Domestic violence as a societal challenge in the medical field

In developing tailored DV curricula for different medical professions and fields, the VIPROM-project is involved in a contemporary struggle to strengthen the field of medicine as a central actor in a broader network to combat gender-based (GBV) and domestic violence (DV). In doing so, however, VIPROM (like many similar initiatives) is confronted with the fundamental challenge of furthering, or in some cases establishing, GBV and DV as a medical issue in the first place.

Large organisations such as hospitals – or for that matter, disciplines like medicine as a whole – are characterised by an institutional inertia, which makes organisational change like the sustainable implementation of DV-trainings and establishment of internal expertise to address DV extremely difficult and slow.

THE SUSTAINABLE IMPLEMENTATION OF DV-MEASURES IN THE MEDICAL FIELD – THREE CASE STUDIES:

There are, however, positive examples of initiatives that have already achieved what could be described as a respectable level of sustainable implementation. In an effort to draw from these good practices, and learn from the structural conditions of their success, VIPROM undertook an analysis (see VIPROM Deliverable D2.2) of Victim Protection Groups in Austrian Hospitals, three different models of decentralised integration of DV-content into the academic training of medical students in Germany, and the state-mandated knowledge goal regarding Men’s violence against women and violence in close relationships in Sweden.

A central focus of the analysis conducted by VIPROM was on the conditions for sustainable implementation of DV-Trainings and expertise in the medical field. This analysis revealed several crucial factors for such a sustainable implementation: Establishing DV as a medical issue and imbuing medical intuitions with expertise and structures to address it, requires, for example, not only resources such as funding, personnel, and dedicated time for personnel to deal with DV-issues, but also strategic positioning of this expertise within the organisational make-up of medical institutions. In Austria, for example, we have seen in one case a push to establish a dedicated unit at the directorate level (and thereby outside the normal hospital structures), to ensure that DV is not a topic solely assigned to an individual unit or profession but rather is seen as a cross-professional and cross-departmental issue.

In Sweden, DV-expertise and training is provided by experts from an organisation entirely external to individual hospitals, thereby insulating this expertise from internal organisational processes which can struggle to provide sufficient resources, staff, or commitment. The focus on DV-Trainings for medical students in Germany, in turn, achieves early sensitisation of future medical doctors, who may then carry that awareness and knowledge into the institutions they are later employed by.

These conditions for sustainable implementation also, however, point to a very different fact central to any initiative seeking to strengthen medical-sector interventions into DV: The very necessity of expending significant effort into achieving the sustainability of early successes in making DV a health issue, reveals the constant danger of these advances being lost again. In medicine and medical institutions – as in other fields – we can observe a continuous threat of DV being relegated to the position of a marginal or specialised topic, in favour of others deemed to be more urgent or important. Other factors for sustainability identified by VIPROM support this claim: The relevance of DV-policy for the medical sector and the legal embeddedness of DV-initiatives (to guarantee national coverage and staying power) points to this constant danger of relegation. The need for organisational recognition and appreciation suggests a current general lack thereof. The call for academic studies to aid in the legitimacy of the claim that DV is an issue that should be central to medicine points to the fact that this is currently not seen to be so.

DOMESTIC VIOLENCE IS FIRST AND FOREMOST A POLITICAL ISSUE:

Since the threat to DV as a health topic cannot be traced back to a single challenge for medical institutions (such as funding, or empirical evidence, or policy), we must surmise that its origin lies in a much deeper issue at the heart of such violence. Despite our struggle to strengthen DV as a health issue, we must remain mindful of the fact that violence against women, children and to a lesser extent males is fundamentally a societal challenge rooted in specific, contemporary gender relations. 

Gender relations, which intersect with other social relations, fundamentally shape our societies and can’t therefore readily be reduced to a topic we need to think about in medicine. Rather, we must recognise that gender relations define the very structure by which we are able to think about challenges in medicine in the first place. Medicine, in many ways, crystalises and thereby makes visible the contradictions stemming from gender relations: the persistent and defining power structures therein are, for example, mirrored in the privileging of what are considered issues of human health in general, at the cost of research, expertise, funding and often interest in issues of women’s health. The very fact that we can describe a discipline that privileges men’s over women’s health as being concerned with “human health” in general, can be seen as proof that we don’t so much think about gender relations, as within them and by means of their logic.

THE ENTANGLEMENT OF GENDER RELATIONS AND THE DEVELOPMENT OF MEDICAL PROFESSIONS:

Similarly, the societal privileging of the so-called “productive” over the “reproductive” spheres are mirrored in how we organise health and medicine in our societies: we assign far greater value to activities that generate profit and are predominantly organized in relations of ownership and wage-labour, than we assign to typically feminised activities such as child-rearing, caring for the elderly, or the social dimension of healing. For example, the expertise, experience, and interpersonal competences required to bathe a stranger while safeguarding that person’s dignity are, for example, valued and renumerated differently than the expertise, experience, and interpersonal competences required to examine that stranger and suggest medical treatment for them. The influence of gender relations on the historical development of professions tasked with the myriad dimensions of caring for the ill remains equally visible in the distribution of genders in different fields of medicine and nursing.

MORE INFORMATION ON DOMESTIC VIOLENCE

If you are interested to learn more about domestic violence in the health sector, please visit our European training platform on domestic violence.

SOURCE

Barbara N. Nagel (2024): „Domestic Violence“, published In “Political Concepts. A Critical Lexicon”, http://www.politicalconcepts.org/domestic-violence-barbara-n-nagel/ (accessed on 8^th January 2025).

ABOUT THE AUTHOR

Paul Herbinger, MA, works as a sociologist and managing director at VICESSE (Vienna centre for societal security) and is involved in the EU project VIPROM – Victim Protection in Medicine amongst others. He holds a master’s degree in sociology and is currently conducting his PhD in sociology. His research focus lies on domestic violence, policing studies and societal security in general.