الفهرس 
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Abstract
Infertility is a very stressful condition that affects social and marital life of a couple. Compared to fertile women, infertile women are twice as vulnerable against violence. Moreover, experience of infertility profoundly affects the personal well-being of women. Violence against women is a global public health issue that has serious implications on women’s health. It affects the lives of millions of women worldwide and occurs in all sections of society regardless of race, ethnicity, religion or sex.
Aim of the study:
This study aimed to identify the domestic violence against infertile women attending El-Shatby Maternity University Hospital.
Subjects:
A convenient sample of approximately 300 infertile women who were available at the time of data collection were recruited from gynecologic and infertility outpatient clinics at El-Shatby Maternity University Hospital. All subjects fulfilled the following inclusion criteria:
- Women at reproductive age.
- Married for at least one year without using any contraceptive methods.
- Infertile (primary infertility).
Materials and Method
A simple descriptive research design was adopted in this study. It was conducted at El-Shatby Maternity University Hospital in Alexandria.
Study tools:
Two tools were used to collect the necessary data:
Tool I: Socio-demographic and clinical data structured interview schedule. It included four parts:
Part1: Socio-demographic characteristics such as age, age at marriage, religion for both woman and her husband…etc.
Part 2: Couple’s health status: past and present medical history for both women and husbands.
Part 3: Gynecological history: past and present gynecological history such as menstrual irregularities, endometrial cancer, vaginitis…etc.
Part 4: Infertility profile such as duration, causes, frequency of in-vitro fertilization (IVF) attempts and traditional practices which were used for treatment of infertility.
Tool II: Domestic Violence against infertile women structured interview schedule: it consisted of two main parts:-
Part 1: Patterns of violence: it consisted of three sections:
D. Physical violence: such as kicking, pushing, slapping, exposure tough housework and forcing woman to do several traditional practices…etc.
E. Psychological violence: such as isolation, public humiliation, threatening with divorce or getting married to a fertile woman...etc.
F. Sexual violence: such as forced sex, humiliation during marital relation, deprivation from sexual satisfaction…etc.
Part 2: Violence correlates: it contained three main sections:
Section I: Reasons for violence: such as family pressure, costly treatment, repeated or failed IVF…etc.
Section II: Violence aggressors such as husband, husband’s family, wife’s family, friends and neighbors.
Section III: Subject’s response to violence such as: leaving home, requesting divorce, isolation, crying, discontinuation of treatment…etc.
Tools were reviewed and tested for content validity by seven experts in the related fields of Obstetric and Gynecological Nursing and Public Health Nursing. A pilot study was carried out on 30 women who were excluded from the main study sample to test the clarity, relevance and applicability of the tools. Each woman was interviewed individually. Data collection covered a period of five months started from the beginning of November 2017 till the end of March 2018. Then the collected data were analyzed and relations were done.
The main findings of the present study were:
Socio demographic characteristics of women:
• Less than one-half (47.7%) of women aged 30 to less than 40 years.
• More than one-half (54%) of women married at the age of 15 to less than 25 years.
• One-third (33.7%) of women were illiterate or read and write.
• The majority (82.3%) of women were housewives.
• More than one-half (54.7%) of women were living in rural areas.
Socio demographic characteristics of husbands:
• About three-fifths (58.7%) of husbands aged 30 to less than 40 years.
• More than one-half (53%) of husbands married at the age of 20 to less than 30 years.
• One-fifth (20%) of husbands were illiterate or read and write.
• More than two-thirds (68%) of husbands were working as non-professional workers.
Health profile of women:
• 9.3% of women had medical diseases such as hypertension (35.7%), diabetes mellitus (28.6%) and hypotension (25%).
• More than two-fifths (46.7%) of women had past history of gynecological diseases. Three-fifths (60%) of them had menstrual irregularities.
• About two-thirds (61%) of women were complaining from gynecological diseases. One-third (33.3%) of them reported uterine diseases.
Health profile of husbands:
• More than one-quarter (27.7%) of husbands had medical disorders.
• The majority (85.3%) of husbands were non-smokers.
Infertility profile of women:
• More than two-thirds (68.7%) of women were infertile for more than 3 years.
• More than one-half (51.3%) of women had female factor infertility.
• One-third (33.3%) of women underwent in-vitro fertilization. Slightly more than three-quarters (76%) of them experienced once IVF attempt.
• About one-quarter (25.3%) of women reported doing traditional practices such as herbs (43.4%), visiting graveyards (39.5%), visiting religious leaders (19.7%), traditional healers (13.2%) and hijama (6.6 %).
Patterns of domestic violence:
• The majority (96.3%) of women were exposed to psychological violence, one-half (50.7%) of them were exposed to physical violence. And less than one-half (45.7 %) of them were exposed to sexual violence.
Women exposure to physical violence:
• Less than one-half (46.1%) of women were exposed to several traditional practices by husband or mother in law. Also, 39.5% of them were exposed to tough housework.
• Only 10.5% of women had been beaten in presence of others. 6.25% of them who reported beating had injuries.
Women exposure to psychological violence:
• Women had experienced different forms of psychological violence such as quarrel (56.1%), isolation (37.4%) and negative comparison to fertile women (17.3%).
• The majority (98.6%) of women were exposed to others intrusion in their private matters.
• More than one-half (58.1% and 53.6%) of them respectively were exposed to public humiliation and grieving names by others as (infertile or unproductive). Also, 30.4% of them were threatened with divorce.
Women exposure to sexual violence:
• More than two-fifths (43.8%) of women reported husband avoidance with sexual relation. Also, 35% of them were deprived from sexual satisfaction.
• 7.3% of them were humiliated during marital relation.
• Forced sex was reported by a small percentage (2.2%).
Violence correlates:
Reasons for domestic violence:
• More than one-half (58.7%) of women reported exposure to violence due to family pressure of both couples.
• 35% and 21.3% of women respectively were exposed to violence due to costly and un-accessibility of treatment.
• Repeated or failed IVF was reported by 10.3% of women.
Violence aggressors:
• About two-thirds (65.7%) of women had experienced violence from husband’s family followed by their husbands (50.3%).
Women’s response to violence:
• Multiple responses were obtained i.e. isolation (43.7%), crying and shouting (24.7%), leaving home (17.3%) and discontinuation of treatment (9.7%).
Concerning seeking help:
• Less than one-half (47.7%) of women sought help when they were exposed to violence.
• The majority (87.4%) of women sought help from the wife’s family.
• Considering reasons for not seeking help, slightly more than one-half (51.6%) of women reported that violent act is considered individual matter.
Relation between socio-demographic characteristics and patterns of domestic violence:
• A significant difference was found between the wife’s age and the exposure to sexual violence. In this regard, less than one-half (46.7%) of women who exposed to sexual violence aged 30 to less than 40 years.
• Another significant difference was observed between women’s residence and exposure to physical violence. In this regard, slightly more than three-fifths (61.8%) of women who exposed to physical violence were living in rural areas.
The main recommendations are:
1. Infertile couples should be provided with appropriate information regarding the causes of infertility that both could be responsible.
2. Routine screening for domestic violence in infertility clinics should be mandatory to identify the victims, and provide them with appropriate health care and supportive services.
3. Further studies are recommended to determine the impact of domestic violence on infertile women.
4. Development of screening tools to identify infertile women at risk of violence and provide clinical services, remedial counseling and social support.