Assignment: Policies on Gender Violence

Nursing and U.S. Policy

Kathryn Laughon, Angela Frederick Amar

“If the numbers we see in domestic violence were applied to terrorism or gang violence, the entire country would be up in arms, and it would be the lead story on the news every night.”

Rep. Mark Green, Wisconsin

Our society is steeped in violence. In the most recent national statistics, more than 26 per 1000 people aged 12 years or older will be the victims of a violent crime (Truman, Langton, & Planty, 2013). Most of our violence prevention strategies prepare potential victims to ward off violent attacks from strangers; yet, someone known to the victim perpetrates most violence against women, children, and older adults. The intimate nature of this violence, often perpetrated behind closed doors, has made these forms of violence less visible. However, the toll of violence on individuals and societies is substantial. The World Health Organization has framed violence as a significant public health problem (Truman, Langton, & Planty, 2013). A public health approach suggests an interdisciplinary, science-based approach with an emphasis on prevention. Effective strategies draw on resources in many fields, including nursing, medicine, criminal justice, epidemiology, and other social scientists.

The purpose of this chapter is to provide an overview of state, federal, and health sector policies regarding violence against women in the United States, briefly discuss policies related to violence against children and older adults, and outline the resulting implications for nurses and directions for future work.

ORDER Assignment: Policies on Gender Violence

Intimate Partner and Sexual Violence Against Women

Intimate partner violence (IPV) is physical, sexual, or psychological harm inflicted by a current or former partner (same sex or not) or a current or former spouse (Black et al., 2011). Almost one third of American women experience being hit, slapped, or pushed by an intimate partner, and nearly a quarter will experience serious forms of IPV during their lifetimes. Additionally, nearly one in five women will experience a completed or attempted rape in their lifetimes. Men experience IPV and rape as well, although at far lower rates than do women. About a quarter of men will experience IPV (about 12% serious forms of violence) and nearly 1.5% a completed or attempted rape. Although more than half of women reporting rape report that the assailant was an intimate partner and 40% that the assailant was an acquaintance, men report that half of rapes were by acquaintances and 15% by strangers; the number raped by an intimate partner was too small to estimate.

The health effects of IPV and sexual violence are substantial and cost as much as $8.3 billion in health care and mental health services for victims (Max et al., 2004). Violence is associated with a wide range of health problems, including chronic pain recurring central nervous system symptoms, vaginal and sexually transmitted infections and other gynecological symptoms, and diagnosed gastrointestinal symptoms and disorders (Black et al., 2011). Mental health symptoms include depression,

675

anxiety, posttraumatic stress disorder, and alcohol and drug use (Black et al., 2011; Campbell, 2002).

State Laws Regarding Intimate Partner and Sexual Violence

State laws address a number of issues important for nurses to understand. Most often, crime of IPV and sexual violence are addressed through state laws. Most, although not all, states have laws specifically providing enhanced penalties for assault and battery that occurs between intimate partners. (It worth noting that most laws refer to domestic violence or family abuse rather than IPV.) For example, at least 23 states have some form of mandatory arrest for IPV (Hirschel, 2008). Research findings are mixed on whether mandatory arrest laws reduce reassault (Felson, Ackerman, & Gallagher, 2005; Hirschel et al., 2007), although findings from at least one study suggest that the overwhelming majority of victims support mandatory arrest laws (Barata & Schneider, 2004). Additionally, states may have enhanced penalties, such as escalating third offenses to felonies.

Until 1975, all states provided what is called the marital rape exemption under which it was legally impossible to commit rape against one’s wife. Beginning in the mid-1970s, based in part on nursing research, these laws began to change (Campbell & Alford, 1989). Although all states now recognize marital rape as a crime, in some states it is still treated differently from rape by a nonspouse (Prachar, 2010).

Nonlethal strangulation of women is a significant but often overlooked threat to public safety. Most (80%) strangulations of women are committed by intimate partners (Shields et al., 2010). They can result in significant physical health problems for victims (Taliaferro et al., 2009) and substantially increase risk of later lethal violence (Glass et al., 2008). These cases can be difficult to charge and prosecute commensurate with the severity of the crime (Laughon, Glass, & Worrell, 2009); therefore, a growing number of states have strengthened laws related to strangulation.

Assignment: Policies on Gender Violence