Criminal Suspicion:
Domestic Violence Leading Cause of Injury to Women

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On July 10, 1994, an article in the Times-Picayune, a major newspaper in New Orleans, Louisiana, led with this news:

You’ve probably seen the fact somewhere now – that domestic violence is the leading cause of injury to women between the ages of 15 and 44.

Newsweek used it. The Washington Post used it. CNN and ABC used it.

And you may have heard that more women are injured by domestic violence than by auto wrecks, cancer and muggings combined.

But there’s a problem with these facts: They aren’t true.^

Uncovering this news required nothing more than standard journalistic practices — checking sources, asking relevant persons significant questions, and recognizing the broader context of current events. The journalist interviewed Linda Saltzman, one of the authors of an influential 1992 Surgeon General’s statement on domestic violence. The journalist reported:

With respect to the claim, “domestic violence is the leading cause of injury to women between the ages 15 and 44,” Saltzman stated: “I spend my life trying to get it unattributed to us because we didn’t say it and it’s not accurate,” Saltzman said. “It’s a very misleading quote, and I don’t know how to stop it.”^

In February, 1995, a government agency with well-established and well-institutionalized statistical expertise published a technical report with summary statistics from a nationally representative survey of hospital emergency rooms. The relevant statistics indicated that violence (not just domestic violence) was the fifth-largest cause of injury to females and accounted for less than a third as many injures to females as did motor vehicle accidents.^ Discerning that domestic violence is far from the leading cause of injury to women doesn’t place large demands on public reason and public information.

Variants of the false claim that domestic violence is the leading cause of injuries to women have been widely supported and disseminated in public discourse. From 1996 to 2005, variants appeared at least 70 times in U.S. Congressional records, at least 19 times in judicial opinions (including in U.S. Supreme Court opinions), at least 202 times in law reviews and law journals, at least 105 times in newspaper articles, and at least 178 times in web pages. In 1999, the prestigious New England Journal of Medicine published an article authored by nine persons, each having an M.D., a Ph.D., or both. The article began by authoritatively claiming:

Domestic violence is the most common cause of nonfatal injury to women in the United States.^

In 2005, Lifetime Television, in conjunction with its fourth annual “Stop Violence Against Women Week,” issued a press release reporting:

young women and men have a much higher “IQ on Violence Against Women” than previous studies have found. … 80% {of 600 persons ages 16-24, surveyed online Feb. 9-16, 2005} knew that, in the US, the leading cause of injury to women between 15 and 25 is battering.^

Across public discourse for more than two decades, influential communicators have encouraged the public to believe a highly damaging, false claim about domestic violence against women.

Support in public discourse for the false claim that domestic violence is the leading cause of injury to women obscures the true distribution and scope of human injuries. A compassionate response to injuries focuses first on injuries, not on causes. Men between ages 15 and 44 suffer about 40% more injuries prompting visits to hospital emergency rooms than do women of those ages. Limiting those injuries to only injuries from violence, men suffer 60% more injuries from violence than women do. Limiting those injuries from violence to only injuries from domestic violence, men suffer 40% fewer injures from domestic violence than women do. Injuries to men and women from domestic violence account for about 2% and 4%, respectively, of all injuries prompting a visit to a hospital emergency rooms. Falsely exaggerating injuries from domestic violence against women obscures many injuries that men and women suffer. Focusing on domestic violence against women does not credibly express compassion for human injury itself. The actual, implicit concern seems to be not helping the injured but spurring criminal suspicion of a particular class of persons: men.

Support in public discourse for the false claim that domestic violence is the leading cause of injury to women undermines public trust. That false claim devalues men’s love for women and supports the criminal disposability of men from their families and their communities of ordinary life. Trust is a fundamental element of civilization.^ Intimate relations are crucial to human flourishing. Domestic violence has been publicly recognized as a problem long before the late-twentieth century. Public media, however, have become far more powerful than they were in the nineteenth century and earlier. Using historically unprecedented capabilities of public media to mislead intimates into fearing each other is extraordinarily damaging to human trust personally and socially.

Support in public discourse for the false claim that domestic violence is the leading cause of injury to women supports sex inequalities in criminal fear and punishment. That false claim is one of many sensational, highly exaggerated domestic-violence factoids that have circulated throughout public discourse.^ Highly exaggerated claims of domestic violence against women foster fear for women and criminal suspicion of men. An academic study of criminals and victims found that the “ideal criminal” is male, and the “ideal victim,” female. That study argued that the consequence for women are bad: “Fear of crime is one of the most oppressive and deceitful sources of informal social control of women.”^ The study didn’t consider a severe formal social control: incarcerating persons. In 2010, about ten men were in prison in the U.S. for every woman in prison. Fostering criminal suspicion of men supports highly disparate criminal punishment of men.

Influential Claim about Domestic Violence Against Women

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The U.S. Surgeon General’s statement in 1992 in the prestigious Journal of the American Medical Association was highly influential for proliferating false claims about domestic violence against women. That journal’s June 17, 1992, issue highlighted domestic violence against women. It included a one-page statement entitled “From the Surgeon General, US Public Health Service.” The Surgeon General’s statement began:

A Medical Response to Domestic Violence: Domestic violence is an extensive, pervading, and entrenched problem in the United States. It is an outrage to women and the entire American family. … It is a violation of our criminal laws and a callous disregard for human life.^

This statement as a whole implicitly equated domestic violence (“an outrage to women”) with domestic violence against women. Its fourth paragraph stated:

One study found violence to be the second leading cause of injuries to women, and the leading cause of injuries to women ages 15 through 44 years (Am J Epidemiol. 1991;134:59-68).

The Surgeon General’s statement, which began with an explicit scope of domestic violence (“A Medical Response to Domestic Violence: “), didn’t address violence in general. Hence a reader would reasonably assume that the reference to violence referred to domestic violence. The appended scholarly citation (“Am J Epidemiol. 1991;134:59-68”), the only scholarly citation in the Surgeon General’s statement, examined injuries treated in hospital emergency departments. The injuries of concern were all injuries from violence, not just injuries from domestic violence. The population studied was poor, urban, black women in western Philadelphia in 1987-88.^ That population is far from representative of the U.S. population as a whole. The Surgeon General’s statement concluded:

As health professionals, we must make every effort to end domestic violence. Women must be able to live their lives free from violence, both inside and outside the home. … As professionals, we can make a remarkable difference.

After the Surgeon General’s statement were the authors’ names and impressive credentials:

  • Antonia C. Novello, MD, MPH, Surgeon General, US Public Health Service
  • Mark Rosenberg, MD, PhD
  • Linda Saltzman, PhD, National Center for Environmental Health and Injury Control, Centers for Disease Control
  • John Shosky, PhD, Consultant to the Surgeon General

With the statement “From the Surgeon General,” these authors made a remarkable difference. Variants of the false claim that domestic violence is the leading cause of injury to women proliferated after its publication. Many scholarly references to that false claim have reference chains leading back to the Surgeon General’s statement in the June 17, 1992, issue of the Journal of the American Medical Association.

That journal issue also included a report that contributed to the proliferation of false claims about domestic violence against women. The report was entitled “Physicians and Domestic Violence.” It was subtitled “Ethical Considerations.” The Council on Ethical and Judicial Affairs of the American Medical Association authored it. This report’s third paragraph stated:

Women in the United States are more likely to be victimized, through assault, battery, rape, or homicide, by a current or former male partner than by all other assailants combined.{one endnote reference} The rate of injury to women from battering surpasses that of car accidents and muggings combined. {four endnote references}^

References to the Surgeon General’s misleading statement about domestic violence often include frightening comparators like “car accidents” and “muggings”. These terms do not occur in the Surgeon General’s statement. References that include these terms seem to have evolved from an intertwining and exchange of symbol material between the Surgeon General’s statement and the report of the American Medical Association’s Council on Ethical and Judicial Affairs. Despite the additional scholarly paraphernalia attached to the latter report, nationally representative injury surveys indicate that the claim about the battering injury rate for women is false by a wide margin.

The June 17, 1992, issue of The Journal of the American Medical Association also included an editorial supporting the proliferation of false claims about domestic violence against women. This editorial was entitled “Violence, Values, and Gender.” Echoing the Surgeon General’s misleading statement, that editorial noted “our findings that domestic violence was a leading cause of women’s injuries.”^ The author of the editorial was “Anne H. Flitcraft, MD.” The American Medical Association’s Council on Ethical and Judicial Affairs thanked Flitcraft for “critical review” of its report in that issue (see above). Flitcraft, along with Evan Stark, had published for the National Clearinghouse on Domestic Violence in 1981 a tendentious monograph entitled, Wife Abuse in the Medical Setting: An Introduction for Health Personnel.^ Apparently established as a domestic-violence expert, Flitcraft testified in 1985 at a Senate hearing on domestic violence and public health. She declared to the Senate:

domestic violence accounts for more injuries to women than street crimes, rapes, muggings, and motor vehicle accidents combined. It is the single largest cause of injury to women in this country.^

Flitcraft also co-authored a paper with Evan Stark for the Surgeon General’s Workshop on Violence and Public Health in 1985. As published in 1991, that paper stated that spouse abuse “results in more than three times as many injuries as auto accidents.”^ Nationally representative injury surveys indicate that these claims grotesquely exaggerate injuries from domestic violence.

The Surgeon General’s statement, in its context in the 1992 issue of the prestigious Journal of the American Medical Association, provided highly authoritative support for the claim that domestic violence is the leading cause of injury to women. That claim and its variants proliferated after 1992. That those claims are false by a wide margin mattered little. In stark contrast, scholarly studies indicating that domestic violence against men is a serious public problem have generated violent scholarly controversy and attracted little public attention. The Surgeon General’s statement on domestic violence provides a stunning example of a fundamental anti-men sex bias in public discourse.

Tracing Proliferation of False Claims about Domestic Violence

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False claims like “domestic violence is the leading cause of injury to women” increased sharply in the U.S. in the late 1980s and early 1990s. No such claims were found in a broad search of U.S. Congressional documents, law journals, and newspapers published in 1985 and 1986. In 1987, that search found 3. The count rose from 17 in 1989 to 115 in 1993. Within the corpus of searched texts, claims that domestic violence is the leading cause of injury to women and closely related variants peaked at 188 in 1994. That was the year that Ronald Goldman and Nicole Brown Simpson, O.J. Simpson‘s wife, were murdered. O.J. Simpson was charged with both murders. The O.J. Simpson case provided a prominent opportunity to sensationalize domestic violence against women.

While the O.J. case supported sensationalization of domestic violence against women, the claim that domestic violence is the leading cause of injuries to women had considerable public significance prior to the O.J. case. A variant of that claim appeared in the U.S. national news weekly Time in 1983. The Surgeon General in 1984 reportedly made such a claim. Additional instances of the claim appear in specialized studies published in the 1980s. In 1992, the prestigious Journal of the American Medical Association published a Surgeon General’s statement on domestic violence. That statement seems to have been the key event in proliferating the false claim that domestic violence is the leading cause of injury to women.

"Domestic violence is the leading cause of injury to women"

Instances, with variants, in Congressional documents, law reviews, and newspapers
yeartotalleading causelargest causegreatest cause
Note: The above figures are from well-defined corpuses of relevant documents. They provide a lower bound on the number of such claims actually published. The newspaper claim count does not include all US newspapers and is probably biased toward greater coverage after the mid-2000s. The above counts exclude court cases, where citing opportunities are case-dependent, and web documents, which aren't easily categorized by year of posting. The underlying data, including the specific text and context of the claims, are available in the Domestic Violence Claims Dataset.
19850000
19860000
19873120
19885023
1989173113
19903412193
19917025441
19928764185
1993115752515
1994188153269
1995101721415
19968969191
19978770107
19985842133
19996146105
2000594955
2001614876
2002282530
20034326152
2004392685
2005373070
2006373052
2007403631
2008231580
2009272322
2010232102
2011201901

The Surgeon General’s 1992 statement on domestic violence included distinctive phrases that help to trace its influence on false claims about domestic violence. The Surgeon General in 1992 was Antonia C. Novello. Here’s the focal text from the Surgeon General’s statement:

One study found violence to be the second leading cause of injuries to women, and the leading cause of injuries to women ages 15 through 44 years

References to this statement have nearly uniformly dropped the reference to “one {unrepresentative} study.” References to this statement have also nearly uniformly replaced “violence” with “domestic violence” or a related term such as “spouse abuse,” “battering,” or “intimate partner violence.” Within that family of variants, the text has distinctive symbolic markers: the phrase “leading cause” and the age specification “ages 15 through 44 years.” These markers help to identify the influence of the Surgeon General’s 1992 statement.

In 1984, the Surgeon General reportedly made a formally distinguishable statement about domestic violence against women. The Surgeon General in 1984 was C. Everett Koop. The U.S. Congressional Record from 1988 to 1993 contains at least seven statements similar to the following example from the Congressional Record in 1988:

In 1984, U.S. Surgeon General C. Everett Koop reported that domestic violence is the single largest cause of injury to women in the United States.

Primary-source evidence for this Surgeon General’s statement apparently doesn’t exist. In any case, this statement doesn’t shield the Surgeon General behind the the findings of “one study.” The statement also explicitly refers to domestic violence, uses the phrase “largest cause,” and contains no qualification as to women’s ages. Some substitution between the phrases “leading cause” and “largest cause” probably occurs in paraphrasing references. The age qualification in the Surgeon General’s 1992 statement, although highly relevant quantitatively, is often dropped. Nonetheless, the relative frequency of references to “leading cause” and “largest cause,” and the relative frequency of the age specification “ages 15 to 44,” help to distinguish the communicative influence of the Surgeon General’s 1984 and 1992 statements.

The Surgeon General’s 1992 statement contributed significantly to false claims that domestic violence is the leading cause of injury to women. Before 1992, such claims favored the phrase “largest cause.” After 1992, the phrase “leading cause” was by far the most common. Moreover, for the sample of claims recorded in the Domestic Violence Claims Dataset (DVCD) from 1996 to 2005, the phrase “leading cause” was associated with an age specification split roughly evenly between “women ages 15 to 44” and “women” in general. Claims referring to “largest cause”, in contrast, referred to women in general six times as frequently as referring to “women ages 15 to 44.” Claims that domestic violence is the leading/largest/greatest cause of injury to women were increasing prior to the Surgeon General’s 1992 statement on domestic violence. The Surgeon General’s 1992 statement is associated not just with continuing increase in these claims, but also with an increase in the relative frequency of the symbolic markers “leading cause” and “ages 15 to 44.”

The false claim that domestic violence is the leading cause of injury to women has persisted with a high public profile for more than two decades. In 1994, a journalist published a newspaper article documenting that domestic violence is far from the leading cause of injury to women. A relatively small number of such debunking articles appeared in newspapers, law journals, and on the web from 1996 to 2007. In contrast, from 1998 to 2007, a fairly steady 46 documents per year within a searched corpus of Congressional documents, law journal publications, and newspaper articles asserted variants of the claim that domestic violence is the leading cause of injury to women. From 2008 to 2011, the number of such claims within the searched corpus fell to about 23 per year. While that decline might indicate some working of public reason, the overall performance of public reason has been poor. Since the mid-1990s, sufficient information has been readily available to make clear to any person engaged in reasonable truth-seeking that domestic violence is far from the leading cause of injury to women.