In Egypt, 30% of ever-married women aged 15–49 reported having been ever subjected to at least one episode of physical, sexual, and/or emotional violence inflicted by their current or most recent spouse; however, sexual violence was only reported by 4% of the participants . In Alexandria, a cross-sectional survey found that more than three-quarters of the participants (77%) reported experiencing spousal violence. Emotional violence was the most commonly reported form (71.0%), followed by physical (50.3%) and sexual violence (37.1%) .
Despite the fact that all married women from all age groups are at risk of spousal violence, married adolescent girls are at much higher risk of exposure to violence and its consequences . In Egypt, one in every four adolescent married girls has been ever exposed to some form of spousal violence while 5.5% have been exposed to sexual violence .
Early marriage is still common in Upper Egypt, and most (89.7) of the participants in this study got married under the age of 18. Since the legal age of marriage in Egypt is 18 years, girls who married before completing their 18th birthday were in discordance with the law and are more liable to be exposed to spousal violence. According to our study, 15.2% of the study participants were exposed to physical violence while 17.8% were exposed to sexual violence in the last year (prior to the year of data collection). This percentage would have been definitely higher if we asked about exposure throughout the marital life.
Our study showed that spousal violence was associated with various cultural factors. In many cultures, it is acceptable for men to control their wives’ behavior and those women who refuse may be punished. Studies found that violence is frequently viewed as the husband’s right to discipline his wife . Moreover, a study conducted between 1998 and 2001 from seven countries found that male acceptance of wife beating ranged from 26% in Kazakhstan to 56% in Turkey . As shown in our study, male attitudes condoning partner violence is a crucial predictor of exposure to physical and sexual violence. This was consistent with various studies where men who justified wife beating and held more gender inequitable attitudes were more likely to abuse their wives [19, 20].
Taking the girls’ acceptance about the timing of getting married and the person she will marry not only is a human right, but also significantly affects her exposure to physical and sexual violence. Multivariable logistic regression analysis in our study showed that girls’ acceptance of the marriage timing was a significant protective factor against exposure to physical and sexual violence. This was consistent with a study conducted in Turkey to identify factors associated with domestic violence. The study found that the prevalence of domestic violence was significantly lower among women whose marriage was by mutual agreement . This is probably due to the similarity between the Egyptian and Turkish culture, as usually the spouses will have no chance to know each other before getting married. Moreover, women especially MAGs that are forced to get married are mostly those without economic independence and thus are less able to overcome violence.
It is common in rural Upper Egypt for married couples to live in extended families specially married adolescent girls, 88.2% of our study sample lived in extended families. The extended family can significantly affect the marital relationship of a couple, especially in the early years of their marriage, and can play a positive as well as a negative role. Bivariate and multivariable logistic regression analyses in our study showed that exposure of MAGs to physical and sexual violence was significantly associated with living with the husband alone while living with other family members was a significant protective factor against exposure to physical and sexual violence. Consistent with our study, a qualitative study done in Pakistan and the UK indicated that the husband’s family can have a positive effect by minimizing conflict through offering the couple personal time and helping the wife to adjust to her new family and the wife’s family could contribute by helping their daughter to adjust to her new extended family .
Moreover, a study done in Jordan to identify the role of the extended family on women’s risk of intimate partner violence using mixed-methods study found that residence with the respondent’s in-laws act as a protective factor against conflict and intimate partner violence between a husband and wife . However, some studies found that a wife’s in-laws act as instigators of conflict between husband and wife or a direct source of conflict with the wife and thus contributing to violence even if they do not live with or were near the couple [24, 25]. In addition, the focus group discussions (FGDs) of a study done in Jordan revealed that families were not always an effective source of assistance .
Sexual satisfaction is an integral part of marital life that affects the couple’s relationship . Our study found a significant association between violence and reported sexual satisfaction; the higher the sexual satisfaction score of the MAG, the less was the exposure to physical and sexual violence. Previous studies have repeatedly shown this association between sexual satisfaction and spousal violence. Ulloa and Hammett  reported a negative correlation between intimate partner violence and satisfaction. Also, a study conducted in Iran showed a significant association between partner violence and all aspects of women’s sexual function .
The norm of Egyptian society is not postponing pregnancy of the first child especially in rural communities. Failure to conceive directly after marriage affects the psychological state of the husband, which leads to violence. Violence against women experiencing delayed pregnancy is an important health problem with serious consequences for their physical and mental health . Our study revealed that longer duration till having the first baby was associated with more exposure to sexual violence.
Consistent with our study, a systematic review on the relationship between infertility, sub-fertility, and intimate partner violence found that infertility (inability to become pregnant)/sub-fertility (inability to maintain a pregnancy) are associated with violence in low- and middle-income countries . Moreover, many studies found that fertility and sub-fertility could be risk factors for intimate partner violence [29,30,31,32,33]. Also, infertile women are exposed to higher levels of marital violence compared to fertile women .
Limitations of the study
This large survey investigated an important and relatively unspoken issue but has some limitations; If husbands and mothers-in-law were interviewed, more insight on the problem would have been given, but this was very difficult in such conservative societies. Many families denied the presence of MAGs during the listing process since the legal age of marriage in Egypt is 18 years and families of MAGs who were below 18 years might face legal penalties if the case was reported to the authorities. To overcome this challenge, the enumeration and listing team members were escorted by outreach workers from the local communities to establish rapport with the families and enable the team to clarify that the collected data will be used for scientific purpose, will never be shared with the authorities, and that the filled questionnaires will have no identifiers, will not be linked to the developed lists, and the results will be presented in an aggregate form. Moreover, the data collectors were provided with identification cards affiliated to Assiut University and copies of the Central Agency for Public Mobilization and Statistics (CAPMAS) approval of the study to assure them that they were only research-participants.