Spanish Intimate Partner Violence Survivors Help-Seeking Strategies Across the Life Span

Abstract

Intimate partner violence (IPV) and its associated factors may vary according to women’s age. In this study, we analyze the effect of age on help-seeking behavior and the associated factors among women exposed to IPV in Spain. Using the Spanish Macrosurvey on Gender Violence of 2014, we analyzed the frequency of help-seeking behavior (police report, formal resources, and informal networks of support) in women who were exposed to lifetime physical/sexual or fear-based IPV (n = 1,567 women). We used Poisson regression models to obtain variables associated with support resources. The analysis was carried out in three age groups: young women (16–29 years old), adults (30–49 years old), and older women (50 years and over). Our results show that informal support networks are the most used resource by all women´s age groups. The probability of filing a police complaint increases among women exposured to physical IPV (PR_adult : 1.58;  PR_elder : 2.17 ). The probability of using formal resources decreased among older women with low family socioeconomic status (PR: 0.80) and in adult women exposed to sexual IPV (PR: 0.78), and increased among young women and adult Spanish women (PR_young: 1.65; PR_adult: 1.34). The use of informal support networks increased among adult women with physical and mental health effects (PR: 1.22). In older women use of informal support networks was associated with the type of IPV (PR_physical: 1.14; PR_sexual: 0.88). The presence of minors who witnessed IPV increased help-seeking behavior among adult and older women.

In conclusion, the knowledge of the differences in help-seeking strategies by women in different age groups could contribute to designing strategies to promote women’s ability to seek formal help when exposed to IPV.

Keywords

intimate partner violence help-seeking behavior age groups surveys Spain sociodemographics social support

Introduction

Intimate partner violence (IPV) is a public health problem that is present around the world; it varies greatly among and within countries (Garcia-Moreno et al., 2006; Sanz-Barbero et al., 2015; World Health Organization, 2013). The risk of IPV within a country varies depending on the characteristics of women and their aggressors (age, place of origin, migratory, and/or socioeconomic status), couple relationships and the other social realities, such as cultural norms and the legal system of the country of residence (Fleming et al., 2015; Sanz-Barbero et al., 2014, 2015).

Women’s age is related to changes in the types of IPV they are exposed to as well as the associated factors. While psychological IPV is greater among younger women (16–29 years old), the severity of physical IPV is greater among adult women (30–49 years old) (Sanz-Barbero et al., 2019). In older women (50 years and over), physical/sexual IPV seems to decrease, but economic IPV tends to increase with age (Pathak et al., 2019; Stöckl & Penhale, 2015). In adult women, the probability of experiencing all types of IPV increases among immigrant women, unemployed women, and those without social support (Sanz-Barbero et al., 2019).

In all cases, independently of social circumstances or a woman’s age, help-seeking, defined as the active search for advice, information, treatment and support in response to a problem that cannot be solved on one’s own, could determines how women fare (Rickwood et al., 2005). In the case of IPV, the search for help could allow women to obtain distance from IPV, increasing their own safety and that of their children, and helping them to cope and recover their wellbeing. It could also reduce their risk of suffering from repeated episodes of IPV in the future (Rivas et al., 2019). The search for help might involve filing a complaint against the aggressor, looking to formal resources or professional services (social services, health services, organizations, etc.), and/or informal networks (family members, friends, teachers, etc.) for support (Baragatti et al., 2019).

To our knowledge, there are few studies that compare the different help-seeking behaviors among women who experience IPV at different ages and that take into account the type of IPV and the social circumstances of women (Lundy & Grossman, 2009). The objectives of this study are as follows: (a) to conduct an analysis of a representative sample of the Spanish population related to the frequency with which women file charges against the aggressor, and the use of formal services or support provided by informal networks in a situation of physical and/or sexual IPV or fear; and (b) to identify the variables (social variables and those related to the type of violence) associated with the use of different resources by age group.

Methodology

Data Source

This was a cross-sectional study of the Macrosurvey on Violence Against Women, carried out in 2014 with a sample of 10,171 women residing in Spain ages 16 and older (Sociological Research Center, 2014a). Multistage sampling was used, stratified by conglomerates, and primary (municipalities) and secondary (sections) sampling units were selected in a random, proportional way. The final units (women) were selected using random routes and age and occupational quotas. The questionnaires were administered through personal interviews at women’s homes. Sensitive questions were answered by using cards that allowed women to indicate the correct answer. All of the interviewers were women. The database of the Macrosurvey of Violence Against Women is publicly available (Sociological Research Center, 2014b). Women’s participation was voluntary and unpaid. The records were kept in an anonymous way.

This study analyzed a sample of women who have or had once had a partner and claimed that they had been exposed to at least one episode of physical and/or sexual violence or fear by their partner (n = 1,567 women). In accordance with the Guidelines for Producing Statistics on Violence Against Women of the United Nations (Statistical Division Publications of the United Nation, 2014), a woman was considered to have been exposed to physical and/or sexual IPV when she experienced one of the situations shown in Supplemental Material Table 1. Women were considered to have suffered from fear when, in response to the question “How frequently were you scared of a partner?” she responded “continuously,” “many times,” or “sometimes.”

Variables

Dependent variables

Women who claimed to have experienced violent physical and/or sexual behavior or who had been fearful of their partner at some time in their life were asked whether they used any resource as a consequence of their partner’s behavior. Information about the following help-seeking behaviors was collected:

Filing a complaint with the police or courts.

Formal services including formal institutions like psychologists, psychiatrists, doctors, health centers, or other institutions that provide health care; social services; women’s shelters; NGO’s/women’s organizations; churches/religious organizations; legal services, attorneys, 016 telephone line.

Informal support networks including individual and personal support such as a mother, father, sisters, other family members, neighbors/work colleagues, teachers, or others.

Covariables

Based on available scientific research (Sanz-Barbero et al., 2014, 2018), we used the following covariables:

Sociodemographic variables: age, used as a stratification variable and also as a continuous variable within strata; country of birth (Spain/ outside of Spain); family social class (medium-high/low) (Domingo-Salvany et al., 2013); the person who provides most financial resources to the household (the woman/ her partner or both equally).

Variables associated with violence: exposure to physical IPV (yes/no); exposure to sexual IPV (yes/no); number of violent behaviors (continuous variable); minor children witnesses of violence (yes/no); effects of the violence on physical or mental health (none or little/ much or very much).

Social support: “Are there people who are concerned about your well-being?” Low support (never/sometimes) and high support (almost always/always).

Analyses were carried out and stratified into three age groups (Sanz-Barbero et al., 2019): young women (age 16–29), adult women (age 30–49), and older women (age 50 and over).

Analysis

A cross-sectional study was carried out, stratified by age, related to the type of violence and behaviors to which women had been exposed, the percentage of use of each of the services and the prevalence of service use by the covariables already described. Differences between age groups were estimated using a chi-square test.

We used prevalence ratios (PR) to measure the association between the variables related to the use of each type of service (filing a complaint, formal service use and informal networks), estimated using Poisson regression models with robust variance. A univariate analysis was carried out, followed by a multivariate analysis. Throughout the analyses, we used the weighting factors included in the Macrosuvey on Violence Against Women. Analyses were carried out using the statistical programs SPSS 21.0 and STATA 15.

Results

Table 1 describes the frequency of IPV exposure by type and age group among women exposed to physical and/or sexual IPV. These types of violence coexist in a high percentage of women of all ages and reach 43% in older women.

Table 1.

Type of Interpartner Violence Against Women by Age Group. Macrosurvey of Violence Against Women, Spain, 2014.

Type of Violence Experienced at Sometime in Life (nc = 1%)	Age 16–29 (n = 256)		Age 30–49 (n = 719)		Age 50 and Over (n = 592)
Type of Violence Experienced at Sometime in Life (nc = 1%)	n*	%	n*	%*	n*	%*	p
Physical, sexual, and psychological	84	32.5	258	36.1	247	43.1	<.001
Physical and psychological	94	38.1	216	29.9	134	22.8
Sexual and psychological	26	10.4	92	13.0	104	17.3
Only psychological	43	17.2	130	18.4	87	14.6
None	5	1.9	19	2.5	13	2.2

Note. n.a = missing; % = percentage; n = frequency.

Variables

Table 2 describes help-seeking behavior among IPV-affected women. About 22% of young women, 35% of adults and 29% of older women filed a complaint against their aggressor (p < .001). Formal services were used by 41% of young women, by 51% of adult women and 48% of older women (p = .020). The formal service most used was psychologists/psychiatrists, followed by other types of health care. The use of legal and/or social services was significantly less in younger women (9%–10%) than in adults and older women (12%–19%). Informal support networks were the resources women of all age groups used the most (86% of young women, 82% of adults and 75% of older women). More than half of women sought help from a friend in response to a situation of IPV or fear.

Table 2.

Resources Used by Women Exposed to Physical and/or Sexual Violence or Fear by Age Group. Macrosurvey on Violence Against Women, Spain, 2014.

Type of Services Used	Young Women (n = 256)		Adult Women (n = 719)		Older Women (n = 592)
Type of Services Used	n	%	n	%	n	%	p Value
Filing a complaint with the police or courts (n.a = 5.5%)	51	21.6	235	34.7	158	28.8	.000
Formal services (n.a = 6.5%)	98	40.9	345	51.2	260	47.7	.020
Psychologist/psychiatrist (n.a = 5.6%)	65	27.4	228	33.6	163	29.3	.105
Health professional (n.a = 6.5%)	45	19.5	166	24.8	134	24.6	.193
Legal services (n.a = 5.8%)	26	10.0	131	19.1	96	17.6	.008
Social services (n.a = 5.9%)	24	8.8	116	17.2	67	12.4	.002
Others (NGO, shelter, 016, church, others) (n.a = 5.8%)	21	9.2	104	15.0	64	12.0	.029
Informal services (nc = 5.9%)	211	85.8	557	82.4	416	74.5	.001
Friends (n.a = 6.5%)	169	69.0	417	61.6	269	49.9	.000
Mother (n.a = 10.8%)	127	52.3	303	46.5	196	39.2	.001
Sister (n.a = 14.6%)	75	34.1	253	39.9	182	36.8	.256
Father (n.a = 16.5%)	69	29.9	153	24.7	92	19.9	.010
Family member (not father/mother) (n.a = 7.2%)	87	36.1	260	38.9	191	34.9	.429
Neighbor/work colleague (n.a = 8.2%)	21	7.9	117	17.9	100	18.7	.000
Teacher (n.a = 8.4%)	9	3.9	16	2.3	8	1.3	.060
Other (n = 8.8%)	20	8.3	40	6.5	25	4.5	.088

Note. n.a = missing; % = percentage; n = frequency.

Tables 3–5 show the prevalence and adjusted PR for women’s use of the different resources analyzed, by age group. The likelihood of filing a complaint against the aggressor (Table 3) increased with the number of violent episodes for all the age groups studied [PR_young(IC95%): 1.10(1.04;1.16); PR_adult(IC95%): 1.07(1.05;1.10); PR_older(IC95%): 1.07(1.04;1.10)]. In adult women and older women, the probability of filing a complaint was greater when there were minor children at home who were witnesses to IPV [Adult:1.56(1.24;1.96); Older:1.43(1.03;1.98)], and when a woman experienced physical IPV [Adult: 1.52(1.05;2.22); Older: 2.17(1.26:3.73)]. Being older decreased the probability of filing a complaint among older women [0.98(0.96;0.99] but not among young or adult women.

Table 3.

Prevalence and Prevalence Ratios of the Variables Associated With Filing a Complaint Among Women Exposed to Physical and/or Sexual IPV and/or Fear. Macrosurvey on Violence Against Women, Spain, 2014.

Filing a Complaint With the Police or Courts (n.a: 5.4%)	Young Women (n = 256)				Adult Women (n = 719)				Older women (n = 539)
Filing a Complaint With the Police or Courts (n.a: 5.4%)	prev	PR	CI 95%		prev	PR	CI 95%		prev	PR	CI 95%
Country of birth (ref: outside of Spain)	29.6	1			40.8	1			18.6	1
Spain	19.6	0.83	0.48	1.45	32.6	1.06	0.86	1.30	30.1	1.65	0.97	2.81
Family social class (ref: high/medium)	19.4	1			29.2	1			27.7	1
Low	22.6	0.96	0.57	1.61	42.5	1.15	0.94	1.39	29.2	0.96	0.76	1.23
Minor children witnesses of violence (ref: no)	18.9	1			22.8	1			15.8	1
Yes	39.4	1.56	0.93	2.64	51.6	1.56**	1.24	1.96	38.4	1.43*	1.03	1.98
Who provides more money to the household (ref: woman)	27.7	1			41.2	1			32.4	1
Partner	20.1	0.84	0.46	1.53	31.5	0.87	0.71	1.06	22.5	0.77	0.58	1.02
Both equally	20.8	0.86	0.32	2.29	25.0	0.70*	0.50	0.98	26.5	0.79	0.50	1.26
Sexual IPV, Everlife (ref: no)	22.2	1			25.2	1			20.0	1
Yes	22.1	0.60	0.36	1.00	44.2	0.89	0.69	1.17	34.0	0.86	0.60	1.23
Physical IPV, Everlife (ref no)					14.8	1			8.7	1
Yes	—		—		44.0	1.52*	1.05	2.22	38.0	2.17*	1.26	3.73
Effects of the violence on physical or mental health (ref none/little)					20.8	1			13.0	1
Much/very much		—		—		37.6	0.86	0.57	1.29	33.2	1.00	0.60	1.68
Social support (ref: never/sometimes)					40.0	1			27.1	1
Almost always/always		—		—		33.6	1.11	0.87	1.41	29.5	1.02	0.77	1.36
	Media (SD)	PR	CI 95%		Media (SD)	PR	CI 95%		Media (SD)	PR	CI 95%
Age	25 (3.5)	1.04	0.97	1.13	40.0(5.7)	1.00	0.99	1.02	63.0 (9.6)	0.98*	0.96	0.99
Number of violent behaviors	13.3 (5.4)	1.10**	1.04	1.16	15.3 (6.1)	1.07**	1.05	1.10	15.3 (6.7)	1.07**	1.04	1.10

Note. n.a = missing; prev = prevalence; RP = prevalence ratio; IC 95% = confidence interval 95%; ref = reference; SD = standard deviation.

— variable not included because there are not enough cases. *p <.05. **p <.001.

Table 4

. Prevalence and Prevalence Ratios for Variables Associated with the Use of Formal Support Services Among Women Exposed to Physical and/or Sexual IPV and/or Fear, Macrosurvey of Violence Against Women, Spain, 2014.

Formal Services (n.a: 6.5%)	Young Women (n = 256)				Adult Women (n = 719)				Older Women (n = 539)
Formal Services (n.a: 6.5%)	prev	PR	CI 95%		prev	PR	CI 95%		prev	PR	CI 95%
Country of birth (ref: outside of Spain)	31.5	1			45.3	1			41.7	1
Spain	44.2	1.65*	1.03	2.62	53.6	1.34**	1.13	1.59	48.5	1.17	0.87	1.56
Family social class (ref: high/medium)	38.9	1			50.3	1			51.6	1
Low	41.6	0.97	0.71	1.35	53.4	0.95	0.82	1.10	43.6	0.80*	0.67	0.95
Minor children witnesses of violence (ref: no)	38.9	1			39.3	1			35.6	1
Yes	57.6	1.29	0.90	1.86	68.5	1.48**	1.26	1.72	56.6	1.23*	1.00	1.51
Who provides more money to the household (ref: woman)	40.4	1			59.9	1			51.5	1
Partner	41.3	0.98	0.66	1.45	44.3	0.84*	0.72	0.97	42.2	0.86	0.71	1.04
Both equally	41.7	1.05	0.58	1.88	45.1	0.82	0.65	1.02	37.5	0.73	0.49	1.08
Sexual IPV, Everlife (ref: no)	33.6	1			45.8	1			40.6	1
Yes	51.3	1.35	0.96	1.88	56.4	0.79*	0.66	0.95	51.6	0.97	0.77	1.24
Physical IPV, Everlife (ref no)	19.7	1			40.9	1			32.4	1
Yes	49.2	2.01*	1.15	3.52	55.9	0.89	0.72	1.09	54.1	1.15	0.88	1.50
Effects of the violence on physical or mental health (ref none/little)	38.5	1			24.0	1			22.6	1
Much/very much	41.9	0.77	0.49	1.21	56.6	1.58*	1.12	2.25	54.0	1.61*	1.09	2.38
Social support (ref: never/sometimes)					59.1	1			47.1
Almost always/always	—	—			49.6	0.96	0.80	1.14	47.8	0.96	0.79	1.17
	Media (SD)	PR	CI 95%		Media (SD)	PR	CI 95%		Media (SD)	PR	CI 95%
Age	24.4 (3.4)	1.02	0.97	1.06	39.9 (5.7)	1.00	0.99	1.01	63.9 (10.2)	0.98**	0.97	0.99
Number of violent behaviors	12.6 (5.4)		0.99		13.7 (6.2)			13.2 (6.7)
1.03	12.6 (5.4)	1.07	0.99	1.05**	13.7 (6.2)	1.03	1.07	13.2 (6.7)	1.03*	1.01	1.05

Note. n.a = missing; prev = prevalence; PR = prevalence ratio; CI 95% = confidence interval 95%; ref = reference; SD = standard deviation.

— variable not included because there are not enough cases. *p < .05. **p < .001.

Table 5

. Prevalence and Prevalence Ratios of the Variables Associated With the Use of Informal Support Networks in Women Exposed to Physical and/or Sexual IPV and/or Fear. Macrosurvey on Violence Against Women, Spain, 2014.

Use of Informal Support Networks (n.a: 5.9%)	Young (n = 256)				Adult (n = 719)				Older (n = 539)
Use of Informal Support Networks (n.a: 5.9%)	prev	PR	CI 95%		prev	PR	CI 95%		prev	PR	CI 95%
Country of birth (ref: outside of Spain)	81.5	1			83.5	1			70.0	1
Spain	86.4	1.09	0.95	1.25	82.1	1.00	0.93	1.09	76.3	1.12	0.95	1.32
Family social class (ref: high/medium)	83.7	1			82.2	1			72.6	1
Low	87.8	1.06	0.96	1.17	83.2	0.99	0.92	1.06	77.7	1.04	0.94	1.15
Minor children witnesses of violence (ref: no)					78.8	1			65.8	1
Yes	—	—			88.1	1.09*	1.01	1.16	82.4	1.16	1.05	1.30
Who provides more money to the household (ref: woman)					83.4	1				78.0	1
Partner	—	—			80.0	0.97	0.90	1.05	69.8	0.90	0.81	1.00
Both equally					86.7	1.07	0.98	1.17	78.0	0.98	0.84	1.15
Sexual IPV, Everlife (ref: no)	86.8	1			80.6	1			78.3	1
Yes	84.2	0.92	0.82	1.03	84.1	0.96	0.87	1.05	74.1	0.88	0.78	0.99
Physical IPV, Everlife (ref no)	79.7	1			78.9	1			63.2	1
Yes	88.3	1.06	0.89	1.24	84.0	0.98	0.89	1.07	81.4	1.14	1.00	1.31
Effects of the violence on physical or mental health (ref none/little)	70.0	1			67.0	1			65.7	1
Much/very much	89.3	1.23	0.99	1.53	85.5	1.21*	1.05	1.40	78.9	1.03	0.89	1.20
Social support (ref: never/sometimes)					81.8	1			78.7	1
Almost always/always	—	—			82.6	1.03	0.94	1.13	80.8	0.99	0.88	1.10
	Media (SD)	PR	CI 95%		Media (SD)	PR	CI 95%		Media (SD)	PR	CI 95%
Age	24.0 (3.6)	1.01	0.99	1.02	39.2 (5.6)	0.99	0.99	1.00	64.4 (10.1)	0.99*	0.98	0.99
Number of violent behaviors	11.1 (5.2)	1.01	0.99	1.02	12.1 (6.1)	1.01	0.99	1.02	11.7 (6.5)	1.01	0.99	1.02

Note. n.a = missing; prev = prevalence; PR = prevalence ratio; CI 95% = confidence interval 95%; ref = reference; SD = standard deviation.

— variable not included because there are not enough cases. *p < .05. **p < .001.

The likelihood of using formal services (Table 4) was greater among adult and older women who had been exposed to a greater number of violent episodes [Adult: 1.05(1.03;1.07); Older: 1.03(1.01;1.05)]; who perceived a greater impact on their physical and mental health [Adult: 1.58(1.12;2.25); Older: 1.61(1.09;2,38)]; and who had minor children who were witnesses to the IPV at home [Adult: 1.48(1.26;1.72); Older: 1.23(1.00;1.51)]. The probability decreased in adult women when the partner was the main breadwinner [Adult: 0.84(0.72;0.97)] and in older women with a low family socioeconomic level [Older: 0.80(0.67;0.95)]. Using foreign-born women as a reference group, being born in Spain was associated with an increased use of formal services in young and adult women [Young: 1.65(1.03;2,62); Adult: 1.34(1.13;1.59)]. Exposure to physical IPV was associated with increased use of formal services among young women [2.01(1.15;3.52)], while exposure to sexual IPV decreased the probability of formal service use among adult women [0.79(0.66;0.95)].

The probability of help-seeking from informal support networks (Table 5) in adult and older women increased when there were minor children who were witnesses of IPV [Adult: 1.09(1.01;1.16); Older: 1.16(1.05;1.30)], and this probability decreased with age [Older: 0.99(0.98;0.99)]. In older women seeking support from informal networks was associated with the type of IPV, and it increased in women who experienced physical IPV [1.14(1.00;1.31)] and decreased in women who experienced sexual IPV [0.88(0.78;0.99)]. Among adult women, a high impact on their physical or mental health increased the probability of seeking help from informal support networks 1.21(1.05;1.40)].

Discussion

Among all age groups, an increase in the number of violent episodes was related to a higher probability of filing a complaint, and, in the case of older women, suffering physical IPV. In adult and older women, having minor children at home who were witnesses of IPV was associated with the three kinds of help seeking (filing a complaint, and formal and informal resources); while the increase in the number of violent episodes and perception of a greater health activates the use of formal resources. Adult and young women born in Spain had a higher probability of attending formal services than did migrants. Among young women, the use of formal resources increased when they experienced physical IPV and decreased when they experienced sexual IPV, while the use of informal services was generalized. In general, we observed a progressive decrease in the use of all resources as age increased.

Our results are similar to those of previously published studies and show that informal support networks are the resources that women use most when they experience IPV (Bundock et al., 2018). In agreement with another study (Ashley & Foshee, 2005), in our study, approximately eight out of every ten women who experienced physical and/or sexual IPV and/or fear sought support first from friends, followed by mothers. Some authors suggest that while informal support can be beneficial, sometimes informal support persons may be unprepared to provide appropriate support to help women cope with complex problems like IPV (Ocampo et al., 2007).

In our work, the use of informal support networks among young women was generalized, therefore it is possible that the sample size was not large enough to identify variables associated with their use. The formal services most used by this age group were health services and primarily mental health services. Despite the fact that the database analyzed in this work did not collect information on help-seeking behavior among women who experienced psychological IPV exclusively, in all cases, the women reported psychological IPV behaviors in addition to sexual and/or physical IPV or fear. This is a finding that should be taken into account, given that psychological IPV contributes to the deterioration of physical and mental health among women, particularly young women (Fernández-Fuertes & Fuertes, 2010; Sanz-Barbero et al., 2019).

In our results the probability of using formal support services increased when young women experienced physical IPV. It is likely that physical IPV is a trigger that initiates the search for formal support (Baragatti et al., 2018). In our study, when the number of violent behaviors increased, the request for protection from security forces increased as well. Therefore, it is important to make formal services more accessible to young women prior to the appearance of physical IPV. The support of specialized services could help to restore women’s physical and psychological well-being, in addition to helping them avoid revictimization (Rivas et al., 2019). A feeling of shame (Martin et al., 2012; Sabina et al., 2014), the lack of trust in professionals (Ocampo et al., 2007), the rejection of authorities (Molidor & Tolman, 1998), the lack of confidentiality (Sabina et al., 2014), the lack of specialized services and the limited capacity of existing services are barriers that women in this age group face (Bundock et al., 2018) when they solicit support from social and/or health services. The World Health Organization has pointed to the need to adapt health services to young people, and it has proposed putting into place friendly health centers that are accessible, available, equitable, acceptable and of good quality for diverse groups of young people (Tylee et al., 2007). In this sense, initiatives that have had a positive impact in terms of improving the sexual health (Rosenberg et al., 2018) and mental health (Lee et al., 2019) of young people could serve as a model for bringing together formal services and women experiencing IPV.

Young and adult immigrant women make less use of formal resources than Spanish women of the same age do. The legislative barriers to accessing services, the absence of culturally adapted services, the lack of knowledge about service availability, the social isolation faced by the immigrant population and greater cultural permissiveness towards IPV are explanations presented in the literature (Briones-Vozmediano et al., 2015). In Spain during the 2012–2018 period (Royal Decree Law 16/2012), foreigners in an irregular administrative situation were only entitled to public health care during emergencies, pregnancy, childbirth and in postpartum care and minors. Irregular immigrants have the right to basic social services such as emergency social aid. It is necessary to make formal services more accessible to immigrant women, since this iGroup has a higher prevalence of IPV (Sanz-Barbero et al., 2014) and probably suffers from more severe cases, given that their probability of being killed due to IPV is five times greater than that of Spanish women (Sanz-Barbero et al., 2016). We did not identify any differences between immigrant and Spanish women in terms of filing a complaint with the police or the courts. Since 2011 (Real Decreto 557/2011) there has been legislation that protects immigrant women with irregular migratory status who report gender violence. This protection is ensured for the duration of the criminal prosecution process. Once the process ends, if the woman is recognized to be a victim of gender violence, she can be granted a residence authorization based on exceptional circumstances.

In the case of adult and older women, there are some commonalities and differences in their use of support resources. In our results, the presence of minors at home who were witnesses to IPV increased the probability of using the support resources analyzed in both age groups. The effect of having children at home in terms of help-seeking behavior has been previously studied, with heterogeneous results. There are studies that argue that the presence of children can worsen existing IPV situations, as women may remain in those situations in an effort to keep the family together or because they fear for the safety of their children were they to separate from their partners; on some occasions, however, it is the protection of minors that promotes the search for support (Herrero-Arias et al., 2019; Kelly, 2009; Meye, 2010; Rhodes et al., 2010). Working with minors who have witnessed IPV is a key component in the prevention of children becoming future IPV victims or aggressors. Longitudinal studies show that exposure to IPV at early ages leads to deterioration of the health of children (Vu et al., 2016) and increases the risk of victimization and becoming an aggressor as an adult (Forke et al., 2018).

Adult and older women with a low family socioeconomic level and/or situations where their partner is the main breadwinner, make less use of formal support services and file fewer complaints against their aggressors. It is possible that women only file a complaint against their aggressor or request help from formal services when they decide to break with the circle of violence and flee. This is a decision that can be influenced by their economic circumstances (Otero-García et al., 2018; Weeks et al., 2016). It is also possible that the inverse care law has an effect, that is, the lower use of resources among those most in need is the result of the accumulation of barriers to access to care among the most socially vulnerable groups (Morteruel et al., 2018). The fact that family economic difficulties could be related to lower levels of help-seeking behavior is an important aspect to take into account in designing future strategies that seek to improve IPV resources (Otero-García et al., 2018).

In line with our results, Próspero and Vohra-Gupta’s (2008) study showed that victims of physical IPV are more likely to seek psychological support than victims of sexual IPV. These results suggest that sexual IPV is related to different barriers to help-seeking behavior than other types of IPV. Feelings of shame, guilt, erroneously believing that sexual IPV requires the use of physical force and penetration (Wolitzky-Taylor et al., 2008), and romantic feelings toward the partner/aggressor often dissuade victims from seeking support for sexual IPV (Alexander et al., 2009; Orchowski et al., 2013). It is necessary to raise awareness among women to help them identify sexual violence in the context of a couple relationship, and to train professionals so that they can offer specialized services to address sexual IPV.

Limitations

This study includes some important limitations that should be considered when interpreting the results. The large time frame of the variable analyzed—exposure to IPV at some time in life—prevented us from establishing a time period between exposure and effect. In the case of immigrant women, it was impossible to know whether the exposure to IPV—and therefore the use of services—took place in Spain or in their countries of origin. It is possible that the lower use of services among the immigrant population could be due in part to the fact that IPV took place in their origin countries, where there could be less access to resources. In the survey analyzed, information on the use of services was collected exclusively in women that had reported experiencing episodes of physical or sexual IPV and/or fear. Women who had only experienced psychological IPV without fear were excluded from the module on service use. This could lead to an underestimation of the use of support or services in Spain, given that exclusively psychological IPV has a strong impact on women’s health (Sanz-Barbero et al., 2019) and probably supports the use of formal services, such as those related to the health system. In cases of assaults with different types of IPV and/or different aggressors, the survey did not allow us to associate a specific episode of violence with the use of a specific service.

Conclusions

Women of any age who experience IPV tend to seek help from their informal networks, especially young women. The search for professional help in general, and filing a complaint in particular, seem to be resources that are used in more severe situations of IPV. Social policies are needed that improve visibility and adapt the response of formal services to the specific needs of women in different life stages. Given that women in general, and young women in particular, seek help from their informal networks, it is important to raise awareness in society about the need to support these women in this process. It is also necessary to strengthen professional assistance services, in order to help women regain their well-being and avoid revictimization.

Supplemental Material

Supplemental Material - Spanish Intimate Partner Violence Survivors Help-Seeking Strategies Across the Life Span

Supplemental Material for Spanish Intimate Partner Violence Survivors Help-Seeking Strategies Across the Life Span by Belén Sanz-Barbero, Erica Briones-Vozmediano, Laura Otero-García, Cristina Fernández-García and Carmen Vives-Cases, in Journal of Interpersonal Violence

Footnotes

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This article presents independent results and research. The views expressed are those of the authors and not necessarily those of the Instituto de Salud Carlos III or of any of the signatory institutions.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The materials and analysis of this study are part of the larger research project financed by the Ministry of Economy and Competitiveness of the Government of Spain, Carlos III Institute (Ref. PI17CIII/0002), directed by Belen Sanz-Barbero. Erica Briones-Vozmediano was supported by Generalitat de Catalunya, Serra Hunter Programme; and by a promotion research aid of the University of Lleida.

ORCID iD

Erica Briones-Vozmediano

Author Biographies

Belén Sanz-Barbero, MD, PhD, is an associate professor at National Health Institute Carlos III in Madrid, Spain.

Erica Briones-Vozmediano, PhD, is a Serra-Hunter Lecturer at the Department and Faculty of Nursing and Physiotherapy of the University of Lleida, Spain.

Laura Otero-García, RN, PhD, is a lecturer at the Autonomous University of Madrid, Nursing Area, Department of Medicine, Spain.

Cristina Fernández-García, Master in Public Health, is a researcher of the National Health Institute Carlos III in Madrid, Spain.

Carmen Vives-Cases, PhD, MPH, is a Public Health professor at the Department of Community Nursing, Preventive Medicine and Public Health and History of Science of the University of Alicante, Spain.

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