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A community-based perspective on living with domestic violence

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Domestic abuse crosses all socioeconomic boundaries. The common factor motivating the perpetrator is the use of control and power over another individual (Dobash and Dobash, 1979). The most severe and chronic domestic abuse is directed at women and their children by male perpetrators (Department of Health, 2000). The risk of violence within a relationship is greatest where the use of violence to resolve issues is socially tolerable (Jewkes, 2002).

Abstract

VOL: 100, ISSUE: 11, PAGE NO: 28

June Keeling, BSc, RGN, RM, is domestic violence coordinator/researcher at Arrowe Park Hospital, the Wirral, Merseyside.

 

Domestic abuse crosses all socioeconomic boundaries. The common factor motivating the perpetrator is the use of control and power over another individual (Dobash and Dobash, 1979). The most severe and chronic domestic abuse is directed at women and their children by male perpetrators (Department of Health, 2000). The risk of violence within a relationship is greatest where the use of violence to resolve issues is socially tolerable (Jewkes, 2002).

 

 

One-quarter of all violent crimes in England and Wales are as a result of domestic abuse (Mirrlees-Black et al, 1996). Domestic abuse accounts for the deaths of two or three women per week in England.

 

 

The perpetrator
Domestic abuse is insidious and the abuse often intensifies with time. The perpetrator of the abuse is most commonly the ‘live-in’ partner but this is not always the scenario. Ex-partners may also gain access to continue the abuse by means of direct threats, breaking and entering the property, or under the pretence of needing access to children.

 

 

The perpetrator has also been identified as having rigid gender role beliefs, low self-esteem and a feeling of ‘ownership’ towards his female partner (Sonkin et al, 1985). Fagan et al (1983) state that a man who abuses his partner may be manipulative and cunning, isolating her from her family and friends. The effects of living within an abusive relationship are profound. The repetitive nature of the abuse erodes a woman’s self-esteem leading to a loss of confidence and an inability to make an autonomous decision.

 

 

The recorded prevalence rates of domestic abuse within the context of an intimate relationship are acknowledged to be lower than the real rates because many cases are not reported. The reasons for this include fear of violence becoming worse, threats to the children, humiliation, and self-blame. Family and friends may be unsure how to help or may be unaware of the violence as the perpetrator often alienates his partner from her family and friends due to his feelings of jealousy and ‘ownership’ over his partner.

 

 

Women’s health
A scenario that community health care professionals typically encounter is one in which they make a domiciliary visit and are greeted by an over-attentive, apparently devoted partner who answers the questions, makes decisions on the partner’s behalf and is constantly in attendance. Of course, in some cases this is a reflection of a genuinely caring and attentive partner.

 

 

However, it may be that the man is exerting control over his partner by inhibiting her choices and controlling her environment. The most common type of abuse is psychological, though its occurrence is usually the most difficult to prove.

 

 

In one London study approximately one in four women experienced physical abuse including punches, kicks, and injuries inflicted by other means (Stanko et al, 1997). In severe cases a weapon may be used. Areas of the body that are commonly targeted are the breasts, genitals, stomach and face. The consequences of this violence may necessitate hospital admission, surgical operations, and psychiatric care. Typically, for two or three women per week this violence results in death.

 

 

Sexual abuse may include enforced sexual intercourse or participating in pornography. A weapon may be used, resulting in severe internal trauma. Genital tract injuries, infections, sexually transmitted diseases, and mutilation may be manifested (Berenson et al, 1993).

 

 

Other types of domestic abuse may include financial control and emotional abuse (constant criticism and blame apportioning).

 

 

Professional responsibilities
When a health professional suspects domestic abuse is occurring, it is not acceptable to assume that someone else will deal with the problem. It is the health professional’s duty to offer appropriate support and empower the survivor of abuse. The decision as to whether or not that offer is accepted, and contact with statutory and voluntary agencies is initiated, then rests with the survivor.

 

 

However, if any concern arises about a child’s welfare, it is paramount that the health professional adheres to child-protection guidelines. The health professional must follow her or his professional remit at all times. This includes establishing multi-agency communication and knowing the services that are available in the local area. Policies and protocols should be established and built up slowly, evaluating them along the way, to ensure they are effective and safe for women.

 

 

Conclusion
Although we live in a socioeconomically and culturally diverse society, there are certain parameters that apply to us all. One of these parameters is zero tolerance towards domestic abuse.

 

 

Domestic abuse has direct consequences for the physical, emotional, psychological and social well-being of the whole family. The community environment provides an ideal opportunity to build a rapport with the family and to detect violence within the home. Often community practitioners know the extended family, which places them in a unique position to offer assistance and support. The health service has a special role to play because everyone accesses it during her or his lifetime.

 

 

Research has highlighted the significant and detrimental effects that domestic abuse has on women’s health. It is vital that all health care professionals are aware of the non-verbal signs that may indicate that a woman is experiencing domestic abuse. The health professional’s responsibilities include the assessment of the situation followed by the active investigation of the possibility of domestic abuse.

 

 

This article has been double-blind peer-reviewed.

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