Reproductive and Sexual Health Handbook

Family, domestic and sexual violence are major health and welfare issues. They occur across all ages, and all socioeconomic and demographic groups, but predominantly affect women and children.

Violence is a common experience; it is also a gendered one. Although men are more likely to experience physical violence of any type, women are more likely to experience sexual violence, intimate partner violence, stalking, sexual harassment and child abuse.

Extensive research indicates violence, abuse and neglect has serious impacts on people’s health and wellbeing (see Figure 16.1). These impacts are cumulative and may be incrementally worse for victims experiencing multiple types of abuse.⁽¹⁾

Note that this chapter generally uses female pronouns to describe victims of violence for ease of reading; while men and women can be the victims or perpetrators of sexualised violence, the majority of crimes are perpetrated by men against women.

Figure 16.1 Risk factors contributing to disease burden in Australian women aged 18-44 years

Ayrne J, Lum On M, Webster K, Gourley M, Moon L. Examination of the burden of disease of intimate partner violence against women: Final report. ANROWS Horizon 2016; 7. Figure: Top 8 risk factors contributing to disease burden in Australian women aged 18-44 years; p.

Domestic violence is also commonly referred to as DV, intimate partner violence (IPV) or family violence.

While there is no single definition, the central element of domestic and family violence is an ongoing pattern of behavior aimed at exerting power and control over an intimate partner or member of the family.

It should be noted that the term ‘family violence’ is used to extend the meaning of domestic violence beyond that perpetrated by an intimate partner. Family violence is a term often preferred in working with Aboriginal communities as this recognizes the diversity of marital and kinship relationships in which violence can occur.

In most cases, the violent behavior is part of a range of tactics used to exercise power and control over women and their children, and can be both criminal and non-criminal. Intimate partner violence refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.⁽¹⁾

It is important to acknowledge that men are also victims of domestic violence and domestic violence also occurs in same sex relationships.

 

The Personal Safety Survey defines adult sexual violence as the occurrence, attempt or threat of sexual assault experienced by a person since the age of 15.⁽⁹⁾ There are two components of sexual violence:

Sexual assault: an act of a sexual nature carried out against a person’s will through the use of physical force, intimidation or coercion, including any attempts to do this. This includes rape, attempted rape, aggravated sexual assault (assault with a weapon), indecent assault, penetration by objects, forced sexual activity that did not end in penetration and attempts to force a person into sexual activity. Incidents so defined would be an offence under state and territory criminal law. Sexual threat: the threat of acts of a sexual nature that were made face-to-face where the person believed it was able to and likely to be carried out.⁽¹⁰⁾

Sexual threat and harassment includes a range of acts such as sexualised bullying, which can increasingly occur in an online or virtual medium.

Note that laws around consent to sex vary between states and territories. See Appendix B – Legislation for age of consent to sexual activity in Chapter 19: Legal Consideration in Reproductive and Sexual Health for

Child sexual abuse is defined in the Personal Safety Survey as any act involving a child (under 15 years old) in sexual activity beyond their understanding or contrary to currently accepted community standards.⁽¹⁰⁾ The prevalence of child sexual abuse in Australia is described in Figure 16.7.

In most cases, children are abused by someone known to them and to their family. Sexual abuse involves penetrative and non-penetrative acts such as sexualised touching, watching pornography or being exposed to or coerced into performing sexual acts.⁽¹⁾

 

Figure 16.7 Child Sexual Abuse

 

National Sexual Assault, Domestic Family Violence Counselling Service

1800RESPECT website 1800RESPECT (1800 737 732) – National counselling helpline, information and support 24/7

Women’s Legal Service NSW

Its time to talk website – When she talks to you about the violence: A toolkit for GPs in NSW

Royal Australian College of General Practitioners (RACGP)

Abuse and violence: Working with our patients in general practice (white book) – this manual offers clinicians’ evidence-based guidance on appropriate identification and response in clinical practice to patients experiencing abuse and violence. It includes useful links to the variations in the legal responsibilities of clinicians across Australia.

NSW Health Education Centre Against Violence – provides training and resources including:

Recovering from adult sexual assault: Navigating the journey booklet When a Man is Raped booklet

Hegarty K, O’Doherty L. Intimate partner violence: Identification and response in general practice. Aust Fam Physician 2011;40(11):852-856. Available at: http://www.racgp.org.au/afp/2011/november/intimate-partner-violence

Wade D, Howard A, Fletcher S, Cooper J, Forbes D. Early response to psychological trauma: what GPs can do. Aust Fam Physician 2013;42(9):610-614.

Blue Knot Foundation

Trauma-informed Care and Practice framework – provides information for adult survivors of childhood trauma and trauma informed care Costello M, Backhouse C. Avoiding the 3 ‘M’s: Myths, mistakes and misinformation in violence, abuse and neglect statistics and research. Master Powerpoint for the Integrated Violence, Abuse and Neglect Statistics Project: Education Centre Against Violence (ECAV) and Prevention and Response to Violence, Abuse and Neglect (PARVAN) Unit (Ministry of Health); 2019; NSW Health. Available at: http://www.ecav.health.nsw.gov.au/van-statistics-and-research/.  Krug E, Dahlberg LL, Maercy JA, Zwi AB, Lozano R. World report on violence and health. [internet]. Geneva: World Health Organization (WHO); 2002. Available at: https://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf;jsessionid=D866EA4EDC79D251D9B6B5DD8E158069?sequence=1.  Australian Medical Association. AMA Position Statement: Family and Domestic Violence 2016. Australian Medical Association; 2016. NSW Family & Community Services. Exchanging information related to child protection and wellbeing [internet]. NSW Family & Community Services: NSW Government; 2019 [updated 2019 Sept 24]. Available from: https://www.facs.nsw.gov.au/providers/children-families/interagency-guidelines/exchanging-information. NSW Health. Policy Directive: Domestic Violence – Identifying and Responding. Report No.: PD2006_084. [internet]. NSW Health; 2006 [updated 2018 June 30]. Available from: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2006_084.pdf.  When she talks to you about the violence: a toolkit for GPs in NSW [internet]. Women’s Legal Services NSW. (Sydney); 2014. Available from: http://www.wlsnsw.org.au/wp-content/uploads/GP-Toolkit-2014.pdf.  Feder G, Hutson M, Ramsay J, Taket AR. Women exposed to intimate partner violence: expectations and experiences when they encounter health care