Introduction

Having a short history both in political arena and academic studies, “Domestic violence against women” started to be regarded as a problem at the end of the 1960s with the second wave feminist movement’s concurrent development in North America, Western Europe and some other regions of the world. Bearing no name until the 1970s, this type of violence has become a widespread and dynamic subject of research, organization, legal reform and political discussion (WHO 2005;Altınay and Arat 2007).

The United Nations Declaration on the Elimination of Violence Against Women defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or physiological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”. (Ruiz-Pérez et al. 2007; Portwood and Heany 2007; Chandrasekaran et al. 2007). Domestic violence is the most common, widespread and far-reaching form of the violence against women (Garcia-Moreno et al. 2006; Ellsberg et al. 2008). Violent behaviors such as beating, pushing, slapping or throwing things by family members; sexual, emotional, economic violence against women in the home, within the family or in a relationship is considered as domestic violence (WHO 2005). Statistical data have indicated that the main reason for the injuries suffered by women is the domestic violence exercised by the men (WHO 2005, Portwood and Heany 2007; Chandrasekaran et al. 2007). The World Health Organization states that violence is observed in the families and against women most (WHO 2005). Only 30% of the violence against women is exercised by a stranger. The greatest threat to the women is inside the house (Güler et al. 2005; Portwood and Heany 2007; Çivi et al. 2008) and the domestic violence suffered by them is usually exercised by their husbands (WHO 2005; Güler et al. 2005; Wahed and Bhuiya 2007; Altınay and Arat 2007). Studies conducted throughout the world have indicated that 9.1–75.9% of the women have suffered from domestic violence by their husbands/intimate partners in a certain part of their lives (Amoakohene 2004; Garcia-Moreno et al. 2006; Ruiz-Pérez et al. 2007; Tiwari et al. 2008; Breiding et al. 2008).

This ratio is 34–78% in Turkey (Institute of Family Researches 1997; Güler et al. 2005; Hıdıroğlu et al. 2006; Kocacik and Doğan 2006; Altınay and Arat 2007; Aksan and Aksu 2007; Çivi et al. 2008). In industrialized countries health costs for domestic violence against women and rape accounts for nearly one in five disability-adjusted life years lost to women at age 15–44 (UNICEF 2000). In developing countries, estimates range from 5% to 16% of healthy years lost to women of reproductive age as a result of domestic violence. (UNICEF 2000).

Violence against women is a serious human rights violation and a pervasive community health problem with substantial consequences for women’s physical, mental, sexual and reproductive health concerning all sectors of society (UNICEF 2000; Altınay and Arat 2007; Wahed and Bhuiya 2007). Domestic violence against women also has serious implications on children who witness the violence. It has been suggested that infants who witness violence not only develop health problems but also suffer behavioral disorders, emotional trauma, and educational difficulties. Domestic violence not only damages and weakens women but impacts their entire families, as well, thus leading to a social emasculation. The cost of violence against women does not only comprise direct costs such as services provided to victims (health care services, shelters, counseling centers, help lines, etc.) and procedures regarding the perpetrators (costs associated with the police forces, prosecutors, courts and prisons), but also indirect costs such as declined productivity and employment (victims’ loss of productivity and substantially effected changes in employability of both victims and perpetrators). The economic cost can be significant. A 2004 study conducted in Great Britain identified the direct cost of violence against women as 5.8 billion pounds; and the indirect cost as 23 billion pounds. Recent analysis has strongly suggested that the cost of preventing domestic violence against women is far less than the cost of protective and curative services for victims and the legal proceedings related with the perpetrators. The preventive initiatives used to combat domestic violence are therefore of utmost importance both for the victimized women and the societies in which they live (UNICEF 2000).

One of the strategic objectives established in the 4th World Conference on women held in Beijing in 1995, was “to study the causes and consequences of violence against women and the efficacy of preventive measures, encouraging governments and organizations to promote research in this area”. (United Nations 2006)

This study determines the frequency of the spousal domestic violence among women who applied to some first level medical institutions located in Ankara, the capital of Turkey.

Material-Method

Study Population

The research has been conducted in the primary care health centers which are located in the health, education and research region of Gazi University Medical Faculty Public Health Division in Ankara Provincial center, in which Public Health and Forensic Medicine education research studies and field works are carried out. Daily number of patients of the mentioned medical institutions and the demographic features of the populations which are given service in these institutions are similar. Among those who applied for any reason to the first level medical institutions in which the research has been conducted between December 4 and 21 2006, 1,178 married women who agreed to participate in the research have been included in the research. The number of the married women who applied to the first level medical institutions in which the research has been conducted during the research period is 1,380 and the study participation rate is 85.4%.

Data Collection

Survey form has been used in the research as a data source. Information about the purpose of the study has been given to the married women who applied to the first level medical institutions in which the research has been conducted. The data collection was performed by the researchers and the senior students of the medicine faculty who were making their internship on public health—forensic medicine during the research period. Survey form has been applied to the women who agreed to participate in the research by face to face interview technique. In order to achieve standardization in the survey application, survey form has been introduced to the intern doctors who were to take charge in data collection before the application Questions have been reviewed with them one by one and each intern doctor have been ensured to make survey application on ten people respectively under the supervision of the researchers as exercise before the real data collection. Application exercises have been conducted in the first level medical institutions located in the health center regions in which the research has been carried out and which serve similar populations but which are not the application institutions of the university.

Survey Form

The questionnaire is composed of two sections. The first section includes questions related to the descriptive features of the woman and her husband. The second includes questions about the condition of husband’s controlling behaviors, emotional violence, economic violence, physical violence and sexual violence against women and the frequency of physical and sexual violence exposure within the last year. In this section, there are also questions on whether or not the women and their husbands perceive “husband violence” as normal, the presence of domestic violence exposure from their own families, the violence background between their own mothers and fathers, risk factors (taking alcohol, gambling, violence background in his family, watching series or films showing violence on television) in terms of the domestic violence exercised by their husbands.

Identification of the Domestic Violence

The questions on husband violence have been prepared on the basis of “WHO multicountry study on women’s health and domestic violence” (WHO 2005)

For physical violence, women have been asked whether the current had ever:

  1. 1.

    Slapped her, or thrown something at her that could hurt her;

  2. 2.

    Pushed or shoved her;

  3. 3.

    Hit her with a fist or something else that could hurt;

  4. 4.

    Kicked, dragged or beaten her up;

  5. 5.

    Choked or burnt her on purpose;

  6. 6.

    Threatened her with, or actually used a gun, knife or other weapon against her.

Sexual violence was defined by the following three behaviors:

  1. 1.

    Being physically forced to have sexual intercourse against her will;

  2. 2.

    Having sexual intercourse because she was afraid of what her partner might do;

  3. 3.

    Being forced to do something sexual she found degrading or humiliating.

The specific acts of emotional violence were following:

  1. 1.

    Being insulted or made to feel bad about oneself;

  2. 2.

    Being humiliated or belittled in front of others;

  3. 3.

    Being intimidated or scared on purpose (for example by a partner yelling and smashing things);

  4. 4.

    Being threatened with harm (directly or indirectly in the form of a threat to hurt someone the respondent cared about).

The study defined controlling behavior by a woman’s partner as including:

  1. 1.

    Keeping her from seeing friends;

  2. 2.

    Restricting contact with her family of birth;

  3. 3.

    Insisting on knowing where she is at all times;

  4. 4.

    Ignoring or treating her indifferently;

  5. 5.

    Getting angry if she speaks with other men;

  6. 6.

    Often accusing her of being unfaithful;

  7. 7.

    Controlling her access to health care.

Economic violence exposure condition has been identified with the following 3 questions:

  1. 1.

    Does your husband take your money from you from time to time?

  2. 2.

    Does your husband decide on how to manage the budget belonging to your family or you and how to spend your money?

  3. 3.

    Does your husband take important financial decisions without consulting you from time to time?

Statistical Analysis

SPSS software (Statistical Package for the Social Sciences, version 15.0, SSPS Inc, Chicago, Ill, USA) was used to monitor progress and analyze the data. Chi-Square test has been used in determining the violence exposure condition according to the possible risk factors. Risk factors have been determined with logistical regression analysis in terms of being subjected to any type of violence. Statistical significance has been set at p < 0.05.

Results

A total of 1,178 married women have participated in the study. Demographic data of the women and their hosbands are shown in Table 2. The mean age of the subjects is 38.5 ± 12.3. The mean household number is 3.7 ± 1.4 (median 4). The mean monthly total household income is 1,254 ± 1,127 YTL (median 1,000 YTL) (1YTL=1,3$ at the study time).

A man’s slapping or beating his wife or girlfriend is seen as a normal behavior by a few women (13 women; 1.1%). Even fewer see a man’s insulting or mocking his wife or girlfriend as normal behavior (9 women; 0.8%) and a husband’s constantly checking and monitoring where their wife are and to whom they talk to is seen as normal behavior by 12.1%. According the reports of the women, 8.6% of the husbands perceive as a normal behavior a man’s slapping or beating his wife or girlfriend, 5.7% of the husbands perceive as a normal behavior a man’s insulting or mocking at his wife or girlfriend, and 23.9% of the husbands perceive as a normal behavior the husbands’ constantly checking and monitoring where their wives are and to whom they talk to (data not shown in the table).

In the childhood period, 30% of the women were subjected to physical violence by their families (data not shown). The lifetime percentage of exposure to of the types of spousal violence namely physical, sexual, emotional, economic violence or controlling behavior is 77.9% (n = 918). The most reported type of domestic violence is economic violence (60.4%). Controlling behaviors is the second with a percentage of 59.6%; prohibition of talking to men is the most reported among the controlling behaviors (52.9%). The lifetime prevalence of being subjected to emotional violence at least once is 39.7%. Humiliation is the most common type of violence (32%). The lifetime frequency of being subjected to economic violence at least once is 60.4%; the most observed type of this is to manage the budget by himself and determine how to spend the money (53.5%). The percentage of lifetime exposure to physical violence by the husband is 29.9%. Slapping is the most reported physical violence (23.8%); 8.2% of the women have been subjected to physical violence in the past year. The ratio of being subjected to sexual violence by her husband at least once during lifetime is 31.3%; being physically forced to have sexual intercourse against their will is the most observed sexual violence (25.8%); 15.9% of the women have been subjected to sexual violence in the past year (Table 1).

Table 1 The percentage of domestic violence exposure among women
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Among the women subjected to physical violence, 61.3% are also exposed to sexual violence. In addition, 83.9% of these women are exposed to controlling behaviors, 83.3% of them are exposed to emotional violence and 84.5% of them are exposed to economic violence. Of those women who are subjected to sexual violence, 57.6% are also exposed to physical violence, 84.5% are also exposed to economic violence, 84.2% are exposed to controlling behaviors and 72.5% are exposed to emotional violence. Among those who are subjected to controlling behaviors, 41% are also exposed to physical violence and 12.5% of these women are exposed to sexual violence (data not shown).

The frequency of being exposed to physical violence (Table 2) is 36% for 45–54 age group whereas it is 19.2% for 15–24 age group (p < 0.05) (OR = 2.37; 95% CI = 1.36–4.14). The higher the education level of the husbands gets, the lower the frequency of being exposed to physical violence (p < 0.05). The employment condition of the husbands does not affect the condition of being exposed to physical violence (p > 0.05). The more the number of people who live in the house gets, the higher the frequency of being exposed to physical violence (p < 0.05). The risk of exposure to physical violence is 2.36 (95% CI = 1.51–3.68) times higher in the families with lower than 500 YTL household income compared to those with a income higher than 1,000 YTL The frequency of being exposed to physical violence increases for the women whose husbands watch films/series showing violence; for the women who are subjected to physical violence by their own families and whose parents exercise physical violence on one another (p < 0.05). The risk of physical violence is 7.65 (95% CI = 5.26–11.25) times higher among women whose husband witnessed physical violence between his parents.

Table 2 Percentage and risk factors of domestic violence exposure
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Evaluating the sexual violence exposure with regard to the age groups (Table 2), no statistically significant difference has been observed between the groups (p > 0.05). The higher the education level of the husbands gets, the lower the frequency of being exposed to sexual violence gets (p < 0.05). Presence of chronic disease, employment condition of the husbands and the household number do not affect the prevalence of being exposed to sexual violence (p > 0.05). The higher the monthly total household income gets, the lower the frequency of being exposed to sexual violence (p < 0.05). The frequency of being exposed to sexual violence shows a statistically significant increase for the women whose husbands watch films/series showing violence; for the women who are subjected to physical violence by their own families and whose parents exercise physical violence on one another (p < 0.05). The risk of sexual violence is 3.83 (95% CI = 2.67–5.51) times higher for the women whose husband witnessed physical violence between his parents.

A statistically significant difference has been observed between the groups in terms of being exposed to controlling behavior according to age group (p < 0.05); The frequency of being exposed to controlling behavior is 64.3% for 25–34 age group whereas it is 50.6% for 15–24 age group. The lower the level of education gets, the higher the frequency of being exposed to controlling behavior gets (p < 0.05); the frequency of being exposed to controlling behavior is 43.3% for the college/university graduates whereas 64.7% for the secondary school and high school graduates. The risk of being exposed to controlling behavior is 2.41 (95% CI = 1.66–3.50) times more in women who are secondary school and high school graduates than in college and university graduates. The risk of being exposed to controlling behavior is 1.97 (95% CI 1.46–2.66) times more in women whose husbands are secondary school and high school graduates than in college and university graduates. Unemployed women are exposed to controlling behavior with a percentage of 60.8% whereas employed women are exposed with a percentage of 54.8% (p < 0.05). Lower the level of income gets, the higher the frequency of being exposed to controlling behavior (p < 0.05). When the condition of husbands’ watching films or series showing violence is examined, controlling behaviors are observed with a percentage of 69% in husbands who watch films or series showing violence whereas this percentage is 60.1% in husbands who do not watch films or series showing violence (p < 0.05). Controlling behaviors are less if the husband gambles or drinks alcohol (p < 0.05). Being exposed to controlling behaviors has been found to be more in women who are subjected to physical violence by their own families, whose parents exercise physical violence to one another and whose husband witnessed physical violence between his parents (p < 0.05) (Table 2).

The distribution of being exposed to emotional violence according to some features of the observed women has been shown in Table 2. The frequency of being exposed to emotional violence is 48.1% for 44–55 age group whereas it is 32% for 15–24 age group. Emotional violence is observed 1.97 (95% CI = 1.21–3.21) times more in 44–55 age group than in 15–24 age group. The higher the education level of the husbands gets or the higher the level of income gets the lower the frequency of being exposed to emotional violence gets (p < 0.05). The frequency of being exposed to emotional violence shows a statistically significant increase for the women whose husbands watch films/series showing violence (p < 0.05) (OR = 2.35; %95 CI = 1.84–3.01). The frequency of being exposed to emotional violence increases in women whose husbands drink alcohol (p < 0.05). Being exposed to controlling behaviors has been found to be more in women who are subjected to emotional violence by their own families, whose parents exercise physical violence to one another and whose husband witnessed physical violence between his parents (p < 0.05).

The risk factors in terms of a woman’s being exposed to at least one type of violence are as follows: the number of people who live in the house, lower level of income, the age of the woman, lower level of education, husband’s having a lower level of education, husband’s having a habit of gambling drinking alcohol, husband’s watching films/series which show violence, woman’s being subjected to physical violence by her own family, the existence of physical violence between her parents and the existence of physical violence between her husband’s parents (Table 3).

Table 3 Risk factors for exposure to domestic violence
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The more the number of people who live in the house gets, the higher the risk of woman’s being exposed to violence gets. The risk of being exposed to violence for the women whose household income is 500 YTL is 3.16 times more than the physical violence observed in the women whose household income is 1,000 YTL or more. The risk of being exposed to violence for the women who have primary school education or lower education is 5.54 times more than the women who have higher education. The risk of being exposed to violence increases 1.38 times if the woman does not work. The state of husband’s employment is not a factor which affects the condition of being exposed to violence. Husband’s having a lower level of education increases the risk of being exposed to violence 2.96 times more. Husband’s drinking alcohol increases the risk of being exposed to violence 4.7 times more. Husband’s gambling increases the risk of being exposed to violence 6.98 times more. The risk of woman’s being exposed to violence by her husband increases 2.02 times more if the woman has been subjected to physical violence by her own family. The risk of woman’s being exposed to violence by her husband increases 2.19 times more if there is a physical violence between her parents. The risk of woman’s being exposed to violence by her husband increases 4.28 times more if there is physical violence between her husband’s parents.

Table 4 shows the percentage distribution of the abused women’s contemplation of “being exposed to violence by husband”. Of those women who are exposed to physical violence, 48.8% do not think that they are subjected to violence by their husbands. Again, of those women who are exposed to sexual violence, 59.8% do not think that they are subjected to violence by their husbands. When women who are exposed to controlling behaviors are prohibited from talking to their families, 59.7% of these women think that they are subjected to violence by their husbands. Of those women who are prohibited from talking to men, 72.8% do not think that they are subjected to violence by their husbands. While 64.9% of the women who are exposed to emotional violence regard being intimidated as violence, 54.3% of the women who are exposed to insult do not think that they are subjected to violence by their husbands.

Table 4 The percentage of thinking “exposed to violence by the spouse” according to conditions of violence
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Discussion

The perception and definition of domestic violence is always shaped among the cultural values of the society and individuals. For this reason, when the use of violence become a current issue for an aim that society interiorize and make legitimate, the perception of that behavior as violence becomes considerable hard (Rittersberger Tılıç 1998, Altınay and Arat 2007). In most of the societies, committing violence to women is perceived as an acceptable behavior and seen as an ordinary characteristic of marriage. Lack of safe and serious support systems for the women violated (ICN 2001; Ulutaşdemir 2002) and inadequacy of legal regulations towards domestic violence make contribution to increase violence (Bunch 1999).

There have been reformatory amendments in Turkish Legislation, primarily in the Constitution, for ensuring gender equality and elimination of violence against women (Turkish Civil Code, Turkish Penal Code, Labor Code, and Municipal Code). Furthermore; the Law No: 4320 on the Protection of the family embraces provisions that aim to protect individuals victimized by domestic violence. The Prime Ministry Circular No: 2006/17 (2006) has internalized the eradication of violence against women as a state policy. The practical repercussions of the legal developments and the attainment of the objectives of combating violence depend on creating social awareness about violence against women and ensuring an absolute mental transformation. The public institutions, the civil society organizations, and the media are undertaking important activities by means of campaigns and training programs in order to demonstrate the negative impacts of violence against women on individuals and the society as a whole, and to create awareness of the fact that each individual has responsibility in the subject matter (Directorate General on The Status of Women 2007). The prime Ministry Circular on “Identification of Necessary Measures for Tackling Honor Killings and Violence against Women and Children” (No: 2006/17) sets out a framework in order to define the responsibilities of different institutions in developing inter-sector collaboration and coordination for prevention of domestic violence against women. The said Circular has designated the Directorate General on the Status of Women as the coordinator agency for the efforts aimed at prevention of violence against women. Within this context the “National Action Plan” is designed to function as a tool to replicate the cooperative network, and develop new models of cooperation (Directorate General on The Status of Women 2007). Even thought egalitarian values of women towards human rights are accepted commonly in Turkey, at the same time, this study has been executed that in capital, seven of each ten women have been exposed to violence from their husbands, approximately 3 of 10 women experience physical violence and also three of them experience sexual violence. According to the research made in our country by prime ministry family investigation foundation on 1997, 35.1% of women married or had experienced a marriage have been declared that they had physical violence from their spouse (Institute of Family Researches 1997). In a study conducted with a sample representing the country on 2007, it has been declared that 34.5% of women in Turkey had experienced a physical violence from their spouse for at least once during their lives (Altınay and Arat 2007).). In this study, the prevalence of physical violence has been determined as 29.9%. Low education level and low socioeconomic level have been a risk factor in terms of violence (Heise et al. 1995; Koenig et al. 2003; Amoakohene 2004; Hassan et al. 2004; Flake 2005; WHO 2005; Avdibegović and Sinanović 2006; Kocacik and Doğan 2006; Altınay and Arat 2007; Breiding et al. 2008; Stickley et al. 2008). Also in this study, while the level of education increases, the number of women saying that they had a physical violence has been decreasing. However, while interpreting those numbers, one should bear in mind that people having high education may behave more secretively on sharing the violence they had experienced. An opposite way of relation also exists between physical violence and income: While the level of income increases, the prevalence of exposure to physical violence decreases, however, while interpreting those data, one should also bear in mind that women of high income level can be in the tendency of saying less than the violence they experience (because they are ashamed or they think that this will damage their name), just like in the education subject.

The frequency of sexual violence in the world is 6–59% (WHO 2005). On the study made in 1993–94, the frequency of domestic sexual violence in Turkey has been explained as 9%, in the study published in 2007, 14.1% of women in Turkey have determined that they had been “forced to sexual intercourse when she didn’t want” for at least once. In another local study in Turkey, the prevalence of sexual violence has been determined as 30.7% (Kocacik and Doğan 2006). Also in this study, the prevalence of experiencing sexual violence is 31.3%. Even thought the prevalence given in Turkey general is low, the response rate about sexual violence in the above-mentioned study is also low. Considering this situation, it has been thought that the determined numbers are just a small visual part of the iceberg, and that the sexual violence in Turkey is much bigger than explained. Of those people who expressed that they had experienced sexual violence, 57.6% also had experienced physical violence. Transitivity among the types of violence makes one think that sexual violence has been experienced as a form of general dominance relation.

It has been indicated that 20–85.6% of women in the world have been experiencing psychological violence (Altınay and Arat 2007). In Turkey, the frequency of verbal violence towards women has been declared as 12.3% in 1997 (Institute of Family Researches 1997), and in another study conducted on women in 2006, it has been declared as 53.8% (Kocacik and Doğan 2006). Also in this study, the prevalence of psychological violence is 39.7%. While in the studies, it has been indicated that psychological violence is a determination of physical violence, which means that if a woman is exposed to psychological violence, the probability of her to be exposed to physical violence is high (UNICEF 2000; Ramiro et al. 2004; Kocacik and Doğan 2006; Altınay and Arat 2007; Stickley et al. 2008), the studies executing factors related with psychological violence are more restricted (Ramiro et al. 2004; Altınay and Arat 2007). In this study, the factors increasing the exposure to psychological violence are determined as being in the age group of 45–54, having a chronicle illness, low education level, low income level, being an employee, the number of people living in the house to be high, low education level of the spouse, alcohol usage, watching films and television series having violence, the spouse witnessed his parents exposure to violence, the woman exposure violence from her family and exposure to violence among her own parents.

The behavior of controlling contains behaviors like secluding the woman with her friends, restricting her relations with her family, making pressure on always telling where she is, getting angry when she speaks to another man, accusing her by being unfaithful, controlling her in reaching health services, controlling use of family planning method (Altınay and Arat 2007). In Turkey, 39.5% of women can visit her neighbors and her friends without her husband’s permission, 29% of women can visit her family without having the need to get permission from her husband, 31% of them can go to the shopping, 17% of them can go to the theaters and cinema, and 11.3% of them can go to another village or city. (WHO 2005) Also in our study, 59.6% of women have been exposed to the controlling behaviors. The most frequent of controlling behaviors is banning to meet with men (52.9%) and the least frequent one is banning to have a health service (6.6%). Being in accordance with the other studies made in the world and Turkey (Ramiro et al. 2004; WHO 2005; Altınay and Arat 2007), in our study, controlling behaviors have been related with other violent behaviors, and it has been determined that 84% of women exposed to physical or sexual violent have also been exposed to controlling behaviors. Through the world, on the other hand, the prevalence of exposition to controlling behaviors changes between 21% (in Japan) and 90% (United Republic of Tanzania) (WHO 2005). The reason of this changeability is that that kind of behaviors are accepted as natural life style in some cultures.

Economical violence is making someone deprive of economical opportunities needed to survive. In other words, using economical sources and money as a tool of sanction, threat and control over the person regularly (WHO 2005; Altınay and Arat 2007; Fawole 2008). Behaviors like avoiding the woman to work, if she is working, holding her income, giving permission of having benefit from her income only through pocket money, asking the woman to manage the house by giving her a small amount of money, capturing her existing goods, taking the jewelry attached to her during the wedding ceremony, asking bride price and dower are considered as economical violence. Of married and unemployed women in Turkey, 36% think that if she had a wage-earning employment, to work, she would have been precluded by her spouse (Altınay and Arat 2007). Along with the fact that there is limited number of literature about economical violence, it has been determined that the number of men taking financial decisions by his own, without asking her wife are quite considerable, and this proportion in Middle East, North Africa and South Asia is 24–34%, in Africa under the Sahara is 64% (UNICEF 2007; Fawole 2008). In this study, 60.4% of women’s exposure to economical violence has been determined. The money 13.5% of women who have an income has been condemned by their husbands, 53.5% of them cannot tell their opinions on how to make house budget, how to spend money, and 47.8% of them cannot on important financial decisions.

In the studies made in the world and in Turkey, it has been observed that when witnessed or exposed to violence in childhood, increases men’s probability of using violence and women’s probability of explosion to violence twice (Koenig et al. 2003; WHO 2005; Flake 2005; Avdibegović and Sinanović 2006; Kocacik and Doğan 2006, Stickley et al. 2008; Nerøien and Schei 2008). Also in this study, it has been determined that if the woman had been exposed to violence by her family, and had witnessed violence among her parents, 2 times, if her husband had witnessed the violence among his parents, 4 times more risk of violence exposure exists. This finding, also named as “violence cycle” in international literature (WHO 2005, Altınay and Arat 2007), presents the importance of socialization without any violence. In this context, it is important to increase the social sensibility against violence, and spreading the fact that violence is not a way of solution through various communication channels and lesson books.

The other and actually very important side of the medallion is woman’s internalizing of violence. According to the results of 2003 Turkey population and health research, 39.1% of women recognize their husband’s hitting or beating them when they burn the food, answering the husband, spending unnecessarily money, being disregardful of taking care of children, refusing sexual relationship. However, in the study made on 2007, 89.4% of women think that there is no beating that can be considered as fair (Altınay and Arat 2007). In our study, 1.1% of women think that men beating their wives are natural; and 8.6% of them consider her husband or a man beating his own wife is a natural right. Of those women who exposed to violence, 79.1% don’t think that they are exposed to violence. She is not aware of the behaviors she is exposed are the infraction of her human rights, and that it is an attack towards her; she sees the violence life cycle she is exposed to as a natural situation of the marriage life. Interestingly, 59.8% of women exposed to sexual violence don’t think that they are exposed to violence, and 61.7% of women being taken her money from her think that this is violence. The reason of this may be because of there is more association between physical violence and economical violence in the shape of taking her money from her.

As a result, physical violence reaching up to 30% and the frequency of sexual violence as 31% and exposure of at least one of the violence kind at 70% are quite high numbers. Considering the women included to the study are the women applied to health services for some reason, it appears that there is a big mission to doctors and other health personnel in determining the domestic violence towards women. Domestic violence against women is prevalent and has significant physical and mental health consequences; accurate identification of violence in health settings can be an important first step in appropriate response and referral to services for women. Screening for domestic violence against women “implies a standardized assessment of patients, regardless of their reasons for seeking medical attention” (Cole 2000) The members of health profession have responsibilities of determination, curing and educating the executed women (Cole 2000; Aksan and Aksu 2007). In the facts of violence, it is important of giving the service of forensic medical as well as medicine to cure (Polat 2000). The Turkish Criminal Law has been obliged the members of health profession to inform legal authorities in case of discovering a crime constituent while they are working. The members not making this obligation are punished with prison punishment. The doctor make his duty of informing to legal authorities by a judicial report containing credentials, anamnesis, physical examinations, radiological examination, results of consultation, diagnosis of the woman being violated and whether she has a life-threat or not. The judicial report is the document demonstrating how much the violated person had been got harmed (Polat 2000) and the violent enforcer can be sued and go to trial with this document.

With the data gained from this study, it has been thought of attracting the authorities to this subject and take cautions to avoid violence; curing and educating women who had executed to violence, and to contribute domestic violence is in minimum level.