Leaving abusive relationships: the hidden burden of poverty

Financial aid should be easier to access, should reflect current living costs and should consider the long term implications of a single parent raising children alone. We have been talking about recognising and ending violence against women for several years now, we need policies in place that do not penalise them financially for leaving

THE word “unprecedented” has been used several times over the past few years. Unprecedented pandemic, floods and fires. The health system is under unprecedented demand. As people grapple with “disaster” fatigue in the context of rising COVID-19 case numbers and deaths, cognitively it becomes harder to understand and deal with yet another unprecedented statistic or problem.

Unfortunately, the issue of women experiencing abuse and poverty is getting worse. Thanks to the work of numerous organisations, survivors and researchers in the field, violence against women is a well recognised issue for Australia. Although efforts to mitigate the problem are ongoing, there is a hidden epidemic of poverty that domestic violence creates that we often do not consider.

Many women reported an increase in violence during the COVID-19 pandemic. Coupled with the rising costs of housing and household expenses that disproportionately impact on affect women (and here), the outlook for women trying to leave abusive relationships is becoming grimmer.

A recent report published by Dr Anne Summers analysing datasets from the Australian Bureau of Statistics showed that a quarter of women wanting to leave abusive relationships could not do so due to a lack of money or financial support. The report delves deeper and shows that 60% of single mothers with children under the age of 18 years experienced physical or sexual violence in a previous relationship.

It is important to contextualise what this means.

Although more than half of the group of single mothers in the dataset were employed, most did not earn enough to support their families and many relied on government support. Many of them live on the brink of a financial cliff and are unable to heat their homes, feed their families or pay their bills. Government support ranges from $892 per fortnight until their child turns 8 years old, after which the unemployment benefit pays $691 per fortnight. Neither payment would really go far in helping pay for rent anywhere in Australia along with other expenses that come with raising children. Crisis payments are offered to women escaping immediately dangerous situations, but these are only temporary. Access to most of these payments often requires a significant time spent on the phone or on the computer to Centrelink – a luxury most women in abusive relationships do not have.

The statistics tell us that one in six women have experienced physical or sexual abuse by a previous or current partner. The risk is higher for Indigenous women, women from culturally and linguistically diverse backgrounds and LGBTQIA2+ people. We see them as patients every day.

The importance of screening for abuse is highlighted in a narrative review published by the MJA on 1 August. It is important to consider the indicators that should trigger asking about abuse, but it is also incredibly important to do it in a sensitive and culturally safe way. We owe it to our patients to train ourselves in recognising signs of abuse and responding to it appropriately. General practice, with its continuity of care, is an excellent place to build a therapeutic relationship with a patient to provide a safe space for them to disclose abuse. Often it is the second or third time that I ask, that a patient trusts me enough to talk about it.

The cases presented here are not anomalies. They are real and becoming increasingly common in my practice. Dowry abuse is another underappreciated cause of financial abuse for South-East Asian women.

Neha* came into the consult room with her husband. She looked miserable and he looked angry. She was there for a routine antenatal check-up. I requested the husband leave while I took a history and examined her. On asking her how she was feeling during the pregnancy, she burst into tears revealing that her husband and his family were angry that she had conceived a girl again. She revealed that she had been enduring years of abuse, both financial and emotional from her husband and his family and the situation had worsened when she moved here from India. She was worried she could not leave; her parents had re-mortgaged their house back in India for the dowry payment and she was employed in her husband’s family business, which meant that she had no other source of income for herself or her two girls.

As a GP, I have a privileged insight into the lives of my patients. It is incredibly frustrating to encourage and support women to leave abusive relationships, but also to witness the significant financial and bureaucratic barriers in place that prevent them from doing so.

Sharon* presented with her two children for their vaccines and checks – 18 months and 4 years old. She was a bit late for her 4-year-old’s vaccines but was concerned Centrelink was threatening to cut off her family benefit payments if she did not get the vaccine done. Her childcare subsidy for their day-care was also tied to their vaccination status and she needed both to maintain care for her children while she worked in hospitality. She had recently escaped a physically abusive relationship with the children’s father and revealed that she might have to move into a tent or a caravan park if a spot became available as there was no emergency housing available for her anymore. Several applications she had made for rental properties had been rejected.

One of my patients who is a survivor, told me how she laughed, literally laughed out loud, when a social worker at Centrelink suggested pursuing child support payments. My patient did not qualify for legal aid because she worked, and she could not afford the private legal fees it would take to pursue the case in court. Her only option was a non-legally binding mediation with her abuser. A woman in her situation must make a choice between pursuing child support payment or accessing certain family tax benefits.

As GPs, we can screen for abuse, but currently, the choice for most women seems to be to either continue staying in an abusive relationship or escape into a life of poverty. It is important as GPs that we arm ourselves with information about local services and organisations that can support women financially or “top-up” any government payments.

In my practice, it is often a creative juggle between crisis accommodation, culturally appropriate counselling services, meal services and Centrelink social workers. I have built links with and keep information in my rooms about local charities and organisations that provide services such as a safe space to use the internet, laundry and shower facilities. If a woman is struggling to make time to talk to Centrelink, I am lucky enough to work at a practice where there are several empty rooms where she can safely sit and make phone calls if needed on the pretext of a doctor’s appointment.

But these are small band-aid solutions to a problem that needs better planning and better policies. Financial aid should be easier to access, should reflect current living costs and should consider the long term implications of a single parent raising children alone. We have been talking about recognising and ending violence against women for several years now, we need policies in place that do not penalise them financially for leaving.

*Names have been changed

Dr Aajuli Shukla is a Sydney-based GP, and a Deputy Medical Editor with the Medical Journal of Australia.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.

Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.

If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.