Domestic Violence: What is the issue and why is it important?
In the Taskforce report on Responding to Violence Against Women and Children – the role of the NHS (2010), Professor Sir George Alberti draws attention to the many health-related issues linked to sexual violence and abuse:
“The NHS spends more time dealing with the impact of violence against women and children than almost any other agency. Physical and sexual violence and abuse have direct health consequences and are risk factors for a wide range of long-term health problems, including mental health problems, alcohol misuse, trauma (including maternal and foetal death), unwanted pregnancy (including teenage pregnancy), abortion, sexually transmitted infections and risky sexual behaviour. ...“… more women suffer rape or attempted rape than have a stroke each year. ... The same effort to ensure that a heart attack victim or a stroke patient gets rapid and appropriate care should be applied to the victims of violence and abuse.”
Violence or abuse (physical, sexual, emotional or financial) against women and children happens everywhere. No one group is immune – regardless of socio-economic status, age, ethnic group or sexual orientation, British Crime Survey 2009/10.
Violence can take many forms, for example, domestic abuse may involve physical violence, or controlling behaviour such as not allowing a woman to leave the house, or not allowing her access to money or to a phone. Commissioning services for women and children who are victims of violence – a guide for commissioners (February 2011) suggests that commissioners with little experience of services for victims of violence and abuse should identify a local expert from the voluntary sector to help identify and explain the types of violence and abuse most prevalent in their local area.
The Government defines domestic violence as:
"Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality." This includes issues of concern to black and minority ethnic (BME) communities such as so called 'honour based violence', female genital mutilation (FGM) and forced marriage.
Domestic violence can take many forms including psychological / emotional abuse, physical violence, physical restriction of freedom, sexual violence and financial abuse. A term which is increasingly used to refer to domestic violence is ‘domestic abuse’, which has the advantage that it reflects the non-physical abuses referred to above. The main characteristic of domestic violence is that the behaviour is intentional and is calculated to exercise power and control within a relationship9.
Source: Commissioning services for women and children who are victims of violence – a guide for commissioners (February 2011)
Table: Examples of the Effects of Domestic Abuse on Women
Recurrent sexually transmitted infections
Increasing likelihood of misusing drugs, alcohol or prescribed anti-depressants
Depression/poor mental health
Burns or stab wounds
Wanting to commit or actually
Post-traumatic stress disorder
General poor health
Loss of self-confidence
Feelings of dependency
Loss of hope
Feelings of isolation
Babies with low birthweight/
Panic or anxiety
Source: Responding to domestic abuse: a handbook for health professionals, Department of Health, December 2005
The vast majority of these violent acts are perpetrated by men on women. In 2009/10, women were the victim of over seven out of ten (73%) incidents of domestic violence.
Cost of healthcare for women who are victims of domestic violence
An indicative national minimum cost of violence against women and children is £36.7 billion, including:
- the cost of providing public services for victims
- the lost economic output of women
- the human and emotional costs for the victims of violence
Women who have suffered domestic violence have approximately twice the level of usage of general medical services and between three and eight times the level of usage of mental health services. The estimated cost (including hospitals, ambulances, GPs and prescriptions) is £1.7bn.
It is estimated that the cost of treating depression in women who have experienced domestic violence is £10.3m (though this figure is based on data from the early 1990s, so it is likely that the actual figure is higher). The cost of providing an Independent Domestic Violence Adviser (IDVA) for a high risk victim of domestic abuse is around £500, and the cost per successful outcome (ie where all forms of abuse stop) is less than £1000 – though cessation of abuse does not necessarily mean that mental health problems cease as well.
This does not include the role that specialist services can play in reducing abuse, and thus costs on other services such as health and housing. Commissioning services for women and children who are victims of violence – a guide for commissioners (February 2011)
Estimated Costs of Domestic Violence in Calderdale
In 2009, Professor Sylvia Walby produced a spreadshseet with the estimates of the costs for Domestic Violence based on the size of the 16-59 year old population (the age range used in the British Crime Survey, from which national estimates of domestic violence prevalence are obtained). The costs are likely to be an under-estimate since they do not include domestic violence by family members who are not intimate partners. The spreadsheet was created by Trust for London and the Henry Smith Charity.
16-59 year olds male & female
Total Cost (excluding human & emotional costs)
Physical & mental health care
Criminal Justice Costs
Social Services costs
Housing & Refuges costs
Civil Legal Services costs
Lost economic output
Human & emotional costs (not included in total)