Domestic violence against women in west
of Iran: the prevalence and related factors
Abdorrahim Afkhamzadeh, Namam-Ali Azadi, Shirin Ziaeei and
Amjad Mohamadi-Bolbanabad
Abdorrahim Afkhamzadeh is
based at the Social
Determinants of Health
Research Center, Research
Institute for Health
Development, Kurdistan
University of Medical Sciences,
Sanandaj, Iran.
Namam-Ali Azadi is based at
the Department of Biostatistic,
Iran University of Medical
Sciences, Tehran, Iran.
Shirin Ziaeei is based at the
Kurdistan University of Medical
Sciences, Sanandaj, Iran.
Amjad Mohamadi-Bolbanabad
is based at the Social
Determinants of Health
Research Center, Research
Institute for Health
Development, Kurdistan
University of Medical Sciences,
Sanandaj, Iran.
Received 24 December 2018
Revised 15 February 2019
Accepted 28 February 2019
This paper is extracted from a
doctoral dissertation for obtaining
a degree in general medicine
which was approved by the
Kurdistan University of Medical
Science under file number
267-1394.
PAGE 364 j INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE
Abstract
Purpose – The purpose of this paper is to determine the prevalence of domestic violence against women
and its related factors in Sanandaj, west of Iran.
Design/methodology/approach – This is a cross-sectional study conducted in 2016. The sample
consisted of 360 women who referred to two educational hospitals in Sanandaj. The data collection tool was
a self-report questionnaire. A multivariate logistic regression was used to determine the risk factors of
domestic violence against women.
Findings – The prevalence of “any form of violence” in the past year was 71 percent (n ¼ 245). The
prevalence of emotional, sexual and physical violence was 62.2 percent (n ¼ 225), 48.7 percent (n ¼ 168)
and 49.9 percent (n ¼ 172), respectively. Multivariate logistic regressions revealed that the “any form of
violence” has significant association with occupation of women, economic status of family and the status of
sexual satisfaction of couples.
Originality/value – The prevalence of domestic violence against women is high and alarming in Sanandaj,
Iran. Given the relationship between experience of violence and sexual dissatisfaction, sexual education
before and after marriage is recommended for couples. Also, the experience of exposure to violence in
women can be included in health centers as screening programs. In this way, couples who have risk factors
will receive the educational programs.
Keywords Domestic violence, Emotional violence, Prevalence, Iran
Paper type Research paper
Introduction
Violence against women is recognized as a public health problem in all countries (Heise, 1993).
The United Nations defines domestic violence against women as “any act of gender-based
violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to
women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether
occurring in public or in private life” (Assembly, 1993).
Violence in the family is the most common form of violence, with the highest probability of
repetition, the most social, psychological and economic consequences and the least reported to
the police (Straus et al., 2017). According to the WHO report, about 15–71 percent of
the population in ten countries experienced physical violence, sexual violence or both
(Garcia-Moreno et al., 2006). In the USA, a woman is beaten up every 18 minutes, and the
reason for 22–35 percent of women’s visits to emergency departments of hospitals is domestic
violence (Logan et al., 2006).
Violence can affect women’s mental, physical, sexual and reproductive health. Depression,
stress, suicide attempts, high-risk sexual behaviors and substance abuse tendency in female
victims of domestic violence are more than those in other women (García-Moreno et al., 2015;
Sepehrdoust, 2009; Pearlman et al., 2016; Ahmadzad-Asl et al., 2016). Other effects of
domestic violence on women’s health include digestive problems, hypertension, increased
unwanted pregnancy and nutritional problems (Garcia-Moreno et al., 2005; Sugg, 2015).
j VOL. 12 NO. 5 2019, pp. 364-372, © Emerald Publishing Limited, ISSN 2056-4902 DOI 10.1108/IJHRH-12-2018-0080
Also, child abuse is more likely in families with a high prevalence of domestic violence
(Sepehrdoust, 2009).
Many personal and social factors are associated with the experience of domestic violence in
women. In many studies, domestic violence against women is associated with husband’s job,
husband’s social class and male authority in the community ( Jahromi et al., 2016; Semahegn
and Mengistie, 2015; Babu and Kar, 2009; Sen and Bolsoy, 2017). Also, substance abuse and
low income of the husband are other factors of domestic violence against women
(Sheikhbardsiri et al., 2017; Costa et al., 2015; Patrikar et al., 2017). In some studies, it was
revealed that women with lower education and unemployed women were more likely to
experience violence (Semahegn and Mengistie, 2015; Babu and Kar, 2009). In some
other societies, including Iran, the prevalence of violence is higher in infertile women
(Ardabily et al., 2011).
The prevalence of violence against women is high in Iran ( Jahromi et al., 2016; Sheikhbardsiri
et al., 2017). In a systematic review, violence against women in Iran was reported to be 23
percent: Zahedan with 5.4 percent and Tehran with 95 percent had the lowest and highest
prevalence, respectively. The results of this study indicate that the prevalence of violence against
Iranian women varies widely from one province to another due to cultural and social differences
(Adineh et al., 2016). Kurds have a different culture than other Iranian ethnic groups. The aim of
study is to determine the prevalence of domestic violence against women and its related factors
in Sanandaj, west of Iran.

Methods
Type of study, participants and sampling
This research is a cross-sectional study conducted in 2016. The study population consisted
of all women visiting and accompanying patients in Besat and Tohid hospitals in Sanandaj.
Taking into account the 30 percent prevalence of emotional violence against women ( p)
based on previous studies (Derakhshanpour et al., 2014), 95% confidence interval, and
precision of 5 percent, the sample size was calculated as 360 people that during a month,
a daily number of 10 to 11 women (5 or 6 people from each hospital) were selected through
convenience sampling:


Z 1ða=2Þ  pð1pÞ
n¼ :
d2

Data collection tool

Measurements
The data collection tool was the WHO’s standard questionnaire (Garcia-Moreno et al., 2005),
whose reliability was reported to be 0.9 by a study conducted in Iran (Ardabily et al., 2011). The
questionnaire has two parts: the first part contains information on the demographic variables of
the husband and wife, and the second part contains items about the exposure of women to all
types of physical, emotional and sexual violence of the husband in the last year.
Outcome variables. In this study, three main variables of domestic violence including physical,
emotional and sexual violence were a dichotomous variable (yes/no), with at least one of 13, 9
and 16 instances of physical, sexual and emotional abuse of the questionnaire, respectively. The
fourth variable, i.e. “any kind of violence,” was a dichotomous variable (yes/no). “Any type of
violence” was considered in case of a positive response to at least one of the 38 examples of the
three types of the abovementioned violence.
Independent variable. Individual variables of women and husbands, economic variables, residence
and sexual satisfaction were considered to compare the types of domestic violence among
different groups. The individual variables of women include age (⩽30; W30), age at marriage

VOL. 12 NO. 5 2019 j INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE j PAGE 365
 (o15; 15–30; W30), education (elementary, high school and university) and occupation
(housewife, salaried jobs, and others, including housework with wage and part-time jobs).
Husband’s individual variables include husband’s work (laborer, salaried jobs and self-employed),
husband’s education (elementary, high school and academic) and smoking history (yes and no).
The variable of the place of residence was categorized into urban and rural residence. Sexual
satisfaction is a dichotomous variable (yes/no) according to the answer to the following question:
“Do you and your husband have sexual satisfaction in marital life?”
Data analysis. Descriptive statistics ( frequency, percentage, mean, standard deviation
and tables) were used to describe the data. In order to determine the relationship
between dependent and independent variables including physical, sexual, emotional and
“any type of violence,” all variables were inserted into the logistic model and odds ratio (OR)
and confidence interval (CI 95%) were calculated for them. SPSS 20 was used to analyze
the data.
Ethical considerations. This research was approved by the Ethics Committee of Kurdistan
University of Medical Science under Code No. 1394-267. After obtaining written consent from the
women, the anonymous questionnaires were distributed.

Findings
A total of 345 women with a response rate of 95 percent participated in this study. The mean ±
standard deviation of respondents’ age was 32.69±8.74 years. In total, 82.9 percent (n ¼ 286)
of the women were between 15–30 years old at the time of marriage. Out of all, 41.2 percent
(n ¼ 142) of the women had elementary education and 31 percent (n ¼ 107) had academic
education. In total, 70.4 percent of the respondents were housewives. The place of residence
of 90.1 percent (n ¼ 311) of the women was rural areas. In total, 73.3 percent (n ¼ 253) of the
respondents gave “no” answer to the question asking about “history of husband’s smoking in
the last year” (Table I).
The prevalence of any type of violence in last year was 71 percent (n ¼ 245). The prevalence of
emotional, sexual and physical violence in the last year was 62.2 percent (n ¼ 225), 48.7 percent
(n ¼ 168) and 49.9 percent (n ¼ 172), respectively. Also, the prevalence of domestic violence, as
separated by different groups, is presented in Table I.
Based on the results of multivariate logistic regression, having salaried jobs in women (OR ¼ 0.35,
95% CI: 0.16–0.78) had a reverse association, having moderate economic status (OR ¼ 3.2, 95%
CI: 1.17–8.71) as well as the sexual dissatisfaction of couples (OR ¼ 10.79, 95% CI: 1.34–86.5) had
a direct association with “any form of violence in the past year.”
Having salaried jobs in women (OR ¼ 0.23, 95% CI: 0.1–0.53) had a reverse association and
elementary education of the husband (OR ¼ 4.76, 95% CI: 1.59–14.25) as well as the sexual
dissatisfaction of couples (OR ¼ 12.54, 95% CI: 3.32–47.39) had a direct association with
“physical violence in the past year.”
Having salaried jobs in women (OR ¼ 0.37, 95% CI: 0.17–0.81) had a reverse association and the
sexual dissatisfaction of couples (OR ¼ 14.34, 95% CI: 3.85–53.31) had a direct association with
“sexual violence in the past year.”
Having salaried jobs in women (OR ¼ 0.41, 95% CI: 0.18–0.87) had a reverse association, and
having moderate economic status (OR ¼ 2.57, 95% CI: 1.02–6.48) as well as the sexual
dissatisfaction of couples (OR ¼ 14.15, 95% CI: 1.78–112.50) had a direct association with
“emotional violence in the past year” (Table II).

Discussion
In this study, 71 percent of women had experienced “any form of domestic violence” in the past
year, the prevalence of emotional, sexual and physical violence in women was 62.2, 48.7 and
49.9 percent, respectively. In line with these results, other studies in Iran and the world have

PAGE 366 j INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE j VOL. 12 NO. 5 2019
Table I The prevalence of experience of emotional, sexual, physical and any form of violence in the past year among the
women in Sanandaj City, Iran
Prevalence* of domestic violence
Variable Number (%) Emotional violence Sexual violence Physical violence Any form of violence

Age group
⩽30 176 (51.3) 119 (67.6)** 91 (51.7) 90 (51.1) 143 (76.1)
W30 167 (48.7) 105 (62.9) 77 (46.1) 82 (49.1) 110 (65.9)
Age at the marriage
o15 34 (9.8) 27 (79.4) 18 (47) 22 (64.7) 29 (85.3)
15–30 286 (82.9) 177 (61.9) 135 (47.2) 136 (47.6) 194 (67.8)
W30 25 (7.2) 21 (84.0) 15 (60.0) 14 (56.0) 22 (88.0)
Education
Elementary 142 (41.2) 108 (76.1) 77 (54.2) 89 (62.7) 117 (82.4)
High school 96 (27.8) 67 (69.8) 52 (54.2) 50 (52.1) 73 (76)
Academic 107 (31) 50 (46.7) 39 (36.5) 33 (30.8) 55 (51.4)
Occupation
Housewife 238 (70.4) 170 (71.4) 129 (54.2) 140 (58.8) 186 (78.2)
Salaried jobs 76 (22.5) 31 (40.8) 23 (30.3) 17 (22.4) 34 (44.7)
Others*** 24 (7.1) 20 (83.3) 13 (7.9) 13 (54.2) 21 (87.5)
Occupation of husband
Laborer 35 (10.3) 26 (74.3) 15 (42.9) 25 (71.4) 27 (77.1)
Salaried jobs 123 (36.1) 60 (48.8) 46 (37.4) 41 (33.3) 67 (54.5)
Self-employed (small business) 183 (53.7) 137 (74.9) 104 (56.8) 104 (61.2) 148 (80.9)
Education of husband
Elementary 94 (27.5) 73 (77.7) 52 (55.3) 69 (73.4) 82 (87.2)
High school 112 (32.7) 84 (75) 64 (57.1) 59 (52.7) 89 (79.5)
Academic 136 (39.8) 67 (49.3) 51 (37.5) 43 (31.6) 73 (53.7)
Economic status of family
Poor 67 (20.8) 48 (71.6) 32 (47.8) 42 (62.7) 51 (76.1)
Moderate 100 (31.1) 74 (74.0) 57 (57.0) 59 (59.0) 79 (79.0)
Rich 155 (48.1) 89 (57.4) 67 (43.2) 57 (36.8) 98 (63.2)
Resident
Urban 311 (90.1) 200 (64.3) 148 (47.6) 148 (47.6) 217 (69.8)
Rural 34 (9.9) 25 (73.5) 20 (58.8) 24 (70.6) 28 (82.4)
The husband’s smoking
No 253 (73.3) 154 (60.9) 118 (46.6) 116 (45.8) 169 (66.8)
Yes 92 (26.7) 71 (77.2) 50 (54.3) 56 (60.9) 76 (82.6)
Sexual satisfaction
Have 310 (90.6) 194 (62.6) 141 (45.5) 142 (45.8) 213 (68.7)
Not have 32 (9.4) 30 (93.8) 26 (81.2) 28 (87.5) 30 (93.8)
Total 345 (100) 225 (65.2) 168 (48.7) 172 (49.9) 245 (71.0)
Notes: *Prevalence is percentage of women reported violence to the total number of women in that category; **number (percent); ***working at home
with income, and part-time job

reported high levels of domestic violence against women. The results of a systematic review in
Iran indicated that domestic violence was 23 percent, ranging from 5.4 to 95 percent
across different provinces (Adineh et al., 2016). The prevalence of domestic violence
against women has been reported to be 56 percent in India, 33–66 percent in Africa,
27 percent in Australia, and 2–70 percent in the USA (Babu and Kar, 2009; Orpin et al., 2017;
Alhabib et al., 2010; Schei et al., 2006). Also, in line with our study results, most studies
have reported that the prevalence of emotional violence is more than physical and sexual
violence (Babu and Kar, 2009; Jahromi et al., 2016). The wide range of domestic violence in

VOL. 12 NO. 5 2019 j INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE j PAGE 367
Table II Results of bivariate logistic regression between socioeconomic characteristics and prevalence of various forms of
domestic violence reported by women in Sanandaj City, Iran
Domestic violence OR (95% CI)
Variable Emotional violence Sexual violence Physical violence Any form of violence

Age at the marriage

o15 1 1 1 1
15–30 0.71 (0.23–2.21) 2.01 (0.77–5.22) 1.48 (0.56–3.89) 1.22 (0.38–3.93)
W30 2.64 (0.47–14.75) 2.74 (0.72–10.42) 1.30 (0.33–5.16) 2.78 (0.48–16.17)

Education
Elementary 1.07 (0.39–2.93) 0.74 (0.29–1.88) 0.44 (0.16–1.17) 0.87 (0.30–2.51)
High school 1.08 (0.49–2.37) 0.98 (0.46–2.08) 0.94 (0.44–2.04) 1.09 (0.48–2.46)
Academic 1 1 1 1
Occupation
Housewife 1 1 1 1
Salaried jobs 0.41 (0.18–0.87) 0.37 (0.17–0.81) 0.23 (0.09–0.53) 0.35 (0.16–0.78)
Others* 1.69 (0.50–5.62) 1.32 (0.48–3.64) 0.76 (0.28–2.06) 1.74 (0.45–6.64)
Occupation of husband
Laborer 1 1 1 1
Salaried jobs 0.35 (0.09–1.31) 0.97 (0.31–3.18) 0.55 (0.16–1.94) 0.61 (0.15–2.38)
Self-employed (small business) 0.64 (0.21–1.92) 1.24 (0.46–3.30) 0.51 (0.18–1.46) 0.85 (0.26–2.74)
Education of husband
Elementary 1.31 (0.45–4.49) 1.39 (0.48–3.97) 4.76 (1.59–14.25) 3.67 (0.99–13.51)
High school 1.38 (0.60–3.16) 1.57 (0.72–3.39) 1.91 (0.87–4.20) 1.94 (0.82–4.63)
Academic 1 1 1 1
Economic status of family
Poor 1.64 (0.67–4.04) 1.47 (0.62–3.38) 1.06 (0.88–4.78) 2.06 (0.78–5.41)
Moderate 2.57 (1.02–6.47) 2.09 (0.92–4.75) 2.06 (0.88–4.78) 3.2 (1.17–8.71)
Rich 1 1 1 1
Resident
Urban 1 1 1 1
Rural 0.90 (0.33–2.41) 1.95 (0.79–4.81) 1.69 (0.66–4.34) 0.99 (0.33–2.95)
The husband’s smoking
No 1 1 1 1
Yes 1.20 (0.64–2.24) 0.87 (0.50–1.54) 1.09 (0.61–1.95) 1.31 (0.66–2.60)
Sexual satisfaction
Have 1 1 1 1
Not have 14.15 (1.78–112.50) 14.34 (3.85–53.31) 12.54 (3.32–47.39) 10.79 (1.34–86.50)
Notes: OR, odd ratio; CI, confidence interval. *Working at home with income, and part-time job

different countries is probably due to the different definition of violence or cultural and
social differences in different regions. Kurdistan province in western Iran seems to be
among the Iranian regions with a high prevalence of violence because of its different and
patriarchal culture.
The results of this study showed that unemployment of the woman was a risk factor for
experiencing emotional, physical, sexual and “any form of violence” in women. In line with these
results, many studies have shown that unemployment of women may increase the likelihood of
experiencing violence (Babu and Kar, 2009; Hoque et al., 2009; Sen and Bolsoy, 2017).
Employment can increase the economic power and authority of women in family decision making
and, as a result, reduce domestic violence against women (Mitchell, 1992). Kurdistan province
has one of the highest unemployment rates, including women unemployment, in Iran. It seems
that one of the reasons for higher levels of domestic violence against women is their
unemployment and low economic power of them.

PAGE 368 j INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE j VOL. 12 NO. 5 2019
According to the results of the study, lower education of the husband was a risk factor for
experiencing “physical violence” in women. In line with these results, many studies have argued
that higher levels of education among men is effective in reducing domestic violence (Ahmadi
et al., 2015; Costa et al., 2015; Oshiro et al., 2011). Higher education level of men improves
their socioeconomic status by having a good job and leads to the incidence of low-risk
behaviors (Soleimani et al., 2016). Considering that education level is directly related to one’s
social and cultural status, the reduction of domestic violence seems to be logical with an
increase in education level. Knowing ways to overcome conflicts in relationships, educated
families can reduce family violence and use sound ways to solve problems.
The results of this study showed that low income of the family was a risk factor for emotional
violence and “any type of violence” against women. Many studies have shown that poor
economic status of the family is associated with an increase in the prevalence of violence against
women (Sheikhbardsiri et al., 2017; Shamu et al., 2011). Unemployed and manual worker men
are more likely to harass their wives due to economic pressure and dependence on others (Leung
et al., 1999). It seems that economic problems in the long run reduce the level of tolerance and
induce aggression in individuals. The stress arising from inability for the proper management of
life, financial strain, feelings of helplessness and lack of control over life, and the feeling of reduced
self-worth for the spouse and children are among the factors that can increase the level of
domestic violence and its severity against women (Renzetti, 2009; Aaltonen et al., 2012). Also,
low-income men are likely to look at their wives’ financial demand as a type of pressure and
respond with increasing violence.
Based on the results of our study, couples’ sexual dissatisfaction was a risk factor for
emotional, physical, sexual and “any kind of violence.” In line with these results, some studies
conducted in Iran have linked sexual and marital dissatisfaction with the increase in domestic
violence against women (Ramezani et al., 2015; Raisi and Hosseinchari, 2012). Tadayon et al.
(2018) indicated that sexual dissatisfaction had direct association with sexual violence
(Tadayon et al., 2018). Sexual satisfaction can affect all the interactions between the husband
and wife. In fact, when one of the most important functions of the family, i.e. satisfaction of the
sexual need, disrupts, other issues will be affected. Or, in other words, other functions of the
family are interrupted. Sexual dysfunction of women can have many consequences including
divorce, violence and depression (Abdolmanafi et al., 2016; Brassard et al., 2012; Guo and
Huang, 2005). Also, it is possible sexual dissatisfaction resulted from domestic violence. Some
research indicated that victims of violence have lower sexual dissatisfaction and the most
common sexual disorder among victims reported fear of sex, desire problem and arousal
problem (Karanfil et al., 2013; Mohammed and Hashish, 2015). Therefore, couples’ awareness
of the impact of sexual satisfaction on reducing domestic violence and educating them about
sexual skills seem to be necessary to reduce violence.

Limitations of the study

The present study had three limitations: first, the self-report questionnaire was used to determine the
prevalence of violence against women, which might have been accompanied by underreporting or
over reporting. Second, given the one-year period of recalling the experience of violence by women,
respondents may have not properly recalled some experiences. Finally, although the interviewer was
women, it is possible Iranian women due to cultural and religious limitations could not talk about their
sexual satisfaction and answer this question honestly.

Conclusion
The prevalence of domestic violence against women is high and alarming in Sanandaj, Iran.
The status of women’s employment, husband’s education, economic status of family and sexual
satisfaction were risk factors for violence against women. Therefore, the experience of domestic
violence in women can be included as screening programs in comprehensive health centers.
In this way, couples who have risk factors will receive the necessary training. Also, given the
relationship between exposure to violence and sexual dissatisfaction, sexual education before
and after marriage is recommended for couples.

VOL. 12 NO. 5 2019 j INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE j PAGE 369
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Further reading
Statistics Center of Iran (2016), “Unemployment in Iran”, available at: www.amar.org.ir/Portals/0/Files/fulltext/
1395/n_ank_95-2.pdf (accessed December 10, 2018).

Corresponding author
Amjad Mohamadi-Bolbanabad can be contacted at: amohammadi1364@gmail.com

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