Domestic violence Dr Ravi Nanayakkara

Objectives Discuss what is meant by domestic violence, diagnosis of domestic violence and medico legal issues

Violence The World Health Organization (WHO) declares violence as intentional use of physical force or power, threatened or action against one self, another or against a group or community that either results in or has a high likelihood of injury, death, psychological harm, maldevelopment. This definition excluded unintentional incidents such as road traffic injuries.  

Violence Self directed Interpersonal Collective

Deprivation or neglects Violence Self-directed Interpersonal Collective Suicidal behavior Family/ partner Community social Economic Self abuse Political Acquaintance Child Elder Stranger PARTNER Nature of violence Physical Sexual Psychological Deprivation or neglects

Domestic violence Violence occurred at home/domestic environment Intimate partner violence Wife battery Child abuse Abuse of elderly

Domestic violence is a pattern of coercive behavior used to establish power and control over another person--usually an intimate partner. It happens when one person believes they are entitled to control another and can include physical, psychological, emotional, verbal, sexual, and/or economic abuse

Why does domestic violence happen Why does domestic violence happen? Abusive relationships can develop gradually. There is a definite cycle that combines the good times with often subtle abusive acts that allow the abuser to gain power and control over the relationship and, eventually, lead the victim to emotional dependence and learned helplessness. By the time a pattern has emerged there are often children involved, financial ties, and emotional bonds that are difficult to break.

Intimate partner violence Intimate partner violence is defined as violence instigated by marital, cohabiting or any other partner within intimate relationships.

Battered wife A woman who has suffered demonstrable and repeated physical injuries at the hands of the man with whom she lives or from the father of one of her children. ICD 995.81

Intimate Partner Violence (IPV) is a currently emerging problem in Sri Lanka. Although during the past it was thought of as a private matter in the family, now there is some awareness among the community. Intimate Partner Violence/Domestic violence Violence against women at home

1988 Jaffna 1998 Colombo Associated with Injuries Poverty Poor education Alcohol Injuries Head and face Blunt injuries prominent Contusions mainly

Sources of Accident Service of National Hospital Sri Lanka stated 5-10% of annual admissions to the unit were following domestic violence.

Risk factors for IPV Socio economic factors Factors related to health of both partners Factors related to the partnership of both individuals Factors related to the male partner Previous violence

Socio economic factors Poverty Low socio economic status of the male partner Low socio economic status of both partners Low female contribution to household income Poor education of the women Poor education of the man Young age of the women Single marital status Urban residence Parity

Factors related to health of both partners Fair / poor mental health of the women Partners’ poor mental health Women’s self reported poor health  

Factors related to the partnership of both individuals History of the violence in husband’s family   Parity Female sterility /not having children Relationship being longer Prior domestic violence Sexual jealousy Having other partner/s Conflicts about man’s infidelity Conflicts about sex

Factors related to the male partner Cigarette smoking   Alcohol consumption by male Drug abuse by the partner Man’s boy child preference /not having a male child Involvement in fights at work or in the community

Previous violence Violence in woman’s childhood   Woman abused by the parents History of violence in husbands family

Triggers for IPV Not obeying the man Arguing back Not having food ready on time Not caring adequately for the children or home Questioning the man about money or girl friends Going somewhere without the man’s permission Refusing the man sex Man suspecting the woman of infidelity

Types of abuse Acts of physical aggression (Slapping, Hitting, beating) Psychological abuse (Threats, intimidation, etc). Forced intercourse and other forms of sexual abuse Various controlling behaviors (Isolation, Restriction of access to assistance)

Presentation to JMO Referred by OPD/ward Directly from police during their complaint Various organizations WIN, Kantha Pihita…

Identification IPV History Some time victim wants to hide Ask directly False story Risk factors

Injury pattern Anatomical area Head and face Upper limbs Lower limbs Neck Chest and abdomen

Injury pattern Nature of injuries Contusions Abrasions Lacerations Cuts Burns Fractures Stabs

Injury pattern Severity / category 80% simple/non grievous <1% FIOCN/NF

The distribution of the category of hurt among the FSIPV

Offending weapon House hold blunt weapon Cutting weapons Acid Broom Clubs Cutting weapons Acid Hot water

Health consequences of IPV Physical Psychological Sexual

Physical Abdominal/ thoracic injuries Bruises and cuts Chronic pain syndrome Disability Fibromyalgia Fracture Gastrointestinal disorder Irritable bowel syndrome Laceration and abrasion Ocular damage Reduced physical functioning

Sexual and reproductive Gynaecological disorder Infertility Pelvic inflammatory disease Pregnancy complication Sexual dysfunction Sexually transmitted diseases including HIV Unsafe abortion Unwanted pregnancy

Physiological and behavioral Alcohol and drug abuse Depression and anxiety Eating and sleeping disorder Feeling of shame and guilt Phobias and panic disorder Physical inactivity Poor self-esteem Post-traumatic stress disorder Psychosomatic disorder Smoking Suicidal behavior and self-harm Unsafe sexual behavior

Postmortem findings Not common History – Risk factors, triggers External injuries Blunt injuries Sharp injuries Acid burns Internal injuries Musculo skeletal dissection

Medical officers duty Acute management Management of consequences of IPV Refer to police Refer for counseling, including partner Guide for social support – WIN… Guide for legal support – LAC Follow up including local health care provider

Prevention of IPV Social support for the victims (Occupation, shelter) Legal assistance for the victims Create organizations/groups for support Change social attitude Special police women desks / WPC Educational programmes (School – public) Address the risk factors Create/amend the laws to punish offenders Manage/Follow up the offenders Counseling service (Both)

Laws related to Domestic violence

Abuse of Elderly Definition Elder abuse is a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an elder person. Act of commission or omission.

Types of abuse Physical abuse – the infliction of pain or injury. Psychological or emotional abuse – the infliction of mental anguish. Financial or material abuse – the illegal or improper exploitation or use of funds or resources of old person.

Contd.. Sexual abuse – non-consensual sexual contact of any kind with older person. Neglect – refusal or failure to fulfill a care giving obligation. This may or may not involve a conscious and intentional attempt to inflict physical or emotional distress on the older person.

Risk factors.. Individual factors. Relationship factors. Community and society factors.

Health consequences Depression Psychological distress Suicide tendency Physical illness due to negligence…..

Medical officers duty..

Prevention..

Thank you!