Public Health Association of Australia: Policy-at-a-glance Domestic and Family Violence Policy Key message: PHAA will 1. Advocate for full implementation and resourcing of the National Plan to Reduce Violence against Women and their Children 2010-2022. 2. Advocate for cross-portfolio action to prevent and reduce the incidence, prevalence, impact and severity of domestic and family violence. 3. Support the introduction of health system and legislative measures at both federal and jurisdictional levels to improve responses to domestic and family violence. Summary: Domestic and family violence is a significant public health issue and a key determinant of women s and children s health. This policy sets out PHAA s position and actions on this issue. Audience: Federal, State and Territory Governments, policy makers, program managers, other professional and non-government groups. Responsibility: PHAA s Women s Health Special Interest Group (SIG). Date policy adopted: September 2016 Contacts: Dr Catherine Mackenzie and Dr Tinashe Dune, Co-Convenors, Women s Health SIG 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605
Domestic and Family Violence Policy Statement The Public Health Association of Australia notes that: 1. Domestic or family violence (DFV) is the abuse of power between immediate and/or extended family members including current and past intimate partners, relatives by blood, marriage/de-facto or kinship, people who are co-habiting, in care relationships or friends (adults and children). 1 Abuse can be physical, sexual (including reproductive abuse e.g. sexual coercion to conceive or to terminate pregnancy), verbal, psychological, economic or social and can include threats to a person, their loved ones, pets or property. 2 2. Overwhelmingly, men perpetrate DFV against women and children, 3 however DFV also occurs in same sex relationships and against male victims. 3. DFV occurs in all population groups across society. Factors associated with gender inequality are the most consistent predictors of violence against women (VAW), including cultural acceptance of VAW, rigid gender roles leading to male control of decision-making, limits to women s independence and male peer to peer relations that emphasize aggression and disrespect towards women. 1 4. DFV is a key determinant of women s and children s health. 4,5,6 VAW is the biggest contributor to ill health and premature death in women aged 15-44. 1 DFV affects the mental and physical health of victims and can cause long-term mental and physical illnesses. 7 5. The 2012 Australian Bureau of Statistics Personal Safety Survey found that 17% of women reported experiencing intimate partner violence. 8 Being pregnant, having young children, and the availability of weapons have been linked to increased risk of DFV. 9,10 6. In 2010-12, 39% of Australian homicides were domestic, 58% of these were identified as intimate partner homicides of which 76% (n=83) of victims were female. 13% of homicide victims where children under 18 years old; most of these killed in the context of DFV. 11 7. Exposure to DFV has serious, often long-term, negative effects on children s physical and social development. Children who witness violence can exhibit physical, mental and emotional problems similar to those experienced by children who have been directly abused. 12,13 8. High rates of DFV in Aboriginal and Torres Strait Islander communities are associated with the ongoing impact of colonisation. 14 Aboriginal and Torres Strait Islander women are three times more likely to be killed than non-indigenous women, usually in the context of DFV. 11 9. Factors such as alcohol and drug use, or childhood exposure to violence, while not causative, can exacerbate the frequency or severity of violent behaviours. 14 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605 2
10. Although universal screening for DFV in the healthcare setting is not recommended, there is a need to build capacity to assess risk, intervene/refer early and respond appropriately to the needs of survivors. 15 11. There is currently no capacity (i.e. Medicare Item Number) for GPs to seek a longer consult in order to take the time to identify, take a detailed history and document findings when they suspect DFV. At present they can only claim a mental health rebate. 16 12. A significant proportion of women who are homeless, or are at risk of homelessness 17 and more than two thirds of women prisoners 18 are victims of DFV. Women s refuges are a critical part of the emergency response for victims. Women also require earlier intervention and support such as 19, 20 affordable counselling, income support, childcare, legal and housing options. 13. Specialist DFV death review mechanisms within the coronial and investigation process can identify systemic issues and recommend actions aimed at preventing future DFV and DFV-related deaths. 3 Not all states and territories have established DFV death review mechanisms and those that have require assistance to negotiate federally based laws and agencies and courts. The Public Health Association of Australia affirms the following principles: 14. DFV must be reduced through primary, secondary and tertiary prevention strategies. Primary prevention addresses the determinants of DFV including gender inequality and adherence to harmful gender stereotypes. Secondary prevention focuses on early intervention. Tertiary prevention involves working with victims and perpetrators of DFV. 14 15. Legislative systems (e.g. Child Protection, Family Law) require more assistance to respond effectively to DFV. The PHAA supports Women s Legal Services Australia s Safety First in Family Law approach to improving legislative systems in relation to DFV. 21 16. The Australian Government s National Plan to Reduce Violence against Women and their Children 2010-2022 provides excellent recommendations, many of which have not yet been implemented or resourced. The Public Health Association of Australia believes that the following steps should be undertaken: 17. Fully implement and resource the National Plan to Reduce Violence against Women and their Children 2010-2022. 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605 3
18. Resource primary prevention programs which target the gendered drivers of VAW by promoting gender equality, as well as introducing, resourcing, and evaluating intervention and response programs, particularly for women in high risk groups. 19. Resource women s refuges and other DFV support services. Provide affordable counselling and outreach services for women choosing not to go into refuges, and initiatives for women to remain in the home. There must be access to affordable, safe, long-term housing for victims of DFV. 20. Legislative reform, particularly in relation to federal family court and child protection systems, needs to continue to address persistent problems with legislative management of DFV. 21. Specialised DFV legal services should be adequately resourced and accessible to women experiencing DFV. 22. Services for children and young people must be funded, e.g. affordable and age appropriate counselling. 14 23. There should be a Medicare Item Number for DFV-related general practitioner consultations plus health professional capacity building to enable appropriate responses, risk assessment, early intervention/referral for DFV victims/survivors. The Public Health Association of Australia resolves to undertake the following actions: The PHAA National Office and Branches, with advice from the Women s Health Special Interest Group, will: 24. Advocate for full implementation and resourcing of the National Plan to Reduce Violence against Women and their Children 2010-2022. 25. Advocate for initiatives to build the capacity of health professionals to assess risk, intervene/refer early and respond appropriately to the needs of survivors. 26. Advocate for and monitor the effectiveness of legislative reform to ensure the safety of women and their children. 27. Advocate for and monitor the effectiveness of DFV programs. 28. Advocate to increase the status of women in Australian society and achieve gender equality (see PHAA Gender and Health Policy). ADOPTED 2010, REVISED AND RE-ENDORSED IN 2013 AND 2016 First adopted at the 2010 Annual General Meeting of the Public Health Association of Australia. The latest revision has been undertaken as part of the 2016 policy review process. 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605 4
References 1. Australian Bureau of Statistics, Conceptual Framework for Family and Domestic Violence Australia - ABS Catalogue No. 4529.0, in Information Paper. 2009, Commonwealth of Australia: Canberra. 2. VicHealth. Preventing violence against women in Australia research summary, 2011, VicHealth, Melbourne. 3. FaHCSIA, Time for Action:The National Council s Plan for Australia to Reduce Violence against Women and their Children, 2009-2021. 2009, Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA), Commonwealth Government: Canberra. 4. WHO, Multi-country study on women s health and domestic violence against women: summary report of initial results on prevalence, health outcomes and women s responses. 2005, World Health Organization: Geneva. 5. Evans, I., Battle-scars: long-term effects of prior domestic violence. 2007, Centre for Women's Studies and Gender Research, Monash University: Melbourne. 6. VicHealth, Violence against women in Australia as a determinant of mental health and wellbeing. 2008, Victorian Health Promotion Foundation: Carlton South. 7. Fisher, C., et al., 'Health's a difficult beast': The interrelationships between domestic violence, women's health and the health sector: An Australian case study. Social Science & Medicine, 2007. 65(8): p. 1742-1750. 8. Australian Bureau of Statistics, 4906.0 - Personal Safety, Australia, 2012, Australian Bureau of Statistics. 9. Wendt, S., Constructions of local culture and impacts on domestic violence in an Australian rural community. Journal of Rural Studies, 2009. 25(2): p. 175-184. 10. Cripps, K., et al., Victims of violence among Indigenous mothers living with dependent children. Medical Journal of Australia, 2009. 191(9): p. 481-5. 11. Australian Institute of Criminology. 2015. Homicide in Australia: 2010 11 to 2011 12: National Homicide Monitoring Program report. Australian Government 12. Flood, M. and L. Fergus, An assault on our future: the impact of violence on young people and their relationships. Redress, 2009. 18(1): p. 40-43. 13. Jaffe, P. and M. Juodis, Children as Victims and Witnesses of Domestic Homicide: Lessons Learned from Domestic Violence Death Review Committees. Juvenile and Family Court Journal, 2006. Summer. 14. VicHealth., Preventing violence before it occurs: a framework and background paper to guide the primary prevention of violence against women in Victoria, 2007, VicHealth, Melbourne. 15. Taft A, O'Doherty L, Hegarty K, Ramsay J, Davidson L, Feder G. Screening women for intimate partner violence in healthcare settings. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD007007. DOI: 10.1002/14651858.CD007007.pub2. 16. O'Doherty L, Taft A, McNair, R, Hegarty K Fractured Identity in the Context of Intimate Partner Violence: Barriers to and Opportunities for Seeking Help in Health Settings. Violence Against Women 17. 2016, Vol. 22(2) 225 248 18. McFerran, L. 2010, It could be you: female, single, older and homeless, Homelessness NSW and Older Women s Network NSW, Strawberry Hills, NSW, Australia. 19. Idig D, Topp L, Ross, Mamoon H, Border B, Kumar S, McNamara M, 2009 NSW Inmate Health Survey, Justice Health, Sydney 2010 20. Gillis, J.R., et al., Systemic Obstacles to Battered Women's Participation in the Judicial System: When Will the Status Quo Change? Violence Against Women, 2006. 12(12): p. 1150-1168. 21. Erwin, P.E., Exporting U.S. Domestic Violence Reforms: An Analysis of Human Rights Frameworks and U.S. "Best Practices". Feminist Criminology, 2006. 1(3): p. 188-206. 22. WLSA. Safety First in family law, 2016 http://www.womenslegal.org.au/files/file/safety%20first%20policy%20platform.may%202016_final.pdf 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605 5