Intimate partner violence is a leading health risk factor for women in Australia

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The Queensland Government plays a critical role in not only ensuring its employees are protected at work, but as the state’s biggest employer, it also demonstrates to the business community that intimate partner violence is a workplace issue. In November 2017 Queensland Health achieved accreditation from White Ribbon Australia and became a White Ribbon Workplace. Previously the Special taskforce on Domestic and Family Violence in Queensland published the landmark “Not Now, Not Ever: Putting an end to domestic and family violence in Queensland” report.

Intimate partner violence is a leading health risk factor for women in AustraliaHistorically called domestic violence, intimate partner violence (IPV) is a pattern of coercive behaviours, including physical, sexual and/or psychological aggression. It’s not just a personal issue, it is also a workplace issue. It can impact a person's safety, wellbeing, attendance, and performance at work. IPV not only affects the work performance and workplace safety of the victim, but also their co-workers and the whole organisation. Employment can also have a positive impact, as holding a job is a key pathway to women leaving a violent relationship. As a White Ribbon Workplace, Queensland Health is nailing its colours to the mast, influencing social change not only for its employees but also within the broader community.

As the health system is often a first point of contact for individuals who have experienced IPV and family violence, a number of the recommendations in the “Not Now, Not Ever” report relate to ensuring that clinicians have an understanding of this violence and know how to respond appropriately.

Intimate partner violence is rarely a one-time transgression and sadly, it typically occurs repeatedly and escalates in severity. Abusers tend to limit a victim’s access to the outside world and foster isolation in order to increase the victim’s dependence on the abuser. While some victims are able to break the cycle and remove themselves from the relationship, many victims remain with the abusive partner for a number of reasons, including: emotional investment in the relationship, sense of obligation to partner or children, economic dependence, fear of the repercussions of leaving, and feeling trapped. Although most frequently IPV is committed by a male against his female partner, IPV also encompasses violent acts toward a male by a female and abuse in same-sex relationships. 

IPV can consist of various kinds of violence:

  • Physical violence: intentional use of force (e.g., hitting, slapping, punching, shoving, choking, kicking, shaking) with the potential to cause injury or death 
  • Sexual violence: forcing a partner to engage in a sex act when the partner does not consent, reproductive coercion (forcing partner to engage in intercourse without contraception)
  • Psychological/emotional violence: verbal abuse, humiliation, name-calling; stalking; threats of physical or sexual violence; violence against pets; damaging/destroying possessions; denying access to basic resources; isolating partner from friends and family

Unsurprisingly IPV can affect the health of victims in many ways. The longer the period of time over which the abuse occurs, the more serious the effects can be. Many IPV victims suffer physical injuries that range from minor physical damage (e.g. cuts, scrapes, welts, bruises) to serious injury (e.g. broken bones, internal bleeding, traumatic brain injury), lifelong disability, and/or death. Victims of IPV often experience psychological impacts including trauma symptoms (e.g. flashbacks, panic attacks, and difficulty sleeping), post-traumatic stress disorder (PTSD), depression, anxiety, suicidal ideation, and substance misuse. IPV has also been linked with chronic physical health problems, including sexually transmitted infections such as HIV/AIDS, unintended pregnancy, gastrointestinal disorders (e.g. stomach ulcers, spastic colon, gastric reflux, indigestion, diarrhoea), frequent headaches, asthma, diabetes, and chronic pain. IPV during pregnancy is associated with decreased or delayed prenatal care, higher prevalence of risky behaviours (e.g. poor nutrition, smoking, drug and alcohol use), and increased risk of miscarriage, low birth weight, and preterm birth and neonate morbidity. IPV can also limit a victim’s ability to manage other chronic illnesses such as diabetes and hypertension.

Women aged 16–24 are the most vulnerable to IPV. Risk factors for IPV include poverty, poor living situations (e.g. unstable housing, overcrowding, homelessness, difficulty paying rent), unemployment, having been abused as a child, having witnessed IPV as a child, having previously been in an abusive relationship, substance abuse by the perpetrator of IPV, and being isolated socially from friends and family. Risk factors associated with severe and/or lethal IPV include extreme jealousy, estrangement from partner, escalating physical violence, previous strangulation, abuse during pregnancy, sexual violence, substance misuse (especially alcohol or “uppers” such as amphetamines, angel dust, cocaine), suicidal ideation, threats to life, threats to harm children, threats with a gun, access to firearms, and recent employment problems.

Australian IPV statistics

A study by Australia’s National Research Organisation for Women’s Safety, “A preventable burden: Measuring and addressing the prevalence and health impacts of intimate partner violence in Australian women: Key findings and future directions” confirms the serious impacts of intimate partner violence. The analysis, undertaken by the Australian Institute of Health and Welfare, provides estimates of the impact of intimate partner violence on women’s health. Data from the 2016 Australian Bureau of Statistics (ABS) “Personal Safety Study (PSS)”, Australia’s most reliable violence prevalence survey, was used as a key input. 

The statistics for intimate partner violence in Australia paint a bleak picture, and sadly have remained relatively unchanged for a decade:

  • Over 12 months, on average, one woman is killed every week by a current or former partner
  • One in three victims of sexual assault that reported to the police were assaulted by an intimate partner
  • IPV affects one in three women over the age of 15. If we only consider physical and sexual violence, then one in six women have experienced at least one incident of violence by a cohabiting partner. One in five women over 18 have been stalked during their lifetime. One in five women experience workplace harassment.
  • IPV has serious impacts for women’s health, including poor mental health, problems during pregnancy and birth, alcohol and illicit drug use, suicide, injuries and homicide. It is the leading contributor to death, disability and ill-health in Australian women aged 15-44
  • Contributing an estimated 5.1 percent to the disease burden in Australian women aged 18-44 years and 2.2% of the burden in women of all ages
  • Adding more to the burden than any other risk factor in women aged 18-44 years, more than well known risk factors like tobacco use, high cholesterol or use of illicit drugs
  • Indigenous girls and women are 35 times more likely than the wider female population to be hospitalised due to intimate partner violence. IPV is estimated to contribute five times more to the burden of disease among Indigenous than non-Indigenous women, and is the leading risk factor contributing to disease burden in Indigenous women aged 18 to 44 years
  • Has serious consequences for the development and wellbeing of children living with violence
  • Intimate partner violence is the principal cause of homelessness for women and their children
  • Violence against women is estimated to cost the Australian economy $21.7 billion a year

...and in Queensland

  • The number of reported domestic violence incidents increased from 58,000 in 2011-12 to 66,000 in 2013-14. This is around 180 reports to police of domestic violence incidents in Queensland every day
  • Between 2006 and 2016, 113 women have been killed by a current or former intimate partner, and 54 by a family member
  • Applications for domestic violence protection orders have jumped from 23,794 in 2012-13 to 32,221 in 2015-16 – a 26% rise
  • Calls for support to Queensland’s domestic violence support line, DVConnect (Ph: 1800 811 811 www.dvconnect.org), have tripled between 2012 and 2016
  • The annual economic cost to Queensland is estimated to be between $2.7 billion and $3.2 billion

The best available national data suggests the domestic violence victimisation rate is unchanged over the last decade, while police data shows substantial increases in the rate of incidents attended by police. Whatever the reason for them, the relative stability of the overall statistics in the ABS study leave no room for complacency. The figures remain too high. 

Most are in agreement that this is a difficult problem requiring complex and coordinated responses. It is generally argued by most stakeholders and commentators that integrating responses and initiatives across the community, all jurisdictions and all levels of government is the best way to promote equality and reduce this form of violence. In line with this, attaining White Ribbon accreditation is a positive and vital step for Queensland Health employees, and by their influence on the greater community. 

Hospitals play a vital front line role in helping protect at-risk women and children. International research shows that 88% of victims of attempted or actual murder had been seen by a hopsital emergency department in the previous year, and 32% of those women had sought help at hospital EDs, hospital inpatient units or outpatient settings for injuries resulting from the abuse.

Identifying intimate partner violence is important in clinical practice as it underlies many common physical and mental health presentations. Facilitating disclosure and responding effectively requires good communication skills, safety assessments of women and their families, pinpointing their level of readiness to take action, and providing appropriate nonjudgmental support. Queensland clinicians have great potential to help identify women and support them safely on a pathway to recovery and better health outcomes, avoiding the long term impacts of intimate partner violence.

CKN Domestic Violence Resources

For more information see the many recent domestic violence articles and resources available on CKN, for emergency and paramedic staff, nurses, midwives, paediatric staff, obstetrics and gynaecology, and all Queensland Health staff coming into contact with women and children: 

 

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