Spouse/partner Abuse
Walker (1999) argued that "the single most powerful
risk marker for becoming a victim of violence is to be a woman" (p. 23).
While strangers or acquaintances commit the majority of the assaults against
men, women are much more likely to be raped, assaulted, or murdered by
romantic/intimate partners (Mahoney, Williams, &
West, 2001).
Unlike street violence, domestic partner violence occurs in the context of "shared" lives.
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Intimate partner abuse includes abuse by current or former spouses or romantic or co- habitating partners. Partner abuse does not typically involve a single violent assault; it is a cyclic, progressive process in which violence is used to control one’s partner. Most violence against women by male partners is best described as battering - that is, "a pattern of behaviors through which one person continually reinforces a power imbalance over another in an intimate/romantic relationship context" (Mahoney et al., 2001, p. 145). Intimate partner abuse includes a variety of abusive and coercive behaviors that may be of a physical, psychological, sexual, or economic nature (Ganley, 1998). It is estimated, for example, that 40 to 45% of battered women also experience forced sex by male partners (Campbell, 1998).
Unlike street violence, domestic partner violence occurs in the context of "shared" lives. In addition to affective ties, the victim and the perpetrator share, or have once shared, a residence, financial obligations and resources, children, and/or friends. The abuse often occurs in the context of an on-going or recently severed relationship; perpetrators may therefore have on-going access to the victim. Because intimate partner violence is considered a "family concern," it is often taken less seriously than stranger or street violence. Victims often experience social and economic barriers to ending the relationship (Ganley, 1998).
Scope
Many health care professionals have
experienced domestic violence in their personal lives.
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Findings from the National Violence Against Women Survey, a telephone survey of a national random sample of 8,000 U.S. men and 8,000 U.S. women, indicated that approximately 22.1 % of the surveyed women were physically assaulted by a current or former spouse, co-habitating partner, boyfriend or girlfriend, or date in their lifetime; 1.3 % of the surveyed women reported such violence during the previous year. Based on these findings and U. S. Census data, the researchers estimated that approximately 1.3 million women are physically assaulted annually by an intimate partner or ex-partner. In addition, 7.7 % of the surveyed women were raped by a current or former intimate partner at some time; 0.2 % experienced such violence in the preceding 12 months. It is estimated, therefore, that over 200,000 women are raped each year in the United States by an intimate partner (Tjaden & Thoennes, 2000a).
Many health care professionals have experienced domestic violence in their personal lives. Ellis (1999) surveyed 40 registered nurses employed in a large emergency department and found that 57.5% reported a personal experience with domestic violence. While 35% reported having been hit, kicked, or punched, only 25% of this group identified these experiences as abuse. In a survey of 275 nurses in perinatal practice, 31% reported abuse of themselves or their family members (Moore, Zaccaro, & Parsons, 1998).
Significant controversy exists about the prevalence and the nature of female violence against male partners. Some experts maintain that women are as violent as are men to their partners, whereas others maintain that female to male violence differs significantly in both frequency and severity, and is often used in self-defense (Tjaden & Thoennes, 2000b). Results of the National Violence Against Women Survey support the latter view. Whereas 22.1 % of the women surveyed had been physically assaulted by a current or former partner at some time, only 7.4 % of the men had experienced similar violence. Women were thus more than 2.9 times as likely as men to report abuse by a partner of the opposite sex. Survey results also indicated that the frequency of victimization was greater for women (7.1 incidents vs 4.7 incidents), as was the duration of the violence (3.8 years vs 3.3 years). The female victims also experienced significantly more life threats (33 % vs 26 %) and fear of bodily injury (45 % vs 20 %). The authors concluded that male and female violence in relationships is asymmetrical as women experience male-perpetrated violence more frequently, and the abuse is more repetitious and physically injurious.
History
According to English common law, women were viewed as chattel - first as property of their fathers, and then of their husbands. When a woman married, her legal existence was consolidated into that of her husband; she was considered to be under his protection and influence and could not inherit property (Schornstein, 1997). Physical violence was used frequently by husbands against wives. According to the "rule of thumb" law, a man could beat his wife with a rod no bigger than his thumb (Barnett, Miller-Perrin, & Perrin,1997).
Schornstein (1997) provided several examples of 19th century U. S. court rulings that reflected the principles of English common law and upheld the right of a husband to physically discipline his wife. In 1864, the Supreme Court of North Carolina ruled in State v. Black that a husband could not be convicted of battering his wife unless he inflicted a permanent injury, used excessive violence, or exhibited malignity or vindictiveness. In 1868, the Supreme Court of South Carolina in State v. Rhodes refused to hold a husband criminally responsible for having beaten his wife with a small stick.
In the late 1800s, legal reform related to domestic violence began in the United States (Barnett et al., 1997). In the 1870s, Alabama and Massachusetts introduced the first legislation making it illegal to beat one’s wife. Several other states followed with similar legislation. Few arrests were made, however, and district attorneys were unlikely to prosecute. In 1882, the state of Maryland passed legislation that outlawed wife beating and made it a crime punishable by 40 lashes or a year in jail (Schornstein, 1997).
Grassroots feminists brought the problem of violence against women to public attention in the U.S. in the l960s and 1970s and began to establish a number of community-based programs for battered women. Haven House in Pasadena, California, the first shelter for battered women and their children, was opened in 1964. Organizations such as the National Organization of Women and the National Coalition Against Domestic Violence pushed for social services and legislative reform to better protect battered women (Barnett et al., 1997).
In 1979, Lenore Walker published The Battered Woman , an influential
book that defined the battered women’s syndrome (BWS). The major components
of BWS are the post-traumatic stress symptoms and learned helplessness
that develop when the woman’s attempt to end the abuse proves futile.
Walker’s work was significant as the symptoms experienced by battered
women were identified as responses to on-going abuse, challenging the
traditional assumption that a woman’s psychological vulnerability causes
or contributes to, rather than results from, her battering.
In 1982, the U.S. Commission on Civil Rights published a report entitled Under the Rule of Thumb: Battered Women and the Administration of Justice evaluating the treatment of victims of domestic violence by the criminal justice system and social service agencies. The report concluded that police officers, prosecutors, and judges provided little relief for victims of domestic violence because they considered domestic violence a private matter rather than a crime (Schornstein, 1997).
The former US Surgeon General, Everett Koop, designated the battering of women as a significant health problem and convened The Surgeon General’s Workshop on Violence and Public Health in 1985 (USDHHS, 1986). The 150 attendees were advocates, practitioners, educators, and researchers concerned with violence against women. Mandatory training and examination of health professionals in the essentials of domestic violence intervention was a major recommendation from the workshop (Hoff, 2001).
In 1994, Congress passed the Violence Against Women Act (VAWA) as a part of the Violent Crime Control and Law Enforcement Act. The VAWA is a "group of individually conceived legislative pieces that were joined together to create a package of federal laws and grant programs specifically addressing domestic violence, sexual assault, and stalking" (Valente, Hart, Zeya, & Malefyt, 2001, p. 285). The VAWA was the first federal law to criminalize domestic violence. The legislation authorized grants to states, Native American tribunals, and local governments to improve criminal justice response to domestic violence. It included new federal statutes for interstate domestic violence, introduced a civil rights cause of action, funded a wide assortment of programs, initiated new federally-funded research on domestic violence, and created a national domestic violence hotline (Schornstein, 1997). In 1995, the Violence Against Women Office of the Office of Justice Programs was created to implement the VAWA (U. S. Department of Justice, 2001).
Since the 1970s, nursing has been involved in efforts to combat the problem of intimate partner abuse.
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The Violence Against Women Act of 2000, which was amended to the Victims of Trafficking and Violence Provention Act of 2000, reauthorized critical grant programs, established new programs, and strengthened federal laws related to domestic violence, sexual assault, and stalking. VAWA 2000 provides coverage for dating violence, supervised visitation centers, civil legal assistance and judicial education, and increased protection for battered immigrant women (U.S. Department of Justice, 2000).
Since the 1970s, nursing has been involved in efforts to combat the problem
of intimate partner abuse. Nurses were strongly represented at the Surgeon
General’s 1985 workshop. The Nursing Network on Violence Against Women
International (NNVAWI), which aims to "end violence against women, empower
battered women, and change the health care system to be more responsive
to the needs of abused women and their children" (Campbell
& Parker, 1999, p. 541) was founded in 1986. In 1997, the Public
Health Service Office on Women’s Health coordinated a National Nursing
Task Force on Violence Against Women with members representing 30 national
nursing organizations. The group’s work resulted in national policy recommendations
that were presented during the National Nursing Summit on Violence Against
Women (U.S. Public Health Service, 2001). Several
nursing organizations have issued position statements acknowledging violence
recognition, prevention, and intervention as health care priorities (the
American Association of Colleges of Nursing, 2001; the
American Nurses’ Association, 1991; the National Black
Nurses’ Association, Inc., 1994; the American College
of Nurse-Midwives, 1997; the Emergency Nurses Association,
1998). During the 1990s, there has been a proliferation of programs
in hospitals and community-based health centers that provide specialized
domestic violence prevention and intervention programs for battered women
and their children (Sheridan, 1998).
Health Consequences
The physical consequences of battering range from minor injuries to permanent disability, disfigurement, and death. The National Violence Against Women Survey found that 30.2 % of the women injured during their most recent physical assault and 35.6 % of the women injured during their most recent rape received some type of medical treatment . Women who are assaulted or raped by a current or former partner are at the greatest risk for injury (Tjaden & Thoennes, 2000a). Nurse researchers have documented that 22 % to 35 % of women who seek treatment at hospital emergency departments do so for injuries related to domestic violence (Campbell, Pliska, Taylor, & Sheridan, 1994).
Domestic violence injuries frequently include lacerations, bruises and contusions, musculoskeletal damage (broken bones, tendon & ligament injuries), neurological problems (hearing and vision loss, impaired concentration), and, in the case of sexual assault, vaginal and anal tears (Warshaw, 1998). Stress-related consequences of battering may include persistent headaches, chronic irritable bowel syndrome, chronic pain, and eating disorders (Campbell, 1998; Warshaw, 1998). Sexual violence may result in increased risk for a number of genito-urinary problems, including pelvic inflammatory disease, sexually-transmitted diseases, bladder infections, sexual dysfunction, pelvic pain, and urinary tract infections. Battering during pregnancy is also considered a major health risk, and may result in miscarriages, placental separation, antepartum hemorrhage, fetal fracture, rupture of the uterus, and preterm labor (Warshaw, 1998). Battering during pregnancy has been associated with low birth weight infants, perhaps through the influence of factors such as smoking, low weight gain, and substance abuse (Campbell et al., 2000). Mental health effects most frequently associated with battering include depressive symptoms, post traumatic stress disorder, substance abuse, and suicidality (Campbell, 1998; Warshaw, 1998). The most grim consequence of domestic violence is death; the majority of women who are killed in the United States are killed by a current or former intimate partner (Campbell, 1998).
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