Framing the Issue: The Impact of the Affordable Care Act on Domestic Violence Discourse and Services

Originally posted on www.carlsonsalon.blogspot.com

Finally acknowledging the causal links between lack of preventative care, poor health outcomes, and soaring healthcare costs, the Women’s Preventative Care Amendment of the Affordable Care Act went into effect last week. As of August 1st, 2012 insurance companies must provide for several essential women’s services free of charge, including annual woman-care visits, gestational diabetes screenings, STI and HIV counseling, breastfeeding support, HPV DNA testing, and, that holy grail, contraception.

As we joyously bid adieu to copays, we cannot underestimate the revolutionary significance of these provisions. For the first time in this country, women’s mental, reproductive, and sexual health are being recognized as essential components of the overall health and well-being of women and their families.

One among the mandated services has especially caught my attention for this reason: screening and counseling for domestic violence. The Department of Health and Human Services fact sheet on the new preventative services states:

Screening and counseling for interpersonal and domestic violence should be provided for all adolescent and adult women. An estimated 25% of women in the United States report being targets of intimate partner violence during their lifetimes. Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women.


Domestic violence– also known by the more-inclusive term, “intimate partner violence”– is still a pervasive and underreported issue in our country. As reported above, one in four women will be attacked by an intimate partner in her life. Here are a few more statistics on the subject:*

  • 5.3 million women are subject to intimate partner violence each year, resulting in nearly 2 million injuries and 1,300 deaths.
  • 30% of female homicides are committed by an intimate partner.
  • 13.6 million days of productivity from paid work and household chores are lost each year due to intimate partner violence.
  • Children under the age of 12 resided in at least 38% of the homes of female victims of intimate partner violence.
    • Witnessing violence between one’s parents or caretakers is the strongest risk factor of transmitting violent behavior from one generation to the next.
    • Boys who witness domestic violence are twice as likely to abuse their own partners and children when they become adults.
  • Teen dating violence is on the rise, as 33% percent of adolescent girls have experienced violence from a dating partner.
    • Studies also show that teens who experience dating violence are more likely to partake in other high-risk behaviors, such as smoking, drinking, engaging in risky sexual behavior, and practicing unhealthy diets.

Despite this, domestic violence is one of the most under-reported crimes in the nation. According to the National Coalition Against Domestic Violence:

  • Only one-quarter of all physical assaults and one-fifth of sexual assaults are reported to the police.
  • Less than one-fifth of victims reporting an injury from intimate partner violence sought medical treatment following the injury.

However, the Affordable Care Act may begin to change all this. By elevating the issue of domestic violence prevention to the category of “health care,” we take it out of the shadows. We acknowledge that domestic violence is a real and prevalent issue that affects the health and well-being of countless women and their families. We recognize the detrimental physical and mental impact– including chronic headaches, anxiety, depression, sleep problems, and PTSD–that intimate partner violence has on women.

It remains to be seen what shape the new DV-related services will take and how widespread of an effect they will have on the levels of intimate partner violence in this country. But it is an incredibly hopeful sign that we are shifting the national discourse surrounding domestic violence from blame, guilt, fear, and avoidance (Did you make him mad? Maybe he was just drunk? What about the children?) to support and positive treatment. This change is a crucial first step to dismantling the culture of shame and permissiveness that has perpetuated such a high level of violence, so that we may create a society intolerant of it.

*Statistics are taken from The Bureau of Justice Statistics, The National Council on Crime and Deliquency, The National Centers for Injury Prevention and Control at the Centers for Disease Control, and The National Coalition Against Domestic Violence.

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