By Perdita Henry
Safety should not be a luxury. When we end a long day in the world that produces its own set of harms, often based on class, race, and gender; home should be a place where we can avoid additional traumas.
Unfortunately, many of us know that home is not always the haven it should be. Danger can come from external forces that enter unannounced and unrepentant at any moment. It can also be ever present. An unspoken threat that hangs in the air or a constant uneasiness that leaves everyone weary. Family and Intimate Partner Violence (IPV), can turn the space where you should be able to be your most true self, into a most unwelcoming place.
The Texas Women’s Healthcare Coalition focuses on ensuring that low income and underinsured women can maintain access to reproductive and preventative healthcare, but bureaucratic red tape and provider availability aren’t the only challenges women face. Family violence can take on several forms—emotional abuse, financial abuse, reproductive coercion, and more—which is why members like the Texas Council on Family Violence (TCFV) are so important to the women’s health conversation.
Founded in 1978, TCFV is the statewide nonprofit coalition dedicated solely to creating safer communities and freedom from family violence. “TCFV serves as a clearinghouse of information regarding family violence in Texas—offering curricula, support and community building around primary prevention efforts, advocating for greater responsiveness, rights and options for survivors within law, policy and systems, and building the capacity of local programs serving survivors and their children and those administering Batterer Intervention and Prevention Programs (BIPP),” Krista Del Gallo, TCFV Policy Manager says. “We are always eager to partner with Coalition members to create a safer, healthier Texas.”
How has the pandemic affected survivors of family violence and intimate partner violence (IPV) ability to get help and find safe spaces?
COVID-19 has been correlated with an increase in domestic violence cases and has further complicated survivors’ ability to safety plan and access resources. With quarantine orders, survivors are often stuck at home with their abusers. This leaves survivors less able to safely reach out to support systems and other resources.
Local mandates and employment status may mean survivors have less freedom of movement outside their homes and may be working from home or unemployed due to the pandemic. Stress, loss of income, and increases in costs related to families staying at home can exacerbate abuse. When in quarantine, abusers can more easily isolate their victims, because they can monitor their phone calls, text messages, and even virtual doctor’s visits. Being at home with the perpetrator makes it more difficult for the survivor to prepare and plan to safely flee an abusive situation. In an attempt to increase survivor safety during the coronavirus pandemic, agencies have adapted services to more virtual platforms, released COVID-specific safety planning tools, and incorporated harm reduction strategies in conversations with survivors.
How important are family and intimate partner violence screenings in the medical setting to assist survivors in getting the help they need?
Conversations between healthcare providers and their patients regarding relationships and intimate partner violence are incredibly influential and preventative. The Texas State Plan demonstrates that healthcare providers are a main access point for information and connections, particularly to safety services, for the many survivors who do not seek help directly from a local family violence program. The universal education approach—talking to every patient about their safety at home and highlighting and offering resources and support—is the effective, trauma informed way to assess a patient’s safety at home.
Utilizing this type of evidence-based approach demonstrates to your patients that your practice is a safe, informed, and supportive space to discuss these issues and empowers everyone coming through your office with resources for themselves or that they can share with others.
What are some of the barriers survivors face when trying to access resources?
Fear/coercion/threats/dominance of the abusive partner;
Smaller rural communities can create confidentiality and privacy concerns, isolation and less accessible resources;
Lack of pet shelter;
Lack of affordable housing options and even limited space in homeless shelters;
Concerns for children, fear of child welfare services, fear the abusive parent will gain custody;
Lack of transportation;
Language barriers and immigration concerns;
Lack of knowledge about what to do or where to go;
Reticence to involve law enforcement or engage with organizations that partner with law enforcement; and
Culturally specific issues-stigma, close knit communities making privacy difficult, loss of community.
How is access to family planning made more difficult for people with violent intimate partners and what can providers do to help?
First, if an abuser accompanies a patient to visits, make sure to talk to and treat that patient alone, do not allow a partner or family member to serve as an interpreter.
Abusers may sabotage certain methods (e.g. flush pills, poke holes in diaphragm); they may refuse to comply with condom use; and they may track menstruation. Discuss the partners’ perspectives on pregnancy and contraception use and inform and offer methods that are less dependent on the other partner’s compliance and less obvious and susceptible to interference (i.e. implants, IUDs).
Additionally, laws and certain practices create barriers to healthcare (i.e. restrictions on minor access; pharmacist refusal to offer emergency contraception; confidentiality concerns with using abuser’s insurance, etc.). Always discuss potential barriers and the safety risks involved with patient’s healthcare choices and support their safe navigation to receive the care they need.
We often hear from people seeking tubal ligation and hysterectomies that their doctors outright deny those services or approach that conversation with doubt, adversity, or even an unwillingness to continue without directly consulting the person’s partner. We fully support a doctor’s medical opinion, and we would like to see the healthcare world respect patients’ expertise about their own bodies and situations. Certainly, providers should give their medical opinion and outline risks, but they should be careful not to impose personal or societal judgments on any patient’s request. Believe and trust patients when they talk about their bodies and offer appropriate professional perspective, so they can make the most informed choice.
Providers can routinely have conversations about the nature of patients’ relationships and how they affect their health and healthcare decisions. They are also uniquely positioned to offer universal information about IPV and the resources available. We always encourage providers to familiarize their practice and peers with local supports and services available to offer warm referrals when the need arises.
We’re heading into the 87th legislative session. What priorities are the Texas Council on Family Violence focusing on this session?
In the 87th Session, we will address the incredibly challenging and grave issue of firearms and see that laws regarding firearm prohibitions are meaningfully implemented. We’ll also seek to ensure that survivors are informed of bond conditions that are set for their safety, and that these conditions are entered into the system, so that law enforcement are aware and can enforce them.
Each Legislative Session we prioritize funding, included in Article Two of the budget for the Health and Human Services Commission, for family violence programs. We also advocate for adequate funding of Batterer Intervention and Prevention Programs and for Domestic Violence High Risk Teams.
And as we do in every session, we’ll monitor, analyze, and support or challenge proposals that impact survivor safety and well-being.
Why is it important for your organization to be a TWHC member?
The Texas Council on Family Violence has been a member of this Coalition since its inception because we recognize the critical intersections between IPV and survivor and child health, well-being and safety. Further we want to continue to emphasize to providers the important role they can play around IPV prevention and survivor support. Access to preventative healthcare—and particularly family planning services—are important components to survivor safety and stability. TWHC helps our Council to stay on top of the issues that impact women’s health services in Texas and keep us connected to providers and healthcare advocacy groups with whom we wish to partner.