WASHINGTON — A new report from the National Academies of Sciences, Engineering, and Medicine says 15 health care services related to intimate partner violence — including reproductive health care, screening for STIs and HIV, forensic medical exams, and mental health care — should be classified by the Health Resources and Services Administration and all U.S. health care systems as essential health care services. The report recommends prioritizing access to these health care services during public health emergencies, such as a pandemic or natural disasters, using a phased approach.  

Nearly half of all U.S. women experience some form of intimate partner violence in their lifetime, which can include physical or sexual violence, stalking, psychological aggression, and reproductive coercion by a current or former intimate partner. Women with a history of intimate partner violence have 4.5 times more emergency department visits than those without. Some of the most serious injuries associated with intimate partner violence include traumatic brain injury, strangulation injuries, and injuries to the head, face, and neck. The effects on gynecological and reproductive health can also be severe. 

Studies after Hurricane Katrina, the Deepwater Horizon oil spill, and the COVID-19 pandemic have found increases in the prevalence and severity of intimate partner violence following these public health emergencies. The availability of health care services needed by women experiencing intimate partner violence is also often more limited during public health emergencies, says the report.  

The report recommends that the following should all be classified as essential health care services during public health emergencies and during regular conditions: universal intimate partner violence screening and education, safety planning, forensic medical examinations, emergency medical care, treatment of physical injuries, obstetric care and reproductive health care (including all forms of FDA-approved contraception and pregnancy termination), screening and treatment of STIs, HIV treatment, substance use disorder and addiction care, pharmacy and medication management, primary and specialty care, mental health care, support services (including shelter, nutritional assistance, and child care), and dental care. In both public health emergencies and regular conditions, health care providers should connect women who disclose intimate partner violence with medical care and support services. 

The report lays out a phased approach for health systems to follow in order to sustain access to essential services during a public health emergency. This phased approach balances the challenges of providing health care during an emergency with the need to ensure access for women experiencing intimate partner violence. For example, though HIV and STI screening for women experiencing intimate partner violence remains essential throughout a public health emergency, health systems can focus on treatment and rapid testing during the initial phase of an emergency, add in testing that requires laboratory capability when response operations have begun, and then fully restore screening and treatment services later in the response phase.   

“In a public health emergency, roads may be damaged, health care facilities may run low on supplies, and care providers may be overwhelmed with other patients — but women experiencing intimate partner violence may need more medical care and support than they typically would outside of a natural disaster or pandemic,” said Sue Curry, chair of the committee that wrote the report and emeritus dean and distinguished professor, College of Public Health, University of Iowa. “Our report offers a plan for restoring services in phases for women experiencing intimate partner violence, to ensure they receive the care they need even during tumultuous times.” 

“During the COVID-19 pandemic, health care providers saw firsthand the severe impact that a lack of resources and support for those facing intimate partner violence had on their patients,” said Victor J. Dzau, president of the National Academy of Medicine. “It is my hope that this report’s recommendations will lead to improved outcomes for women, and help health care providers better serve their needs during disasters and emergencies.” 

Training and Education for Disaster Responders 

Training to care for women experiencing intimate partner violence is not always a part of the education provided for response teams or volunteer organizations leading disaster response. Education and training are key to developing the capacity of disaster responders to provide appropriate care for these women and ensuring essential health care services are available, says the report. 

The report recommends: 

• Federal, state, local, and tribal governments should ensure that coordinated planning and response protocols for essential health care services are in place before public health emergencies occur. They should also ensure the necessary supplies for delivering these services are available, such as by conducting an annual review of supplies and establishing a procurement plan.  
• The Health Resources and Services Administration should disseminate best practices for ensuring services are available for adolescents experiencing intimate partner violence, including prevention services.  

• HRSA and the Administration for Strategic Preparedness and Response should create an open-access training hub on intimate partner violence for disaster health responders, for example, to help responders better recognize the signs and symptoms of intimate partner violence. HRSA and ASPR should also create guidance to be used by those developing care protocols for women experiencing intimate partner violence during public health emergencies.

• Federal, state, local, and tribal governments should ensure that coordinated planning and response protocols for essential health care services are in place before public health emergencies occur. They should also ensure the necessary supplies for delivering these services are available, such as by conducting an annual review of supplies and establishing a procurement plan.  
• The Health Resources and Services Administration should disseminate best practices for ensuring services are available for adolescents experiencing intimate partner violence, including prevention services.  

• HRSA and the Administration for Strategic Preparedness and Response should create an open-access training hub on intimate partner violence for disaster health responders, for example, to help responders better recognize the signs and symptoms of intimate partner violence. HRSA and ASPR should also create guidance to be used by those developing care protocols for women experiencing intimate partner violence during public health emergencies.

Ensuring Equity

Black, American Indian and Alaska Native, Hispanic, multiracial, lesbian, bisexual, transgender, disabled, and immigrant women report a higher prevalence of intimate partner violence, the report says. Health care deserts, mistrust of the medical system, and language barriers can create additional hurdles to accessing care.  

Health care systems should work to reduce health inequities by ensuring that historically marginalized communities are included in development and planning of care programs for intimate partner violence. Health care providers should also provide culturally and linguistically specific resources for those experiencing intimate partner violence and monitor the reach of their programs to ensure women are accessing them equitably. 

The study, undertaken by the Committee on the Sustaining Essential Health Care Services Related to Intimate Partner Violence During Public Health Emergencies, was sponsored by the U.S. Department of Health and Human Services.  

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, engineering, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. 

Contact:

Megan Lowry, Media Relations Manager
Office of News and Public Information
202-334-2138; email news@nas.edu