Responding to Domestic Violence: A Student’s Perspective
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Nearly one-third of women will be affected by physical and/or sexual violence perpetrated by a husband or boyfriend at some time in their lives.1 Each year, between 600,0002 and three million1 women suffer domestic violence (DV), which includes physical, sexual, psychological, and economic abuse that occurs in an intimate relationship. This devastating public health problem has both physical and psychological consequences. In addition to acute injury from physical violence, chronic health problems result from inflicted injuries and stress. Women who have lived with domestic violence more often face chronic pain, headaches, arthritis, and other long-term sequelae. The mental health consequences of violence include depression, posttraumatic stress disorder, anxiety, sleep disorders, and substance use.3 Domestic violence has also been linked to 8 out of the 10 leading health indicators chosen for Healthy People 2010, including access to health care.4
Health care providers should be aware that the incidence of violence often increases with pregnancy. Although domestic violence is more common than preecplamsia or gestational diabetes and is associated with increased rates of infections and bleeding in pregnancy, few physicians screen for it during pregnancy.5 Children are also affected by domestic violence as witnesses or as victims. Studies have increasingly shown the negative consequences to children’s future health,6 including changes in the neurobiological development of children who have witnessed or experienced violence.7
Despite the significant impact of interpersonal violence (IPV) on health, domestic violence has not always been considered a health problem. Outraged at statistics like those described above, former U.S. Surgeon General C. Everett Koop stated in a 1985 hearing before the US Senate Committee on Labor and Human Resources,
No nation that calls itself civilized can live with those kinds of numbers, and no society that values life as much as we do can tolerate this level of human catastrophe. What can we do about it? […] Prevention is the key to reducing the level of interpersonal violence in American life. […] It is my feeling that the most effective approaches to prevention in the area of interpersonal violence, and especially domestic violence, could well spring from the disciplines of public health, medicine, nursing, and social service.8 [End Page 665]
Dr. Koop’s message helped to bring awareness to the role that health care and public health communities can play against domestic violence.
Fifteen years after the hearing, Dr. Koop’s message reached me when I read it during my freshmen year in college. During that year I took a course on women in medicine, and reading the document helped me to connect my interests in women’s health and violence against women. I saw how as a future health care provider I could use the tools of the profession to influence larger social issues—the social determinants of health. The experience clarified for me that not only could we affect health by targeting social issues, but that it was our responsibility as health care providers to do so.
In college, I formed an interest in public health that overlapped with my long-standing interest in studying medicine. Graduate training provided me with tools for community empowerment, program development, policy analysis, and greater knowledge of the social determinants of health. I benefited from many experiences while in public health graduate school, such as evaluating a batterer intervention program in Oakland, learning how to apply behavioral health theories to domestic violence, and learning how to advocate for practices such as universal screening during pregnancy. It became clear to me that domestic violence, like many social issues, requires collaboration for effective, comprehensive, and creative solutions.
As I moved through graduate school, I tried to understand the social determinants of health and domestic violence from a variety of perspectives. Seeking to learn from advocates, I went through the training at La Casa De Las Madres, a domestic violence service organization and women’s shelter in San Francisco. This shelter was one of the first in the country and represents the beginning of a movement guided by survivors, advocates, and grassroots organizing.9 The training from La Casa...
