II. violence prevention and intervention in health care and community settingsAdverse consequences of intimate partner abuse among women in non-urban domestic violence shelters
Introduction
Intimate partner abuse (IPA), defined as physical or sexual assault by a husband, intimate partner, or ex-intimate partner, has emerged as a significant health concern for women in the United States.1 A nationally representative telephone survey conducted in 1998 estimated that 1.9 million women are physically assaulted each year.2 This survey corroborates the findings from other epidemiologic studies that illustrate the prevalence of violence perpetrated by men; 76% of women surveyed reported being physically assaulted or raped by a current or former spouse, cohabiting male partner, or date in their lifetimes.2 Annual victim-related costs of IPA in the United States have been estimated at $67 billion.3
Despite increasing awareness that IPA is a serious economic, legal, and public health problem that can result in injury or death, there still exists a need to more fully understand the wide array of health consequences related to IPA. Previous research has demonstrated that between one half to two thirds of women who are physically abused are also sexually abused.4 However, there is little empirical research examining whether being sexually abused confers additional stress and is associated with more adverse health outcomes among women who also report physical abuse.5 Understanding the health-related consequences for women who have experienced both sexual and physical abuse could assist in designing more efficacious counseling services and treatment programs for this population.
The limited literature in this area often lacks information about the perpetrators; provides limited detail about the duration, chronicity, and severity of the abuse experience; and is usually conducted among urban nonresidential populations. These studies may not be representative of rural survivors who may have very limited IPA-related community resources6 and are residing in domestic violence shelters. Domestic violence shelters provide a critical venue in which public health practitioners could intervene by providing mental health counseling and diagnostic and treatment services.
The present study examined the health-related consequences of being both sexually and physically abused among a sample of women residing in rural and nonurban battered women’s shelters. We hypothesize that compared to women experiencing physical abuse, women experiencing both sexual and physical abuse will report more adverse health outcomes.
Section snippets
Subjects
Between June 1997 and December 1997, we recruited 203 women from five of the 17 domestic violence shelters in Alabama. The five shelters were selected because they represented the largest domestic violence shelters in Alabama. Four of the five shelters were located in rural communities; however, all five shelters served women residing in rural areas. To be eligible for shelter services, women had to be aged ≥18 years and involved in an emotionally, physically, or sexually abusive relationship.
Abuse measures
All questions assessing intimate partner abuse were focused on the abusive relationship that was the impetus for seeking residence at the shelter. The interview assessed sexual and physical abuse using well-established definitions.7, 8 Sexual abuse was defined as nonconsensual sex, including having a partner who forced women to have sex with him, who forced women to touch him sexually, who touched women sexually against their will, or who forced objects onto a woman against her will. Using a
Results
A total of 205 women were seen at the five study shelters, but only 203 were used for the analyses (two were excluded as they had experienced sexual abuse, but had no history of physical abuse in the relationship in question). Fifty-five percent of the women (n=106) reported that they had been both sexually and physically abused in the relationship they left before entering the shelter. The average time from the initial episode of sexual abuse to entering the shelter was 43.1 months. These
Discussion
Research examining the health consequences of having a physically abusive partner often does not consider the impact that sexual abuse experiences have on women involved in physically violent relationships. Results from the present study suggest that women experiencing both sexual and physical abuse were more likely to report having adverse sexual health, physical abuse, and mental health consequences compared to women who had a history of physical but not sexual abuse. While the findings
Conclusions
Services are urgently needed for women experiencing abuse. Counseling should emphasize avoidance of alcohol/drug use as a coping strategy and, additionally, educate women about healthy coping strategies.19 Increasing the availability of female-controlled barrier methods for STD/HIV prevention and providing sexual risk-reduction counseling may help reduce women’s anxiety, and their risk of STD/HIV and pregnancy. Finally, domestic violence shelters are an important venue for the provision of STD
Acknowledgements
This research was funded by a grant for the Center for Social Medicine and Sexually Transmitted Diseases at the University of Alabama, Birmingham, Alabama.
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