Elsevier

Women's Health Issues

Volume 11, Issue 3, May–June 2001, Pages 244-258
Women's Health Issues

Article
Prevalence of violence and its implications for women’s health

https://doi.org/10.1016/S1049-3867(01)00085-8Get rights and content

Abstract

This study estimates the lifetime prevalence of violent experiences and their relationship to health and the use of health services in U.S. women aged 18–64 years. The Commonwealth Fund’s 1998 Survey of Women’s Health provides a nationally representative sample. Use of weighted data allows projections to be made to the U.S. population. Over four of ten women in the U.S. are likely to have experienced one or more forms of violence, including child abuse (17.8%), physical assault (19.1%), rape (20.4%), and intimate partner violence (34.6%). In multivariate logistic regression models that control for sociodemographic characteristics, violence—particularly intimate sexual violence—is significantly related to poorer physical and mental health and increased problems with access to medical care. Only one-third of women who experience violence have discussed it with a physician. Health care professionals need to initiate the conversation about violence and offer referrals for needed services.

Introduction

Violence against women is a U.S. and world-wide public health priority.1, 2 Sensational stories and horrific statistics seek to increase awareness of violence against women. However, shame, fear, and an unresponsive health care system continue to silence and isolate women who suffer abuse, rape, and other assaults.

Most of the available literature deals with specific categories of violence (eg, child abuse, rape, spouse abuse), but little is known about the implications of sexual versus non-sexual violence, or whether specific types of violence have differential health—physical and/or psychological—consequences. Much of the research is based on either nonrandom convenience samples or clinical samples that tend to be comprised of more urban, less educated, and poorer women than are representative of the general U.S. population, and this may result in an overestimation of the prevalence and associated effects of violence.3 Many of the violence—health effects studies rely on bivariate analysis and fail to take into account and control for socioeconomic status, insurance, and other access measures. Few studies have a nationally representative sample and requisite range of data for estimating burden of violence (overall and by type of violence), health effects, and relevant physician-patient communication issues.

The Tjaden study, based on a 1997 national survey, reports that 55% of women experience some type of violence in their lifetime.4 Various national and regional studies of child abuse offer a range of estimates from 7% to 40%.5, 6, 7, 8, 9 Other studies offer estimates of 13–25% for women who experienced rapes, as adolescents or adults.4, 7, 10, 11, 12, 13 The only national study to examine lifetime prevalence of physical assault by a non-spouse reports a prevalence rate of 15%,14 and the only regional study (in Georgia) of lifetime intimate partner violence reports a prevalence rate of 30%.15 Various studies also report that violence is likely to be repeated,8, 16 and that childhood abuse is a risk factor for experiencing violence as an adult.17, 18, 19

Various health effects have been linked to specific types of violence, including poorer subjective ratings of health status, disability, chronic pelvic pain, general chronic pain, headache, gastrointestinal disorders, depression, anxiety, suicide, and suicide ideation. Studies that focus on specific subgroups show significant associations between compromised physical health status and child abuse,8, 20, 21 sexual assaults,14, 18, 22 and intimate partner violence.8, 22, 23, 24 Studies also document relationships between mental health disorders and child abuse,9, 19, 20, 21, 25, 26 sexual assault,6, 7, 27, 28 and intimate partner violence.22, 23, 29 Several studies note a “dose-response” effect, with more frequent and more severe violence linked to more severe or greater morbidity.17, 24, 30

Logically, compromised health could translate into an increased use of outpatient and inpatient services. On the other hand, abused women might face barriers to seeking care, for example, prevented by the perpetrator of abuse or by her own fears or feelings (eg, embarrassment). Some studies found a greater use of health care services among women who experienced violence as an adult,30 child abuse,31, 32 rape,14, 27, 33 and intimate partner violence.8, 34, 35, 36 Studies also found that health care costs for intimate partner violence victims are significantly higher than costs for other women.36, 37 Among women abused by a male intimate, studies have documented delay in seeking care and evidence of barriers to obtaining timely care and unmet needs for medical care.8, 38, 39

Some studies indicate that patient-physician communications are less than adequate. One researcher notes that female violence survivors often have the “thick chart syndrome”—frequent visits, comprehensive exams with extensive testing, and no known physical cause for their complaints.26 Women rarely initiate the conversation about either current or past violence in their lives,24, 40, 41, 42, 43, 44, 45 and it is widely acknowledged that the vast majority of women harmed by violence are never asked about violence or identified by their health care providers as having experienced violence.46, 47 Other studies, however, report that women would welcome physician inquiries and would reveal, if asked, their abuse histories.41, 48

With data from the Commonwealth Fund 1998 Survey of Women’s Health, we seek to provide a more current and complete profile of violence against women. More specifically, we present lifetime prevalence estimates and examine several types of violence, with corresponding health effects and implications for doctors. In contrast to prior research, we classify violence to explore the differential effects of intimate sexual violence.

Section snippets

Sample

The study sample of women is drawn from the Commonwealth Fund 1998 Survey of Women’s Health, a national, cross-section sample of women 18 years of age and older. The subsample of women aged 18–64 includes 2,381 women, or 83.5% of the unweighted survey sample (2,850 women). The corresponding weighted sample is 1,840 women. For our analysis, the weighted sample includes 1,821 women (exclusive of 19 women who did not answer the requisite violence questions).

Violence

A series of survey questions asked about

Prevalence estimates

Four-in-ten (43.7%) women aged 18–64 years report at least one type of violence, at least once, in their lifetime (Table 1). This translates into a national estimate of 36 million women who experienced violence, as a child and/or as an adult. Table 1 shows the lifetime prevalence for specific types of violence in our sample and national projections for each category: 17.8% of women were abused (physical and/or sexual) as a child, 19.1% experienced at least one physical assault as an adult,

Discussion

Consistent with prior studies and smaller scale surveys, we document horrific rates of violence that women experience—as children and as adults—in the streets and in their homes. Four of ten U.S. women experience violence, at least once, in their lives, and over 50% of these women were raped or sexually violated, as a child and/or as an adult. The vast majority of sexual violence occurs at the hands of someone she knows—a spouse, partner, relative, or friend, rather than a stranger.

Several

References (72)

  • D.D. Femina et al.

    Child abuseadolescent records versus adult recall

    Child Abuse Negl

    (1990)
  • S.M. Buel et al.

    Family violencepractical recommendations for physicians and the medical community

    Womens Health Issues

    (1995)
  • T.S. Harwell et al.

    Results of a domestic violence training program offered to the staff of urban community health centers

    Am J Prev Med

    (1998)
  • R.L. Muelleman et al.

    Effects of an emergency department based advocacy program for battered women on community resource utilization

    Ann Emerg Med

    (1999)
  • United Nations Population Fund. Violence against girls and women. #445. New York: UNFPA;...
  • Healthy People 2010 (conference edition, in two volumes)

    (2000)
  • Tjaden P, Thoennes N. Prevalence, Incidence, and Consequences of Violence Against Women: Findings from the National...
  • J.M. Leventhal

    Epidemiology of child sexual abuse

  • B.E. Saunders et al.

    Child sexual assault as a risk factor for mental health disorders among womena community survey

    J Interpersonal Violence

    (1992)
  • N.A. Croswell et al.

    Understanding Violence Against Women

    (1996)
  • Plichta SB. Violence and abuse: implications for women’s health. In: Falik MM, Collins KS, editors. Women’s Health: the...
  • S.C. Wilsnack et al.

    Childhood sexual abuse and woman’s substance abusenational survey findings

    J Stud Alcohol

    (1997)
  • G.E. Wyatt

    The sociocultural context of African-American and white women’s rape

    J Social Issues

    (1992)
  • Kilpatrick DG, Edmunds CN, Seymour AK. Rape in America: A Report to the Nation. Arlington, VA: National Victim Center;...
  • Draucker CB. Early family life and victimization in the lives of women. Res Nurs Health...
  • N.D. Brener et al.

    Forced sexual intercourse and associated health risk behaviors among female college students in the United States

    J Consult Clin Psychol

    (1999)
  • M.P. Koss et al.

    Criminal victimization among primary care medical patientsprevalence, incidence and physician usage

    Behav Sci Law

    (1991)
  • Lifetime and annual incidence of intimate partner violence and resulting injuries— Georgia 1995. MMWR...
  • V.M. Follette et al.

    Cumulative traumathe impact of child sexual abuse, adult sexual assault, and spouse abuse

    J Trauma Stress

    (1996)
  • J.M. Golding et al.

    Sexual assault history and health perceptionsseven general population studies

    Health Psychol

    (1997)
  • National Research Council. Understanding Child Abuse and Neglect. Washington, DC: National Academy Press;...
  • J. McCauley et al.

    Clinical characteristics of women with a history of childhood abuse

    JAMA

    (1997)
  • J. McCauley et al.

    Inside Pandora’s boxabused women’s experiences with clinicians and health services

    J Gen Intern Med

    (1998)
  • E.F. Pribor et al.

    Psychiatric correlates of incest in childhood

    Am J Psychiatry

    (1992)
  • R. Kimerling et al.

    Somatic symptoms, social support, and treatment seeking among sexual assault victims

    J Consult Clin Psychol

    (1994)
  • P.S. Hutchings et al.

    Symptom severity and diagnoses related to sexual assault history

    J Anxiety Disord

    (1997)
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