Violence Against Women as a Public Health Concern

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The United Nations (UN) states that despite being a developed country, Australia has yet to overcome the social ill that is violence against women. In its annual report, the UN characterizes the phenomenon as “disturbingly common” and calls to action. VicHealth uses the definition of violence put forward in the World Health Organization’s 2002 World Report on Violence and Health. The document highlights the three components of violence: intentionality, the use of physical force or power, and a high likelihood of injury, death, moral damages, deprivation, or maldevelopment as a result of violent actions (1). While violence against women fits the definition of violence against individuals or groups as a whole, it does have some unique characteristics. According to VicHealth, women are more likely to fall victim to sexual violence, be forced into prostitution, and be trafficked (1). Stalking, which encompasses the following, watching, or harassing, is an issue that affects women the most. Another subset of violence against women is harmful cultural practices such as genital mutilation, dowry-related violence, and traditions that humiliate, belittle, or endanger women.

To put the issue in perspective, one may take a glance at the most recent numbers and figures reflecting the situation with violence against women in Australia. Before the age of 15, one in six women experiences violence, while after the age of 15, the share increases up to two in every five women (41) (1). One-third (34%) of Australian women were victims of physical violence, and every fifth girl or woman (19%) was sexually assaulted (1). When addressing violence against women, it is critical to identify risk groups.

Risk identification was one of the primary goals of the 2018 report by the Australian Institute of Health and Welfare Institute. According to their findings, there are at least eight vulnerable demographics: children, young women, senior citizens, disabled women, and LGBTQ+ women (2). Socioeconomic determinants are also at play as Australians from minor cultural and linguistic backgrounds, socioeconomically underprivileged people, and people residing in rural Australia also bear a high risk (2). Aside from that, the Australian Institute of Health and Welfare Institute expresses its concerns regarding the soaring rates of domestic violence among Aboriginal and Torres Strait Islander populations.

In recent years, the Australian Government has put effort into combating violence against women at the national level. In 2010, the Council of Australian Governments introduced the National Plan to Reduce Violence Against Women and Their Children 2010–2022 (3). The new plan obliged state and territory governments across the country to devise strategic plans to manage and prevent gendered violence (3). Around the same time, researchers observed mobilization within communities and the emergence of health services. These services can be put into three categories: screening for domestic violence, providing responses to incidents, and managing diversity (4).

Each Australian territory has health services and helplines that can be used by women at risk and in immediate danger of violence. For example, in New South Wales, NSW Domestic Violence Line takes calls 24 hours a day/ seven days a week. It provides primary counseling over the telephone as well as gives the callers information on the next steps and refers them to other services (6). Queensland operates an around-the-clock DVConnect Womensline that not only provides telephone counseling to women trying to escape domestic violence but also helps with temporary crisis accommodation for them and their children (6). In South Australia, the lead public health agency responds to calls regarding sexual assault and offers not only counseling but also information regarding law enforcement (6). Aside from helplines, Australia has numerous crisis centers and women’s shelters, many of which adopt a “No wrong door” policy. The policy implies that even if a particular shelter cannot accept a woman, they refer her to another service.

Australia recognizes that violence against women is a grave public health concern, which is why, from year to year, it increases the funding of related health services and initiatives. In 2019, the Prime Minister announced that as part of the National Plan to Reduce Violence against Women and their Children 2010-2022, the Government would be investing the record AUS$328 million (6). The Government prioritizes prevention, which is why AUS$68 million are reserved for measures such as free training for health workers to identify abuse and violence. $82 million will go to frontline services designated to keep Australian women safe.

Helplines such as the nationwide 1800RESPECT will also receive large funding of $64 million. Shelters and crisis centers will be able to use $82 million to better provide accommodation to victims (6). Lastly, the Government shows awareness of the standalone gender dynamics in indigenous communities and the unique treatment that they require. Addressing the issues in the Aboriginal and Torres Strait Islander communities is estimated at $35 million (6). Lastly, some community-based centers use philanthropy, fundraising, and donations as the primary sources of funding. It is difficult not to acknowledge the Government’s commitment to addressing the issue with an adequate funding plan accompanied by residents’ individual efforts.

At present, there are a number of public health interventions that are being implemented to target violence victims and risk groups. As mentioned before, when it comes to gendered violence and abuse, prevention is a top priority, which is why screening has gained a lot of traction. The Domestic Violence Routine Screening Program is an early identification intervention that allows healthcare professionals to prevent escalation and refer women to other services. The screening strategy is a part of the routine assessment of all women receiving antenatal, child, and family health care as well as women attending mental health and substance abuse services (7). In addition, screening is recommended when women present themselves for presenting for sexual health or HIV testing (8).

According to the University of New South Wales, routine screening conducted by a skilled professional is associated with higher rates of disclosure of violent incidents (8). A healthcare worker can be a trusted person as they can guarantee confidentiality. A professional has validated screening tools at their disposal, which allows for effective communication that would not be possible with general questions. On the other hand, the impact of a single screening may be limited and not lead to a follow-up from the potentially vulnerable women.

The implementation of routine screening requires professional training, which is another public health intervention against gendered violence in Australia. There is a plethora of training programs and workshops available to health professionals. The goals of education include the ability to react to disclosure of violence, screen for violent incidents, provide an initial response (risk assessment and safety planning), and support the victim (8). There is no information about nationwide legislation regarding health worker education, meaning that such interventions are probably community-based and hospital-based. Without additional support, they are likely to yield underwhelming results, mostly due to administrative barriers. Healthcare providers may be under pressure to work within stringent time constraints, which leaves little time for education (9). When putting their knowledge into practice, they may face an unresponsive criminal justice system (9).

The limitations of the previous two interventions demonstrate the complexity of violence against women as a public health concern. Indeed, efforts need to go beyond the healthcare system and involve other institutions as well. Ideally, there should be a strong health-justice partnership that would offer “joined up solutions to joined-up problems (8, p. 16).” Together with the Women’s Council, the Department for Child Protection and Family Support provides a framework for multi-agency interventions to protect women from violence (10). Their recent report covers successes in building closer ties between institutions such as the Department for Child Protection and Family Support and the Department of Corrective Services, and Western Australia Police (10). The stakeholders advocate for further involvement of agencies such as Domestic Violence Outreach and Safe at Home programs and family violence courts.

Multi-agency interventions may lead to women’s improved access to services. Collaboration would reduce the response time and lead to a more efficient execution of justice. On the flip side, however, uniting efforts always means the investment of additional time and resources. Coordinating two or more agencies is extremely challenging, and a lot of bureaucracy might be involved. There is still a lot of variation in how stakeholders operate individually, which means there might be no universal solution for bringing them together.

Public health interventions introduced to combat violence against women mean extra workload for healthcare professionals. There is evidence that Australia is experiencing healthcare workforce shortages, which means that the existing cadres have to take up more responsibilities (11). Training, education, and screening may become additional stress for those working at already understaffed facilities. However, it is not only stress from working under time pressure that may be daunting for healthcare providers. Research shows that people working with abuse victims are prone to burnout due to the intensity of emotions involved in the process. For instance, one study shows that caring for victims with severe injuries may impact nurses’ turnover intentions (12). To recapitulate, while the new interventions may bring the quality of health care to a new level, they are likely to take a physical and mental toll on healthcare workers.

Reference List

Violence against women in Australia. An overview of research and approaches to primary prevention [Internet]. Melbourne: VicHealth; 2017. Web.

Family, domestic and sexual violence in Australia: continuing the national story 2019 [Internet]. Australia: Australian Institute of Health and Welfare; 2018. Web.

Weeks W, Gilmore K. How violence against women became an issue on the national policy agenda. In Making social policy in Australia 2020 (pp. 141-153). Routledge.

Signorelli MC, Taft A, Pereira PP. Intimate partner violence against women and healthcare in Australia: charting the scene. Ciência & Saúde Coletiva. 2012; 17(4):1037-48.

Support services [Internet]. Australia: Australian Government; n.d. [2020]. Web.

Record funding to reduce domestic violence [Internet]. Australia: Prime Minister of Australia; 2019. Web.

Domestic violence routine screening program [Internet]. Australia: NSW Government; 2019. Web.

Health Interventions for Family and Domestic Violence: A Literature Review [Internet]. Australia: The University of New South Wales; 2015. Web.

Forsdike K, Humphreys C, Diemer K, Ross S, Gyorki L, Maher H, Vye P, Llewelyn F, Hegarty K. An Australian hospital’s training program and referral pathway within a multi‐disciplinary health–justice partnership addressing family violence. Australian and New Zealand journal of public health. 2018; 42(3):284-90.

Responding to high risk cases of family and domestic violence: guidelines for multi-agency case management [Internet]. Australia: Government of Western AustraliaDepartment for Child Protection and Family Support; 2015. Web.

Karakachian A. Caring for victims of child maltreatment: pediatric nurses’ moral distress and burnout [doctoral thesis]. [Pittsburg (US)]: Duquesne University; 2020.

The crisis in the caring workforce [Internet]. Australia: Parliament of Australia; n.d. [2020]. Web.

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Violence Against Women as a Public Health Concern

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