By Ronald L. Scott
rscott@central.uh.edu

Domestic violence and abuse has increasingly been recognized as a major public health issue in the United States, and the role of health care providers in detecting and preventing domestic violence is becoming better accepted.  A recent article in the New England Journal of Medicine (Eisenstat & Bancroft, Domestic Violence, Sept. 16, 1999) advocates that medical providers should “routinely screen patients for a history of abuse…refer patients for appropriate services, and assess whether the patients are in immediate danger.”  Implicit in any referral is the promise that the victim will be safe—or at least safer—under protection provided by support agencies.  The authors define domestic abuse or battering as “a pattern of psychological, economic and sexual coercion of one partner in a relationship by the other that is punctuated by physical assaults or credible threats of bodily harm.”

In Houston, an irate husband recently shot his way through glass doors at the entrance of a women’s shelter, found his wife, and chased her to the cafeteria.  The man ran out of bullets, no one was physically injured, and security at the shelter has been tightened.  This widely reported incident is particularly unfortunate since health care providers already have a difficult time convincing victims of domestic violence that resources are available to increase their safety.

It is clear that whatever the risks of violence within a shelter (real or perceived), the risks of remaining with an abusive spouse are greater.  In its 1997 report titled Family Violence and the Health Care System in Texas, the Health Law & Policy Institute (Institute) reported the following chilling statistics:

• nationally, 30% of female murder victims were killed by their “loved ones.”
• Injuries to women sustained from domestic violence exceed the number of injuries women suffer from car accidents, muggings, and rapes combined.
• In 1994, Texas had 166,657 arrests for spousal abuse—and 283 of such arrests were for spousal murder.
• 39% of women in Texas have suffered physical, emotional or sexual abuse since they were age 18.

• 181,773 family violence incidents were reported in Texas in 1997.
• 824,790 women were battered in Texas in 1998.
• the 1998 level of funding left 95% of battered women and their children without services. (The 76th Texas Legislature appropriated significant additional funds to programs combating family violence.)

As efforts to better educate health care providers about domestic violence yield promising results (and therefore more referrals), we must be ready to assist the victims of domestic violence and at a minimum ensure their physical safety.

10/19/99