October is breast cancer awareness month. As we sign up for 5Ks, save yogurt lids, and take in the sights of familiar buildings awash in pink backlighting, women’s health is at the forefront of everyone’s minds. And in a coincidence of scheduling, October is also domestic violence awareness month. The color of the anti-DV cause is purple, but you won’t be seeing much of that around.

Domestic violence is a women’s health issue. It can be screened for, like cancer; its treatment can be as essential and lifesaving as reproductive care. DV does not discriminate—it is not restricted by gender, sexual orientation, education level, religion, ethnicity, or socioeconomic status, and it affects millions of women each year. Yet it is consistently relegated to the background, the dirty secret no one wants to talk about.

The oft repeated statistic that 1 in 4 women will experience domestic violence in their lifetime only tells a small part of the story. That number, from the CDC’s National Intimate Partner and Sexual Violence Survey, is specific to “severe physical violence” by an intimate partner. Almost a third of women (31.5 percent) will experience physical violence of some form. Nearly half of all women (47.1 percent) will be subject to psychological aggression from an intimate partner at some point in their lifetime. Five million women in the United States experience domestic violence each year, affecting 20 people per minute. In some countries, almost 70 percent of women will experience physical violence in their lifetime.

Domestic violence is indisputably a pandemic.

Because the news cycle leans hard on celebrity and extremes, America discusses domestic violence primarily in the context of the most horrifying cases, which narrows our conception of DV to graphic, physical, and—crucially—publicized incidents. We become acquainted with particularly brutal incidents, or anything involving celebrities or sports stars, in excruciating detail. Everything else under the umbrella of domestic violence generally lives within a single throwaway contextual sentence on how common domestic violence is: one in four.

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So, DV has become synonymous with closed fists and carefully disguised bruises. But by emphasizing only the most tragic cases, we leave many others in the dark. The negative effects of abuse reach far beyond visible injuries. Verbal and emotional abuse affect the psychological and physical health of victims; economic abuse forces dependence on the abuser, limiting access to money and outside support. Reproductive coercion restricts women’s reproductive health choices. Rape and sexual abuse deprive victims of their right to sexual agency. These forms of abuse, which leave no mark and are easily disguised by the abusers, can nonetheless be as difficult to escape as physical violence and, moreover, have a statistically significant effect on women’s health.

A study published this month in the Journal of Interpersonal Violence suggested that, for older women in Germany, controlling behavior by partners was the form of intimate partner violence most consistently associated with health symptoms. Health problems associated with domestic violence can be lifelong, persisting even after someone has left the abusive relationship. Victims have higher rates of depression, anxiety, post traumatic stress disorder, and sleep disturbances. They are more likely to suffer from poor physical health, including headaches, chronic pain, and gastrointestinal disease. There is increased risk of unplanned pregnancies and sexually transmitted diseases, including HIV. Aside from the chronic health problems that are often compounded by inadequate medical care, women who have been abused may restrict their regular activities or take abuse-related leave from work, affecting their earning power and restricting support systems outside of the home.

Again: Domestic violence is a women’s health issue if there ever was one. But somewhere along the line, the focus on women’s health narrowed to breasts and uteruses, letting everything else fade into the background. Breast cancer is now the most visible cause in women’s health; breast cancer awareness, a noble thing to work for, now occupies the vast majority of space not just during October but in general, on the women’s health stage.

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Breast cancer awareness is a comparatively new phenomenon. Historically, breast cancer was rarely discussed. There was something shameful in getting it—a cancer almost exclusively affecting women in a body part that was considered uncouth to mention. Through the laudable work of millions of dedicated women and advocates, that has changed. In 2015, you may not be able to show your nipples on social media, but there is no shame in talking about breast cancer. The pink of breast cancer awareness is ubiquitous during not only the month of October but any women’s health program year-round. Well-funded research programs have dramatically decreased the number of deaths caused by a cancer that affects 1 in every 8 women in their lifetimes. Screenings for breast cancer are a standard part of women’s care.

This all makes sense. Breast cancer is not a political lightning rod, like reproductive health. No need to argue about cancerous breast cells, because no one is going to say, “But really, was the boob asking for it?” as they may with sexual assault or DV. The fundraising races are all there, companies advertising their support for breast cancer at every turn. It doesn’t matter that the most common cause of death in women is heart disease and the most fatal type of cancer is cancer of the lungs.

Though a full quarter of women will be affected by physical domestic violence in their lifetime, it’s understandable that most companies don’t want to become identified with something as messy and frightening as domestic violence. DV awareness has an image problem. It does not lend itself as easily to sales gimmicks and catchy campaigns. Talking about it requires speaking out against people many love and worship, indicting celebrities and athletes and respected public figures. There is no “cure” to race towards. Funding research will not give us a clear solution. With most cases happening behind closed doors and out of the public eye, it is still viewed as a family issue, rather than a public health one.

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But this reluctance to talk about and focus on domestic violence is killing women, men, and children every day. People all over the world are suffering and we don’t discuss it because it’s charged and uncomfortable. And, unless you or a loved one has been a victim of domestic violence, it can be hard to fathom. Unlike breast cancer—a future health care concern for the majority of women—most people are confident that they are safe from domestic violence because they believe they would never stand for it.

In this belief, which is often implicit and subconscious, we contribute to the large-scale shaming of victims of domestic violence. Liz Roberts, deputy CEO of Safe Horizons, the largest non-profit victims services agency in the United States, identifies part of the problem as the “persistent stereotypes about victims. When it comes to domestic violence, there is still this view that it is somehow the victim’s fault. Those stereotypes allow the public to distance themselves from the issue and see it as something that only affects certain people, not me or anyone I care about. They think that women who let this happen must have something wrong with them. Because they would never stay if their boyfriend hit them.”

That’s a commonly repeated line about victims of domestic violence. “They should just leave.” But to where, exactly? Domestic violence centers are underfunded and support systems are sorely lacking. Every year, the National Network to End Domestic Violence takes a 24-hour census of domestic violence shelters and services, looking at the use of resources on one day across the country. Last year, on September 10, 2014, domestic violence programs served 67,646 victims. In that same time period, there were 10,871 unmet requests for services for victims of domestic violence. Of those, 6,126 were from men and women seeking a safe space to spend the night. Thousands of people took the extraordinary step of trying to escape from an abusive home and were denied due to lack of resources. Even if it were easy to leave—if victims were not often forced to be reliant on their abusers, if there was no threat of escalated violence when leaving, if they could cut all emotional ties, if it was that simple to just pack up your life and walk out the door—where are they supposed to go?

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In the census, nearly 30 percent of shelters reported reduced government funding as the cause of unmet requests. During the recession, there were several waves of budget cuts across the country that have yet to be restored. There were no protests against these changes, no national uproar. Ruth Glenn, the executive director of the National Coalition Against Domestic Violence (NCADV), explains that when federal, state, and local funding was cut during the recession, “A lot of shelters were not able to stay open, some of them had to scale back services. Many of the programs still have not recovered from the cuts two or three years ago.” If they were not forced to shutter entirely, many had to reduce legal aid, child care programs, and transportation, among other resources.

The Department of Defense spends millions of dollars funding medical research programs for breast cancer, but has no such funding listed for domestic violence, despite the high rates of domestic violence in military families. The NIH reported spending over $700 million dollars funding breast cancer research, compared to $36 million earmarked for “violence against women” and none to address domestic violence against men. The breast cancer research postage stamp, officially created in 1998 and recently renewed through 2019, has raised over $80 million for cancer research; in contrast the domestic violence awareness stamp, available from 2003 to 2006, raised a little over $3 million. Those numbers don’t include the hundreds of millions of dollars raised by breast cancer foundations annually. Race for the Cure alone brings in over a million dollars, $500,000 of which comes from three corporate teams—Barclays, JP Morgan Chase, and PepsiCo.

This is not the women’s health Olympics, and I am not suggesting that domestic violence is more important than breast cancer, which affects 1 in 8 women and takes more than 40,000 lives each year. But it is not suffering from lack of awareness. Our focus on breast cancer as the default cause for women’s health must stop.

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Based on its prevalence and serious health outcomes, domestic violence should be a major fixture in any discussion of women’s health, but it is not exclusively a “women’s issue,” either. Men are victims as well, reporting psychological abuse at almost the same rate as women. More than 3 million children are exposed to domestic violence each year. Even when they are not the direct victims of abuse, these children are more likely to have health problems and are likely to be imprisoned and to commit violent crimes as adults. DV affects people from all walks of life.

When the Ray Rice video was released last year, there was an enormous increase in calls to the domestic violence hotline. Anytime the silence surrounding domestic violence is broken, it’s painful; it also empowers people to know they are not alone and that others share their struggle; that other people know it’s wrong.

So: we should talk about it. We should expand our conversation of women’s health to include the domestic violence epidemic. Be a voice for the 1 in 4 women who will suffer severe physical intimate partner abuse in their lives, the 1 in 3 who will experience some form of physical abuse, the 1 in 2 who experience psychological abuse in the United States, and the millions more experiencing domestic violence in countries around the world. Draw attention to the male victims who get left out of the conversation. Donate to local shelters or international support programs. Advocate for improved laws protecting victims and increased funding for domestic violence prevention. Educate ourselves on recognizing the signs of abuse and how to support survivors.

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Buy something purple to raise awareness for domestic violence, which affects millions of women each year, worldwide, and has long reaching consequences that may persist over a lifetime. It goes really well with pink.

If you or a loved one is a victim of domestic violence, please know that you are not alone. There is hope. Support is available through the National Domestic Violence Hotline, open 24/7 at (800) 799-7233. They also offer live chat through their website from 7 am to 2am. Information on local shelters is available at https://www.domesticshelters.org/.

If you would like to donate or become involved in domestic violence advocacy, a list of local shelters in the US can be found here. Donations are always welcome. Many also offer opportunities to volunteer, for those who would like to become involved in other ways. Information Safe Horizon’s #putthenailinit awareness campaign can be found here. Details on the Domestic Violence Hotline’s Pass the Peace campaign can be found here.

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Caroline Weinberg has previously written about science and health at Eater, Vice Motherboard, Aeon, the Washington Post, and a few dry academic publications. You can find her on twitter @ckw583.

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