A Hidden Cost of Domestic Violence: How Big Is This Secret Epidemic?

An abusive man may stomp on his partner’s head and neck, wearing his heavy work boots. Or he might hit her head repeatedly against a wall, at least twice a week, for a year. Maybe he pushes her so hard she falls and knocks her head against a massive piece of furniture, giving her a concussion. Perhaps he strangles her until she loses consciousness, and when she wakes up, he does it again.

Brain injuries to women, from intimate partner violence, are often unidentified and untreated. Shutterstock

Most domestic violence injuries are blows to the head or neck or face — you’ve seen that iconic image on a poster of a woman with a black eye. Strangulation cuts off oxygen to a woman’s brain. Often the results are undetected. At a recent Webinar on domestic violence produced by the Annenberg Center for Health Journalism at the University of Southern California, two neuroscience researchers at the Harvard School of Public Health spotlighted a hidden cost of intimate partner violence: brain injuries in women, mostly unidentified and untreated.                       

Dr. Julianna Nemeth

In March 2021, Brain Injury Awareness Month, the National Indigenous Women’s Resource Center sponsored a Webinar with Rachel Ramirez, founder and director of the Center on Partner-Inflicted Brain Injury at Ohio Domestic Violence Network. Ramirez works with a research partner, Dr. Julianna Nemeth, domestic violence advocate turned public health scientist at Ohio State University, to raise awareness of brain injuries among survivors and advocates. During the webinar, Ramirez detailed the myriad adverse physical, psychological, emotional and behavioral effects for brain injury survivors. Left undiagnosed and untreated, Ramirez said, these injuries can be “very disabling.”

Ramirez points out that athletic injuries happen before an audience, whereas partner violence is inflicted in private. Soldiers and athletes with brain injuries are almost all men. But there are important sex differences between men and women regarding brain injury; women’s physiology is distinct. Ramirez and Valera both work closely with Pink Concussions, which promotes the study of brain injuries in girls and women from any cause, including intimate partner violence.

Rachel Ramirez

Both the military and most sports have plenty of resources, Ramirez adds, so any soldier or athlete with a brain injury can receive the best possible care and rehabilitation. Abusive intimate partners, however, often isolate victims from health care and other sources of help.  Finally, Ramirez says, victims are often blamed for their own injuries, and the subject of intimate partner violence can carry a stigma, even in academia.

To carry out her initial research gathering data, Valera had to ask her university for small grants to offer survivors $5 McDonald’s gift cards to thank them for spending time with her, being interviewed and tested. She said that because women suffering effects of brain injuries are often misunderstood by law enforcement and doctors, some subjects found the process therapeutic. But she had to rely on interns’ free help to get the women’s brain scans done. She had to work with her program officer at the National Institute of Health to switch grant review committees after the first deadlocked over the value of her work.

Dr. Eve Valera

But recently, Valera and Ramirez say, prospects have brightened. In June 2020, at Congress’ behest, the General Accounting Office released a report on 12 non-government initiatives in nine states that were gathering data on brain injuries in domestic violence survivors, and included some of Ohio Domestic Violence Network’s educational materials. The GAO concluded there was no dedicated funding for this topic, and that Health and Human Services and NIH should find out how big a public health problem it is, and provide funding accordingly. HHS has agreed with the GAO’s findings. NIH has awarded Valera a six-figure grant, finally.

Nevertheless, Ramirez says she and Valera “live in a very small world. There aren’t many new friends to make” among those studying the link between women’s brain injuries and intimate partner violence, even though the few are “very passionate and very collaborative.” When it comes to getting attention, "the NFL, which leads studies of concussion and whose players get the best medical care, and the women who come to us are at opposite ends of the spectrum.”

 Ann Marie Cunningham is a Columbia University Lipman Fellow for 2020 who will be working with the Mississippi Center for investigative Reporting. She is a veteran journalist/producer and author of a best-seller. Her work has appeared in The New York Times, Los Angeles Times, Technology Review, The Nation and The New Republic. Contact her at amc@mississippicir.org.