People experiencing intimate partner violence who live in rural communities often face bigger challenges and have fewer options for safety and support. But when prevention and support programs are adapted to fit rural life, they can make a real difference – improving safety, expanding options, and helping build healthy relationships across communities.
Intimate partner violence affects people in all regions across the United States, across every race, gender, religion, income level, and other identities. To close out October, Domestic Violence Awareness Month, we’re continuing our series on rural health issues with this post on intimate partner violence in rural communities.
📊 Intimate Partner Violence Rates and Severity of Physical Violence
A recent national study using Pregnancy Risk Assessment Monitoring System (PRAMS) data shows that people in rural communities face rates of intimate partner violence that are slightly higher than those in suburban and urban areas, and often experience more severe physical violence and worse outcomes due to lack of preventive care and access to services. Differences in how “rural” is defined, underreporting, and barriers to accessing help make rural intimate partner violence harder to measure and harder to address.
🔍 Screening Gaps in Rural vs. Urban Settings
Pregnancy and the months after birth can be high-risk times for people experiencing abuse, so it’s especially important to notice warning signs and offer help for pregnant people and new parents. The same national study noted above (using Pregnancy Risk Assessment Monitoring System data) looked at how often people are screened for intimate partner violence during prenatal care and postpartum visits. Screening during these visits are an important chance to identify and support people experiencing abuse.
The study found that about 21% of pregnant people and new parents weren’t screened in rural areas, compared with 17% in urban areas. Even though most patients are being screened, missing 1 in 5 pregnant people in rural areas (and 1 in 6 in urban areas) means that some people at risk are not being reached. Among those who did experience abuse and were not screened, the article notes that the gaps were even bigger for rural residents who were younger (18–24), using Medicaid, or unmarried. Because rural communities overall often face additional barriers – like longer travel distances, fewer providers, and limited local resources – consistent screening becomes even more important.
🌄 Challenges & Effective Solutions for Intimate Partner Violence in Rural Areas
Living in a rural area can make it harder to leave a relationship or even talk about intimate partner violence. Survivors often face three main barriers: visibility, access, and trust.
- Visibility: In small communities, people often know each other well. Survivors may worry that asking for help will affect how they’re seen or treated. Their partner may also be seen positively in the community as a coach, a church member, a coworker, or a community leader. This can make it harder for others to recognize abuse, and harder for survivors to feel safe speaking up.
- Access: Geographic isolation, fewer local services, and long travel distances make it harder to get help. For people with disabilities that require accommodations, people who need services in a language other than English, or people without access to a car, access can be even harder. Limited internet and cell phone service also causes basic safety issues: it may not be possible to call for help.
- Trust: Survivors may fear stigma, retaliation, or discrimination (especially in rural areas that are less diverse), or worry that their confidentiality and privacy will not be respected.
These overlapping challenges often lead to under-reporting and under-serving, highlighting the need for discreet, trusted support networks.
🌱 Promising Strategies for Rural Communities
1. Consistent Screening in Healthcare
Healthcare visits can be one of the few places where someone experiencing intimate partner violence can seek help without raising their partner’s suspicion.
The American Association of Nurse Practitioners (AANP), the American College of Nurse-Midwives (ACNM), and the American College of Obstetricians and Gynecologists (ACOG) all emphasize the importance of intimate partner violence screening in healthcare settings and provide guidance on screening practices. These clinicians are trained to build trusting relationships, ask sensitive questions in a trauma-informed way, and offer support. When properly trained, they can assess immediate safety, consider the emotional and physical effects of abuse, and connect patients with local resources.
Helpful in close-knit or rural communities: Midwives who provide home-based care often see the broader context of someone’s life, relationships, and support system. Clinicians who are well-known and trusted in the community can use these relationships to foster safety, build trust, and encourage survivors to seek help when they are ready. Because people of all genders can experience abuse, screening should be offered to everyone.
Best practices for intimate partner violence screening include:
- Asking all patients, in private
- Training staff to respond appropriately when someone discloses abuse
- Offering resources, safety planning, and connections to local support
📣 Policy Advocacy alerts:
A 2021 systematic review found that hospital emergency departments screen patients less often than primary care settings. This is concerning because hospitals are often crucial points of contact for people experiencing abuse and violence – especially in rural areas where access to healthcare is limited.
Also, despite recommendations for clinicians to consistently screen for intimate partner violence, The Department of Health and Human Services Office of Inspector General notes that there are no specific billing codes for Medicaid primary care clinicians to use for time spent screening for intimate partner violence and referring patients to support resources. While Medicaid officially covers preventive services like intimate partner violence screening, there isn’t a dedicated code that lets clinicians get paid for the extra time and work involved in screening and referrals. The National Rural Health Association has highlighted the need for policy changes to address this issue and suggests measures to encourage screening, including: special billing codes, higher reimbursement, or including intimate partner screening in quality measures.
2. Medical-Legal Partnerships
Medical-Legal Partnerships integrate legal services into healthcare settings. Clinicians partner with legal and advocacy services so that patients – whether or not they have abuse-related injuries or conditions – can access legal help for custody, protection orders, housing, and benefits. These partnerships work well in rural areas because they meet survivors where they already are and help bypass travel and stigma barriers.
3. Community Allies
Everyday community members – librarians, teachers, hair stylists, clergy, and small business owners – can become informed helpers with a few hours of targeted training that prepares them to:
- Understand intimate partner violence dynamics, including that abusive partners may seem “nice” and use control or isolation tactics
- Protect confidentiality and listen without judgment
- Recognize why survivors might not contact police due to local dynamics, fear of discrimination, or other safety/economic concerns
- Know local intimate partner violence resources and connect someone discreetly
A recent study of laws in several states requiring hairstylists to receive domestic violence training found that these programs show promise – but only when they include clear referral pathways, wraparound support for both stylists and clients, and training tailored to local community needs, including groups that may face added barriers (e.g. LGBTQ survivors, rural clients, non-English speakers, etc.).
📣 Health Equity Alert:
Because of historical and continued experiences with law enforcement, people from some communities may be understandably hesitant about reporting abuse to law enforcement. It’s important that community members trained in supporting survivors know that Black people and other people of color, immigrants, LGBTQ+ people, people with a history of psychiatric hospitalization, and people with prior experiences with the criminal justice system may find it an extra breach of trust if a support calls the police on their behalf without permission. Maintaining promised confidentiality is important. If law enforcement involvement is recommended by a support person, a warm handoff to a specific member of a police department can be key. ✳️ If you are a mandated reporter, you can let survivors know up front what your reporting requirements are.
4. Evidence-Based Prevention
Early intervention with children and youth is an important part of preventing intimate partner violence over the long term. But prevention doesn’t stop there – effective strategies span the individual, family, and community levels, reducing risk factors and building skills for healthy, respectful relationships. These evidence-based approaches include teaching healthy relationship skills, engaging peers and role models, interrupting pathways to violence, creating protective environments, and strengthening economic supports.
5. Stronger Local Coordination
Task forces or Coordinated Community Response Teams that bring together law enforcement, courts, healthcare, intimate partner violence service agencies, and community organizations see better safety and accountability outcomes. Networks across larger rural regions amplify these benefits. Safety planning that addresses the needs of rural survivors is also key (e.g. for safely getting to and from court, planning for dangerous situations in places without cell phone service, etc.), and these collaborative efforts can help.
6. Service Adaptation for Rural Life
There are many ways to support survivors in rural communities without increasing their risk. These include:
- Mobile services that allow advocates and support staff to meet survivors where it is safe and convenient.
- Tele-counseling options.
- Offices with computers and phones that survivors can use privately.
- Outreach through trusted community networks.
- Strong coordination between partners and organizations to fill gaps in safety planning, housing, counseling, and other support.
- Awareness campaigns designed for rural communities, with attention to privacy and close-knit relationships.
🧩 Putting it all together: Rural communities may need to adapt urban-centric models, but integrated medical-legal services, community training, resource networks, and outreach help survivors feel less isolated, less forced into binary “stay or leave” decisions, and more empowered with support grounded in their local context.
💛 What You Can Do
Whether you live in a rural area or not, getting to know your local intimate partner violence resources – like crisis hotlines, advocacy centers, legal aid, and tele-services – can help you to be a trusted connection if someone reaches out. You don’t need to have all the answers. Just knowing where to turn can make a real difference.
If you or someone you know is experiencing relationship abuse, free and confidential help is available 24/7:
- National Domestic Violence Hotline: 800-799-SAFE (7233) – Open 24/7Text START to 88788
www.thehotline.org/
Free, confidential 24/7 support, safety planning, and resources for anyone experiencing intimate partner violence, as well as guidance for friends, family, and professionals supporting survivors. - The Network/La Red: 800-832-1901 – Open 24/7
www.tnlr.org/en/24-hour-hotline/
A Massachusetts-based organization offering a free, 24-hour confidential hotline for LGBTQ+ people and those in polyamorous or kink communities who have been abused by a partner. They provide hotline support and referrals to people nationwide and training for other agencies. - National Teen Dating Abuse Helpline: 866-331-9474 – Open 24/7
www.loveisrespect.org/
Text LOVEIS to 22522 or live chat through the website.
Free, confidential, 24/7 support, information, and advocacy for teens and young adults experiencing dating abuse, as well as for their friends, parents, and others who want to help. - Learn more about intimate partner violence in rural communities at The Rural Health Information Hub’s page on violence and abuse – www.ruralhealthinfo.org/topics/violence-and-abuse
- Find resources on youth dating violence/abuse prevention and healthy relationships at One Love Foundation – www.joinonelove.org/
- Find general resources and information on the CDC’s webpage about intimate partner violence – www.cdc.gov/intimate-partner-violence/about/index.html
