{"id":47913,"date":"2020-07-01T15:19:53","date_gmt":"2020-07-01T14:19:53","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47913"},"modified":"2020-07-06T17:29:27","modified_gmt":"2020-07-06T16:29:27","slug":"intimate-partner-violence-during-covid-19-expanding-our-understanding-of-safety","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/07\/01\/intimate-partner-violence-during-covid-19-expanding-our-understanding-of-safety\/","title":{"rendered":"Intimate partner violence during covid-19\u2014expanding our understanding of safety"},"content":{"rendered":"<p class=\"standfirst\">Survivors face compounded challenges when intimate abuse intersects with structural violence, write Amrapali Maitra and Jackie Savage-Borne<\/p>\n<p><!--more--><span style=\"font-weight: 400\">Nearly <\/span><a href=\"https:\/\/www.cdc.gov\/violenceprevention\/intimatepartnerviolence\/fastfact.html\"><span style=\"font-weight: 400\">one in five women and one in seven men in the US<\/span><\/a><span style=\"font-weight: 400\"> have experienced severe physical violence from an intimate partner in their lifetime. The healthcare costs of physical, sexual, and emotional abuse exceed <\/span><a href=\"https:\/\/www.cdc.gov\/violenceprevention\/pdf\/ipvbook-a.pdf\"><span style=\"font-weight: 400\">$4 billion a year<\/span><\/a><span style=\"font-weight: 400\">, largely due to injuries and lasting mental health effects. During covid-19, such violence has escalated. The lockdown has worsened abusers\u2019 <\/span><a href=\"https:\/\/www.nytimes.com\/2020\/04\/06\/world\/coronavirus-domestic-violence.html\"><span style=\"font-weight: 400\">tactics of isolation, coercion, and control<\/span><\/a><span style=\"font-weight: 400\">. Survivors currently face unprecedented barriers to frontline care: reduced in-person support, closure of courts, and paucity of shelters.\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">As clinicians and domestic violence advocates, our experiences trying to support survivors over the past few months confirm these challenges. Even before covid-19, Massachusetts, where we work, was like many other states in having limited short term housing options\u2014about <\/span><a href=\"https:\/\/janedoe.org\/wp-content\/uploads\/JDI_Map.pdf\"><span style=\"font-weight: 400\">22 emergency shelters<\/span><\/a><span style=\"font-weight: 400\"> according to the statewide coalition for domestic violence and sexual assault. Now, with concerns about exposure to covid-19 and overcrowding, shelters have run out of beds or paused lotteries. The pandemic has led to a <\/span><a href=\"https:\/\/fivethirtyeight.com\/features\/what-we-know-about-crises-and-domestic-violence-and-what-that-could-mean-for-covid-19\/\"><span style=\"font-weight: 400\">global rise in the incidence of intimate partner violence<\/span><\/a><span style=\"font-weight: 400\">, yet many survivors have literally no place to go.<\/span> <span style=\"font-weight: 400\">For instance, we called 10 shelters in a single day looking for a bed for a survivor. Each gave the same response: we wish we could help, but we cannot take anyone new.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In a context of strapped resources, some survivors are even more constrained than others. Many survivors of intimate partner violence also face homelessness, unemployment, and social stressors. And many survivors from racial and ethnic minorities are fearful about going to a shelter where they could be subjected to further harm or targeting simply <\/span><a href=\"https:\/\/psycnet.apa.org\/record\/2014-46789-004\"><span style=\"font-weight: 400\">because of their lived identities<\/span><\/a><span style=\"font-weight: 400\">. These survivors must weigh <\/span><a href=\"https:\/\/psycnet.apa.org\/record\/2015-00354-001\"><span style=\"font-weight: 400\">challenging tradeoffs<\/span><\/a><span style=\"font-weight: 400\">: return to an abusive partner; remain vulnerable on the streets; or accept a distant shelter in a predominantly white neighborhood where they might be at risk for racism.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Unfortunately, such experiences do not surprise us. As domestic violence advocates, we know that survivors face compounded challenges when intimate abuse intersects with structural violence. We have cared for transgender survivors who fear shelters where they might be persecuted based on gender identity. We have cared for immigrant survivors whose uncertainty about visa status guides the decision to involve the police or the law. <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16338756\/\"><span style=\"font-weight: 400\">Marginalization affects seemingly simple choices<\/span><\/a><span style=\"font-weight: 400\"> like going to the hospital, filing a report, or seeking protection.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Covid-19 has shed new light on intimate partner violence. With this increased attention, we urge our colleagues to embrace a broader definition of safety. It can feel natural to persuade a survivor to leave a partner or home, and it can be frustrating if this does not happen. Unlike the diagnosis of a broken bone, safety is not absolute. It is social, systemic, and structural. As we hear from many survivors who feel uneasy even after reaching a shelter, \u201csafe from my partner\u201d does not equal \u201csafe here\u201d: distance from the abuser is but one aspect of a layered picture.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Survivors face tremendous barriers to disclosing abuse, such as fear of retaliation by the partner, of judgment by the healthcare team, or of pressure to take action by social services. If we do not empower survivors to drive interventions according to their needs, they understandably may not seek help the next time. We should not replicate the relationship dynamics of power and control within our delivery of healthcare services; yet too often, we do. Instead, we must unlearn our preconceived notions and meet patients where they are.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Much like covid-19, intimate partner violence <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2766096\"><span style=\"font-weight: 400\">magnifies health inequities<\/span><\/a><span style=\"font-weight: 400\">. We may all be in the same storm, but we endure within decidedly different boats. Survivors from racial and ethnic minorities, though vastly resilient, often sit in boats worn thin by poverty and structural racism, where every wave threatens shipwreck. For example, survivors who are black may fear or distrust law enforcement due to a <\/span><a href=\"https:\/\/www.theatlantic.com\/magazine\/archive\/2015\/10\/the-black-family-in-the-age-of-mass-incarceration\/403246\/\"><span style=\"font-weight: 400\">history of harsher policing of black families<\/span><\/a><span style=\"font-weight: 400\"> and an ongoing <\/span><a href=\"https:\/\/www.vox.com\/science-and-health\/2020\/6\/1\/21276828\/pandemic-protests-police-public-health-black-lives-matter\"><span style=\"font-weight: 400\">epidemic of police brutality<\/span><\/a><span style=\"font-weight: 400\">. Black perpetrators of abuse face a more punitive system of accountability. Black survivors face higher rates of incarceration in <\/span><a href=\"https:\/\/academic.oup.com\/jah\/article\/102\/1\/25\/686630\"><span style=\"font-weight: 400\">instances of self-defense<\/span><\/a><span style=\"font-weight: 400\"> or greater institutional involvement in states with <\/span><a href=\"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10896-019-00103-w.pdf\"><span style=\"font-weight: 400\">mandatory reporting<\/span><\/a><span style=\"font-weight: 400\"> laws.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In order to \u201c<\/span><i><span style=\"font-weight: 400\">do no harm<\/span><\/i><span style=\"font-weight: 400\">,\u201d the defining tenet of medicine, we can no longer afford to treat racism as peripheral to intimate violence. Now more than ever, we must open our eyes to the pain of marginalized communities and acknowledge that choices are unequal. We have heard from black survivors of abuse who want to hold their partners accountable but are still reluctant to file a police report. One woman\u2019s words reflect this pained compromise and unjust reality: \u201cI\u2019m not going to put another black man in jail.\u201d\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><i><span style=\"font-weight: 400\"><strong><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-47917\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/07\/amrapali_Maitra.jpg\" alt=\"\" width=\"103\" height=\"105\" \/>Amrapali Maitra<\/strong> is a resident physician in internal medicine at Brigham and Women\u2019s Hospital in Boston, MA, and a medical anthropologist studying domestic violence. Twitter <\/span><\/i><a href=\"https:\/\/twitter.com\/amrapalimaitra\"><i><span style=\"font-weight: 400\">@amrapalimaitra<\/span><\/i><\/a><\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n<p><i><span style=\"font-weight: 400\"><strong><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-47916 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/07\/jackie_savage_born.jpg\" alt=\"\" width=\"103\" height=\"105\" \/>Jackie Savage-Borne<\/strong> is a social worker, adjunct faculty at Simmons School of Social Work, and the program manager of\u00a0<\/span><\/i><a href=\"https:\/\/www.brighamandwomens.org\/about-bwh\/community-health-equity\/passageway-domestic-abuse-intervention-and-prevention\"><i><span style=\"font-weight: 400\">Passageway<\/span><\/i><\/a><i><span style=\"font-weight: 400\">, the domestic violence advocacy program at Brigham and Women\u2019s Hospital.<\/span><\/i><\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Survivors face compounded challenges when intimate abuse intersects with structural violence, write Amrapali Maitra and Jackie Savage-Borne [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/07\/01\/intimate-partner-violence-during-covid-19-expanding-our-understanding-of-safety\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":47915,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357],"tags":[],"class_list":["post-47913","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-us-health-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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