Integrating Domestic Violence Prevention and Mitigation into Global COVID-19 Preparedness and Relief Efforts

This week is National Public Health Week (NPHW), marking the recognition of important public health issues. During these trying times and amidst the COVID-19 pandemic, the acknowledgement of public health contributions is more important than ever. With today's NPHW theme focused on violence prevention, Dr Nafisa Halim, Associate Editor for BMC Public Health, discusses the recent increase in domestic violence in light of lockdowns and how prevention is key.

The coronavirus disease (COVID-19) is an unprecedented global health emergency. At this writing, COVID-19 has affected more than 173 countries, causing 972,303 infections and 50,322 deaths. Highly contagious, coronavirus spreads through human-to-human contact, with the number of infections doubling every three days. Neither vaccine nor cure exists for COVID-19, although several clinical trials are underway. Prevention is cure, and physical distancing is the most effective prevention endeavor.

Mandatory quarantines or non-mandatory stay-at-home advisories are in effect in countries around the world, affecting one third of the global population. Homebound, people are physically distant from wider social networks: school-age children are receiving homeschooling; college students are attending online classes from home; non-essential service employees are working from home.

Globally, one in three women experience domestic violence over their lifetimes, and 4-12% during pregnancy.

Unfortunately, stay-at-home may not mean safer-at-home for millions of women worldwide. Home is where women experience violence in the hands of their spouses or extended family members. Domestic violence, including physical, sexual, reproductive, emotional, or economic, is a health and human rights violation, leading to mental and physical health consequences, including death. Globally, one in three women experience domestic violence over their lifetimes, and 4-12% during pregnancy.

Domestic violence can be an unintended consequence of COVID-19 lockdowns, which have been essential for suppressing the spread. Prior evidence makes it a possibility: domestic violence rates went up during emergencies in the US, and globally. High risk (stuck in home with abuser), low protection (socially distant from family, friends, neighbors, coworkers) makes it a probability. Indeed, frontline workers from a diverse set of countries and cultures, including USA, France, Italy, Spain, Australia, Cyprus, Brazil, China, Nepal, India, Lebanon, and South Africa, have reported an increase in the number of calls to domestic-violence hotlines, or of police complaints. In absence of population-based estimates before and after COVID-19 lockdowns, existing reports are invaluable alternatives, indicating, at a minimum, an upswing in violence re-victimization, potentially globally.

To be clear, domestic violence happens in homosexual as well as heterosexual relationships. Violence can be perpetrated by both men and women against their partners of the same or opposite gender. However, men’s perpetration of violence against women is the most common form of domestic violence worldwide, with consequences more intense, lingering across generations.

Preventing a potential outbreak of domestic violence during an emergency seems plausible. Conceptually, programs found to be effective in preventing conditions triggering men’s perpetration of domestic violence are likely be effective in reducing domestic violence. I discuss three such conditions and programs. Intersecting vulnerabilities (younger age, poverty, lower education levels) increase women’s vulnerability to experiencing multiple violence-triggering conditions, simultaneously.

COVID-induced economic recession heightens the risk of marital conflicts, often resulting in men’s violence perpetration

First, COVID-induced economic recession, and consequent livelihood loss by either or both partners, and subsequent financially stressful times leaving families with resource constraints for life essentials, or the need for rationing, heightens the risk of marital conflicts, often resulting in men’s violence perpetration. Conversely, potential COVID-19 exposures through employment in essential services can be traumatic, triggering marital conflicts. Cognitive burdens (preoccupation with financial woes impedes one’s ability to do the right thing; fear of disease exposure) make both partners vulnerable to violence perpetration; the higher social position of men make them more susceptible. The risk is greater for men holding traditional views on gender roles (feeling that they have failed as “the provider of the family,” and at-risk of losing power and control), growing up experiencing or watching violence (getting cues of action from “mental models” of conflict resolutions), or are engaged in substance use (blurring judgement, misplaced priorities), compared to men with comparable levels of vulnerability and susceptibility but without such attributes.

Second, disruptions in the operation of service-delivery institutions (e.g., schools; day care centers; restaurants; dry cleaners) and subsequent abrupt need for (primarily) women assuming significantly more roles than usual can result in women’s excessive workload, stress, anxiety, maladaptive coping including substance use, increasing their vulnerabilities to domestic violence (re)victimization.

Third, homebound for long, couples, even those more egalitarian, may experience increasing intensification or rebound of traditional gender roles and relations, with women, charged with caregiving among other domestic responsibilities, becoming the default target of blame for discomforts, inconveniences, or unmet needs. A prolonged, 24/7 stay at a proximity increases the use of household space and resources for meeting most daily-living essentials, increasing the frequency of interactions between intimate partners and, thereby, opportunities for marital conflicts.

Easier access to domestic violence hotlines and to shelters that are safe will improve women’s ability to seek help despite constraints

As for violence prevention and mitigation, the following three policies or programs seem promising. However, a broader, multisectoral approach to address women’s deprivation in terms of education, nutrition, healthcare, family planning or economic empowerment underlying women’s vulnerability to violence should be integrated into overall emergency preparedness efforts.

First, a financial safety net (for example, unemployment insurance in the US, India’s direct unconditional cash transfers to women, and poor households, etc.) will likely keep household’s overall consumption at a comparable level, enhancing women’s capacity for violence-risks management, and, thereby, enhancing the safety of women and their children. Second, addressing factors that trigger violence during stressful times is key. For example, a ban on alcohol sales, limiting hours of alcohol sales, or limiting the volume sold per person, as appropriate in each context, will curb access to alcoholic beverages, reducing excessive alcohol consumption and related harms including violence against women and children. Third, easier access to domestic violence hotlines and to shelters that are safe will improve women’s ability to seek help despite constraints (i.e., abuser is nearby) and relocate (i.e., women can still practice physical distancing in shelters), significantly limiting the risk of violence re-victimization. To ensure easy access, countries must ensure: (a) adequate resources for domestic-violence services and shelters as an essential service; and (b) legal protection against domestic violence.

It’s in our common interest, as human beings and social and economic actors, to be serious about integrating domestic violence prevention and mitigation into COVID-19 preparedness and relief efforts. The alternative is unethical, keeping a blind eye to human right violations, and seems suboptimal: needing direct medical and mental health care services, a global surge in domestic violence could be costly, potentially compromising COVID-19 responses inside and outside the health sector.

View the latest posts on the BMC Series blog homepage