Medicine and books: Violence Against Women
Authors: Iona Heath
Journal: BMJ (1998)

Ed Susan Bewley, John Friend, Gillian Mezey 

RCOG Press, £35, pp 355 

ISBN 1 900364 03 4 

The family is consistently presented as the moral foundation of our society, and yet, apart from the police and the military, the family is society’s most violent grouping and the home its most violent setting. At some time in their lives, as many as one in four women suffer violence at the hands of the men with whom they have intimate relationships. The 1992 British crime survey showed that violence against women by partners, former partners, and relatives is the most common form of physical interpersonal crime. The total number of domestic assaults in the 12 months covered by the survey was estimated at just over 500 000. Domestic violence, occurring across all social classes and all ethnic groups, makes a huge contribution to the totality of violence and crime in society. 

The evidence suggests that domestic violence usually escalates in frequency and severity. By the time a woman’s injuries are visible, violence may be a long established pattern. On average, a woman has been assaulted by her partner or former partner 35 times before actually reporting it to the police. For some women, the escalation is fatal: one in five of all murder victims is a woman killed by a partner or former partner, and almost half of all murders of women are killings by a partner or former partner. 

None of this is new, but over the past two decades feminist campaigning and scholarship have created a much greater awareness of the extent and prevalence of violence against women. This, in turn, has led to a gradual extension of the definitions of crime to recognise more of the reality of women’s experience of violence, and to signal progress, albeit slow, towards zero tolerance. 

The NHS and the medical establishment have been relatively slow to acknowledge these shifts of attitude, and the consequent obligation to provide a more substantive response to the pervasive effects of violence against women beyond the minimum treatment of obvious physical injuries. 

Violence tends to worsen during pregnancy and has been associated with miscarriages, premature labour, low birth weight, and fetal injury and death. Responding to this particular challenge, the Royal College of Obstetricians and Gynaecologists convened a special study group last summer, bringing obstetricians and gynaecologists together with a range of other experts including midwives, lawyers, police, sociologists, and Women’s Aid activists. The aim was to raise awareness of the size and nature of the problem, particularly among doctors, and to formulate recommendations covering clinical practice, education and training, and research. 

This excellent book is the product of the group’s deliberations. It includes a series of papers offered by a comprehensive range of experts, interspersed with a record of the discussions that took place within the group. In this way, it provides an inspiring account of a profession, sometimes regarded as insular, in the process of opening itself to knowledge and expertise from beyond its traditional boundaries. Only time will tell whether this imported learning will lead to a more sensitive and effective response from ordinary obstetricians and gynaecologists to the needs of women who have been subject to violence. The book deserves such an outcome.