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Ivey International Centre for Health Innovation

Women’s experiences with intimate partner violence and healthcare in rural environments

  • Katie Shillington
  • |
  • Mar 12, 2019
Women’s experiences with intimate partner violence and healthcare in rural environments

At some point in their lives, 25% of women worldwide will experience intimate partner violence (IPV). This is the equivalent to one in every four people. IPV against women is a grave public health concern, with both direct and indirect health implications to those who have experienced it. These experiences are often perpetuated by the healthcare system even after the abusive relationship has ended. Namely, the health consequences that women experience as a result of IPV place them at an increased risk of marginalization, which decreases their ability to engage in services and supports tailored to their needs. These health issues are amplified in rural settings, as rural environments are often associated with higher rates of IPV, and face a resource deficit, which are further compounded by geographic location.

The dominant response in North America to support women who have experienced violence is the utilization of women’s shelters. Shelters create an access point for health and social services; however, the needs of women who experience IPV in rural settings are changing. Women are shifting to utilize shelter resources but are not necessarily staying in the shelter, which suggests a modification from an inpatient to an outpatient model.

Dr. Tara Mantler, a professor in the School of Health Studies and a researcher in women’s health with a specific focus on IPV in rural settings, shared her insights on addressing women’s needs in rural environments. She suggests that an innovative solution to tackle the shift in service delivery might centre around a ‘hub’ model, which would allow women to access services while remaining in their community. This ‘hub’ would serve as a central location for women who have experienced IPV to access services, and in turn would reduce organizational silos and accessibility challenges.

In her interview, Mantler explained that research surrounding IPV mainly takes an urban-centric approach, which means that the services offered, and the studies conducted are mapped in urban settings. However, healthcare is delivered differently in rural settings compared to urban, as the values of the two communities are not necessarily synonymous. In Mantler’s article, they attempt to shed light on the needs of women who have experienced IPV in rural settings. They achieve this by dropping pre-conceived notions and viewing IPV from a capacity building standpoint, bridging community action and health promotion to engage individuals from the ground up.

According to Mantler, they found that the way women are leaving abusive relationships is changing, as it is becoming increasingly more common for women to have planned, strategic exits compared to escaping in the middle of the night. Women are accessing online safety planning and resources even before leaving their abusive partner, which demonstrates that they are utilizing numerous resources when they are not actually staying at the shelter. To meet the changing needs of women, Mantler highlighted five innovative shelters attempting to make the shift towards a ‘hub’ model; however, to actually enact this is a bit challenging. Mantler states that although people want to facilitate interdisciplinary collaboration and integration, the way that the funding is structured makes this difficult. Shelters are shifting to integrate health and social services that extend beyond their current mandate; however, in order for this integration to be effective, sectors have to be willing to share resources with one another and given the financial constraints, this is often difficult. To overcome these barriers, it is important that various sectors work together, specifically fostering collaboration between academia and rural shelters. Notably, Mantler in consultation with the shelters, is hoping to imbed a nurse practitioner into a clinic in a rural setting, someone who can provide care in a trauma and violence informed way. In her interview, Mantler raised an interesting point, “If you have cancer you want to see an oncologist you don’t want to see a general practitioner, if you have diabetes you want to see a specialist you don’t want to see a general emergency room physician, if you have experienced violence then doesn’t it make sense for you to see a practitioner who understands the health consequences of violence? [The ‘hub’ model] is going to improve system navigation and therefore integration.”

Further, Mantler expressed the positive impact that the ‘hub’ model would have on the healthcare system as a whole. Currently, women experience negative health outcomes that inhibit their ability to navigate the system, even after the abusive relationship has ended. Mantler notes that as a result, women are high system users, as they often do not understand that the multitude of health problems they are experiencing is a manifestation of their history of violence. Similarly, when women’s needs are not being met, they repeatedly go back, only further frustrating physicians. Thus, Mantler notes the importance of having a practitioner actually embedded in the social context who understands and can help women to better articulate what they are experiencing. Mantler believes that “it will result in a significant decrease in healthcare resources, especially in the healthcare resources that aren’t being used properly”, which would ultimately improve the system as a whole.

The central ‘hub’ model is an innovative approach to meeting the needs of women who have experienced IPV in rural settings. Dr. Tara Mantler is working hard to empower women who have experienced IPV and to highlight their voice in a world where they are used to being silenced. Complex problems require complex solutions. It’s time that we stop trying to make simple solutions for complex problems and truly recognize the complexity that IPV is.


A special thank you to Dr. Tara Mantler, an associate professor in the School of Health Studies, for her willingness to share her insights on IPV in rural settings.

Katie Shillington is practicum student working as a Student Research Analyst at the Ivey Centre for Health Innovation. She is in her fourth year pursuing a Bachelor of Health Sciences with an Honours Specialization in Health Promotion.