Preventing Intimate Partner Violence: Integrating Routine Screening into Primary Care

by Gina Tan


Public Health Commentaries by Students is the result of a classroom writing assignment by Dr. Erika Martin at the University at Albany-SUNY who required students to write a 1,000 to 1,200 word commentary on a health-related topic of interest, explaining some of the complexities of solving the problem and offering recommendations. Four commentaries have been selected for publication on JPHMP Direct. Other public health educators may find Dr. Martin’s process helpful in developing their own course materials. Learn more: “Designing University Writing Assignments to Foster Interest in Public Health Issues and Build Professional Skills.”

There are nearly 5 million incidents of Intimate Partner Violence (IPV) against women annually, with a strong relationship to poor health outcomes. In recent years, the Centers for Disease Control and Prevention’s (CDC) Violence Prevention Unit conducted a survey to collect data about people who have experienced IPV, Sexual Violence (SV), and stalking victimization of men and women over the age of 18. It found that women experience sexual violence, physical violence, and/or stalking by an intimate partner in their lifetime more than men. More than 27% of women and 11% of men experience such IPV-related impacts. It has both short- and long-term physical and mental health consequences that can extend to the families of the affected women. Violence against women especially is a far-reaching public health problem that can be curtailed through the implementation of routinized clinical screening.

The cycle of abuse is a social cycle theory developed in 1979 by Lenore E. Walker to explain patterns of behavior in an abusive relationship. [Image available in public domain and recreated using Canva.]

Despite being a more common concern than other health outcomes that are routinely screened for, a majority of clinicians do not provide IPV screening even with the existence of the validated tools that are needed. Only 7% – 29% of women receive assistance, and roughly only one-third of victims voluntarily discuss their problems with health care providers. There are not many protocols currently available to help identify perpetrators, so routinized screening for IPV must be integrated into primary health care, for it may be the only access to help that a victim of IPV may get. In Tanzania, 44% of women experience IPV, but since it has been normalized, most affected women do not seek help. Sociocultural barriers, such as gender social norms that make IPV an accepted part of society and the stigmas that are often imposed on survivors, inhibit women from seeking help. Such structures even extend to women who reject the normality of IPV.

A sizeable proportion of the female population is affected by IPV, a situation that has been popularized by a social movement known as “Me Too.” This engenders serious health problems for many women and children. Research in South Carolina shows victimization rates from IPV approximately three times higher for women than men. Victimization by such violence not only has numerous social costs but a large monetary burden as well. A conservative estimate of its cost is $5.8 billion annually; it is comprised of medical and mental health care, which averages $4.1 billion, and lost earnings from women murdered by their partners totaling $900 million. Women suffering from IPV disproportionately use health care services, making more visits to emergency departments, primary care facilities, and mental health facilities than non-abused women.

The physical and mental health consequences of IPV divulge the severity of this issue. Emotional abuse, sexual coercion, and stalking or obsessive behavior are all forms of IPV that are affecting men and women at an alarming rate. 40% of women and 32% of men have reported experiencing expressive aggression, and 41% of women and 33% of men have reported some form of coercive control. The National Research Council also recognizes IPV when there is an occurrence and/or co-occurrence of physical assault, sexual assault, battering, and perceived emotional abuse. In such instances, battering differs from assault due to the chronic, continuous nature of abusive behavior.

Socioeconomically disadvantaged women are more likely to suffer from IPV-related effects. The U.S. and Canada have established a relation between food insecurity and IPV. A study by Tolman and Rosen examined the link between IPV and material hardships such as eviction, homelessness, and household food insufficiency and found that female welfare recipients reported more severe abuse (51%), and they found that 35.7% and 26.5%, respectively, reported food insufficiency in the past year. This is an important correlation as it establishes more contributing factors to the difficulty in curtailing this issue. Longer durations of IPV are attributed to poor health, and more recently, shorter term durations of IPV are often associated with unstable employment. Food insecurity and IPV are interdependent. In instances of economic abuse, if one partner is in control of financial assets, that partner can inhibit his or her partner’s access to economic stability. Those who get out of abusive situations might be in a disproportionately lower financial status as well. Just as economic abuse can produce food insecurity, IPV may impose greater risks for food insecurity. Lastly, environmental factors that sustain food insecurity also may increase IPV.

A study conducted in urban Michigan found that women who have experienced IPV had higher rates of depression, posttraumatic stress disorder, and substance abuse than non-abused women. According to Staggs and Riger (2005), a study in Massachusetts found disproportionality in abused women who reported physical disabilities and chronic health problems. Such consequences further affect individuals to the extent that women who have been abused are prone to experience poor health outcomes. These outcomes are both mental and stress-related physical health problems and include an array of complications regarding sleep, gastrointestinal and gynecological functions and abnormalities, and headaches. In a study from the Enuwa Primary Health Care Center in Nigeria, 36.7% of women reported IPV within the past year. 5.6 % had anxiety, and 15.5% were depressed. Being battered by an intimate partner is also accompanied by the lasting feelings of fear, loss of control, and entrapment. Prioritization of women’s health in the scope of IPV is integral to curbing its effects; efforts to universally screen for and to effectively intervene are necessary to reduce impact.

Primary care providers ought to provide more screenings for IPV to identify more instances of this abuse. Contact with doctors might be someone’s only feasible means of accessing help; asking about IPV in clinical settings makes it easier for health care providers to support victims. This includes validating their concerns, providing them with the necessary community and medical referrals, and providing more appropriate health care tailored to their situations. Many interrelated factors go into the public health problem of IPV; an effective approach to mitigate the severity of IPV would be to diagnose the issue early and get the victim help. Clinical screenings allow for earlier interventions that can be aimed at minimizing violence in the home or to help women safely leave abusive relationships. The community is essential to reducing the negative health consequences associated with IPV. Coker et al. (2007) found that the IPV screening technique was feasible and acceptable to women seeking care within clinics. This demonstrates the viability of the technique and stresses the importance of implementing IPV screenings. They are integral to an initiative to reduce the prevalence of violence in intimate relationships.

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Gina Tan

Gina Tan is a junior in the honors college at University at Albany, majoring in political science with a double minor in public policy and business. She is studying to become a lawyer and hopes to be able to help and create policies to help those who have suffered from domestic violence.

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