Domestic abuse and the duties of physicians: a case report

Abstract

Domestic violence against women is a global issue. An earlier report from the Centers for Disease Control and Prevention (CDC), USA, reported that injury caused by domestic violence was the second most common cause of death during pregnancy and in the postpartum period (1). The pregnancy-associated homicide ratio was found to be 1.7 per 100,000 deliveries and firearms were identified as the main source of injury. Domestic violence is more common in developing countries than in the developed world, and rural areas are worse affected than urban ones. The risk factors associated with intimate partner violence include husbands being unemloyed, belonging to a lower socioeconomic group, poor educational status, and alcohol and substance abuse. In a hospital-based study of 500 women, around 12.6% reported physical abuse by their spouses in index pregnancy (2). In another hospital-based study in which women were interviewed during the postpartum period, 23% reported physical abuse during index pregnancy (3). Death as a result of violence is not a new phenomenon. In 1994 the Human Rights Commission of Pakistan reported 372 cases of domestic violence, due to which around 274 women died during an 8-month period. According to a report for the year 2012-13 around 389 cases of domestic violence were reported in the Pakistani media that year. The same report states that in 2013, more than 800 women committed suicide due to domestic violence. In 2013, the Provincial Assembly of Sindh, Pakistan, passed The Domestic Violence (Prevention and Protection) Bill, 2013, which imposes a fine of Rs 20,000 for violent offences against women. Such bills have not been passed in other provincial assemblies of the country. Other countries in South Asia (India, Nepal, Bangladesh, the Maldives, Sri Lanka and Afghanistan) have national laws which make provision for extending medical assistance to women who have suffered domestic violence (4). However, a lot remains to be done to translate these laws into actual practice. In Nepal, special cells have been set up in police stations to offer services to women reporting domestic violence. Among those responsible for the implementation of these services, only a few were found to be aware of the fact that such services were supposed to be provided (5). Only 8% of women knew that such services were available (6). In Bangladesh, crisis centres have been established in tertiary care hospitals to deal with domestic abuse. Manuals have been designed for the attending doctors on how to provide assistance to the women and on the reporting of such events (6). In India, providers of medical care do not consider it their duty to report domestic violence (4).There is a need to sensitise the medical fraternity to this issue, especially since many victims present to hospitals. Health providers also need to be given guidance on the steps they can take when confronted with cases of domestic violence. Around two decades ago, the American Medical Association recommended universal screening for intimate partner violence. This led to a sharp increase of 30% in reporting of intimate partner violence among certain groups of the population (7).