It has been said that the home is a refuge from life's ever-expanding battlefield. But, for many, home is more like the front line of a war zone. Home is where one of this country's most insidious crimes takes place...far more often than most people realize.

It occurs among people of all ages, races, income levels, and educational backgrounds. The statistics are chilling:

l Thirty percent of the women murdered in this country are killed by their husbands, ex-husbands or boyfriends.

l Three to four million women are beaten in their homes each year by their husbands or partners.

l Attacks by husbands or significant others account for more injuries that require medical attention than do all the rapes, auto accidents and muggings combined.

l In Texas alone, 1,308,216 women -- 18 and over -- have experienced physical abuse.

l A woman is battered every 12 seconds in the United States.

According to a study conducted late in 1998* and reported in the Journal of the American Medical Association, more than one out of three women treated in community hospital emergency departments say they have experienced domestic violence during their lifetimes. The survey also identified four risk factors for physical or sexual injury from abuse within the past year: women between the ages of 18 and 39, who report a monthly income of less than $1000, who have children younger than 18 years old living in the home, and who have ended a relationship within the past year. Researchers point out that heightened awareness among hospital emergency departments because these may be the only contacts that many abused women have with health care professionals.

According to Harris County Constables Pct. 4 Chief Deputy Karen Moore, domestic violence not only can but does occur on a regular basis in our neighborhoods. "Our Department handles 155 abuse cases each month, which include aggravated and sexual assaults. These cases occur in the very best, upscale neighborhoods and in the poorest homes. Only a small percentage get reported," she explained, "because the women are embarrassed or fear retaliation."

"There are many types of abuse in addition to physical violence," Deborah Svoboda pointed out. "These include sexual, verbal, financial and emotional abuse." "An abuser can range from a Dr. Jekyll to Mr. Hyde in a matter of minutes. Abusers tend to be very possessive of their spouse," she said. "And, very often they are loners with few friends. They tend to be traditionalist and regard their illegal actions as their given right. Amazingly," Svoboda continued, "they see themselves as the victim of either circumstances or of other people."

"I am told that the cycle of violence includes a tension building stage where conflicts arise without resolutions," Dr. Birken said. "Then, ultimately, tensions build until they explode into assaults. After a violent discharge, the batterer becomes apologetic and remorseful, only to repeat the cycle again and again. It's that single straw of hope that things will change that seems to keep many women home with an abusive man. How long does it take before a women makes the decision to leave?" he asked.

"Research indicates that a woman leaves an average of six times," Chief Moore said, "before she leaves for good.

Many suggest that there is an "abuse-prone personality, and Faye Turner says she believes they might exist. "Volunteers in our organization have interviewed women seeking shelter who are perpetually in the victim mode. They are often very anti-social and very negative, and many believe they were somehow responsible for the beating they received."

Turner points out that it is never easy to leave. "There are dozens of decisions a woman has to make before she exits an abusive household. It's not like just packing up and abandoning ship."

"If she leaves, she has to take on the responsibility of raising her children alone," Turner continued. "In far too many cases, she stopped her education when she married and now she suddenly finds herself in need of marketable skills if she is to enter today's competitive job market."

"Then, perhaps at the heart of it all," Turner suggested, "there is the reality that she loves this person and any decision to leave will put an end to however many years she has devoted to their relationship. She married him, had his children, and leaving him may well be even harder than putting up with abuse."

This is where a great deal of rationalizing takes place, Turner explains, blaming a battering incident on "stress from the office." They tell themselves, "It has never happened before...he said it won't happen again."

The necessary steps to change demand a whole new lifestyle. Through the Constable's Victim Assistance Program, Svoboda sees hundreds of women each month at the worst, and possibly the lowest, point of their lives.

"The women are embarrassed and very often unaware of their options," Svoboda said. "One of the goals of our program is to inform these women of their rights. We work to get them counseling, legal aid, emergency housing, medical care, and child care they need to get through the crisis. We can sometimes help them get emergency funds through the Texas Crime Victim's Compensation Fund. Sometimes, we refer them to organizations like Women Helping Women, where they can learn job skills that lead to better self esteem and self reliance."

Rep. Peggy Hamric pointed out that media attention of famous cases of domestic violence, such as O.J. Simpson and Warren Moon, have brought public awareness to a new level. People now realize that domestic violence doesn't just impact certain social and economic groups, but affects those who appear to be leading "perfect" lives, as well. "In the last two sessions of the Texas Legislature, bills have been passed that would have never been considered a few years ago," the State Representative said.

"Laws are made because the community demands change. This is certainly reflected in recent legislative actions regarding abuse," Hamric said.

"As a women's physician, it is becoming increasingly important to be alert to any outward signs of abuse. There is a fine line, here," Dr. Birken said, "between being receptive if a woman wants to confide that she has been battered, and being intrusive."

"What we can do," he suggested, "is to make sure that there is literature for patients to read in various locations in the office that will provide information about her options in case of family violence."

"Doctors can be more alert and sensitive to body language, bruises and other physical signs, and to the interaction between husband and wife when both spouses are present for consultations." 

"Does he tend to dominate the conversation or to answer for his wife? Are there any other obvious tensions? Is she looking for someone to help her but perhaps is too afraid to ask for confidential assistance? I guess it starts with being aware of just how prevalent this problem is and learning to ask the right questions."

Faye Turner has worked with victims of abuse and domestic violence for more than five years with Women Helping Women, the non-profit organization she founded in 1991 to help women learn non-traditional, higher-paying job skills. She agrees with Dr. Birken that it can be frustrating to want desperately to help, only to watch a woman return again and again to an abusive situation.

"In order for there to be real change," she said, "the woman must have a solid plan of action. She may rehearse it over and over in her mind, but until she actually takes action, it is only a plan. I ask these women, 'Where do you see yourself a year from now...or ten years from now.' If she can answer these questions, she can work on meeting her financial needs, to provide transportation and housing for her and her children, and to set in motion a plan that will succeed."

"By taking action and being responsible for their own positive outcomes," Turner said, "they gain attributes that help to form a strong foundation for their new life...self-esteem, self-reliance and independence."

Dr. Birken and the Forum participants all agreed that the key to breaking the cycle of abuse is education. The public needs to have the same intolerance toward domestic violence and abuse that they have toward child abuse.

"No one wants a sex offender living next door to them," Turner said. "People need to feel the same way about having someone who abuses his wife as a neighbor."

Education is needed on the part of victims, as well. There are many more options now for assistance and protection than in years past and the Pct. 4 Constable's Victim Assistance Pro-gram provides a wealth of information -- as well as other, more active assistance -- upon request. One of their ongoing education efforts is to provide special training to deputies who encounter domestic violence to help them be more sensitive to the needs of someone who has been abused, and to the impact the situation has on the entire family.

Dr. Birken hopes that by keeping the issue in the spotlight, more and more people will view domestic violence as the insidious crime that it is and not only insist on tougher penalties for the abusers, but be more alert and helpful if they suspect that violence has touched a neighbor or a friend.
 
 
 

* Referenced study was conducted by Stephen Dearwater, M.S., Allegheny University of the Health Sciences in Pittsburgh, PA

Randy A. Birken, M.D., P.A. Gynecology/Urogynecology 17070 Red Oak Drive, Suite 201-A Houston, Texas 77090 (281) 893-1246 drbirken@yourfamilyshealth.com

Dr. Birken graduated Cum Laude from Adelphi University, Garden City, New York and earned his M.D. from the Boston University School of Medicine. He completed his internship and Residency in Obstetrics and Gynecology at Baylor College of Medicine, Houston, Texas, and was then Chief Resident in OB/Gyn at that institution. He completed a Preceptorship in Urogynecology at the University of California, Irvine. Dr. Birken is a Diplomate of the American Board of Obstetricians and Gynecologists, and was recertified in June 1995. He is the father of three sons, and has served as a Little League baseball coach and as team physician for a youth football league.