Definition

Domestic violence (also referred to as intimate partner abuse) is a crime. It results from an imbalance of power and control over one's partner. Domestic violence is primarily committed by men against women but also occurs in same sex relationships and by women against men. All survivors are not physically battered or beaten. Abuse can include other forms of mistreatment and cruelty such as constant threatening, psychological/emotional, sexual, financial/material, spiritual and verbal abuse. In the event of a sexual assault within domestic situation the client has the same options as any other person who has a complaint of sexual assault. Gays, lesbians, transgender, immigrants and Native Americans may experience additional forms of abuse. Partner abuse happens to many women at all income and education levels, in all social classes, in all religions, racial and cultural groups¹. For more information on tactics used by an abuser to maintain power and control over their partner see power and control wheels.

Primary Goals

• To increase the safety for women and men who are being abused
• To increase access to resources
• To assist in the collection of relevant medical evidence should the client choose to engage in the legal process

Possible Health Effects

Most health care providers are aware of the physical injuries that can occur during a domestic violent situation, however other common effects of abuse include, but are not limited to:

• Acute Anxiety
• Depression
• Hypertension
• Headaches
• Suicidal ideation
• Eating disorders
• Sexual dysfunction
• Irritable bowel syndrome
• Gastrointestinal pain
• Obsessive Compulsive disorder
• Chronic Vaginal/urinary infections

Children Witnessing Abuse

In Canada, it is estimated that 800,000 children are exposed to woman abuse each year². When children witness abuse they are receiving the messages that violence is okay and therefore a normal part of a relationship, it is a way to resolve conflict and to gain power and control over another human being. The impact of witnessing abuse depends on the age and developmental stage of the child, the frequency and severity of the abuse along with the supports systems in place for the child.

Typical Long-Term Effects of Woman Abuse on Children by Age
Adapted from Health Canada: A handbook for Health and Social Service Providers and Educators on Children Exposed to Woman Abuse/Family Violence, 1999³

Children are affected by abuse on many different levels:⁴

• Emotionally (anxiety, anger, depression, low self-esteem)
• Physically (difficulty sleeping/eating, health problems)
• Socially (poor social skills, peer rejection)
• Cognitively (developmental delays, poor school performance)
• Behaviorally (aggression, tantrums, immaturity)

Screening For Violence

Identifying woman abuse provides the health care professional an opportunity to intervene by providing support and resources. Some hospitals have already begun implementing a screening process.

Two common types of screening methods are

• Indicator based
• Universal

Domestic Violence is a major health care concern. Studies have shown up to 37 percent of women looking for help in a hospital ER department are there because of abuse inflicted by an intimate partner⁵ and yet many women are not identified in the healthcare setting. Approximately $4.2 billion (CAN) is spent in Canada per year on variety of forms of violence against woman: sexual assault, woman abuse and childhood sexual assault. This figure covers areas of medicine, criminal justice, social services and employment⁶.

Asking The Question

There are different ways to ask about domestic violence. Health care providers need to find a way in which they are comfortable, some suggestions are:

• "I ask all my clients if they are experiencing violence in their lives."
• "I found that many of my female clients have been hurt by one or more types of abuse, and I'm wondering whether you have ever experienced abuse, either as a child, adolescent or adult?"
• "I am very concerned about your injuries, did someone hurt you?"

Ensure privacy when asking about abuse to maintain their safety.

If She Says YES

If the client has disclosed abuse to you, believe her.

Things that are useful to hear from the health care provider:

• "Thank you for sharing this with me."
• "You are not alone."
• "There is help available."
• "Domestic violence is a crime."
• Validate her feelings

Questions to ask if she says yes:

• "Would you like to talk about it?"
• "When did this happen?"
• "Have you talked to anyone else about this?"
• "How are you coping?"
• "What do you need right now?"

These questions can lead into discussions about safety planning, risk assessment, providing referrals to shelters, counselling or to a SA/DVCC.

If She Says NO

She may not be in an abusive situation or she may not be willing or able to disclose at this time. In asking a screening question the health care provider is opening the door and ensuring that the client knows that your facility is a safe place. Use this opportunity to education clients on violence against women issues.

Statistics

• 37% of female patients who are treated in the ER for violent injury have been injured by an intimate partner⁷.
• 1 in 3 women treated for trauma in the ER has been injured by an intimate partner⁸.
• Twenty-five percent of women who entered shelters in 1995 had injuries that required medical attention, and 3% required hospitalization⁹.
• Twelve percent of Canadian women aged 18-24 reported at least one incident of violence by an intimate partner in a one-year period, compared with the national average of 3% of all married or cohabiting women¹⁰.
• A 2004 study done on the incidence and prevalence of DV in a northern emergency department discovered that the incidence of DV resulting in emergency department presentation on the day of assessment was 2%. Of women with partners 9% (66) had previously been threatened or injured by those partners. Lifetime prevalence of DV was 51%; physical DV was experienced by 40%. One-year prevalence was 26%¹¹.

Links

If you would like more information on domestic violence please visit the following websites:

• Action ontarienne contre la violence faite aux femmes (AOCVF).url http://francofemmes.org/aocvf/
• Assaulted Women's Helpline http://www.awhl.org
• DisAbled Women's Network Ontario http://dawn.thot.net/main.html
• Education Wife Assault http://www.womanabuseprevention.com/
• LEAF http://www.leaf.ca/
• Metro Action Committee on Violence Against Women and Children http://www.metrac.org/
• Ontario Women's Justice Network http://www.owjn.org/info.htm
• For information on research assessing screening approaches see http://www.fhs.mcmaster.ca/vaw/index.html

¹ Education Wife Assault. (1997, September) About Abuse [http://www.womanabuseprevention.com/html/about_abuse.html]

² Jaffe,P. and Poisson, October 1999 (Peel committee against woman abuse)

³ Health Canada: A handbook for Health and Social Service Providers and Educators on Children Exposed to Woman Abuse/Family Violence, 1999

⁴ Peel Committee Against Woman Abuse. (2001, April). Breaking the cycle of violence: Children exposed to woman abuse. Desktop Publishing: Peel Region. Ontario

⁵ Eisenstat, S. and Bancroft, L. (1999, September). "Domestic Violence," The New England Journal of Medicine. Vol. 341, No. 12: pp886-892

⁶ Greaves, L. et al. (1995). Selected Estimates of the Costs of Violence Against Women and Children. The Centre for Research on Violence against Women and Children. London.

⁷ Ibid. Eisenstat, S. and Bancroft, L.

⁸ Ibid. Eisenstat, S. and Bancroft, L.

⁹ Bunge, V. P., and A. Levett. 1998. Family Violence: A Statistical Profile. Ottawa: Statistics Canada, Ministry of Industry.

¹⁰ Bunge, V. P., and A. Levett. 1998. Family Violence: A Statistical Profile. Ottawa: Statistics Canada, Ministry of Industry.

¹¹ Cox, Bota, Carter, Bretzlaff-Michaud, Sahai & Rowe, (2004) Domestic violence: Incidence and prevalence in a northern emergency department. Canadian Family Physician. Vol. 50:90-97