INTRODUCTION
The majority of victims of child abuse, sexual assault, intimate partner violence, and elder abuse are women. Indeed, physical, sexual and emotional violence against women is increasingly recognized to be both an important clinical and a public health issue. Only recently, however, has the medical profession begun to recognize the enormity of this problem -- or the profundity of its consequences to female victims, their children, and their communities.

In addition to the long-term physical harm that may be caused by violence, there is a growing body of research that links violence with a wide range of emotional and behavioral sequelae. These responses may, in turn, lead to additional health care problems and are frequently associated with over-utilization of health care resources, often as a result of the failure to recognize underlying etiology. The following list includes clinical presentations frequently associated with victimization:

• Depression, anxiety, post-traumatic stress
  
• Eating disorders, sleep disturbances
  
• Alcohol, drug, and tobacco abuse
  
• Somatizing disorders
  (e.g. chronic pelvic pain, migraines, gastrointestinal disorders)
  
• Early initiation of sexual activity, compulsive sexual behaviors, sexual dysfunction
  
• Poor or no contraceptive compliance
  
• Self-neglect, malnutrition, failure to thrive
  
• Aggression towards self and others
  
• Suicide attempts
  
• Poor adherence to medical recommendations
  
• Diminished capacity for acquisition of knowledge (especially in children)
  
• Lying, stealing, truancy, running away (in children)

Girls and Violence
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• In 1996, child protective services agencies investigated more than 2 million reports alleging maltreatment of more than 3 million children. (US Department of Health and Human Services, 1998)
  
• Child protective services agencies determined that almost 1 million children were identified as victims of substantiated or indicated abuse or neglect in 1996, an approximate 18% increase since 1990. (US Department of Health and Human Services, 1998)
  
• Seventy seven percent of perpetrators of child maltreatment were parents; an additional 11% were other relatives of the victim. (US Department of Health and Human Services, 1998)
  
• An estimated 1,077 child maltreatment fatalities occurred in the 50 States and the District of Columbia in 1996. (US Department of Health and Human Services, 1998)
  
• More than half (53%) of all victims were white. African American children represented the second-largest group of victims (27 %). Hispanic children were about 11% of victims. (US Department of Health and Human Services, 1998)
  
• Fifty two percent of all victims suffered neglect, 24% suffered physical abuse, and 12% suffered sexual abuse. Children suffering medical neglect and emotional maltreatment accounted for 3% and 6% of all victims, respectively. (US Department of Health and Human Services, 1998)
  
• A greater proportion of neglect and medical neglect victims were children younger than 8 years old, while a greater proportion of physical, sexual, and emotional abuse victims were children age 8 or older. (US Department of Health and Human Services, 1998)
  
• Girls were sexually abused three times more often than boys; in 1993, an estimated number of sexually abused children was 300,200. (US Department of Health and Human Services, 1996)
  
• Studies of the general population of adults show that anywhere from 6 to 63% of females were sexually abused as children. The true extent of sexual abuse is unknown. (National Committee to Prevent Child Abuse, 1995)
  
• Homicide is the second leading cause of death of females 15�19 years old; homicide is the leading cause of death of African American females 15�19 years old. (National Center for Health Statistics, 1996)
  
• For female victims, the offender was most often someone known to them (62%). (Bureau of Justice Statistics, 1997)
  
• Victims of rape are disproportionately children and adolescent girls � 60% of forcible rapes occur before the victim is 18 years old; 29% of victims are younger than 11 years old when raped. (The National Victim Center, 1992)
  
• More than 52% of all rape/sexual assault victims were females younger than 25. (Bureau of Justice Statistics, 1997)
  
• Of girls involved in the juvenile justice system, 40�70% have a past history of family abuse (physical, sexual or emotional) compared to 23�34% of girls in the general population. (Girls Incorporated, 1996)
  
• Twenty six percent of girls in grades 9�12 report experiencing physical abuse, sexual abuse, or date-forced sex; for girls in grades 5�8, 9% report experiencing physical abuse and 7% report experiencing sexual abuse. (Commonwealth Fund, 1997)
  
• Of children who witness their mothers being abused by their fathers, 40% suffer anxiety, 48% suffer depression, 53% act out with their parents, 60% act out with siblings. (Pfout, Schopler & Henley, 1982)

• Between 1992 and 1994, the number of violent incidents involving a female victim totaled 14 million crimes during the 3-year period. (Bureau of Justice Statistics, 1996)
  
• In 1994, women were about 6 times more likely as men to be victims of violence; 20 years ago women were half as likely as men to be victimized. (Bureau of Justice Statistics, 1996)
  
• In 1996, females were the victims of 75% of intimate murders and about 85% of the victims of non-lethal intimate violence. (Bureau of Justice Statistics, 1997)
  
• The highest rates of intimate violence affected women ages 16�24. (Bureau of Justice Statistics, 1998)
  
• Seventy five percent of female victims knew the offender: 29% were current or former spouses or boyfriends; 40% were acquaintances; 9% were relatives. (Bureau of Justice Statistics, 1996)
  
• About 7 in 10 female victims of intimate violence reported they were physically attacked. For the remainder, the attack was attempted or threatened. Nearly a third of these victims saying the offender threatened to kill them. (Bureau of Justice Statistics, 1998)
  
• Nearly a third of female victims of non-lethal intimate violence were victimized at least twice during the previous 6 months. (Bureau of Justice Statistics, 1998)
  
• More than half of the female victims of intimate violence live in households with children under age 12. (Bureau of Justice Statistics, 1998)
  
• In 1994, hospitals recorded nearly a quarter million hospital visits resulting from intimate violence. (Bureau of Justice Statistics, 1998)
  
• Between 0.9 - 21% of pregnant women are battered. (CDC, 1997)
  
• Battered women account for 22-35% of all women seeking emergency medical services, 25% of women who attempt suicide, 23% of pregnant women who seek prenatal care, and 50% of women over 30 years old who have been raped. (AMA, 1994)
  
• Medical expenses from domestic violence are estimated to total at least $150 million annually. (Bureau of Justice Statistics, 1998)
  
• Nationally, the number of rape and sexual assault victims in a recent year was estimated at 1.1 million (National Victim Center, 1992)
  
• In 1995, 354,670 women were the victims of a rape or sexual assault. (Bureau of Justice Statistics 1996)
  
• The FBI estimates that 72 of every 100,000 females in the US were raped last year. (Federal Bureau of Investigation, Uniform Crime Statistics, 1996)
  
• Approximately 28% of victims are raped by husbands or boyfriends, 35% by acquaintances, and 5% by other relatives. (Bureau of Justice Statistics, 1994)
  
• Total economic loss to victims of crime in 1992 for rape was $ 33,000,000. (Bureau of Justice Statistics, 1994)
  
• The FBI estimates that only 37% of all rapes are reported to the police. US Justice Department statistics are even lower, with only 26% of all rapes or attempted rapes being reported to law enforcement officials. (National Crime Victimization Survey, 1996)
  
• One out of every 12 women have been stalked at some time in her life; an estimated 1,006,970 women are stalked annually in the US (National Institute of Justice & CDC, 1998)
  
• Fifty two percent of the stalking victims were 18�29 years old and 22% were 30�39 years old when the stalking started. (National Institute of Justice & CDC, 1998)
  
• Fifty nine percent of victims were stalked by an intimate partner; even when the relationship is still intact. (National Institute of Justice & CDC, 1998)

• Research studies indicate that only 1 in 4 elder abuse incidents are reported. (National Aging Resource Center on Elder Abuse, 1990)
  
• An estimated 1.01 million elders became victims of various types of domestic elder abuse in 1996, excluding self-neglect. (National Center on Elder Abuse, 1996)
  
• Women make up 68.3% of elder abuse victims. (National Center on Elder Abuse, 1994)
  
• Approximately two-thirds of perpetrators are family members, typically adult children, most often those serving as caregiver, followed respectively by spouses and �other relatives.� (National Aging Resource Center on Elder Abuse, 1993)
  
• Neglect is the most common form of elder maltreatment (55%), followed by physical abuse (14.6%), financial exploitation (12.3%), emotional abuse (7.7 %), and sexual abuse (0.3%). (National Center on Elder Abuse, 1996)
  
• The median age of elder abuse victims was 77.9 years (National Center on Elder Abuse, 1996)
  
• In 1996, 66.4% of the victims of domestic elder abuse were white, 18.7% were African American, and 10.4% Hispanic. (National Center on Elder Abuse, 1996)