Health Effects of Domestic Violence
last updated August 2013
The effects of violence on a victim's health are severe. In addition to the immediate injuries from the assault, battered women may suffer from chronic pain, gastrointestinal disorders, psychosomatic symptoms, and eating problems. Although psychological abuse is often considered less severe than physical violence, health care providers and advocates around the world are increasingly recognizing that all forms of domestic violence can have devastating physical and emotional health effects. Domestic violence is associated with mental health problems such as anxiety, post-traumatic stress disorder, and depression. Women who are abused suffer an increased risk of unplanned or early pregnancies and sexually transmitted diseases, including HIV/AIDS. As trauma victims, they are also at an increased risk of substance abuse. According to a U.S. study, women who experience intimate partner abuse are three times more likely to have gynecological problems than non-abused women.[1]
Women are particularly vulnerable to attacks when pregnant, and thus may more often experience medical difficulties in their pregnancies. Recent research has called for increased study of pregnancy associated deaths. "Pregnancy associated deaths" are "deaths occurring to women who have been pregnant within the previous year." A study conducted by researchers in Maryland of 247 pregnancy associated deaths found that the leading cause of death was homicide. The researchers have called for "enhanced surveillance" of pregnancy associated deaths and additional research focusing more specifically on the role of domestic violence.[2]
Other studies have shown that there are significant obstetric risk factors associated with domestic violence. Abused women are more likely to have a history of sexually transmitted disease infections, vaginal and cervical infections, kidney infections and bleeding during pregnancy, all of which are risk factors for pregnant women. Abused women are more likely to delay prenatal care and are less likely to receive antenatal care. In fact, "[i]ntimate partner abuse during pregnancy may be a more significant risk factor for pregnancy complications than other conditions for which pregnant women are routinely screened, such as hypertension and diabetes."[3]
As discussed in more detail in the section on marital rape, in many countries, marriage is believed to grant men unconditional sexual access to their wives, and to permit the use of violence if their wives do not comply. Women's lack of sexual autonomy in these situations puts them at risk of unwanted pregnancies and sexually transmitted infections. According to the UN Population Fund, “research shows that 222 million women in developing countries today do not have the means to delay pregnancies and childbearing,” in part due to coercion and violence by an intimate partner.[4] And research presented at the 2010 International AIDS Conference in Vienna indicates that the risk of contracting HIV is at least two times greater for women who experience domestic violence.[5] Additionally, the World Health Organization (WHO) reports that women who are victims of domestic violence are more likely to report having had an induced abortion. Abortions tend to be underreported and frequently take place in unsafe conditions, which place a woman’s health in greater risk.[6]
The WHO estimates that roughly 40% of all female victims of intimate partner violence are injured by the violence.[7] The most common non-fatal injuries are to the head, neck, or face, followed by musculoskeletal and genital injuries.[8] In the United States, authorities estimate that half of female domestic violence victims are physically injured by an intimate partner.[9]
Domestic violence can be fatal; women are both intentionally murdered by their partners and lose their life as a result of injuries inflicted by them. The WHO estimates that 38% of all women murdered are killed by an intimate partner.[10] Studies in the United States have focused on strangulation, a tactic often used by batterers. Because strangulation rarely leaves vivid external physical marks, police may not recognize the victim's need for medical assistance or the seriousness of the violence. Injuries resulting from strangulation can often be lethal; such injuries "may appear mild initially but they can kill the victim within 36 hours."[11] Whether or not strangulation results in death, it has been recognized to increase the risk of death at the hands of the intimate partner. A 2008 study in the Journal of Emergency Medicine found that 43% of women murdered by an intimate partner and 45% of women who had been a victim of attempted murder by an intimate partner had been strangled by that partner in the past year.[12]
In addition to the danger of death from injury or intentional homicides, research also indicates that women who are abused may be more likely to commit suicide.[13] In 2000, UNICEF reported that a "close correlation between domestic violence and suicide has been established based on studies in the United States, Fiji, Papua New Guinea, Peru, India, Bangladesh and Sri Lanka,” finding “[s]uicide is 12 times as likely to have been attempted by a woman who has been abused than by one who has not."[14]
The World Health Organization's Global and Regional Estimates of Violence against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-partner Sexual Violence (2013) details the health consequences of violence against women around the world. The National Center for Injury Prevention and Control and Futures without Violence (formerly the Family Violence Prevention Fund) provide an excellent overview of the health effects of domestic violence on women and children.
For a list of research and reports on the health effects of domestic violence, click here.
[1] B. Shane and M. Ellsberg, “Violence Against Women: Effects on Reproductive Health,” Outlook 20 (2002), accessed August 2, 2013, http://www.path.org/publications/detail.php?i=597.
[2] Nancy K.D. Lemon, “Health Watch, in Domestic Violence Report,” 8 (2003): 69 (citing Isabelle L. Horon & Diana Cheng, “Enhanced Surveillance for Pregnancy-Associated Mortality—Maryland, 1993-1998,” JAMA 285 (2001):1455).
[3] B. Shane and M. Ellsberg, “Violence Against Women: Effects on Reproductive Health,” Outlook 20 (2002), accessed August 2, 2013, http://www.path.org/publications/detail.php?i=597.
[4] UNFPA State of World Population 2012, By Choice, Not By Chance: Family Planning, Human Rights and Development 1 (2012), accessed August 2, 2013, http://www.unfpa.org/webdav/site/global/shared/swp/2012/EN_SWOP2012_Report.pdf. At the 1994 International Conference on Population and Development, eliminating violence against women and allowing women to control their fertility were recognized as “cornerstones of population and development policies.” Ibid. at 5.
[5] Fiona Hale and Marijo Vazquez, Violence Against Women Living with HIV/AIDS: A Background Paper, 13 (2011), accessed August 2, 2013, http://www.dvcn.org/uploads/client_70/files/VAPositiveWBkgrdPaper2011.pdf.
[6] World Health Organization, Global and Regional Estimates of Violence against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-Partner Sexual Violence, 23 (2013), accessed August 2, 2013, http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/index.html.
[7] Ibid. at 26.
[8] Ibid. at 25.
[9] “Intimate Partner Violence in the U.S.: Injury and Treatment,” U.S. Bureau of Justice Statistics, accessed August 7, 2013, http://www.bjs.gov/content/intimate/injury.cfm.
[10] World Health Organization, Global and Regional Estimates of Violence against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-Partner Sexual Violence, 26 (2013), accessed August 2, 2013, http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/index.html.
[11] “When Abusers Choke Their Victims,” Violence Against Women 22-5 (Joan Zorza ed., 2002).
[12] Nancy Glass, et al., “Non-fatal Strangulation is an Important Risk Factor for Homicide of Women,” J. Emerg. Med. 35(3) (2008): 329–335, accessed August 7, 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2573025/.
[13] Karen M. Devries and Maureen Seguin, “Violence against Women and Suicidality: Does Violence Cause Suicidal Behaviour?,” in Violence against Women and Mental Health. Key Issues Mental Health, 178(Garcie-Mereno C, Riecher-Rossler A (eds) 2013): 148.
[14] UNICEF, “Domestic Violence Against Women and Girls”, Innocenti Digest 6 (2000):1, 4, accessed August 3, 2013, http://www.unicef-icdc.org/publications/pdf/digest6e.pdf.