Among the hidden costs of the COVID-19 pandemic is an alarming rise in domestic violence and intimate partner violence, a form of domestic violence in sexual and romantic relationships with devastating effects that can ripple across generations. 

According the American Journal of Emergency Medicine, domestic violence cases increased by 25-33% globally in 2020, compared to 2019. More locally, domestic violence calls in Jefferson County, Alabama increased by 27% in March 2020, as compared to March 2019. Parallel increases were observed in other cities around the U.S., from Portland, Oregon to San Antonio, Texas or New York City.

In the midst of Domestic Violence Awareness Month, Sumayah Abed, M.D., assistant professor in UAB’s Department of Family and Community Medicine and UAB Hoover Primary Care Clinic physician, is working to raise awareness among health care providers. She is especially concerned about the risk of intimate partner violence, which is already underreported and underdiagnosed by physicians.

“Even after recognizing the problem of intimate partner violence, victims may not get the necessary support, as many healthcare workers are unfamiliar with the policies and the resources to help them,” Abed said.

Intimate partner violence, defined as violence among current or former partners that may include stalking, physical, psychological and sexual violence, is common worldwide and affects both sexes. It is more commonly reported by heterosexual women, Abed said, but is likely to be underreported in men, transgender and gender non-conforming people and same-sex relationships.

According to the National Coalition Against Domestic Violence, nearly 20 people per minute are physically abused by an intimate partner in the United States. Intimate partner violence accounts for 15% of violent crime in the U.S., and approximately one in four women and one in nine men experience intimate partner violence.

The pandemic intensified many of the conditions that can fuel intimate partner violence. Some businesses shut down suddenly. Many families faced economic tension as well as the stress and uncertainty created by COVID-19.

“Besides the quarantine situation, the pandemic also aggravated alcohol abuse, depression and post-traumatic stress disorder,” Abed said. “All of these factors created an environment that exacerbates domestic violence.”

Sumayah Abed, M.D.

Assessing Risks

As the pandemic continues, health care providers should be especially conscious of those risk factors, including psychiatric illness, alcohol consumption, drug abuse and economic stress. Pregnant women are also at higher risk of domestic violence, which can also increase the risk of pregnancy-related complications, such as miscarriage, pre-term labor, and low birth weight in infants.

Additionally, children who come from families with a history of domestic violence are at a higher risk of replicating or falling victim to those behaviors in adulthood. All forms of domestic violence, including intimate partner violence, can have a devastating ripple effect in families and communities, something that family care providers like Abed are particularly concerned about. Early awareness, intervention and help can prevent generations of trauma.

What Health Care Providers Can Do

At the clinical level, prevention of intimate partner violence starts with consistent and accurate screening, Abed said. She and her colleagues at Hoover Primary Care and Hoover Family Medicine use several screening tools to detect domestic violence and intimate partner violence, including both self-reported information from the patient, physician-administered questions. They also follow the U.S. Preventative Services Task Force recommendation to screen all women of childbearing age for intimate partner violence.

Health care providers should pay particular attention to families at risk of domestic violence, Abed said, in order to protect the family and prevent future domestic violence by children in that family, who are exposed to that behavior early on.

Providers can also ask more general questions, such as, “Do you feel safe at home?”

More broadly, media campaigns, such as one launched by the World Health Organization to provide education about intimate partner violence, can also help to raise awareness and educate patients and providers. The WHO campaign aims to make that information accessible in clinics and patient settings, as well as among policymakers and researchers.

Finally, macro-level changes such as empowering women economically and creating a broad, interprofessional support network for victims can help bring about long-term change, Abed said.

“Interprofessional collaboration is key to helping victims of domestic violence,” she said. “Health care workers, social services, and legal and law enforcement officers are all essential to help victims and survivors of domestic violence.”

Anyone experiencing domestic violence or concerned about a loved one facing domestic violence can connect anonymously to a crisis counselor by texting “UAB” to 741-741 or call the Birmingham Crisis Center at 205-323-7777.

Written by Caroline Newman