Domestic violence is like a disease in our society. More than 10 million American women and men are physically abused by an intimate partner every year. That breaks down to almost 20 people per minute.
According to the National Coalition Against Domestic Violence (NCADV), one in four women in the United States has experienced “severe intimate partner physical violence, intimate partner contact sexual violence, and/or intimate partner stalking”—which have lasting effects from fearfulness to physical injuries to PTSD to the need for victim services.
And one in three women (plus one in four men) have experienced some form of violence—slapping, shoving, or pushing—at the hands of an intimate partner.
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Traditionally, law enforcement handles domestic abuse cases, while doctors and nurses tend to physical and mental wounds. But in recent years, healthcare providers are taking the lead in spotting and intervening in ongoing cases of domestic violence.
How Doctors Are Stepping Up
Domestic violence is often treated as a criminal justice problem, which is why law enforcement has traditionally taken charge in domestic abuse cases. But that approach can leave victims to navigate traumatizing situations on their own.
It’s not that doctors haven’t noticed abuse or tried to help in the past. But there’s never been a systemic, health-focused response to domestic violence overseen by trained healthcare professionals and social service partners.
But that could be starting to change thanks to people like Dr. Anita Ravi.
She runs an unusual clinic in New York City called PurpLE Family Health which takes a holistic approach to treating women who are victims of intimate partner violence, sexual assault, and human trafficking. It’s part of a growing network of medical centers and clinics that has realized the crucial role they can play in treating—and ultimately reducing—domestic violence.
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Beyond questionnaires in the emergency room with no follow-up, Ravi advocates for screenings and conversations in a range of medical settings—including primary care and pre- and post-natal care, because childbirth is a high-risk time for abuse.
Homicide is the leading cause of death during pregnancy or the first year after birth in the United States, according to a study published by Tulane University’s Maeve Wallace and her colleagues in the journal Obstetrics and Gynecology. “Homicide during pregnancy or within 42 days of the end of pregnancy exceeded all the leading causes of maternal mortality by more than twofold,” they wrote in the paper.
Instead of waiting for a domestic violence victim to show up in an ER and get handed a brochure, physicians and other healthcare providers are starting to collaborate. Even policymakers are looking closer at abuse as a health factor.
Ultimately, the goal is to have a health-based approach to domestic violence cases that can then be handed off to social service partners. Instead of law enforcement taking the lead, the healthcare and social service workers will handle the cases while recognizing that women’s health can be affected by larger social and economic factors.
“Exposure to violence, including intimate partner violence, has a direct impact on mental and physical health outcomes, and is directly tied to injury, psychological distress, and death in all age groups,” Center for Medicare and Medicaid Services administrator Chiquita Brooks-LaSure told Politico in September.
Treating Domestic Abuse Like A Disease
At Ravi’s clinic, she treats her patients’ immediate medical needs, but she also connects them to a network of services and resources that can help them get out of their relationship or at least reduce harm.
All of the care at Ravi’s clinic is free, paid for by her PurpLE Health Foundation—a non-profit that she also started.
Rather than seeing domestic abuse as a collection of broken bones and bruises, Ravi looks at it “as an infection,” recognizing the chronic harm that can spread not only to other people but to the next generation. Children who witness domestic violence or have been victims of it are at risk of perpetuating the cycle when they grow up.
Ravi has developed tools and protocols to teach healthcare practitioners that their role requires more than handing abused women off to law enforcement. So far, she has trained 5,000 people and counting.