Introduction

“ Among women who are physically assaulted or raped by an intimate partner, one in three is injured.” (1)

The North Dakota State Plan on Domestic Violence and Sexual Assault is the result of a collaborative effort between the North Dakota Department of Health (NDDoH), Injury Prevention Division, and the North Dakota Council on Abused Women’s Services/Coalition Against Sexual Assault in North Dakota (NDCAWS/CASAND).  Under a supplemental “Violence Against Women” grant through the Centers for Disease Control and Prevention, the State Plan was developed with the vision of creating “a state that is safe through an integrated, coordinated continuum of response to domestic violence and sexual assault”.  

Intimate partner violence, which includes domestic violence and sexual assault, crosses all racial, economic, geographical and gender boundaries, making a comprehensive, broad based approach to violence against women necessary for the state.  The purpose of the State Plan is to provide a framework within which to focus statewide efforts in the areas of education, prevention and training, services, data collection, and funding for the reduction of violence against women.  The State Plan Steering Committee prioritized the issues that are the focus of the State Plan and identified recommendations to sustain current services and implement strategies for change.  Particular attention was paid to rural areas, the needs of special populations, and an aging population, since these are the primary realities we as a state face when attempting to confront, prevent, and intervene in violence against women.

North Dakota Background

North Dakota is a rural state with approximately 642,200 people (2).  Communities in North Dakota consist of urban centers with populations of 36,567 to 90,599, to rural or “frontier” boundaries that include communities with populations of fewer than 7 persons per square mile.  North Dakota’s four tribal nations: The Standing Rock Sioux, The Three Affiliated Tribes of Ft. Berthold, The Spirit Lake Sioux, and The Turtle Mountain Band of Chippewa make up 5% of the state population, or 35,228.   92% of the population is Caucasian, or 593,181, with the remaining 3% consisting of African Americans (3,916), Asian Americans (3,606), and Hispanics (7,786). 

Special Considerations for North Dakota

North Dakota is a statewide community facing a future with dying rural communities, a sagging agricultural economy, an aging population of dramatic proportions, and a population that grew only a fraction of a percent in the last decade. 

 Rural victims face many barriers to receiving services when escaping violent situations.  Limited access to transportation, few financial resources, obligations to the family farm, and lack of services in the area are all daily battles that women face living in rural communities.  Urban victims, comparatively, may have more access to services but also face the fear of leaving the abusive relationship because they may have no place to go or means to survive independently.  Having children only further complicates a violent relationship and makes leaving an abusive relationship appear even more impossible.

 North Dakota’s aging population and a lack of population growth, except for Native Americans and immigrants/refugees, made the needs of those groups a priority for the State Plan.  Children, the elderly, offenders, persons with disabilities, Native Americans, and many immigrants and refugees are groups for which services and programs are currently available, but not with any consistency statewide.  Victims of violence in these groups have unique needs, and services need to be developed and sustained to create a more inclusive response to all victims.

 North Dakota experiences the same type of violent crimes and violence against women as the rest of the nation.  Violence against women includes domestic violence, sexual assault, and stalking.

 For the purpose of the North Dakota State Plan, domestic violence (3) is defined as “a system of power and control over an intimate partner.”  Domestic violence includes any and all forms of abuse: physical, sexual, and emotional.  The motivation is always to control another person’s thoughts and behavior.  Sexual assault (4) is any sexual contact or sexual attention committed by force, threats, bribes, manipulation, pressure, tricks, or violence. It includes rape and attempted rape, child molestation, incest, and sexual harassment.

 National Crime Statistics indicate that among all female murder victims, 32% were slain by husbands or boyfriends (5).  Comparatively, according to the ND Bureau of Criminal Investigation, in 1999, 55% of the state’s murders were domestic violence related.  Fifty percent of all homicides in the state since 1978 can be identified as domestic violence homicides.

 In 2001, 5,720 incidents of domestic violence were reported to crisis intervention centers in North Dakota; 93% of the victims were women; and 4,787 children were directly impacted by these incidents.  In the same year, 755 primary victims and 292 secondary victims of sexual assault were served by the 19 sexual assault crisis centers in North Dakota.   At least 91% of the victims were female and 47% of the primary sexual assault victims reported being under the age of 18 at the time of the assault. 94% of the assailants were male, 42% were reported to be a friend, acquaintance or date of the victim; only 64% of the cases were reported to law enforcement (6).  Sexual assault and domestic violence continue to be among the most underreported crimes, thus the true magnitude of domestic violence and sexual assault is unknown.  This creates a sense of urgency to reach victims and potential victims in communities throughout the state.  The State Plan provides a framework within which to create, sustain, and implement more effective prevention and intervention efforts in the state.

 Intimate Partner Violence as a Public Health Issue

Ninety-two percent of women who were physically abused by their partners did not discuss these incidents with their physicians.  In 40% of cases in which physicians treated battered women in an emergency department setting, staff did not discuss the abuse with their patients (U.S. Department of Human Services (7)).  Historically, intimate partner violence has been viewed as a social or criminal justice issue, but as research has indicated, intimate partner violence is a leading cause of injury to women between the ages of 15-44 (8).  It is important that we as a society and as a state begin to face the major impact intimate partner violence is having on women and what we can do to prevent or intervene.  Intimate partner violence has been brought out of the privacy of the home and into the public eye, but more needs to be done.  By increasing the ability of the first line of prevention and intervention, the healthcare providers, to diagnose, treat and refer women to appropriate domestic violence and sexual assault services, we could make significant strides in putting an end to the violence that many women endure over many years.  Collaboration is key among domestic violence and sexual assault programs, health care providers, and the criminal justice system to increase the capability of physicians and nurses to assist victims and stop the cycle of violence.

 Historically, intimate partner violence has been perceived as a private family matter.  Due to the serious risks presented to women and the cost of caring for victims of domestic violence and sexual assault, the Centers for Disease Control and Prevention (CDC) has begun efforts to address intimate partner violence as a public health issue. 

 The Center for Disease Control and Prevention (CDC) uses a “systematic process to confront and solve public health problems called the public health approach”.  This approach has four steps that were applied in the development of the State Plan on intimate partner violence in North Dakota.  The first step in this approach is to define the problem.  In January 2002, 40 agencies throughout the state sent representatives to the State Plan Advisory Committee Meeting to define the current strengths, realities, weaknesses, and barriers in the reduction of violence against women in North Dakota.  Next, the State Plan Advisory Committee identified risks and protective factors, in order to assess the state’s current services and recommendations for sustaining these services and implementing new strategies for change.  The State Plan Steering Committee was formed in June, 2002 to develop and test prevention strategies.  Keeping in mind the issues identified at the January meeting, the group was able to prioritize the needs of North Dakota, create recommendations, strategies, and action steps for the prevention of and intervention in domestic violence and sexual assault.  Finally, to assure the widespread adoption of intimate partner violence as a public health issue, the State Plan was drafted to provide a framework within which to focus statewide efforts in the areas of education, prevention and training, services, data collection, and funding for the reduction of violence against women in North Dakota (9).

 Advocacy in North Dakota

One of the state’s leading advocacy groups in the area of violence against women is the North Dakota Council on Abused Women’s Services/Coalition Against Sexual Assault in North Dakota (NDCAWS/CASAND).  The coalition formed in 1978 as an informal group of five programs that organized across the state of ND to provide shelter and advocacy to battered women.  In June 1980, the coalition was incorporated in the state of ND; and in 1983, the IRS formally recognized it as a non-profit organization.

 In 1992, the Council on Abused Women’s Services merged with the Coalition Against Sexual Assault in ND.  It is the mission of the coalition to pursue and expose the causes of domestic and sexual violence, assure direct and immediate services to those who are victimized, and support those who provide such services.  Currently, there are 19 programs throughout the state, which provide domestic violence and sexual assault services.  Each program offers a variety of services based on location and availability of resources and funding.  Some services provided include crisis intervention, counseling, assistance with protection orders, shelter, advocacy, and visitation centers (see Appendix A for list of ND programs and services).