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The Gynecologist’s Role in Preventing Intimate Partner Violence 1/3

Part One: Understanding the Cycle of Intimate Partner Violence

Flowchart explaining the cycle of IPV
The Cycle of IPV (Data from JAMA 226: 9, 1991)

Trigger Warning: If you’ve encountered or experienced IPV in the past, please proceed with caution while reading this blog. Furthermore, if you don’t feel safe in your relationship you can take this quiz to determine if your relationship is abusive, call the Domestic Violence Support Hotline at (800) 799- SAFE or contact Catalyst Domestic Violence Services for resources if you’re in Chico, CA.

Intimate partner violence (IPV) is one of the most prevalent types of violence and accounts for more than half of female murder victims. As many as 2 million women experience intimate partner violence every year, partner abuse occurs in a quarter of American families. Women are statistically more likely to be victims of abuse but IPV isn’t exclusive to one gender. According to the CDC’s National Intimate Partner and Sexual Violence Survey, 35.6% of women and 28.5% of men in the US reported enduring sexual assault, physical violence, and/or stalking by an intimate partner. Furthermore, there is a well-established link between spousal and child abuse where if a spouse is abused by their partner, that spouse is likely to also be abusive to the children in the home. 

Medical care is often necessary for victims of intimate partner violence. Studies show that as many as 37% of women who go to the emergency room, 21–66% of women seeking general medical care, and up to 20% of women seeking prenatal care report having experienced intimate partner violence. 

Although an estimated majority of primary care physicians routinely screen injured patients for intimate partner abuse, fewer than 15% of women say they have been questioned about abuse in a health care setting. One survey asked survivors of intimate partner violence to rank the professionals who were involved in their care; physicians were typically ranked lower than social workers, local church officials, nonprofit workers, legal professionals, and law enforcement. This is despite the fact that health care providers, particularly obstetricians/gynecologists, are particularly well-equipped to identify, assess, and initiate intervention for patients who are victims of intimate partner violence.

The identification of IPV victims must become part of routine medical care performed by obstetricians and gynecologists. Among many factors, IPV is not spoken about during routine exams for all women seeking obstetric or gynecological care because there is a lack of education among practitioners as well as societal misconceptions regarding IPV that medical practitioners aren’t immune from. Medical practitioners typically give various explanations to explain their exclusion of conversation regarding IPV including; inadequate training, lack of time, discomfort, lack of understanding, misperceptions, and a feeling of powerlessness. 

Misconceptions and biases are also to blame, including:

1. IPV is rare. The idealistic view of the family as safe and loving can prevent outsiders from accepting the fact that some family members can pose a threat to the rest of their family. To combat this bias, it’s important to educate the public on the prevalence of IPV in this country. According to results from the CDC’s National Intimate Partner and Sexual Violence Survey (NISVS), “About 1 in 4 women and nearly 1 in 10 men have experienced contact sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime and reported some form of IPV-related impact.” Being informed about IPV prevalence keeps the provider on guard for signs of IPV, which should be addressed routinely.

2. IPV does not happen in ordinary relationships. Stereotypes about what abusers and victims look or act like can cause signs of abuse to be overlooked. Not all abusers can be easily identified and IPV isn’t exclusive to any specific group of people. Typically, it is more evident if the abuse is physical but abuse isn’t limited to just physical. Abuse can be sexual, emotional, economic, and/or verbal. Furthermore, all forms of abuse cause significant damage to the victim and their loved ones.

3. Victim blaming. There are many barriers that victims of IPV face when trying to stop or escape their abuser. These barriers include, but aren’t limited to; denial, cultural/religious beliefs, fear/shame, low self-esteem from being abused, hope that their abuser can/will change, and financial limitations. Medical practitioners have one-on-one access to their patients, and if that patient is a victim of abuse, that may be one of the few times an outsider has that type of access to ensure the victim’s safety. Doctors also often take on the responsibility of educating their patients on other medical issues that are much less life-threatening like diet, exercise, and the dangers of nicotine products. Furthermore, medical professionals who try to intervene have much less success helping patients with the latter factors as opposed to helping victims of abuse get the resources they need. Leaving an abuser, like many other difficult things in life, can require frequent encouragement from outsiders like medical professionals.

4. IPV is a private, personal matter that should be handled within the family. This is potentially the most dangerous misconception someone could have about abuse. Not only does this further stigmatize the issue, but it can also potentially prevent victims from reaching out for help because they think it should be handled internally. The cycle of violence tells us that abuse escalates and, as previously mentioned, more than half of female murders are related to IPV. This is why when abuse is mentioned by a patient, the healthcare practitioner is required to follow up to ensure the victim’s safety. The cycle of violence should be understood by practitioners so that they might understand how violence escalates and why women typically seek care only during certain points in the cycle.

Come back next week for part two of this important series where we will be discussing how to identify and respond to signs of intimate partner violence.

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