Elsevier

Women's Health Issues

Volume 21, Issue 5, September–October 2011, Pages 400-406
Women's Health Issues

Original article
Violence Against Women from Different Relationship Contexts and Health Care Utilization in Spain

https://doi.org/10.1016/j.whi.2011.04.003Get rights and content

Abstract

Background

Studies reported an excess of health services utilization among women with violence by an intimate partner (IPV). However, little is known about health utilization by women victims of other forms of interpersonal violence than IPV. This study aimed to determine the effect of violence from different relationship contexts on health care utilization.

Methods

A cross-sectional study following a multistage cluster sampling scheme was conducted. Women aged 18 to 70 years were randomly selected according to their scheduled health care visit. The number of women invited to participate was 16,419 and 73% accepted. After exclusion, the final sample consisted of 10,815 women. The outcome variables were health care utilization (primary care, specialty services, emergency rooms, and hospital admissions) and the predictor variable was interpersonal violence from different relationship contexts. Multivariable adjusted logistic regression models were conducted to assess the independent effect of each violence relationship context on health care utilization.

Main Findings

Compared with never abused women, use of health services was significantly higher for abused women, although the rates varied depending on the violence relationship context. The greatest probability of service use was among women whose abuse was perpetrated by both a partner and others. Comparing the magnitude of effect of each violence category by perpetrators other than a partner, this effect was stronger for violence in a social context in the case of emergency rooms only.

Conclusion

Regardless of the perpetrator, lifetime violence increased health services utilization. Violence affects women’s behavior in terms of how they use health services.

Introduction

Violence against women is a worldwide phenomenon and has been recognized as a significant contributor to women’s ill health (World Health Organization [WHO], 2002), with interpersonal violence being the most universal form of violence against women (Kranz & Garcia-Moreno, 2005).

International research has focused mainly on intimate partner violence (IPV), given its high prevalence and significant impact on health (Thompson et al., 2006). Prior studies consistently reported many adverse physical and mental outcomes linked to IPV (Golding, 1999, Campbell, 2002, Plichta, 2004, Ellsberg et al., 2008). These associations between IPV and negative health consequences have been reported regardless of the type of violence (physical, psychological, or sexual), current versus lifetime history, and clinic- or population-based recruitment strategies (Nicolaidis, Curry, McFarland, & Gerrity, 2004).

Women with a history of IPV also use health care services more than women without a history of IPV. This increased health care utilization for women with IPV has been found for inpatient hospitalization, primary and specialty care, and mental health care (Bergman, Brismar, & Nordin, 1999; Coker et al., 2004, Kernic et al., 2000). It may thus be deduced that IPV represents a problem for the health care system, by increasing already overstretched resources as well as both short- and long-term costs (Rivara et al., 2007, Snow Jones et al., 2006).

Research has documented that IPV is among the most serious forms of violence against women because of its significant impact on health and its greater chronicity. However, there are other types of interpersonal violence against women, besides IPV, implying direct abuse of the woman throughout her lifetime. Among these are physical, sexual, or psychological abuse within the family by someone other than a partner, sexual harassment in the workplace, in educational institutions, and in other social settings, as well as abuse suffered at the hands of unknown perpetrators (Koss et al., 1994, World Health Organization (WHO), 2002).

Despite considerable frequency of violence by a nonpartner, detected both in population-based studies (WHO, 2002; Fanslow and Robinson, 2004, Moracco et al., 2007) and in clinical samples (Eberhard-Gran et al., 2007, Schraibe et al., 2007) its impact on health has received less attention. Nevertheless, a wide range of health consequences, such as reproductive health problems, injuries, somatic disorders, substance abuse, and a tendency to be revictimized (Plichta & Falik, 2001) have been found to be associated with different forms of lifetime violence including child abuse, physical assault, and rape.

To our knowledge, no study has examined the effect on health care utilization related to violence inflicted by perpetrators from different relationship contexts, nor do we have information on the use of services by women who reported revictimization by a partner and by someone other than a partner throughout their life.

The objectives of this study are to 1) compare the sociodemographic characteristics and services used by ever abused women and never abused women; 2) analyze the effect of lifetime violence against women from different relationship context settings on services utilization (primary care, specialist services, emergency rooms and hospital admission); and 3) determine health care services utilization by women exposed to a combination of IPV and abuse by perpetrators other than a partner. Health care utilization was hypothesized to be higher for women who reported lifetime abuse, regardless of the perpetrator.

Section snippets

Study Sample and Data Collection

The study population consisted of adult women attending primary health care services who participated in a broader cross-sectional study to estimate national data of prevalence, risk factors and health effects of violence against women in Spain (Ruiz-Perez et al., 2010). It was developed in coordination with six research groups across the country and was approved by the corresponding ethics committees in each group.

Independent and representative samples were taken based on a multistage cluster

Results

Of the 10,815 female patients who completed the questionnaire, 3,538 (32.7%) reported a history of lifetime abuse; 1,868 (17.3%) reported that the abuse was perpetrated only by a partner, 1,079 (10.0%) by someone other than a partner, and for 591 (5.4%), the abuse was perpetrated by both partner and nonpartner. The most frequent abuse experienced by women by perpetrators other than a partner was by someone from their family context (421 [3.9%] Figure 1).

Abused women were slightly older, had a

Discussion

This study used a large, random sample of women seeking medical care for any reason in primary health care services around Spain. At least one act of physical, sexual, or psychological violence was reported by approximately one out of three female patients aged 18 and over. Our results confirmed what other authors have documented (Moracco et al., 2007) that a significant proportion of violence is directed at women, and that much of this violence occurs in the context of intimate relationships.

Acknowledgments

The authors thank all the physicians who voluntarily participated in this study, and also all the women who gave their time to complete the questionnaire and shared their violence experiences with us. Without them, this study would not have been possible. We gratefully acknowledge the research assistants who collaborated in this study, who all worked with immense dedication and commitment to ensure the successful completion of the study.

Isabel Montero, PhD in Medicine, Professor in Psychiatric Unit, University of Valencia. Expert on gender violence research, mental health and public health.

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    Isabel Montero, PhD in Medicine, Professor in Psychiatric Unit, University of Valencia. Expert on gender violence research, mental health and public health.

    Isabel Ruiz-Perez, PhD in Medicine, Specialist in Preventive Medicine and Public Health and Master of Public Health, Professor of Research Methodology (IVESP and EASP), Andalusian School of Public Health. Currently, Director of Research at the EASP.

    David Martín-Baena, Bachelor of Statistics, University of Valencia. CIBERESP technical researcher and professor in the School of Nursing La Fe, who are highly experienced in creating, debugging and operation (descriptive and multivariate analysis) of health databases.

    Marta Talavera, PhD in Biology, Professor in the Department of Experimental and Social Sciences, School of Magistario, University of Valencia. His current research is violence against women, health and gender.

    Vicenta Escribà-Agüir, PhD in Medicine, a researcher in the Department of Health Disparities in Centre for Public Health Research (CSISP) and professor in the School of Nursing La Fe. Great experience in gender research, women's health and violence.

    Carmen Vives-Cases, PhD in Sociology. Professor in the Department of Preventive Medicine and Public Health, University of Alicante. Expert on gender violence research and public health.

    Supported with funding from the Health Institute Carlos III (1/06-36, PI05/0676) (Ministry of Health, Spain).

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