Making the ‘invisible’ visible: transforming the detection of intimate partner violence

Abstract

On 25 November 2018, the United Nations chillingly reported that the most dangerous place for women is inside their own homes. Each year more than half of female homicides are committed by current or former intimate partners or family members.1 Intimate partner violence (IPV), within the domestic violence spectrum, is defined as physical, sexual or emotional violence between partners or former partners.2 It is a serious public health concern with millions of people experiencing violence at the hands of an intimate partner. WHO recognizes IPV as a global issue, prevalent at epidemic proportions in every society, socioeconomic and educational group. According to the National Intimate Partner and Sexual Violence Survey, one in four women and one in nine men in USA have reported severe form of physical violence by an intimate partner during their lifetime.3 Despite the high prevalence and urgency of this critical public health issue, IPV continues to be profoundly underdiagnosed and is considered a persistent hidden epidemic. In addition to physical injuries, IPV has both short-term and long-term negative health consequences including asthma, irritable bowel syndrome, diabetes, poor reproductive health, chronic pain syndrome and mental health problems.4 With victims of IPV seeking medical care more often, healthcare providers can play a vital role in reducing the devastating impact of IPV by representing a trusting source of divulging abuse. The major obstacle to its early detection and intervention is victim under-reporting of physical violence to healthcare providers. Screening for IPV can be an effective tool for detecting and preventing future violence. However, several barriers limit the use and success of these screening programs. Due to shame, privacy, economic dependency, fear of retaliation, legal factors or lack of trust of providers, a patient may not self-report and even fabricate the history of her injury.5 …