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When Women's Health Improves, Domestic Violence Diminishes

Chronically ill low-income women who thought they were dying experienced a sharp reduction in domestic violence after getting access to a life-saving treatment, a Johns Hopkins University-led study found.

The results, featured in a National Bureau of Economic Research working paper and highlighted in the bureau's latest Bulletin on Aging and Health, demonstrate for the first time how improving women's health can reduce cases of abuse by roughly 10%.

"When these women who thought they were going to die realized this new treatment gave them many years to live, they faced stronger incentives to avoid abusive partners," says lead author Nicholas Papageorge, a Johns Hopkins economist.

Previous research shows a connection between poor health and domestic abuse, of which there are an estimated 4.5 million cases a year just in the United States. But until now researchers say no one has looked at whether improving women's health could change their likelihood of suffering domestic violence.

To test this, Papageorge and his coauthors returned to a singular moment in health care history, the introduction in 1996 of HAART, or highly active antiretroviral therapy, which transformed HIV infection from a virtual death sentence into a manageable condition.

The Women's Interagency HIV Study, an ongoing study that began in 1994, offered the authors a chance to see how HIV-positive and -negative women behaved before and after the treatment was available. The women in the pool were mainly low-income, non-white and below national averages for education and employment.

When HAART came on the market, instances of domestic violence dropped by roughly 10 % for women with HIV who had symptoms of the disease, compared to control groups of healthier HIV-positive women, the researchers found. Drug use, including crack cocaine and heroin, also dropped, by 15%, in the same pool of women. The drops in both domestic violence and drug use were even greater when looking at just black women in the same groups.

"We think the reduction happened because the women experienced a change to their expected health and longevity. They also experienced better prospects on the labor market," Papageorge says. "We started seeing changes immediately after the introduction of the treatment. Though it is difficult to say with our data, there is some evidence that women not only left violent partners, but were also less likely to get into violent partnerships in the first place."

Papageorge says the findings suggest that giving women greater access to better health care can have far-reaching implications, even for abuse and addiction—two of the United States' most frustratingly persistent social problems. Better health care also seems to change outcomes by offering hope for a better life to women in seemingly hopeless positions—those plagued by poverty, lack of education and under-employment.

"With other domestic violence interventions, women tend to go back. But here the change was medical and the women decided to make it on their own. They took this second chance and ran with it," Papageorge says. "This could be a longer-lasting change that keeps them away from these partners in the long run."