Violence and abuse rates during women's lifetimes remain disturbingly high and have long-term health effects, according to The Commonwealth Fund 1998 Survey of Women's Health. Based on women's reports of physical or sexual abuse as children, rape and assault, and physical abuse by a domestic partner, the survey finds that two of five women have experienced at least one type of abuse or violence in their lifetime. Those who had any indication of violence or abuse were at notably higher risk for physical and mental health problems.
Reports of domestic abuse are most prevalent. One-third (31%) of all women have been kicked, hit or punched, choked, or otherwise physically abused by a spouse or partner in their lifetimes. Three percent—a figure representing more than 3 million women in the United States—reported domestic abuse during the past year.
When asked about abuse as a child, about one of six (16%) women said they were either sexually (10%) or physically (11%) abused during their childhood. Half the women who reported a history of childhood abuse said that the perpetrator was an immediate family member. Women with a history of childhood abuse were at notably greater risk of experiencing violence later in life. Nearly two-thirds (62%) of women reporting childhood abuse had experienced domestic violence as an adult, compared with only one-quarter of women without a history of childhood abuse.
A separate question asked women whether they had ever been raped or physically or sexually assaulted. One of five women (21%) said they had been a victim of rape or assault.
VIOLENCE AND ABUSE CROSS DEMOGRAPHIC AND GEOGRAPHIC BOUNDARIES
Violence and abuse rates vary little by whether women live in cities, suburbs, or rural areas; by which region of the country they live in; or by their race, ethnicity, or education. While women living on low incomes tend to be at higher risk for various types of violence, rates remain high across the income spectrum. Overall, nearly half (47%) of women with incomes of $16,000 or less reported at least one incident of violence or abuse in their lifetime, as did one-third (34%) of women with incomes of more than $50,000.
Women who are under economic stress appear to be particularly at risk. More than half (52%) of women who said they have "a lot of trouble" paying for basic needs such as food, phone, gas, and electricity have been victims of domestic abuse. One-third (31%) of these women also indicated a history of child abuse.
VIOLENCE INCREASES THE LIKELIHOOD OF HEALTH PROBLEMS
The survey confirms other recent findings on the long-term, negative health consequences of violence. Whether abuse was experienced as a child or as an adult, women who have been victims of violence were significantly more likely to report general health problems, to exhibit depressive symptoms, or to have been diagnosed with a mental health problem.
Based on women's own ratings of their health, victims of violence are in generally worse health than women who reported they had not experienced domestic violence or abuse. While 22 percent of women who have been victims of domestic abuse rated their health as fair or poor, the same was true for only 15 percent of women who had not been victims. Similarly, roughly one of four (27%) women who had been abused as a child rated her health negatively, compared with only 16 percent of women who had not experienced childhood abuse.
Women with a history of violence or abuse were considerably more likely to report mental health problems. Half of women revealing any type of abuse exhibited high levels of depressive symptoms, compared with one-third of women with no indications of violence. One-third of women who had a history of childhood abuse (36%) or had been raped or assaulted (34%) had received a diagnosis of anxiety or depression from a physician within the past five years, compared with less than one of 10 women with no such history.
Experience with violence may also lead to behaviors that could put health at risk: women who have been exposed to violence or abuse are twice as likely as other women to smoke (32% vs. 16%) and nearly 40 percent more likely to drink alcohol regularly (22% vs. 16%).
COMMUNICATION BETWEEN PHYSICIANS AND VICTIMS OF VIOLENCE NEEDS IMPROVEMENT
While three-quarters of the women surveyed who had been exposed to domestic abuse had discussed their problem with a friend or relative, less than one-third had done so with their doctor. Among women who had experienced childhood abuse, only 30 percent had disclosed this information to a physician. In addition, the victim was four to five times more likely than the physician to raise the subject of violence or abuse. Even so, among the women surveyed who had been victimized through assault, rape, or other violent crimes, only 28 percent had sought medical attention. Of those, just half were referred to support services.
VICTIMS OF VIOLENCE, ABUSE FACE UNMET HEALTH CARE NEEDS
Women who have experienced violence or abuse appear to have greater difficulty accessing health care than other women. More than one-third who had experienced violence or abuse reported a time they did not get needed care. Victims of violence were nearly twice as likely as other women to say that they have had an “extremely,” “very,” or “somewhat” difficult time obtaining health care (22% vs. 13%). Among women who had been victims of any violence or abuse, 31 percent believed that at some time they had needed to see a mental health professional, but only slightly more than half of those were able to do so.