Newsletter: Winter 2005: Out of Sight, Not Out of Mind

On October 18th, The New York City Council's Health Committee, chaired by Councilwoman Christine Quinn, held a hearing on universal screening for sexual violence among women in New York City who receive health care in primary care clinics.  The hearing was the last in a series initiated by Council Speaker Gifford Miller to explore the role of local government in improving the public response to sexual violence.  The following is an excerpt from testimony provided by Tamara Pollak, RN, MPH, Director of the Forensic Healthcare Program.

By training, I am a nurse and a public health advocate.  As a symptom of my professions, I am compelled to find solutions: If you, Councilwoman Quinn, come and tell me you have a headache, sure, I'll probably end up telling you to take some Motrin.  But before I do, chances are I'll ask you, "How bad is the headache? How long have you had it? Is this hearing making it worse? Do you think this hearing caused it?"  The only rational way to begin speaking about a health problem is to focus on finding a solution, and the way we find solutions to any health problem, including public health problems is to:

• Define the scope of the problem: How bad is the headache? How far-reaching is the problem of sexual violence in New York City, and how profound are the health consequences of sexual violence.
• Determine the cause of the problem: What caused the headache? And just the same, I need to ask, what causes people who survive sexual violence to then suffer chronic health conditions that diminish their quality of life? 
• Determine effective interventions: A Motrin or maybe another cup of coffee for the headache.  For sexual violence: Maybe, providing people the opportunity to talk about sexual abuse; maybe just asking people if they have ever been forced to do something sexual they did not want to do, and letting them know where they can go for help.  
• The final step is to implement the intervention: I've got some Motrin in my bag. I can give you one now.  I also have colleagues at this table who have designed programs to screen people for past and present sexual violence, and they are ready to help train health providers and set up more programs now.

The acute health outcomes of sexual violence are direct results of the assault, and in most cases the cause and effect relationship is easy to conceptualize.  In some cases, the chronic health outcomes of sexual violence follow this same pattern.  For example, pelvic inflammatory disease is a chronic and direct health outcome of an untreated sexually transmitted infections contracted through rape. However, many chronic health consequences of sexual assault do not lend themselves to this sort of clean cause-and-effect model. Instead, the chronic health outcomes of sexual violence are often mediated by a number of factors that are important to recognize in the context of a public health analysis.

Extensive research has linked sexual abuse to a host of psychosocial and behavioral characteristics including depression, anxiety, post traumatic stress, and poor impulse control.  Victims sexually abused as children usually become consensually active at earlier ages, are at higher risk of becoming teen parents, of practicing unsafe sex, of abusing alcohol and other drugs.  Any childhood sexual abuse is associated with impaired adult physical, behavioral, and psychosocial functioning.

Over 10 years ago, Dr. Anne Flitcraft, a gynecologist, wrote in the Journal of the American Medical Association wrote, "Quicker than you can put on a Band-Aid, you can acknowledge the violence the battered woman has experienced, you can assert that it is illegal, not her fault, and that a lot of women are in the situation. You can educate her about the community-based resources available to her, and ask 'Are you safe?'"

In a study published in 2000 in the American Journal of Preventive Medicine, women with an abuse history answered questions about how they felt when a health provider asked them about abuse.  Eighty-six percent of women agreed that routine screening for sexual violence and intimate partner violence would make it easier to get help.  Ninety-six percent were glad someone took an interest, and 74.5 percent of abused women said that when their physician or other health care professional talked to them about abuse, it was helpful.

Sexual violence is a citywide problem. It's a statewide problem. It's a dire national concern. It's an international dilemma. New York City needs to respond to this problem not only because of the significant health care costs, but out of concern for the wellness and quality of life owed to everyone who lives in New York City. Asking women if they have or are experiencing violence and pointing them to resources will help.  There is an urgent need to begin implementing these programs and measuring their effectiveness.  We have the resources here today to guide the New York City Council in how it can help to do this.

Ms. Pollak is the Forensic Healthcare Program Director at the New York City Alliance Against Sexual Assault. [more]

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