by, Ann L. Bianchi, PhD, RN
What is Intimate Partner Violence?
Intimate Partner Violence (IPV) affects women of all ages, races, ethnic backgrounds, religions, educational levels, and economic levels. Abuse is inflicted upon a current or former partner or spouse, or boyfriend, or dating partner. Intentional behaviors are used by the abuser to induce fear, terror, coercion, and threats to gain power and control over the other person and the relationship.
Abusive behaviors, according to Centers for Disease Control and Prevention National Center for Injury Prevention and Control, may include physical abuse such as: hitting, pinching, shoving, grabbing, pushing, being kicked, thrown, or shaken, even punched, slapped, or strangulated. Depending on the severity of the assault it may lead to death.
Emotional abuse may include: wearing down the partner’s self worth or self-esteem, humiliating the partner, controlling what the dating partner can and can not do, withholding information from the partner, deliberately doing something to make the dating partner feel diminished or embarrassed, isolating the dating partner from family and friends. The acts may lead to suicide.
Sexual abuse may include: any sexual act that is forced against someone’s will such as rape, attempted sexual contact, abusive sexual contact such as intentional touching, non-contact sexual act such as harassment or threats of sexual violence. These acts may also lead to death.
Economic abuse may include: limiting or controlling the others access to resources i.e. work or school.
Spiritual abuse may include: using their religion to justify the mistreatment or prevention of religious freedom.
IPV is a crime and can creep into any relationship at anytime. Unfortunately is happens to 1 in 4 women, 1 in 3 teens, and 1 in 5 college women. These numbers only include those who have come forward and reported the abuse. Many women do not report the abuse to authorities. Unfortunately only 50% will tell someone and only 20% will tell the police. (references below) So why are women silent?
Women are silent for many reasons:
- Shame, guilt, embarrassment
- Belief that they still need to have a financial dependence on the abuser
- Fear of not being believed
- Reluctance to prosecute a friend
- Lack of knowledge of resources or available services
- Concerns about confidentiality
- Fear of retaliation, possibly the biggest reason.
- Escalation in the abusive behaviors, fear what is next.
Low reporting rates have been associated with many factors. Women may have difficulty in recognizing that these types of behaviors are abusive, may think abuse is only physical or sexual or they do not have enough experience in relationships to know the abusive behavior is not normal. Women may also feel trapped by close environments and social networks such as those on college campuses, at work, neighborhoods, church groups, or other social groups. They may not want to shake up the dynamics of their group or social network. They may fear that telling family members about the abuse will split up the family.
What Can I Do To Help?
If we don’t ask, they won’t tell. We need to address this sensitive topic with all women so they may be offered appropriate and timely referrals to supportive agencies. Not addressing this topic may put their health and safety at risk.
Women are more likely to disclose IPV when they feel they are in a safe environment and can trust you. Always ask in private and explain confidentiality. Avoid terms such as “domestic violence”, “beaten”, or “battered”, as these may sound judgmental and may be misunderstood. Instead say “partner” and name the behaviors, for example hit, kicked, shoved. When doing an assessment during a clinical visit or taking an admission history you may begin by saying: “since partner abuse is so prevalent I ask all of my patients these questions………” or: “now-a-days we hear so much about partner violence therefore I routinely ask everyone….” Then proceed to the screening questions.
Once a woman discloses she is in a violent relationship let her know that you believe her, be empathetic, validate her feelings, most of all listen to her. Allow her to make her own decisions and support whatever that decision happens to be. She disclosed the information because she trusts you , tell her it is not her fault and that you are concerned for her safety. Coming forward and telling others takes away the abuser’s control and power over the victim. The more people know the less powerful the abuser feels. Disclosure stops the silence, validates that the abuse is happening and ends the private nature of the abuse.
Once she discloses it is also most important to assess her immediate danger. Ask if she feels safe in her home. Leaving or escaping a relationship is the most dangerous time for the woman being abused, therefore it is vital to have a safety plan.
Safety plans usually include:
- Securing all important documents in a safe place (birth certificate, marriage license, insurance)
- Hiding money, keys, an extra set of clothes.
- Identifying a place to go. Making a plan to leave.
- Keeping in a safe place a list of contact numbers of friends, police, and community shelters, as well as anything that you think is needed to show for documentation purposes to receive assistance.
- Securing all valuables.
- Creating a secret code and give to family or friends ahead of time so if you do leave or need help they will know.
- Removing guns or dangerous equipment from the house.
Abused women many times suffer in silence and their support systems may have slipped away. They feel there is no way out. Unfortunately the consequences resulting from IPV may extend long after the abuse. We need to help women who experience intimate partner violence find their voice so they have the opportunity to have a life without violence. Their health and safety may depend on it.
Ann Bianchi, PhD, RN
Ann L. Bianchi is an Associate Professor, College of Nursing , The University of Alabama in Huntsville, Huntsville Alabama.
Helpful resources on intimate partner violence
- The National Domestic Violence Hotline
- National Resource Center on Domestic Violence
- Types of Violence against Women from the Office on Women’s Health at the U.S. Department of Health and Human Services
- Centers for Disease Control and Prevention’s Intimate Partner Violence: Definitions
- Futures Without Violence
- Break the Cycle (Empowering Youth to End Domestic Violence)
The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) opposes laws and other policies that require nurses to report the results of screening for intimate partner violence (IPV) to law enforcement or other regulatory agencies without the consent of the woman who experiences the IPV. Nurses and other health care professionals, however, should become familiar with laws on mandatory reporting in their states and comply as applicable.
Women should be universally screened for IPV in private, safe settings where health care is provided. Nurses are ideally positioned to screen for IPV for the purpose of initiating a referral for services and support when applicable. To protect the woman’s safety, AWHONN supports policies that require a woman’s consent before reporting occurs.