have been piloted in Indian communities.

Limitations

The primary limitations of the current study relate to the sample characteristics and subsequent generalizability of findings. This study used a convenience sample and as such may not adequately represent Indian women across a range of societies. However, the strength is that women from 31 countries took part in the study. Second, the Partner’s Patriarchal Beliefs scale asked women to rate their perception of their partner’s beliefs, and therefore may not have accurately reflected men’s ideologies. However, attempting to understand and validate women’s lived experiences and perceptions is important in any feminist enquiry ( Yllö and Bograd, 1984 ) and wives’ accounts of their husband’s behavior have been found to be more accurate than husband’s account of his own behavior ( Arias and Beach, 1987 ). Nevertheless, future research may wish to further establish the validity and psychometric properties of the scale used. Finally, the cross-sectional nature of this study limits the extent to which we can draw conclusions regarding the temporality or causal nature of the observed associations. While theories of patriarchy suggest it fuels DV, it is also plausible that use of DV also strengthens patriarchal beliefs, by further reinforcing a system of male domination and female subordination in the family. Future studies employing a prospective or longitudinal design and representative sample will strengthen the practical significance of the findings described in this study.

Conclusions and implications for future research

Notwithstanding the aforementioned limitations, this study is novel in showing the effects of individual-level patriarchal beliefs on women’s experiences of both abuse and control using a large, cross-national sample that adjusted for a range of established risk factors and employed a validated, culturally-sensitive measure of DV. The findings raise awareness of the extent of DV in Indian communities and emphasize the need to collectively acknowledge how gender and culture interact to shape women’s experiences of DV. Such an understanding can have far-reaching implications for the reduction and prevention of DV in Indian communities, by providing mental health practitioners, community leaders, policy makers, women’s activists, and the wider community more broadly, a principal target for intervention. Given the observed associations between partners’ patriarchal beliefs and both abuse and controlling behavior, efforts should be targeted at developing culturally-tailored education strategies aimed at challenging men’s enactment of their investment in patriarchy regardless of their social situation, includingtheir education level, religion, and caste.

While this study focused on patriarchal beliefs as an explanatory model for DV, future research may wish to incorporate other theoretical frameworks in order to develop a comprehensive, integrated, ecological theory of DV that considers other individual, interpersonal, and sociocultural factors alongside patriarchal ideology. Furthermore, whilst this study focused on men’s beliefs, women’s perceptual, cognitive, and behavioral responses to DV are also shaped by patriarchal beliefs ( Ahmed-Ghosh, 2004 ). Therefore, future research should examine how patriarchal beliefs influence other DV processes such as reduced help-seeking behavior that place women at further risk of DV; the intersections between the prevalent Indian social contexts of gender, caste, and violence should also be examined – this will enable the more nuanced understanding of whether women from some castes, especially the lower castes are more prone to controlling and abusive behavior than women in the upper castes [see Deshpande (2003) and Khubchandani et al. (2018) for a broad review of the discrimination between people of different castes and the intersections of this with gender in the Indian society]. Finally, given that culturally-diverse groups of women remain underrepresented in the DV literature, future researchers should consider how patriarchal beliefs manifest in other communities to further enhance our understanding of DV and pave the way for the prevention of violence against all women.

Data availability statement

The datasets presented in this article are not readily available because the data is sensitive by nature and according to the Deakin University Human Research Ethics Committee protocol, we are not allowed to share this data, even in anonymized form. Requests to access the datasets should be directed to [email protected] .

Ethics statement

The studies involving humans were approved by the Deakin University Human Research Ethics Committee. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

LS: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing. MB-I: Data curation, Formal analysis, Investigation, Methodology, Writing – original draft. BR: Data curation, Formal analysis, Validation, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Acknowledgments

We thank women from across the world who generously gave their time and shared their experiences by completing the survey. We also acknowledge the feedback and suggestions provided by two reviewers that helped strengthen our manuscript.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: domestic violence, patriarchal beliefs, control, feminist framework, Indian communities

Citation: Satyen L, Bourke-Ibbs M and Rowland B (2024) A global study into Indian women’s experiences of domestic violence and control: the role of patriarchal beliefs. Front. Psychol . 15:1273401. doi: 10.3389/fpsyg.2024.1273401

Received: 07 August 2023; Accepted: 05 January 2024; Published: 01 March 2024.

Reviewed by:

Copyright © 2024 Satyen, Bourke-Ibbs and Rowland. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Lata Satyen, [email protected]

† These authors have contributed equally to this work

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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• v.29(2); 2022

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Women’s experiences of marital rape and sexual violence within marriage in India: evidence from service records

Padma-bhate deosthali.

a Senior Advisor, Centre for Enquiry Into Health and Allied Themes, Mumbai, India

Sangeeta Rege

b Coordinator, Centre for Enquiry Into Health and Allied Themes, Mumbai, India

Sanjida Arora

c Research Officer, Centre for Enquiry Into Health and Allied Themes, Mumbai, India. Correspondence : gro.tahec@adijnas

Sexual violence within marriage is common and manifests in various forms, including marital rape. It has serious physical and mental health consequences and is a violation of women’s sexual and reproductive health rights. Marital rape, reproductive coercion, inserting objects in the vagina or anus, and withholding sexual pleasure are forms of violence routinely experienced by women. Based on service records of survivors coming to public hospitals in an Indian city, this paper presents their pathways to disclosure and institutional responses such as hospitals and police. The findings highlight that a large proportion of survivors of domestic violence confide having experienced forced sexual intercourse by the husband while sharing their experience of physical, economic, and emotional violence with crisis intervention counsellors. However, a small number of women do report marital rape to formal systems like hospitals and police. These systems respond inadequately to women reporting marital rape, as the rape law exempts rape by husband. Sexual violence within marriage can have serious health consequences, and a sensitive healthcare provider can create an enabling environment for disclosing abuse and providing relevant care and support. The paper argues that a necessary precondition to enable women to access health care and justice is to nullify “Exception 2 to Section 375 of the Indian Penal Code” This exception exempts rape by the husband from the purview of the rape law.

Résumé

Les violences sexuelles dans le mariage sont communes et se manifestent sous différentes formes, notamment par le viol conjugal. Elles ont de graves conséquences sur la santé physique et mentale et constituent une violation du droit des femmes à la santé sexuelle et reproductive. Le viol conjugal, l’obligation de procréer, l’insertion d’objets dans les parties intimes et le refus du plaisir sexuel sont des formes de violences fréquemment subies par les femmes. Sur la base des dossiers des victimes s’étant rendues dans des hôpitaux publics d’une ville indienne, cet article présente leur cheminement vers la révélation et les réponses institutionnelles données par l’hôpital et la police. Les conclusions mettent en lumière le fait qu’une forte proportion des victimes de violences familiales confient qu’elles ont été obligées par leur mari de subir des rapports sexuels tout en ayant partagé leur expérience des violences physiques, économiques et psychologiques avec des conseillers spécialisés dans les interventions en situation de crise. Néanmoins, un petit nombre de femmes signalent le viol conjugal aux systèmes officiels comme les hôpitaux et la police. Ces systèmes répondent de manière inadéquate aux femmes qui font état d’un viol conjugal, puisque la loi sur le viol fait une exception pour le viol perpétré par le conjoint. Les conséquences des violences sexuelles pendant le mariage sont graves et un prestataire de santé sensible peut créer un environnement propice à la révélation de mauvais traitements et prodiguer un soutien et des soins pertinents. L’article avance qu’une condition préalable nécessaire pour permettre aux femmes d’avoir accès aux soins de santé et à la justice est d’annuler « l’exception 2 à la section 375 du Code pénal indien ». Cette exception concerne le viol par le mari qui est hors du champ d’application de la loi sur le viol.

La violencia sexual dentro del matrimonio es común y se manifiesta en diversas formas, entre ellas la violación marital. Tiene graves consecuencias para la salud física y mental, y es una violación de los derechos sexuales y reproductivos de las mujeres. La violación marital, coacción reproductiva, inserción de objetos en las partes privadas y la denegación de placer sexual son formas de violencia que sufren las mujeres de manera rutinaria. Basado en registros de servicios proporcionados a sobrevivientes que acuden a hospitales públicos en una ciudad de India, este artículo presenta las rutas de esas mujeres a la denuncia y las respuestas institucionales tales como las de hospitales y la policía. Los hallazgos destacan que un gran porcentaje de sobrevivientes de violencia doméstica confesaron haber sufrido coito sexual forzado por su esposo, cuando relataron su experiencia de violencia física, económica y emocional a consejeros de intervenciones en respuesta a crisis. Sin embargo, un pequeño porcentaje de mujeres denuncia la violación marital a sistemas formales, tales como hospitales y la policía. Estos sistemas responden inadecuadamente a las mujeres que denuncian la violación marital, dado que la ley sobre violación exime la violación perpetrada por el esposo. La violencia sexual dentro del matrimonio tiene graves consecuencias para la salud; un prestador de servicios de salud sensible puede crear un entorno propicio para denunciar maltrato y brindar atención y apoyo pertinentes. Este artículo argumenta que una precondición necesaria para ayudar a las mujeres a acceder a servicios de salud y justicia es anular la “Excepción 2 a la Sección 375 del Código Penal de India”. Esta excepción exime la violación por el esposo del alcance de la ley sobre violación.

The outrage after the rape and assault resulting in the murder of a health professional in December 2012 in India * led to several public demands for addressing the issue of violence against women and changes in the criminal justice system. One response by the Indian government was to introduce amendments to the criminal law of rape. Before these amendments, an act was considered rape only if there was an attempt at peno-vaginal penetration. The law did not include as rape other forms of sexual violence, such as inserting objects or any other body part into a woman's vagina, anus, mouth, or urethra. The Criminal Law Amendment Act, 2013 brought in critical changes providing a standardised framework on rape and sexual violence but, regrettably, the issue of sexual violence by the husband in a marital relationship (marital rape) is left out. These amendments thus failed to address the concern of sexual violence within marriage. The law retains the exemption from the offence of rape of forced sexual intercourse by a husband with his wife. This exemption is based on the notion that there is “implied and irrevocable consent to sexual intercourse by women” in marital relationships. 1 This impunity of marital rape ignores the relationship which has been established between sexual violence within marriage and health consequences for women.

Current evidence on sexual violence by an intimate partner

Violence against women (VAW) has been recognised as a public health issue and a violation of women's human rights. The 2030 Agenda for Sustainable Development Goals has emphasised the need to monitor VAW. Yet, there is limited high-quality, actionable data on the prevalence of VAW due to limited capacities to measure prevalence, lack of resources and the ethical and methodological challenges in researching VAW.

Asking women about sexual violence by an intimate partner is challenging across cultures. Global estimates based on Demographic and Health Surveys (DHS) provide some insights into the prevalence of intimate partner violence. The latest available estimate on intimate partner violence from the World Health Organization (WHO) is that “globally about 1 in 3 (30%) of women worldwide have been subjected to either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime”. (WHO, 2021) Further, a multi-country study found that in 10 countries sexual VAW of age 15–49 years from an intimate partner varied from 6% to 59%. (WHO, 2005)

In India, the National Family Health Surveys (NFHS) † and National Crime Records Bureau (NCRB) ‡ are the only two sources which provide national-level data on VAW. The NCRB data include only those women and/or their families who have mustered up the courage to register a police complaint. Additionally, as the law does not recognise sexual violence by husbands, the reporting of marital rape is almost negligible. A working paper based on a comparison of NFHS and NCRB data indicated that less than 1% of cases of sexual violence by the husband are reported to the police. 2

The NFHS uses two categories to measure sexual violence: “use of physical force by the husband to have sexual intercourse even when the wife did not want to” and “forcing a woman to perform sexual acts she did not want to”. A study carried out in urban parts of Southern India reported on several forms of sexual violence by the husband. These included the use of physical force by the husband for engaging in “sexually degrading or humiliating acts, using weapons for forcing sex, forcing wife to engage in sex in absence of privacy, and criticising or humiliating wife for or during sex”. 3 The study did not include actions such as “preventing access to contraception and safe abortion” as forms of violence by the husband, but these have been now recognised as reproductive coercion, a form of domestic violence. A cross-sectional study in Gujarat and West Bengal also found underestimation by research studies of sexual violence in marital relationships. The study concluded that measuring sexual violence with questions focusing only on forced sex would lead to underestimation. Women were less likely to indicate sexual contact as coercive if physical violence was not involved. 4

The reported prevalence of sexual violence by intimate partners varies widely across studies in India. A survey carried out in 2010 reported that one in five men reported having ever forced their wives for sex. 5 In another study carried out in rural Karnataka, 36% of the women agreed to the statement that “a husband might force his wife to have sex even if she refuses”. 6 A mixed-method study in Chennai found that about 31% of women reported sexual violence by husbands. 7 A large-scale survey on married men in four districts of Uttar Pradesh found that about 32% of husbands in their lifetime had forced their wives to have sexual intercourse. 8 More recently, the National Family Health Survey (2019–2020) showed that 29% of ever-married women had experienced some form of physical or sexual violence from their husbands. 9

There is also substantial evidence on the occurrence of sexual violence by the husband during pregnancy. 10 A study conducted by Varma and colleagues 11 in an antenatal setting found that, in the previous 12 months, 14%, 9% and 15% of pregnant women faced physical, psychological, and sexual violence, respectively. A recent study found that 40% of women who reported domestic violence during pregnancy faced sexual violence from husbands. 12 More recently, the National Family Health Survey (2019–2020) showed that 29% of ever-married women had experienced some form of physical or sexual violence from husbands. 9

These estimates on the prevalence of marital rape should be interpreted carefully. In general, there is gross under-reporting of sexual violence in India due to stigma and barriers faced by survivors related to notions of shame and honour. 13

Health consequences of sexual violence in marriage

There is strong evidence in the literature to indicate that marital rape leads to severe physical, sexual, reproductive, and psychological health consequences. 14–16 As women are abused multiple times by a person they trusted, the consequences of marital rape on women's health are grave. 17 , 18

Health consequences include an increased risk of getting sexually transmitted or reproductive tract infections (STIs/RTIs) and HIV/AIDS due to forced sex and the wife’s inability to negotiate the use of condoms by her husband. 19–21 It is evident from the literature that men who inflict violence on their spouses are more likely to engage in sex outside marital relationships, have sexually transmitted infections, and thus pose an increased risk for their spouses through sexual coercion. 22–24 Further, sexual violence has also been found to be associated with stillbirths, pelvic inflammatory diseases (PIDs), poor access of women to prenatal care, and attempted suicides by women. 25

Women facing domestic violence were found to be 2.59 times more likely to experience perinatal and neonatal mortality in a study conducted in North India among 2199 pregnant women. 8 A study by Johri et al. recommended that reproductive health services must include screening for spousal violence as they found an association between miscarriage and violence faced by women from an intimate partner. 26

This paper attempts to describe the experiences of women facing sexual violence in marriage, how these women come in contact with the health system, and the response they receive from the health system and police. The findings raise important concerns regarding the inadequacy of redressal mechanisms and the limited roles played by the police and health system, influenced significantly by the impunity afforded to marital rape by the law. The paper highlights the pivotal role that a sensitive health system can play in identifying sexual violence by recognising the health consequences associated with it.

Methodology

The paper is based on service records of violence survivors. These service records include counselling records of a public hospital-based crisis intervention department and medico-legal forms of three public hospitals in Mumbai. The authors are part of a non-governmental organisation (NGO) working with public hospitals on strengthening their response to VAW. As part of monitoring the quality of services and adherence to standards of care, the authors are responsible for the review of service records, including medico-legal forms and counselling records, and building the skills of healthcare providers to provide a comprehensive response to women facing violence. A team of counsellors routinely reads the service records and monitors the documentation quality regularly.

For this paper, we have analysed the following records quantitatively and qualitatively:

These women did not come to the hospital with a complaint of marital rape. They sought services for domestic violence from the crisis intervention department at the hospital. We analysed the counselling records to understand the profile of survivors who disclosed sexual violence while seeking domestic violence services from the counsellor, their experiences of violence, consequences on health, and coping mechanisms. Counselling records are maintained by counsellors and include socio-demographic profile, history of violence, health consequences, support sought in the past, and intervention provided by the department.

• Medico-legal forms of all survivors who reported sexual violence from an intimate partner at all the three hospitals during a nine-year period (April 2008 to March 2017): We analysed these forms to present the profile of survivors, the types of sexual violence reported, the pathways through which these survivors reached the hospital, and their experience of seeking justice. Medico-legal forms include the basic profile of the survivor, the reported incident of sexual violence, time since the incident, details of physical examination, evidence collected, and medical opinion of the doctor.

The two data sources represent different pathways to disclosure, as shown in Table 1 .

Pathway to disclosure

The Anusandhan Trust’s Institutional Ethics committee approved the study to analyse these records (ATIEC06/2016, 15 October 2016). In the process of analysing the data, all ethical guidelines have been adhered to. The original service records were photocopied and the identifiers were removed from xerox copies with white ink. The data were entered into the Statistical Package for Social Sciences (SPSS) for Windows, Version 20.0. Armonk, NY by IBM Corp. The data were entered jointly by the data entry operator and counsellors to avoid abstraction of information. We gave a unique registration number to each case of domestic and sexual violence to maintain confidentiality. The unique registration numbers were used to maintain the Management Information System of these cases. This information system was accessible only to the team members who were involved in this project. The photocopied case records are also kept under lock and key.

Domestic violence survivors reporting sexual violence to counsellors: analysis of counselling records

Most often women first disclose physical, financial, and emotional violence to a counsellor. Once trust is established, women feel comfortable about sharing their experience of sexual violence with a counsellor.

Profile of women

At the hospital-based counselling centre, of a total of 1783 women registered during the period 2008–2017, 79.4% (1416) were currently married, 10.4% were separated/widowed or deserted, and 10.2% were never married. Of the currently married women (1416), 58.5% (828) women reported experiencing sexual violence from their husbands. The majority of women were young, with 8% being in the age group of 18–35 years.

Pathway to the crisis intervention department in public hospitals

Forty-one percent (339) of the women were referred to the crisis intervention department by the health system as they had come to the hospital for treatment of health complaints as a result of ongoing violence. The health complaints ranged from physical assault reported by 46%, attempted suicide by 28%, reproductive health complaints by 25% and attempted homicide by 1%.

Forms of violence

The history of violence revealed that 91% of women had been experiencing violence since marriage. One in four women (25.6%) who were married for less than a year were pregnant when they reached the crisis intervention department. They reported that they were not using any form of contraception due to the sexual control exerted by their partners.

Table 2 shows different forms of sexual violence reported by women. Sixty-eight per cent of the women reported “forced sex,” referring to forced penile penetration and 8% of women reported that they had experienced “forced anal or oral penetration”. These forced sexual acts would be recognised as “rape” under Section 375 only if exception 2 to the law were not to exclude marital rape.

Forms of sexual violence disclosed to a counsellor

The analysis of case records also revealed several forms of sexual violence experienced by women in addition to forced sexual intercourse ( Table 2 ). Twenty-four per cent of women reported reproductive coercion as the husband refused to use any contraceptive and also prohibited her use. Four percent of women reported facing sexual violence from the husband’s relatives.

As seen here, sexual violence within marriage takes various forms that go beyond “forced sexual intercourse”/marital rape. The partner's refusal to use contraception or allow the woman to use any form of contraceptive, and forcing the woman to have children, are recognised as reproductive coercion and a form of sexual violence. Women also complained of being forced into oral and anal sex against their wishes and having sexual acts forced on them against their will, as well as acts that they found repulsive. Twenty-nine per cent of women reported husbands’ withholding of sexual pleasure. Their husbands either had other partners or were going to sex workers, and the women shared that lack of sexual relations was painful for them and was difficult to talk about to anyone.

About 92% of women informed about experiencing physical and financial violence concurrently with ongoing sexual violence. Table 3 presents other forms of violence reported by women.

Forms of violence reported by those experiencing sexual violence

Health consequences

The impact of ongoing abuse on the physical and mental health of survivors was assessed by counsellors. Physical health consequences such as injuries were reported by 82% of women while reproductive health problems like abortion, miscarriage, RTIs, and prolapse of the uterus were reported by 22% of women. Mental health consequences were reported by 98% of women, among whom 26% had attempted to end their life while 29.4% reported thoughts of ending life (suicidal ideation). Other mental health consequences experienced by survivors included nervousness and tension (72%) and feeling afraid all the time (36%). Forty-eight percent of the women sought help from police by filing a domestic violence complaint but in all these cases the police had registered a non-cognisable offence, i.e. an entry in a police diary that does not warrant any investigation. At present, there is no option for such women to file a criminal complaint due to “exception 2 in Section 375 of the Indian Penal Code”.

Women reporting marital rape to the hospitals: analysis of medico-legal forms of survivors of rape

Based on the data from three public hospitals in Mumbai, from 2008 to 2017, of 1664 rape survivors, at least 18 women reported marital rape and sought medico-legal support.

Women reporting marital rape were mostly young. Thirteen were in their 20s, and five were in their 30s. Of the 18 women, 8 were residing with their husbands and 10 were separated from their husbands due to severe violence. Those currently living with their husbands were married for a year or two.

Pathway to hospital

Ten women reported directly to the hospital, and police brought in eight. The women who reported to the hospital directly had been raped in the previous one to five days. These women suffered injuries and came to the hospital for treatment. One of these women was pregnant when she had been raped. Of those brought by police, the incident occurred two to three days back in one case, and two to six months ago in the remainder. As there were ongoing threats of rape or physical assault or attempts at rape by the husband, the women wanted to file a case of rape.

Forms of sexual violence and health consequences

The forms of marital rape included forced peno-vaginal and anal intercourse, inserting materials like rods, bottles, chilli powder in the vagina, forced oral sex, and forcing women to watch pornographic material. Women reported experiencing physical assault along with sexual violence. Thus, women came to the hospital to get treatment for vaginal/anal injuries, bruises, and bite marks on the body.

All the women reported experiencing domestic violence including forced sexual intercourse. Only women separated from their partners had registered domestic violence cases against their partners that included physical, emotional, and economic abuse. The women who were separated from their partners said that the husbands had either come to meet them at their residence on the pretext of asking for forgiveness or meeting the children. They had then raped them, or assaulted the women on the roads and dragged them home before raping them.

“In one such case, a woman (22-year-old) has been living separately from her husband due to sexual abuse, physical violence and demands for money. When she was going back home from the office, her husband caught her and asked for money, had sex with her forcefully and put kerosene on her. She suffered burns and reached the hospital for treatment.” (From service record of a 22-year-old survivor)

“A survivor who had divorced her husband because of domestic violence said that he came to her house, asked for forgiveness, and had forced sex with her.” (From service record of 32-year-old survivor)

It was not the first time the partner had raped them after separation. But the continued threats and fear prompted them to seek help. These threats also included threats to rape a child or relative. Two women had been raped by their husbands several times, but they reported the recent incident as the husband threatened to rape their child or relative.

Women currently married and living with their partners had been experiencing domestic violence for one or two years. The incident reported by them was not the first incident they had experienced, but the consequences of such repeated acts pushed them to seek support. They told the doctor about the violent sex that their partners forced on them. In one case, a 20-year woman married for six months came to the hospital after sustaining several injuries. She disclosed to the doctor that her husband would have sex violently with her.

“A 21-year-old survivor married for a year said that her husband injected a syringe of blood in her back when she was pregnant, which she suspects to be HIV-positive blood. She came to the hospital for a medical check-up and abortion. She disclosed that her husband had been inserting pens and bottles in her vagina, throwing chili powder, and forcing her to watch pornographic material on the mobile.” (From service record of a 21- year- old survivor)

Response of police to marital rape

All 18 women contacted the police either directly or after the medico-legal examination at the hospital. Women reported that they had been kept waiting for a long time at the police station as the police did not know what to do in cases where women reported rape by their husbands. For those who had reached the police first, such delay caused loss of medical evidence and delay in accessing medical care, causing further agony to the survivor.

For 2 of the 10 separated or divorced women, the police had registered domestic violence cases under the Indian Penal Code (IPC) 498A and/or IPC 377, but none had filed a rape case. § The police were not aware of the amendments to rape law that recognised sexual violence by the husband who was separated or divorced as rape. ** Of the eight women who were currently living with their husbands, the police noted the complaint and brought three women to the hospital but did not register a First Information Report (FIR) †† as the perpetrator of rape was the husband. The police told four women that they could not do anything in cases of rape by the husband, as marital rape was not a crime. In the case of the 21-year-old woman who reported that her husband had injected HIV-positive blood, a social worker accompanied the woman to the police and the police filed a case under Section 498A. ‡‡ The inadequate police response is of concern as all the women had suffered severe violence. The least that the police should have done was record a cognisable offence or FIR and ensure immediate medical care and examination of the survivors.

Response of health workers to marital rape

Women narrated their experience of violence to the examining doctor. Whether they came directly to the hospital or were brought by police, the hospital had followed the protocol mandated by the MoHFW for examination, treatment, and evidence collection of victims/survivors of sexual violence. The health workers had registered a medico-legal case documenting the history as told by the survivor. They had also carried out a medico-legal examination and provided treatment without speculation over whether or not this was a case of “rape” as per the law. They noted the current and past incidents of violence, conducted a medical examination, collected evidence where necessary, and provided the woman with treatment and counselling. They followed due procedure without any debate around whether a “rape pro forma” should be filled or not. It is important to note that such a response is not routine but an exception in Indian public hospital settings. The study hospitals have been following a Standard Operating Procedure since 2008 and receive technical support, such as training, supervision, and monitoring of the quality of response to survivors of rape from the NGO to which the authors belong.

However, this is not the case in most other health facilities in the city or other parts of India, where providers are not trained to respond sensitively to cases of sexual violence. The difficult experience of one of the survivors is evidence of this. The woman was denied medico-legal examination by two public hospitals in the city and spoke about how she was kept waiting at the hospital. The doctor discussed her case with senior colleagues and told the survivor that rape by her husband was not “rape” and that the hospital could not carry out a medico-legal examination. When she insisted, they asked her to register a police complaint and come back with the police. Finally, she was referred to the hospital where a crisis intervention department is located and her complaint was recorded but by then she had lost two days. This narrative depicts the routine response of most hospitals, where there is a failure to recognise marital rape as “rape” that requires medico-legal care, and underscores the need to have clear protocols and training of healthcare providers to adhere to them.

The findings from service records of survivors suggest that marital rape and other forms of sexual violence within marriage are common. Sexual violence within marriage is not limited to rape/forced sexual intercourse but also includes reproductive coercion, which causes health consequences that bring survivors in contact with a health provider. Large numbers of survivors of marital sexual violence seek health care from hospitals and counselling services from the crisis intervention department. However, very few survivors reach the hospital to report marital rape for medico-legal purposes.

Fifty-eight per cent of domestic violence survivors reported facing sexual violence from their husbands. Despite this high proportion, it is likely that many women may not have disclosed marital rape to the counsellor due to shame and the perception of sexual violence as being part and parcel of intimate relationships. It is recognised that patriarchy allows men to exert sexual and reproductive control over women. 27 It is, therefore, quite likely that the proportion of women experiencing marital rape is much higher.

Marital rape may be under-reported for many reasons other than stigma around reporting intimate experiences. These include the absence of a physical injury, normalisation of husbands forcing sex on their wives, perceptions about the difference in sexual desire of men and women, or of non-consensual sex being inevitable in marriage, 28 and the socio-cultural norms and legal statutes that condone such violence. 29

It should be noted that, rather than existing in isolation, sexual violence in marriage coexisted with physical, emotional, and economic violence. The survivors who sought services for domestic violence from the crisis intervention department spoke about marital rape and other forms of violence only as part of history-taking by the counsellors when they were encouraged to describe their experiences in detail. Findings highlight the significant impact of marital sexual violence on the physical and psychological health of women.

The findings of this study support the evidence in the literature that married women commonly experience forced sex. 30 , 31 Marital rape appears to be a daily phenomenon in the lives of a large number of women, and yet only a few women sought any formal support for marital sexual violence.

The paper presents the case of 18 women who reported marital rape and wanted their complaints to be recorded and their husbands arrested. They did not remain silent because of shame but reported it to the police and the health system. However, the response of the police was found to be very problematic in these cases. As per the amended law, in the cases of women who were separated from their husbands, the police should have promptly registered an offence of rape (against the husband) but no such case was registered, perhaps because of the police's attitude and the lack of standard protocols. The perception about marital rape amongst the police is that it is “part and parcel” of marriage. They are also influenced by societal norms that justify all forms of domestic violence, including forced sexual intercourse by the husband. Such perceptions prevent them from recognising that even within a marital relationship the consent of women is essential for sexual relationships. There are media reports that the common response of the police towards women reporting marital rape included “go back home and adjust” and “this is an internal matter”. 32 , 33

The findings from 18 cases make a strong case for marital rape to be recognised as an offence and not to be condoned just because an intimate partner perpetrates it. Not recognising marital rape is unconstitutional and violates a woman's fundamental right to healthy life and dignity. The fact that these 18 women reported marital rape indicated that they had enough of it and wanted justice.

Contrary to the response of the police, the trained health workers in the hospitals from which medico-legal forms are analysed did not compromise on their therapeutic duty. They responded by documenting the women’s history and conducting relevant medico-legal examinations and evidence collection. They ensured survivors’ access to care and provided an empathetic environment for them to seek redressal. A supportive response by healthcare providers was made possible through ongoing sensitisation and training, implementing Standard Operating Protocols (SoPs), monitoring, and supervision. Given the high occurrence and serious impact of marital rape on women's health, and the lack of legal recourse, the role of health systems is critical in the provision of supportive care and documentation. Women may not seek any legal or police support but do access treatment for the health consequences of violence. The health consequences of sexual violence must be recognised so that they can be identified and appropriate support provided to women. Several research studies have recommended that social workers, counsellors, doctors, and nurses routinely assess for sexual violence. 34–36 A longitudinal study that included clinical examination of women recommended that healthcare providers ask women with a complaint of STIs about partner sexual violence. 24

The experience of the public hospital-based crisis intervention department in this study demonstrates that hospitals geared to respond to VAW could identify abuse based on symptoms, such as vaginal infections, repeated abortions, reluctance to use contraception, multiple pregnancies, boils/swelling on genitals, amongst others. The SoP ensured a sensitive response to women reporting marital rape without speculation over whether it is criminalised or not. In contrast, a study in Bangalore had reported that healthcare providers recognise their critical role in responding to marital sexual violence in India, but their response was constrained due to barriers such as the absence of hospital protocols requiring them to assess signs and symptoms associated with VAW, and high caseload. 37 The health system can be made more responsive, as evidenced by the crisis intervention department, by allocating resources for training and sensitisation and implementing rights-based SoPs. Such an approach has been found useful and replicated in other settings. 38 The ongoing work on strengthening health systems’ response to violence survivors has significant learnings for building an effective and sensitive response of police towards survivors of marital sexual violence.

The findings of this paper highlight that Exception 2 to Section 375 of the IPC, 1860, that “sexual intercourse or sexual acts by a man with his wife, the wife not being under eighteen years of age is not rape”, is problematic. The exception contradicts the Constitution of India and various international covenants and the Protection of Women from Domestic Violence Act (PWDVA) 2005 39 itself. Section 3(a) of the PWDVA defines sexual abuse as “any conduct of sexual nature that abuses, humiliates, degrades or otherwise violates the dignity of a woman”, and squarely places spousal sexual violence as a type of domestic violence. Despite the clear legal recognition of sexual violence within marriage by PWDVA, the exception to Section 375 condones rape within marriage. But the PWDVA is civil law. The civil remedy available in such cases is a Protection Order to stop violence and offer compensation and other reliefs to the aggrieved wife. The only criminal law that a woman can use is Section 498A IPC which recognises cruelty within marriage. Cruelty is defined as any conduct that may cause serious injury or harm or drive a woman to commit suicide as a consequence of ongoing abuse. Such a definition raises the bar of evidence very high as women often have no evidence of acts of violence perpetrated against them. 40 The Supreme Court has rejected cases of marital rape where women reported sexual violence by the husband that included insertion of torches into the vagina, leading to hospitalisation following severe haemorrhage. 41

One of the recommendations of the Justice Verma Committee that was set up after the Nirbhaya case described above was that marital rape be penalised. (Verma Committee Report, 2013). In 2014, the Special Rapporteur on Violence Against Women also recommended “the amendment of Criminal Law (Amendment), Act 2013 [to] include a definition of marital rape as a criminal offence”. 42 In 2015, the Pam Rajput Committee appointed by the Government of India to study the status of women in India strongly recommended that marital rape be criminalised and argued that marriage does not presume consent. 43

International criminal law has a broad definition of rape that includes various invasive acts perpetrated by and against people of any sex or gender. It also recognises rape within marriage as a crime. In the last decade or so, several countries have amended national laws to align with these human rights standards. Such amendments are critical in ensuring access to health care and other services for redressal. There are still 36 countries in the world that do not criminalise marital rape, of which India is one.

Recognising marital rape as an offence and criminalising it will ensure that the police and other law enforcement agencies are mandated to respond to marital rape and not to trivialise it. As women have inevitable contact with the health system, doctors, nurses, and hospital-based crisis centres can play a critical role in supporting women. 44 Thus, the penalisation of marital rape and sensitisation of the health system and police can help build a sensitive response of police towards survivors of sexual violence.

The resistance to including marital rape as an offence in the existing definition of rape is rooted in patriarchal values and gender norms that define the “duties” of a wife. The marital exemption to rape is based on implied consent. The data presented here make a strong case for recognising marital rape as a crime. Removing marital exemption to rape requires policy and institutional support and allocation of resources for necessary infrastructure, human resources, and staff capacity building. The health system can play a critical role in documenting the present and past incidents of sexual violence and can help the survivor access care and justice. Whether or not the law recognises an incident of violence as an offence, the role of health professionals is to provide treatment and refer the survivor to support services. The police also must follow due process, listen to what the woman says, record her complaint and help her seek supportive services.

Limitations of the study

The primary limitation to generalising the findings of this study is that the analysis is based on service records of women who could reach the public hospital, not on population data. Moreover, since the data is based on self-reporting by women, rape and sexual violence within marriage may be more common than reported in this study.

Acknowledgements

We would like to extend our sincere gratitude to members of CEHAT’s Programme Development Committee and Anusandhan Trust Institutional Ethics Committee for reviewing the project at different stages. We would like to thank Chitra Joshi, Mrudula Sawant, Sujata Ayarkar, Aarthi Chandrasekhar and Rajeeta Chavan for providing counselling services to the survivors of violence.

Funding Statement

This project was funded through the American Jewish World Service (AJWS)

* There has been widespread national and international condemnation of the assault and gang rape of a 23-year-old health professional in Delhi in 2012, which led to her death. This case is also widely known as the Nirbhaya case.

† NFHS is the only national-level source of data on the prevalence of intimate partner violence along with related indicators

‡ The National Crime Records Bureau (NCRB), under the Ministry of Home Affairs, Government of India, collects and analyses all data on crime as defined by the IPC.

§ These are sections under criminal law.

** The current law criminalises any form of sexual intercourse by the husband upon his wife during a period of separation, as provided under section 376B of the Indian Penal Code, 1860.

†† First Information Report (FIR) is a “written document prepared by the police when they receive information about the commission of a cognisable offence” (Indian Law Watch).

‡‡ Section 498A makes it criminal for a husband and his relatives to subject a married woman to cruelty. The law has defined 'cruelty' “to include inflicting physical or mental harm to the body or health of the woman and indulging in acts of harassment to coerce her or her relatives to meet any unlawful demand for any property or valuable security” (India Code: Digital Repository of all Central and State Acts).

Disclosure statement

No potential conflict of interest was reported by the author(s).