Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018.

BACKGROUND: Intimate partner violence against women is a global public health problem with many short-term and long-term effects on the physical and mental health of women and their children. The Sustainable Development Goals (SDGs) call for its elimination in target 5.2. To monitor governments' progress towards SDG target 5.2, this study aimed to provide global, regional, and country baseline estimates of physical or sexual, or both, violence against women by male intimate partners. METHODS: This study developed global, regional, and country estimates, based on data from the WHO Global Database on Prevalence of Violence Against Women. These data were identified through a systematic literature review searching MEDLINE, Global Health, Embase, Social Policy, and Web of Science, and comprehensive searches of national statistics and other websites. A country consultation process identified additional studies. Included studies were conducted between 2000 and 2018, representative at the national or sub-national level, included women aged 15 years or older, and used act-based measures of physical or sexual, or both, intimate partner violence. Non-population-based data, including administrative data, studies not generalisable to the whole population, studies with outcomes that only provided the combined prevalence of physical or sexual, or both, intimate partner violence with other forms of violence, and studies with insufficient data to allow extrapolation or imputation were excluded. We developed a Bayesian multilevel model to jointly estimate lifetime and past year intimate partner violence by age, year, and country. This framework adjusted for heterogeneous age groups and differences in outcome definition, and weighted surveys depending on whether they were nationally or sub-nationally representative. This study is registered with PROSPERO (number CRD42017054100). FINDINGS: The database comprises 366 eligible studies, capturing the responses of 2 million women. Data were obtained from 161 countries and areas, covering 90% of the global population of women and girls (15 years or older). Globally, 27% (uncertainty interval [UI] 23-31%) of ever-partnered women aged 15-49 years are estimated to have experienced physical or sexual, or both, intimate partner violence in their lifetime, with 13% (10-16%) experiencing it in the past year before they were surveyed. This violence starts early, affecting adolescent girls and young women, with 24% (UI 21-28%) of women aged 15-19 years and 26% (23-30%) of women aged 19-24 years having already experienced this violence at least once since the age of 15 years. Regional variations exist, with low-income countries reporting higher lifetime and, even more pronouncedly, higher past year prevalence compared with high-income countries. INTERPRETATION: These findings show that intimate partner violence against women was already highly prevalent across the globe before the COVID-19 pandemic. Governments are not on track to meet the SDG targets on the elimination of violence against women and girls, despite robust evidence that intimate partner violence can be prevented. There is an urgent need to invest in effective multisectoral interventions, strengthen the public health response to intimate partner violence, and ensure it is addressed in post-COVID-19 reconstruction efforts. FUNDING: UK Department for International Development through the UN Women-WHO Joint Programme on Strengthening Violence against Women Data, and UNDP-UN Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, a cosponsored programme executed by WHO.

Exploring factors associated with pregnant women's experiences of material hardship during COVID-19: a cross-sectional Qualtrics survey in the United States.

BACKGROUND: The COVID-19 pandemic has exacerbated the financial insecurity of women and their families globally. Some studies have explored the impact of financial strain among pregnant women, in particular, during the pandemic. However, less is known about the factors associated with pregnant women's experiences of material hardship. METHODS: This cross-sectional study used a non-probability sample to examine the factors associated with pregnant women's experiences of material hardship during the COVID-19 pandemic. In January 2021, 183 pregnant women living in the United States participated in an online Qualtrics panel survey. In addition to socio-demographic characteristics, individuals were asked about their finances and predictors of financial well-being, mental health symptoms, and intimate partner violence (IPV) experiences. Chi-square analysis and one-way ANOVA were used to examine whether women's experiences with material hardship and associated factors differed by income level (i.e., less than $20,000; $20,000 to $60,000; more than $60,000). Ordinary least squares regression was used to calculate unadjusted and adjusted estimates. RESULTS: Study findings showed that the majority of women in the sample experienced at least one form of material hardship in the past year. Individuals with an annual household income less than $20,000 reported the highest average number of material hardships experienced (M = 3.7, SD = 2.8). Compared to women with household incomes less than $20,000, women with incomes of more than $60,000 reported significantly fewer material hardships, less financial strain, and higher levels of financial support, economic self-efficacy, and economic-self-sufficiency. Women with incomes of $60,000 or more also reported significantly lower levels of psychological abuse, and a smaller percentage met the cut-off for anxiety. Economic self-sufficiency, financial strain, posttraumatic stress disorder, and economic abuse were all significantly associated with material hardship. CONCLUSIONS: A contribution of this study is that it highlights the significant, positive association between economic abuse, a unique form of IPV, and material hardship among pregnant women during the pandemic. These findings suggest the need for policy and practice interventions that help to ameliorate the financial insecurity experienced by some pregnant women, as well as respond to associated bidirectional vulnerabilities (e.g., mental health symptoms, experiences of IPV).

'I will rather be killed by corona than by him ': Experiences of abused women seeking shelter during South Africa's COVID-19 lockdown.

BACKGROUND: In April 2020, the United Nations predicted that the COVID-19 pandemic will have a 'calamitous' impact on the lives of women. This was based on concerns about an upsurge in Intimate Partner Violence (IPV) arising from increased opportunities for relational conflict due to forced co-existence and therefore additional time spent with abusive partners. AIM: Research has shown an increase in IPV during times of crisis. The COVID-19 pandemic has generated unprecedented circumstances and stress, and opportunities to do research to understand whether the COVID-19 pandemic impacted on IPV experiences were limited. Thus, the present study aimed to understand women's experiences of being in and leaving an abusive relationship during the COVID-19 pandemic. METHODS: Individual, telephonic interviews were conducted with 16 women living in domestic violence shelters within three Provinces during South Africa's lockdown period. RESULTS: Findings reveal that the public health measures implemented by the South African Government to curb the spread of the virus, may have placed vulnerable groups at increased risk of violence. Specifically, lockdown likely magnified the risk for escalation of abuse in families already experiencing IPV prior to COVID-19. The study highlights an IPV and COVID-19 relationship, showing that the gender insensitive pandemic control measures, such as stay at home orders and travel restrictions, likely placed women at risk of increased abuse. Given the recurrency of COVID-19 epidemic waves, attention must be given to gender disparities or many South African women may experience worse outcomes. CONCLUSION: This study reminds us that being ordered to stay at home is not always the safest option for women and thus, in a country with one of the highest levels of GBV, it becomes imperative to ensure that IPV safeguards are integrated into COVID-19 measures. It also becomes evident that COVID-19 requires enhanced ways of responding by paying attention to gender disparities.

Examining Violence Against Women at a Regional Level 1 Trauma Center During the COVID-19 Pandemic.

INTRODUCTION: There is a growing concern that certain public health restrictions imposed to prevent the spread of coronavirus disease 2019 (COVID-19) could result in more violence against women (VAW). We sought to determine if the rates and types of VAW changed during the COVID-19 pandemic at our level 1 trauma center (L1TC). METHODS: We performed a retrospective review of female patients who presented to our L1TC because of violence from 2019 through 2020. Patients were grouped into a pre-COVID or COVID period. The primary aim of this study was to compare rates of VAW between groups. Secondary aims sought to evaluate for any difference in traumatic mechanism between periods and to determine if a temporal relationship existed between COVID-19 and VAW rates. RESULTS: There was no difference in rates of VAW between the pre-COVID and COVID period (3.1% vs 3.6%, P = .6); however, rates of penetrating trauma were greater during the COVID period (38.2% vs 10.3%, P = .01). After controlling for patient age and race, the odds of penetrating trauma increased during the pandemic (OR 5.8, 95% CI 1.6-28.5, P < .01). From February 2020 through October 2020, there was a direct relationship between rates of COVID-19 and VAW (r2 .78, P < .01). CONCLUSION: Rates of VAW were unchanged between the pre-COVID and COVID periods, yet the odds of penetrating VAW were 5 times greater during the pandemic. Moving forward, trauma surgeons must remain vigilant for signs of violence and ensure that support services are available during future crises.

Prevalence and risk factors of violence against women and children during COVID-19, Germany.

OBJECTIVE: To assess the prevalence and exacerbating factors of violence against women and children in Germany during the coronavirus disease 2019 pandemic. METHODS: We conducted a representative online survey with partnered women (18-65 years) between 22 April and 8 May 2020, when participants had been under lockdown for a month. We determined the prevalence of several forms of violence within the previous month using both direct elicitation and a list experiment. We conducted a multivariable logistic regression to assess the impact of pandemic-associated risk factors. FINDINGS: Of our 3818 survey respondents, 118 (3.09%; 95% confidence interval, CI: 2.54 to 3.64) reported incidents of physical conflict, 293 (7.67%; 95% CI: 6.83 to 8.52) reported emotional abuse, and 97 (6.58%; 95% CI: 5.31 to 7.85) of 1474 respondents with children reported child corporal punishment. We estimated that 3.57% (95% CI: -0.33 to 7.46) had non-consensual intercourse with their partner. Our regression analysis revealed an increased risk of physical conflict with home quarantine (odds ratio, OR: 2.38; 95% CI: 1.56 to 3.61), financial worries (OR: 1.60; 95% CI: 0.98 to 2.61), poor mental health (OR: 3.41; 95% CI: 2.12 to 5.50) and young (< 10 years) children (OR: 2.48; 95% CI: 1.32 to 4.64); we obtained similar results for other forms of violence. Awareness and use of pertinent support services was low. CONCLUSION: Our findings of an increased risk of domestic violence during the pandemic should prompt policy-makers to improve the safety of women and children. Interventions to alleviate risks factors and extend support services are required.

Males as victims of intimate partner violence - results from a clinical-forensic medical examination centre.

Only few studies have reported on males as victims of intimate partner violence (IPV) so far. The aim of the present study is to analyse frequency and case characteristics of physical violence against male IPV victims examined in a clinical-forensic medical examination centre for victims of violence in Germany over an 11-year period, contributing to a better understanding of IPV in men. Male victims represented 6.2% of IPV cases (n = 167) with a median age of 40 years. Cases were reported to the police in 78.4% before medicolegal examination. In 60.5% of the cases, the perpetrator was the current partner, and 82% occurred in a domestic environment with a predominance of female offenders. In more than half of the cases (57.5%), the victims consulted the examination centre without prior healthcare utilisation. About one-third of the victims reported previous IPV (31.7%). The findings point to the relevance of men as victims of IPV, case group-specific risk factors, injury-dependent behaviour related to healthcare utilisation, the need to establish or strengthen specialised support services for affected men and underscore the importance of clinical-forensic services in documenting and assessing violence-related injuries.

Digital or Digitally Delivered Responses to Domestic and Intimate Partner Violence During COVID-19.

Before the coronavirus disease (COVID-19), 1 in 3 women and girls, globally, were victimized by an abusive partner in intimate relationships. However, the current pandemic has amplified cases of domestic violence (DV) against women and girls, with up to thrice the prevalence in DV cases compared to the same time last year. Evidence of the adverse effects of the pandemic on DV is still emerging, even as violence prevention strategies are iteratively being refined by service providers, advocacy agencies, and survivors to meet stay-at-home mandates. Emotional and material support for survivors is a critical resource increasingly delivered using digital and technology-based modalities, which offer several advantages and challenges. This paper rapidly describes current DV mitigation approaches using digital solutions, signaling emerging best practices to support survivors, their children, and abusers during stay-at-home advisories. Some examples of technology-based strategies and solutions are presented. An immediate priority is mapping out current digital solutions in response to COVID-19-related DV and outlining issues with uptake, coverage, and meaningful use of digital solutions.

Household food insecurity and its association with self-reported male perpetration of intimate partner violence: a survey of two districts in central and western Uganda.

OBJECTIVES: This study aimed to determine the lifetime prevalence of male-perpetrated intimate partner violence (IPV), and to assess the association with food insecurity, sociodemographic factors and health risk behaviours in Uganda in the year preceding COVID-19-associated lockdowns. DESIGN: Population-based, cross-sectional household survey. SETTING: Urban, semiurban and rural communities of the Wakiso and Hoima districts in Uganda. PARTICIPANTS: A total of N=2014 males aged 13-80 years participated in the survey. The current study included males who reported having ever been in a sexual union and responded to the IPV questions (N=1314). MEASURES: Data were collected face-to-face from May 2018 to July 2019 using an interviewer-mediated questionnaire. Lifetime IPV perpetration was measured as 'no physical and/or sexual IPV', 'physical' versus 'sexual violence only', and 'physical and sexual violence'. Past-year food insecurity was measured through the Food Insecurity Experience Scale and categorised into 'none', 'low' and 'high'. Multinomial logistic regression was used to determine the crude and adjusted relative risk ratios (aRRRs) of IPV perpetration in relation to self-reported food insecurity, adjusting for sociodemographic and health risk behaviours. RESULTS: The prevalence of self-reported lifetime IPV perpetration was 14.6% for physical and 6.5% for sexual violence, while 5.3% reported to have perpetrated both physical and sexual IPV. Most (75.7%) males reported no food insecurity, followed by low (20.7%) and high (3.6%) food insecurity. In adjusted models, food insecurity was associated with increased risk of having perpetrated both physical and sexual violence (aRRR=2.57, 95% CI 1.52 to 4.32). IPV perpetration was also independently associated with having had more than one lifetime sexual partner and drinking alcohol, but not with education level or religion. CONCLUSION: This study suggests that food insecurity is associated with male IPV perpetration, and more efforts are needed to prevent and mitigate the expected worsening of this situation as a result of the COVID-19 pandemic.

The Endemic Amid the Pandemic: Seeking Help for Violence Against Women in the Initial Phases of COVID-19.

During the first months of the COVID-19 pandemic, governments instituted a series of measures to control the spread of the virus. The measures were widely believed to increase women's risk of violent victimization, most of which is by an intimate partner. We examined help-seeking during this period in a large U.S. city and used an interrupted time series analysis to assess the effects of three government interventions on domestic violence and sexual assault hotline calls and on "911" calls regarding domestic violence, assault, and rape. Declaration of an emergency appeared to reduce victim calls to the rape crisis hotline and the few "911" calls about rape. School closure was associated with a reduction in "911" calls about assault and rape and victim calls to the domestic violence hotline. Implementation of stay-at-home orders was associated with a gradual increase in domestic violence hotline calls. Although "911" calls regarding assault fell by nearly half, calls to police for domestic violence were unchanged. In sum, there was a decrease in help-seeking for sexual assault and assault in general but not for domestic violence during the initial phases of the COVID-19 outbreak. The analysis underscores the importance of distinguishing between the violence itself, calls to police, and calls to helplines when claims are made about changes over time in violence against women. The opportunities and constraints for each can differ widely under usual circumstances, circumstances that were altered by public health interventions related to the pandemic.

Evidence for changing intimate partner violence safety planning needs as a result of COVID-19: results from phase I of a rapid intervention.

OBJECTIVES: The aim of the study was to examine the need for modified safety planning strategies in response to COVID-19-related increases in intimate partner violence (IPV) as the initial phase of adapting an IPV safety planning intervention in Toronto, Ontario. METHODS: A rapid, systematic review was conducted to elucidate existing safety planning strategies used during public health emergencies. These were supplemented with strategies from an expert panel. A survey of IPV survivors and service providers gauged the helpfulness of each strategy during COVID-19. RESULTS: Together, the systematic review and expert panel yielded 26 conceptually distinct strategies, which were evaluated by 111 IPV survivors and providers. Of these, 19 (69%) were 'highly recommended', 3 (12%) were 'somewhat recommended' and 6 (23%) were not recommended for use during the COVID-19 pandemic because they might make the violence worse. CONCLUSIONS: Safety planning needs have changed owing to the effect of COVID-19 on IPV incidence, service provision and risk factors, as well as policies restricting freedom of movement. These results will be used to modify an existing IPV safety planning mobile application for use during COVID-19 and future public health emergencies.

Intimate partner violence among prenatal care attendees amidst the COVID-19 crisis: The incidence in Ethiopia.

OBJECTIVE: To assess the incidence and predictors of intimate partner violence (IPV) during pregnancy amidst the coronavirus disease 2019 pandemic. METHODS: This cross-sectional study was conducted at the prenatal care clinic of St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, among pregnant women from 31 August to 2 November 2020. Participants were interviewed using Open Data Kit. Logistic regression was used to assess predictors. RESULTS: Among the 464 pregnant women, 33 (7.1%) reported IPV during pregnancy, and among these 24 (72.7%) reported emotional violence, 16 (48.5%) reported sexual violence, and 10 (30.3%) reported physical violence. Among the study participants, only 8 (1.7%) were screened for IPV. IPV was reported 3.27 times more often by women who reported that their partner chewed Khat compared with those women whose partner did not (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.45-7.38), and 1.52 times more often women who reported that their partner drank alcohol compared with those women whose partner did not (aOR 1.52; 95% CI 1.01-2.28). CONCLUSION: Very few women were screened for IPV. Partners drinking alcohol and chewing Khat are significantly positively associated with IPV during pregnancy. IPV screening should be included in the national management protocol of obstetric cases of Ethiopia.

Exacerbation of Physical Intimate Partner Violence during COVID-19 Pandemic.

Background Intimate partner violence (IPV) is a global social and public health problem, but published literature regarding the exacerbation of physical IPV during the coronavirus disease 2019 (COVID-19) pandemic is lacking. Purpose To assess the incidence, patterns, and severity of injuries in IPV victims during the COVID-19 pandemic in 2020 compared with the prior 3 years. Materials and Methods The demographics, clinical presentation, injuries, and radiologic findings of patients reporting physical abuse arising from IPV during the statewide COVID-19 pandemic between March 11 and May 3, 2020, were compared with data from the same period for the past 3 years. Pearson χ2 and Fisher exact tests were used for analysis. Results A total of 26 victims of physical IPV from 2020 (mean age, 37 years ± 13 [standard deviation]; 25 women) were evaluated and compared with 42 victims of physical IPV (mean age, 41 years ± 15; 40 women) from 2017 to 2019. Although the overall number of patients who reported IPV decreased during the pandemic, the incidence of physical IPV was 1.8 times greater (95% CI: 1.1, 3.0; P = .01). The total number of deep injuries was 28 during 2020 versus 16 from 2017 to 2019; the number of deep injuries per victim was 1.1 during 2020 compared with 0.4 from 2017 to 2019 (P < .001). The incidence of high-risk abuse defined by mechanism was two times greater in 2020 (95% CI: 1.2, 4.7; P = .01). Patients who experienced IPV during the COVID-19 pandemic were more likely to be White; 17 (65%) victims in 2020 were White compared with 11 (26%) in the prior years (P = .007). Conclusion There was a higher incidence and severity of physical intimate partner violence (IPV) during the coronavirus disease 2019 (COVID-19) pandemic compared with the prior 3 years. These results suggest that victims of IPV delayed reaching out to health care services until the late stages of the abuse cycle during the COVID-19 pandemic. © RSNA, 2020.

Violence against women in the Covid-19 pandemic: A review of the literature and a call for shared strategies to tackle health and social emergencies.

The aim of this article was to conduct a rapid critical review of the literature about the relationship between violence against women (VAW) and the current COVID-19 pandemic. After the screening process, a total of 42 articles were considered. Our review confirmed that the "stay at home" policies to contrast the pandemic have increased the problem of VAW, creating a "shadow pandemic within the pandemic", as it was called by the United Nations. However, rigorous studies estimating the relationship between VAW and COVID-19 pandemic are scarce; most of the articles are commentaries, letters, editorials, and most of the published data derives from social media, internet, anecdotal evidence and helplines reports. Health care systems should promote further investigations into the relation between VAW and COVID-19, to identify creative solutions to provide clinical care and forensic services for victims of VAW.

The impact of the COVID-19 pandemic on women's mental health.

The current worldwide outbreak of COVID-19 has changed the modus operandi of all segments of society. While some pandemic-related stressors affect nearly everyone, many especially affect women. PURPOSE: To review what is known about the pandemic's effect on women's mental health, what makes them more predisposed to vulnerabilities and adverse impacts, and strategies for preventing and treating these mental health consequences in the female population during specific stages across the lifespan. METHODS: The authors performed a narrative review in combination with their observations from clinical experience in the field of women's mental health and reproductive psychiatry. Articles on women's mental health and COVID-19 up to May 30, 2020, were searched using the electronic PubMed and PsychInfo databases, as well as publications by major health entities (e.g., World Health Organization, Centers for Disease Control and Prevention, the United Nations) and press releases from prime communication outlets (e.g., National Public Radio). RESULTS AND CONCLUSIONS: Women who are pregnant, postpartum, miscarrying, or experiencing intimate partner violence are at especially high risk for developing mental health problems during the pandemic. Proactive outreach to these groups of women and enhancement of social supports could lead to prevention, early detection, and prompt treatment. Social support is a key protective factor. Similarly, parenting may be substantially more stressful during a pandemic. Gender disparities may be accentuated, particularly for employed women or single parents, as women are disproportionately responsible for the bulk of domestic tasks, including childcare and eldercare.

Recognising and responding to intimate partner violence using telehealth: Practical guidance for nurses and midwives.

AIMS: To synthesise the current, global evidence-informed guidance that supports nurses and midwives to recognise and respond to intimate partner violence (IPV), and how these practices can be translated from face-to-face encounters to care that is delivered through telehealth. BACKGROUND: COVID-19-related social and physical distancing measures increase the risk for individuals who are socially isolated with partners who perpetuate violence. Providing support through telehealth is one strategy that can mitigate the pandemic of IPV, while helping patients and providers stay safe from COVID-19. DESIGN AND METHODS: In this discursive paper, we describe how practical guidance for safely recognising and responding to IPV in telehealth encounters was developed. The ADAPT-ITT (Assessment, Decisions, Administration, Production, Topical Experts, Integration, Testing, Training) framework was used to guide the novel identification and adaptation of evidence-informed guidance. We focused on the first six stages of the ADAPT-ITT framework. CONCLUSIONS: This paper fills a gap in available guidance, specifically for IPV recognition and response via telehealth. We present strategies for prioritising safety and promoting privacy while initiating, managing or terminating a telehealth encounter with patients who may be at risk for or experiencing IPV. Strategies for assessment, planning and intervention are also summarised. System-level responses, such as increasing equitable access to telecommunication technology, are also discussed. RELEVANCE TO CLINICAL PRACTICE: Integrating innovative IPV-focused practices into telehealth care is an important opportunity for nurses and midwives during the current global COVID-19 pandemic. There are also implications for future secondary outbreaks, natural disasters or other physically isolating events, for improving healthcare efficiency, and for addressing the needs of vulnerable populations with limited access to health care.

The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets.

BACKGROUND: Family violence (including intimate partner violence/domestic violence, child abuse, and elder abuse) is a hidden pandemic happening alongside COVID-19. The rates of family violence are rising fast, and women and children are disproportionately affected and vulnerable during this time. OBJECTIVE: This study aims to provide a large-scale analysis of public discourse on family violence and the COVID-19 pandemic on Twitter. METHODS: We analyzed over 1 million tweets related to family violence and COVID-19 from April 12 to July 16, 2020. We used the machine learning approach Latent Dirichlet Allocation and identified salient themes, topics, and representative tweets. RESULTS: We extracted 9 themes from 1,015,874 tweets on family violence and the COVID-19 pandemic: (1) increased vulnerability: COVID-19 and family violence (eg, rising rates, increases in hotline calls, homicide); (2) types of family violence (eg, child abuse, domestic violence, sexual abuse); (3) forms of family violence (eg, physical aggression, coercive control); (4) risk factors linked to family violence (eg, alcohol abuse, financial constraints, guns, quarantine); (5) victims of family violence (eg, the LGBTQ [lesbian, gay, bisexual, transgender, and queer or questioning] community, women, women of color, children); (6) social services for family violence (eg, hotlines, social workers, confidential services, shelters, funding); (7) law enforcement response (eg, 911 calls, police arrest, protective orders, abuse reports); (8) social movements and awareness (eg, support victims, raise awareness); and (9) domestic violence-related news (eg, Tara Reade, Melissa DeRosa). CONCLUSIONS: This study overcomes limitations in the existing scholarship where data on the consequences of COVID-19 on family violence are lacking. We contribute to understanding family violence during the pandemic by providing surveillance via tweets. This is essential for identifying potentially useful policy programs that can offer targeted support for victims and survivors as we prepare for future outbreaks.