TAFP Perspective: April is Sexual Assault Awareness and Child Abuse Awareness Month

By Beverly Nuckols, M.D.
posted 4/6/05

Recent news stories have focused on sensational allegations of sexual assault and child abuse. While we can hope that the publicity about these trials will heighten awareness of these abuses, there are still many myths in popular knowledge about these and other forms of intimate partner violence (also called domestic violence). Family doctors can use the national campaigns in April on sexual abuse and child abuse awareness to educate ourselves and our patients.

Research shows that most physicians only ask direct questions about abuse when there is some specific reason for suspicion. The rate of routine screening for intimate partner violence in medical practices is directly related to the physician’s belief that our patients are affected and that it is our responsibility to screen. However, the odds are that one-third to one-half of our patients have experienced domestic violence, and all forms of intimate partner violence are found in all social, economic and education levels. One in six females -- as high as one-quarter of women in college -- and one in 33 males will be subjected to either a completed or attempted rape at some time in their lives, with the totals for sexual assault much higher. Half of sexual assaults happen before the age of 18. The prevalence of intimate partner violence during pregnancy is estimated to be nine percent.

The consequences of this violence are wide-ranging. There is an increased risk of premature birth, low birth weight and miscarriages for pregnant women who are victims of violence, and homicide is second only to car accidents as the cause of death during pregnancy. Sexual violence is associated with acute injuries other than rape in one-third of survivors, with fewer than one-third of the injured receiving medical treatment. About a quarter of this treatment takes place in the doctor’s office. According to the U.S. Department of Justice, survivors of sexual assault develop posttraumatic stress disorder in 50 percent of cases and are more likely to suffer from eating disorders including bulimia and anorexia, depression, substance abuse, promiscuity and other risky sexual practices and suicide than control groups. Children who are victims of abuse and neglect are likely to have been abused by battered mothers or the mother’s abuser. Adult sex offenders are more likely to have witnessed domestic violence as a child than non-offenders. Up to one-third of parents who were abused or witnessed intimate partner violence as children abuse their own children. The cycle just continues.

Survivors of intimate partner violence are more likely to report abuse when asked directly about their history of abuse than to volunteer such information. In the case of sexual assault, they may seek medical care for physical trauma other than the sexual contact itself. Because of our ongoing relationship with families, our involvement in health maintenance for all ages including well-child, well-woman, pregnancy, treatment of chronic disease and geriatric care, family physicians have a unique position in the effort to stop the cycle of domestic violence and sexual abuse. AAFP has published a position paper advising the routine screening of patients, use of the screening questions as opportunities to explore attitudes about intimate partner violence, and methods to teach coping skills. The American College of Obstetricians and Gynecologists, along with the Centers for Disease Control and Prevention, has developed a slide program on violence in pregnancy which can be used to develop skills in screening and intervention for intimate partner violence.

Physicians must report abuse of minors, and ensuring the safety of the child is paramount to other concerns. However, adult victims of intimate partner violence should be given the option of making their own choices and decisions. The physician can help by assuring victims that they are not to blame for the abuse, providing a safe, non-judgmental environment in which to seek help and advice, by assisting in the making of a safety plan, and by providing hotline and shelter information. We should also recognize that safety for patients, their families, ourselves and our staff is the first priority. The most dangerous time for victims of domestic violence and those around them is when they attempt to leave the abuser. The ACOG program includes guidelines for developing a safety plan for women who are experiencing violence but who do not wish to leave their abuser immediately.

Family physicians should be acquainted with local resources for survivors of sexual assault and intimate partner violence, and use these contacts to become more knowledgeable about intervention and treatment. For more information, contact your nearest Domestic Violence and Rape Crisis Centers about their plans to commemorate Sexual Assault Awareness Month and Child Assault Awareness Month.