Fighting for survival and escape from violence: Interviews with battered women

Abstract

The present study is a qualitative study aiming at explaining and understanding the experience of being battered. It explores the act of searching for help, from the health service and others, and the ending of abusive relationships. In-depth interviews were conducted with nine battered women. The study adopted a grounded theory method and produced an emerging core category fighting for survival and escape, and three key categories: having a personal construct of violence, struggling to cope with the violence, and feeling a need for support. The women with deep internal scars struggled to understand and to recover from the violence. They struggled between feeling guilty and feeling innocent. In the process of leaving, an important other, often a friend, played a supportive role in creating an inner strength within the woman, which enabled her to break up. Supportive professionals found relevant solutions and helped the women to maintain their new situation, while other professionals re-victimized the women. We conclude that battered women with enhanced support include affirmation, information, and safety leading to increased survival and recovery.

• Intimate partner violence
• battered women
• violence against women
• grounded theory

Introduction

Seen in an international perspective, violence against women is a major public health problem in most societies (Mayer, 2000; WHO, 2002). Significantly, intimate partner violence (IPV) is almost universally under-reported (Watts & Zimmerman, 2002). In some countries, for women who have been physically abused in the home by men they live with, radical changes have been seen during the past two decades (Dobash & Dobash, 1992). A worldwide social movement to support battered women has started, driven mainly by women's organizations, although, in some societies, resistance to changing cultural norms, beliefs and attitudes persists. The accounts by researchers reveal similar patterns: violence affects the health and well-being of women and their children (Lemmey, Malecha, McFarlane & Willson, 2001; Katz & Low, 2004). Among the health problems described by battered women are depression (Campbell & Soeken, 1999; Daniels, 2005), injuries due to trauma (Campbell, 2002), and suicide (Coker, Reeder, Fadden & Smith, 2004). Research shows that violence that causes physical, psychological and emotional harm to the woman sometimes ends in a brutal death (Heiskanen & Piispa, 1998). Most spousal homicides involve men killing their female partners as a result of jealousy and possessiveness (Dobash & Dobash, 1992). Women are mainly killed after leaving their partners. Most of them have been in contact with the health services (Sharps, Koziol-McLain, Campbell, McFarlane, Sachs & Xu, 2001). Despite the abuse that women experience, they often leave and return to their violent partner several times before finally leaving (Campbell, 1992; Smith, 2003; Gordon, Burton & Porter, 2004). Eliasson (2003) reports that women were most likely to leave their spouse when violence became a life-threatening event when the line of what a woman could tolerate had been crossed, and when they felt that the children in the family were in danger.

Despite life-threatening risks, women stay years in IPV relationships. A frequent question is why they do not leave (Risberg, 1994; Smith, 2003). One answer to the question relates to the complex and multifaceted context in which the women live (Landenburger, 1993; Smith, 2003). The development and maintenance of a relationship in which the perpetrator gains control and power over the woman, thus minimizing the woman's living space, is known as the normalization process (Lundgren, 2004). The woman identifies with the aggressor, adapts his view of her, and internalizes the violence. By finding faults within herself, she can thereby normalize and justify the violence he exposes her to (Rönnberg & Hammarström, 2000). The perpetrator uses different strategies to gain and maintain control over her by isolation, either physically or mentally (Corbally, 2001). As a result, the battered woman is forced into a situation where her partner controls her actions, thoughts and experiences, and each one of these sectors is gradually reduced for her. The question of why she does not leave is irrelevant for a woman who has normalized the violence (Lundgren, 2004). Another theory, described by Wood (2001), is that IPV is sustained through cultural withholding. The theory ‘a romance narrative’ portrays women as needing to be rescued by men, and men needing to be complete and fulfilled. Women are taught to be accommodating and to seek and please men; men are taught to be dominating and to regard women as inferior. The situation, in which a partner hurts the woman at times, is often documented as the ‘honeymoon period’. The woman perceives her partner's violence as wrong, but maintains that her partner loves her ((McFarlane, Malecha, Gist, Watson, Batten, Hall & Smith, 2002). Another opinion that is well established in western cultures is that violence is a routine part of a loving relationship (Wood, 2001). Nevertheless, the woman's situation is life-threatening and highly dangerous. Therefore, early identification of the problem can reduce its consequences, decrease the likelihood of further victimization, and reduce the danger (Campbell, 2002; Jewkes, 2002).

Garcia-Moreno (2002) and Jewkes (2002) state that there is little evidence about the effect on the women themselves of asking them about violence, and how this effect may vary for women. Thus, this study addresses the perspectives of the battered women. In the area of this study, an operation kvinnofrid (peace for women) international programme was set up, though no efforts were made to involve battered women or to allow them to participate. A recent study showed that nurses in general have little knowledge about battered women's living conditions and their need for support and help (Häggblom, Hallberg & Möller, 2005). An understanding of which interventions are effective and why can only be reached through the voices of the battered women themselves (Smith, 2003). Gordon et al. (2004) emphasized the need for further research, to find more effective options for battered women (Rönnberg & Hammarström, 2000; Davis, 2002a; Smith, 2003; Flinck, Paavilainen & Åstedt-Kurki, 2005). In this study, the women's perspectives were highlighted with the aim of gaining a deeper understanding of what being battered means to women and the strategies they use to handle the situation.

Method

Subjects

The study sample consisted of nine battered women who were all separated from their spouses at the time of the interview, and most of them were survivors of horrifying traumatic events. However, eleven women were asked to participate in in-depth interviews. Two of them did not participate for unknown reasons. The sampling was purposive rather than random and aimed to select cases that provided rich data. All the participants had to confirm that they had had abusive experiences in intimate relationships and that they were willing to share these experiences. The relationships had lasted from one and half years to 23 years. Some of them were currently living happily with non-violent partners. They had not experienced violence at home in their childhood. In contrast, the perpetrators, as far as the women knew, had experienced violence in their childhood. One man had had a violent mother, who had used both physical and psychological violence. Two men had had violent fathers (one father was also violent to his mother). Another man had parents who were described by the woman as “a mother barking like a dog at home and the father always responding in biblical terms”. All of the women also reported mental, verbal, and emotional abuse from their partners, which included belittling comments, degrading remarks, and controlling, manipulative behaviour. Three of the women had experienced sexual abuse. In one case, the woman's daughter had been molested by the partner, and in two cases the children had experienced violence.

Procedure

The interviews were conducted by one of the authors (AH) and carried out as open-ended interviews. The data were collected using taped in-depth interviews (Hallberg, 2000; Dellve, Henning Abrahamsson, Trulsson & Hallberg, 2002). The interviews were mainly carried out in the women's homes, according to the women's preferences for place and date. One woman requested that the interview should be stopped after 45 min, because she felt distress and pain, though she did not need any further assistance. The interviews were completed between June 2004 and June 2005. The interviewer used themes — although not in a leading manner — for example, experience of care and treatment, experience of violence, consequences of violence, support and security, recovery and plans for the future. The interviews lasted from 35 to 90 min and were tape-recorded. The complete recorded interviews were transcribed verbatim (by AH) within a few weeks of the interview.

Analysis of data

The data analysis was based on techniques described by Glaser and Strauss in their book The Discovery of Grounded Theory (1967) and later modified by Strauss and Corbin (1998), including constant comparison data analysis, theoretical sensitivity, memo writing, and theoretical saturation. The verbatim-transcribed interview protocols were subjected to three types of coding processes: open, axial and selective coding (Pandit, 1996; Strauss & Corbin, 1998; Dellve et al. 2002). Open coding involves closely scrutinizing the data and breaking them down into segments or parts, so called codes (Glaser & Strauss, 1967). The data were examined sentence by sentence. Codes with similar content were grouped together into concepts at a higher, more abstract level. As the interviews progressed, the constant comparison technique allowed categories to be built up, adding depth and richness. At this point, a process of axial coding occurred, whereby identification of properties and dimensions further developed each category; additional categories and subcategories of each category were then explored (Strauss & Corbin, 1998). At this point, subcategories were arranged according to major themes that emerged, for example, battered women's ambiguity, emotional reactions, and individual recovery from violence. A constant comparison analysis process was then carried out, in which the data were categorized and subcategorized until theoretical saturation was achieved (Vehviläinen-Julkunen, 2000). The content of each category was described, and extracts from the interviews were selected to illustrate each category. Selective coding involved identification of a core category and the integration of categories that had been developed to form the initial theoretical framework.

The aims were to generate hypotheses, models, or preliminary theories about what is revealed in a social situation rather than aiming to verify existing theory. The researchers kept close contact when analyzing the data for the purpose of modifying theory based on the data collection (Charmaz, 2000). The study was regarded as completed when the data were saturated (Strauss & Corbin, 1998). Saturation point is reached when additional data will not contribute anything new to the emerging theory (Hallberg, 2006).

Ethical considerations

The investigation was carried out in a local community in Finland. Permission to undertake the study was given by the ethical board of the province. A letter of introduction describing the aim of the research was sent to units within the health organization in the area based on an approval given by the director of the organization. The letter was also sent to the shelter home for women in the community, the social service in the community and to the voluntary organization ”Folkhälsan” (“Public Health”), which runs a family therapy service. Nevertheless, most of the participants were found through word-of-mouth network sampling. For this study, nurses acted as gatekeepers, putting the researcher in touch with abused women. The women were all guaranteed secrecy and they consented to participate by signing a contract. However, they were told that they could break the contract at any time, since battered women are at risk. In order to increase safety and give them support, the women were invited to contact the emergency department at the hospital if they needed to (Ellsberg & Heise, 2002).

Results

The core category in this study has been conceptualized as fighting for survival and escape. The abused women's lives were closely tied up to the abusive partner, who most often totally controlled them and entrapped them. The battered women had to be careful how they related to their partners, since just a word or a tone could trigger their partners’ abusiveness. Three categories emerged from the interviews with the battered women and they were related to develop the core category. The categories that were developed were having a personal construct of violence, struggling to cope with the violence, and feeling a need for for support. The three categories were related to the core category and formed a conceptual model (Figure 1). This conceptual model gives a deeper understanding of the process of fighting for survival and escape as narrated by the battered women. However, the strategies to handle the situation were seldom “one-directional” or linear. Instead, they contained both steps forward and relapses backward. All the time the women, in their strivings for life, had to fight their own feelings of low self-worth, and worries about the children and the abusive partner. They also had to find ways to relate to their social and physical surroundings. The women tried to understand their partners’ violent behaviour and to find support from others, in order to manage their own and their children's daily life of being controlled, intimidated, and subjugated, and eventually to escape from the violent partner.

Figure 1.  The process of fighting for survival and escape (core category) including the categories “having a personal construct of violence”, “struggling to cope with the violence”, and feeling a need of support” grounded in data from battered women.

Having a personal construct of violence

Characteristics of this category are the women's different expressions of their views of violence. The women were deeply concerned by their violent situations, and were trying to understanding the problem and find a solution to it.

Ambiguity to the violence

At the beginning of violent relationships, the women did not understand what was happening to them. This ambiguity caused confusion; most of the women blamed themselves for being untalented, and felt that they deserved the man's reprimands. The women gave the following reasons for not breaking up: religious reasons, the man was a recovered alcoholic, they were very attracted to the partner even though they were being abused. The religious woman explained: “I didn't understand what it was all about” and she thought that for some reason she was caught up in trauma for the rest of her life, being married to a violent partner. Another woman did not recognize and define the violence against her as IPV. Although her husband had almost killed her, she explained: “It was not real violence against women that I experienced … it was self-caused when I couldn't get away, I should have had the strength … but I thought it could be better, I still had hope.”

They described how at one moment they wondered how they could live in the situation, and at the next moment, they felt guilt and responsibility for the violence. Living in this confusion, the women's living space was falling to pieces as one woman described it. Another woman had a different perception. She explained:

I thought there was nothing very wrong with me because I have always been loved at home … I thought what he says cannot be true … but anyhow being abused and not discussing it with other people … it becomes so confusing, because I thought that it was me that was wrong.

Other women explained that the violence against them made them hover between the two extremes of self-denial (feeling guilty and a failure) and of not feeling any responsibility for the violence. The women also emphasized that they had felt brainwashed by the perpetrators, and therefore they repressed their feelings of innocence. In addition, the women described their earlier attitudes to IPV, thus, “the first slap or push, yes, and then I would go.” Their explanation for not leaving when they found themselves trapped in a violent relationship was that they could not manage to leave at that moment.

Emotional reaction

The women reported that being battered for years of their lives led to low self-confidence balancing between failure and guilt. The women described different situations in which they had been insulted by their partners. For example, the partners raped them, forced them to watch pornographic films, and kept their income. The women struggled with feelings of deep sorrow for all their lost years, which also caused anger as well as a great powerlessness. One said “A sorrow of a lost life … nothing else than hell.” Another woman was angry when thinking of all the years that had been stolen from her. Often the women described their experience as sorrow over a lost love and family happiness. This was described by one woman as “All the dreams I had” (about family happiness) “were not there any more”, and by another woman as “I regret tremendously that I had a sorrow (about lost love and dreams) within me but that I didn't understand it”. In addition to the sorrow, the women felt deeply hurt. One woman described in tears the scars that the violence had caused her. She said, “He slapped me on my belly during my first pregnancy. It hurt my soul more than my body; it is in the soul the scar appears.”

Individual recovery from violence

All the women described how they had worked in different ways to increase control and balance in life, most of them through supportive psychiatric therapy for years. Some of the women started in psychotherapy while they were in the relationship, others after leaving. They emphasized that they had had to work hard to be “back on stage” as the saying goes. One woman explained: “I have really struggled to get over it.” Another one said: “I have worked on my self-confidence, I have done things and I am back.” One woman reflected that after one year and seven months of therapy she felt that she was starting to live again. It was like waking up for her. Another woman described how she had felt her identity being totally manipulated by her partner: “It took five years (after the separation) before I could think my own thoughts without thinking what he would say if I did this or that …”. Her description of her recovery was “Today I have five children and enjoy myself in a different way … I exist, and I exist 100%.” In addition, the women read battered women's stories, wrote poems, joined self-defence courses and went away for some months. Forgiveness was mentioned by some of the women as being an important factor in the recovery process. Forgiveness was described as a door opener in the healing process. Some of them studied nursing and social sciences, with the aim of helping battered women in the future.

Struggling to cope with the violence

Tempted to negative solutions to violence

All the women described living with an abuser following a pattern called the normalization process, which means a process of degradation for the woman. Parallel to this, the man's use of violence develops and is perceived and experienced as normal (Lundgren, 2004). One woman recalled the effects of her partner's violence to her as “I was totally isolated in my home and totally broken down. I had absolutely no value.” The women described the psychological abuse as the worst. Most of the women were threatened by the perpetrators that they would take them to a mental hospital by force due to their craziness and stupidity. The women told how they had been under a high risk of suicide; one woman took an overdose of medicine, but she was found in time by her children. The reason they gave for not committing suicide was the responsibility they felt for their children. One woman said “If I hadn't had the children, I think it would have been close at hand. But I could not face the thought that I would be spared from something and they would be left” (she meant if she died she would get peace, but the children would still be in difficulties). “The children have given me strength, helped me to fight. I couldn't do them such harm.”

Struggling to balance towards violence

The women struggled in their daily lives, uncertain about what mood their partner would be in when he returned home. They explained how sensitive they became and still were to recognize and analyse people's reactions. One woman described the scene like this: “I was always on tenterhooks, I always had this anxiety … this tension to never be able to relax, I couldn't sleep, I didn't know from moment to moment what was the rule …”. Another woman said: “I have been balancing on a tightrope in this home.”

The women described their relationship to the perpetrators after the separation. One had a friendly relationship, while four women were still under threat. The men often used the telephone. In one case, the man often stood outside the woman's house waiting for her. That woman was one of four who lived alone; she tackled her fear by staying alone. In general, however, the women felt released, five of them had a new partner who was described as secure and loving. However, the women mentioned that some of the psychological effects of the trauma could suddenly appear as fear.

Finding a way out of the violence

One woman described her life as “I was not living, I was breathing, eating and going to work, but was not living.” The realization that life was not how they wanted it to be often came slowly, through an insight. One woman described this awareness, “I didn't know what was going on until one day when I realized that my parents were not allowed to come and visit me.” Another woman said “I discovered that this wasn't a life … I had twins … I never slept at night … I felt that if he could rape me every night something is wrong, and I had to go.” Through such realization, the women started to develop ways to get out. Two of the women told that when they were in hospital their mothers found them a new apartment in secret. Another woman got a job in another place, and before she returned home, her mother had found a new apartment for her. Leaving is a process; one woman needed half a year, others needed much longer than that. The women often had said in frustration and under threats that they were going to leave. They told that the violence had escalated after they had told their partner that they would leave. Nevertheless, there was often a long time between first mentioning leaving until they actually left.

Feeling a need for support

Battered women often worked out a solution on their own; however, they emphasized how important the support of a close person had been for them to be released from the entrapment. The women expressed how they had needed support by being understood, which they felt gave them the strength to continue searching for a way out. The person who gave the support that was needed acted as a door opener. Obviously, the women were disappointed that most people withdrew their help and support.

Support from intimate friends

Feeling supported is a key category, which can be understood as the opportunity to deal with feelings and to find ways to escape, involving supportive others. In fact, all of the women had a friend and/or their parents, or even the men's parents who supported them to escape. One woman described her friend's support as “I have overcome this because of my friend … she was there all the time and I went back and it ended … she never gave up, never ever.” Another woman told how her father had become aware of his son-in-law's abuse against his daughter, and said “Throw him out … I can help you.” The women often told that relatives, friends, and other people they met, had warned them about the partner's abusiveness. The warnings seemed to give the woman strength during the process of leaving, by affirming that the violence was neither her fault nor a normal act in a relationship.

Support from health professionals

Battered women contacted the health service due to trauma, physical illness or pregnancy. They expected to be understood and given treatment and advice. Their expectations of the health professionals included being respected and understood, but not receiving definite solutions. The women used health services a lot, because of their need for treatment of the results of severe violence, and because of sleeping problems and tiredness. They also told about post-traumatic stress syndrome. The women described their contact with health professionals as being totally dependent on the person who was on duty. The women described nurses who had understood them and who had found ways of dealing with difficult situations. Other nurses were non-responsive, even though the women tried to explain about the violence. The women said that they felt ashamed and totally naked, opening up the innermost parts of themselves when narrating their stories. Therefore, they often made up a story about an accident, though they often changed their minds and told the truth. Some of the women explained that they expected that the nurses would ask about violence, give them affirmation, believe them, and emphasize that the fault was not theirs. One woman said: “Just saying that it is not your fault … nobody has the right to hit you, was a relief.” They explained how they had been examined and given different kinds of treatment and “Now you can go home”, without being questioned or given advice about what to do. They said that when they felt totally manipulated by the batterer they needed a professional who took action and made decisions. One woman who had asked for help and told the nurses about her situation said that the nurses had responded as follows:

I remember that I felt that I got no response at the MCH clinic, but at the hospital, yes they listened, of course they did, but I had a feeling that they didn't know how to handle and tackle … especially at the maternity clinic it is often a situation where people are happy to give birth to their children and for me it was a very unhappy event, especially with the second child.

Support from social workers

The battered women had high expectations of social workers, who they thought would act as problem solvers. They expected the social worker to be a person who mainly listened, who understood and gave support, who gave economic help, who helped the woman to move out, and who stood up in court. The women mentioned that a few social workers were helpful and concerned, and gave them support. Social workers arranged a lot of practical issues. As one woman said “She listened to begin with, she didn't interrupt a single time, she let me talk and cry, she looked into my eyes … now we help you with the rent … medicine costs … go and see a physician, you need a sick leave … .” Another woman said: “The social worker is an angel.” However, other social workers did not understand and had an unsympathetic attitude to the women. One woman described this as, “The social worker suggested that I should refuse my share of the money to calm him down (the partners were dividing their belongings at the time of their separation).” That woman lost the dispute over the custody of her two children. The social worker acted in favour of the man, despite the fact that he had a criminal record of violence to an earlier partner. This was not even raised in the case. Another social worker had asked a woman seeking her help at the time of being battered if she expected the social worker's support only to start a custody trial? The woman felt deeply insulted by the social worker's attitude.

In the province, a shelter home offered help and support to the battered women. The shelter home was run by the same official organization as the social service. The women were aware of the service that was offered by the shelter home, although they saved their need of help to times of severe difficulties. Some of the women had sporadic telephone contact with the shelter home, and one woman had escaped to the shelter home in times of terrifying violence and had stayed for some time. The women were satisfied with the help they had received, and said that the staff were knowledgeable. They listened, they knew when to leave the woman alone, they contacted the police, and they arranged practical issues such as renting an apartment. However, they suggested that the staff should approach the women sooner, and should take decisions for them to remain much longer at the shelter home.

Support from the police

The women did not hesitate to call the police when they were in need. Most of them were impressed by the attitudes of the police and the kind reception they received, which they had not expected to receive from police officers. One woman described the support as “I was treated very well … it didn't take long before they were there … they explained what would happen … and you don't need to worry.” All the women experienced the police's responses as positive. The police often suggested that the woman should sue the man, although very few did, because of fear. However, the interviewees told that two of the partners had been sentenced, one to jail and one to a fine. Another one died of an overdose before his case was raised in court. Often women only asked the police to record their story “just in case”. One of the women who had done that had almost been killed in an arranged car accident by her partner. She said the reason she asked the police to record the event was that she was “scared for her life.” She was frightened that he would succeed the next time. Another woman, supported by a lawyer, raised a case against her partner with help from the police. The partner got a fine, so the woman felt relieved. She also felt that her perception of him behaving wrongly was confirmed. Further, the court's decision reduced her fear of him and her fear that he would mistreat their child.

Discussion

The results of this study show that even though the battered women's partners used threats and slaps, and arranged lethal accidents, all the women had been able to escape the torture. The study also shows the importance of a supportive ‘other’ playing a major role in leave-taking (Dobash & Dobash, 1992; Pakieser, Lenaghan & Muelleman, 1998; Piispa, 2004). This other person was one who listened, believed, and understood, as also reported by Smith (2003). The women vacillated between feelings of guilt and deserving punishment, and feelings of innocence, unfairness and hopelessness. As they remarked, they were “responsible for letting it happen and letting it continue, but not responsible for the violence.” This awareness raised strong inner feelings of sorrow, anger and self-pity. The women felt deeply hurt, though some of them were able to leave the scars behind while others were not. The women's self-image was marked by poor self-esteem and an impaired sense of self, although in reality they had coped with violence and showed remarkable strength in overcoming violence. Despite this, the women expressed their perspectives on coping with violent relationships in balancing their daily life and providing valuable depictions of developing and using inner resources. In balancing their lives these inner resources sanctioned survival, strength and identity formation. As reported by Gordon et al. (2004), this study demonstrated that a woman is more likely to remain and return to a violent relationship when she does not interpret her partner's behaviour as malicious and intentional, due to being brainwashed (manipulated). Nevertheless, the severity of the violence contributed to a woman's decision to leave, as also reported by Eliasson (2003). Some of the women were almost killed before they changed their behaviour towards the violence. Jacobson and Gottman (1998) reported the same findings that women left as a last straw, which often came after years of abuse. According to Campbell and Soeken (1999), the danger escalates. After leaving the perpetrators, the risk of being killed by the partner increases (Campbell, 1992; Shalansky, Ericksen & Hendersen, 1999; Jewkes, 2002; Flinck et al., 2005). Calling themselves survivors, and not victims, they showed remarkable courage (Davis, 2002b). They regained strength to plan escape tactics, such as one woman who started judo training. These strategies aiming to end the relationship gave them the strength and courage to leave the perpetrator eventually.

The results of this study increase our understanding of battered women's complex living reality, as reported by Wuest, Ford-Gilboe, Merritt-Gray and Berman, (2003). The women remarked that before the violent events, they had advised others to leave such a relationship immediately after the first sign, and they themselves had intended to do so in case of abuse. As they looked back, they found that they had not been able to do so. The reason they gave was that their lives had been much more complex. The women's existence narrowed and they felt isolated, often paralyzed by fear that the perpetrator's horrible threats to hurt the children would become real. The uncertainty whether the violence was acceptable due to their faults and/or due to violence as a normal behaviour in a partnership sustained the women's tolerance (Wood, 2001). The person, who gave the woman support, gave her the strength to stake her life and to leave her husband. Nurses, when meeting women with experience of being abused, should use their unique opportunity to act as a firm person, or they should arrange for other professionals to give the woman support for as long as she needs it (Häggblom & Möller, 2006). In this study, the women most willingly shared their stories, thus probably enhancing their own healing process. Besides that, they expressed hope that by contributing with their stories others would be spared the pain they had experienced.

The use of grounded theory in this study gave insight and provided understanding about how the study group perceived their lives. Further, the method identified the main categories that are important to how women understand and experience their lives as battered women. The finding from current studies (Häggblom et al., 2005; Häggblom & Möller, 2006) was verified; some nurses responded to battered women in a professional way, while others withheld their help and support. Some studies have shown that battered women often use health service in times of violence (Roberts, Beverly Raphael, Lawrence, O'Toole & O'Brien, 1997). In this study, the women reported that they experienced a limited need of the health service in relation to the violence situation, for some of them because they obtained unexpected support from other persons. However, some of the women had used health services because of other symptoms and needs, which they did not directly associate with the violence, which is also reported by Caralis and Musialowski (1997); Krantz and Östergren, (2000); and Campbell (2002).

A limitation of this study is that some of the women had recently separated from the perpetrator, while others had separated 5–10 years ago. A possible limitation of the study is loss of valuable understanding and experiences because of forgotten and repressed events. One woman initially said no when asked if she had had any contact with health services because of being battered. Later on, she discovered that: “I had repressed it!” This reaction demonstrates that memories of violent events are embedded in various contexts (Eisikovits & Winstok, 2002). Another limitation is that the experiences of IPV only came from the women who were willing to share their life events of violence with a researcher. The stories of the silent women are never told.

This study confirms that battered women are commonly re-victimized by helping systems. Some of the women reported that they felt insulted by health and social workers who offered haphazard services (Corbally, 2001; Wuest et al., 2003). The systems provide services where the patients/clients experience a lack of planning and knowledge. Some of the women reported that they met the “right” nurse or social worker on duty “by chance”. Is that a sign of the services’ blind spots? Are health services provided by health professionals who feel that they have total control and no weaknesses, whereas this study shows that the women experienced some pitfalls (May, 1986)? In all nursing sciences, avoiding the inability (blind spot) to respond to the women's call requires advance planning, and openness and willingness to learn and to go beyond what is known. This demands courage by the nurses and support from administrators. Buber (1990) and May (1986) described the true encountering between persons, which enables a constructive process. They portrayed that what is desirable is a meeting between I and You, ahead of I and It. The real meeting takes place when the partners are equals, both touching and being touched by each other (Möller & Nyman, 2003). The true meeting in the situation described in the present study may enable and strengthen the woman's recovery process. Nurses “being present” and creating opportunities for the women to talk about their experiences, empowers and strengthens women's resilience to balance their existence (Davis, 2002b).

Consequently, IPV remains a burning and often hidden public health issue. The issue may be underestimated by family members, religious leaders, politicians, health workers, social service agencies, the police, the judiciary, the media, and other institutions. Some even justify the suffering caused by physical, sexual, and emotional abuse of women, thus re-victimizing the woman (Guedes, Bott, Güezmes & Helzner, 2002). Consistently, the issue is a women's rights issue. IPV is an embarrassment to the authorities, who hamper prevention through negligence. In a public health perspective, the single-parent family headed by the mother must be seen as the most vulnerable. According to the Finish researchers Heiskinen and Piispa (1998), 79% of single-parent mothers with children below the age of seven years have been battered by their ex-partners, often they are left with a minimum budget (Niemi-Kiesiläinen, 1999). Abused women may also loose custody of their children, such as the abused woman who was left in disparity, disparagement and sorrow. Society needs to promote zero-tolerance of discrimination of women and an equal sharing of resources.

Lawyers should reconsider before battered women loose custody of their children. The primary caretaker, that is the parent who has mainly taken care of the children, should be given priority. The courts should recognise children's rights, and should ask the children's opinion in such circumstances (Kurki-Suonio, 1995). The issue remains unfair and far from being addressed according to an equal human rights perspective. Society still has a long way to go (Jones, 2000). Finally, this study underlines the need for further studies exploring women's inner resources to survive and recover in order to be equipped much earlier to leave violent relationships. Studies of how resource organizations can support these women to survive, recover, and improve their quality of life are also needed.

Acknowledgements

This study was supported by grants from The Crime Victim Compensation and Support Authority in Sweden, by grants from Åland's kulturstiftelse r.s., and the Nordic School of Public Health in Gothenburg.