Transcript Women’s Health - American Pharmacists Association

The Culture of Domestic Violence
Essentials of Cultural Competence in Pharmacy
Practice: Chapter 15 Notes
Chapter Author: Dr. Brenda Hall
Learning Objectives
Understand what contributes to the
continuation of domestic violence.
2. Know common characteristics of abusers.
3. Understand the typical cycle of abuse.
4. Know how to talk with potential victims of
abuse.
1.
Overview of Domestic Violence
 American Psychological Association defines domestic
violence (DV) or intimate partner violence (IPV) as a
“pattern of abusive behaviors including a wide range of
physical, sexual, and psychological mistreatment used by
one person in an intimate relationship with another to
gain power unfairly or maintain that person’s misuse of
power, control and authority.”
Prevalence of Domestic Violence
 Not limited to a specific part of the world, a particular
culture or economic status.
 Occurs in families from all racial, ethnic, educational,
and religious backgrounds, and in inner city, suburban,
and rural communities.
 10-59% of women around the world each year
experience violence in their relationships with male
partners or husbands.
 In the U.S., DV is cited as the most common cause of
serious injury among women.
Prevalence of DV (continued)
 Approximately 1.5 million women are physically assaulted or
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raped by an intimate partner annually.
For male victims, the estimate is 834,732 annually.
Many victims experience multiple acts of violence, so there may
be as many as 4.8 million physical assaults and rapes of women
each year in the U.S.
Approximately 2.9 million intimate partner physical assaults are
committed against men.
If one considers all types of domestic abuse, the statistics are
consistently high.
In any given year, 1 in 9 women experiences violence; 1 in 4
women will suffer DV at some stage of their life.
Cultural Considerations
 Individuals from different racial and ethnic groups may view and
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respond differently to IPV.
For instance, compared to white women, African-American
women are more likely to leave their abusive partners; yet, they
are also more likely to return to the relationship.
Black women are also more likely to fight back.
Several studies conducted in the U.S. indicate that all racial
minorities experience more intimate partner violence than their
white counterparts.
While it may be assumed that these cultures are more accepting or
prone to aggressive acts, the literature suggests otherwise.
Minorities’ economic and marginalized status puts them at a much
greater risk for intimate partner abuse.
Cultural Considerations of DV
 Socially and economically disadvantaged men and
women are more vulnerable to experience violence as a
consequence of difficult life experiences.
 Abused ethnic minority women, particularly blacks and
Hispanics, seek help at lower rates than white abused
women.
 Low acculturation is cited as the most significant cultural
barrier to utilization of services and resources.
Abuse
 Women who are part of an ethnic minority who consider
leaving a violent relationship may hesitate due to fear of
supporting existing negative stereotypes and stigmatization.
 They may try hard to avoid attention that could be perceived
as a sign of weakness or disloyalty to their ethnic group.
 In a qualitative study, Russian immigrants who were brought to
the U. S. to marry American citizens described how their abuse
was linked to coercion.
 These women relocated to the U.S. not speaking the language, not
having a support group or any financial resources, and not aware
of their rights.
Cycle of Violence
 Cycle of abuse. Scenarios such as this one demonstrate typical
dynamics within the culture of domestic violence. Domestic
violence is systematic.
 The negative behavior is rarely exhibited at the beginning of the
relationship, yet over time hurtful behaviors escalate, becoming
more frequent and severe.
 Abusers believe they are entitled to control the other person and
rationalize that violence is acceptable if it is necessary in order to
gain and maintain control.
 Typically the abuser establishes power with intimidation and fear
or threat of physical harm. Intimate partner violence occurs in a
cycle of three repeating phases.
Characteristics of Abusers
 Batterers:
 Often grandiose, overidentifying with traditional and cultural
sex-role stereotypes
 Exaggerated sense of worth and power and feel entitled to what
they want when they want it
 Many have grown up in violent homes
 Generally self-absorbed and can identify their own needs, wants
and desires, but not those of their partner or children.
 Often low on assertiveness skills and difficulty expressing their
needs, wants and desires.
 Generally avoid or deny personal responsibility and
consequences for their feelings and actions.
 May appear strong and independent but are usually emotionally
dependent on their partner.
Health Effects
 Workforce—A major public health issue that results in $5.8
billion spent yearly.
 Physical—Physical and sexual assaults lead to injuries such as
broke bones, bruises, sprains, cuts, concussions, bleeding, and
internal injuries. Prolonged exposure to domestic violence results
in long-term medical conditions.
 Mental—High rates of depression, anxiety, and trauma are
common experiences.
 Pregnancy—In the U.S. IPV rates for pregnant women vary
between 1% and 20%.
Considerations
 Communication
 Care
 Encouragement
Reflection Questions
1. If you suspect a patient is in an abusive relationship, what
will you do?
2. How can you prepare yourself, as well as the others with
whom you work, to identify abuse?
3. How have your own biases about victims of domestic abuse
changed after reading this chapter?