Domestic Violence: Who Is Helping Canada's Hidden Health Crisis?

It’s a sunny afternoon as you wait for your friend to be given the green light to go home from the emergency room. She was admitted earlier for a head injury and may have a concussion. You’re there to accompany her, but you feel a deep concern that this might happen again – it’s already the third time this year. You wonder: have the doctors fully explained the impact of repeated injuries? Are they noticing what you’re noticing? 

You’re probably thinking that this ‘friend’ is into sports, or maybe she’s an accident-prone gym rat. The reality is that she is living through conjugal abuse. Women who endure abuse are 11 to 12 times more likely to experience head trauma compared to combat veterans or athletes, yet they typically will not seek out help (St-Cyr-Leroux, 2022)., and eighty percent of survivors do not report to the police (Statistics Canada, 2019). Most survivors who experience injury or infection opt for taking time off instead, and downplay their experiences to family members, doctors, or nurses (Statistics Canada 2019). Canada has also seen a steady rise in femicides of 27% from 2019 to 2022 (Canadian Femicide Observatory for Justice and Accountability, 2024). 

Tailoring compassionate care with survivors

Even when survivors who experience intimate partner violence seek out medical support, experience with institutions has influenced them to be unsure of the healthcare system. There is a persistent concern that healthcare professionals’ ideas of what ‘evidence’ of abuse looks like do not match up with the actual medical health consequences. For example, though psychological abuse may not leave any bruises, healthcare practitioners aren’t always aware of the physical manifestations of emotional and mental strain that psychological abuse causes, and many forget to screen for a steady decline in health and symptoms such as chronic painful migraines (Snugg, 2015). There are other concerns facing survivors too: that practitioners won’t schedule follow-ups on their patient’s health progress, respond in ways that are compassionate and informative, or discreetly offer appropriate referrals (Snugg, 2015). Without proper follow-ups or appropriate care, survivors are coming in for multiple medical visits and getting to serious points of infection or persistent negative health. This puts immense pressure on not just the body of the individual seeking support, but also the health care system. 

It was especially important to both them and Women Aware that they speak directly with the survivors at the shelter with which they would choose to collaborate. 

An anonymous survivor of intimate partner violence shared, “During the relationship, I kept having inflammation, and even a Zona [a type of localized rash that can and is triggered by chronic stress] on my shoulder. Right after the breakup, I had a huge infection and a fever that wouldn't go away […]”  

This highlights just how much of a gap exists in our understanding of how domestic violence can impact health. Enduring multiple injuries as well as the effect of sustained fear and consistent stress in the home can cause survivors to continuously experience symptoms such as headaches, back pain, rashes and inflammation, pelvic infections, urinary tract infections, ulcers, and gastrointestinal issues (Rakovec-Felser, 2014). These are only some of the health symptoms that are most common and frequently disrupt the well-being of survivors. As another survivor shared: 

“…the impact the abuse/violence had on my mental health have been profound […] Part of the abuse were sexual abuse which have impacted my sexual health and my relationship with intimacy and sexuality. […] it took years of unlearning and relearning to become healthier and have a healthier relationship with sex and intimacy.” 

The Women Aware partnership

So, what’s being done? Concerned and dedicated healthcare practitioners, students, and researchers are bringing attention to this health crisis and advocating for preventative measures with community and intervention workers. Despina Mistos  and Sofia Tiseo, medical students at McGill University, revealed it was “mind-boggling” for them to discover how emotional, psychological, and even economic abuse can alter women’s access and outcomes in medical health (Johnson et al, 2022). They repeated just how common these occurrences are, but that healthcare practitioners can make preventative change by collaborating with organizations and shelters and getting institutions involved in the solution to societal issues.  

They have partnered with Women Aware – a Montréal-based non-profit run by survivors, for survivors – to create interactive, considerate, and accessible workshops for survivors in shelters exploring the health impacts of intimate partner violence as well as the benefits that recovery and healing can have on survivors’ brains and bodies. Their goal? Get these workshops into shelters so that this knowledge can empower survivors to understand what is happening in their bodies and to seek help. Despina and Sofia first met with Women Aware through community engagement that they were already doing. After discussing with the Women Aware outreach coordinator more in depth, they realized that this would be the ideal organize with which to co-create tailored intervention. It was especially important to both them and Women Aware that they speak directly with the survivors at the shelter with which they would choose to collaborate. This is because group dynamics and survivor needs can shift how the information will be tailored for them. They met several times with a group of survivors through a pilot project at Anne’s House – a shelter for survivors of IPV – and incorporated their input and follow-up feedback to fully encompass their needs. Co-creation is more than just a process, especially in circumstances such as these: it’s empowering and destigmatizes the experience, and engages survivors in humanizing discussion, reminding them that they are more than the vulnerabilities they endured.  

Compassion is the key to making better decisions for society in general

By making this knowledge available and compassionately discussed with survivors, Women Aware, Sofia and Despina are hopeful that this community-based approach will shift intervention beyond top-down learning and healthcare practitioners to move away from ‘expertise’ types of approaches to tailor client-centered care on this social justice and medical issue. The goal is to make this type of health information readily available and digestible so that it equips survivors with the tools to safely leave abusive relationships. 

Christina Achkar – community outreach coordinator at Women Aware – believes that cultivating hopeful and informed collaborations is necessary for treatment and community healing, saying “Compassion is key to making better decisions for society in general”. 

Collaborative projects like this one have the potential to directly address some of the systemic challenges that exist for survivors. She explained that there currently aren’t enough incentives and funding going toward the realm of feminine health, let alone how this connects to intimate partner violence. However, Women Aware – with the clients it serves and the outreach initiatives it runs - has the capacity and willingness to collaborate with organizations, institutions, and researchers to bring practical options to the forefront while integrating survivors’ input. By integrating community discussions and feedback, it brings value and priority to an issue that all too often leads to fatal consequences. Through more community-based collaborations with IPV shelters and organizations such as Women Aware, healthcare organizations and professionals can be equipped to identify and consider the connection of this social crisis with preventative healthcare.