Mulder & Chang

Domestic Violence in Rural Communities: A Literature Review and Discussion

Pamela L. Mulder, Marshall University & Alice F. Chang, University of Arizona

Abstract

Twenty-five percent of the United States population lives in regions designated as rural. However, the needs of rural residents have frequently been overlooked in favor of more readily identified urban concerns. There is no single, best definition of "rural;" this large population includes members of every cultural and ethnic group and crosses all economic boundaries. Hence, no individual community, region, or style of life can be considered representative of the entire "rural" population.

Although culturally and economically diverse, rural residents across the United States face many common challenges and have many similar needs. Many of the mental health problems confronted by rural residents are similar to those of urban dwellers. Domestic violence, for example, is neither less prevalent nor less lethal in rural communities than in metropolitan settings.

However, mental health concerns and problems are uniquely expressed in rural communities. The socio-cultural environment in which family violence and other maladaptive patterns occur differs tremendously from urban to rural settings, as do the availability, nature, and effectiveness of mental health services, support systems and interventions.

This commentary offers a review of literature which suggests that the rural socio-cultural environment will have a unique impact on the manifestation and outcome of domestic violence. Based on this review, the authors offer some suggestions for intervention and highlight the importance of culturally sensitive, community-based interventions.

The rate of violent crime in rural areas, including both rape and assault, has tripled during the last three decades. A comparison of domestic violence rates across urban, suburban and rural populations demonstrated that, although women residing in the inner cities were more likely to be victims of violent crimes, rural and urban women were equally at risk for violence perpetrated by an intimate partner (Bachman, 1992; 1994). It is estimated that at least half of all domestic violence incidents are unreported and that from one third to one half of all homicides in rural areas involve violence within the family; the majority of these victims are women.

Socio-cultural factors influence the manifestation and outcome of violence. To the extent that specific socio-cultural factors have a unique impact on rural communities, it is reasonable to speculate that the nature and outcome of domestic violence incidents may differ from those which occur in more urban settings. It is also reasonable to suggest that interventions should be designed to address the specific nature of the problem under consideration. For example, one distinction between rural and urban violence is that rural women who are victims are more likely to know their attacker (Monsey, Owen, Zierman, Lambert & Hyman, 1995). This finding alone suggests that assessment and intervention issues may be different in rural areas.

Despite the diversity of the rural population, certain socio-cultural factors are common, though not universal, characteristics of rural communities. This article provides a brief review of the literature related to the most frequently identified factors and discusses possible implications for domestic violence intervention. Based on conclusions suggesting that culturally sensitive, community-based interventions against domestic violence are needed in rural communities, the article presents a brief review of the literature concerning such interventions and offers additional suggestions for consideration.

Common Socio-cultural Characteristics of Rural Communities

Isolation

The geographic isolation commonly experienced by rural families limits opportunities for identification of domestic violence and for timely intervention (Monsey, et. al., 1995). Great distances may separate not only communities, but individual family homes as well. These distances may be spanned by mountainous terrain, impassable waterways, or large gorges.

Transportation and communication difficulties are common. Public transportation is usually extremely limited or non-existent in rural areas. Many families do not have an automobile or have only one vehicle which is not equally available to all members of the family. Weather conditions may render roads impassable for lengthy periods. The expense of providing reliable telephone service in geographically challenging regions is often prohibitive and many rural families do not have telephones in their homes (Feyen, 1989; Mulder, Daugherty, Teel, Midkiff, Murray & Smith, 1994; Navin, Stockum, & Campbell-Ruggaard, 1993).

In contrast to urban areas, rural isolation decreases the probability that a domestic violence incident will be witnessed by objective others and increases the abuser's capacity to actively prevent the victim's escape. It is not uncommon for rural victims to report that their abuser controlled the access to any vehicles, refused to allow the victims to drive (or to learn to drive), and/or disabled any existing telephone system, or took other steps to isolate victims from emotional support and sources of assistance (Navin, et. al., 1993).

Economics

Increased frequency and severity of abuse have been associated with higher levels of women's economic dependence (Kalmuss & Strauss, 1982). Although economic conditions vary across rural communities and groups, chronic, persistent poverty is common, particularly in the southeast, southwest and Appalachian region (Rowley, 1995) and rural economics are generally unfavorable to women (DeLeon, Wakefield, Schultz, Williams & VandenBos, 1989; Ieda, 1986; Navin, et al, 1993). In many rural areas, there are no jobs for women; in other rural regions, women may be more likely to find employment than their male partners, but the jobs available to them tend to be menial and low paying with little or no opportunity for economic advancement (Byers, 1993; Rowley, 1995). Because rural women may be more willing to accept such positions, particularly when unemployment rates for men are high, working mothers may violate entrenched sex role stereotypes. The wife's capacity to function as a breadwinner when the husband cannot often places even greater strain on the rural home (Ergood & Kuhre, 1978; Flora, Flora, Spears & Swanson, 1992; Gochros, 1974).

The strong socio-cultural emphasis on marriage and motherhood commonly observed in rural communities has an impact on the educational and occupational choices made by rural women. Women in rural communities are often undereducated in comparison to those who live in more urbanized settings (Rowley, 1995) and, on the average, they tend to marry earlier and to have children at a younger age (Flora, Flora, Spears & Swanson, 1992). Many rural working mothers must commute long distances and those who work outside the home often continue to bear virtually all of the responsibility for maintaining the home and raising the children as well (Gagne, 1992). The serious lack of child care facilities in rural America further limits the rural woman's opportunities for economic independence (Navin, et al., 1993).

Lack of Services

Victims who seek assistance in rural areas are hampered by the lack of adequate services. Hospitals, mental health centers and emergency shelters are usually few in number and are typically difficult to access because of distance or other geographic barriers. Rural service agencies often lack funding and tend to be staffed by less qualified personnel than those in more urban regions and rural Americans are less likely to have health insurance (Bogal-Allbritten & Daughaday, 1990; Olsen, 1988). Health professionals, including psychologists and physicians, are also fewer in number and are usually concentrated in more metropolitan areas (Rowley, 1995; U. S. Congress, Office of Technology Management, 1990).

Community mental health centers are located to meet catchment area requirements with the result that many rural counties do not have community mental health services within their own borders (U. S. Congress, Office of Technology Management, 1990). Although understaffed and under funded, individual rural agencies are frequently expected to serve the residents of several counties, often including many culturally distinct groups (Bogal-Allbritten & Daughaday, 1990; Navin, et al., 1993; Wagenfeld, Murray, Mohatt & De Bruyn, 1994).

There are significantly fewer emergency shelters for domestic violence victims in rural communities than in metropolitan regions (National Coalition for the Homeless, 1997) and, because economically depressed rural areas typically lack services and opportunities of many kinds, the rural victim's decision to go to an emergency shelter may result in greater lifestyle disruption than would result from a similar decision in an urban environment. The nearest shelter may be so distant from her home community that the victim risks forfeiting one of a very few, highly coveted jobs or child care placements and separation, perhaps for the first time in her life, from her emotional support system.

Police agencies in rural communities typically cover very broad geographic service areas with limited personnel and equipment (Feyen, 1989). Law enforcement personnel are often unwilling to respond to calls for help in domestic violence incidents (Feyen, 1989) and rural women do not necessarily believe that the police can help them (Schecter, 1982). Overall, criminal justice systems are less likely to be utilized in rural battering cases (Abel & Suh, 1987).

Social Norms

The anonymity which exists in metropolitan settings is not possible in rural areas. Confidentiality is of particular concern for rural residents who fear stigmatism, not only for themselves but for family or clan members. The residents of small, isolated rural communities not only know one another to an extent unimagined in an urban setting, the members of the community frequently have a common history which may have spanned several generations. The police officer who responds to a domestic violence call may have a close personal relationship with the abuser, as may the local physician, nurse, psychologist, minister or other available resource.

Although the rural population, as a whole, is culturally diverse, and tremendous diversity can be found in large rural counties, there is often very little diversity within small, individual rural communities (Rowley, 1995; Spears, 1996). Often there is a socially accepted, but largely unspoken, understanding of "how things are done around here." The lifestyle lived by one's parents and grandparents may, over the generations, have taken on a normative value and any deviation can constitute a stigmatizing event capable of defining an individual's (or family's) identity for generations to come . Women are commonly held responsible for any loss of family stature which follows a report of family violence (Alsdurf, 1985; Navin, et. al., 1993; Szikla, 1994). Fear of the personal stigma associated with "breaking up" the family unit often prevents women from reporting (American Bar Association Commission on Domestic Violence, 1997).

Many of the characteristics commonly associated with rural communities are likely to limit the rural victim's potential for both support and escape. In small, isolated communities, violence against women may become a tolerated, even socially accepted norm. Frequently, given "the way things are," a battered woman's female friends and relatives have also been victims of partner perpetrated abuse and the support that a victim receives may be limited by a general unwillingness to disrupt community life. Considering the lack of anonymity and the compounding lack of available services, the degree to which a battered woman can receive objective and confidential assistance in many rural communities is questionable at best (Davenport & Davenport, 1979). As a result, when domestic violence has become a pattern in a family across generations or is silently tolerated by community members, older women who have been victims may fail to support efforts by younger wives to escape from or change the pattern (Dobash & Dobash, 1979, Szikla, 1994). Many rural clients report that friends and family members urged them, time after time, to maintain silence (American Bar Association Commission on Domestic Violence, 1997).

Infrequently challenged, local norms often support an authoritarian status quo based on male domination. The patriarchal, traditionalist character of many rural communities fosters women's dependence, limits help seeking behavior, maintains a pathological status quo and restricts individual development while simultaneously lessening the likelihood that an abusive partner will be censured (Szikla, 1994).

Hull and Burke (1991) reported results suggesting that males who had perpetrated serious levels of sexual abuse expressed more negative attitudes toward women than those who had not. Perpetrators also supported traditional sex roles, with women having primary responsibility for child rearing and housekeeping. Other typical opinions of these batterers were that the husband should have greater authority in the home than the wife and that women's social, political and economic rights should be more limited than those of her husband. Hull and Burke (1991) also found that women who had been victims expressed similarly negative views toward their own gender.

The division of labor in many rural communities is often extremely gender stereotyped. Rural women may be socialized to adopt "feminine" attitudes including dependence on, and subservience to, men (Tice, 1990). Many rural communities are defensive with regard to "feminist" activities and conservative rural women, who place tremendous value on their roles as wives and mothers, typically reject any identification with concepts that are "feminist" as potential threats to the traditional family structure (Gagne, 1992; Mangis, 1995; Tice, 1990; Whipple, 1987).

Escape from a battering relationship and recovery from sexual assault are most likely when the victim has support from important others, a good level of self esteem and a sense of power (Caplan, 1985). However, battered women have been found to exhibit similar patterns of behavior, including low self esteem, dependence, anxiety, denial, learned helplessness, guilt, shame, psychosomatic complaints, depression and withdrawal (Claerhout, Elder & Jones, 1982; Hartik, 1982; Ieda, 1986). Women who remain in abusive relationships often blame themselves, accepting responsibility for the abuser's behavior and presenting a passive facade which facilitates the denial of their own anger and terror (Hull & Burke, 1991; Navin, et al., 1993).

Interventions and Conclusions

Rural women frequently seek support in the traditional value systems of their culture, including close knit families, religious affiliations and community familiarity. Interventions which are clearly in opposition to the socio-cultural values of a given rural population are unlikely to be successful. These formal and informal community support systems, however, have been described as harmful and oppressive as often as they have been lauded (Alsdurf, 1985; Whipple, 1987). Certain religious dogmas and culturally determined concepts of family and the role of women increase the potential for violence by providing self-serving justification for the perpetrator's behavior, and simultaneously limiting the victim's self efficacy expectations and problem solving efforts, lessening the likelihood that clients in need of services will seek out, and benefit from, the assistance of mental health providers (Feyen, 1989; Szikla, 1994; Whipple, 1987).

Rural women are unlikely to seek the services of a psychologist as a first choice. Most of the women included in the sample of rural Appalachian women surveyed by Mulder, et al (1994) reported that they would hesitate to seek psychological intervention, citing concerns involving confidentiality and social stigma. Significantly, more than half of the respondents associated psychology with atheistic and immoral practices and beliefs. Therefore, those women who do seek psychological intervention often face ostracism.

Ministers or other culturally appropriate religious leaders and physicians or other medical personnel are frequently cited as the first resources consulted by rural women in distress (Byrne, 1977; Feyen, 1989; Meystadt, 1984; Pagelow, 1982; Roy, 1982). Acceptance of mental health interventions in rural communities is enhanced by interdisciplinary associations with other primary care providers. It is also obviously important to establish collaborative and cooperative relationships with local religious authorities, shamans, healers, teachers, school administrators, law enforcement personnel and other individuals identified by the indigenous population who may have equally important, if less formalized, leadership positions in the community.

The rural clinician must first understand the accepted norms, religious beliefs and cultural identities of the women to be served, then it will be possible to design intervention strategies which will accomplish the objective of violence reduction without endangering the woman's sense of self and of belonging in the community. Effective collaborative interventions may require clinicians to re-examine their methods and their goals. The clinician must be willing to consider the end of the violence in a family to be an entirely acceptable goal even when there is no indication of significant change in gender attitudes or when the end of violence is brought about by non-psychological procedures (such as prayer, ritual, or religious censure). Clinicians may also be forced to acquiesce to local norms for women, actively exploring alternatives to marital separation and divorce. Although the cultural values of the clients may differ from those of the clinician and despite the probability that norms which foster subservience and dependence would not be those which the clinician considered ideal, traditional support systems can offer the open minded, flexible, culturally sensitive clinician a compassionate framework within which their healing efforts can be effective. Furthermore, this does not preclude attitude change and facilitation of empowerment and independence. Rather, these broader goals are more likely to be accomplished when they are introduced with "gentle perseverance" within the context of a non-threatening collaborative effort.

Interventions and models which may be effective in urban areas do not necessarily represent the best solutions for rural communities ( Monsey, et. al., 1995). For example, the individual therapy model based on 50 minute sessions conducted on a weekly basis is not particularly effective in rural communities. Transportation problems and inclement weather often prevent clients from keeping regular appointments. The lack of accessible mental health services in many rural areas often results in an extremely high ratio of 'persons in need' to available service providers (Rouse, 1995). Recent changes in third party payment opportunities and anticipated declines in public assistance are both likely to result in financial burdens for rural private practice clinicians. Stigma associated with the traditional therapy model is a barrier to service provision that can be avoided when other strategies are employed.

Community based collaborative interventions which emphasize culturally sensitive education and self-help components are often of great value in rural areas (Monsey, et. al., 1995). Consultation and organizational interventions which involve training and mobilizing indigenous paraprofessionals can enhance service provision for a broad client population, are generally more sensitive to the socio-cultural environment, and are more likely to be self-sustaining even in the absence of the founding professional.

Actual interventions will vary from one rural community to another. The suggestions for interventions offered here are examples which are specific to the issues outlined in this paper. These examples represent only a small fraction of potentially useful ideas and they have been included with the intention of facilitating ongoing constructive discussion and exchange.

The rural psychologist who intends to intervene against domestic violence should consider going to those locations which women with limited transportation can, and will, access. Mobile medical units, schools and churches are all potential "office" sites. These same sites are often appropriate, non-threatening meeting places for offender and substance abuse self help meetings, can be excellent resources during volunteer and paraprofessional recruitment activities, and are invaluable in attempts to broadly disseminate information. Self help literature for domestic violence victim should be available at locations which are readily accessible to women and which offer some degree of privacy, such as the women's restrooms at supermarkets, schools, and medical clinics.

Prevention programs are often welcome additions to school curricula and can be of value to children and teenagers of both genders. These must be designed in collaboration with educational personnel and the support of the teachers and administrators must be actively solicited. Open and frank presentation of the issues in the classroom in addition to educational materials related to making personal choices and careers may produce long term benefits for rural youth. Teachers and peer counselors, with appropriate training and supervision, can provide non threatening opportunities for young people to begin dealing with issues related to family violence. Asking students to prepare and offer a presentation on the topic of family violence at meetings attended by parents and other community members may help to reinforce material that has been learned.

The founding of "safe houses" has proven to be very effective in rural areas (Edleson & Frank, 1991). Edleson and Frank (1991) point out that access to a crisis hotline is very important in rural communities. Hotlines are readily established and can be staffed by volunteers from their own homes. Volunteers from the community or the surrounding area, properly trained, would be able to offer information concerning specific assistance that may be locally available although concerns about anonymity and confidentiality require careful consideration.

The variety of possible interventions and the points at which interventions are applied are as varied as the communities themselves. To be successful, programs designed to reduce or eliminate family violence must be perceived as culturally appropriate. From this vantage point, attitudes in opposition to those which support abuse can be fostered and accepted. Over time, these new but accepted norms and can become a part of "the way things are."

It is very likely that domestic violence in rural communities will be expressed somewhat differently than abuse in more urbanized areas. It is equally likely that effective interventions will differ across regions, cultures, and social classes. Yet it is also reasonable to assume that there will be overlapping aspects of successful interventions, just as there are overlapping concerns, and that these aspects can provide a basis on which to establish other, more culturally specific programs. This commentary has been intended to open discussion and to elicit ideas and information from the clinicians and researchers who are on the "front lines" in rural communities. By sharing ideas and the results of empirical study, domestic violence in rural communities can be addressed.

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