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Violence and Abuse in Rural America

Violence and abuse are critical problems throughout the United States. Their effects in rural America are often exacerbated by limited access to support services for victims, familial connections with those in positions of authority, a lack of cultural acceptance for alternative lifestyles, distance, transportation barriers, the stigma of abuse, lack of available shelters, and poverty as a barrier to care, among other challenges. In small communities there is often an overlap among healthcare providers, law enforcement officers, and abuse victims. Therefore, some people may be reluctant to report abuse, fearing that their concerns will not be taken seriously or that their reputations may be damaged.

This guide addresses the wide range of abuses that may take place in rural communities, including but not limited to:

  • Neglect
  • Child abuse
  • Domestic violence, also known as intimate partner violence (IPV)
  • Sex crimes, including rape, assault, and abuse
  • Abuse of vulnerable populations, such as elders and people with disabilities
  • Bullying, harassment, and stalking
  • Assault
  • Homicide

Frequently Asked Questions

How prevalent is violence and abuse in rural America?

According to the 2015 Federal crime statistics, violent crime rates in nonmetropolitan areas were lower than the national average. According to the 2014 Update of the Rural-Urban Chartbook, homicide rates were lower overall for both men and women, with an average of six deaths per 100,000 for males and two deaths per 100,000 for females in non-core (rural) counties.

Violent Crime in the United States, 2015 – Rates per 100,000 inhabitants
  United States, total Metropolitan Statistical Areas Cities outside of metropolitan areas (i.e., rural cities & towns) Nonmetro (rural) counties
Violent Crime 383.2 401.9 388.4 193.9
Murder and non-negligent manslaughter 4.9 5.1 4.3 3.5
Rape (revised definition) 38.6 38.0 52.5 34.6
Robbery 101.9 114.6 49.1 11.7
Aggravated Assault 237.8 244.2 282.4 144.2
Source: Federal Bureau of Investigation, 2015 Crime in the United States, Table 2

Of course, crime statistics are limited by the fact that not all crimes are reported or otherwise known to police. The Bureau of Justice Statistics' Victimizations Not Reported to Police, 2006-2010, based on a survey administered by the Census Bureau, reports similar rates of non-reporting of violent victimizations across geographic types with 51% not reported in urban and rural areas and 54% not reported in suburban areas. Reasons for non-reporting in rural areas included:

  • Dealt with in another way/personal matter – 36%
  • Not important enough to victim to report – 18%
  • Police would not or could not help – 16%
  • Fear of reprisal or getting offender in trouble – 15%
  • Other reason or not one most important reason – 15%

Similar to many violent crimes in rural communities, sex crimes are often underreported. According to Unspoken Crimes: Sexual Assault in Rural America, some reasons for not reporting rape, incest, or other sex crimes may include lack of anonymity, greater physical isolation/lack of access to support services, distrust of outside assistance, perceptions of sexual assault, and other concerns. For a more complete overview of rural sex crimes and perpetrators, see Sexual Violence in the Backlands: Toward a Macro-Level Understanding of Rural Sex Crimes, a 2014 article in Sexual Abuse: A Journal of Research and Treatment.

One common type of violence and abuse in rural communities is domestic or intimate partner violence (IPV). Victims of domestic violence are typically women, with offenders typically being male; however, being a victim or offender is not specific to a particular gender. According to the CDC's Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner Violence report, 1 in 4 women in the United States has experienced violence by a partner at some point in her life. A 2011 study published in the Journal of Women's Health found that 22.5% of women in small rural areas and 17.9% in isolated areas reported being victims of intimate partner violence, compared to a national average of 16.1%. Domestic violence often escalates into repeated and more violent abuse, with a national average of 3 women killed each day by an intimate partner or spouse. In a March 2015 policy brief, the National Advisory Committee on Rural Health and Human Services called on the Centers for Disease Control and Prevention (CDC) to include a geographic breakdown in the National Intimate Partner and Sexual Violence Survey to provide better information and understanding about how IPV affects rural residents.

Neglect and abuse of children is also ever present in rural communities. A 2010 report to Congress from the Administration for Children and Families (ACF) states that the incidence for all categories of maltreatment was higher in rural counties than in urban counties, with rural children being 2 times more likely to experience harm or endangerment. This includes overall abuse, sexual abuse, and emotional abuse.

Incidence of Harm Standard Abuse by County Metro Status

Source: Fourth National Incidence Study of Child Abuse and Neglect (NIS-4), Administration for Children and Families, 2010

The Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine's 2013 Report New Directions in Child Abuse and Neglect Research indicates a need for cooperative approaches to the recognition and reporting of child abuse and neglect, particularly in geographically isolated areas. For more information about working with children impacted by abuse and neglect, see Promising Futures.

Violence and abuse based on sexual orientation and gender identity is also a concern in rural communities. A component of violence and abuse based on sexual orientation is bullying, harassment, and assault of LGBT students in rural schools. A 2012 report from the Gay, Lesbian, & Straight Education Network indicates that among rural LGBT students in the past year:

  • 87% had been verbally harassed (e.g., called names or threatened) at school at least once on the basis of their sexual orientation
  • 68% had been verbally harassed due to their gender expression
  • 45% had been physically harassed (e.g., pushed or shoved) at school at least due to their sexual orientation
  • 31% had been physically harassed because of their gender expression
  • 22% had been physically assaulted at school because of their sexual orientation in the past year
  • 16% had been physically assaulted because of their gender expression

How does poverty relate to violence and abuse in rural areas?

Rural America has a greater level of poverty than the nation as a whole. According to a report from the U.S. Department of Justice, rates of violent victimization are impacted by poverty level, with 40 victims per thousand persons categorized as poor (household income below $15,000) versus 18 victims per thousand persons categorized as high income (household income above $75,000).

Rate of Violent Victimization, by Poverty Level and Location of Residence, 2008-2012

Chart reproduced from: Household Poverty and Nonfatal Violent Victimization, 2008–2012

How does rural healthcare access affect current victims and survivors of abuse?

On a basic level, one of the largest struggles for victims and survivors of abuse in a rural area is immediate and continued access to healthcare and social services. In the immediate aftermath of violence or abuse, particularly sexual violence, critical supports such as a sexual assault nurse examiner program and/or a rape and sexual assault crisis center are absent in many rural communities, according to Rural Victim Assistance: A Victim/Witness Guide for Rural Prosecution.

Isolation due to geographic location is also an issue in terms of reported violence. Overall distance to clinics and hospitals and lack of access to public transportation often make access to healthcare insurmountable.  Additionally, lack of providers plays a role in the overall care of victims and survivors of abuse, with limited funding and higher per capita costs for social services leaving limited resources for specialized staff to assist with violence and abuse support.

When services are lacking, victims may be reluctant to report abuse due to the high probability that it will just make their situation worse.

Examples of successful programs to support victims and survivors of abuse include the National TeleNursing Center, the Butte Child Evaluation Center, and the Family Advocacy Network.

What services do rural victims of violence need?

Social Services: A 2005 study from the Journal of Family Violence highlights the fact that rural survivors of abuse are more likely than urban survivors to need a social services such as education, transportation, and housing services, due to geographic isolation and lack of societal support. Transportation and emergency housing are top priorities for rural victims of abuse and violence. According to Rural Disparity in Domestic Violence Prevalence and Access to Resources,

“over 25 percent of women in small rural and isolated areas live more than 40 miles from the closest Intimate Partner Violence Program, compared with less than 1 percent of women living in urban areas.”

Transportation and housing, both emergency and long term, can be a barrier not only to getting out of an abusive living situation, but also to finding employment and becoming self-sufficient enough to leave the relationship or seek social service support. Increased access to telecommunications is also necessary to allow for emergency services access via phone and internet, as reported in Rural Survivors & Economic Security.

Advocacy and Legal Services: For all forms of violence and abuse, victims may need an advocate to help them manage the legal system or locate and use social service and support programs that are available in their region. Rural victims may need these services even more because of the close-knit and often familial connections in their communities and criminal justice systems. Victims may need an advocate to:

  • Provide expertise on victim safety and emotional support
  • Help navigate financial systems to retain or regain assets and establish Power of Attorney or guardianship/conservatorship or custody documents
  • Assist with restraining or protective orders

The American Bar Association offers a Consumers' Guide to Legal Help that connects people to services in their state. The Legal Services Corporation also provides a search tool to find legal aid in each state. Additionally, the National Clearinghouse on Abuse in Later Life provides a useful toolkit for assisting survivors of abuse in Rural Domestic and Sexual Abuse Program Advocates: Making a Difference in the Lives of Older Survivors of Abuse. The National Sexual Violence Resource Center also offers The Advocate's Guide: Working with Parents of Children Who Have Been Sexually Assaulted.

Another consideration for healthcare specific legal needs in rural communities is a medical-legal partnership. This partnership provides on-site legal aid in a medical setting (such as a clinic, hospital, or dental practice), which in turn allows for a safe and immediate space for those needing help. More information about these types of partnerships is available in the Rural Monitor or through the National Center for Medical Legal Partnership.

What can rural communities do to prevent violence and abuse?

Rural communities can come together to prevent and respond to violence and abuse through an approach called a Coordinated Community Response (CCR). This collaborative effort among healthcare providers, community groups, faith-based organizations, schools, criminal justice, and social service agencies allows for a broad opportunity to stop violence before it starts. Resources such as Preventing Family Violence: Community Engagement Makes the Difference and Advocates & Educators links from the National Sexual Violence Resource Center can provide a starting point for conversation between agencies and the larger community. There are resources available for prevention, intervention, and public education regarding elder abuse in the National Center on Elder Abuse’s State Resources page. Additionally, the RHIhub's Human Services to Support Rural Health topic guide has resources to help address child welfare and discusses the use of Family Resource Centers to assist those in rural communities.

As with services for victims in rural areas, services for offenders are also limited. For those interested in establishing an offender treatment program in their region, more information is available at:

What are strategies that rural healthcare providers can use to identify and support victims of violence?

In rural areas, healthcare providers often play many roles with little specific training to support victims of violence. There is a need for integration of screening and counseling for victims and survivors of violence and abuse in primary care practices. The March 2015 policy brief from the National Advisory Committee on Rural Health and Human Services suggests that routine screening for signs of violence or abuse should become standard practice for primary care providers and nurses. These professionals should be trained to understand the resources available to victims and survivors in their communities, including non-traditional sources such as churches or community clubs.

Screening of elders for violence, neglect, and abuse is important since elders may be reluctant or unable to report being victimized. According to the National Center on Elder Abuse (NCEA), elder abuse is underreported. NCEA offers a summary of currently available screening tools available to health professionals. Additionally, a brief elder abuse screening protocol and tool that has been tested and implemented in rural primary care practices by the University of Maine Center on Aging is also available.

Routine screening for intimate partner violence is recommended by the U.S. Preventive Services Task Force for all women of childbearing age. An October 2016 American Family Physician article, Intimate Partner Violence, provides recommendations for routine screening for domestic violence and includes examples of screening tools, as well as tips for discussing this issue with patients. is a resource healthcare providers can use to learn more about the health impact of violence and abuse. It offers tools and resources for establishing a partnership between domestic violence agencies and health settings. A related project, offers a toolkit, Prevent, Assess, and Respond: A Domestic Violence Toolkit for Health Centers & Domestic Violence Programs, based on the experiences of successful community health center-domestic violence agency partnerships.

Healthcare facilities can also help raise awareness of services available through placement of brochures and posters in exam rooms. Facilities and providers can facilitate the process of accessing services for domestic violence, sexual assault, or other violence by providing a safe place for victims to meet with service providers (such as counselors), which may include a telehealth connection to counselors or other crisis intervention professionals located at a distance for those in particularly rural and remote areas.

The Office on Violence Against Women in the U.S. Department of Justice provides grants to communities, medical providers, and other service providers who are working to implement strategies to protect women and their children who are victims of violence and abuse. The Office sponsors the Rural Sexual Assault, Domestic Violence, Dating Violence, and Stalking Assistance Program which provides targeted funding for rural communities, as well as numerous funding programs for tribal communities. Other resources available to address intimate partner violence for all communities include IPV Health's Domestic Violence Survivor Health, Safety and Empowerment and Health Partners.

What is the prevalence of violence and abuse in Native American populations? What factors and barriers do Native American populations face in dealing with violence?

According to the Indian Law and Order Commission's report A Roadmap for Making Native America Safer, American Indian/Alaskan Native children experience post-traumatic stress disorder due to chronic exposure to violence at the same rate as veterans returning from Iraq and Afghanistan and triple that of the general population. Additionally, a Department of Justice report estimates that assaults on women residing on Indian Reservations to be as much as 50% higher than the next most victimized demographic. Historical trauma also plays a role in terms of American Indian/Alaska Native cultural understanding of violence and abuse, leaving victims with layers of distrust for those in positions of authority who may be able to help them in the aftermath of current trauma.

Judicial authority for crimes of abuse or violence by non-tribal people on tribal land has also been historically limited, though some updates to legal reach were included in the May 2013 Violence Against Women Reauthorization Act, which amended the Indian Civil Rights Act to authorize special domestic violence criminal jurisdiction to tribal courts over non-Indian offenders. Included in this act is a definition of a tribal coalition, which gives support to Indian service providers to help them establish and maintain culturally appropriate services such as shelters and rape crisis centers.

Additional resources available that specifically focus on Native American victims and survivors of violence and abuse include the National Indigenous Women's Resource Center, Indian Health Services Domestic Violence Prevention Initiative, and the StrongHearts Native Helpline. The National Indigenous Elder Justice Initiative (NIEJI) also offers resources to support tribal capacity to access culturally appropriate support for those suffering elder abuse, neglect, and exploitation.

What are the barriers to addressing rural domestic violence/intimate partner violence?

Access to healthcare, prevention, social and human services, and protection services in rural communities is often limited based on funding and availability of healthcare workforce who are trained in domestic violence intervention. According to Rural Social Work Practice (2012), rural women and children, in particular, have less access than their urban counterparts to domestic violence shelters, healthcare providers, mental health services, law enforcement, and court officials. Rural Disparity in Domestic Violence Prevalence and Access to Resources states that:

“rural women are also nearly twice as likely to be turned away from services because of the insufficient number of programs and inadequate staffing of community-based health programs and face barriers of access due to geographic distance and isolation.”

How does living in a rural community impact sexual assault victims and survivors?

In rural communities, survivors of abuse and violence face unique challenges due to the same elements that often stop them from reporting the abuse initially. The community or cultural understanding of the roles of women, close or familial connections of law enforcement or criminal justice figures, geographic isolation or remoteness, lack of access to education or social services, the higher risk of being socially isolated, and other issues play a role in how a survivor will be supported in a rural area. Community conversation and cooperation are important factors in establishing and maintaining survivor support, using such resources as Stopping the Stigma: Changing Public Perceptions of Sexual Assault in Rural Communities and Safe Havens' Rural Communities Responding to Sexual and Domestic Violence.

How do child abuse and neglect in rural communities compare to cases in urban areas?

Exposure to violence and incidents of child abuse and neglect are higher in rural communities as a whole. According to The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2011-2012, 8.9% of rural children have been victims or witnesses to neighborhood violence, compared to 8.6% in urban areas. Similarly, 9.9% of children in small rural communities have witnessed domestic violence versus 6.8% in an urban setting.

Family stress, caused by a variety of factors such as poverty and health problems, add to the incidence of child abuse and neglect by caregivers. According to the Carsey Institute's Rural Families with a Child Abuse Report are More Likely Headed by a Single Parent and Endure Economic and Family Stress, over 60% of rural caregivers reported for child maltreatment experience high family stress, compared to 50% in urban areas. Rural families dealing with child maltreatment issues also had more difficulty paying for basic needs than urban families. According to the same Carsey report, the most commonly reported type of child maltreatment in rural areas is child neglect, the failure by the caregiver to provide needed age-appropriate care. Neglect makes up 46% of reported rural cases, compared to 28% for physical abuse and 14% for sexual abuse. More than a quarter of reported child abuse cases in both rural and urban locations include more than one type of maltreatment.

In rural communities, child abuse or neglect is often underreported due to factors such as isolation and geographic remoteness, lack of social services or other support programs, lack of or limited foster care or emergency housing, and social stigma for survivors.

What concerns are there for protecting the rural elderly and other vulnerable rural populations from financial abuse, violence, and neglect?

Rural elderly and other vulnerable rural populations who suffer violence and abuse have special considerations when it comes to the need for protection and support, both as victims and survivors. Health concerns associated with aging, such as physical limitations and dementia, make elderly populations more susceptible to physical neglect, personal neglect, and financial coercion. Victims who have physical and cognitive disabilities may need advocates to help them access resource materials or interpret legal proceedings. The National Center on Elder Abuse, a part of the Administration on Aging, provides prevention strategies and intervention partner information.

What is the impact of a rural setting on victims of harassment, stalking, and bullying?

According to a 2012 article Perceptions and Observations of County Crime and Disorder among Small Sheriffs' Agencies in Suburban and Rural America, law enforcement in rural areas and the public they serve see crime in their communities very differently. Law enforcement officers report that crimes related to harassment and stalking (including domestic violence) are within the top 10 service calls, whereas the general public's understanding of the prevalence of those crimes was much less. According to Perspectives on Civil Protective Orders in Domestic Violence Cases: The Rural and Urban Divide, one reason for this disconnect is that law enforcement officials are aware of the problem but, for reasons of confidentiality and the need to live and work closely with the people involved, educating the public on the level of impact is not often a top priority.

Bullying, primarily associated with school age children, can be particularly harmful in a rural community where access to support services and small class size impede the administrator's ability to intervene or solve the problem effectively. According to The Differential Impacts of Episodic, Chronic, and Cumulative Physical Bullying and Cyberbullying: The Effects of Victimization on the School Experiences, Social Support, and Mental Health of Rural Adolescents, cyberbullying has become prevalent in rural schools. Geographic isolation does not affect the bully's ability to digitally harass the victim. Chronic bullying, both of the cyber and traditional variety, may negatively impact mental wellbeing, long term self-esteem, and future success. Bullying based on sexual orientation or gender identity is a problem in rural communities. The Gay, Lesbian, and Straight Education Network provides a report and training webinar addressing this issue in Strengths & Silences: LGBT Students in Rural Schools. Resources to help communities prevent bullying are available at

Last Reviewed: 5/16/2017