Letters

Screening for domestic violence

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7377.1417 (Published 14 December 2002) Cite this as: BMJ 2002;325:1417

Cultural shift is needed

  1. Jo Nurse (Jo.Nurse@lshtm.ac.uk), specialist registrar in public health
  1. Health Policy Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. University of Michigan Hospitals and Health Centers, Obstetrics and Gynecology, Division of Women's Health, 1500 East Medical Center Drive, L 4000 Woman's 0276, Ann Arbor, MI 48109-0276, USA
  3. Mixenden Stones Surgery, Halifax HX2 8RQ
  4. Centre for the Study of Mothers' and Children's Health, La Trobe University,251 Faraday Street, Carlton, Victoria 3053, Australia
  5. Department of General Practice, University of Melbourne, Australia
  6. Department of Public Health, University of Aberdeen Medical School, Aberdeen AB25 2ZD
  7. East Lancashire Public Health Network, Accrington BB5 1LN
  8. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop K-35, Atlanta, GA 30341 USA
  9. Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
  10. Barts and the London, Queen Mary's School of Medicine and Dentistry, London E1 4NS
  11. BMJ

    EDITOR—The systematic review of Ramsay et al makes a valuable contribution to the debate on whether to screen for domestic violence.1 This debate also needs to consider some of the wider cultural issues influencing the acceptability of the existence of domestic violence in society.


    Embedded Image

    Hundreds of pairs of shoes belonging to victims of domestic violence, placed on steps of capitol building in Frankfort, Kentucky, October 2002

    Credit: AP/ED REINKE

    The taboo of recognising, acknowledging, and bringing into the open issues surrounding domestic violence has led to resistance by the health profession in dealing with what is increasingly becoming understood as an important influence on the health of women.25 Domestic violence is not unique: the recent history of the denial of the existence of child sexual abuse has undergone a major societal and cultural shift in the past 20 years, resulting in a heightening of awareness and recognition by health professionals and society at large.

    A similar cultural shift is starting to take place in attitudes towards domestic violence—for example, with its inclusion within the community safety plans of local authorities. Although clear needs exist for research in determining the effectiveness of interventions for the prevention of domestic violence, part of the resistance towards screening for domestic violence seems to be related to negative attitudes held by health professionals.

    To address this, more work needs to be done in assessing the training needs of health professionals in relation to domestic violence. Furthermore, the approach to dealing with domestic violence in the health sector may benefit from creating an environment whereby health professionals are seen not to support the use of violence as a means to deal with interpersonal conflict in any setting. A stronger emphasis needs to be placed on becoming a part of the cultural shift …

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