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      The impact of the Covid-19 pandemic in the precipitation of intimate partner violence

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          Abstract

          Intimate Partner Violence (IPV) is a global pandemic and many have been victims of it long before Covid-19. International organizations have documented an increase in IPV reports during the current pandemic, raising awareness of the potential causes for such an increase. Reflecting on risk factors associated with IPV, and the underlying need of the perpetrators to exert control over the victims, it becomes increasingly important to understand how the current policies of social distancing, self-isolation, and lockdown can precipitate episodes of IPV. Furthermore, access to specialized services and health care can be compromised, and health care professionals face new challenges and demands imposed by the pandemic while managing IPV cases. This article begins by examining the main risk factors more commonly associated with IPV in the literature. It proceeds by reflecting on how these risk factors may be exacerbated during the Covid-19 pandemic, which can explain the increased number of reports. Finally, it emphasizes the new challenges faced by health care professionals, while assisting IPV victims during the pandemic and provides possible recommendations on actions to implement during and beyond the Covid-19 pandemic to prevent such cases.

          Highlights

          • Intimate Partner Violence cases increase during emergencies.

          • An increase in IPV cases has been reported during the Covid-19 pandemic.

          • IPV has been related to numerous risk factors.

          • Risk factors for IPV can be exacerbated during the Covid-19 pandemic.

          • Health care professionals face new challenges managing IPV cases during the Covid-19 pandemic.

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          Most cited references35

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          COVID-19: the gendered impacts of the outbreak

          Policies and public health efforts have not addressed the gendered impacts of disease outbreaks. 1 The response to coronavirus disease 2019 (COVID-19) appears no different. We are not aware of any gender analysis of the outbreak by global health institutions or governments in affected countries or in preparedness phases. Recognising the extent to which disease outbreaks affect women and men differently is a fundamental step to understanding the primary and secondary effects of a health emergency on different individuals and communities, and for creating effective, equitable policies and interventions. Although sex-disaggregated data for COVID-19 show equal numbers of cases between men and women so far, there seem to be sex differences in mortality and vulnerability to the disease. 2 Emerging evidence suggests that more men than women are dying, potentially due to sex-based immunological 3 or gendered differences, such as patterns and prevalence of smoking. 4 However, current sex-disaggregated data are incomplete, cautioning against early assumptions. Simultaneously, data from the State Council Information Office in China suggest that more than 90% of health-care workers in Hubei province are women, emphasising the gendered nature of the health workforce and the risk that predominantly female health workers incur. 5 The closure of schools to control COVID-19 transmission in China, Hong Kong, Italy, South Korea, and beyond might have a differential effect on women, who provide most of the informal care within families, with the consequence of limiting their work and economic opportunities. Travel restrictions cause financial challenges and uncertainty for mostly female foreign domestic workers, many of whom travel in southeast Asia between the Philippines, Indonesia, Hong Kong, and Singapore. 6 Consideration is further needed of the gendered implications of quarantine, such as whether women and men's different physical, cultural, security, and sanitary needs are recognised. Experience from past outbreaks shows the importance of incorporating a gender analysis into preparedness and response efforts to improve the effectiveness of health interventions and promote gender and health equity goals. During the 2014–16 west African outbreak of Ebola virus disease, gendered norms meant that women were more likely to be infected by the virus, given their predominant roles as caregivers within families and as front-line health-care workers. 7 Women were less likely than men to have power in decision making around the outbreak, and their needs were largely unmet. 8 For example, resources for reproductive and sexual health were diverted to the emergency response, contributing to a rise in maternal mortality in a region with one of the highest rates in the world. 9 During the Zika virus outbreak, differences in power between men and women meant that women did not have autonomy over their sexual and reproductive lives, 10 which was compounded by their inadequate access to health care and insufficient financial resources to travel to hospitals for check-ups for their children, despite women doing most of the community vector control activities. 11 Given their front-line interaction with communities, it is concerning that women have not been fully incorporated into global health security surveillance, detection, and prevention mechanisms. Women's socially prescribed care roles typically place them in a prime position to identify trends at the local level that might signal the start of an outbreak and thus improve global health security. Although women should not be further burdened, particularly considering much of their labour during health crises goes underpaid or unpaid, incorporating women's voices and knowledge could be empowering and improve outbreak preparedness and response. Despite the WHO Executive Board recognising the need to include women in decision making for outbreak preparedness and response, 12 there is inadequate women's representation in national and global COVID-19 policy spaces, such as in the White House Coronavirus Task Force. 13 © 2020 Miguel Medina/Contributor/Getty Images 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. If the response to disease outbreaks such as COVID-19 is to be effective and not reproduce or perpetuate gender and health inequities, it is important that gender norms, roles, and relations that influence women's and men's differential vulnerability to infection, exposure to pathogens, and treatment received, as well as how these may differ among different groups of women and men, are considered and addressed. We call on governments and global health institutions to consider the sex and gender effects of the COVID-19 outbreak, both direct and indirect, and conduct an analysis of the gendered impacts of the multiple outbreaks, incorporating the voices of women on the front line of the response to COVID-19 and of those most affected by the disease within preparedness and response policies or practices going forward.
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            The pandemic paradox: The consequences of COVID‐19 on domestic violence

            COVID‐19 (the new strain of coronavirus) has been declared a global pandemic. Measures announced over recent weeks to tackle it have seen people's day‐to‐day life drastically altered. These changes are essential to beat coronavirus and protect health systems (UK Home Office, 2020). However, there are unintended, negative consequences. As the virus continues to spread across the world, it brings with it multiple new stresses, including physical and psychological health risks, isolation and loneliness, the closure of many schools and businesses, economic vulnerability and job losses. Through all of that, children and their mothers are particularly vulnerable (End Violence against Children, 2020) to the risk of domestic violence. Domestic violence refers to a range of violations that happen within a domestic space. It is a broad term that encompasses intimate partner violence (IPV), a form of abuse that is perpetrated by a current or ex‐partner. In this editorial, we talk about “domestic violence” because this is the term used most often in the media. It is important to clarify though that we are mainly referring to IPV and its impact on children who live with or are exposed to IPV between adults. We also focus mainly on women, because they are disproportionately affected by domestic violence; however, we recognise that domestic abuse happens to men and occurs within same‐sex relationships. It is a matter of just about a week ago where one of us (Bradbury‐Jones) was writing another editorial about COVID‐19 for the Journal of Clinical Nursing, reflecting on life in the pandemic (Jackson et al., 2020). Within that editorial, we raised the emerging concern as to whether domestic violence rates would rise as a result of the “lockdown” that is being imposed by many countries across the globe. Although these measures vary, to some degree, in their timing and severity, they generally require that people stay at home and only leave for an essential reason such as buying food, collecting medication or carrying out a key worker role. At the time of writing this first editorial, the concern was expressed as speculation, a questioning as to whether it might happen. Within such a short time span, there is clear evidence that we need to speculate no more. Domestic violence rates are rising, and they are rising fast. Experience in New Zealand and internationally has shown that family violence (including IPV, child abuse and elder abuse) and sexual violence can escalate during and after large‐scale disasters or crises (NZFVC, 2020). Around the world, as communities have gone into lockdown to stop the spread of coronavirus, the mass efforts to save lives have put women in abusive relationships more at risk. A very recent article published in The Guardian (2020) reported on how the surge of domestic violence cases is a pattern being repeated globally. Reporting from several different countries, the article highlighted alarming figures, for example a rise of 40% or 50% in Brazil. In one region of Spain, the government claimed that calls to its helpline had risen by 20% in the first few days of the confinement period and in Cyprus, calls to a similar hotline rose 30% in the week after the country confirmed its first case of coronavirus. In the UK, Refuge, one of the leading domestic abuse organisations reported that calls to the UK Domestic Violence Helpline increased by 25% in the seven days following the announcement of tighter social distancing and lockdown measures by the government. During the same period, there was a 150% increase in visits to the Refuge website (BBC, 2020). Governments across the globe are imposing necessary draconian measures to try to level the curve of the virus and to delay its peak. In the UK where we both live and work, we have listened to what has become a well‐rehearsed mantra: Stay Home; Protect the National Health Service (NHS); Save Lives. We use this editorial to propose the pandemic paradox, to unravel and problematise these measures in terms of what they mean for those who are living and surviving abusive relationships. Let us start with staying at home. Home is not always a safe place to live; in fact, for adults and children living in situations of domestic and familial violence, home is often the space where physical, psychological and sexual abuse occurs. This is because home can be a place where dynamics of power can be distorted and subverted by those who abuse, often without scrutiny from anyone “outside” the couple, or the family unit. In the COVID‐19 crisis, the exhortation to “stay at home” therefore has major implications for those adults and children already living with someone who is abusive or controlling. Stringent restrictions on movement shut off avenues of escape, help‐seeking and ways of coping for victim–survivors. Restrictive measures are also likely to play into the hands of people who abuse through tactics of control, surveillance and coercion. This is partly because what goes in within people's homes—and, critically, within their family and intimate relationships—take place “behind closed doors” and out of the view, in a literal sense, of other people. Unintentionally, lockdown measures may therefore grant people who abuse greater freedom to act without scrutiny or consequence. Social norms and attitudes that suggest there is a “sanctity” to family life—to home, in a social rather than physical sense—can also make it difficult for people to speak out about, let alone leave, abusive situations as a result of feelings of shame and embarrassment. During the COVID‐19 crisis, it is therefore important to think critically about idealised representations of home and family and to make it possible for people to talk about, and where possible take action to counter abusive and controlling family life. Asking people directly, on repeated occasions, about whether they consistently feel safe at home is one way of doing this; however, it is also important that people asking this question have the time and emotional resources to listen and respond to the often‐subtle ways that people indicate they are scared and unsafe. As regards protecting health, social and therapeutic services, of course there has been considerable focus on front‐line staff, directly relevant to dealing with the novel coronavirus. Nurses and health professionals are clearly at the forefront of the response to COVID‐19 and we stand with those underlining the need to meet, as a basic requirement, health professionals’ physical, practical and emotional needs during and after the immediate impact of the pandemic. It is vital that health services are protected and resourced. It is also vital, however, that we continue and where necessary increase support to the services who work alongside health and avoid tendencies to pit services against one another in practical or moral terms. Services working alongside health include the advocates, therapists and helpline practitioners working in specialist domestic and sexual violence services in the voluntary sector. These organisations provide an array of services, including but not limited to refuge accommodation, independent advocacy and peer support and mentoring services. Their independence is often highly valued by victim–survivors, many of whom may have had difficult experiences with institutions such as the police or social services. During the COVID‐19 crisis, these services are more crucial than ever. They provide support and care to victim–survivors experiencing immediate danger and distress. Thus, it is critical that governments across the world enable these services to remain open. This means ensuring that voluntary sector practitioners can access personal protective equipment, be paid in full and be supported to care for their own families whilst working. It also means finding new solutions, including increasing capacity for helpline services and running targeted campaigns, alongside specialist services, about discrete ways that victim–survivors can contact the emergency services without alerting their abuser (Independent Office for Police Conduct, 2019). For people already accessing crisis and therapeutics services, the use of phone support and online technologies to provide advice and counselling is welcomed. However, it is also important to recognise that victim–survivors may not have access to these mechanisms because of control tactics used by an abusive partner, or more simply, because they cannot afford them. This underlines the need to provide different types of support and to recognise that many people will simply not be able to access help or care whilst social restrictions are in place and this will have an impact on their safety, health and well‐being now and in the longer term. In terms of saving lives, one of the most serious manifestations of intimate partner and familial abuse is domestic homicide. In the UK, approximately two women are killed every week by their current or ex‐partner. During the COVID‐19 pandemic, reports have emerged of an apparent increase in domestic homicides in a number of affected countries. In March 2020, Spain (a country that has been particularly hard hit by the pandemic) saw its first domestic violence fatality just 5 days following lockdown; a woman was murdered by her husband in front of their children in Valencia. There is also emerging evidence of an increased number of domestic homicides in the UK since the lockdown restrictions were enacted (Ingala Smith, 2020). At this early stage of the pandemic, it is too early to verify whether the increased reporting of these deaths represents an actual rise in domestic homicide rates or increased media attention. However, it is important to highlight that reported cases are of violence are known to be a small percentage of actual incidents. Moreover, the emerging homicide numbers underline the serious and potentially devastating unintended consequences of the pandemic for victim–survivors of abuse. At the time of writing, we are grappling, like everyone else, with the myriad, often deeply worrying effects of this novel coronavirus. Seeking to stem its spread, safeguard our health systems and, critically, best protect those with health vulnerabilities that put them at risk of life‐limiting or life‐ending illness, it has been necessary to alter social behaviours like never before and for governments to alter radically, the extent to which they intervene into our private lives and behaviours. We raise concerns about the needs and experiences of victim–survivors of domestic violence as a way of drawing attention to some of the unfortunate and troubling paradoxes of social distancing and isolation measures, not in opposition to them. We do so because the voices and needs of victim–survivors are too often over‐looked and under‐represented in some parts of the media and within policy and political spheres. We also raise these issues because there are actions that may help to mitigate the additional risks that COVID‐19, and its attendant social and economic effects, may have on victim–survivors. National and local governments can, for example, take action now in terms of protecting and supporting services that provide crisis and therapeutic support to victim‐survivors. However, it is also by being aware of and, where possible, reaching out to those who may be affected by domestic violence that we can support one another, whether in our personal or professional lives. This pandemic creates a paradox as regards staying safe at home and it is one to which we should all pay attention. Governments across the globe have called upon us all to play our individual part in tackling COVID‐19 by staying at home, but a critical mindfulness of what this means for many women and children is also important.
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              Alarming trends in US domestic violence during the COVID-19 pandemic

              The COVID-19 pandemic caused by the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused significant destruction worldwide. In the United States (US) as of April 18, 2020 there were 690,714 reported cases and 35,443 deaths [1]. In order to curb the spread of SARS-CoV-2 quarantines, social isolation, travel restrictions and stay-at-home orders have been adopted [2,3]. While many states in the US implement stay-at-home orders differently, in most cases individuals are expected to stay indoors except for essential activities (e.g., obtaining food, medication, medical treatment) or for work in essential businesses (e.g., health care, essential infrastructure operations). Although these measures can be effective to control the spread of disease, they have a profound impact on society leading to social, financial and psychological repercussions. Isolation may expose or worsen vulnerabilities due to a lack of established social support systems. The temporary shutdown of non-essential businesses has led to unemployed and economic strain [4]. Quarantine conditions are associated with alcohol abuse, depression, and post-traumatic stress symptoms [5]. Stay-at-home orders may cause a catastrophic milieu for individuals whose lives are plagued by domestic violence (DV). DV usually occurs in a domestic space when one individual holds power over another. DV is a broad term and typically includes intimate partner violence (IPV) (e.g., usually occurs between current or former intimate partners and includes stalking, psychological, sexual and physical violence) elder abuse (e.g., involves negligent or intentional acts which cause harm) and child abuse (e.g., includes neglect, physical harm, sexual violence, and emotional harm) [6]. However, for the purpose of report we will primarily refer to DV as it pertains to IPV. Forms of DV such as IPV are unfortunately quite common. According to the CDC, approximately 1 in 4 women and 1 in 10 men report experiencing some form of IPV each year [7]. In the wake of the COVID-19 pandemic trends regarding DV are already starting to emerge on a global scale. Reports from local police near the epicenter of the COVID-19 outbreak in China's Hubei province, indicate that DV tripled during February 2020 compared to February 2019 [8]. Also, according to the United Nations entity UN Women, DV reports in France have increased 30% since they initiated a March 17 lockdown. DV calls in Argentina have increased 25% since their March 20 lockdown [9]. The organization also reports a 30% increase in helpline calls in Cyprus and 33% increase in Singapore [9]. However, in the US, the effect of the COVID-19 pandemic on DV is just beginning to be realized via anecdotal reports since there is limited data available to assess how DV has changed following implementation of stay-at-home orders. Data from US police departments provide some early insight into the effect COVID-19 has had on DV in some regions. For instance, in Portland, Oregon public schools closed March 16, 2020 and on March 23 came stay-at-home orders [10]. Following these events, the Portland Police Bureau recorded a 22% increase in arrests related to DV compared to prior weeks [11]. In San Antonio, Texas schools closed March 20, 2020 and stay-at-home orders came March 24 [12]. The San Antonio Police Department subsequently noted they received an 18% increase in calls pertaining to family violence in March 2020 compared to March 2019 [13]. In Jefferson County Alabama, the Sheriff's Office reported a 27% increase in DV calls during March 2020 compared to March 2019 [14]. In New York City schools closed March 16, 2020 and stay-at-home orders started on March 22, 2020 [15]. During the month of March, the New York City Police Department responded to a 10% increase in DV reports compared to March 2019 [16] [Fig. 1A & B]. Fig. 1 (A). Percent increase in US domestic violence in the locations studied in 2020. (B). Percent increase in US domestic violence in the locations studied 2020. Fig. 1 Reports of shootings in Philadelphia have increased since the state enacted its stay-at-home orders on April 01, 2020 [17]. According to data published by the City of Philadelphia, the number of shooting victims has increased approximately 7% during the period of April 01, 2020 to April 15, 2020 compared to the same time last year [18]. This cursory analysis illustrates that stay-at-home orders may create a worst-case scenario for individuals suffering from DV and demonstrates a need for further research. With the apparent rise in DV reports, there is a need for more current and standardized modalities of reporting actionable DV data. First responders, physicians and other healthcare personal need to be made aware of the potential for increased DV during the COVID-19 pandemic so they can respond appropriately. Steps could also be taken on an administrative level to make IPV screening tools more readily available in clinical settings and media outlets should be utilized to raise awareness. Social media should also be leveraged while stay-at-home orders are in place to reach a wider audience and provide support. Overall, it is vital that health care providers do not lose sight of the increased potential for violence while fighting this global pandemic since they may be the first point of contact for survivors. Funding None. Declaration of competing interest Authors declare no competing interests.
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                Author and article information

                Contributors
                Journal
                Int J Law Psychiatry
                Int J Law Psychiatry
                International Journal of Law and Psychiatry
                Published by Elsevier Ltd.
                0160-2527
                1873-6386
                26 June 2020
                26 June 2020
                : 101606
                Affiliations
                [a ]Santa Maria Family Health Unit, North Regional Health Administration, Rua Actor Mário Viegas, s/n°, 4435-076 Rio Tinto, Porto, Portugal
                [b ]Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
                [c ]Hospital de Magalhães Lemos, Porto, Portugal
                [d ]Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Newham Centre for Mental Health, London E13 8SP, United Kingdom
                Author notes
                [* ]Corresponding author at: Rua Actor Mário Viegas, s/n°, 4435-076 Rio Tinto, Porto, Portugal. dianansmoreira@ 123456gmail.com
                Article
                S0160-2527(20)30065-0 101606
                10.1016/j.ijlp.2020.101606
                7318988
                32768122
                9c618e67-4b15-4ba5-b481-c8365ca83aca
                © 2020 Published by Elsevier Ltd.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 17 May 2020
                : 22 June 2020
                : 22 June 2020
                Categories
                Article

                Law
                intimate partner violence,covid-19,pandemic,risk factors,domestic violence
                Law
                intimate partner violence, covid-19, pandemic, risk factors, domestic violence

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