The lingering effects of woman abuse

When a woman leaves an abusive partner, she may be removing herself from certain forms of abuse but the abuse may continue in other forms for some time, e.g. harassment and breaches of no-contact orders. Sometimes an ex-partner may refuse to pay child support or may pass intimidating or threatening messages to the woman via the children or during child exchanges. There can be constant fear that the ex-partner will come back and "finish the job off" or harm those close to her in her life, especially a subsequent partner or child. The continuing threat can make it difficult for a woman to resolve the psychological trauma.

Even once a woman is no longer exposed to her ex-partner's abusive behaviour, she will often continue to experience trauma from the abuse until she is able to feel safe and has had the time and support needed to work through her feelings related to what she has endured.

Sometimes a woman will experience flashbacks of the abuse brought on by triggers in her environment. She may be very afraid of the night or avoid certain places (hospitals, churches, public bathrooms). She may have post traumatic stress/spectrum disorder (PTSD), or exhibit other signs of the trauma she has experienced, such as the following:

• intrusive, recurrent and distressing recollections of the event(s), including sensations, images and perceptions
• self-destructive behaviors
• guilt, shame, self-blame
• hopelessness
• inability to trust others
• fixation on hurting the perpetrator
• loss of crucial belief systems, "there can't be a God"
• isolating oneself from others, feeling detached, estranged
• chronic pain
• panic

— Source: The PTSD Workbook

There are also anxiety conditions that manifest themselves in women as a result of living with abuse. A woman who has been abused may find comfort in repetition and routine and show visible signs of distress during times of change. Other women may experience panic attacks or fear being in new places or meeting new people. As a means to cope with physical and sexual abuse, she may also have learned ways to disconnect from her body or "numb-out." She may also have been given negative messages about her body so frequently that caring for herself is challenging.

Abuse has profound impacts on women's mental, physical and emotional health often long after the abuse has ended — it is important not to assume that she will feel safe and secure because she has left her abusive partner. This is often when the work for her is just beginning. Rebuilding her self-esteem, finding new support networks, repairing family relationships, navigating the legal system, seeking out counseling, perhaps even relocating, are just some of the challenges she will face once she has made the difficult decision to leave an abusive partner.

When we gain an understanding of the impact abuse continues to have on the lives of women once they leave an abusive partner or the abusive relationship has ended, it becomes clearer how these past experiences can impact women in the childbearing year. She may bring with her huge anxieties about trusting others and have a very difficult time dealing with the uncertain nature of the birth experience.

Her pregnancy may also not have been her decision. Sometimes women in abusive relationships are denied the right to make decisions around if/when they would like to conceive. She may have conflicting feelings about having a baby that was conceived with her ex-partner, especially if the baby is a product of rape by her ex-partner. Extra care and concern should be extended and caregivers need to recognize that not all pregnancies are welcomed or wonderful experiences for women.

She may have concerns about her ex-partner having access to the baby and may not know what her legal rights/obligations are. She may be worried about the stigma attached to being without a partner and raising a baby. She may have cultural or religious beliefs that further isolate her from the support of her community if the relationship is over. You can be a tremendous resource for her through your compassionate and knowledgeable support and unwavering belief in the strength and ability of women to survive and even transcend their trauma.

Sexual assault is a traumatizing experience in the lives of women who have survived it. It impacts them on an emotional, spiritual, physical, sexual and mental level. Regardless of the circumstances of the assault, women are often left with the sense that they are somehow to blame and responsible, and with feelings of shame and confusion. If the person was someone known to her, these feelings can be further complicated by the relationship to the person, e.g. co-worker, ex-partner.

She may have been threatened with harm, loss of her job, kicked off a sports team or a school activity. She may fear an unwanted pregnancy, health concerns or the attacker may have threatened to disclose other personal information if she tells, such as HIV/AIDS status, substance use or mental health issues. The person who assaulted her may have higher status in the community or have the capacity to defend himself against the accusations using his privilege or relationships with people in power.

If the perpetrator is not known to the woman, or was never found, she may fear that the person may come after her.

Common reactions after experiencing a sexual assault include the following:

• fear, terror and anxiety
• confusion
• feeling frozen or numb
• overwhelming grief
• rage
• erratic mood swings

— Source: Sexual Assault Centre London (SACL)

Women can sometimes feel as though people do not understand the lifelong impact that a sexual assault(s) can have on their lives. Pregnant women who were sexually assaulted may have unique needs in the childbearing year that are important to understand and accommodate when possible.

Remember to convey to her:

• she was not to blame, she did not ask for the assault to happen
• you believe her
• she is not alone — sexual violence is all too common and there are people who can provide her with counseling and support
• she was courageous to share this information with you and it will be kept confidential

For additional support strategies please refer to the support guidelines in the section about Survivors of Childhood Sexual Abuse.

Please note: There are other forms of sexual violence not discussed here which also impact women, such as harassment, flashing, being exposed unwillingly to pornography, and being watched without consent. As well, women are systematically raped as a tactic of war, are subjected to female genital mutilation, are trafficked and subjected to other forms of sexual violence that have devastating impacts on their lives and the lives of their families. Any form of sexual violence that a woman in your care has experienced necessitates compassionate and respectful awareness and responsiveness on your part.