is a general lack of interest in the impact of partner violence. on women of color. Furthermore, existing research investigating ethnic differences suffers from methodological complications. Crenshaw (1993) pointed out that research measures are developed and validated in majority populations and they tend to ignore the social and cultural context of other ethnic groups. Current instrumentation reflects uniformity assumptions about family organization, lifestyle, place of residence, and beliefs about what is acceptable conduct within a relationship. Specifically, partner violence screening questions may assume a nuclear family when extended families are the norm in many cultures, may be written from a paternalistic family model that ill-suits matrilinear and matrilocal kin structure that is prevalent among American Indians as well as other groups, and are biased toward urban lifestyles, failing to consider that denying telephone or transportation may be frequent and serious forms of intimidation in rural areas.
Current instrumentation reflects the assumption that beliefs about what is acceptable conduct within a relationship and what constitutes violence are the same across cultural groups. Questions may emphasize behaviors that are less important within some cultures, while failing to elucidate others that could cause more damage to the physical and emotional safety of women. Research on the definitions of violence in different groups is necessary in order to develop an instrument that competently measures violence, as well as providing health care providers with cross-cultural information on the best ways to screen for victimization among their patients.
More descriptive research is also needed on women's experience in the medical system. As the chronic pelvic pain and irritable bowel syndrome literature is beginning to suggest, some women may be shunted through the system and treated according to the diagnosis they receive, while in fact their symptoms may overlap both, and may be related to an undisclosed history of abuse. The problem of inappropriate prescribing of tranquilizers and sedatives to victims of partner violence is another area in need of further research.
As in the case of physical violence and sexual assault, there is currently little understanding of how other factors may interact with partner abuse to result in the high utilization of health services. Current studies on health outcomes of victimization generally include women with any history of abuse thus failing to partial effects among cumulative violence a woman may have faced across her life span. A second area of investigation must be directed toward isolating the effect of partner violence, as well as attempting to identify and assess other components accompanying the abuse, such as substance abuse, poverty, and childhood experience that may either interact with partner violence or work in isolation to produce health effects.
A final area of research involves the provision of more information on the potential effects of screening in order to base recommendations regarding victim identification on reasonable conclusions. Although patient screening is currently being encouraged in all health care settings, there has been no evaluation of whether identification improves treatment or actually assists the victims in some way. Negative outcomes must also be assessed, such as the possible threat to confidentiality by institutions that may discriminate against the victim. It is also necessary to examine the impact of forcing physicians to screen while their attitudes regarding women and partner violence remain the same. If physicians do not agree with the underlying causes and effects of partner violence, then they may be less likely to make the referrals proposed by the protocol.
The research community has begun to respond to the need for more research in the area of women's health. However, the overwhelming impact of violence on the lives and health of women outlined here is not reflected in the allocation of resources. The research community must begin to make violence against women a priority in order to adequately address a major health concern of women and provide the medical community with an appropriate response.
Abbot, J., Johnson, R., Koziol-McLain, (1995). Domestic violence against women: Incidence and prevalence in an emergency department population. Journal
J., & Lowenstein, S. R.
American Medical Association, 273, 1763–1747.
Amaro, H., Fried, L. E., Cabral, H., & Zuckerman, B. (1990). Violence during pregnancy and substance abuse. American Journal of Public Health, SO, 575–579.
American College of Obstetrics and Gynecology. (1989). The battered woman. ACOG
American Medical Association. (1992). Diagnostic and treatment guidelines on domestic violence. Archives of Family Medicine, 1, 39–47.
Baker, N. J. (1995). Strategic footholds for medical education about domestic violence. Academic Medicine, 70, 982–485.
Berk, R. A., Berk, S. F., Loseke, D. R., & Rauma, D. (1983). Mutual combat and other family violence myths. In D. Finkelhor, R. J. Gelles, G. T. Hotaling, & M. A. Straus (Eds.), The dark side of families: Current family violence research (pp. 197–212). Beverly Hills, CA: Sage.
Berrios, D. C., & Grady, D. (1991). Domestic violence: Risk factors and outcomes. Western Journal of Medicine, 05, 133435. Bouza, A. (1991). Responding to domestic violence. In M. Steinman (Ed.), Women battering: Policy responses (pp. 191–202). Cincinnati, OH: Anderson.
Bowker, L., & Maurer, L. (1987). The medical treatment of battered wives. Women and Health, 12, 25–45.
Browne, A. (1993). Violence against women by male partners: Prevalence, outcomes, and policy implications. American Psychologist. 48, 1077–1087.
Browne, A., & Williams, K. R. (1989). Exploring the effect of resource availability and the likelihood of female-perpetrated homicides. Law and Society Review, 23, 75–94.
Browne, A., & Williams, K. R. (1993). Gender, intimacy, and lethal violence: Trends from 1976 through 1987. Gender and Society, 7, 78–98.
Brush, L. D. (1990). Violent acts and injurious outcomes in married couples: Methodological issues in the National Survey of Families and Households. Gender and Society, 4, 56–67.
Bullock, L., Bt McFarlane, J. (1989). The birth weight/battering connection. American Journal of Nursing, 89, 1153-l 155. Bureau of Justice Statistics. (1994). Violence Technical Bulletin, 124, whole.
Office of Justice Programs. Washington, DC: U.S. Department of Justice.