It left no marks

There should be a ‘no wrong door’ approach to women experiencing violence. This means that regardless of where a woman enters the service system, she is supported to access appropriate care that meets her holistic needs. For women disclosing experiences of non-fatal strangulation (NFS) including those who might be suffering from an acquired brain injury (ABI), this means all the services she encounters need to have appropriate referral pathways and protocols and staff who are supported by regular training to use them. The Pathways Project was designed to support and strengthen professional understanding and local capacity to respond to sexual assault related NFS.

Women do not always disclose NFS at the time it occurred or attend an emergency department directly after being strangled. Studies have shown that when women disclose other forms of physical intimate partner violence there is higher likelihood that they will have also experienced NFS. The way we ask about NFS is particularly important as victims and survivors can minimise the impact of NFS or fail to relate their experiences to screening questions that use jargon or legal terminology. Services need to be cognisant of children’s needs, as research indicates they are often in the home when strangulation by an intimate partner occurs. When appropriate, services may also need the knowledge and skills to deliver effective health promotion to women who are engaging in sexual choking.

The evidence

This Women’s Health NSW evidence brief brings together Australian research and grey literature with supporting international evidence to define the issues and illuminate data gaps relevant to preventing and responding to NFS and ABI in the context of sexual violence. It covers the intersection of health and legal responses to NFS and addresses the normalisation of sexual choking and how to build capability to better support specific and informed consent. You will also find information relevant to shaping service responses to meet the needs of women and children experiencing NFS and ABI in different life stages and in cohorts where it intersects with other forms of discrimination and marginalisation. Non-fatal strangulation and acquired brain injury in the context of sexual violence: An evidence brief

Medical referral letter

This medical referral letter is a peer-reviewed template that is able to be downloaded and customised to your service. It is designed to support women’s self-advocacy with general practitioners when seeking medical help following NFS and possible ABI. Medical referral for incidents of non-fatal strangulation and suspected brain injury

Case notes and record keeping

Developed in conjunction with Women’s Legal Service NSW, this 2024 Ask Lois webinar provides information about how to ensure case notes and record keeping can best support women who opt to pursue legal or compensatory outcomes following strangulation: Ask Lois webinar on strangulation. Women’s Legal Service NSW have also produced a separate webinar on subpoenas and record keeping that you can access here: Ask Lois webinar on subpoenas and case notes

Health promotion

We have created a series of print-ready promotional resources designed to connect women to this Women’s Health NSW website and the information it contains about strangulation and sexual choking. You can download and print It Left No Marks posters, postcards and wallet cards here: It Left No Marks postcard, poster and wallet card

Further training

Women’s Health NSW currently offers free in-service training for service providers in NSW. This is a time-limited opportunity to have a virtual or face-to-face session with the Pathways Project team to introduce NFS and ABI and improve the way your service responds to women experiencing them. Contact us for more information. 

Insight Exchange offer a free 60-minute online learning module for service providers in Australia, New Zealand and Canada called Building understanding of and responses to strangulation. The video includes AUSLAN sign language. There is a time-limited opportunity to supplement this online module with a free session for your whole team where, across a 90-minute session, staff watch the module then take part in a live question and answer session with a facilitator.

Further reading and viewing

Professor Heather Douglas, University of Melbourne (2023): The Australian legal response to non-fatal strangulation: Policy recommendations

Legal Aid NSW (2021): Strangulation or Suffocation

Red Rose Foundation (2023): Brain injury [WEBINAR]

Dr Samantha Keene, Victoria University of Wellington (2021): Pornography, rough sex, and choking: Insights and challenges [WEBINAR] Pornography, rough sex, and choking: Insights and challenges

Dr Michelle Fitts, Western Sydney University (2022): Understanding the lives of Aboriginal and Torres Strait Islander women who have experienced a traumatic brain injury through family violence

Victorian Institute of Forensic Medicine (2022): It’s Never OK [VIDEO]:

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