Domestic violence in Rawalpindi

Objectives: To study the prevalence of domestic torture in Rawalpindi. Study design: Retrospective, cross-sectional. Place and duration of study: DHQ Hospital Rawalpindi, from 1st January 2016 to 31st Dec 2016. Material and methods: Record of Medico-legal cases of domestic violence was obtained from DHQ Hospital Rawalpindi. Analysis of all the domestic torture cases regarding age group involved, injury pattern, pregnant/non-pregnant victims, urban/rural distribution and culprits were done. Results: A total of 118 cases of domestic torture reported at the DHQ Hospital Rawalpindi. All the victims were females, 110 cases of blunt trauma and 8 cases of firearm injuries reported. 12 females were pregnant, the most common age group of victims was 20-30 years, and 113 cases belonged to urban areas as compared to only 5 cases


Introduction
As defined by the World Health Organization, domestic violence encompasses physical and psychological distress including sexual coercive acts towards primarily women by a current or former male intimate partner. 1 Domestic violence includes but is not limited to, all acts of gender-based and other physical and psychological abuse committed by a respondent against women, children and other vulnerable persons with whom the respondent is or has been in domestic relationship. 2 Domestic violence is a worldwide problem but in developing countries like Pakistan, the cases of domestic violence are increasing at an alarming rate. An estimated 5000 women are killed per year from domestic violence, with thousands of others maimed or disabled worldwide. 3 There are many forms of domestic violence against women ranging from psychological abuse in the form of controlling behavior, economic abuse or pressures and social isolation; physical in the form of torturing, beating or slapping and sexual abuse in the form of forced sexual intercourse. 4 Among the main causes of domestic violence in Pakistan are arranged marriages, different psyche/social background of husband and wife, disagreements, low education/illiteracy of spouses particularly of women, non-employment of females, poverty, addiction among males, ignorance about rights of women, prolonged lethargic litigation procedure, misconceptions about religion, traditional norms of society. Traditionally the females have considered the sole property of the males as unmarried women are under the ownership of their brothers and fathers and married women are under their husbands and in-laws. Due to this proprietorship, males are much more dominant in our culture. The male has right not only to verbal, physical, mental, sexual abuse. Even the killing of females under different names as honor killing/karokari, are taken as norms of the community. The male is physically strong and also the only earning member of the domestic setup so his decision is taken as final and he can also impose financial sanctions on women and families. A cross-sectional survey of 490 randomly selected women of reproductive age from a rural health center in Pakistan, reported that 65% of those interviewed had experienced domestic violence. 5 Psychologically the women in our country consider themselves incompetent, incomplete and defective without males, which is another cause of male superiority and domestic torture.

Materials and Methods
This is a retrospective, cross-sectional study, done in DHQ Hospital Rawalpindi, a public sector hospital, attached with Rawalpindi Medical University, catering medico legal and postmortem cases. The medico legal registers of the duration of the calendar year of 2016 were consulted. The cases of domestic violence were isolated and month-wise analyzed with reference to the age of the victims, nature of injuries, kind of weapon used, accused person relationship, pregnant/non pregnant victims and rural/urban settlement. Postmortem cases regarding death due to domestic violence were not considered.

Result
In 2016 in Rawalpindi 118 cases of domestic violence were reported. Regarding age group maximum of 49 (41.53%) of domestic torture belonged to the age between 21-30 years the peak age of youth, in contrast to a study conducted at Faisalabad, where only 35.19% cases were between age 20-29 years. 6 The next age of the victim of domestic torture remained between 31-40 years, a total of 28 (23.73%) cases. 13 (11.02%) cases belonged to age between 41-50years, the age of maturity. The cases of domestic torture were decreasing with increasing age. Only 11 cases (9.32%) of age between 51-60 years, the same number (9.32%) were between age 11-20 years. only 4 cases (3.39%) of age 60 years and above reported. In 2 cases, the age of a victim has not been mentioned by the CMO (Causality Medical Officer). (Table 1). Not mentioned 2 Grand total 118 As for as the perpetrator is concerned, in 77 (65.25%) cases the person responsible for torture is not mentioned by the CMO. In 15 out of the remaining 41(36.59%) cases, the highest number of this study, it is the husband who is responsible for inflicting injuries on the wife. In each of 6(14.63%) cases in-laws and neighbors were involved. in 3 (7.32%) cases the husband and in-laws acted jointly for torture; with the same numbers (7.32%) the relatives were responsible. In 3 (7.32%) cases of torture, with one case each, the ex-husband, landlord, and daughter-in-law were responsible for torture. In 5 (12.2%) cases random persons were involved ( Figure 1). Figure 1: Perpetrators who were involved in domestic violence.
Regarding the kind of weapon used blunt trauma is on the top with 107 (90.68%) reported cases. The physical abuse is the most common type of abuse. 7 19% of cases of domestic violence involve a weapon. 8 In 8(6.78%) cases, the cause of injury is firearm weapons. In 3(2.54%) cases bony injuries (fracture/dislocation) were noted. (Table 2).  [16][17] However, in a study conducted in Turkey no association between alcohol consummation and prevalence of domestic violence found. 18 The quality and quantity of dowry items also play a role in domestic violence. The domestic torture may be as verbal abuse, psychological abuse, physical injuries, sexual abuse, acid attack or even death of the female. Sexual violence affects millions of women worldwide cutting across cultural and religious barriers. 19 In Pakistan, 83.6% of study participants reported having suffered from emotional abuse at some point of time in their life. 20 Illiteracy and misbelieves play a leading role in domestic torture. In most cases, it is considered appropriate for the male partner or any other male in the house to kill a female under various guises such as honor killing etc. 21 In another study conducted in Islamabad the capital of the country, 68.4% of men and 53.1% of women were of the view that honor killing is justified. 22 Society's acceptance and sanctification of extra-judicial killings masquerading as saving honor are disturbing and need to be studied and documented so as to develop a meaningful response in our country. 23 Islamabad, the capital city of Pakistan is considered well educated in the whole country and these people believe that killing of a female by the male partner is justified, what can we say the state of affairs in other parts of the country. It is also another reason Pakistan has been named once again the second-worst country in terms of gender equality in the world by the Global Gender Gap Index 2018, flanked by Iraq (147) and Yemen (149). 24 Victims of domestic violence have to suffer mental torture, various types of anxieties, depressions, and other psychological illnesses, in addition to physical injuries pain, agony and various types of temporary and permanent physical disabilities. Violence has a profound negative impact on the physical and mental health of the victim with short and long term consequences. 25 The children who observe various types of tortures by their fathers will also suffer a lot, as these are mentally affected and feel insecure. Such children easily become victims of addiction. They also indulge in inflicting tortures on their wives after marriages. Some type of recognition of problem at the national level is present as Govt. has taken many steps and laws have been promulgated e.

Conclusion
The females should be encouraged to report every case of domestic violence so that the culprits may be taken to task. Effective legislation by the Parliament, strict implementation of the law, speedy trials and proper protection of the victim by the state, will provide a remedy to control the domestic violence in the society. Reforms in the judicial system, Police (thana) culture, means of investigations and introduction of scientific techniques as DNA, Biometrics, in investigations are the basic requirements in our country to control the law and order situation in society. Strict punishments for corrupts and up-gradation of the Forensic Science Agency, employment of proper staff are other ways to curb crimes in the country.