Intimate Partner Violence and Women’s Health

I’ve been thinking about writing a post on domestic violence for a while now. And I decided that this week I would finally sit down and do it. I’m not sure why it took me so long, maybe it’s just one of those things where I have so much to say that I never quite know where to start. But I guess I picked the right time because just hours before I sat down to start writing, the World Health Organization released a report presenting the first global systematic review of scientific data on the prevalence of violence against women, including intimate partner violence (IPV). The WHO found that intimate partner violence is “shockingly” common. Well, I personally find it shocking that they thought it was so shocking. I also find it shocking that this is the first time a scientific report has been released discussing this issue that is affecting so many women globally. It seems in the past reporting on violence against women did not differentiate between IPV and and non-partner sexual violence. And now that they have, people are starting to see the problem. I’ve discussed in previous posts some of the short- and long-term effects of non-partner sexual violence, including rape. But I just want to shed some light on IPV as the effects are usually more chronic, and arguably, more devastating.

Some of you might be surprised to hear that one in every three women has experienced IPV. That is, ? of women in the world have been beaten, coerced into sex or otherwise abused some time during her lifetime. With such a large fraction, you would think that IPV is just a normal, run of the mill occurrence. A lot of people consider IPV to be a private matter, a couple’s personal issue for them to deal with on their own. But this is the kind of attitude and undue tolerance that has created this outrageous statistic and caused a multitude of problems in women’s health. Did you know that women who have experienced IPV have higher rates of depression, HIV, injury and even death? Or that 38% of all women murdered are murdered by their partner? The crazy thing is that IPV is not some kind of incurable disease — it’s 100%, completely preventable! But it seems like we need to look at it as if a disease and public health concern to solve it, in which there is a need for multi-sector engagement in eliminating tolerance. Maybe viewing it through a health lens will give people more perspective on the severity of the effects.

As the report indicates, intimate partner violence has both physical and mental impacts. Injuries are the most common result of IPV. About 42% of women who have experienced violence are injured. Even in the U.S. 35% of all emergency room calls are made because of domestic violence. A victim of IPV is also 1.5 times more like to acquire sexually transmitted diseases like chlamydia, gonorrhea and HIV. It is also possible they will have an unwanted pregnancy, and are thus, twice as likely to have an abortion. Mentally, IPV is a major contributor to women’s depression and alcohol abuse. They are almost twice as likely to experience these problems compared to women who have not been abused.

With this relatively new data it becomes pretty clear that we need to invest more in IPV. I think part of the problem of addressing IPV is that much of the response to it and preventative measures focus on helping women get out of violent situations and preventing further violence. But by that time it might be too late, the damage is likely to have already been done. Not enough attention is being given to preventing the situations in the first place, addressing the root causes. We need to address these causes as well as figure out ways to prevent them, that’s the only way we’ll reduce prevalence.

I acknowledge this can be difficult because, as mentioned, a big reason IPV is a problem is because people don’t like to talk about it out of fear and stigma. This is not only a barrier to data but a barrier to prevention. How can we stop violence if we don’t know where, why and how it’s happening. This is more of a concern in other countries where IPV is severely underreported. Nations where patriarchy is still prevalent and common, IPV becomes somewhat of a social norm. That said, there needs to be a scaled up effort to prevent violence against women by  addressing the social and cultural factors behind it.

In terms of what the health sector can do to join the fight against IPV, they need to take it more seriously. A lot of times victims will seek medical attention without disclosing the cause of their injuries and health problems and the crime goes unnoticed and unreported. The WHO report suggests several clinical and policy guidelines to help health workers address this issue. They stress the importance of training workers to recognize women at risk and victims of IPV and respond appropriately. These suggestions include:

• Health providers have been trained how to ask about violence.
• Standard operating procedures are in place.
• Consultation takes place in a private setting.
• Confidentiality is guaranteed.
• A referral system is in place to ensure that women can access related services.
• In the case of sexual assault, health care settings must be equipped to provide the comprehensive response women need – to address both physical and mental health consequences.

These are all great suggestion for the health sector. However I still maintain that to truly tackle and intimate partner violence there needs to be a multi-sector effort. This includes working with other government sectors such as education, social care, criminal justice and departments of women or gender equality. Only with real commitment can we solve the problem of IPV.