Research on violence against women in the context of natural disasters and emergencies suggest that intimate partner violence rates increase following a disaster. The COVID-19 pandemic caused major economic devastation leaving millions in the United States unemployed and uncertain of the future, as well as disconnected residents from their social support systems, community resources, and healthcare systems. In efforts to control the coronavirus spread, social distancing and stay-at-home-orders were imposed early 2020 (Sorenson, Sinko, and Berk, 2021). Although measures were necessary in reducing virus transmission, the combination of these efforts, widespread panic and stress, and social isolation may have inadvertently increased risks for intimate partner violence against women as “home” became a dangerous place. This literature review will examine the effects of the COVID-19 pandemic on intimate partner violence against women living in the US, particularly after the implementations of social distancing and lockdown/stay-at-home orders. The review will then provide recommendations on how to improve screening and support for intimate partner violence victims and survivors.
The COVID-19 pandemic affected all demographic segments of the population, particularly as it exposed and exacerbated pre-existing hardships and disparities faced by various underserved populations in the United States. In efforts to control the spread of the coronavirus within the US, public health mitigation strategies included screening, social distancing, mask/facial covers, and stay-at-home/lockdown orders (Schuchat, 2021). Although these mandates and recommendations were attempts to reduce the spread of one pandemic, these efforts may have inadvertently led to a rise in another ongoing shadow pandemic – intimate partner violence (IPV).
IPV is a significant public health issue in the US as rates prior to the COVID-19 pandemic affected more than ten million people each year, where as many as one in four women and one in ten men reported being a victim of domestic violence (Huecker, King, Jordan et al, 2021; CDC, 2015). For this literature review, it is recognized that IPV affects both men and women; however, for the purposes of this study, the paper will focus on IPV against women.
There are four main types of IPV: stalking, sexual violence, physical violence, and psychological aggression. In 2015, about 36.4% (43.6 million) of US women reported experiencing sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime. 25.1% (30 million) of US women experienced sexual violence, physical violence, and/or staking by an intimate partner during their lifetime and reported some form of IPV-related impact – severe physical violence, slapped, pushed shoved (Smith, Zhang, Basile, et al, 2015). Subtypes of IPV reports can further be broken down to show that 18.3% of women experienced sexual violence, 30.6% experienced physical violence, and 10.4% experienced stalking during their lifetime (Smith, Zhang, Basile, et al, 2015). And about 36.4% US women experienced psychological aggression by an intimate partner during their lifetime (Smith, Zhang, Basile, et al, 2015). It should also be noted that these IPV reports can be an underestimation as many cases go unreported each year (National Center for Injury Prevention and Control, 2003).
As a result of IPV, victims and survivors have an increased risk of cardiovascular disease, chronic pain, sleep disturbances, sexually transmitted infections, and multiple mental health conditions (i.e., anxiety disorders, eating disorders, posttraumatic stress disorder, substance, or alcohol abuse) (Mazza, Marano, Lai, Janiri, and Sani, 2020). In addition, exposure to domestic violence increases an individual’s risk for perpetrating violence in their future relationships or staying in the cycle of domestic violence (Mazza, Marano, Lai, Janiri, and Sani, 2020).
Past research evidence has recognized that rates of IPV increase during and after natural disasters and emergencies (Rezaeian, 2013; First J, First N, and Houston J, 2017; Kaukinen, 2020). In examining the impact that the COVID-19 pandemic had on women experiencing ongoing or new episodes of IPV during this time, several studies have shown an increase in the incidence of reported IPV and severity of IPV after the pandemic began, while others indicate a decrease in calls (Sorenson, Sinko, and Berk, 2021; Bradley, DiPasquale, Dillabough and Schneider, 2020; Bright, Burton and Kosky, 2020). This literature review will examine how pre-existing hardships and related risk factors of IPV were further intensified by the COVID-19 pandemic itself, as well as examine help-seeking challenges that arose due to the COVID-19 pandemic control efforts of social distancing and stay-at-home-orders.
POTENTIAL RISE IN INCIDENCE AND SEVERITY OF IPV
Several direct and indirect mechanisms from the COVID-19 pandemic consequently influenced the potential increase of IPV incidences, with the first being the contribution of new risk factors and the reinforcement of IPV-related risk factors. During the wake of the pandemic, global recognition and data collection of IPV incidences were noted and collected; however, the effect of the COVID-19 pandemic in the US on IPV was still fairly new in recognition and in data collection around February of 2020 (Boserup, McKenney and Elkbuli, 2020). Therefore, an overall IPV incidence rate for the US cannot be provided for the time during the pandemic; however, data from police reports from a few regions may possibly shed some light on the pandemic’s impact. For instance, San Antonio Texas recorded an 18% increase in domestic violence from March 2019 to 2020, since school closings and stay-at-home-orders had occurred March 2019 (Boserup, McKenney and Elkbuli, 2020). Similar increases in domestic violent reports and arrests were noted from stay-at-home orders from 2019 to 2020 for Jefferson County, Alabama with a 37% rise, New York City with 10% rise, and Portland, Oregon with a 22% increase (Boserup, McKenney and Elkbuli, 2020).
The COVID-19 pandemic led to an increase in many financial and economic stressors and tension for most communities, especially underserved populations, while dealing with an unknown future prior to vaccine development and distribution (Mazza, Marano, Lai, Janiri, and Sani, 2020). The pandemic led to a significant drop in unemployment and increased poverty levels. Financial stressors have been strongly associated to IPV incidences, as this can increase the strain in the relationship and complicate interactions at the home (Lucero, Lim and Santiago, 2016; Schwab-Reese, Peek-Asa and Parker, 2016). Financial hardship and lockdown/stay-at-home orders would consequently reduce the likelihood for IPV victims to leave their homes and abusers (Lyons and Brewer, 2021). During the pandemic, there was also an increase in drug and alcohol consumption, where a 54% increase in national alcohol sales was reported by March 2020 (Pollard, Tucker and Green, 2020). A combination of financial stressors with widespread panic, emasculation and increased alcohol consumption among other stressors may increase the risk and possible severity of IPV against women.
Furthermore, the pandemic provided abusers an excuse to use the outbreak as a method for coercive control and power over their partners. Stay-at-home orders, the period of quarantine and isolation away from others fueled power for the abusers’ ability to stalk and control their partners within the house. Observations recorded from women in some of the articles cited examples where their partners threatened to “contract the COVID-19 virus to force their wives to stay home longer,” “throwing [her] outside if she coughs one more time,” denying victims necessary items like soap, and preventing victims from seeking medical care in case of infection (Bright, Burton and Kosky, 2020; Moreira and Pinto da Costa, 2020). This then makes it difficult for IPV victims to engage in more protective factors against IPV as barriers and a sense of hopelessness increased due to the COVID-19 pandemic (Moreira and Pinto da Costa, 2020). With a reinforcement of some of the IPV risk factors due to the pandemic, research is still needed to further understand the how COVID-19 exacerbated those factors leading to IPV episodes and more details on the types of abusive behavior resulted, in addition to the possible increase in mental health consequences.
Among many factors of IPV that could contribute to and affect the IPV experience of women, isolation remains a key underlying component in better understanding the intensity of IPV (Lanier and Maume, 2009). Social isolation is measured by the type and extent of social support present in an individual’s life (Mojahed, Brym, Hense et al, 2021). An increased social support system outside of the intimate relationship lessens the chance for violence against women to occur, and in turn, is seen as a protective factor against IPV. Isolation can also be geographic where remoteness, and inaccessibility and distribution of resources can directly increase risk for IPV, particularly for marginalized women also facing discrimination due to their race, class, language barriers, etc. (Mojahed, Brym, Hense et al, 2021).
Social isolation due to quarantine, social distancing, stay-at-home orders, the fear of contracting the COVID-19 virus in addition to stressors stemming from economic and social instability made “home” a dangerous place for women at risk for IPV (Zero and Geary, 2020; Mazza, Marano, Lai, Janiri, and Sani, 2020). Social and geographic isolation removed connectedness from friends, family, and key community members outside of the home, which as a result limited or removed a part of their support system during the pandemic (Mojahed, Brym, Hense et al, 2021; Goodman and Epstein, 2020; Bright, Burton and Kosky, 2020). Connectedness for many could only occur through phone and virtual means of communication; however, for some women this can still pose potential risk in reaching out to others while being stuck at home with their abusers close-by and an inability to leave the home.
A qualitative study looking at the effects of COVID-19 on the health and safety of immigrant women demonstrated that this marginalized group was disproportionately vulnerable to IPV-related health risks during the pandemic as many reported increased episodes of stalking and authoritative control, similarly noted in other emergency crises (Sabri, Hartley, Saha, et al, 2020). Decreased calls to hotlines were attributed to greater control and stalking by their partners, whereas increased calls were associated with an increase in frequency and severity of abuse by their partner due to increased interaction between the couple (Sabri, Hartley, Saha, et al, 2020). Additional studies also denoted the stigma that remains around seeking help for IPV (Sabri, Hartley, Saha, et al, 2020; Kaukinen, 2020). Thus, the frequency of interaction and barriers related to IPV help-seeking greatly contributed to whether survivors and victims were less or more likely to seek help, while also trying to stay within the means of the COVID-19 pandemic’s efforts to “stay home, save lives.”
IMPACT ON AVAILABLE IPV RESOURCES AND SERVICES
Prior to the pandemic, most victims of IPV could contact law enforcement, seek help from doctor visits, and use other services such as help hotlines for incidence reporting, emotional support, safety planning, emergency shelter locations, and for connections to other social service agencies. However, these services that normally would be available to IPV victims and survivors began to function at reduced capacity or were no longer available as residents entered a period of lockdown and most jobs and resources transitioned to remote positions.
COVID-19 control efforts created challenges in access to healthcare and screening for IPV. Health care providers typically serve as the first point of contact for IPV victims where physical marks and confidential questions in the office can help encourage disclosure of IPV episodes (Bradley, DiPasquale, Dillabough and Schneider, 2020). The limited availability of healthcare/emergency room access and the move to telemedicine could have reduced the number of IPV incidences being identified and reported (Bradley, DiPasquale, Dillabough and Schneider, 2020). IPV victims dealt with challenges of having their partner present during virtual appointments and low comfortability with virtual platforms. Additionally, the new communication skills primary care professionals were asked to adopt may have had some holes in efficiently diagnosing and assessing clinical problems related to IPV, altering the way IPV was being screened (Moreira and Pinto da Costa, 2020).
An example of these changes was seen with the challenges that came for veteran women, a population at high risk for IPV, and the way veteran health care was initially altered to follow COVID-19 healthcare delivery. IPV screening for veteran women takes place primarily in-person and at specialty clinics. Challenges in providing screening and support to these veteran women required creative solutions such as: establishing a trauma-informed screening protocol, creating codes, creating new safety plans for communication, and discreet dissemination of resources through a website link with an attached “escape button” or discreetly placed brochures at grocery stores (Rossi, Shankar and Buckholdt, 2020). These initial solutions helped to ensure no one else was present during appointments and reducing overall risk of danger.
The COVID-19 pandemic therefore highlighted the inadequacies of health systems and resources intended to support victims of IPV and prevent IPV incidences from taking place. States and local officials were unsuccessful in properly communicating shelter and other resource information to IPV survivors, and in explaining the extent to which stay-at-home order applied to IPV survivors seeking shelter elsewhere (Bleiweis and Ahmed, 2020). The concern with IPV victims and survivors not properly being screened and provided support may have left victims unnoticed during the pandemic; therefore, calling for a need for increased awareness and new innovations to address the issue of IPV during the COVID-19 pandemic.
CONCLUSION AND RECOMMENDATIONS
The challenges imposed by the COVID-19 pandemic and the measures implemented by governments to control virus transmission, had unintentionally exacerbated those factors precipitating episodes of IPV. In better understanding the dynamics between IPV episodes and the associated risk factors, further understanding can be extended into the cases of natural disasters and emergencies, such as the COVID-19 pandemic, and how they influence and impact IPV episodes and resource availability for survivors. Stressful situations that bring about financial hardship, increase alcohol consumption, fear/panic of the unknown, reinforce other IPV risk factors and reduce the protective factors of IPV, can consequently increase the strain in the relationship and complicate interactions at home to the point where IPV episodes are more prevalent and possible more intensified. However, the estimations for these IPV episodes during this time may not truly reflect the gravity of the public health issue. There could be an increase in reporting due to severity and frequency of abuse occurring, but at the same time, IPV victims may be unable to reach out to support systems and resources because they are confined and controlled closely to their abusers at home. This pandemic created special difficulties for services that are routinely available; thus, creating challenges for health professionals in screening and supporting victims.
Therefore, to better protect IPV victims from this pandemic and any future lockdowns or emergencies in general, a multidisciplinary approach should be created in order to not only better prepare for natural disasters/emergencies but also include IPV protective measures in their contingency plans. Implications for the current policy could include the following:
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