Slow descent into violence and death

Women in West Philadelphia are dying violent deaths.

The numbers are shocking to Jeane Ann Grisso, who headed a case-controlled survey of West Philadelphia women who came into emergency rooms at the Hospital of the University of Pennsylvania, Misericordia and Presbyterian. The survey compared the answers of women with injuries to those with other health concerns.

"It was an eye opener to me," Grisso said. A huge portion of the women who came in with other health concerns also reported having experienced domestic violence.

The Association of Women Faculty and Administrators last month recognized Grisso's work to improve women's health, especially as relates to violence, by awarding her the first Robert E. Davies Award for involvement in social change. Grisso, M.D., M.Sc., is an associate professor of medicine, of biostatistics and epidemiology, and of obstetrics and gynecology, and is director of the Medical Center's Focus on the Health of Women program.

Dr. Jeane Ann Grisso

Photo by Candace diCarlo

She is also part of a first-of-its-kind city-wide effort to do something about the violence that sometimes ends in death - a "death review" for women under 60. The death review is a monthly roundtable meeting with 30 to 40 representatives from agencies and organizations that work with victims of violence - including the district attorney, Women Against Abuse, Women in Transition, the Department of Human Services (DHS), police, substance abuse organizations, city health clinics.

They reconstruct a woman's life to see of any agencies could have done something else to prevent the death.

Their reviews - as well as the case-controlled study - point to the strong connection between violence and substance abuse, Grisso said. "The addiction issue is unbelievable for women."

Grisso paints a grim picture of addicted women: "They become addicted. Then they have to survive. So they get arrested for retail theft. ... Then they get arrested for prostitution." While they're in prison, DHS takes the children away. And because the law does not treat prostitutes as substance abusers, the police do not release the women to substance abuse programs.

"The moms are just out there, not linked to any people or agencies. And then they end up dead."

The perpetrator? "Some guy usually - a dealer, a client, a boyfriend." The other half of the addicted group die of overdoses, Grisso added, but those are listed as accidental.

"Homicide is a huge issue for black women, four to five times higher than for white women," said Grisso of the national figures.

"Death is a very tiny tip of the iceberg of women and violence," she said, because most violence to women is weaponless. "It's smashing, battering, pummeling, so they don't die."

A policy sub-group of the death review is trying to make changes to incorporate substance abuse and mental health programs for addicted women on parole. The group is also working with DHS on programs for children who witnessed the violence.

"There are a lot of desperate people out there, and I don't think anyone in this flourishing society is paying attention to them."

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Originally published on May 13, 1999