By: Alexander Curtis, MD, MPH, Resident, Holzer Health System
Reprinted from the Summer 2020 Issue of The Ohio Family Physician
Women in the United States are 21 times more likely to die by firearms homicide than women in peer nations.1 Intimate partner homicide (IPH) is the most extreme form of intimate partner violence (IPV) and is responsible for the deaths of over 1,000 women in the U.S. annually. Between 2008 and 2017, there was a reduction in IPH of women involving weapons – except homicides by guns, which increased by 15%.2 Intimate partner incidents that involve a firearm are 12 times more likely to result in death than incidents that do not involve a firearm.3 A National Violent Death Reporting System analysis reveals that on average from 2014 to 2017, female IPH victims outnumbered male IPH victims by a ratio of nearly four-to-one.
A death rate analysis that weights the deaths occurring at younger ages more heavily than those occurring in older populations more accurately reflects IPH’s societal impact. Years of potential life lost (YPLL) is used to quantify social and economic loss owing to premature death. Women ages 20-29 years represent the largest percentage of firearms-related IPH victims in the U.S. Over the past five years, female IPH victims accounted for an average of more than 60,000 YPLL annually in the U.S. Between 2009 and 2018, women in Ohio experienced a larger percent increase of YPLL from baseline due to firearm fatalities compared to males (44:32). Over 500 Ohioans die by gun homicide every year. This makes Ohio the 20th highest ranking state for gun homicides in the country.4 In Ohio, the rate of gun homicide increased by 49% from 2009 to 2018, compared to an 18% increase nationwide.5
Public health research reveals an inverse relationship between IPV victim safety and gun ownership. States with the highest rates of firearm ownership have a 65% higher rate of IPH than states with the lowest rates of gun ownership.6 Furthermore, there is no research to support the idea that women’s gun ownership increases their safety. In fact, studies show that women who purchased a gun died by firearm homicide at twice the rate of women who did not.7
- Experts use the Danger Assessment8 (DA) to assess the likelihood for lethality associated with IPV. The DA includes 20 yes/no questions such as, “Does he own a gun?” “Is he employed?” and “Do you have a child that is not his?” Incorporating the DA in your practice could increase the likelihood of saving your patient’s life.
- The great majority of IPH victims experienced IPV within the previous year.9 Conversations can be initiated by asking questions like, “Have you ever felt unsafe in your relationship?” If the answer is “yes,” then ask about the kind of violence, when it happened, and how frequently it occurs.
- For about 20% of women, the fatal IPH incident was the first act of physical violence they had experienced.10 Family physicians can better safeguard their patients against IPH by knowing the associated risk factors. Risk factors associated with IPH include:
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- Partner’s drug use
- Partner’s access to firearms
- Partner’s controlling behavior or jealousy
- Unintended pregnancy.
- Leaving can end the violence. When it does not, however, the violence that follows leaving can become more severe than for women who stay in the relationship.11 We not only need to provide support and information about available resources for patients thinking about leaving an abusive relationship, we should also discuss the risks of leaving and how best to minimize those risks.
- Common-sense laws that keep guns out of the hands of abusive partners lower the risk for IPH.12
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- Advocate for laws that prohibit domestic abusers from acquiring guns and that require abusers to relinquish the guns they own. States that prohibit abusers subject to domestic violence restraining orders from possessing guns have reduced IPH rates by 13%.13
- Advocate for the closure of deadly loopholes, (A) Gun Show Loophole; (B) Boyfriend Loophole; and (C) Charleston Loophole.
- Advocate for laws requiring gun dealers to notify law enforcement when a domestic abuser attempts to buy a gun and fails a background check.
- Advocate for the repeal of the Dickey Amendment, which restricts the ability of the Centers for Disease Control and Prevention from conducting firearms research.14
References available on the OAFP website.