Intimate Partner Violence: The Under-Addressed Pandemic

By | March 23, 2017

Violence against women and girls is an international concern that cuts across all sectors of society. The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”

Intimate partner violence (IPV) is defined by the World Health Organization as behavior by an intimate partner or ex-partner that inflicts physical, sexual, or psychological harm upon the victim, who may be any gender; however, IPV is experienced by women far more frequently than men. A recent analysis by the World Health Organization and the London School of Hygiene and Tropical Medicine estimates that 30% of all ever-partnered women have experienced physical and/or sexual violence by an intimate partner. A 2006 article by Wittenberg and colleagues published in Medical Care addressed the negative health consequences of intimate partner violence, and the article also aimed to provide cost-effectiveness estimates for intervention and prevention programs. Wittenberg and colleagues note that women who suffer from intimate partner violence experience markedly decreased health-related quality of life.

Healthcare providers are in a unique position to screen for intimate partner violence. Committee Opinion No. 518 from the American Congress of Obstetricians & Gynecologists (ACOG) notes the recommendation from the U.S. Department of Health and Human Services and the Institute of Medicine that screening for IPV should be a primary component of women’s health visits. Furthermore, ACOG notes that screening at various intervals is vital in order to normalize the conversation and provide additional opportunity for women to disclose violence, as many women will not disclose violence when first asked. As one might suspect, it is important that women be screened alone, with no family members or friends in the exam room. ACOG also notes signs of intimate partner violence, including “depression, substance abuse, mental health problems, requests for repeat pregnancy tests when the patient does not wish to be pregnant, new or recurrent STIs, asking to be tested for an STI, or expressing fear when negotiating condom use with a partner.”

I would also emphasize the negative physical and mental health consequences of psychological intimate partner violence. Psychological violence is oftentimes more difficult to identify, yet it carries the same types of health consequences as physical and sexual intimate partner violence, including depression, post-traumatic stress disorder, other anxiety disorders, substance abuse, eating disorders, sleep difficulties, and suicide attempts, among others, according to the World Health Organization.

The World Health Organization also details the social and economic costs of intimate partner violence, including isolation, lack of work, lost wages, and reduced capacity for victims to care for themselves and their children. It is widely accepted that education and empowerment of women is a primary strategy for prevention of intimate partner violence. Thus, we must continue to strive for equality in addressing and preventing gender-based violence in our families, our communities, our nation, and our world.

Rebekah Rollston

Rebekah Rollston

Rebekah L. Rollston, MD, MPH, is a Family Medicine Resident at Tufts University at Cambridge Health Alliance in Massachusetts. She earned her Medical Degree from East Tennessee State University James H. Quillen College of Medicine and her Master of Public Health from The George Washington University Milken Institute School of Public Health. Her professional interests include increasing access to primary care, health disparities among marginalized women, gender-based violence & intimate partner violence, access to contraception, adolescent pregnancy prevention, transgender health, self-esteem development, addiction medicine, and international health.