WUNRN
Denmark
- Barriers among Danish Women & General Practitioner Doctors to
Raising the Issue of Intimate Partner Violence: Study
This study provides important knowledge regarding the barriers and attitudes towards inquiry about Intimate Partner Violence - IPV in primary care in Denmark. Results indicate that Denmark is facing the same challenges when responding to survivors of IPV as other similar countries, including Sweden, Norway, the UK, USA, and Australia. Danish women want general practitioners to ask about violence in a respectful and non-judgemental manner. However, general practitioners are resistant towards such an inquiry and would benefit from training regarding how to respond to women who have been exposed to IPV.
Every day the human rights of hundreds of thousands of women are violated all over the world. In many cases they are violated because of women’s unequal status in society [1]. Domestic violence is accepted across many layers of society and occurs among all socio-economic groups in all countries [2]. From a lifetime perspective, more than 30% of all women will experience violence and/or sexual violence [2,3]. The implications for women who experience intimate partner violence (IPV) are grave as it can lead to serious injury, disability, or death. Indirectly, IPV can lead to a number of health problems, such as a loss of personal autonomy, fertility challenges, substance abuse, depression, anxiety, and sleep and eating disorders [1-5]. It is estimated that IPV costs the Danish society a minimum of 280 million Danish Kroner per year [6]; however, this is likely to be grossly underestimated.
There are no relevant data from research or other investigations regarding inquiries about IPV in General Practice settings in Denmark. Thus, General Practitioners’ (GP) attitudes towards IPV and performing routine inquiries about it are still unknown. In general, the Danish healthcare system lacks information regarding IPV. Literature from other countries suggests that women want to be asked about violence in a safe, confidential, caring, and non-judgemental environment [7-9]. When professionals fail to address obvious signs of violence and the underlying causes of injuries, women do not feel that they are being respected. They feel unimportant, isolated, discouraged in their efforts to leave the relationship, and even more alienated from the rest of society [10]. Literature from other countries suggest that health professionals’ barriers towards routine inquiry are primarily, but not exclusively, about the lack of knowledge about prevalence within different groups of women, lack of experience in addressing IPV and lack of knowledge about specialised services that are available [11,12]. It is estimated that 28,000 Danish women each year experience IPV [6]. Of these 28,000 women, just 7% seek assistance at a shelter for abused women and their children [6]. These refuges offer a place to live for short or long periods and where women can receive help. The remaining 93% handle these situations by themselves or receive some assistance from different hotlines provided by NGOs such as the Mothers’ Help (Mødrehjælpen), which provides counselling, psychology sessions, and financial assistance [13]. Most women exposed to IPV never contact a refuge despite this being the only comprehensive service currently provided by the Danish welfare state.
Within the Danish system, general and private practices provide free medical assistance from a general practitioner. The general practitioners occupy a central position in the health service as they are the patients’ primary contact. General practitioners must ensure that patients are provided with proper treatment and referred to appropriate hospitals and specialists. There are approximately 4,100 general practitioners in Denmark who participate in the collective agreement with the public healthcare scheme. Each general practitioner has approximately 1,300 patients [14].
Survivors of IPV identify medical doctors as the healthcare professionals from whom they would most likely seek help [15]. Although it has not been considered in Denmark, routine inquiry and/or screening for IPV have been discussed and investigated for years in many neighbouring countries, such as Sweden, Norway, and the UK. Recent research from the UK shows promising results regarding a training and support programme that focuses on GPs and administrative staff. The results indicate an increase in referrals and disclosures [15].
The weave project from Australia was designed to evaluate whether a multi-faceted intervention in General Practice would increase women’s well-being, safety, and mental health. The intervention consisted of a screening with feedback, training for health providers, a brief counselling intervention for women who had experience of IPV, and minimum organisational change [16]. An evaluation of this intervention provided some promising results [17].
The current paper presents the results of an exploratory investigation in Denmark. The views of three different respondent groups were examined, as follows: general practitioners, survivors of IPV, and women who did not report any experiences with IPV. These groups can be expected to have different levels of acceptance and attitudes towards introducing inquiry about intimate partner violence in the General Practice setting. The research question for this study was the following: What attitudes and barriers exist among General Practitioners, survivors of partner violence, and women with no history of violence towards routine inquiryain General Practice?........
The overall conclusion of the study is that there are differences in attitudes regarding IPV among GPs, survivors of IPV, and women with no history of violence. The GPs believe that they are able to recognize victims of IPV and do not believe that routine inquiry is a useful or appropriate tool for their private practice. The GPs have poor skills with regard to detecting IPV and lack knowledge of the consequences of IPV. They believe that the normal practice of seeing a patient is sufficient for detecting that a woman is being abused. Women believe that routine inquiry is acceptable when general information is provided first and the inquiry is conducted in a non-judgemental way. Emphasis is placed on confidentiality, coherence, security, and respect for the women as real people. The women preferred to be asked, as they do not know how to raise the issue themselves. In sum, the survivors of IPV are reluctant to disclose abuse and the GPs falsely believe that they are able to detect abuse. This results in very few women receiving help to leave abusive relationships.
It is important to note that the attitudes of Danish GPs have never been investigated before; therefore, this area of research is important given the amount of information needed before real steps can be taken towards designing a comprehensive framework for the early detection of IPV. Society should not under-recognize the value of being “seen”, even when women remain within abusive relationships and are subjected to further abuse. This point was emphasised by the participants in the current study.
Findings from this study indicate that Denmark does not differ from other similar countries with regard to IPV; therefore, successful interventions from the UK, Australia, USA, and Sweden could be successful in a Danish setting. Future research should investigate how a possible framework for the early detection of IPV might be implemented in Denmark with private practice as the platform for its implementation.
There appears to be a general reluctance to address the issue of IPV akin to a fear of ‘opening a can of worms’. This study emphasises the importance of applying a bolder rhetoric to send the message to all stakeholders dealing with IPV that it is not a private matter, it is not accepted nor tolerated in society, and all means will be utilised to end abuse against women. One billion women will be raped or beaten in their lifetime, which is one-third of the world’s female population. This is not only a woman’s issue; this is a global and local public health crisis.
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