IPV is the physical, sexual, and/or psychological abuse and
stalking by an intimate partner. Although all genders are
affected by IPV, the prevalence rates of violence against
women and the co-occurrence of women's health issues
require a gendered framework. During the webinar,
Meredith Bagwell-Gray, Ph.D., MSW, highlighted these
intersections between IPV and women's health risks.
Dr. Bagwell-Gray is an assistant professor in the School of
Social Welfare at the University of Kansas with an emphasis
on health equity research. She studies the impact of gender-
based violence on women's health and safety and is
currently designing and testing trauma-informed approaches
to promoting sexual health. Her research aims to facilitate
post-traumatic growth and prevent cervical cancer amongst
survivors of intimate partner violence.
Barriers to Care
According to the Centers for Disease Control and
Prevention's (CDC) 2015 National Intimate Partner and
Sexual Violence Survey, about one in four women –
compared with one in ten men – experienced violence or
stalking by an intimate partner and reported an IPV-related
impact during their lifetime. Of these women, those who
discussed their abuse with a health care provider were four
times more likely to use an intervention and 2.6 times more
likely to exit the abusive relationship.
However, many women in violent and abusive relationships
are kept from accessing health care services. Partner-
related barriers to health care, such as preventing someone
from attending OB-GYN appointments, is a form of coercive
control. Coercive control theory is a framework developed
by award-winning sociologist Evan Stark whose work helped
shift the perception of violence from incident-based, such as
the number and severity of physical hits, to a systematic
deprivation of freedom. "To really understand IPV and what
is happening, we have to understand it with a new lens," Dr.
Bagwell-Gray said. "It's really a human rights issue because
someone is being denied their freedom."
According to Dr. Bagwell-Gray, abusive partners are one
possible link between IPV and women's sexual health
concerns, especially sexually transmitted infections (STIs).
"Abusive partners or partners who use violence are also
more likely to engage in other high-risk behaviors
associated with toxic masculinity: having sex with multiple
partners, having unprotected sex with partners, forcing and
coercing unwanted sex with a primary partner and with
other partners, etc. That risk-taking means that within the
woman's relationship, she's at higher risk of direct infection
from her partner."
Women with sexually abusive partners and partners who
restrict their access to OB-GYN services and birth control are
at similarly increased risk of STIs. "Without control over
their own sexual decision-making and autonomy, forced or
coerced sex can be a direct pathway to infections," Dr.
Bagwell-Gray said. A partner's coercive control over
contraception may lead to women being afraid to request
the use of a condom, leading to increased risk of pregnancy
as well.
IPV and Trauma
The traumatization of women in abusive, controlling, and
violent relationships over time can have negative cognitive
effects such as low self-esteem, low self-efficacy, sexual risk
taking, and substance use. "That constellation of risk factors
can lead to an STI or other negative sexual health
outcomes," said Dr. Bagwell-Gray. "We also know now that
trauma over time can change your immune system and
make your body more at risk for disease."
Women who have experienced trauma, especially
surrounding sexual assault or OB-GYN care, may avoid
seeking care out of fear of triggering painful memories.
"After doing group sessions with women, I've heard stories
after stories of providers engaging in a way that is not
trauma-informed," Dr. Bagwell-Gray said. "This hurts the
survivor and leaves them feeling further victimized by their
providers. There's also mistrust of providers and a concern
about a lack of understanding of what the provider is
communicating."
Helping Women Heal
According to Dr. Bagwell-Gray, the unique risk factors that
increase women's likelihood of STIs create a need for
specialized sexual health services and programs that
address women's experiences of IPV. Her proposed ideal
solutions include a trauma-informed sexual safety planning
program featuring collaborations between health care
providers and social services. Any solutions should focus on
survivor strengths and rebuilding self-worth; Dr. Bagwell-
Gray's work is informed by women who described their
healing from IPV as a journey.
HRSA OWH focuses on four priorities to address IPV: train
the public health workforce, raise awareness of IPV,
increase access to IPV-informed health care services, and
address gaps in knowledge about IPV risks, impacts, and
interventions. Learn more about the OWH's efforts and
resources to combat IPV:
https://www.hrsa.gov/about/organization/bureaus/owh/hrsa
-strategy-address-intimate-partner-violence.
Watch the recorded webinar and register for the next
session, "Maternal Health Series: Focus on Racial Equity," on
August 12.
PAGE 17 August Issue 2021
