Family violence and intimate partner violence is a hidden societal problem. It can and does affect families of all types although women who are in relationships with men, are more likely to experience family violence to the order of one in four. Almost every 11 days a woman was killed in 2022-2023, as compared to every ninety-one days for men according to the Australian Institute of Health and Welfare (AIHW). The statistics are abominable and expose the gendered nature of this issue. It all comes down to power, control and entitlement.

  1. Violence against women is about power and control
  2. One in four women in Australia has experienced physical or sexual violence by a current male partner or male known to her
  3. On average one woman was killed every 11 days by an intimate partner and one man was killed every 91 days, during 2022-2023
  4. When the frequency of threats and violent behaviour increase, there is a danger of the woman and her children being seriously injured or killed.

Using violence against a partner or child is a choice and there are no excuses that should allow this to continue. Government is now trying to address this and they have established the overarching framework outlined in the National Plan to end Violence Against Women and Children 2022-2032 . The Plan outlines the need to hold perpetrators to account and was established to prevent deaths of women and children, but little can be achieved if women living with abusive partners fear making a disclosure to others. Feelings of shame or a fear of being judged, stops women from talking about this to others. There is also a tendency to assume that whatever happens between a couple is private business and shouldn’t be talked about outside of the family home.

General practitioners can play their part in helping women who live with a violent partner by identifying, listening to, validating and then responding sensitively to their situation. The Royal Commission into Family Violence (The Commission) findings stated that nine out of ten women would tell their GP if they were asked and GPs are being trained to ask without re-traumatising the woman. Women don’t always choose to leave, as many would be unable to fund family life and the cost of housing on their income, if they have one. Some stay because they hope deep down that their partner will change and that things will get better, but they rarely do.

It’s true that the GP cannot fix the underlying social problem of family violence and violence against women, however being able to tell the GP without being judged or expected to leave their partner, is a relief to those trapped in silence or denial. The feeling of living with violence is often described as being like ‘walking on eggshells’ around their partner. There is a build-up of tension from living with fear, being controlled, and trying to placate their angry partner when threatening or acting out violence. All sorts of stress related symptoms develop such as sleep disturbance, headaches, abdominal and pelvic pain and they just don’t go away. Conditions that don’t respond to usual treatment give a GP the sense that there is more to their recurrent physical problems, which inevitably leads to a GP asking about how things are at home are. The next question is around whether the woman fears their partner, even sometimes. Violence can be physical and includes being hit, kicked, slapped or pushed. It can be coercive and controlling, there can be sexual coercion, financial and emotional control, jealousy and stalking behaviour. It is common for controlling partners to limit their partner’s social interaction only to those people he wants around and it’s common for the perpetrator to criticise her friends and family and track everything she does throughout the day. This all leads to social isolation resulting in her being cut off from a support network. Women feel alone and everything looks normal to others on the, which makes leaving even more difficult. Many cultures consider it shameful to quit from a marriage even when living with violence. Women are expected to ‘fix’ the problems at home, and to keep their partner happy and satisfied. Leaving is equivalent to failure and women can be ostracised for shaming their families making the ‘pull’ to stay stronger, than the ‘push’ to leave.

When the frequency of threats and violent behaviour increase, there is a danger that she or her children might be seriously injured or even killed. In fifty percent of families where domestic violence occurs, children will also be physically harmed. Behaviours that signal dangerous violence include strangulation, being pregnant or hit during pregnancy, hurting a pet, owning a weapon, loss of job, abusing alcohol or other illicit drugs, threatening to kill her or someone she cares for, jealousy, stalking or recent separation. It’s important to warn her that these are ominous signs and even if she believes she is safe, preparing for an escape can be lifesaving. Encouraging the woman to share this information with someone such as a close friend, relative or neighbour and preparing a bag with duplicate sets of keys, official documents, passports, clothes and credit card details, is key. The bag should of course be concealed or kept at someone else’s house. When things get to this point, it might be necessary to call the police for an intervention order and to report the perpetrator.

Prof. Magdalena Simonis. Photo: Supplied

In a clinical setting, after having identified and talked about the violence, then assessing the level of risk she faces, next steps are to provide the woman access to support services according to the needs she expresses. In most cases women are the best judges of how things are, and they can request support from a family violence service if and when they require. As stated earlier, most tend to remain in the relationship mostly for financial reasons, but having disclosed this to someone who listens, believes and cares about her is very helpful. It can even be empowering.

Partners who are perpetrators of violence generally feel entitled to behave the way they do towards women. There are occasionally those who acknowledge the harm they have caused and come to learn through retraining, that violence is about power, control and entitlement that stem from gender norms. Holding perpetrators to account and monitoring them is an essential aspect of the framework to end violence against women and girls.

Over the years, I have talked to and managed the needs of many women of all backgrounds and ethnic groups who are victim survivors of family violence. There are those who have stayed and those who have left, after years of trying to ‘make their marriage work’. Living a full and happy life in your own home without fear is everyone’s right. As the training of the medical profession in family violence continues, we understand that this is a small part of a bigger system to end all violence against women and girls, but GPs can make a big impact if disclosures are made, and interventions put in place. This is more important than ever if the bleak family violence statistics are to improve.

Call 000 if you or someone you know is in immediate danger:

*A/Professor Magdalena Simonis AM is a Family violence educator/facilitator, Safer Families Centre of Research Excellence Department of General Practice University of Melbourne.