Victims Of Domestic Violence Research Articles

Prevalence of intimate partner violence in pregnant women during the COVID-19 epidemic in Qazvin-Iran 2021

IntroductionIntimate partner violence (IPV) in pregnant women is considered one of the most important types of violence, which can include physical, psychological abuse and sexual violence. During the lockdown due to COVID-19, the home is at risk of becoming a very dangerous place for victims of domestic violence. We aimed to determine the prevalence of IPV and associated factors in pregnant women in Qazvin, Iran.MethodsThis cross-sectional study was conducted on 450 pregnant mothers who were referred to the Kowsar Hospital Prenatal Clinic in Qazvin in 2021. Participants were assessed using a questionnaire consisting of four parts (demographic data, Abuse Assessment Screen (AAS) for domestic violence, The Revised Conflict Tactics Scale (CTS2) for IPV. Data were collected and analysis was performed via SPSS software version 22 using a non-parametric test; Mann–Whitney and × 2 tests.ResultsThe overall prevalence of IPV was higher in pregnant women than their husbands in Qazvin. The most common form of IPV was psychological aggression (24.8%), followed by scale of injury (8.2%), physical (3.3%) and sexual (4.2%) violence. In addition, analysis of the AAS questionnaire shows that psychological violence is the most common form of domestic violence among pregnant women.ConclusionIn this study, IPV in pregnant women has increased slightly compared to studies conducted in the years leading up to the COVID-19. Risk of IPV was not related to previous COVID-19 infection. Collaborative efforts between various stakeholders and policy actions must be taken to ensure the safety and protection of pregnant women during this challenging time.

Legal basis and main technologies of socio-psychological work with vulnerable categories of the population in the community

The war in Ukraine has led to an increase in the need for social assistance among vulnerable populations, which requires strengthening the capacity of social services to respond to new challenges. The purpose of this study is to examine the legal and technological framework for wartime assistance and to demonstrate the effectiveness of modern methods through theoretical and empirical analysis. Data collection and analysis were conducted in compliance with ethical and legal standards for social research. Currently, Ukrainian policy makes it possible to support models such as the proposed Integrated Social Services approach. However, the findings of the study indicate a potential need for legal/regulatory reforms to further strengthen the capacity to respond to crisis situations. The results confirm that the implemented interventions successfully address the problems of displaced persons, veterans, most-at-risk families, etc. Individual case management and group social and psychological trainings contribute to capacity development, and the model of integrated services allows for quick resolution of acute problems. Comparative evaluations show that the integrated system is superior to individual methods in quickly addressing crisis situations. However, new groups that fall outside the scope of current legislation, such as victims of domestic violence, may require mandatory expansion of eligibility criteria. Laws could also include standards for interagency coordination to address fragmentation. This urgent relevance highlights how robust legal/ethical foundations uphold assistance models in turmoil. It was also concluded that the implementation of legal reforms that would create a unified system of cooperation could mitigate these problems. In particular, legislation could formalise requirements such as data and information sharing between service providers, common case management procedures, common reporting standards and interdisciplinary partnerships. The practical significance of the study lies in the possibility of using the results of the problem analysis to create accessible mechanisms to improve the quality of support for vulnerable demographic groups. Enshrining access to care as an inalienable guarantee creates an ecosystem that is resilient to modern threats

Legal Protection for Women and Children Victims of Domestic Violence in Gorontalo City

Violence against women and children is worrying enough. There is a lot of violence against women and children in the domestic (household) environment. Violence against women and children is an act that is contrary to the basic principles of humanity. Because acts of violence against women are violations of human rights, a national legal instrument is needed to eliminate violence against women and children in Indonesia. The purpose of this research is to find out the legal protection efforts given to women and children as victims of domestic violence. data analysis The description used in this study is a qualitative type of qualitative research that aims to find facts, conditions, changes in phenomena, conditions during the research and what is presented. The results of this study indicate that there are efforts to protect themselves from the law. In Indonesian law, such as: Law Number 23 of 2004 concerning the Elimination of Domestic Violence Reform Forms of direct legal protection from existing institutions such as: Integrated service centers and legal support offices.

Criminal Law Protection for Domestic Workers Victims of Domestic Violence by Employers

This article discusses the importance of criminal law protection for domestic workers who are victims of domestic violence by their employers. Domestic violence against domestic workers is a serious problem and should not be ignored. Through criminal law analysis, this article identifies the challenges and obstacles faced by domestic workers who are victims of violence in obtaining justice. In this article, we highlight the need for a revision of the criminal law that is more stringent in providing protection for domestic workers who are victims of violence. We also discussed the importance of increasing public awareness and education as well as the government's role in protecting the rights of domestic workers.

Reexamining Domestic Violence: A Study on Male Victims in the Context of Pakistani Legislation

This article endeavors to highlight and publicize the misunderstanding and misconception in Pakistani society that the men are always perpetrators of Spousal Violence (SV). It intends to establish that SV is not only wrong against women but also against men but it is not recognized in Pakistani society at its real degree. This study delves deeper into examining the causes and forms of SV by women perpetrator against men as well as the analysis of SV legislation in Pakistan. Analytical Legal research technique is used to collect data regarding SV against men and legislation on SV in Pakistan. Different enactments at National and provincial level and bills introduced for legislation on the topic of SV are looked into and compared with each other. SV against men is now being recognized to some extent but still a lot of work is needed to establish that the men may also be victim of SV and women may be perpetrator. As compared to women, SV against men is less perceived, especially in Pakistani society and some time it is not recognized. All legislative bodies of Pakistan, except one, do not recognize the SV against Men. There is rarity of legislation on SV against men in Pakistan, because there is only one enactment in Pakistan on the topic of Domestic Violence (DV), which defines the “man” as aggrieved person and recognize him as victim of DV or SV, and that is for Balochistan Province. Through provision of adequate resources and educating the masses male victims of SV may be supported and number of male victims of SV may also be reduced. For securing the rights of men, existing laws concerning DV requires amendments in accordance with the needs of time.

A cross-sectional study of the impact of the COVID-19 lockdown on domestic violence-related oral and maxillofacial injuries.

During the COVID-19 lockdown, more domestic violence-related traumas were reported. In this study, we investigated and compared the incidence of domestic violence-related injuries-in particular oral and maxillofacial injuries-in Ulaanbaatar, Mongolia, before and during the COVID-19 lockdown. We conducted a cross-sectional study based on 3974 domestic violence cases registered at the Public Health Department, National Traumatology and Orthopedics Research Center of Mongolia between 2018 and 2022. Descriptive and binary logistic regression analyses were conducted. The victims were categorized according to their age (child, adult, and elderly). The mean age of the victims was children 9.7 ± 5.4 years, adults 34.8 ± 8.3 years, and elderly 64.3 ± 8.7 years. Binary logistic regression analysis (no/yes) showed that oral and maxillofacial injuries during the lockdown increased 1.3 times (OR = 1.3; CI 95% = 1.0-1.6; p = .003) in adults and 2.5 times in children (OR = 2.5; CI 95% = 1.7-3.9; p = .001). Additionally, injuries to upper limbs increased 4.6 times (OR = 4.6; CI 95% = 3.5-6.1; p = .001) in adults and 5.2 times in elderly patients (OR = 5.2; CI 95% = 1.8-16.2; p = .01). Additionally, thorax injury in children increased 3.1 times (OR = 3.1; CI 95% = 1.7-5.7; p = .001). During the lockdown, injury to oral and maxillofacial regions increased in adult and child victims of domestic violence.

Breaking the Silence: Exploring Peritraumatic Distress and Negative Emotions in Male and Female Physical Domestic Violence Victims.

Domestic violence is a widespread problem affecting individuals, families, and communities worldwide. Peritraumatic distress is associated with post-traumatic stress disorder and other mental health problems among victims, but research on men's experiences is limited. We analyzed data from 48 physical domestic violence victims (16 males and 32 females) to compare their levels of peritraumatic distress and negative emotions, and to examine the types of aggressors they faced. We used descriptives to summarize sample characteristics and Peritraumatic Distress Inventory scores and used statistical tests such as Mann-Whitney U, Shapiro-Wilk, Levene's test, contingency tables, and chi-square to investigate differences and associations between variables. Female victims of domestic violence had significantly higher scores on the Peritraumatic Distress Inventory than male victims and experienced significantly higher levels of negative emotions than male victims, including impotence/inability to react, sadness, anger/frustration, loss of control, fear, guilt, and shame. Husbands and domestic partners were the most frequent aggressors against female victims, while wives and ex-wives were the most frequent aggressors against male victims. In addition, partners were found to be the most frequent type of aggressor in the sample. Descriptive statistics, box plots, and scatter plots were used to provide a clear picture of the sample characteristics. Female victims of domestic violence reported higher levels of peritraumatic distress and negative emotions compared to men victims. Partners were the most frequent type of aggressor in the sample.

The Necessity of Developing Psychological Resilience in Individuals who have Experienced Domestic Violence: Analysis of the Issue

Introduction. The article is aimed at analysing the problem of overcoming the consequences of domestic violence through increasing the victim’s resilience. The relevance of the study is explained by several factors: firstly, the increasing frequency of domestic violence, and secondly, the necessity of including in rehabilitation programs blocks for the development of those personal characteristics that will allow not only to overcome the experienced stress, but also to reduce the possibility of getting into situations of violence again. Adequate levels of psychological resilience are seen by the authors as a necessary condition for optimizing the exit from the victim position. The novelty of the study is expressed in the fact that for the first time in our country resilience is considered as a factor influencing overcoming the consequences of violence.Objective. To explore the importance of developing psychological resilience in victims of domestic violence.Definition of violence and its types. The authors provide the main theoretical provisions regarding the psychological analysis of violence, the consequences of violence for the victim, and psychological resilience. Violence is distinguished from aggression and conflicts by its systematic nature and actions aimed at suppressing the will of the victim.The effects of violence on the victim. The authors mention the main consequences of violence, which include deterioration of physical and mental health, changes in behavioural patterns, and suicidal tendencies. The concept of psychological resilience. Psychological resilience as a factor influencing the recovery of a victim of violence is understood by the authors as the ability to withstand difficult life situations while maintaining mental and physical health.Discussion. The authors’ ideas about the mandatory development of resilience in victims of domestic violence are confirmed by the opinion of researchers of victim behaviour. The development of victim psychological resilience is associated with the replacement of victim behaviour with assertive behaviour. The ability to resist violence is also influenced by the development of such aspects of psychological resilience as fight avoidance, meaningfulness, emotional regulation, and building supportive social ties. In general, an adequate level of psychological resilience affects the ability to part with the subject of violence, as well as the development of psychological disorders in victims. The author’s position is expressed in the opinion that the formation of resilience in victims of violence will lead to the possibility of their self-change, which will transform public opinion about them.

ANALYSIS OF COMPLAINTS OF VICTIMS DUE TO DOMESTIC VIOLENCE THROUGHOUT 2018-2023, ACCORDING TO THE ARCHIVED DATA OF THE REGIONAL BUREAU OF FORENSIC MEDICAL EXAMINATION OF THE ZHYTOMYR REGIONAL COUNCIL

The results of a statistical analysis of the appeals of victims of domestic violence during 2018-2023 according to archival data of the of the regional bureau of forensic medical examination of the Zhytomyr Regional Council are presented.
 Aim of the work. To analyze the appeals of victims of domestic violence during the years 2018-2023 based on archival data of the regional bureau of forensic medical examination of the Zhytomyr Regional Council.
 Materials and methods. The work used archival material of the regional bureau of forensic medical examination of the Zhytomyr Regional Council, which related to the appeals of victims of domestic violence during 2018 – the first quarter of 2023. The obtained quantitative data were processed by methods of variational statistics.
 Results. Statistical processing of archival material of the regional bureau of forensic medical examination of the Zhytomyr Regional Council for the years 2018-2023 revealed 1,328 appeals by women regarding bodily injuries caused in the family and 10 cases of appeals regarding adult molestation of children. It should be noted that during the acute respiratory disease of COVID-19 in 2020-2022 the trend of the number of appeals by women – remained constant and even increased somewhat, and during the Russian military aggression during 2022 and the first quarter of 2023 – the number of appeals almost halved. During 2018-2022 there were manifestations of family violence in the form of child molestation by adults, and in all cases it was the father of the victims.
 Conclusions. Analysis of appeals by victims of domestic violence during 2018-2023 according to archival data of the regional bureau of forensic medical examination of the Zhytomyr Regional Council revealed that: 1) by age, the most appeals were made by women aged 25-44; 2) in terms of the degree of severity of physical injuries, mild and mild injuries with a short-term health disorder, the physical manifestations of which were cuts, bruises, were dominant.

The use of video and audio recordings provided by victims of domestic violence as evidence

The relevance of the study lies in the urgent need to develop scientifically grounded and practically applicable criteria for the admissibility of using secret audio and video recordings made by victims in criminal proceedings regarding domestic violence. The purpose of the study is to establish whether the information contained in secret audio and video recordings made by victims can be used as evidence in criminal proceedings regarding domestic violence. The main research methods are systemic, analysis and synthesis, historical, heuristic, formal-legal methods. The issues of providing recordings by victims, witnesses, and other persons for criminal investigation purposes; general criteria for restricting the right to privacy in criminal proceedings regarding domestic violence; problems of evidence presentation by victims and applicants; issues of documenting domestic violence facts; the issue of admissibility of documentation are investigated. It is proved that aspects of the legality test for limiting the offenderʼs right to privacy in cases of conducting criminal proceedings regarding domestic violence may involve inquiries concerning the importance of evidence gathered through covert recordings and the exclusivity of the necessity of such measures. It is argued that when considering the criterion of a secret operation, which is identified as a condition for recognising audio and video recordings as inadmissible evidence, it should be acknowledged that in criminal proceedings related to domestic violence, video and audio recordings provided by victims cannot meet this condition in the vast majority of cases. The practical value of the study lies in the possibility of unifying judicial practice in determining the admissibility of evidence contained in audio and video recordings made secretly by victims in criminal proceedings regarding domestic violence

Supportive Interventions of Chinese Police in Domestic Violence: Do Officer Knowledge and Training Matter?

Policing domestic violence (DV) poses significant challenges in China due to cultural, legal, and organizational complexities. Policing DV in China favors mediation over assertive interventions, complicating law enforcement's role. While previous research has focused on coercive interventions by Chinese police, there is limited information on non-coercive, supportive approaches. This study investigates the relationship between police officers' knowledge and training regarding the Anti-DV law and their willingness to provide supportive services to DV victims in China. It also considers various individual and organizational factors. The data used in this study are derived from the Policing DV in China project, with a sample of 1,353 respondents who had experience dealing with DV cases within the past 3 years. The study focuses on three dependent variables representing supportive approaches to DV cases: Referral, Counseling, and Protection orders. Independent variables include officers' knowledge of the Anti-DV law and agency training. Control variables include the use of body-worn cameras (BWC) and attitudes toward Violence Tolerance, Male Dominance, and Gender Equality. Additionally, demographic variables, working environment, length of service, and police rank are considered. The analytical approach involves a three-step strategy, incorporating descriptive, bivariate analyses, and regression analyses. The results are interpreted using odds ratios and average marginal effects, and statistical software such as SPSS by IBM and R by Open-Source Model is utilized for data analysis. Key findings indicate that more than half of the officers referred intimate partner violence survivors to shelters and assisted victims in filing protection orders. Counseling practices varied across provinces and between male and female officers. Agency training and the use of BWC were positively associated with non-coercive and supportive approaches, while knowledge of the DV Act, male dominance score, and gender equality score did not predict the use of such approaches. Demographic characteristics, including police rank, length of service, and province of employment, influenced the utilization of non-coercive and supportive approaches. This study examines the challenges faced by Chinese police officers when responding to DV cases and their willingness to provide supportive interventions. The study highlights the complexities surrounding the initiation of protection orders due to officers' legal knowledge and discretion. The study emphasizes the importance of police support in addressing DV in China and the role of agency training in promoting non-coercive responses. It highlights regional variations in police support and underscores the need for addressing disparities in service provision across different provinces.

Pemaparan Dampak Potensial bagi Istri yang Mengalami Kekerasan

This presentation discusses the potential impact that may be experienced by wives who are victims of domestic violence. Through in-depth analysis, this article presents information on the psychological, physical, and social consequences that can arise from such violence. In addition, this presentation highlighted socialization efforts aimed at increasing public understanding of the risks faced by women in these situations.

The Child Protection Response to Domestic Violence and Abuse: a Scoping Review of Interagency Interventions, Models and Collaboration

Abstract Purpose There is a growing acknowledgement that children are direct victims of domestic violence and abuse, and require support and protection in their own right. However, professional interventions designed to protect children may unintentionally further victimise parents, most often mothers. In response, a number of new interagency approaches have been developed. Method Updating a previous review by Macvean et al. (Australian Social Work,71(2), 148–161, 2018), we report the findings of a scoping review of models of interagency working between child protection and either domestic abuse services or family law services, or all three services, to improve understanding of practices that may facilitate collaboration between child protection and other agencies in the context of domestic violence and abuse. We also consider the effectiveness of such approaches in improving the safety of child and adult victims. Results A systematic search of all sources identified 4103 documents that were screened for inclusion. The outcome of this screening was the identification of thirteen papers or reports dated between 2018 and 2022 that comprised an evaluation of six models of interagency interventions. Nine publications originated in Australia, three in the UK and one in the USA. The most referenced model was Safe & Together, primarily due to the number of publications from the same research team in Australia. None of the included studies reported the outcomes or impact for children and families. Conclusions While there are a growing number of promising approaches identified, there is little evidence of effectiveness, or the views of child and adult family members about the acceptability and utility of such approaches.

The impact of the COVID-19 pandemic on treatment for domestic violence injuries: evidence from medical claims

AbstractPrevious studies have observed heterogeneous changes in domestic violence-related 911 calls, police incident reports, and arrests at the onset of the COVID-19 pandemic. In this study, we use a large-scale medical claims database with coverage of over 100 million patients to examine the impact on domestic violence victims’ use of emergency department care for their injuries in the early weeks of the pandemic compared to the corresponding weeks in previous years. We find a 23–35% decrease in utilization of emergency medical services by domestic violence victims between March and June of 2020. Based on this finding, it is essential to use caution when using medical claims to measure domestic violence in future research covering this time period. Decreases in care utilization also have important implications for the detection, screening, and treatment of domestic violence injuries during future public health crises.

The Maria da Penha Patrol as an affirmation of women’s rights in the State of Paraná

Addressing a topic of extreme complexity and topicality, domestic and family violence permeates a historical context that highlights its relevance. This problem has been constantly highlighted in the media, highlighting a phenomenon that, although it has gained greater visibility in recent years, has always existed, but was often covered up by social taboos. Notably, women were the primary victims of this type of violence and were often silenced due to entrenched social conventions. The impacts of domestic and family violence are devastating, affecting countless lives. According to the Atlas of Violence (2023), between 2011 and 2021, the number of murders of women reached an average of 1.2 per 100 thousand women in the country. This alarming data illustrates the seriousness and urgency of tackling this problem effectively. Through data analysis, doctrine and interviews, the objective is to analyze the effectiveness and importance of the Maria da Penha Patrol of the Military Police of the State of Paraná as a crucial tool in the affirmation of women's rights, analyzing the theoretical foundation and the practical implementation of this type of patrol, which, although it acts in an ostensive and uniformed way, Its scope is the optimization of care and greater reception for victims of domestic violence, aiming at the reduction of service rates and the minimization of the number of fatal victims. In this context, the Maria da Penha Patrol in the PMPR emerges as a tool to help meet the established national goals, along with the actions provided for in the internal guidelines of the military organization, playing a fundamental role in the prevention, monitoring and protection of victims.

Victim Turning Victimizer: Criminal Tendencies in Female Survivors of Domestic Violence

The study aimed at identifying the criminal tendencies in the domestic violence survivors and assessing the possibilities of crime being committed by the survivors in the future. The ideology around which the study revolved is the social suppression of females in Indian society leading to female criminality. It is a phenomenological study design and the data was collected using semi- structured interview. The sample included fifteen females who had been the victims of domestic violence at some point of their life after marriage (N=15). The analysis and the interpretation of the obtained data was done using thematic analysis. It was found in this qualitative research that the females were inclined towards inflicting pain to their husbands/in-laws and exhibited a tendency to indulge in behaviours that are unacceptable by law and society to gain and attain justice for themselves.

What can veterinary professionals do? Measuring the effect of one domestic violence training pilot program on veterinary professionals' capacity to recognize, respond, and refer human victims of domestic violence.

Veterinary professionals have a key role in facilitating multi-agency collaboration to prevent and respond to domestic violence (DV) in situations where animals may be directly or indirectly involved. Yet despite their position as potential touchpoints for victim-survivors with animals, many veterinary professionals do not feel equipped to act on suspicions or disclosures of DV. In response to this identified need, one service operating in Melbourne, Australia, developed the Vet-3R's training program (Recognize-Respond-Refer) which was piloted on 65 veterinary professionals in Melbourne's Eastern Metropolitan Region. This is an exploratory study aimed at measuring the effect of the Vets 3-R's program on veterinary professionals' confidence and capacity to recognize, respond and refer victims of DV. Participants were invited to complete online surveys before and after the training to evaluate their understanding of DV and their capacity to support suspected victim-survivors with animals who present at their service. The pre-training self-evaluation scores indicated that while most veterinary professionals are aware of the link between animal abuse and DV, they lack the confidence to respond and refer individuals when confronted with suspicions or disclosures of abuse. However, upon completion of the Vets 3-R's program, participants reported marked improvements in their ability to recognize, respond, and refer victim-survivors. The most significant improvement could be seen in participants' self-reported ability to respond appropriately to suspicions of DV. While results are indicative only due to the small sample size, this study suggests that veterinary professionals may be an underutilized intervention point for DV victim-survivors with animals. The Vet-3R's training program can be a useful tool for increasing effectiveness of this intervention point to safely assist DV victim-survivors. More research on similar programs with a larger cohort of participants would be beneficial to measure the impact of such programs on a wider scale.

Lethality assessment protocol: Challenges and barriers of implementation for domestic violence victim advocates

This exploratory qualitative research study examined the attitudes and barriers domestic violence victim advocates identified in successful implementation of the lethality assessment protocol, a collaborative intervention between police departments and domestic violence advocacy agencies in the state of Connecticut. Focus groups were conducted at four domestic violence agencies to ascertain advocates’ perceptions of the lethality assessment protocol. Advocates (N = 24) were recruited through an individual contact at each agency. Responses to focus group questions indicated both system-wide and individual agency and police department collaboration barriers. Results showed advocates generally support the protocol and believe it has beneficial intent and purpose. Challenges identified included lack of victim cooperation, variations in law enforcement officer attitude, and deficiencies in training. Implementation barriers and advocates’ attitudes are also discussed. Lethality assessment protocol is a useful tool, yet all stakeholders must actively engage in cooperative training, tackle personal biases toward domestic violence victims, and gain a better understanding of victim psychology.

Assessment of a domestic violence telecare protection system from the victims’ perspective

This article presents an evaluative study of the telecare protection system (TPS) implemented in Portugal as a protection order for domestic violence victims. A survey was applied to a representative sample of victims who were supported by the system ( N = 171) and their responses were compared with those of domestic violence victims who did not benefit from it ( N = 100). Victims were asked about their: (i) knowledge, expectations, and experiences with the implementation of the system; (ii) assessment of agencies’ activities, and (iii) levels of satisfaction, safety, and re-victimisation. TPS had an activation rate of 32% for emergencies. Victims with the TPS showed great expectation fulfilment and a very positive assessment of the demeanour and behaviour of police and other support agencies. Generally, very satisfied with the system, victims reported, however, relatively lower satisfaction with the police responses in specific emergencies. Victims reported that the actions of agencies involved in the system allow them to feel safer; nonetheless, they also reported stable and continued fear and risk of being victimised. Finally, victims benefiting from TPS significantly differed from victims who did not benefit from it in terms of physical re-victimisation (7% and 15%, respectively).

A grand multipara woman in the modern era: A case of public health dilemma from an urban slum

With the advancement in family planning practices and shifting norms from “hum do hamare do” to “one child,” there still exist mothers who are delivering their 10th children. Such an example is a woman residing in an urban slum in the Khordha district of Odisha, India. She has never used any modern methods of contraception. Neither the health workers in that area could fulfill her unmet need for family planning. The helpless mother missed all the antenatal checkups as she did not have anyone to accompany her to the hospital. Three of her children were delivered at home and none of them were immunized to date. She has become a victim of domestic violence by her husband, who is addicted to alcohol. She has done two medical terminations of pregnancy due to non-usage of any contraception. Neither she is able to provide herself nor her children sufficient food every day, as she is not able to go to work in her post-partum period. Her alcoholic husband is not able to earn regularly and there is no other family member to support her. There is no Accredited Social Health Activist appointed for that area whom she can rely on. We need to look at what is the cause of such a scenario – Is it poverty, lack of awareness, lack of education, or our health system has failed to achieve universal health coverage.