Addressing a Global Pandemic within a Global Pandemic

Bill Gates told us we were not ready–and he was right. In 2015, he issued a warning that if anything were likely to kill over 10 million people, it would not be missiles but microbes (1). “If we start now, [he said,] we can be ready for the next epidemic.” But we were not ready and, as a result, we have scrambled to address the immediate health and social needs of those affected by COVID-19 without always recognizing some of the harmful secondary impacts of the SARS-CoV-2 virus or its impacts on specific populations such as women.

It is clear that there is a gendered aspect to the epidemic. International as well as numerous grassroots organizations have identified that women have been experiencing additional challenges during the pandemic (2, 3). Much of this extra burden is the result of socially prescribed roles and responsibilities–particularly those related to home, family, and caregiving. As a result, more women than men are employed part-time or in casual positions with low wages. The resulting economic insecurity, among other issues, contributes to challenges in escaping an abusive partner and finding safe accommodation.

In the mid-1990s, the United Nations and World Health Organization declared violence against women as one of the most pernicious and pervasive human rights violations and public health concerns of our time. The most prevalent form of this violence, globally, is intimate partner violence with almost one-in-three ever partnered women having experienced physical or sexual assault at the hands of an intimate partner (4); 35% of women who were intentionally killed in 2017 were murdered by an intimate partner (5). The fallout of intimate partner violence, particularly in the context of health, is striking; 42% of women abused by their partners are physically injured. They are also twice as likely as those who are not abused to experience depression and have issues with alcohol use and 1.5 times as likely to contract a sexually transmitted infection, including HIV (4).

In the context of COVID-19, where 1-in-10 women are concerned about violence occurring in the home, intimate partner violence, the “Double Pandemic” or “Shadow Pandemic”, is front of mind (6). In fact, with lockdowns increasingly common and recommendations/orders to isolate in one’s home to prevent the spread of the virus, rates of intimate partner violence against women, have skyrocketed. Noted in a series of media reports:

● Intimate partner violence was three times higher in February 2020 than February 2019 in a county in Hubei province, China (7).
● During a 16-day period in March, an American national domestic violence hotline received more than 1200 calls that mentioned COVID-19 being used as an abusive strategy (8).
● Police in York Region, Ontario, Canada, reported on April 1, a 22% increase in intimate partner violence incidents during the pandemic (9).
● Within 11 days of lockdown in France, reports of intimate partner violence soared by 30% (10).
● Between the first documented case of COVID-19 and March 24, Google searches related to intimate partner violence had increased by 75% in New South Wales, Australia (11).
● In Cyprus, in a one-week period in March, calls to an intimate partner violence helpline rose by almost one-third (12).
● Fourteen women were murdered in Turkish homes within 20 days of the March 11 lockdown (13).

These reports of escalating rates of intimate partner violence during COVID-19 have been attributed to an increase in men’s feelings of impotence, incompetence, desperation, and depression due to stress and anger related to confinement, loss of social supports, and unemployment with attendant income loss. Importantly, overlooked in many of these data reports are those most marginalized in our societies: homeless, migrant, and refugee women.

What has been the immediate impact of the soaring violence? Having tracked the news stories, read the blogs, followed the twitter accounts of activists, service providers, and women reaching out for help, it is clear that shelters–where available–are stretched to capacity, helplines are responding as best they can to the increased volumes in calls, while other services–where there are other services–have been trying to adapt to virtual modes of delivery.

How can women experiencing intimate partner violence be supported in the current reality of having to isolate or be quarantined and with resources taxed to the limit? Some possible strategies in moving forward, a few in the early stages of implementation in different locales, include developing social media campaigns to widely share existing or modified web-based applications that help women determine whether they are being abused, assess the situation for potential lethality, and access relevant services. Particularly important to these web-based applications is the need to adapt safety planning to include an emphasis on de-escalation strategies to defuse a partner’s abusive behaviours. In addition, activating pharmacies, grocery stores, and markets as sites of disclosure outside the gaze of the abusive partner can serve as gateways to emergency police intervention. Organizing local telephone-based safety programs could aid in ensuring the well-being of women and assisting in any need to escape. In implementing these strategies, it will be necessary also to develop emergency housing plans to help relieve shelters, potentially leveraging available motel or hotel rooms, as well as creating up-to-date lists of empty homes or places of worship that could shelter women. Ensuring women’s safety must always be paramount.

It is critical that a group of worldwide experts comes together to address intimate partner violence now while in the midst of a crisis–women with lived experience, frontline workers, researchers, and policymakers–to fully develop these strategies and explore other innovative ways of responding to the needs of diverse women, including those most vulnerable, as well as men willing to modify or address their abusive behaviours. A priority consideration for the group would be to develop standardized measures for documenting the scope of intimate partner violence globally as a baseline to monitoring progress. In the longer term, this group could advise on the best means of changing cultures of male privilege and dominance and advocate for the advancement of legal and legislative frameworks to better protect women.

Violence against women is as old as time itself, but as a society we can do better in supporting abused women by heeding the lessons learned during the present crisis and applying these to the next wave of the virus, future pandemics and, as well, times of non-crisis. In doing so, it will finally signal our commitment to addressing and preventing intimate partner violence. This time, let us pay attention!

References
1. Gates B. The next outbreak? We’re not ready [Internet]. Ted.com. 2015 [cited 9 April 2020]. Available from: https://www.ted.com/talks/bill_gates_the_next_outbreak_we_re_not_ready?language=en
2. UN backs global action to end violence against women and girls amid COVID-19 crisis. UN News [newspaper on the Internet]. 2020 April 6 [cited 9 April 2020]; Women: [about 3p.]. Available from: https://news.un.org/en/story/2020/04/1061132
3. Gunraj A. Gendered impacts of coronavirus [Internet]. Canadian Women’s Foundation. 2020 March 14 [cited 9 April 2020]. Available from: https://canadianwomen.org/blog/gendered-impacts-of-coronavirus/
4. García-Moreno C, Pallitto C, Devries K, Stöckl H, Watts C, Abrahams N. Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence [Report]. World Health Organization. 2013 [cited 9 April 2020]. Available from: https://apps.who.int/iris/bitstream/handle/10665/85239/9789241564625_eng.pdf;jsessionid=52FFB275BDD6F1A4EBE7BC989B5DC14B?sequence=1
5. Global study on homicide: Gender-related killing of women and girls [Report]. United Nations Office on Drugs and Crime. 2019 [cited 9 April 2020]. Available from: https://www.unodc.org/documents/data-and-analysis/gsh/Booklet_5.pdf
6. Impacts of COVID-19. Statistics Canada Daily [newspaper on the Internet]. 2020 April 8 [cited 9 April 2020]; Canadian Perspectives Survey Series 1: [about 2p.]. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/200408/dq200408c-eng.htm
7. Wanqing Z. Domestic violence cases surge during COVID-19 epidemic. Sixth Tone [newspaper on the Internet]. 2020 March 2 [cited 9 April 2020]; Rising tones: [about 2p.]. Available from: https://www.sixthtone.com/news/1005253/domestic-violence-cases-surge-during-covid-19-epidemic
8. Dzhanova Y. NY domestic violence programs see client numbers decline as coronavirus traps survivors at home. CNBC [newspaper on the Internet]. 2020 March 31 [cited 9 April 2020]; Politics [about 4p.]. Available from: https://www.cnbc.com/2020/03/31/new-york-coronavirus-domestic-violence-programs-see-decline-as-disease-spreads.html
9. Katawazi M. These are the crimes that have been on the rise since the COVID-19 pandemic. CTV News [newspaper on the Internet]. 2020 April 1 [cited 9 April 2020]; Toronto [about 1p.]. Available from: https://toronto.ctvnews.ca/these-are-the-crimes-that-have-been-on-the-rise-since-the-covid-19-pandemic-1.4877760
10. Domestic violence cases jump 30% during lockdown in France. Euronews [newspaper on the Internet]. 2020 March 28 [cited 9 April 2020]; France [about 1p.]. Available from: https://www.euronews.com/2020/03/28/domestic-violence-cases-jump-30-during-lockdown-in-france
11. Olle E. Coronavirus lockdown results in 75 per cent increase in domestic violence Google searches. 7NEWS.com.au [newspaper on the Internet]. 2020 March 30 [cited 9 April 2020]; Health & Wellbeing: [about 2p.]. Available from: https://7news.com.au/lifestyle/health-wellbeing/coronavirus-lockdown-results-in-75-per-cent-increase-in-domestic-violence-google-searches-c-901273
12. Domestic violence up by 30% since Covid-19 broke out in Cyprus. knews.com.cy [newspaper on the Internet]. 2020 March 18 [cited 9 April 2020]; News: [about 1p.]. Available from: https://knews.kathimerini.com.cy/en/news/domestic-violence-up-by-30-since-first-covid-19-case-confirmed
13. Soylu R. Coronavirus: Fourteen women murdered in Turkish homes since lockdown. Middle East Eye [newspaper on the Internet]. 2020 April 2 [cited 9 April 2020]; Coronavirus: [about 2p.]. Available from: https://www.middleeasteye.net/news/coronavirus-women-murder-turkey-increase-domestic