picture: European Parliament, Flickr
picture: European Parliament, Flickr

“I kept, you know, disassociating myself from domestic violence… But you know after receiving the pamphlets and reading certain things, I was thinking, I’ve experienced this.”  What can be done for women, like the one quoted here, who experience consistent intimate partner violence and don’t dare to ask for help?

According to the WHO women are more likely to experience physical, sexual, and psychological violence inflicted by their partners rather than by a stranger. The opposite is the case for men, which is why this article focuses only on female victims.

The immediate intuitive question that arises from this discussion is why women do not leave abusive relationship.

Firstly, some cases show that, women may be under such an extent of suppression by their husbands or boyfriends, that it renders them unable to realize that they are being abused. In many cases continuing abuse leads to a decline in self-esteem and the misperception of reality by the abused women.

Studies have also indicated that abusive men tend to rigidly restrict their partners’ chances to interact with life outside the family and home. There are some examples from Turkey which demonstrate that women, who are obliged to get permission from their husbands to participate in the activities of public life, are more likely to experience abuse by their husbands. Similarly, in Egypt, it is shown that 90% of abused women need permission from their husbands to visit a doctor.

Who can help woman realize that they are caught in an abusive relationship?

In these circumstances, health care providers hold a unique position as they are often the first contact for abused women outside their homes, therefore they have a high potential to change these women’s attitudes towards abusive relationships. The denial of the reality of abuse, self-blame and the fear of being socially ostracized discourage women from reaching out for help. Studies by the WHO have shown that 20-70% of female victims of domestic abuse had never told another person about the suffering inflicted on them by their partners. It has been shown that a very low percentage of abused women contact the police. In some developing countries, such as Turkey, reporting to the police, often does not guarantee protection from a violent partner.  It is common that the Police consider domestic violence as a “private” matter and advise women to resolve their problems within their family. Similarly, many women do not access the help of other official services such as women crisis centers, battered (abused) women shelters, or all-women police stations that are specifically intended for them, simply because they do not know about them.

All these factors often make health care providers the first contact available to women outside their homes. How doctors, nurses and other medical personnel respond to abused women in many cases determines whether a victim will change their attitude towards the appropriateness of abuse, or retreat into self-blame and inaction.

Do medical personnel usually screen for abuse?

According to WHO research from 2002, doctors and nurses rarely screened for domestic violence and therefore did not intervene with the aim to change women’s misperception of abuse.  One study showed that despite the fact that 78% of domestic violence victims stated that they would prefer to be asked about violence as a part of a normal medical history review, this does not occur in most instances.  Only 7% were ultimately asked, which indicates that it is hard for victims to initiate a conversation about the origin of health problems or wounds but they would share if they were asked directly. Furthermore, if health service providers do not try to identify domestic violence, the victim may think that her victimization is not an important issue.

What role can medical personnel play?

Physicians can help such patients in a number of ways; starting by creating a confidential and nonjudgmental environment, in which a victim feels they can disclose their circumstances and receive judgment-free feedback about the inappropriateness of abuse in a family. Even a short discussion with a doctor can help woman question their abusive partner’s behavior.

Medical personnel can also refer women to institutions designed to support them in cases of abuse. These may be women shelters, advocates, psychological counseling services or support groups. Health care providers must keep an up-to-date list of these support institutions. Interviews with abused women have shown that referral to further services, should be provided regardless of whether the women disclosed her experiences of abuse. It has been found, that some women prefer that such information is made available in the form of posters, brochures or other ways that allow women to avoid personal contact with the provider of the information, or even allow them to get the information secretly. Seeing information on a poster or in a brochure may encourage women to return to get it when she is ready to access help.

What has already been done?

Several studies have suggested that the failure to identify and react to abuse is due to a lack of medical personnel training. There is also evidence which shows that training targeted at primary care clinicians and administrative staff increases referrals to specialists. A group of developing countries, including Brazil, Malaysia, Mexico, Nicaragua, the Philippines and South Africa recognized these findings and therefore initiated health workers training to identify and respond to abuse.

Women should not be left alone to deal with an abusive partner. But when abuse occurs, in order for a woman to start to seek help she must be shown that there are ways to escape from, or deal with an abusive partner. Health care providers must be supported by the wider society in order to fulfill this role, as they are often the only ones in a position to provide help.

NATALIYA TARAN