Isolated and afraid: challenges of intimate partner violence in rural areas

The research is somewhat scant, but the message is clear: in rural areas, the incidence of intimate partner violence is higher than in cities, and the challenges for seeking care and safety can be significant.

A 2011 study of 1,478 women in Iowa found the prevalence of intimate partner violence to be 22.5% in small rural areas and 17.9% for isolated areas, compared to 15.5% for urban women. Rural women reported significantly higher severity of physical abuse, that study found. And over a quarter of them lived at least 40 miles from the nearest domestic violence shelter – a long and for some an impossible journey to make.

October is Domestic Violence Awareness Month – a good time to recognize that more needs to be done to raise understanding of the realities and prevalence of intimate partner violence in small towns and rural areas, and particularly the need for more training for health care workers, social service providers, law enforcement officers and others on the front line of response. Cases are often under-reported and screening for domestic violence not part of routine care; survivors may be reluctant to seek help, even when their lives are at risk. And seeking safety from domestic violence in a rural area can post particular challenges.

Public transportation and rideshare services can be scarce or nonexistent. If a survivor doesn’t have access to a car or money for gas, it may be hard to leave a violent situation – especially in more isolated areas.

If the nearest domestic violence shelter is full, there may be no other options within a reasonable distance.

Survivors from small towns and rural areas may have limited access to affordable housing, to educational opportunities and to employment that pays a living wage. Economic dependence on an abuser always makes leaving more difficult.

And in rural areas and small towns, the webs of relationship often run deep, making privacy and confidentiality hard to come by. Many rural areas tend to be conservative, with traditional views of gender roles and sometimes a stigma attached to admitting abuse or asking for help. A 2015 policy brief from the National Advisory Committee cited a studywhich found that half of primary care providers saw confidentiality concerns in rural communities as a barrier to patients seeking care.

 “Victims who live in small communities may be acquainted with healthcare providers and law enforcement officers, but reluctant to report abuse, fearing that their concerns will not be taken seriously, their confidentiality will not be maintained, their reputations may be damaged, or that they may incur even more abuse because their abusers may be closely aligned with those who would otherwise offer protection,” said one report on “Violence and Abuse in Rural America.”

In a study released in 2020, drawing on data from 2009-2014, a study of emergency room visits for people aged 15-64 due to intimate partner violence found significantly higher rates for rural residents compared to urban ones – 15.5 per 100,000 population for rural areas, compared to 11.9 for urban communities. For rural areas, 95% of those patients were women (compared to 93% in urban areas).

That study also highlighted an economic connection. Almost 2/3 (64%) of those patients experiencing intimate partner violence lived in zip codes where the median household income was in the lower half – where housing insecurity, food insecurity and poverty may be added stressors in relationships.

Researchers also have cited other findings worthy of attention.

• While rural areas tend to be predominantly White (rural America was 76% non-Hispanic White, according to the 2020 Census) – and one researcher has found that rural Ohio tends to be even less racially diverse, with roughly92-97% of the population being White non-Hispanic. There can, however, be regional differences in particular counties, such as when employers such as meat-packing or auto plants tend to hire higher percentages of immigrant workers. It’s important for service providers to have a clear understanding of the local community and of cultural considerations.
• The rates of violence against Native Americans are stunning- with more than 4 in 5 Native American and Alaska Native adults, both women and men, experiencing violence in their lifetimes, according to the National Institute of Justice. Over half of Native women (56.1%) have experienced sexual violence and nearly half (48.8%) stalking – with 66.4% reporting psychological aggression by an intimate partner and 55.5% physical violence by an intimate partner. Most Native American and Alaska Native victims (97% of women and 90% of men) have experienced at least one incident of inter-racial violence. In the 2020 Census, Indigenous people represented 2% of Ohio’s population.
• In the study of emergency department patients in rural areas with visits related to domestic violence, one-fifth of the patients were young – ages 15 to 24. Some studies report possibly higher levels of teen dating violence in rural areas compared to urban ones. In Ohio, six teens were killed by a boyfriend or former boyfriend from July 1, 2023 through June 30, 2024, according to the Ohio Domestic Violence Network’s 2024 Lethality Report. One takeaway: the importance of teaching teens and young adults about dating violence.
• Access to some resources can be limited in rural areas – there may be long wait times for mental health services and a shortage of rural health professionals who specialize in treating traumatic brain injuries. Given that, some studies suggest it’s particularly important to provide training on trauma-informed care and culturally-rooted healing centered care for front-line health care providers in rural communities, such as primary care physicians and nurses.

For more information, see these resources:

• Violence and Abuse in Rural America, from the Rural Health Information Hub
• How Trauma-Informed Care Nurtures Healing in Rural America
• A webinar on creating domestic violence high-risk teams in rural communities.