# Presentation: 305867

## Domestic Violence 

- A Health Care Epidemic
- Don Clark MD, MPH
- Rachel E. Locker MD

## Alarming Statistics

- In the US a woman is more likely to be raped, injured, assaulted or murdered by a male partner than any other type of assailant.
-  Resource Availability for Women at Risk..., American Society of Criminology 1987

**Notes:**

54 %, I of murders in another  estimate
Victoria BC 1990 71% 
	       1991 42%

## The Facts 

- Domestic Violence is the
- ...leading cause of injury among women of reproductive age
- ...the single most common trigger for female suicide
- ...up to 60% of women who are murdered  die as a result of a domestic dispute
- Webster 1995

**Notes:**

54 %, I of murders in another  estimate
Victoria BC 1990 71% 
	       1991 42%

## In the Medical Scene...

- Murder is the leading cause of death related to pregnancy
- JAMA 2001
- 5.8 billion $ per year in health related cost due to DV in the U.S.
- CDC 4/03

**Notes:**
In a study done in Maryland  25% of deaths in women that occurred during or in the year following pregnancy were murder.
Put 2 and 2 together ......

These are the ones we know about

## Closer to Home

- At least 59 % of Women served in the Warm Springs Health and Wellness Center between 1990 and 2000 had a documented history of domestic violence
- Unpublished study 2001

**Notes:**

54 %, I of murders in another  estimate
Victoria BC 1990 71% 
	       1991 42%

## Bureau of Justice 1993-1998 study

- American Indian females were victimized by an intimate partner at rates higher than others
- Twice as often as African Americans
- 3 times as often as Caucasians
- 11.5 time as often as Asian Americans

## Responding

- In order to respond to domestic violence  effectively  we need to have an understanding of ...
- What is domestic violence?
- Who are the perpetrators
- Who are the victims
- Why does it happen
- The impact on the victim, children and society

## What is domestic violence?

- Relationship violence is an escalating
- pattern of abuse where one partner in
- an intimate relationship **controls** the
- other through force, intimidation or
-  threat of violence.

**Notes:**
Look for confusion about the definition of domestic violence
	escalating
	control
	connection of physical force , intimidation, threats, 
	pattern 
multiple episodes over time
	range of tactics

Stress  that control is the issue

present both ws and jc legal definitions

## Who are the victims?

- From all races, religions, social groups, educational levels, and sexual orientations.
- Male or female
- Adolescent to elderly
- No specific personality traits
- Any level of physical ability

**Notes:**
Listen for victim blaming attitudes, dispel myths

Note that violence is more prevalent  in African American  and more so in 
Native American  
No statistics to quote

## Who are the perpetrators?

- Come from all races, religions, sexual orientations, education levels, and social groups.
- Can be male or female
- Can be adolescent to elderly

**Notes:**
Give examples

DJ, batterer and victim
Give examples of elderly murder age 80s, to teens

## Abuse comes in many forms...

- _Physical _
- Kicking, punching, choking, burning
- any other acts which may harm a body.
- _Psychological /Destructive Acts_
- Actual or threatened assault to victim, children, pets, property to scare you.
- Stalking

**Notes:**
Use examples here
take examples from participants

## Abuse comes in many forms...

- _Sexual _
- criticizing body parts or sensuality,
-  forced or pressured sexual acts,
- rape.
- _Financial_
- Controlling and manipulating you by threatening your economic status and basic needs.

## Abuse comes in many forms...

- _Emotional/ Verbal_
- Assaults against your self-esteem
-  “You are so stupid, no one else would want you.”
-  Name-calling, threats, put-downs.
- “stupid,  fat, whore” etc.

## Abuse comes in many forms...

- _Use of Children _
- hostages,
- physical or sexual abuse,
- as spies,
- custody fights,
- forcing children to engage in abuse of the victim

## Abuse comes in many forms...

- _Using “male privilege” _
- -Master of the castle, treating partner like a servant

## Why do they stay?

**Children-** “ He is the father of my children”, “I thought my children needed a father”
**Isolation-** social, family, geographical
**Lowered Self Esteem-**  fear that she is “ stupid”, that no one else would want to be with her.
**Religious beliefs/marriage vows- **“till death do us part”

**Notes:**
Give examples of cases for isolation 

Examples for children

Children used by the batterer to bring the victim back

## Why do they stay?

**Fear -** threats of suicide, homicide, threats to family or children
**Blame-** victims believes that she is at fault and the cause of the violence.
**Optimism-** “I thought it would get better if he stopped drinking”, “He said he would never do it again”

**Notes:**
Give examples  in of blame 
take examples from participants

## Special Issues For Teens

**Lack of Experience/Might think it’s normal **
**May be involved with drugs and alcohol**
**Peer Pressure/ Status**
**Jealousy and Possessiveness  = love**
**Heavily influenced by the media/role models**
**Stalking - on the campus**

## What is the Cause ofDomestic Violence ?

## Causes of Domestic Violence

- Domestic Violence is _**not**_...
- genetically inherited
- caused by illness
- caused by alcohol or drugs
- the result of stress or anger
- due to “a bad temper”
- due to the behavior of the victim or children
- a “problem” in the relationship

**Notes:**
Stress that this is  not caused by these things
And is 
Reinforced by misconceptions from the public, police, medical, family, TV, religion

what did you do to make him mad?

## Causes of Domestic Violence

- Domestic Violence _**is...**_
-               a learned behavior.

**Notes:**
Look for confusion about DV as an anger management issue,out of control behavior, alcohol, victim blaming , drug use

Studies of primates show violent behavior towards mates in order to maintain the harem, to control mating habits
Don’t get to carried away here

## Cultural Aspects 

-   Domestic Violence occurs in more than 90% of cultures/societies

## Cultural Aspects

- More prevalent
- Patriarchal
- Matrilineal
- Highly gender polarized
- Closeness of living quarters

## Cultural Aspects

- Less Prevalent
- Matriarchal
- Matrilineal
- Little gender polarization
- Closer living arrangement

## Why does this happen? 

**	**
**       ****Abusive relationships are based on the belief that one **
**person has the right to **
_***control***_** another.**** **
**	**