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Women in the US also emphasize the power of validation, noting that it provided “relief,” “comfort,” “planted a seed,” and “started the wheels turning” toward changing their perception of their own situation (171). Some of the ways in which health workers can promote healing for women living with violence are described in the “Empowerment Wheel” used in violence prevention training (see Pullout Guide).

Even if an abused woman does not disclose the violence on a first visit, asking about it shows that the clinician cares, and thus she may decide to talk about it later. While health workers ideally should coordinate their actions with community-based services, such as local women's groups, providers can take several useful actions immediately during the clinic visit (350, 460):

1. Assess for immediate danger. Find out whether the woman feels that she or her children are in immediate danger. If so, help her consider various courses of action. Is there a friend or relative who can help her? If there is a women's shelter or a crisis center in the area, offer to make contact. Some hospitals and clinics have adopted explicit policies allowing abused women to be admitted overnight if it is unsafe for them to return home (243, 277). Leaving a violent partner temporarily does not necessarily end the violence, however. The most dangerous moment for a woman with an abusive partner is often immediately after she leaves or decides to leave a relationship (60).

2. Provide appropriate care. For women who have suffered sexual assault, appropriate care may include providing emergency contraception and presumptive treatment for gonnorhea, syphilis, or other locally prevalent STIs. Unless clearly necessary, clinicians should avoid prescribing tranquilizers and mood-altering drugs to women who are living with an abusive partner since these may impair their ability to predict and react to their partners' attacks.

3. Document women's condition. Few providers adequately document cases of abuse against women. In Johannesburg, South Africa, a review found that in 78% of cases of abuse providers had not recorded the identity of the perpetrator. Clinical records included such graphic but general descriptions as “chopped with an axe” or “stabbed with a knife” (313).

Hesperian Foundation (54)

Most health care providers can do more to document cases of abuse.

4. Develop a safety plan. Although women cannot prevent violence from recurring, and they may not be ready to report their partner to the police, there are ways that they can protect themselves and their children. These include keeping a bag packed with important documents, keys, and a change of clothes, or developing a signal to let children know they need to seek help from neighbors. Health care providers should review a sample safety plan with the woman and decide together which actions may help in her situation (see Developing a Safety Plan of the Pullout Guide). Sample safety plans can also be taped to clinic bathroom and examining room walls, where women can read them without embarrassment.

5. Inform women of their rights. When a woman takes the step of disclosing her situation, it is crucial that medical practitioners reaffirm that the violence is not her fault and that no one deserves to be beaten or raped. The penal codes of most countries criminalize rape and physical assault, even if specific laws against domestic violence do not exist. Medical staff should find out what legal protections exist for victims of abuse and where women and children can turn for genuine help in enforcing their rights.

6. Refer women to community resources. Health care providers can help victims of abuse by identifying them early and referring them to available local resources. The needs of victims generally extend beyond what the health sector alone can provide. Therefore it is essential that health care providers know in advance what other resources are available to help victims of abuse. It is especially useful for health workers to meet personally with others who provide services for victims of violence because a provider will be more likely to refer a woman to someone whom they know—when there is a face behind the name.