COVID‐19 pandemic and the prevalence of domestic violence against Iranian married women

Abstract

Aim

Domestic violence is an important public health and human rights problem. In most countries of the world, including Iran, the COVID‐19 pandemic made quarantine necessary to reduce the disease transmission rate. Therefore, due to the spread of the COVID‐19 disease and the emergence of mandatory quarantine conditions, the present study was conducted to determine the prevalence of domestic violence against women during the COVID‐19 pandemic in Iran.

Methods

In this cross‐sectional study, which was done in 2020, 240 married women were investigated. Due to the COVID‐19 pandemic, data collection was performed through virtual networks using standard questionnaires. Data were analyzed using SPSS. Descriptive statistics (relative frequencies, mean, and standard deviation) were used to determine the extent of violence. Independent t‐test and Chi‐square were used to analyze the data of the relation between the types of violence with independent variables. Also, the data were analyzed using the logistic regression model.

Results

In this study, 240 married women with a mean age of 36.27 were studied. The highest frequency was related to social violence (56.3%), and the lowest was related to financial and verbal violence (11.7%). In addition, a significant relationship was observed between sexual violence and age (p‐value < 0.05). A significant relationship was also observed between social violence and education [(OR = 1.99)] Jobs [(OR = 2.4, CI = 95%, 1.30–4.4), quarantine duration [(OR = 1.94, CI = 95%, 0.98–3.7)] and underlying diseases [OR = 1.90].

Conclusion

The high prevalence of domestic violence against women during quarantine indicates the poor health of women in society. Therefore, the roots of violence against women and methods to reduce this problem should be sought. Therefore, identification of subjects at risk and raising women's knowledge may be useful for the prevention of domestic violence and its physical and psychological complications.

INTRODUCTION

Violence is a behavior that is committed with overt or covert intent to inflict physical, psychological, or social harm on another person.¹ Domestic violence is an important public health and human rights problem and amounts to violent behavior and domination by a family member against other member(s) of the same family.² Violence occurs in various forms in different settings, including school, workplace, and society, but violence against family members, known as “domestic violence,” is the most common form of violence. Domestic violence takes many forms, such as violence against children, men, women, and the elderly.³ Women and girls are the first victims of domestic violence.⁴ Domestic violence, or spousal abuse, is the most common form of violence against women, with the highest likelihood of recurrence, lowest number of reports to the police and highest social, psychological, and economic complications.¹ Social violence puts people in a traumatic situation and is a product of the society-social/political structure and economic organizations of our world and leads to the creation and maintenance of inequality within and between different social groups (for example, women) as well as ethnic and cultural groups. Therefore, social violence is an institutional thing and is caused by unequal relations of one group over another group or a majority over a minority, and it goes beyond the differences related to individual health and aims to provide a clear understanding of (social) inequalities and power relations in the social structure. It opens the way for direct physical violence in different ways.⁵

The World Health Organization has reported the prevalence of domestic violence between 13% and 71%,⁶ occurring in 90% of cases against women, 7% to 8% in both parties, and only 2 to 3% against men.¹ Every year, more than 6 million women worldwide die from violence, many more are injured, and suffer from physical, sexual, reproductive, and mental problems.² According to the World Health Organization, 14% of deaths in men 15–44 years old and 7% of deaths of women of the same age have been due to domestic violence.⁷ Violent and harassing behaviors damage the family institution and in such situations, the family suffers serious damage. Due to the interactions of family members with each other and with those outside the family circle, violence also spreads to the surrounding community. This can incur heavy costs for society.⁸ This type of violence, in addition to early consequences such as injury or death, has long-term health consequences, such as chronic pain, enteric nervous disorders, migraine, depression, unwanted pregnancy, bleeding, sexual infections, AIDS, pelvic pain, etc. On the other hand, domestic violence causes health problems in women aged 15 to 44 more than diseases such as breast and uterine cancer, painful deliveries, and accidents. Also, it incurs a negative impact on maternal safety, family planning, prevention of sexually transmitted diseases, AIDS, and mental health.^9,10

Domestic violence is a complex and serious social issue with high social, economic, and health costs for individuals and families,¹¹ in a way that it causes such problems as aggressive behaviors, anxiety, low self-esteem, delinquency, run away from home, suicide, drug addiction, and numerous social harms.¹² Violence is an acquired behavior that is passed down from generation to generation and disrupts family cohesion. On the other hand, children are influenced by their family experience to transmit violence to society, which is known as the “cycle of violence”. In fact, domestic violence is the root of all social violence.¹³

Such studies are expected to play an important role in creating public awareness and policies and plans to control this type of violence.¹⁴ It should be noted that the COVID-19 pandemic in mid-December 2019 in Wuhan, China, and with its unimaginable expansion, in a short period of time, people's lives around the world underwent extensive changes and imposed a heavy burden on the health and treatment systems in different regions of the world.^15–17 The incubation period of the disease is between 3 and 7 days and sometimes, 14 days. In addition, the disease can be transmitted during the incubation period, so the quarantine of individuals is necessary to reduce the rate of transmission.¹⁸ Iran has also experienced the COVID-19 pandemic. Therefore, the quarantine of individuals has been inevitable, so due to the spread of the COVID-19 disease and the emergence of mandatory quarantine conditions The present study was conducted to determine the extent of domestic violence against women following the outbreak of COVID-19 in Iran and the more extensive and obligatory interactions of individuals these days. In the past months, there were reports of an increase in domestic violence in other parts of the world in the media, which were considered to be the consequences of the COVID-19 pandemic and the effects of quarantine in many countries. Accordingly, an increase in cases of domestic violence has been reported worldwide, especially in China, England, the United States, Brazil, France, and Australia.²

Therefore, due to the spread of the COVID-19 disease and the emergence of mandatory quarantine conditions, the present study was conducted to determine the prevalence of domestic violence against women with the COVID-19 pandemic in Iran.

METHODOLOGY

In this cross-sectional study, which was done in the spring of 2020, 240 married women were examined. The method of calculating the sample size has been chosen according to the prevalence in previous studies and based on the sample size calculation formula to estimate the ratio (qualitative attribute).¹⁹ The target population in this study is all married women in Iran. Data collection was performed through virtual networks and using a standard questionnaire due to COVID-19 pandemic and the high transmissivity of this disease. Since the data collection was performed using social media, initially the convenience non probability sampling method was used, so that the questionnaires were provided to administrators of the groups, and the administrator was asked to provide the members with necessary explanations regarding voluntary answering of questions and the purpose of collecting data. Then, by snowball sampling method, the individuals were asked to hand the questionnaire down to their friends and acquaintances. At first, 271 subjects completed the questionnaire, but about 31 subjects were single and excluded from the study. Finally, the data of 240 individuals were analyzed. The questionnaire used in this study was prepared and adjusted by the Center for Standard Questionnaires of Rovan Po. The questionnaire used in this study has 11 demographic items, items related to COVID-19 pandemic, and a standard questionnaire regarding domestic violence against women. This questionnaire has 34 items aiming at measuring violence against women from different dimensions (sexual, emotional, psychological, verbal, financial, and social violence). It uses a five-point Likert scale in the following order: very low (1), low (2), medium (3), high (4), very high (5) and has 8 subscales of sexual, emotional, psychological, verbal, financial, and social violence. This questionnaire is scored from 0 to 170, such that a score below 85 indicates nonviolence, and a score above 85 indicates the presence of violence. To determine the validity of this questionnaire, the values of CVI and CVR were calculated as 0.87 and 0.9, respectively, and the reliability of the questionnaire was 0.9 as obtained through Cronbach's alpha test. After collecting data, they were analyzed in SPSS.24. Descriptive statistics (relative frequencies, mean, and standard deviation) were used to determine the extent of violence. Independent t-test and Chi-square test were used to analyze the data of the relation between the types of violence with independent variables. Also, the data were analyzed using the logistic regression model.

FINDINGS

In this study, 240 married women with a mean age of 36.27 were examined for domestic violence following the outbreak of COVID-19 pandemic in Iran. Table 1 shows the frequency distribution of 6 domains of domestic violence (sexual, social, financial, verbal, emotional, and psychological violence). Among these 6 domains, the highest frequency was related to social violence (n = 135 or 56.3%), and the lowest frequency was related to financial and verbal violence (n = 28 or 11.7%).

TABLE 1 Frequency distribution of six areas of domestic violence following the outbreak of Corona pandemic in Iran.

Sexual violence	Social violence	Financial violence	Verbal violence	Emotional violence	Psychological violence
Nonviolence, n (%)	Violence, n (%)	Nonviolence, n (%)	Violence, n (%)	Nonviolence, n (%)	Violence, n (%)	Nonviolence, n (%)	Violence, n (%)	Nonviolence, n (%)	Violence, n (%)	Nonviolence, n (%)	Violence, n (%)
203 (84.6)	37 (15.4)	105 (43.8)	135 (56.3)	212 (88.3)	28 (11.7)	212 (88.3)	28 (11.7)	144 (60)	96 (40)	199 (82.9)	41 (17.1)

Based on the findings of this study, a significant relationship was observed between sexual violence and age (p-value = 0.05). Also, there was a significant relationship between social violence and education (p-value = 0.02), such that those with university education were 1.99 time more exposed to social violence than those without university education (OR = 1.99, CI = 95%, 1.09–3.6). In this study, a significant relationship was observed between social violence and job (p-value =  0.01). In this regard, those with nongovernmental jobs were 2.4 times more likely to experience social violence (OR = 2.4, CI = 95%, 1.30–4.4). There was also a significant relationship between social violence and quarantine duration (p-value = 0.05). Those who quarantined themselves for one month were 1.94 more likely to experience social violence than those who had a shorter quarantine duration (OR = 1.94, CI = 95%, 0.98–3.7). Those with underlying diseases were 1.90 times more likely to experience social violence than those without underlying diseases (p-value = 0.04) (OR = 1.90, CI = 95%, 1.00–3.5) (Table 2).

TABLE 2 Frequency distribution of two domains of domestic violence (sexual, social) based on demographic variables and variables related to Corona pandemic.

Variables	Domestic violence
Sexual violence	p-Value	OR (95% CI) Univariate	Social violence	p-Value	OR (95% CI) Univariate
Nonviolence, n (%)	Violence, n (%)	Nonviolence, n (%)	Violence, n (%)
Education
Academic	158 (87)	23 (12.7)	0.07	1	72 (39.8)	109 (60.2)	0.02	1.99 (1.09–3.6)
Nonacademic	45 (77.6)	13 (22.4)	1.98 (0.93–4.2)	33 (56.9)	25 (43.1)	1
Occupation
Governmental	22 (78.6)	23 (21.4)	0.57	1.73 (0.61–4.9)	13 (46.4)	15 (53.6)	0.01	1.27 (0.55–2.9)
Nongovernmental	62 (84.9)	11 (15.1)	0.49 (0.49–2.5)	23 (31.5)	50 (68.5)	2.4 (1.30–4.4)
Unemployed	102 (86.4)	16 (13.6)	1	62 (52.5)	56 (47.5)	1
Medical field or occupation
No	158 (84.5)	29 (15.5)	0.94	1.03 (0.44–2.4)	78 (41.7)	109 (58.3)	0.23	1.45 (0.78–2.6)
Yes	45 (84.9)	8 (15.1)	1	27 (50.9)	26 (49.1)	1
Number of children
No children	29 (90.6)	3 (9.4)	0.10	1	18 (56.3)	14 (43.8)	0.29	1
Less than 3 children	119 (81)	28 (19)	2.27 (0.64–8.0)	62 (42.2)	85 (57.8)	1.76 (0.81–3.8)
More than 3 children	31 (93.9)	2 (6.1)	0.62 (0.09–4.0)	13 (39.4)	20 (60.6)	1.97 (0.73–5.3)
Spouse job
Governmental	8 (66.7)	4 (33.3)	0.10	1	6 (41.7)	7 (58.3)	0.51	1
Nongovernmental	100 (88.5)	13 (11.5)	2.39 (0.63–9.0)	45 (39.8)	68 (60.2)	1.30 (0.38–4.4)
Unemployed	67 (82.7)	14 (17.3)	0.62 (0.27–1.5)	39 (48.1)	42 (51.9)	1.4 (0.78–2.4)
Duration of marriage
More than 10 years	38 (84.4)	17 (15.3)	0.99	1	40 (41.4)	65 (58.7)	0.19	1.76 (0.43–3.5)
More than 5 years	47 (83.9)	9 (16.1)	1.05 (0.43–2.5)	22 (39.2)	34 (60.7)	1.93 (0.87–4.2)
Less than 5 years	67 (82.7)	7 (15.5)	1.01 (0.39–2.6)	25 (55.6)	20 (44.4)	1
Housing status
Rental house	63 (80.8)	15 (19.2)	0.25	1.54 (0.73–3.2)	29 (37.2)	49 (62.8)	0.14	1.52 (0.86–2.6)
Personal housing	117 (86.7)	18 (13.3)	1	64 (47.4)	71 (52.6)	1
Quarantine period
More than a month	145 (86.3)	23 (13.7)	0.66	1	68 (40.5)	100 (59.5)	0.05	1.94 (0.98–3.7)
Less than a month	35 (79.5)	9 (20.5)	1.62 (0.69–3.8)	25 (56.8)	19 (43.2)	1
Underlying disease
No	151 (84.4)	28 (15.6)	0.59	1.27 (0.52–3.09)	86 (48)	93 (52)	0.04	1
Yes	48 (87/0.3)	7 (12.7)	1	18 (32.7)	37 (67.3)	1.90 (1.00–3.5)
Reason to leave home
Do not leave the house	49 (87.5)	71 (12.5)	0.42	1	24 (42.9)	32 (57.1)	0.21	1
Walking	27 (84.4)	5 (15.6)	1.19 (0.37–4.48)	16 (50.0)	16 (50.0)	0.75 (0.3 1–1.7)
Excursion in the city	16 (94.1)	1 (5.9)	0.43 (0.05–3.8)	10 (58.8)	7 (41.2)	0. 52 (0.71–1.5)
Going to work	41 (75.9)	13 (24.1)	2.22 (0.81–6.0)	24 (44.4)	30 (55.6)	0.93 (0.44–1.9)
Family visit	40 (87.0)	6 (13.0)	1.05 (0.32–3.3)	22 (47.8)	24 (52.2)	0.81 (0.37–1.7)
Shopping	30 (85.7)	5 (14.3)	1.16 (0.34–4.0)	9 (25.7)	26 (74.4)	2.16 (0.86–5.4)
Age	Mean ± SD	Mean ± SD	0.05	–	Mean ± SD	Mean ± SD	0.64	–
36.79 ± 9.90	33.31 ± 8.75	35.93 ± 10.95	36.53 ± 8.85

In this study, a significant relationship was observed between financial violence and spouse's job (p-value = 0.002), such that those whose spouse's had a governmental job were 7.55 times more likely to experience financial violence (OR = 7.55, CI = 95%, 1.89–30.1). In this study, there was a significant relationship between financial violence and leaving home (p-value = 0.02). Those who left home for shopping were 3.25 times more likely to experience financial violence than those who did not leave home (OR = 3.25, CI = 95%, 0.87–12.0). There was a significant relationship between verbal violence and medical education (p-value = 0.04). Those who have a medical degree are 0.76 less likely to suffer from verbal violence (OR = 0.24, CI = 95%, 0.05–1.50). Those whose spouse had a governmental job were 5.71 times more likely to experience verbal violence (p-value = 0.04) (OR = 5.71, CI = 95%, 1.49–21.8). Also, there was a significant relationship between verbal violence and duration of marriage (p-value = 0.05). Those who had married for a duration between 5 and 10 years were 2.01 times more likely to suffer from verbal violence (OR = 2.01, CI = 95%, 0.82–4.9) (Table 3).

TABLE 3 Frequency distribution of two domains of domestic violence (financial, verbal) based on demographic variables and variables related to Corona pandemic.

Variables	Domestic violence
Financial violence	p-Value	OR (95% CI) Univariate	Verbal violence	p-Value	OR (95% CI), Univariate
Nonviolence, n (%)	Violence, n (%)	Nonviolence, n (%)	Violence, n (%)
Education
Academic	162 (89.5)	19 (10.5)	0.30	1	163 (90.1)	18 (9.9)	0.24	1
Nonacademic	49 (84.5)	9 (15.5)	1.56 (0.66–3.6)	49 (84.5)	9 (15.5)	1.66 (0.70–3.9)
Occupation
Governmental	24 (85.7)	4 (13.3)	0.43	1.47 (0.43–4.9)	25 (89.3)	3 (10.7)	0.58	1.06 (0.27–4.0)
Nongovernmental	61 (83.6)	12 (16.4)	1.73 (0.73–4.1)	66 (84.9)	11 (15.1)	1.56 (0.65–3.7)
Unemployed	106 (89.8)	12 (10.2)	1	106 (89.8)	16 (10.2)	1
Medical field or occupation
No	165 (88.2)	22 (11.8)	0.92	1	161 (86.1)	26 (13.9)	0.04	1
Yes	47 (88.7)	6 (11.3)	0.95 (0.36–2.4)	51 (96.2)	2 (3.8)	0.24 (0.05–1.05)
Number of children
No children	20 (90.6)	3 (9.4)	0.56	1.60 (0.25–10.2)	30 (93.8)	2 (6.3)	0.51	1
Less than 3 children	129 (87.8)	18 (12.2)	2.16 (0.47–9.81)	129 (87.8)	18 (12.2)	2.90 (0.46–9.5)
More than 3 children	31 (93.9)	2 (6.1)	1	28 (84.8)	5 (15.2)	2.67 (0.48–14.9)
Spouse job
Governmental	7(58.3)	5 (41.7)	0.002	7.55 (1.89–30.1)	7 (58.3)	5 (41.7)	0.003	5.71 (1.49–21.8)
Nongovernmental	103 (91.2)	10 (8.8)	1.02 (0.37–2.8)	103 (91.2)	10 (8.8)	0.77 (0.30–2.0)
Unemployed	74 (91.4)	7 (8.6)	1	72 (88.9)	9 (11.1)	1
Duration of marriage
More than 10 years	99 (89.2)	12 (10.8)	0.99	1	99 (89.2)	12 (10.8)	0.05	1
More than 5 years	50 (89.3)	6 (10.7)	0.99 (0.35–2.7)	40 (80.4)	11 (19.6)	2.01 (0.82–4.9)
Less than 5 years	49 (88.9)	5 (11.7)	1.03 (0.34–3.1)	43 (90.6)	2 (4.4)	0.38 (0.08–1.7)
Housing status
Rental house	67 (85.9)	11 (14.1)	0.23	1.70 (0.73–3.95)	66 (84.6)	12 (15.4)	0.20	1.68 (0.70–4.01)
Personal housing	123 (91.1)	12 (8.9)	1	122 (90.3)	13 (9.6)	1
Quarantine period
More than a month	152 (90.5)	16 (9.5)	0.42	1	15 (89.9)	17 (10.1)	0.28	1
Less than a month	38 (86.4)	6 (13.6)	1.50 (0.55–4.09)	37 (84.1)	7 (15.9)	1.68 (0.64–4.3)
Underlying disease
No	161 (89.9)	18 (10.1)	0.35	1	161 (89.9)	18 (10.1)	0.35	1
Yes	47 (85.6)	8 (14.5)	1.52 (0.62–3.7)	47 (85.5)	8 (14.5)	1.52 (0.62–3.7)
Reason to leave home
Do not leave the house	52 (92.9)	4 (7.1)	0.02	1	49 (87.5)	7 (12.5)	0.26	1
Walking	32 (100)	0 (0)	–	30 (93.8)	2 (6.3)	0.046 (0.09–2.3)
Excursion in the city	17 (100)	0 (0)	–	17 (100)	0 (0)	–
Going to work	44 (81.5)	10 (18.5)	2.95 (0.86–10.0)	49 (90.7)	5 (9.3)	0.71 (0.21–2.4)
Family visit	39 (84.8)	7 (15.2)	2.33 (0.63–8.5)	39 (84.4)	7 (15.2)	1.25 (0.40–3.8)
Shopping	28 (80)	7 (20)	3.25 (0.87–12.0)	28 (80)	7 (20)	1.75 (0.55–5.5)
Age	Mean ± SD	Mean ± SD	0.63	–	Mean ± SD	Mean ± SD	0.34	–
36.38 ± 9.85	35.43 ± 9.57			36.49 ± 9.82	34.6 ± 9.70

In this study, a significant relationship was observed between emotional violence and quarantine duration (p-value = 0.03). Those who were in quarantine for less than one month were 2.02 times more likely than those who were in quarantine for more than one month to experience emotional violence (OR = 2.02, CI = 95%, 1.03–3.9). There was a significant relationship between psychological violence and medical education (p-value = 0.01). Those who have a medical degree are 4.25 times more likely to suffer from psychological violence (OR = 4.25, CI = 95%, 1.25–14.3). Also, psychological violence was also significantly related to the number of children (p-value = 0.008). Those who had more than 3 children were 8.62 times more likely to suffer from psychological violence (OR = 8.62, CI = 95%, 1.13–65.6). Those whose spouse had a governmental job were 5.07 times more likely to be subjected to psychological violence (p-value = 0.03) (OR = 5.07, CI = 95%, 1.34–19.0). Also, there was a significant relationship between psychological violence and quarantine duration (p-value = 0.02). Those who were in quarantine for less than one month were 2.4 times more likely to experience psychological violence than those who were in quarantine for more than one month (OR = 2.4, CI = 95%, 1.11–5.5) (Table 4). It is necessary to explain that in Tables 2 and 3, quarantine is directly related to the COVID pandemic, other variables in the table are also affected by COVID conditions and their effects on people's lives are indirectly related to COVID-19. Based on the questionnaire Filled and obtained points (0–170) and after descriptive analysis of the results, emotional and social violence had the highest frequency. Also, sexual and financial violence had the least cases, and psychological and verbal violence were also in the middle of this spectrum.

TABLE 4 Frequency distribution of two violence domains (emotional and psychological) based on demographic variables and variables related to Corona pandemic.

Variables	Domestic violence
Emotional violence	p-Value	OR (95% CI) Univariate	Psychological violence	p-Value	OR (95% CI) Univariate
Nonviolence, n (%)	Violence, n (%)	Nonviolence, n (%)	Violence, n (%)
Education
Academic	113 (62.4)	68 (37.6)	0.14	1	153 (84.5)	28 (15.5)	0.22	1
Nonacademic	30 (51.7)	28 (48.3)	1.55 (0.85–2.8)	45 (77.6)	13 (22.4)	1.57 (0.75–3.2)
Occupation
Governmental	15 (53.6)	13 (46.4)	0.67	1.40 (0.61–3.2)	22 (78.6)	6 (21.4)	0.89	1.26 (0.45–3.5)
Nongovernmental	42 (57.5)	31 (42.5)	1.19 (0.66–2.1)	60 (82.9)	13 (17.9)	1.00 (0.46–2.1)
Unemployed	73 (61.9)	45 (38.1)	1	97 (82.2)	21 (17.8)	1
Medical field or occupation
No	107 (57.2)	80 (42.8)	0.09	1.72 (0.89–3.32)	149 (79.7)	38 (20.3)	0.01	4.25 (1.25–14.3)
Yes	37 (69.8)	16 (30.2)	1	50 (94.3)	3 (5.7)	1
Number of children
No children	22 (68.8)	10 (31.3)	0.52	1	31 (96.9)	1 (3.1)	0.008	1
Less than 3 children	86 (58.5)	61 (41.5)	1.56 (0.69–3.5)	115 (78.2)	32 (21.8)	8.62 (1.13–65.6)
More than 3 children	21 (63.6)	12 (36.4)	1.25 (0.44–3.5)	31 (93.9)	2 (6.1)	2.00 (0.17–23.2)
Spouse job
Governmental	5 (41.7)	7 (58.3)	0.27	2.03 (0.59–6.9)	7 (58.3)	5 (41.7)	0.03	5.07 (1.34–19.0)
Nongovernmental	73 (64.6)	40 (35.4)	0.79 (0.44–1.4)	95 (84.1)	18 (15.9)	1.34 (0.58–3.09)
Unemployed	48 (59.3)	33 (40.7)	1	71 (87.7)	10 (12.3)	1
Duration of marriage
More than 10 years	63 (56.8)	48 (43.2)	0.35	1.85 (058–5.8)	94 (84.7)	17 (15.3)	0.08	1.68 (0.80–3.5)
More than 5 years	35 (62.5)	21 (37.5)	3.41 (1.03–11.2)	42 (75)	14 (25)	1.32 (0.57–3.0)
Less than 5 years	31 (68.9)	14 (31.1)	1	41 (91.1)	4 (8.9)	1
Housing status
Rental house	49 (62.8)	29 (37.2)	0.68	1	63 (80.8)	15 (19.2)	0.4	1
Personal housing	81 (60)	54 (40)	1.12 (0.63–2.0)	115 (85.2)	20 (14.8)	1.36 (0.65–2.8)
Quarantine period
More than a month	109 (64.9)	59 (35.1)	0.03	1	146 (86.9)	22 (13.1)	0.02	1
Less than a month	21 (47.7)	23 (52.3)	2.02 (1.03–3.9)	32 (72.7)	12 (27.3)	2.4 (1.11–5.5)
Underlying disease
No	111 (62.0)	68 (38.0)	0.61	1	152 (84.9)	27 (15.1)	0.38	1
Yes	32 (58.2)	23 (41.8)	1.17 (0.63–2.1)	44 (80)	11 (20)	1.4 (0.6–3.06)
Reason to leave home
Do not leave the house	35 (62.5)	21 (37.5)	0.18	1	47 (83.9)	9 (16.1)	0.66	1
Walking	27 (84.4)	5 (15.6)	0.30 (0.1–0.92)	29 (90.6)	3 (9.4)	0.54 (0.13–2.16)
Excursion in the city	11 (64.7)	6 (35.3)	0.90 (0.29–2.82)	15 (88.2)	2 (11.8)	0.69 (0.13–3.5)
Going to work	32 (59.3)	22 (40.7)	1.14 (0.53–2.46)	45 (83.3)	9 (16.7)	1.04 (0.38–2.8)
Family visit	24 (52.2)	22 (47.5)	1.52 (0.69–3.27)	36 (78.4)	10 (21.7)	1.45 (0.53–3.9)
Shopping	15 (42.9)	20 (57.1)	2.22 (0.94–5.2)	27 (77.1)	8 (22.9)	1.54 (0.53–4.4)
Age	Mean ± SD	Mean ± SD	0.64	–	Mean ± SD	Mean ± SD	0.97	–
36.02 ± 10.28	36.63 ± 9.10	36.26 ± 9.67	36.32 ± 10.52

DISCUSSION

Violence against women existed even before the onset of the pandemic and was a global problem.²⁰ In recent months, there have been reports in the media of an increase in domestic violence in many countries, which is a consequence of the COVID-19 pandemic as well as quarantine. Accordingly, there has been an increase in domestic violence worldwide, especially in China, the United Kingdom, the United States, Brazil, France, and Australia.²¹ Preliminary research in this regard also indicates the need for an immediate response and the development of strategies to prevent and respond to domestic violence.²²

The present study aimed at the investigation of domestic violence against women following the COVID-19 pandemic in Iran. In this study, the responses of 240 married women with a mean age of 36.27 were evaluated. According to the results, social and emotional violence had the highest frequency and financial and verbal violence had the lowest frequency.

In a study to assess the prevalence of domestic violence against women during the COVID-19 pandemic, Gebrewahd et al. also found a prevalence of 13.3% in psychological violence, 8.3% in physical violence, and 5.3% in sexual violence.²³ The UN Women also reports a 30% increase in domestic violence since March 17, when quarantine began in France. In Cyprus and Singapore, emergency telephone numbers recorded 30% and 33% of domestic violence-related calls, respectively.²¹ Previous studies in Iran have also shown emotional, sexual, and physical violence. In this study, a significant relationship was observed between sexual violence with age, social violence with the level of education, occupation of individuals, duration of quarantine and their background illness, and verbal violence with the length of marriage, medical field of study, and spouse's occupation. In other studies, there is a significant relationship between violence and the age, education level, occupation of women and their husbands, as well as the addiction status of their husbands^23,24 which is in line with the present research. Also, in the present study, a significant relationship was observed between financial violence with spouse's occupation and the reason for leaving home, emotional violence with quarantine period, and psychological violence with medical field of study, number of children, spouse's occupation, and quarantine period.

Other studies during the COVID-19 pandemic have found a significant relationship between social, emotional, and psychological violence with quarantine duration. The chances of social violence increase with increasing quarantine duration and the proportion of other types of violence decreases with increasing quarantine duration,²⁵ which is somewhat consistent with the present study. Imperfect consistency can be due to study time and response limitations.

On the other hand, the lack of legal protection for women against violence of their husbands can also be considered as one of the reasons for the increase in spousal abuse.²⁶

Given the complexities of the domestic violence phenomenon, new protocols and approaches have been recommended to combat the problem, including educating people. Also, to deal with this problem, health professionals should be taught with related information and warning signs. Domestic violence can affect both men and women, and both may experience the same amount of violence. In situations such as the Covid-19 pandemic, gender bias is possible and may marginalize men's problems. Therefore, we must be careful in equalizing and measuring this situation. Last but not least is the readiness of health and security systems to pursue cases of violence and to take steps to prevent, identify, and combat them. This highlights the need for a teamwork.^21,22

One of the limitations of the present study is the limited number of women who participated in the study and also the fear and anxiety of some participants in answering the questions raised and the presence of their husbands in the Q&A session. Among the other limitations of this project, we can mention the difficulty in persuading and obtaining the consent of some virtual network managers to upload the project questionnaire in virtual groups and channels and their lack of cooperation. Also, the people present in the groups may not cooperate and trustless due to the nature and conditions of answering in the virtual space, and as a result, there is a possibility of giving unrealistic and even irrelevant answers. One of the best ways to control and prevent violence, not only at the family level but also at the community level, is to provide continuous and effective training through the media and educational institutions to people in the community. Meanwhile, providing training in life skills, such as the power of saying no, increasing self-confidence and self-esteem, maintaining mutual respect, etc., is of particular importance. Also, there should be appropriate legal mechanisms to investigate and deal with violence at the family and community level, and these mechanisms should be fully known at the community level and be easily accessible to the people.

CONCLUSION

The high prevalence of domestic violence against women during the quarantine reflects the poor health status of women in society. Therefore, the roots of violence against women and ways to reduce this health problem should be sought. Identification of the subjects at risk and raising women's awareness may be the ways to prevent the domestic violence and its physical and psychological complications.

The important point is that women whose husbands' jobs were in the government were more often subjected to financial, verbal, and emotional violence, which can be due to fatigue, working conditions, etc. Therefore, training employees in this regard can be useful in reducing violence.

AUTHOR CONTRIBUTIONS

NM, HS, MH, and KKF designed and conceived the study. RKH, AA, and MM collected the data. NM, MM, HS, and FVS analyzed and interpreted the data. All authors drafted manuscript. HS and NM provided administrative, technical, or material support. All authors contributed to the article and approved the submitted version.

FUNDING INFORMATION

None.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT

The data presented in this study are available in the Supporting Information of this article.

ETHICS STATEMENT

Approval of the research protocol by an Institutional Reviewer Board: IR.MEDSAB.REC.1399.023 Sabzevar University of Medical Sciences.

Informed Consent: N/A.

Registry and the Registration No. of the study/trial: N/A.

Animal Studies: N/A.

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