Confronting Violence Against Women: The Role of the Healthcare Professional

Before the 1970’s, violence against women was largely unrecognized as a public health issue by the healthcare industry. However, since the late 20th century, generations of reformers have passionately and persistently worked to raise awareness of this issue among medical professionals, as well as establish practices and protocols to identify, hep, and advocate for victims. The history of this reformation is the topic of our current traveling exhibit from the National Library of Medicine – “Confronting Violence: Improving Women’s Lives.” But how far have we gotten? According to the World Health Organization, the global lifetime prevalence of sexual and physical violence among women aged 15 years and older is 30.0%. With doctors, nurses, and other healthcare professionals often the first to see women after abusive and violent incidents, it is imperative that healthcare professionals be vigilant in identifying and treating women who are victims of violence.

A neighborhood health fair organized by nurses at Brigham and Women’s Hospital, 1980. Image via the National Library of Medicine

Nurses were among the first to identify women who were battered as a population with specific health needs that were largely neglected by the medical community. Through both their research and practice, nurses saw firsthand the epidemic of violence in women’s lives. In response, they prioritized improvements in the medical attention and treatment for battered women. Based on their research and experience, nurses and their allies created and implemented some of the first hospital protocols for treating women who were battered. Using these protocols, medical practitioners learned how to identify, properly treat, and provide support and resources to this population. Following suit, in the mid-1980s, the public health community identified domestic violence as a priority health issue. This recognition marked a significant step toward the reform of the medical and health professions in treating victims of domestic violence.

Today, we know that in addition to fatal and non-fatal injuries that can be a direct result of inflicted violence, partner abuse has been linked to a wide range of negative health outcomes including sexually transmitted infections, HIV, unwanted and unintended pregnancies and unsafe abortions, gastrointestinal and gynecological disorders, chronic diseases, harmful substance use, depression, post-traumatic stress, and anxiety disorders. According to the World Health Organization, partner violence survivors are more likely to seek health care and to come in contact with healthcare professionals/providers than those who have not experienced partner violence. It is estimated that 24% to 54% of all women who visit emergency rooms have been abused during their lifetime, and it is suggested that victims utilize the healthcare system as much as 2.5 times as often as non-abused patients. Therefore, healthcare providers often serve as the first point of contact for survivors of violence, and further, according to researchers, healthcare providers are often the preferred point of disclosure for victims of domestic violence. Therefore, healthcare providers are in an ideal position to identify and provide care and support for women who have been victims of partner violence, and to contribute to reduction in violence and improved outcomes for women and their children.

Since healthcare professionals are often “the first-line response” for many women who experience violence, it is vital to have education, policies, and protocols in place so that they can identify and record incidents of domestic violence and assist victims with getting the services and support they need. Unfortunately, healthcare professionals can face many barriers that may hinder their ability to effectively identify and assist victims. A primary barrier to asking about partner violence includes the belief (of healthcare professionals) that by screening, they will enter a personal and complex situation that they will be unprepared to handle, as they have not been adequately trained to do so. Further, healthcare professionals may fear that if they inquire about potential abuse without proper training, they may cause more harm to the victim. According to research, about 50% of healthcare professionals believe it is not their role to screen for intimate partner violence, 9% believe that abuse is rare and some even believe that abused women are to blame.

It is also important to note that although many professionals are worried about offending their patients by screening them, studies reveal that the majority of women actually want healthcare providers to ask them about abuse and reported that if asked directly, they would disclose. This is a positive finding, as when healthcare professionals identify victims, they have a unique opportunity to create a bridge for patients to appropriate community agencies specializing in addressing and protecting victims of violence. It is clear that although the healthcare field has improved in its awareness of violence against women and developed some policies for screening and helping victims of violence, there are still improvements to be made. It is imperative that healthcare professionals continue to focus on the needs of this population, and that they receive training in how to screen, treat, and connect victims to community resources.

Resources:

http://www.nj.gov/dcf/women/archive/WhitePaper_DomesticViolence.pdf

http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/409520

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635968/

https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-473

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012423/full

https://quod.lib.umich.edu/m/mfr/4919087.0002.105/–domestic-violence-the-role-of-the-health-care-professional?rgn=main;view=fulltext

http://www.who.int/gender/violence/v9.pdf

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