ABC of Domestic and Sexual Violence

Susan Bewley, Jan Welch, Susan Bewley, Jan Welch

• Publisher: BMJ Books
• Year: 2014
• Print ISBN: 9781118482186
• eBook ISBN: 9781118482162
• Edition: 1
• Topic: Medicine
• Subtopic: Family Medicine & General Practice

ABC of Domestic and Sexual Violence is a practical guide for all health care professionals who are looking after abused individuals (whether knowingly or not) and who wish to learn more in order to help their patients. It employs a positive and hands on approach, emphasising simple history taking skills and clinical 'tips' and pitfalls to help demystify what is often considered a sensitive or difficult subject area.

This new ABC title covers background and epidemiology, including: international and cultural perspectives, common presentations, how to identify abuse, and guidance on subsequent acute and longer-term medical and psychosocial interventions. It provides guidance on legal perspectives including documentation and sources of help and advice. While focusing mainly on women, it will also cover aspects relating to children and men. It also incorporates victim testimonies and case scenarios throughout.

From a multidisciplinary team of contributors ABC of Domestic and Sexual Violence is ideal for all general practitioners, accident and emergency, practice nurses, health visitors, midwives, social workers, and other primary and secondary care health care professionals.

Chapter 1
The Epidemiology of Gender-Based Violence

Gene Feder and Emma Howarth

Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, UK

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OVERVIEW

• The most consistent risk factor for domestic and sexual violence is being a woman; most severe domestic violence and most sexual violence is perpetrated by men
• Hence, sexual and domestic violence are gender-based, although men can also be victims of interpersonal violence
• The term ‘gender-based violence’ highlights the roots of violence against women in gender inequality
• Gender-based violence is both a breach of human rights and a major challenge to public health and clinical practice

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What are domestic violence and sexual violence and why are they gender-based?

This chapter outlines the epidemiology of gender-based violence in the UK and internationally in terms of prevalence, community vulnerability and health impact. It concludes with reflections on why it remains so hidden from doctors and other clinicians and the need for robust research on effective health care responses.

In the UK, domestic violence is defined as any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between people aged 16 or over who are or have been intimate partners or family members, regardless of gender or sexuality.

This can encompass, but is not limited to, the following types of abuse:

• Psychological.
• Physical.
• Sexual.
• Financial.
• Emotional.

Sexual violence is a major component of domestic violence, often co-occurring with other forms of abuse, and includes sexual abuse from carers, strangers, acquaintances or friends. It is defined as any sexual act, attempt to obtain a sexual act, unwanted sexual comment or advance, attempt to traffic, or other act directed against a person's sexuality using coercion, by any person regardless of their relationship to the victim, in any setting.

Gender-based violence is not confined to domestic and sexual violence. It includes:

• Female genital mutilation (see Chapter 17).
• Femicide, including (so-called) honour- and dowry-related killings (see Box 3.2).
• Human trafficking, included forced prostitution and economic exploitation of girls and women (see Box 3.3).
• Violence against women in humanitarian and conflict settings.

The World Health Organization (WHO) definition of gender-based violence explicitly includes its impact: ‘…[it] is likely to result in physical, sexual or mental harm or suffering to women…’ As discussed later in the chapter and elsewhere in this book, the health impacts are substantial and often persistent.

Gender-based violence is best understood in terms of the ecological model presented in Figure 1.1, which highlights factors at all levels from the societal to the individual.

Figure 1.1 Factors associated with violence against women.

Source: WHO 2012 Understanding and addressing violence against women: overview. Reproduced by permission of the World Health Organization.

Globally, men are more likely to die violently and prematurely as a result of armed conflict, suicide or violence perpetrated by strangers, whereas women are more likely to die at the hands of someone close to them, on whom they are often economically dependent. In much of the world, prevailing attitudes justify, tolerate or condone violence against women, often stemming from traditional beliefs about women's subordination to men and men's entitlement to use violence to control women.

Prevalence in the UK

The Crime Survey for England and Wales (formally known as the British Crime Survey) is the most reliable source of community prevalence estimates of domestic violence and sexual violence in the UK. The 2011–12 survey reports lifetime partner abuse prevalence of 31% for women and 18% for men; 7 and 5% respectively had experienced abuse in the previous 12 months. The definition of partner abuse includes nonphysical abuse, threats, force, sexual assault or stalking. The Crime Survey for England and Wales also measures nonpartner domestic violence (termed ‘family abuse’), reporting a lifetime prevalence of 9 and 7% for women and men, respectively. The starkest gender difference in prevalence revealed by the Crime Survey for England and Wales is for sexual assault: 20 and 3% lifetime prevalence for women and men, respectively, although these figures include assaults by partners, ex-partners, family members or any other person. A more detailed examination of nature of physical abuse incidents recorded in 2001 also shows a greater gender asymmetry than the headline prevalence figures. Women, as compared to men, were more likely to sustain some form of physical or psychological injury as a result of the worst incident experienced since the age of 16 (75 vs 50% and 37 vs 10%, respectively), and more likely to experience severe injury such as broken bones (8 vs 2%) and severe bruising (21 vs 5%). Moreover, 89% of those reporting four or more incidents of domestic abuse were women. Data reported in 2010 showed that the majority of violent incidents against women are carried out by partners/ex-partners/family members (30%) or acquaintances (33%) rather than by strangers or as part of mugging incidents (24 and 19% respectively). In contrast, the majority of incidents against men are categorised as stranger victimisation or mugging (44 and 19%, respectively, vs 6% domestic and 32% acquaintance, mirroring the international data on murder discussed earlier).

The Crime Survey for England and Wales module on sexual assault reported that 2.5% of women and 0.4% of men aged 16–59 had experienced a sexual assault (including attempts) in the previous 12 months. It also showed that 0.6% of women and 0.1% of men had been the victim of a serious sexual assault in the year prior to interview. It did not distinguish between sexual violence as part of domestic violence and that perpetrated by a friend or stranger.

Domestic violence internationally

The WHO multicountry study conducted in 2000–03 estimated the extent of physical and sexual intimate partner violence against women in 15 sites across 10 countries (Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Tanzania and Thailand). This study, involving 24 000 participants aged 14–59 years and using standardised survey methods, is the most robust comparison between countries conducted to date, although figures do not represent national prevalence rates as the samples were based in specific rural or urban settings.

The reported lifetime prevalence of physical and/or sexual violence for ever-partnered women varied from 15 to 71%; 12-month prevalence rates varied from 4 to 54%. The percentage of ever-partnered women in the population who had experienced severe physical violence ranged from 4% in Japan (city) to 49% in Peru (province). The proportion of women reporting one or more acts of their partner's controlling behaviour (including isolation from family and friends and having to seek permission before seeking medical treatment) ranged from 21 to 90%. These wide-ranging rates may reflect cultural differences in the normative level of control in intimate relationships. However, the finding that women across all sites who suffered physical or sexual partner violence were substantiall...

Table of contents

• Cover
• Title Page
• Copyright
• Contributors
• Foreword
• Introduction
• Chapter 1: The Epidemiology of Gender-Based Violence
• Chapter 2: ‘Culture’ and Violence
• Chapter 3: Domestic Violence and Abuse
• Chapter 4: The Impact of Trauma
• Chapter 5: Children
• Chapter 6: Sexual Assault of Men and Boys
• Chapter 7: Identifying Domestic Violence and Abuse
• Chapter 8: Community-Based Responses to Domestic Violence
• Chapter 9: Sources of Referral and Support for Domestic Violence
• Chapter 10: Perpetrators
• Chapter 11: General Practice
• Chapter 12: Emergency Medicine and Surgical Specialities
• Chapter 13: Elder Abuse
• Chapter 14: The Dental Team
• Chapter 15: Mental Health Services
• Chapter 16: Women's, Reproductive and Sexual Health Services
• Chapter 17: Female Genital Mutilation
• Chapter 18: Sexual Violence: What to Consider First
• Chapter 19: Rape and Sexual Assault: Medical and Psychosocial Care
• Chapter 20: Documenting in the Notes
• Chapter 21: Law and Prosecuting Practice in Relation to Serious Sexual Assaults and Domestic Violence
• Chapter 22: Writing a Statement as a Professional Witness
• Chapter 23: Going to Court
• Chapter 24: Violation of Professional Boundaries
• Chapter 25: Moving Forward: Developing Care Pathways within the Health Service
• Chapter 26: Moving Forward: Pursuing a Career and Implementing Better Services
• Appendix A: Useful Resources
• Appendix B: CAADA-DASH Risk Identification Checklist
• Index
• End User License Agreement