The prevalence of domestic violence against women in Australia
Domestic violence affects about 30% of the women in the world and it is a serious public health problem. Women subjected to physical, mental and economic abuse lead a life of fear, poor health and are unable to contribute at home and work due to the constant threat to their well being. A review of studies done in this area yield several approaches to tackle the problem. Women are screened for signs of domestic abuse by healthcare professionals, and offered treatment and help. Their physical, mental and emotional health suffers due to the infliction of harm. They live in fear and suffer from low self esteem and their overall quality of life suffers. Several new ways to help the women in distress are being tested in Australia and around the world. The economic burden of the social malady is enormous.
The terms ‘domestic violence in Australia’ and ‘intimate partner violence in Australia’ were used to search for research papers on the subject. The PMC and PubMed databases were used for the search. Only studies published between 2013 to 2018 based in Australia were selected. Studies that were chosen studied the impact of domestic violence on women, or involved screening of patients for domestic abuse or studied the effect of reduced incidence of domestic violence on women and on the healthcare system. The benefits of prevention rather than treatment as in case of chronic diseases were studied when domestic abuse is prevented. The economic benefits of prevention of domestic abuse and reduction in disease burden are significant outcomes.
Identification of women who have suffered domestic violence by health professionals could be an important step in reducing further episodes. Pregnant women are particularly more vulnerable to violence and this can cause serious complication before and after the child is delivered (Sprague, et al., 2016). Miscarriages and still births are serious outcomes of severe physical trauma. Postpartum cases of domestic violence were screened for by healthcare professionals in an Australian study where the mothers were asked about prevalence of domestic violence by their spouse or any other family member. The intervention known as mothers experiencing domestic violence (MOVE) was theory informed and included a model developed by nurses. The mothers could choose whether they wanted disclosure while completing a maternal health and maternal and well being check list. In postpartum cases of violence in homes the care of the infant could be adversely affected. Since face to face interaction was not involved women were more likely to disclose events related to domestic abuse. A nurse mentor and liaison workers working in the area of domestic violence were part of the team who scrutinised the check lists. This increased the chances of disclosure and further advice to reduce episodes of violence (Taft, et al., 2015).
Impact of domestic violence on physical and mental health of women
Other than maternal and child health, few studies have tried to study the impact of domestic violence on the overall health of women. As part of the Australian Longitudinal study on women’s health (ALSWH), the health and well being of women from different age groups was studied. Three age groups of women were part of the study, those born between 1973 to 1978 formed one group, those born between 1946 to 1951 were in the second group while those born between 1921-1926 were in the third and the oldest group of women. The women were given a questionnaire that was used to determine their physical and mental health. They were also asked question on whether they experienced intimate partner violence. Women who had been victims of violence at home were found to suffer from poorer physical and mental health across all the groups. 40,395 women were part of the longitudinal study over 16 years. Poor general health, bodily pain and lower physical function were reported by women who had experienced intimate partner violence, however the severity of violence inflicted was not recorded (Loxton, et al., 2017).
The current levels of intimate partner violence in Australia are pegged at 27 %. A reduction in the incidence of violence in homes can reduce the financial burden of treating the patients who have been victims of physical or mental abuse. About three quarters of the disease burden due to intimate partner violence occurs in the form of psychological health issues. Severe psychological distress causes mental health problems and their ability to work at home or at work is severely affected. If fewer incidents of violence occurred, there would be reduced disease, fewer cases o injury, deaths and Disability adjusted life years. The cost savings in the health sector would be accompanied by reduced cases of distressed women in the population. A more able workforce and lower levels of absenteeism at work would impact the economy in a positive manner. Unpaid household production and better leisure hours at home would be added benefits. A saving of AUD 370 million was estimated during the study if the incidence of domestic violence was brought down from 27% to 22% through public health interventions in Australia (Cadilhac, et al., 2015).
One method of surveying women for domestic abuse against them is to take written interviews when visiting a healthcare facility, another method that is often used is home-visits by health professionals or social workers. But whether these methods reduce the incidence of domestic violence is not clear. A systematic review studied 1258 articles from databases to study the outcome of studies involving home visiting. Short term benefits of reduced violent episodes on mothers and their children were reported by Australian, American and Dutch studies. But whether the impact of home visits on reduced domestic violence was sustained for longer periods of time was not clear (Prosman, et al., 2015).
Approaches to tackle domestic violence
In the above studies the assessment of domestic violence and its reduction was based on written feedback given by mothers during their visit to the hospital or through home visits. Another method that has been studied is web-based intervention to reduce domestic violence (Bacchus, et al., 2016). The main idea is to reduce the disease burden of treatment in the manner where prevention of chronic diseases rather than treatment has been the focus. The economic benefits from prevention have been described in the study described above. Non-judgemental support, supportive listening and compassion have long been the ideas behind provision of support to distressed women facing domestic violence. But there are cases where face-to-face setting acts as a barrier and women may want the comfort of anonymity and a forum that does not judge. Web-based online safety provision for such women is concept that is gaining more acceptance. I-DECIDE in Australia is an online tool that offers a safety decision tool to women facing domestic violence. It has components that include therapy and self-reflective exercises that focus on healthy relationships other than safety decisions. The tools include safety and danger assessment, priority setting exercise and motivational interviews. n individualised and customised action plan helps the women find solutions to their set of problems. The security and privacy of the web tool makes it unique and easy to access for the distressed women (Tarzia, et al., 2016).
The public health problem of domestic violence is a complex one and requires sensitive handling. Issues of privacy, social stigma and fear may prevent women from voicing their concerns and fears. Home visits, hospital visits by the victim and contact through social workers are areas where studies have been done. The economic benefits of reducing the disease burden through prevention of violence in homes are enormous. The high penetration of internet in homes has made web -based interventions feasible. These may help to circumvent problems that lead to reluctance on the part of the women who are victims of domestic abuse and offer them the choice and comfort of anonymity. So mobile apps and other forms of web technology may be the way forward to tackle the social scourge.
Conclusion
The problem of domestic violence has been reported from across the world and 30% of women in the world are affected by the social menace. Not only does the affected woman suffer from physical and mental health issues but so do her children. Home visits, hospital check lists and nurses and healthcare professionals play an important role in detecting cases and offer solutions. But the economic burden of the physical and mental issues is enormous and Australia alone pays the heavy price of AUD370 million due to the ill health of victims. Web -based technology offers a variety of solutions to the affected women.
References
Bacchus, L. J. et al., 2016. Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention. Journal of internet medical research, 18(11), p. e302..
Cadilhac, D. A. et al., 2015. The health and economic benefits of reducing intimate partner violence: an Australian example. BMC Public Health, 15(625).
Loxton, D., Dolja-Gore, X., Anderson, A. E. & Townsend, N., 2017. Intimate partner violence adversely impacts health over 16 years and across generations: A longitudinal cohort study. PLoS ONE, 12(6), p. e0178138.
Prosman, G., Lo Fo Wong, S., van der Wouden, J. & Lagro-Janssen, A., 2015. Effectiveness of home visiting in reducing partner violence for families experiencing abuse: a systematic review.. Family Practice, 32(3), pp. 247-56.
Sprague, S. et al., 2016. A Scoping Review of Intimate Partner Violence Screening Programs for Health Care Professionals. PLOS ONE, 11(12), p. e0168502.
Taft, A. J. et al., 2015. Maternal and child health nurse screening and care for mothers experiencing domestic violence (MOVE): a cluster randomised trial.. BMC Medicine, 13(150).
Tarzia, L., May, C. & Hegarty, K., 2016. BMC Women. Assessing the feasibility of a web-based domestic violence intervention using chronic disease frameworks: reducing the burden of “treatment” and promoting capacity for action in women abused by a partner., 16(73).
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