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Handbook of WMA Policies
S-1996-02-2010 ⏐ World Medical Association
WMA STATEMENT
ON
FAMILY VIOLENCE
Adopted by the 48th
WMA General Assembly, Somerset West, South Africa, October 1996
editorially revised by the 174th
WMA Council Session, Pilanesberg, South Africa,
October 2006
and amended by the 61st
WMA General Assembly, Vancouver, Canada, October 2010
PREAMBLE

Recalling the World Medical Association Declaration of Hong Kong on the Abuse of the
Elderly and the World Medical Association Statement on Child Abuse and Neglect, and
profoundly concerned with violence as a public health issue, the World Medical Associa-
tion calls upon National Medical Associations to intensify and broaden their efforts to
address the universal problem of family violence.
Family violence is a term applied to physical and/or emotional mistreatment of a person
by someone in an intimate relationship with the victim. The term includes domestic vio-
lence (sometimes referred to as partner, spouse, or wife battering), child physical abuse
and neglect, child sexual abuse, maltreatment of older people, and many cases of sexual
assault. Family violence can be found in every country in the world, cutting across gender
and all racial, ethnic, religious and socio-economic lines. Although case definitions vary
from culture to culture, family violence represents a major public health problem by virtue
of the many deaths, injuries, and adverse psychological consequences that it causes. The
physical and emotional harm may represent chronic or even lifetime disabilities for many
victims. Family violence is associated with increased risk of depression, anxiety, sub-
stance abuse, and self-injurious behaviour, including suicide. Victims often become per-
petrators or become involved in violent relationships later on. Although the focus of this
document is the welfare of the victim, the needs of the perpetrator should not be over-
looked.
Although the causes of family violence are complex, a number of contributing factors are
known. These include poverty, unemployment, other exogenous stresses, attitudes of ac-
ceptance of violence for dispute resolution, substance abuse (particularly alcohol), rigid
gender roles, poor parenting skills, ambiguous family roles, unrealistic expectations of
other family members, interpersonal conflicts within the family, actual or perceived physi-
cal or psychological vulnerability of victims by perpetrators, perpetrator pre-occupation
with power and control, and familial social isolation, among others.
POSITION

There is a growing awareness of the need to think about and take action against family
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Vancouver ⏐ S-1996-02-2010
Family Violence
violence in a unified way, rather than focusing on the particular type of victim or com-
munity affected. In many families where partner battering occurs, for example, there may
be abuse of children and/or of older people as well, often carried out by a single perpe-
trator. In addition, there is substantial evidence that children who are victimized or who
witness violence against others in the family are later at increased risk as adolescents or
adults of being re-victimized and/or becoming perpetrators of violence themselves. Final-
ly, more recent data suggest that victims of family violence are more likely to become
perpetrators of violence against non-intimates as well. All of this suggests that each in-
stance of family violence may have implications not only for further family violence, but
also for the broader spread of violence throughout a society.
Physicians and NMAs should oppose violent practices such as dowry killings and honour
killings.
Physicians and NMAs should oppose the practice of child marriage.
Physicians have important roles to play in the prevention and treatment of family violence.
Of course they will manage injuries, illnesses, and psychiatric problems deriving from the
abuse. The therapeutic relationships physicians have with patients may allow victims to
confide in them about current or past victimization. Physicians should inquire about vio-
lence routinely, as well as when they see particular clinical presentations that may be as-
sociated with abuse. They can help patients to find methods of achieving safety and access
to community resources that will allow protection and/or intervention in the abusive rela-
tionship. They can educate patients about the progression and adverse consequences of
family violence, stress management and availability of relevant mental health treatment,
and parenting skills as ways of preventing the violence before it occurs. Finally, physi-
cians as citizens and as community leaders and medical experts can become involved in
local and national activities designed to decrease family violence.
Physicians recognise that victims of violence may find it difficult to trust their physician at
first. Physicians must be prepared to develop a trusting relationship with their patient over
time until s/he is ready to accept advice, help and intervention.
RECOMMENDATION

The World Medical Association recommends that National Medical Associations adopt
the following guidelines for physicians:
• All physicians should receive adequate training in the medical, sociological, psy-
chological and preventive aspects of all types of family violence. This would in-
clude medical school training in the general principles, specialty-specific infor-
mation during postgraduate training, and continuing medical education about
family violence. Trainees must receive adequate instruction in the role of gender,
power and other issues of family dynamics in contributing to family violence. The
training should also include adequate collecting of evidence, documentation and
reporting in cases of abuse.
• Physicians should know how to take an appropriate and culturally sensitive history
of current and past victimization.
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Family Violence
• Physicians should routinely consider and be sensitive to signs indicating the need
for further evaluations about current or past victimization as part of their general
health screen or in response to suggestive clinical findings.
• Physicians should be encouraged to provide pocket cards, booklets, videotapes,
and/or other educational materials in reception rooms and emergency departments
to offer patients general information about family violence as well as to inform
them about local help and services.
• Physicians should be aware of social, community and other services of use to vic-
tims of violence, and refer to and use these routinely.
• Physicians have the obligation to consider reporting to appropriate protection
services suspected violence against children and other family members without
legal capacity.
• Physicians should be acutely aware of the need for maintaining confidentiality in
cases of family violence.
• Physicians should be encouraged to participate in coordinated community acti-
vities that seek to reduce the amount and impact of family violence.
• Physicians should be encouraged to develop non-judgemental attitudes toward
those involved in family violence so their ability to influence victims, survivors
and perpetrators is enhanced. For example, the behaviour should be judged but not
the person.
• National Medical Associations should encourage and facilitate coordination of
action against family violence between and among components of the health care
system, criminal justice systems, law enforcement authorities, family and juvenile
courts, and victims’ services organizations. They should also support public aware-
ness and community education.
• National Medical Associations should encourage and facilitate research to under-
stand the prevalence, risk factors, outcomes and optimal care for victims of family
violence.