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. 2002 Jul 6;325(7354):44.

Domestic violence

It's not only men who commit domestic violence

Mark S Horner 1
PMCID: PMC1123557  PMID: 12098734

Editor—I am disappointed by Jewkes's editorial on domestic violence.1 The clear implication is that men are the oppressors and women suffer. Sadly this is often true, but it is far from being the whole picture.

The 1996 British crime survey asked a representative sample of 16 500 adults in England and Wales directly about their experiences of crime, and whether it was reported to the police. The survey included a computer assisted self interviewing questionnaire, designed to give findings on the extent of domestic violence in England and Wales. The results found that 4.2% of women and 4.2% of men said that they had been physically assaulted by a current or former partner in the past year.2

Many studies have found similar results. The work of Straus (a good example of which can be found at www.vix.com/menmag/straus21.htm) is particularly authoritative. Indeed, when one considers that most violence against children is committed by women, in terms of gender it is women who are most likely to be perpetrators of domestic violence.

Does this manner of presentation matter? I think it does. On a personal level it leads to the situation I encountered recently in my local police station. A man with quite severe injuries after an attack by his former (female) partner was in the cells for breach of the peace. On a broader level it adds to the negative image of men that is so widespread in parts of our popular culture. This does nothing to help the forging of a masculine identity in certain vulnerable young men, which Jewkes says is a risk factor for violence.

Why, I wonder, is domestic violence so often portrayed in such a partisan and unscientific way?

References

BMJ. 2002 Jul 6;325(7354):44.

Literature is biased as studies rarely look at female-to-male violence

Chris Carlsten 1

Editor—Several papers in the BMJ have looked at domestic violence.1-1,1-2,1-3 Although this problem has been well documented, in the movement to expose it properly there is a gender bias that, ironically, betrays the underlying concern with gender equality.

The language of domestic violence reporting often makes a bold assumption by speaking exclusively of violence by men against women. The title of Richardson et al's paper is misleading.1-2 It implies that they are reporting a cross sectional study, but what the authors actually looked at was 50% of the population—namely, women. The title of Jewkes's editorial is gender neutral, yet the subtitle shows the exclusion, lamenting that women are not consistently asked about the possibility of domestic violence. This is not necessarily more misleading than the early studies of coronary artery disease, which were presumed to be inclusive though in fact studied only men.

The justification for this slant in the domestic violence literature has been that female victims vastly outnumber male victims. Many data, however, suggest otherwise. Cascardi et al found that 86% of marital aggression was reported as reciprocal between husbands and wives.1-4 Schafer et al reported lower and upper bounds on intimate partner violence of 5.21% and 13.61% for male-to-female partner violence and 6.22% and 18.21% for female-to-male partner violence.1-5 Interestingly, female-to-male violence was reported to be higher than male-to-female.

These data force a recognition that female-to-male violence must be included in any discussion. Bradley et al note that “there is generally no universally agreed method of defining and measuring domestic violence.”1-1 A simple first step would be for the authors to recognise that, regardless of the precise percentages, this is a bi-directional, bi-gender issue. The authors lament that women are inconsistently asked about domestic violence, but they ignore the even greater lack of inquiry into men's potential victim status. This reporting bias may partly explain the disparity in the limited literature that attempts to include data on bi-directional violence.

None of the three articles in the BMJ even allude to female-to-male domestic violence. This reflects a literature bias that will undoubtedly influence future work. Such bias ignores many thousands of male victims and alienates those who demand a more balanced presentation.

Let's keep working to get better data, but let's recognise the bi-gender nature of this societal ill. That way, all of us can become involved in research, advocacy, and teaching and be part of the solution. In other words, “it is now time for the medical establishment to embrace the issue of gender.”1-3

References

  • 1-1.Bradley F, Smith M, Long J, O'Dowd T. Reported frequency of domestic violence: cross sectional survey of women attending general practice. BMJ. 2002;324:271–274. doi: 10.1136/bmj.324.7332.271. . (2 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Richardson J, Coid J, Petruckevitch A, Wai SC, Moorey S, Feder G. Identifying domestic violence: cross-sectional study in primary care. BMJ. 2002;324:274–277. doi: 10.1136/bmj.324.7332.274. . (2 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-3.Jewkes R. Preventing domestic violence. BMJ. 2002;324:253–254. doi: 10.1136/bmj.324.7332.253. . (2 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-4.Cascardi M, Langhinrichsen J, Vivian D. Marital aggression. Impact, injury, and health correlates for husbands and wives. Arch Intern Med. 1992;152:1178–1184. doi: 10.1001/archinte.152.6.1178. [DOI] [PubMed] [Google Scholar]
  • 1-5.Schafer J, Caetano R, Clark CL. Rates of intimate partner violence in the United States. Am J Public Health. 1998;88:1702–1704. doi: 10.2105/ajph.88.11.1702. [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 2002 Jul 6;325(7354):44.

European sentinel network of practices has been established

Cécile Morvant 1,2,3, Jacques Lebas 1,2,3, Pierre Chauvin 1,2,3

Editor—Two studies on domestic violence highlighted the lack of routine involvement of primary care practitioners2-1 and the difficulties in screening for domestic violence in general practice.2-2 These two studies are of great importance as European data on domestic violence are scarce.

Richardson et al concluded that the introduction of screening for domestic violence in healthcare settings is premature because of its limited acceptability (20% of women said that they would mind being asked about it by their general practitioner), whereas Bradley et al observed that only 7% of women would mind such routine inquiry by their doctor.

Unlike Richardson et al, we find this rate of spontaneous acceptability high, and favourable for the adoption of this type of screening. After all, it is not done at present; other types of screening, such as that for breast, cervical, or prostate cancer, were probably greeted with similar views initially. Other authors report good sensitivity and good specificity from primary care questionnaires regarding severe violence by intimate partners.2-3

Why do doctors find it so difficult to recognise marital violence, even in cases of visible physical violence? A study in 2000 among 235 general practitioners in the Paris area showed that in only 7.7% of the cases of domestic violence finally recognised as such had the doctor raised the question of domestic violence. It also showed that most general practitioners do not know how to cope with this problem: 76% did not know of any structure or other professional able to help their patient, 60% declared themselves insufficiently trained to detect and provide follow up for domestic violence, 47% judged themselves unable to do so, and 21% declared that they had too little time to raise this question.

In view of these findings, a multilingual internet site was created in 2001 with the support of the European Union's Daphne initiative. It provides health professionals with information and recommendations for detecting female victims of domestic violence and providing follow up for them (www.sivic.org).

In addition, a European surveillance network of primary care practices (the Vigil network) now brings together health professionals (general practitioners, staff of emergency services, gynaecologists) and associations that help female victims of domestic violence in eight European countries. For each case recognised the volunteer doctors are questioned about how the violence was detected, their intervention, and the difficulties encountered. The female victims are also questioned about their contacts with health professionals (or why there were none) and the proposals that were made.

References

  • 2-1.Richardson J, Coid J, Petruckevitch A, Chung WS, Moorey S, Feder G. Identifying domestic violence: cross sectional study in primary care. BMJ. 2002;324:274–277. doi: 10.1136/bmj.324.7332.274. . (2 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2-2.Bradley F, Smith M, Long J, O'Dowd T. Reported frequency of domestic violence: cross sectional survey of women attending general practice. BMJ. 2002;324:271–274. doi: 10.1136/bmj.324.7332.271. . (2 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2-3.McNutt LA, Carlson BE, Rose IM, Robinson DA. Partner violence intervention in the busy primary care environment. Am J Prev Med. 2002;22:84–91. doi: 10.1016/s0749-3797(01)00407-x. [DOI] [PubMed] [Google Scholar]
BMJ. 2002 Jul 6;325(7354):44.

Screening can be made acceptable to women

Joan Webster 1, Debra K Creedy 1

Editor—We wish to highlight outcomes of the Queensland health domestic violence initiative, which incorporated screening for domestic violence into routine history taking protocols as a component of core clinical practice.3-1 The provider asks the client two or three additional questions relating to domestic violence during the history taking procedure. This small change has improved diagnosis and the provision of health services and information to women who experience domestic violence.

Respondents in the studies by Richardson et al3-2 and Bradley et al3-3 completed a self report questionnaire, but many had never been asked directly about domestic violence in a screening process. Only 12% of women in Bradley et al's study reported that their doctor had asked about domestic violence. In our study 83% of women presenting to the antenatal or gynaecology outpatient services were screened for domestic violence, with roughly 6.5% disclosing that some form of domestic violence had occurred. Of those women who were positive on screening, about 10% accepted help.

Clients thought that screening women for domestic violence was a good idea, with 97% of those surveyed supporting it. This is higher than the figures reported in the BMJ (77% by Bradley et al and 80% by Richardson et al). Richardson et al report that at least 20% of women objected to screening. To determine the extent of acceptability more accurate conclusions can be drawn from research that reports on the views of women who have experienced personalised screening.

Richardson et al report that 42% of women would find it easier to discuss issues concerning domestic violence with a female doctor. Issues of gender, power, and interpersonal sensitivity must be considered when assessing people for domestic violence. Neither Richardson et al nor Bradley et al identified whether certain contexts were described in the questionnaire when investigating women's attitudes to screening. For example, a woman's attitude to screening about domestic violence might alter if the questions were asked in private with no family member present, if they were asked by a female health professional, if the woman perceived the health professional to be genuinely concerned about her, and if the woman was offered access to information and referral. Such issues need to be considered when investigating attitudes of service users.

The papers also report on the low rate of documentation of domestic violence—for example, only 17% of cases were documented in Richardson et al's paper. Our work identified that quick, simple, routine screening can be effective, with documented compliance of around 88% and 97% acceptability to women.

Footnotes

Nursing and Women's Health Research Centre, Royal Brisbane and Royal Women's Hospital, Post Office Herston 4029, Queensland, Australia joan_webster@health.qld.gov.au

References

  • 3-1.Webster J, Stratigos S, Grimes K. Women's responses to screening for domestic violence in health care settings. Midwifery. 2001;17:289–294. doi: 10.1054/midw.2001.0279. [DOI] [PubMed] [Google Scholar]
  • 3-2.Richardson J, Coid J, Petruckevitch A, Chung W, Moorey S, Feder G. Identifying domestic violence: a cross sectional study in primary care. BMJ. 2002;324:274–277. doi: 10.1136/bmj.324.7332.274. . (2 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3-3.Bradley F, Smith M, Long J, O'Dowd T. Reported frequency of domestic violence: cross sectional survey of women attending general practice. BMJ. 2002;324:271–274. doi: 10.1136/bmj.324.7332.271. . (2 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]

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