"We need to work on changing social norms," Dr. Elizabeth Miller said Tuesday in her keynote address to the three-day conference of the Nursing Network on Violence Against Women International, hosted by the University of Virginia School of Nursing.
Miller, an expert in reproductive coercion, teen dating violence and gender-based violence, chief of the Division of Adolescent Medicine at the University of Pittsburgh Medical Center\'s Children\'s Hospital of Pittsburgh and professor of pediatrics, talked about her research and work to train health care providers in issues related to domestic violence in the clinical setting.
"The link between violence and reproductive health is painfully prevalent. It is a public health problem," she said.
Miller\'s work focuses on adolescent relationship abuse from the perspective of females ages 10 to 24. She researches approaches and interventions to help adolescent girls recognize and avoid birth control sabotage and reproductive coercion and educate them about what a healthy relationship looks like.
This age group engages in a range of abusive behaviors that go beyond physical and sexual violence, Miller said.
Text abuse is one area she cited. One in five young women in this age group send nude or semi-nude photos of themselves via text message, she said, adding, "That behavior is normalized in this age group."
Further, negotiating condom use with an abusive partner can be dangerous, she said. "Knowledge is not enough. Being in an abusive relationship makes things more complicated."
"Violence" encompasses not just physical and sexual violence, but includes manipulation, which women do not always recognize as abusive behavior, Miller said. One study found that a quarter of 14- to 20-year-old women reported males engaged in behavior intended to impregnate them.
Another study of adult women found that roughly 75 percent had experienced similar "pregnancy-control behavior," including throwing away birth control pills; physically invasive actions, such as pulling out an intrauterine device; or threats of physical violence or death.
Health care providers have successfully used scripted assessment tools and teamed with violence victimization advocates to address relationship-violence issues, she said. Providers should question patients about their relationships and birth control behaviors, and should be ready to provide a list of advocates and their contact information, plus space and access to clinic phones to make those calls – which can provide anonymity for the patient and prevent her partner from seeing the call on her cell phone, she said. Providers also can offer counseling about options for making better decisions to address relationship concerns.
All of these interventions help create a safe environment for adolescents to make decisions about birth control, pregnancy and relationships, she said.
The goal is to reduce harm and build a safety net, Miller said, adding that in teaching about healthy relationships, it should be noted that, "the absence of an abusive relationship does not mean they are in a healthy relationship."
On the changing social norms side of the story, she cited a study with boys in an athletic setting in California. The study found that coaching about respecting women, not bragging about sexual activities, and other relationship behavior led to a reduction of abuse and increased intentions to intervene when abusive behaviors are observed – and more actual interventions.
"This is a collaborative effort," Miller said. "We cannot do the work without being part of a team."
One of the conference participants, Jane Koziol-McLain, a nursing professor at the Auckland University of Technology in New Zealand, works with abused MÄï¿½ori women and children through an organization, Futures Without Violence. "Violence against women is very complicated, a complex social problem, so it\'s just a matter of making sure health steps up and does its part in addressing the issue," she said.
"In New Zealand, our Ministry of Health has been very forward-thinking and has supported a systems response to violence against women that they started funding in 2007. So, we\'ve had great success in having a national program rolled out across the acute-care hospitals. I think it really is quite novel in having a well-supported, standardized systems approach."
Conference organizer Kathyrn Laughon, an associate professor of nursing, said hosting the conference was important for the University.
“This conference is always a tremendous opportunity to strengthen collaborations with incredible researchers from around the world," she said. "Hosting it at the University this year meant that we had the added benefit of building stronger connections with colleagues in other departments in the University. “
Julianne Koch, assistant director of the Victim/Witness Assistance Program in Charlottesville\'s Office of the Commonwealth\'s Attorney, said the conference was inspiring.
"It\'s helpful to have the reminder on a personal level of why I do what I do," she said. "It can get really easy to get burned out in the job that I have, so it\'s nice to be reminded of the bigger policy and research directions that people are going in."
The conference, which kicked off Sunday with a pre-conference symposium, "Global Violence Against Women," touched on a host of concerns and issues devoted to emerging topics in violence research that affect women, children and families and their health.
U.Va. nursing doctoral student Michael Swanberg is researching maternal and child health. He said, "I think women\'s health is the area where you can make the greatest impact." He quoted an adage:"Teach a man and you teach one person. Teach a woman and you teach the whole family, you teach the community."
"If you are going to impact one area of health, it\'s actually working with women," he said.
Funding for the conference was provided in part by the Center for International Studies and the Office of the Vice Provost for International Programs, the Office of the Vice President for Research, Mr. and Mrs. Benjamin H. Graham and the Verizon Foundation.
– By Jane Ford