15 years after the Violence Against Women Act, what's the next step toward helping the 1.5 million women assaulted by domestic partners every year? Barbara Kantrowitz and Pat Wingert at Newsweek explore that question, but the answer remains unclear.
Most of the proposed strategies Kantrowitz and Wingert mention involve attempts to identify more victims and potential victims of domestic violence, in hopes of helping them as early as possible. Routine screening of all women who end up in an emergency rooms, at-home visits to new mothers thought to be at risk, and interventions in substance abuse treatment programs are all suggested as ways that social workers and health providers might look for victims. But what then? A recent study, led by Harriet MacMillan at McMaster University in Ontario, examined the efficacy of domestic violence screening in medical settings and found that after 18 months, "there was no significant difference in [reported] levels of violence between the women who had been screened and those who had not."
Because medical professionals are often in a position to intervene earlier than police or social services, "everyone agrees that doctors and nurses can play a critical role," say Kantrowitz and Wingert. Unfortunately, everyone also agrees that "health-care providers are unprepared to spot more subtle signs of abuse. Broken bones or bruises aren't the only symptoms." MacMillan adds that more doctors "have to be aware of the mental-health problems associated with domestic violence." Says Lisa James of The Family Violence Prevention Fund, "There is some minor teaching of this issue in medical and nursing school, but it's spotty and it's nowhere near where it needs to be."
Raising awareness among medical professionals of the symptoms and side effects of domestic violence would undoubtedly be a positive step, but the question remains: What then? The only intervention the authors mention that's been proven effective is "consistent counseling with specially trained advocates " for women already already living in shelters for victims of domestic violence. There are a whole lot of steps between identifying a woman who's at risk or already suffering violence, and helping her out of that situation and into "consistent counseling." Victims are often reluctant to leave their abusers — for some very good reasons. I can just see this sort of screening backfiring, with well-meaning medical professionals badgering victims to leave — making them feel ashamed and unsafe at the doctor's office as well as at home.
Not to mention, I find it the idea of blanket screenings a bit unsettling. Generally speaking, I'm of the opinion that false accusations of abuse — though truly devastating — are so rare relative to unreported abuse, I would much rather spend my time talking about the latter. But if you start training doctors and nurses to assume that every woman who comes through the ER doors might be a victim, I imagine false positives would become a serious concern. How do they tell the woman who's lying to protect her abuser (and/or herself) from the woman who's not being abused? How does that affect trust between medical professionals and female patients across the board? And chillingly, in light of the news that it's legal in 8 states and D.C. to deny insurance coverage based on the "pre-existing condition" of domestic violence, could a doctor's suspicion of abuse affect a woman's ability to pay for health care?
Kantrowitz and Wingert note that all of these ideas require further study, which means that at the moment, we simply don't know what will work and what won't. "In the long run, it will be to everyone's benefit if we find what's effective," says MacMillan. Yeah, no kidding.