NEW YORK — According to the surgeon general, the single major cause of injury to women is not car crashes, muggings or accidents at home or work. It is beatings from their husbands or boyfriends.
Domestic violence seriously affected an estimated 3.5 million women and their children last year, according to women's groups.
It is believed violence is a common occurrence in 15% of America's 47 million couples, and that an episode of domestic violence occurs at least once in half of all couples.
"Most people don't think about battering as a health care issue but the U.S. surgeon general has said it is the single most common cause of injury to women," said Marcia Niemann, director of the National Coalition Against Domestic Violence. "Women suffer bruises, broken bones, bites.
"But most women say the psychological damage--the fear, intimidation, the sexual abuse--is worse than the battering that goes with it," she said.
There have been few well-researched studies of why some men beat women and why some women put up with it, psychologists say.
"It's a relatively new field and research is just beginning," Niemann said. "Obviously there are many ethical concerns about doing research on women whose lives are at stake."
However, researchers have noted that domestic violence tends to escalate over time.
"It starts with him putting his fist through the door or deliberately hurting the family pet," Niemann said. "After that comes violent shoving and then beating, kicking, punching, weapons and threats of death. Sometimes it is death."
Researchers in the field said it appears pregnancy may trigger the first episode of violence and that pregnant women are more likely to be beaten.
"Pregnancy usually marks the first time or a high risk time," said Mary Ann Douglas, professor of psychology at Nova University in Fort Lauderdale, Fla., who has studied domestic violence.
"The belief that hurting pregnant women in our society is taboo is a myth," Niemann said. She said surveys indicate one out of every 12 pregnant women are beaten, shoved or harmed by their partners.
'Insecure or Jealous'
"Many batterers are insecure or jealous," she said. "It could be the attention a pregnancy receives triggers him into wanting to assert more control. We just don't know."
Niemann said studies suggest more women enter emergency rooms because of domestic beatings than for any other reason, but said few hospitals are equipped to help them.
"They may not ask, or if they ask, they don't deal with the answer," Niemann said of emergency health care workers. "They concentrate on healing whatever is wrong without dealing with the factors behind it."
Douglas said a woman may attempt to leave an abusive relationship five or six times before she eventually does so.
Most abuse follows a cycle, starting with a build-up of tension, then the beating is followed by a make-up period when the man is contrite and the woman is hopeful he will change.
"Most women go back during this last phase because they have hope," she said. "There are also economic reasons, the difficulty of a woman in this society living on her own, raising children."
"Many women are taught they are nothing without a man," she said. "They are taught the relationship is her responsibility. She has to make it good."
At All Levels in Society
The researchers said it appears that domestic violence crosses all social and economic lines, although poor women are more likely to seek help from agencies than are wealthy women.
"The one who flies across the country to visit her sister for a few days, we don't see," Douglas said. "That doesn't mean wealthy, educated women don't get beaten."
In the past decade the number of shelters for battered women has increased from a dozen to 1,200 nationwide, researchers said.
"We've found the best way to help battered women is to have them talk with their peers," Niemann said. "When they find they are not the only ones, when they open up and just talk about their secrets, that's a major relief to them."
The researchers said neighbors, friends and family members of battered women should offer support but should not tell the victim what to do.
"She already has someone in her life trying to control her," Douglas said.