FAMILY VIOLENCE AS A PUBLIC HEALTH ISSUE

As you know, family violence is a broad term, and includes spousal or intimate partner abuse, elder abuse and neglect, and child abuse and neglect.

Family violence can include physical assault and battery, sexual assault or rape, and for children and the elderly, neglect. And therein lies one of our problems – lack of public recognition of the depth and breadth of the problem.

There is an inter-connectedness among the various forms of family violence as well. Studies have shown that men who frequently assault their wives also frequently physically abuse their children. Mothers who are beaten are more likely to physically abuse their children than mothers who are not abused.

We have heard the statistics about the prevalence of family violence.

According to the National Violence Against Women Survey, one out of four women in the United States has been physically assaulted or raped by an intimate partner; one out of 14 men also reported such experiences. Each year, an estimated four million women are physically abused by their spouses or live-in partners.

Of the women who are physically assaulted or raped by an intimate partner, one in three is injured and requires medical treatment.

In the year 2000, an average of 2,400 children were victims of child abuse each day, most in their own homes at the hands of a parent.

An average of three children die in this country every day because of child abuse or neglect, over 1,000 each year.

While underreported, elder abuse is a concern as a large fraction of America’s population continues to age. Most victims of elder abuse are older women with a chronic illness or disability. Again, the most typical abusers are spouses, adult children, or family members, those from whom one would expect protection, care and love.

The individual and societal consequences of family violence can be severe:

• Physical injury or death
• Chronic health conditions: Research shows a correlations between domestic violence and health conditions such as arthritis, chronic neck, back and pelvic pain, migraine headaches and stomach ulcers.
• Broken families, and the emotional devastation that occurs, both for adults and children.
• Increased health care expenditures: According to the Centers for Disease Control and Prevention (CDC), the health-related costs of rape, physical assault, stalking, and homicide by intimate partners exceed $5.8 billion each year.

The physical consequences are bad enough.

Imagine for a moment what it is like emotionally to be the victim of family violence. There is the terrible fear of physical intimidation that is sometimes hard for those of us who are men to understand.

Think of what it must be like to be a 100-pound woman trying to run away from the anger of her 200-pound husband. Or a 60-pound child feeling the terror of being punished by a 130-pound, emotionally out-of-control mother. Or a disabled elderly woman, unable to move quickly, being threatened by a grown son or caregiver.

And then, there is the aspect of betrayal. It is natural to expect love and caring from our family members and intimate partners.

So imagine the emotional as well as physical devastation that occurs when someone you love, and who is supposed to love you, hits you, kicks you, punches you, or shakes you. It’s horrifying. And because it occurs in the home, the victim feels trapped, and unable to escape.

WHY DOES FAMILY VIOLENCE OCCUR?

According to the Centers for Disease Control and Prevention (CDC), the common element in every incident of intimate partner violence is the abuser’s need for power and control in the relationship.

We talk a lot about ‘risk factors’ in the field of public health. For example, an obese person has a greater risk of contracting cardiovascular disease than a person of normal weight. Similarly, there are risk factors for being either a perpetrator of, or victim of, family violence.

Mental illness is a risk factor. Evidence indicates that violent intimate partners may be more likely to have personality disorders such as schizoidal/borderline personality, and dependency and attachment problems.

Perpetrators are also more likely than their non-violent peers to be depressed and have low self-esteem.

Alcohol and drug use or addiction is also a risk factor. Perpetrators of family violence are often using alcohol or drugs when they lash out at their victims.

There is also an intergenerational, or cyclical aspect to abuse.

If a child witnesses violence or experiences it in his or her family growing up, he or she is more likely to perpetrate or become a victim of it as an adult. Women who witness domestic violence as children may be at higher risk for victimization in their own relationships.

The child who is abused becomes the teenager who is violent toward his peers, and then the man who is violent toward his wife, or elderly parent. The cycle keeps repeating itself unless it is broken.

Even now, societal norms reinforcing male dominance and violence as an acceptable problem-solving strategy and means of control still exist in many areas.

The notion that "domestic violence is a family or private matter" and not the business of the state is now considered to be a myth in public health circles, but for many years that is the way our law enforcement, criminal justice and military communities saw it. It will take sustained effort to overcome that mistaken perception where it still exists. Fortunately our law enforcement and judicial systems have evolved to a ‘no tolerance’ attitude.

Another aspect of this question deals with the attitudes and behaviors of men who batter. The following presents some of the characteristics associated with batterers:

INTIMIDATION AND VIOLENCE

• Resolves conflict with intimidation, bullying, and violence.

• Holds her down, restrains her from leaving a room, pushes, or shoves.

• Uses threats and intimidation as instruments of control or abuse. This includes threats to harm physically, to defame, to embarrass, to restrict freedom, to disclose secrets, to cut off support, to abandon, to kidnap children, and to commit suicide. Says things that are meant to be cruel and hurtful. Degrades her, curses her, or minimizes her accomplishments. May wake her up to yell at her or not let her go to sleep by yelling at her.

RAPE AND SEXUAL ABUSE

Rape and sexual abuse can be extraordinarily difficult for victims to talk about because of the unimaginable ways in which this type of violence often is perpetrated. Sexual abuse or rape can be indicated when the batterer:

• Is jealously angry and assumes she will have sex with anyone.

• Withholds sex and affection as punishment.

• Calls her sexual names.

• Pressures her to have sex when she doesn’t want to.

• Insists that his partner dresses in a more sexual way than she wants.

• Coerces sex by manipulation or threats.

• Physically forces sex or is violent during a sexual assault.

• Coerces her into sexual acts that she is uncomfortable with, such as sex with a third party, physically painful sex, sexual activity she finds offensive, or verbal degradation during sex.

• Inflicts injuries that are sex-specific.

• Denies the victim contraception or protection against sexually transmitted diseases.

My Safety plan

This is my plan to prepare for the possibility for future violence. Although I do not have control over my partner’s violence, I do have a choice about how to respond to him/her, and how best to get myself and my children to safety.

STEP 1: Safety during a violent incident.

Women cannot always avoid violent incidents. In order to increase safety, battered women may use a variety of strategies.

I can use some (or all) of the following strategies:

If I decide to leave, I will ____________________. (Practice how to get out safely. What doors, windows, elevators, stairwells or fire escapes would you use?)

I can keep my purse and car keys ready, and put them (place)____________________ in order to leave quickly.

I can tell ___________________ about the violence and request they call the police if they hear suspicious noises coming from my house.

I can teach my children how to use the telephone to contact the police and the fire department.

I will use ____________________ as my code for my children or my friends so they can call for help.

If I have to leave home, I will go ____________________. (Decide this even if you don’t think there will be a next time.) If I cannot go to the location above, then I can go to __________________or _________________.

I can also teach some of these strategies to some/all of my children.

When I expect we are going to have an argument, I will try to move to a space that is lowest risk, such as ____________________. (Try to avoid arguments in the bathroom, garage, kitchen, near weapons, or in rooms without access to an outside door.)

I will use my judgment and intuition. If the situation is very serious, I can give my partner what he/she wants to calm him/her down. I have to protect myself until I/we are out of danger.

STEP 2. Safety when preparing to leave. Battered women frequently leave the residence they share with the battering partner. Leaving must be done with a careful plan in order to increase safety. Batterers often strike back when they believe that a battered woman is leaving the relationship.
 
I can use some (or all) of the following safety strategies:

I will leave money and an extra set of keys with ____________________, so that I can leave quickly.

I will keep copies of important documents or keys at __________________.

I will open a savings account by ____________________, to increase my independence.

My Local domestic violence program hotline number is _______________, and I can seek shelter by calling this hotline.

I can keep change for phone calls on me at all times. I understand that if I use my telephone credit card, the following month the telephone bill will tell my batterer the numbers that I called after I left. To keep my telephone communications confidential, I must either use coins or I might get a friend to permit me to use their telephone credit card for a limited time when I first leave.

I will check with ____________________ and ____________________ to see who would be able let me stay with them or lend me some money.

I can leave extra clothes with ____________________.

I will set down and review my safety plan every ____________________ in order to plan the safest way to leave the residence. ____________________ (domestic violence advocate or friend) has agreed to help me review this plan.

I will rehearse my escape plan. I will, practice it with my children when appropriate.

STEP 3: Safety in my own residence. There are many things that a woman can do to increase her safety in her own residence. It may be impossible to do everything at once. But safety measures can be added step by step.
 
I can use some (or all) of the following safety strategies:

I can change the locks on my doors and windows as soon as possible.

I can replace wooden doors with steel/metal doors.

I can install security systems, including additional locks, window bars, poles to wedge against doors, electronic system, etc.

I can purchase rope ladders to be used for escape from second floor windows.

I can install smoke detectors and purchase fire extinguishers for each floor in my house/apartment.

I can install an outside lighting system that lights up when a person is coming close to my house.

I will teach my children how to use the telephone to make a collect call to me, and to ____________________ (friends/minister/other) in the event my partner takes the children.

I will tell people who take care of my children which people have permission to pick up my children, and that my partner is not permitted to do so. The people I will inform about pickup permission include:
 
________________________________________ (School),
 
________________________________________ (Daycare staff),
 
________________________________________ (Baby-sitter),
 
_____________________________________ (Sunday school teacher),
 
________________________________________ (Teacher),
 
________________________________________ (and),
 
________________________________________ (others)

I can inform _____________________ (neighbors), ____________________ (pastor), and ___________________(friend) that my partner no longer resides with me and they should call the police if he is observed near my residence.

STEP 4: Safety with a Protective Order. Many battered women obey protection orders, but one can never be sure which violent partner will obey, and which will violate protection orders. I recognize that I may need to ask the police and the court to enforce my protection order.
 
The following are some steps that I can take to help the enforcement of the protective order:

Always keep a copy of the order with you. If you change purses, that’s the first thing that should go in.

I will also keep a copy of my Protective Order ___________________ (location) next to my telephone in case I need to call the police. I will give my protection order to the police department in the communities where I usually visit family or friends, and in the community where I live.

I will inform my employer, my minister, my closest friend and __________________, and __________________ that I have a protection order in effect.

If my partner destroys my protective order, I can get another copy by going to the District or Circuit Court Civil Clerk’s office, depending on which court issued my order

If my partner violates the protective order, I can call the police and report a violation, contact my attorney, call my advocate, and/or advise the court of the violation.

If the police do not help, I can contact my advocate or attorney and he or she will assist me with getting help.

I can also file a criminal complaint with the District Court commissioner in the jurisdiction where the violation occurred. I can charge my battering partner with a violation of the Protective Order. All the crimes that he commits in violating the order. I can call the domestic violence advocate to help me with this.

STEP 5: Safety on the job and in public. Each battered woman must decide if and when she will tell others that her partner has battered her, and that she may be at continued risk. Friends, family and co-workers can help to protect the woman. Each woman should consider carefully which persons to invite to help secure her safety.
 
I might do any (or all) of the following:

I can inform my boss, the security supervisor and ____________________ at work of my situation.

I can ask ____________________ to help screen my telephone calls at work.

 When leaving work, I can ____________________________________________________ ___________________________________________________________________________

When driving home, if problems occur, I can _______________________________________
______________________________________________________________________________

If I use public transportation, I can ______________________________________________
_____________________________________________________________________________

I will go to different grocery stores and shopping malls to conduct my business, and shop at hours different from those I used when residing with my batterering partner.

I can use a different bank and take care of my banking at hours different from those I used when residing with my battering partner.

I can also _______________________________________________________________.

STEP 6: Safety and drug or alcohol use. Most people in this culture use alcohol. Many use mind-altering drugs. Much of this use is legal, and some is not. The legal outcomes of using illegal drugs can be very hard on a battered woman. It may hurt her relationship with her children. Drug use can put her at a disadvantage in other legal actions with her battering partner. Therefore, women  should carefully consider the potential cost of the use of illegal drugs. Even more important, alcohol or other drug use can reduce a woman’s awareness and ability to act quickly to protect herself from her battering partner. Alcohol or other drug use by the batterer may give him/her an excuse to use violence. A woman needs to make specific safety plans about drug and alcohol use.

If drug and alcohol use has occurred in my relationship with the battering partner, I can enhance my safety by some or all of the following:

If I am going to use, I can do so in a safe place and with people who understand the risk of violence, and are committed to my safety.

I can also _______________________________________________________________.

If my partner is using, I can ________________________________________________.

I might also _____________________________________________________________.

To safeguard my children, I might ____________________________________________ and _____________________________________.

STEP 7: Safety and my emotional health. The experience of being battered and verbally degraded by partners is usually exhausting and emotionally draining. The process of building a new life for myself takes much courage and incredible energy.
 
To conserve my emotional energy and resources and to avoid hard emotional times, I can do some of the following:

If I feel down and ready to return to a potentially abusive situation, I can _____________________________________________________________.

When I have to communicate with my partner in person or by telephone, I can
________________________________________________.

I can try to use “I can . . . “ statements with myself and to be assertive with others.

I can tell myself, “_________________________________________________________ ___________________________” whenever I feel others are trying to control or abuse me.

I can read ______________________________________________________ to help me feel stronger.

I can call ____________________, ____________________ and ___________________ as other resources to be of support to me.

Other things I can do to help me feel stronger are: ________________, ______________,
_________________________ and _______________________.

I can attend workshops and support groups at a domestic violence program, or _______ ____________________ or _______________________ to gain support and strengthen my relationships with other people.

STEP 8: Items to take when leaving. I will use the Checklist to plan my possible leaving.

I will keep this document in a safe place and out of the reach of my abuser.
 
Review date: ______________________________________________

Source: This material is based on a piece entitled "Creating My Safety Plan" by Marie Smith and Laura Kniaz, House of Ruth.