ATrain Education

 

Continuing Education for Health Professionals

Kentucky: Domestic Violence

Module 8

Considerations in Rural Domestic Violence

Rural living may present additional problems for victims of domestic violence, as well as for healthcare providers practicing in rural settings. Unfortunately, research on the specific problems of domestic violence in rural areas is still only a small portion of the work done on domestic violence overall.

Available research suggests some important differences between domestic violence in rural and urban areas and highlights details that merit further research. While the rates of domestic violence in rural and urban areas appear to be similar, victim experiences may be very different. For rural victims of domestic violence, levels of education, employment opportunities, and income are all usually lower. More are homeless, and economic and social support options are generally fewer. Rural victims also appear to experience abuse earlier in their relationships than do urban women (Logan et al., 2003). While protective orders appear to be equally effective in rural and urban areas, rural victims encounter more problems obtaining the orders and getting them enforced, and they experience more personal distress and fear than do their urban counterparts (Logan et al., 2009).

In 2005 a study of twenty years of FBI statistics demonstrated that the more rural the area (based on size of population and distance from a major urban area) the more likely a murdered person was to have been murdered by a family member or intimate partner. Analysis of the data from 1980–1999 showed that “rates for family and intimate partner murders declined regardless of place, whereas rates of intimate partner murders increased only with rurality” (Gallup-Black, 2005).

As noted earlier, isolation—emotional, physical, and economic—can be a factor in why some victims stay in abusive relationships; the geographical circumstances of rural living can exacerbate this factor. There are numerous behaviors employed by abusers to create isolation for their victims, such as limiting a victim’s access to family vehicles or preventing her from obtaining a driver’s license, ridiculing her in front of others, or accusing her of flirting—thus making her even less likely to invite others to the home or go out herself; and even removing the telephone when leaving the house so that she has no means to communicate with others.<

For rural victims these abuser behaviors may be compounded by the realities of rural living, including:

  • Lack of phone service (landline or cell access)
  • Limited or no public transportation
  • Limited access to routine health care
  • Long response times for police and medical emergency teams
  • Weather and road conditions
  • Weapons and dangerous tools more commonly available
  • Seasonality of work that may leave the woman “trapped” with her abuser for long periods of time, and in winter alcohol use may increase
  • Economic conditions of farm life—single income, value tied to land, need for all to work to stay solvent. If farm is only source of income a restraining order can’t be used to keep the abuser away
  • Emotional conditions of farm life—strong ties to animals and land
  • Intimidation of travel to a “big city” (WRAP-2, n.d.; Clifford, 2003)

Not only is access to routine health care often limited in rural areas, but rural citizens tend to have fewer insurance resources, providers may be unprepared to do routine IPV screening, and tight-knit communities may discourage people from reporting abuse. Locating shelters in rural areas is also more difficult because they are harder to hide.

Rural healthcare providers not only need to be able to identify domestic violence victims but also to be prepared to offer assistance that addresses the particular needs and problems of rural women. Patients experiencing abuse may have complaints or injuries that include arthritis, irritable bowel syndrome, stomach ulcers, chronic pain, migraines, and eating disorders, and one study found that approximately 64% of rural women with an STD are involved in an abusive physical and sexual relationship. Other closely associated complaints include insomnia, depression, post-traumatic stress disorder, panic disorder, and substance abuse (Clifford, 2003). In addition, safety plans and escape options for rural women may need to be adjusted to meet the specific realities of their situations.

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