Incidence, Prevalence, and Consequences of Intimate Partner Violence Against Women in the United States

 
Incidence, Prevalence, and Consequences of Intimate Partner Violence Against Women in the United States

Before estimating the costs of intimate partner violence, one needs to know how many women were injured nonfatally as a result of IPV; how many women used medical and mental health care services after IPV victimization; and how many women lost time from paid work and household chores after IPV. The National Violence Against Women Survey (NVAWS) provided that information. One also needs to know how many women died as a result of IPV. This information was obtained from the FBI’s Uniform Crime Reports Supplementary Homicide Reports (Fox 2000).

This chapter describes the findings of the NVAWS, along with the national estimates calculated from those findings. It also presents estimates of the number of IPV homicides. The data presented reflect the incidence of IPV and related health care service use in 1995; these data are the most appropriate, reliable data currently available about the health care costs associated with IPV.

 
Incidence and Prevalence of Nonfatal Intimate Partner Rape, Physical Assault, and Stalking

The NVAWS asked the 8,000 U.S. women ages 18 and older if they had been victims of IPV at any time in their lives or within the 12 months preceding the survey.

Intimate partner rape. Of the female NVAWS respondents, 7.7% had been raped by an intimate partner at some point in their lifetimes; 0.2% reported intimate partner rape in the past 12 months.¹ Extrapolating these percentages to U.S. Census population data, nearly 7.8 million women have been raped by an intimate partner at some time in their lives, and an estimated 201,394 women are raped by an intimate partner each year (Table 1).

Because some respondents reported multiple intimate partner rapes in the 12 months preceding the survey, the incidence of rape exceeded the prevalence. Women who were raped in that year experienced an average of 1.6 victimizations. This calculates to an estimated 322,230 rapes by intimate partners each year, an annual victimization rate of 3.2 intimate partner rapes per 1,000 women [322,230 rapes / 100,697,000 women = 0.0032 or 3.2 per 1000] (Table 2).

Intimate partner physical assault. The NVAWS found that 22.1% of women had been physically assaulted by an intimate partner at some time in their lives, and 1.3% reported such an event in the 12 months preceding the survey. Thus, an estimated 1.3 million women are victims of physical assault by an intimate partner each year (Table 1). Women who were physically assaulted by an intimate partner in the previous 12 months experienced an average of 3.4 separate assaults. Using these data, an estimated 4.5 million IPV physical assaults occur annually, a victimization rate of 44.2 per 1,000 (Table 2).

Intimate partner stalking. The survey found that 4.8% of women reported being stalked by an intimate partner at some time in their lives. One-half percent of women had been stalked in the 12 months preceding the survey, which equates to an estimated 503,485 women stalked by intimate partners each year (Table 1).

Because stalking, by definition, involves repeated acts of harassment and intimidation, and because no woman in the NVAWS reported being stalked by more than one intimate partner in the 12 months preceding the survey, the incidence and prevalence of intimate partner stalking are identical. Thus, the annual victimization rate for intimate partner stalking among women is 5.0 per 1,000 (Table 2).

 
Injuries Among Victims of Intimate Partner Violence

To explore the extent and nature of injuries associated with intimate partner violence, respondents disclosing rape or physical assault were asked whether they were injured during their most recent victimization, and if so, what types of injuries they sustained. Victims of stalking were not asked about injuries because the NVAWS definition of stalking does not include behaviors that inflict physical harm.

The NVAWS found that 36.2% of the women who were raped by an intimate partner sustained an injury (other than the rape itself) during their most recent victimization (Figure 1), and 41.5% of physical assault victims were injured (Figure 2). The majority of women who were injured during the most recent IPV episode sustained relatively minor injuries, such as scratches, bruises, and welts. Relatively few women sustained more serious types of injuries, such as lacerations, broken bones, dislocated joints, head or spinal cord injuries, chipped or broken teeth, or internal injuries.²

 
Victims’ Use of Medical Care Services

Respondents who were injured were asked if they received medical treatment and, if so, what type of care.³

NVAWS Findings
Of the women injured during their most recent intimate partner rape, 31.0% received some type of medical care, such as ambulance/paramedic services, treatment in a hospital emergency department (ED), or physical therapy (Figure 1). A comparable proportion (28.1%) of IPV physical assault victims who were injured received some type of medical care (Figure 2).

More than three-quarters of the rape and physical assault victims who received medical care were treated in a hospital setting (79.6% and 78.6%, respectively). Among women seeking medical care, 51.3% of rape victims and 59.1% of physical assault victims were treated in an ED, while 30.8% of rape victims and 24.2% of physical assault victims received some other type of outpatient service. Of those who were treated in a hospital, 43.6% of rape and 32.6% of physical assault victims were admitted and spent one or more nights in the hospital (Figures 1 and 2).

National Estimates of Medical Care Service Use
Of the estimated 322,230 intimate partner rapes each year, 116,647 result in injuries (other than the rape itself), 36,161 of which require medical care. And of the nearly 4.5 million physical assault victimizations, more than 1.8 million cause injuries, 519,031 of which require medical care. Nearly 15,000 rape victimizations and more than 240,000 physical assault victimizations result in hospital ED visits (Table 3).

Multiple medical care visits are often required for each IPV victimization. For example, victims of both rape and physical assault averaged 1.9 hospital ED visits per victimization, resulting in an estimated 486,151 visits each year to hospital EDs resulting from rape and physical assault victimizations (Table 4). Consequently, the total number of medical service uses exceeds the total number of victimizations resulting in medical care.

¹ Only 16 women participating in the NVAWS reported IPV rape in the 12 months preceding the survey. Estimates based on this small number are marginally stable and should be viewed with caution.

²For information about specific injuries, see Tjaden P, Thoennes N. Extent, Nature, and Consequences of Intimate Partner Violence: Findings from the National Violence Against Women Survey. Washington (DC): U.S. Department of Justice, Office of Justice Programs, National Institute of Justice; 2000. NCJ 181867.

³To yield more reliable estimates for service use, all most-recent IPV victimizations reported in the NVAWS— including those that occurred more than 12 months before the interview—were used to establish use patterns.

^a Estimates are based on the most recent intimate partner victimization since the age of 18.
^b The percentage of victims who received medical care is based on 158 responses from victims who were injured, excluding one "don’t know" response.
^c Estimates are based on responses from victims who received medical care.
^d Estimates are based on responses from victims who received hospital care.

Note: Total percentages for type of medical and hospital care received exceed 100 because
some victims had multiple forms of medical/hospital care.

Sources: Tjaden and Thoennes 2000; Bardwell Consulting, Ltd. (unpublished data) 2001.

Figure 2.
Percentage Distributions of U.S. Adult Female Victims of Intimate Partner Physical Assault by Medical Care Service Use, 1995

^a Estimates are based on the most recent intimate partner victimization since the age of 18.
^b The percentage of victims who received medical care is based on 598 responses from victims who were injured, excluding 4 "don’t know" responses.
^c Estimates are based on 168 responses from victims who received medical care, although the percentage of victims who received physician care is based on 166 respondents, excluding 2 "don’t know" responses.
^d Estimates are based on responses from victims who received hospital care.

Note: Total percentages for type of medical and hospital care received exceed 100 because some victims had multiple forms of medical/hospital care.

Sources: Tjaden and Thoennes 2000; Bardwell Consulting, Ltd. (unpublished data) 2001.

Victims’ Use of Mental Health Care Services

NVAWS respondents who were victimized by an intimate partner were asked whether they talked to a psychologist, psychiatrist, or other type of mental health professional about their most recent victimization, and if so, how many times.

NVAWS Findings
One-third of female rape victims, 26.4% of physical assault victims, and 42.6% of stalking victims said they talked to a mental health professional, most of them multiple times. Among these women, rape victims averaged 12.4 visits, physical assault victims averaged 12.9 visits, and stalking victims averaged 9.6 visits (Table 5).

National Estimates of Mental Health Care Service Use
Of the estimated 5.3 million rapes, physical assaults, or stalking incidents by intimate partners each year, nearly 1.5 million result in some type of mental health counseling.The total number of mental health care visits by female IPV victims each year is estimated to be more than 18.5 million (Table 5).

 
Victims’ Lost Productivity 

The NVAWS asked IPV victims whether their most recent victimization caused them to lose time from routine activities, including employment, household chores, and childcare. Victims who lost time from employment and household chores were asked how many days they lost from these activities. This information was then applied to the estimated number of women victimized each year by intimate partners to produce annual estimates of total lost productivity.

NVAWS Findings
Of adult female IPV victims, 35.3% who were stalked, 21.5% who were raped, and 17.5% who were physically assaulted lost time from paid work (Table 6). Women stalked by an intimate partner averaged the largest number of days lost from paid work (10.1). Women raped by an intimate partner lost an average 8.1 days from paid work, and victims of IPV physical assault lost 7.2 days on average per victimization (Table 7).

Among IPV stalking victims, 17.5% lost days from household chores; IPV rape and physical assault victims lost 13.5% and 10.3% respectively (Table 6). Victims of IPV rape lost the largest average number of days from household chores (13.5), followed by stalking (12.7) and physical assault (8.4) victims (Table 7).

National Estimates of Lost Productivity
According to NVAWS estimates, U.S. women lose nearly 8.0 million days of paid work each year because of violence perpetrated against them by current or former husbands, cohabitants, dates, and boyfriends. This is the equivalent of 32,114 full-time jobs each year. An additional 5.6 million days are lost from household chores (Table 7).

 
Intimate Partner Homicides Among Women

Data about fatal IPV were obtained from the Federal Bureau of Investigation’s Uniform Crime Reports (UCR) Supplementary Homicide Reports. Data in the UCR are submitted to the FBI by nearly 17,000 law enforcement agencies nationwide. In 1995, the same year as data from the NVAWS, 1,252 U.S. women ages 18 and older were killed by intimate partners.

Nearly 5.3 million intimate partner victimizations occur among U.S. women ages 18 and older each year. This violence results in nearly 2.0 million injuries and nearly 1,300 deaths. Of the IPV injuries, more than 555,000 require medical attention, and more than 145,000 are serious enough to warrant hospitalization for one or more nights. IPV also results in more than 18.5 million mental health care visits each year. Add to that the 13.6 million days of lost productivity from paid work and household chores among IPV survivors and the value of IPV murder victims’ expected lifetime earnings, and it is clear to see that intimate partner violence against women places a significant burden on society.

Bardwell Consulting, Ltd. Unpublished data for task order 0621-15, funded by the Centers for Disease Control and Prevention; 2001. Fox JA. Uniform Crime Reports [United States]: Supplementary Homicide Reports, 1976–1998 [Computer file]. ICPSR version. Boston (MA): Northeastern University, College of Criminal Justice [producer]. 2000. Ann Arbor (MI): Inter-University Consortium for Political and Social Research [distributor]. 2000. Available from: URL: http://www.icpsr.umich.edu:8080/ICPSR-STUDY/03000.xml.

Max W, Rice DP, Golding J, Pinderhughes H. Cost of Intimate Partner Violence Against Women in the United States, 1995; 1999. Unpublished report for contract 282-92-0048, funded by the Office of the Assistant Secretary for Planning and Evaluation and the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.

Tjaden P, Thoennes N. Prevalence, Incidence, and Consequences of Intimate Partner Violence Against Women: Findings from the National Violence Against Women Survey; 1999. Unpublished report for grant 93-IJ-CX-0012, funded by the U.S. Department of Justice, National Institute of Justice; and the Centers for Disease Control and Prevention.

Tjaden P, Thoennes N. Extent, Nature, and Consequences of Intimate Partner Violence: Findings from the National Violence Against Women Survey. Washington (DC): U.S. Department of Justice, Office of Justice Programs, National Institute of Justice; 2000. NCJ 181867.

Wetrogen SI. Projections of the Population of States by Age, Sex, and Race: 1988 to 2010, Current Population Reports, P25-1017. Washington (DC): U.S. Bureau of the Census; 1988.

Table 1. Percentage of NVAWS Respondents and Estimated Number of U.S. Adult Women Nonfatally Victimized by an Intimate Partner in Their Lifetimes and in the Previous 12 Months, by Type of Victimization, 1995

^a Percentage of respondents is based on NVAWS interviews with 8,000 U.S. women ages 18 and older.
^b Estimated number of women is calculated by applying the NVAWS percentage to the 1995 projected population estimate of women ages 18 and older in the U.S. (100,697,000).
^c Only 16 women participating in the NVAWS reported IPV rape in the 12 months preceding the survey. Estimates based on this small number are marginally stable and should be viewed with caution.
^d The individual types of victimizations do not sum to the total number of women victimized because some victims reported multiple types of victimization.

Sources: Tjaden and Thoennes 2000; Wetrogen 1988.

Table 2. Estimated Number of Nonfatal Intimate Partner Rape, Physical Assault, and Stalking Victimizations Against U.S. Adult Women, 1995

Type of Victimization	No. of Victims	Average No. of Victimizations  Per Victima	Total No. of Victimizations	Annual Rate of Victimization Per 1,000 Women
Rape	201,394	1.6	322,230b	3.2b
Physical assault	1,309,061	3.4	4,450,807	44.2
Stalking	503,485	1.0	503,485	5.0

^a The average number of victimizations per victim is based on the previous 12 months. Because stalking by definition means repeated acts, and because no woman was stalked by more than one intimate partner in the 12 months preceding the survey, the number of stalking victimizations was imputed to be the same as the number of stalking victims. Thus, the average number of stalking victimizations per victim is 1.0.
^b Relative standard error exceeds 30 percent. Based on 16 women who reported intimate partner rape in the previous 12 months, this estimate is unstable and used only as part of intermediate calculations to determine the total costs associated with IPV.

Sources: Tjaden and Thoennes 2000; Bardwell Consulting, Ltd. (unpublished data) 2001.

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Table 3. Estimated Victimization Outcomes and Medical Care Service Use by U.S. Adult Female Victims of Nonfatal Intimate Partner Rape and Physical Assault, 1995

Victimization Outcomes and Medical Services Used	Rape	Physical Assault	Total
Victimizations	322,230	4,450,807	4,773,037
Victimization resulting in injurya	116,647	1,847,085	1,963,732
Victimization resulting in some type of medical careb	36,161	519,031	555,192
Victimization resulting in:
Hospital carec	28,784	407,958	436,742
Physician carec	21,407	268,858	290,265
Dental carec	6,654	49,308	55,962
Ambulance/paramedic carec	7,377	77,336	84,713
Physical therapyc	8,100	46,194	54,294
Victimization resulting in hospital:
ED cared	14,766	241,103	255,869
Outpatient cared	8,865	98,726	107,591
Overnight cared	12,550	132,994	145,544

aDerived by applying the injury percentages (Figures 1 and 2) to the total number of victimizations.
bDerived by applying the medical care percentages (Figures 1 and 2) to the number of victimizations resulting in injury.
cThe number of victimizations resulting in each particular type of medical care (e.g., physician care) was derived by applying the percentage of victimizations resulting in that particular service (Figures 1 and 2) to the overall number of victimizations resulting in some type of medical care.
dThe number of victimizations resulting in each particular type of hospital care (e.g., ED care) was derived by applying the percentage of victimizations resulting in that particular type of care (Figures 1 and 2) to the overall number of victimizations resulting in hospital care.

Sources: Tjaden and Thoennes 2000; Bardwell Consulting, Ltd. (unpublished data) 2001; Max, Rice, Golding and Pinderhughes (unpublished data) 1999.

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Table 4. Estimated Average and Total Number of Medical Care Service Uses by U.S. Adult Female Victims of Nonfatal Intimate Partner Rape and Physical Assault, 1995

	Rape		Physical Assault		Rape and Physical Assault
Type of  Medical Service	Average No. of Uses	Total No.  of Uses	Average No.  of Usesa	Total No.  of Uses	Total No.  of Usesa
ED visits	1.9	28,055	1.9	458,096	486,151
Outpatient visits	1.6	14,184	3.1	306,051	320,235
Hospital overnights	3.9	48,945	5.7	758,066	807,011
Physician visits	5.2	111,316	3.2	860,346	971,662
Dental visits	2.3	15,304	4.4	216,955	232,259
Ambulance/paramedic services	1.3	9,950	1.1	85,070	95,020
Physical therapy visits	13.4	108,540	21.1	974,693	1,083,233

^a The total number of uses for each type of medical care service for rape and physical assault victimizations was derived by multiplying the total number of victimizations resulting in that medical care service (Table 3) by the average number of uses of that service.

NOTE: Estimates were derived separately for each type of victimization. Overall totals for service use were subsequently derived by summing the respective estimates across victimization types. Consequently, the overall average number of medical care service uses was not derived.

Sources: Tjaden and Thoennes 2000; Bardwell Consulting, Ltd. (unpublished data) 2001; Max, Rice, Golding and Pinderhughes (unpublished data) 1999.

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Table 5. Estimates of Mental Health Care Service Use by U.S. Adult Female Victims of Intimate Partner Violence by Victimization Type, 1995

Victimization and  Mental Health Use Estimates	Rape	Physical Assault	Stalking	Total
Total number of victimizations	322,230	4,450,807	503,485	5,276,522
Percent of victimizations resulting in mental health care services	33.0%	26.4%	42.6%	N/A
Number of victimizations resulting in mental health care services	106,336	1,175,013	214,485	1,495,834
Average number of mental health care visits per victimization	12.4	12.9	9.6	N/A
TOTAL number of mental health care visits	1,318,566	15,157,668	2,059,056	18,535,290

NOTE: Estimates were derived separately for each type of victimization. Overall totals for victimizations and mental health care visits were subsequently derived by summing the respective estimates across victimization types. Consequently, the overall percentage receiving mental health care services and overall average number of mental health care visits per victimization were not derived.

Sources: Tjaden and Thoennes 2000; Bardwell Consulting, Ltd. (unpublished data) 2001; Max, Rice, Golding and Pinderhughes (unpublished data) 1999.

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Table 6. Estimated Percentage of Victims and Number of Nonfatal Victimizations of Intimate Partner Rape, Physical Assault, and Stalking Against U.S. Adult Women, by Time Lost from Paid Work and Household Chores, 1995^a

Victimization Type	Activity	Percent Victims	Number of Victimizations
Rape	Paid Work	21.5	69,279
	Household Chores	13.5	43,50
Physical assault	Paid Work	17.5	778,891
	Household Chores	10.3	458,433
Stalking	Paid Work	35.3	177,730
	Household Chores	17.5	88,110
TOTAL	Paid Work	N/A	1,025,900
	Household Chores	N/A	590,044

^aEstimates are derived from the NVAWS based on the most recent intimate partner victimization since age 18.

NOTE: Victimization estimates of time lost from both paid work and household chores were derived separately for each victimization type. The total number of victimizations was subsequently derived by summing the respective estimates across victimization types. Consequently, the overall percentages of victims reporting time lost from paid work and household chores were not derived.

NOTE: See Appendix A for calculations of lost productivity and related values.

Sources: Tjaden and Thoennes (unpublished data) 1999; Bardwell Consulting, Ltd. (unpublished data) 2001.

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Table 7. Estimated Lost Productivity Among U.S. Adult Female Victims of Nonfatal Intimate Partner Violence, by Victimization Type and by Time Lost from Paid Work and Household Chores, 1995 ^a

		Days Lost
Victimization Type	Activity	Average	Total	Lost Full-Time  Job Equivalentb
Rape	Paid Work	8.1	561,160	2,263
	Household Chores	13.5	587,264	N/A
Physical assault	Paid Work	7.2	5,608,015	22,613
	Household Chores	8.4	3,850,837	N/A
Stalking	Paid Work	10.1	1,795,073	7,238
	Household Chores	12.7	1,118,997	N/A
TOTAL	Paid Work	N/A	7,964,248	32,114
	Household Chores	N/A	5,557,098	N/A

^aEstimates are derived from the NVAWS based on the most recent intimate partner victimization since age 18.
^bThe estimates of lost full-time job equivalents for paid work conservatively assume 248 work days per year.

NOTE: Victimization estimates of the average and total number of days lost from both paid work and household chores were derived separately for each victimization type. The overall total number of days lost was subsequently derived by summing the respective estimates across victimization types.
Consequently, the overall average number of days lost from paid work and household chores were not derived.

NOTE: See Appendix A for illustrations of calculations of lost productivity and related values.

Sources: Tjaden and Thoennes (unpublished data) 1999; Bardwell Consulting, Ltd. (unpublished data) 2001.

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