By Melinda Young

EXECUTIVE SUMMARY

Emerging research suggests a wave of increased domestic violence accompanying the pandemic and its stay-at-home restrictions.

  • Family planning providers can help women affected by intimate partner violence by screening them at in-person visits and telehealth visits.
  • Domestic violence hotlines saw increases in calls in April 2020, compared with April 2019.
  • The increase in domestic violence has particularly affected vulnerable populations, including minority women.

Recent research suggests domestic violence may be increasing during the COVID-19 pandemic. Family planning clinics will need creative techniques to screen for signs as many visits continue through telehealth.

“These actions during COVID-19 of physical distancing, sheltering in place, and others have dramatically increased the risk for violence across the globe,” says Nelia Viveiros, LLB, EdD, vice chancellor for diversity, equity, and inclusion at the University of Colorado Denver Anschutz Medical Campus.

Family planning clinicians still have an opportunity to help women affected by intimate partner violence (IPV), but during the pandemic, these provider-patient encounters often take place through telemedicine, making screening trickier.

One technique is to give women ways to change the topic or get off the phone quickly if an abusive partner enters the room when the patient is on a telehealth call, says Catherine Kaukinen, PhD, professor and chair of criminal justice and co-lead of the Violence Against Women Cluster at the University of Central Florida.

“If your partner comes in, pretend this is the U.S. Census or pretend we’re a telemarketer and drop off the phone very quickly,” Kaukinen suggests. “They can say, ‘We’re going to talk about some sensitive issues and whether these apply to you.’”

Then, tell the woman to give them a safe word to change the topic if the call suddenly seems dangerous because the abuser enters the room or becomes suspicious.

“Family planning providers should be able to switch quickly and talk about the gynecological exam,” Kaukinen says. “Quickly and nimbly get off that topic.”

Clinicians should acknowledge that with telehealth, the patient’s partner could be there, listening, she adds.

Although research is ongoing and definite conclusions are not yet available, early indications are that domestic violence hotlines saw an increase in calls during the lockdown period of March and April 2020, says Jhumka Gupta, ScD, associate professor in the department of global and community health at George Mason University in Fairfax, VA. Increases in hotline calls occurred both in the United States and globally, she notes.

In New York City, domestic violence hotline calls increased by 30% in April 2020 when compared with April 2019, Viveiros says. (More information is available at: https://www.governor.ny.gov/news/following-spike-domestic-violence-during-covid-19-pandemic-secretary-governor-melissa-derosa.) People being abused in their homes might not even be able to call a hotline because they are being watched more closely by their abusers.

“Regardless of whether women call the hotline or not, there’s this idea that the pandemic, the lockdown, and the aftermath can increase vulnerability to violence, as well as exacerbate existing violence, for various reasons,” Gupta says. (See a list of reasons domestic violence is on rise in this issue.)

Researchers note even national leaders’ disparaging comments about women create an environment that condones or tolerates domestic violence. For instance, the authors of a recent study noted name-calling comments about women, such as when President Trump called the Michigan governor “Gretchen ‘half’ Whitmer,” create a climate of hostility and negativity toward women.1 Other study results revealed the pandemic’s effect on the risk of IPV is likely to affect vulnerable populations, including minority women and those with histories of victimization and mental health issues.2

“My research, going on right now, is mostly with Latina immigrant women with low income, who have been facing fear for a long time now,” Gupta says. “It’s the pandemic on top of ongoing fear of violence against their communities, increased surveillance against their communities, and this affects their ability to get help.”

Family planning providers should not forget these vulnerable populations and the potential of IPV. “There has been so much anti-immigrant sentiment targeting immigrant women, they just don’t want to go to the authorities right now out of fear of being targeted,” Gupta explains. “Any service provider who is working with this community should be able to say to the women, ‘This information is not going to be shared with immigration authorities,’ and reassure them that it is confidential.”

Also, pandemic-enhanced stressors, such as high male unemployment and homeschooling of children, contribute to the problem.2

The pandemic’s quarantine has meant that many survivors of IPV have had to shelter in place with their abusers, says Eva PenzeyMoog, designer and founder of The Inclusive Safety Project of Chicago. The project’s goal is to end technology-facilitated domestic violence.

“This proximity gives abusers so many more ways to enact control, while the survivor has less access to their usual support networks,” PenzeyMoog says. “We know that shelters and hotlines have seen a notable increase in the number of people reaching out for help.”

A domestic violence disaster-response protocol needs to include technology, according to the authors of a recent study. The authors also recommend victims and those supporting them encourage use of the One Love app, which includes a danger checklist and validates their experience of abuse.3

Family planning providers can continue to screen patients for IPV, but now these screening sessions might take place virtually or through telehealth visits. This will require more creativity from providers, as direct and private screening questions might not be possible during a video or audio counseling session between patients and clinicians. (See story in this issue on ways to make screening safe through telehealth visits.)

“What we’re learning more and more is that, especially during telehealth visits, screening that asks someone directly, ‘Are you experiencing violence in your home?’ might not be the best way to go because of safety and privacy concerns,” Gupta says.

A safer approach is not to ask women to disclose their IPV status, but to give them information and resources. “That is way more normalizing it,” Gupta explains. “You’re not putting a woman in a difficult position to answer that question if her partner is nearby.” Also, if the woman is not experiencing intimate partner violence, she can share the information with someone else, she adds.

Results of a recent study revealed police departments in one province of China reported three times more situations of IPV than before the outbreak. Some domestic partners used physical distancing measures to further isolate women from resources that could help them. In the United Kingdom, one project that tracked violence found deaths from domestic abuse had more than doubled in March and April 2020, compared with the average rate previously.4

“Intimate partner violence is an issue, pandemic or not,” Gupta says. “But it can be exacerbated in the pandemic.”

The pandemic can be used as weapon by violent partners. “Rather than physically assaulting female partners, they might use emotional abuse, threatening to kill a pet, or threatening to take custody of a child,” Kaukinen explains. “If a woman works in a grocery store or an essential industry and is daily exposed to COVID, the male partner might use that in a divorce, saying he will have the court give him custody.”

Or the partner might threaten to take the child to a party or some other crowded place without a mask. “COVID could be used as a tool to terrorize and frighten an emotionally abused current partner or separated partner,” Kaukinen says.

Healthcare providers should start a discussion with IPV patients about safety planning and de-escalating violence. “They could tailor that message to a pandemic situation,” Gupta says. “Women could have a code word to use with family and friends in case they need help right away. Or they could think about having women familiarize themselves with the types of safety services that are available so they have that information in case there is an escalation.”

Family planning providers should keep in mind that screening patients for IPV is not a one-and-done action.

“Maybe there are patients they’ve already screened once, and then they have an assumption that we cleared her last time,” Kaukinen says. “You have to find dynamic ways to reach out to women and protect their safety.”

REFERENCES

  1. Viveiros N, Bonomi AE. Novel coronavirus (COVID-19): Violence, reproductive rights and related health risks for women, opportunities for practice innovation. J Fam Violence 2020;1-5. doi: 10.1007/s10896-020-00169-x
  2. Kaukinen C. When stay-at-home orders leave victims unsafe at home: Exploring the risk and consequences of intimate partner violence during the COVID-19 pandemic. Am J Crim Justice 2020;1-12. doi: 10.1007/s12103-020-09533-5
  3. Slakoff DC, Aujla W, PenzeyMoog E. The role of service providers, technology, and mass media when home isn’t safe for intimate partner violence victims: Best practices and recommendations in the era of COVID-19 and beyond. Arch Sex Behav 2020; https://doi.org/10.1007/s10508-020-01820-w. [Online ahead of print].
  4. Roesch E, Amin A, Gupta J, et al. Violence against women during COVID-19 pandemic restrictions. BMJ 2020;369:m1712.