Experiences of African women who migrate to a developed country and encounter intimate partner violence: a systematic review of qualitative evidence

Abstract

Objective:

The objective of this review was to synthesize the available evidence on the experiences of African women who migrated to a developed country and encountered intimate partner violence (IPV).

Introduction:

IPV is a significant public health issue, and migrant women living in developed countries are particularly vulnerable to IPV, experiencing disproportionately higher rates of IPV. Understanding the experiences of these women can inform health policy and decision-making in clinical practice to minimize IPV.

Inclusion criteria:

This review considered studies that included women of African descent, aged 16 years or older, who migrated from any of the 54 countries in the African continent to a developed country and who experienced IPV. Qualitative studies including, but not limited to, grounded theory, ethnography, phenomenology, case studies, and action research designs, were considered for inclusion.

Methods:

A comprehensive database search of CINAHL (EBSCOhost), Embase, MEDLINE (Ovid), PsycINFO (OvidSP), and Scopus was conducted in February 2022 and updated in November 2022 and February 2023. ProQuest Dissertations and Theses were searched for gray literature. Studies in the English language were considered, with no date limitation. Eligible studies were assessed by 2 independent reviewers for methodological quality. The findings were extracted and pooled, categorized by similarity of meaning, and synthesized using the JBI meta-aggregation method. The synthesized findings were graded using the ConQual approach.

Results:

Eleven qualitative studies were included in the review. The narratives of 234 women generated a total of 95 findings and 10 categories based on similarity of meaning, from which 4 synthesized findings were generated: i) The influence of cultural and gender norms, religion, and women’s perceptions of IPV; ii) Control and the cone of silence; iii) Psychological and emotional impact of IPV and ways of coping; and iv) Support for women who are victims of IPV.

Conclusion:

IPV is an ongoing issue for African migrant women in developed countries. The women reported that their partners continued their controlling behavior that was accepted in their country of birth, particularly regarding emotions and finances. The experience of IPV was exacerbated for women who did not have access to extended family members, and they often faced practical barriers in accessing available formal support. The synthesized findings from this review can be used to support the urgent need to address IPV in this migrant population.

Supplemental digital content:

A Yoruba-language version of the abstract of this review is available at: http://links.lww.com/SRX/A77.

ConQual Summary of Findings

Experiences of African women who migrated to a developed country and encounter intimate partner violence
Population: Women of African descent aged 16 years or older who migrated to a developed country
Phenomenon of interest: Experiences of domestic violence, also known as intimate partner violence
Context: Developed countries (advanced economies with high resources)
Bibliography: Ogunsiji O, Foster J, Green H, Sikhosana N, Gauci P, Kayesa N, et al. Experiences of African women who migrate to a developed country and encounter intimate partner violence: a systematic review of qualitative evidence. JBI Evid Synth. 2025;23(2):331–362.
Synthesized finding	Type of research	Dependability	Credibility	ConQual score	Comments
The influence of cultural and gender norms, religion, and women’s perceptions of IPV	Qualitative	Moderate	High	Moderate	Dependability: 11 studies scored 3/5 or more on critical appraisal checklist. Therefore, rating downgraded 1 level.
					Credibility: 33 findings ranked unequivocal. Therefore, score remains high. ConQual score moderate.
Control and the cone of silence	Qualitative	Moderate	High	Moderate	Dependability: 8 studies scored 3/5 or more on critical appraisal checklist. Therefore, rating downgraded 1 level.
					Credibility: 21 findings ranked unequivocal. Therefore, score remains high. ConQual score moderate.
Psychological and emotional impact of IPV and ways of coping	Qualitative	Moderate	High	Moderate	Dependability: 5 studies scored 3/5 or more on critical appraisal checklist. Therefore, rating downgraded 1 level.
					Credibility: 16 findings ranked unequivocal. Therefore, score remains high. ConQual score moderate.
Support for women who are victims of IPV	Qualitative	Moderate	High	Moderate	Dependability: 10 studies scored 3/5 or more on critical appraisal checklist. Therefore, rating downgraded 1 level.
					Credibility: 25 findings ranked unequivocal. Therefore, score remains high. ConQual score moderate.

IPV, intimate partner violence

Introduction

Domestic violence, particularly intimate partner violence (IPV), is a major public health issue affecting 1 in 3 women worldwide.1 Domestic violence is violence that occurs within a domestic setting. This can include people who reside in the same household and those who may frequent the same setting.2 IPV is a type of domestic violence that occurs in an intimate (often sexual) relationship.2 Although the terms IPV and domestic violence are often used interchangeably, the phenomenon of interest of this review is IPV.

The estimated prevalence of lifetime IPV in high-income countries is 22%, with 1 in 6 women in Australia experiencing IPV.3 Due to migration-related issues such as language proficiency, fear of being deported, and lack of social support, migrant women in developed countries experience a disproportionately higher rate of IPV than non-migrant women, face unique help-seeking barriers, and lack access to culturally sensitive support.4 To optimize care and provide targeted support, an insight into African migrant women’s collective experiences in developed countries will provide opportunities for information-sharing.

There are 54 countries in the African continent. Findings from several studies revealed that prevalence of IPV against women in Africa varies from 12% in Morocco to about 54% in Ethiopia,5 while studies also report that the lifetime prevalence rates of violence from an intimate partner range from 31% in Nigeria to 80% in Uganda.1,6 This suggests that the high prevalence rate of IPV against African women often continues when they migrate to a developed country.

Numerous studies have explored the experience of IPV among migrant women in developed countries and advocate the need for understanding the intersection of various factors exacerbating a migrant woman’s experience of IPV.7,8 Intersecting migration, culture, individual factors, and societal factors are among the important considerations for gaining in-depth insight into the women’s vulnerability to IPV. In terms of migration, women must handle the challenge of experiencing IPV while being in a new country and being socially isolated from family members and support networks.6 The thought of shame from a family break-up and divorce prevents migrant women from disclosing IPV, thus forming a barrier to help-seeking and escaping from a violent relationship.9,10 Lack of legal residence and documentation for migrant women results in an absence of confidence to act independently in their new countries. Additionally, restricted mobility and financial stress leave migrant women dependent on their husband or partner for support, making them susceptible to continued IPV.10,11 However, despite women’s increased vulnerability to IPV due to migration, studies also show that migration, particularly to developed countries, offers several opportunities in terms of increased awareness of their abuse, and enhanced motivation for help-seeking and ending abuse.12,13

Cultural and social norms around gendered roles and patriarchal attitudes are socialized from migrant women’s birth countries and accepted as part of shared expectations.11,12 Migrant women report that, culturally, they are required to be submissive and dependent on their husbands.12 As a result, the risk of experiencing IPV increases when migrant women defy their inflexible gender role expectations, seek employment and different activities, and develop social networks in their new countries.12 Individual factors such as lower self-esteem, worthlessness, humiliation, and entrapment have been reported as challenges when facing marital difficulty in a new country.9 Studies have reported that poor system responses, lack of political will and interest regarding multicultural community needs, and funding cuts to culturally sensitive support services make help-seeking within migrant women’s new countries particularly distressing.7,8,12,13

Migrant and refugee women, irrespective of their visa status (eg, students, humanitarian and asylum seekers, temporary residents, permanent residents),12,14 have been found to understand IPV, and view it as abnormal and unacceptable.14 Social and psychological distress is associated with IPV9,13 and experienced by migrant women. One study of Indian migrant women in Australia revealed the emotional and mental health impact of IPV among women and their children.13 Despite this, the lack of awareness of legal processes and resources, and the lack of formal supports are barriers to migrant women’s use of the criminal justice system in their new countries.7,15

There are studies focusing on IPV among African migrant women who migrate to developed countries. Some contemporary studies on IPV among African migrants focus on influences that contribute to resilience in the course of IPV,16 measures to tackle IPV,13 and factors that influence the disclosure of IPV and seeking help. Through a range of qualitative and mixed methods methodologies, findings have revealed that spirituality and social support are important sources of resilience for African migrant women.16 African women in the United States have stated that IPV is part of a patriarchal ideology that reinforces it in the first instance.17 Furthermore, Nigerian women in England have identified that socialization from their country of origin and acculturation in their new country determined their disclosure.17 These Nigerian women in England were more likely to seek help from leaders and faith-based organizations. Despite ongoing severe experiences of IPV among African migrant women, a synthesized report of these experiences is lacking.

During an initial search of CINAHL (EBSCOhost), MEDLINE (Ovid), JBI Evidence Synthesis, and the Cochrane Database of Systematic Reviews, 1 systematic review that reported on African immigrant women and IPV was identified.18 This review was authored by 1 person and was, therefore, subject to methodological limitations related to the conduct of systematic reviews (eg, a single author selecting papers and undertaking data extraction for the review). In addition, the search was restricted to 2005 to February 2022, and there was no reporting of critical appraisal, data synthesis, or discussion of results. Given that the review18 was not consistent with a systematic review methodology, it is timely for a robust systematic review to synthesize the available evidence on the experiences of African women who have migrated to a developed country and have encountered IPV.

Review question

What are the experiences of African women who have migrated to a developed country and encountered IPV?

Inclusion criteria

Participants

This review considered studies that included women of African descent aged 16 years or older who migrated from any of the 54 countries in the African continent to a developed country. The women may be married, single, in a de facto relationship, or widowed. The women of African descent may be married to African men or men of any other cultural background, or in a same-sex marriage. Studies related to African women within the African continent were excluded. For studies that included men and women as participants, only the voices of women were extracted for this systematic review.

Phenomenon of interest

This review focused on the experiences of African women who migrated to a developed country and encountered IPV. These experiences may include their perspectives, challenges, and beliefs in relation to their migration to a developed country and encountering IPV. Experiences could include, for example, help-seeking and health-seeking behaviors, facilitators, barriers, and types of support.

Context

This review considered studies involving women aged 16 years or older who had migrated to a developed country. Developed countries are advanced economies with high resources, high income, and are technologically advanced.19

Types of studies

Qualitative studies including, but not limited to, grounded theory, ethnography, phenomenology, case studies, and action research designs were considered. Mixed methods studies were considered only if data from the qualitative component could be clearly extracted.

Methods

The JBI methodology for qualitative studies guided the conduct of this review, and the corresponding JBI appraisal tools were used.20 The protocol was published in JBI Evidence Synthesis (formerly the JBI Database of Systematic Reviews and Implementation Reports).21

Modifications to the a priori protocol

This review was conducted with the following modifications to the a priori protocol: MEDLINE (Ovid) was searched instead of PubMed as it is specific to the subject area. Additionally, the search was not performed in ScienceDirect, Google Scholar, or Web of Knowledge, as the review team deemed that searching these sources would not identify literature in addition to the databases searched.

Search strategy

An initial search of CINAHL (EBSCOhost) and MEDLINE (Ovid) was undertaken. An analysis of the text words included in the title and abstract, and of the index terms used to describe the article, was then performed. A second search was undertaken using CINAHL (EBSCOhost), Embase, MEDLINE (Ovid), PsycINFO (OvidSP), and Scopus. ProQuest Dissertations and Theses (ProQuest Central) was searched for gray literature. Two websites were also searched for relevant reports: International Office of Migration and the Foundation for Research and Women’s Health. The search was first conducted in February 2022, and updated searches were conducted in November 2022 and February 2023 (Appendix I). These databases were searched from 1998 onward to capture a wide range of contemporary data on the topic. Published studies in English were included, as stated in the published protocol. The reference lists of the included studies were searched for other studies.

Study selection

All identified citations were imported into EndNote v.20 (Clarivate Analytics, PA, USA) and duplicates were removed. Two independent reviewers (OO, NS) screened titles and abstracts against the inclusion criteria. Any study authored by a member of the review team was not screened by that reviewer. In the case of a study authored by OO, the title, abstract, and full-text screening were conducted by HG and NS. Studies that met the inclusion criteria were imported into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI; JBI, Adelaide, Australia).22 The full texts of selected studies were assessed against the inclusion criteria; those that did not meet the inclusion criteria were excluded. Any study authored by a member of the review team was not assessed by that reviewer. Reasons for exclusion of full-text studies are provided in Appendix II. The search results are presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Any disagreements that arose between the reviewers at each stage of the study selection process were resolved through discussion with the other reviewers. When the authors identified another systematic review that reported on African immigrant women and IPV, they disagreed on whether to continue with the review.18 After a comprehensive discussion, the decision was made to continue with the review as methodological flaws were identified in the other systematic review, given that it was authored by 1 person who also conducted the study selection and data extraction.

Assessment of methodological quality

Studies selected for inclusion were assessed by 2 independent reviewers (OO, NS), with the exception of an included study23 that was authored by OO. JF and NS assessed the methodological quality for this study.23 The reviewers used the standardized JBI critical appraisal instrument for qualitative studies.24 Any disagreements between the reviewers were resolved without the need for a third reviewer.

Data extraction

The standardized data extraction tool from JBI SUMARI22 was used to extract qualitative data from the included papers. The findings from all the studies were extracted verbatim at the subtheme level. The data extracted included details about the phenomenon of interest, populations, context, study methods, and findings that were significant to the review question and objectives. Reviewers (OO, HG, PG, NK) independently entered data into JBI SUMARI,22 and results were then verified by the first reviewer (OO), except for the study she authored.24 For any study authored by a member of the review team, data were not extracted by that reviewer. Findings from the included papers were extracted verbatim together with the participant quotes. Authors of primary studies did not need to be contacted, as there were no missing or unclear data.

Data synthesis

The qualitative findings were pooled using JBI SUMARI,22 and the findings were synthesized to generate statements representing the major themes. Data were based on their quality, relevance, and likeness in meaning to yield a meta-aggregation of findings. The reviewers then reviewed and re-examined the original studies, identified categories, and reached a consensus on interpretation. These categories were then synthesized into a single set of synthesized findings.

Assessing the confidence in the findings

The generated synthesized findings were graded according to the ConQual approach and are presented in the ConQual Summary of Findings. The Summary of Findings comprises the synthesized findings and outlines how the ConQual scores were developed. Each synthesized finding is presented with scores for dependability, credibility, and the overall ConQual score.25

Results

Study inclusion

The systematic search identified 1813 potential publications for the review through database searching. A total of 570 studies were identified as duplicates and excluded. After removal of duplicates, the titles and abstracts of 1243 studies were screened in search of eligible full-text papers for retrieval, and 1223 studies were excluded. A total of 20 studies were retrieved and screened for eligibility. On further review, 10 studies were excluded, as they did not meet the inclusion criteria (Appendix II). One study was identified from the references of included studies and was included in the final review. The process of searching, screening, inclusion, and exclusion of papers is presented in a PRISMA flow diagram26 (Figure 1).

Figure 1.

Search results and study selection and inclusion process26

Methodological quality

All 11 studies23,27-36 met the criteria that were essential to the concept of dependability in qualitative research. Eight studies23,28-31,33,34,36 addressed the question related to the congruity between the stated philosophical perspective and the research methodology. All studies addressed the question related to congruity between the research methodology and the research question, the methods used to collect the data, the representation and analysis of data, and the interpretation of the results. Only 2 studies30,33 provided a statement locating the researcher culturally or theoretically, and only 3 studies23,30,33 addressed the question related to the influence of the researcher on the research and vice versa. There was representation of participants’ voices in 10 of the studies.23,27-29,31-36 All studies reported that ethical approval was obtained, and the conclusions drawn in all research reports flowed from interpretation of the data. No studies were excluded based on critical appraisal. Critical appraisal of the study authored by Ogunsiji23 was completed by NS and verified by HG. There were no disagreements between the reviewers regarding the critical appraisal. The methodological quality of the 11 included studies was assessed, and 8 of the studies27-29,31,32,34-36 scored 7 or 8 out of 10, while 3 of the studies23,30,33 scored 9 or 10 out of 10 on the JBI critical appraisal checklist for qualitative research (Table 1).

Table 1.

Critical appraisal of included qualitative studies

Citation	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10
Akinsulure-Smith et al., 201333	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Corley & Sabri, 202129	Y	Y	Y	Y	Y	N	N	Y	Y	Y
El Abani & Pourmehdi, 202131	Y	Y	Y	Y	Y	N	N	Y	Y	Y
Fisher, 201328	Y	Y	Y	Y	Y	N	N	Y	Y	Y
Njie-Carr et al., 202136	Y	Y	Y	Y	Y	N	N	Y	Y	Y
Ogunsiji et al., 201223	Y	Y	Y	Y	Y	N	Y	Y	Y	Y
Sabri et al. 201834	Y	Y	Y	Y	Y	N	N	Y	Y	Y
Sullivan et al. 200530	Y	Y	Y	Y	Y	Y	Y	U	Y	Y
Ting, 201035	U	Y	Y	Y	Y	N	N	Y	Y	Y
Ting and Panchanadeswaran, 200927	U	Y	Y	Y	Y	N	N	Y	Y	Y
Ting and Panchanadeswaran, 201632	U	Y	Y	Y	Y	N	N	Y	Y	Y
%	73	100	100	100	100	18	27	91	100	100

Y, yes; N, no; U, unclear

JBI critical appraisal checklist for qualitative research:

• 1. Is there congruity between the stated philosophical perspective and the research methodology?
• 2. Is there congruity between the research methodology and the research question or objectives?
• 3. Is there congruity between the research methodology and the methods used to collect data?
• 4. Is there congruity between the research methodology and the representation and analysis of data?
• 5. Is there congruity between the research methodology and the interpretation of results?
• 6. Is there a statement locating the researcher culturally or theoretically?
• 7. Is the influence of the researcher on the research, and vice versa, addressed?
• 8. Are participants, and their voices, adequately represented?
• 9. Is the research ethical according to current criteria or, for recent studies, is there evidence of ethical approval by an appropriate body?
• 10. Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data?

Characteristics of included studies

The 11 included studies were published between 2005 and 2021. Eight studies27,29,30,32-36 were conducted in the United States, while 2 studies were conducted in Australia23,28 and 1 study in the United Kingdom.31 The included studies used either semi-structured interviews23,27,31,32,34-36 or a combination of both focus groups and semi-structured interviews28,29,33 for data collection, while 1 study used a focus group.30 A total of 234 participants were included, and their ages ranged from 18 to 56 years. The length of time the participants had been in their new country ranged from 1 to 17 years. None of the included studies reported on IPV perpetrated by women against men or by women in same-sex marriages. The characteristics of included studies are presented in Appendix III.

Review findings

A total of 95 findings were extracted from the 11 included studies.23,27-36 All 95 findings were rated as unequivocal. The 95 findings were categorized according to similarity of meaning, and a total of 10 categories were created. The 10 categories were then further synthesized to create 4 synthesized findings that illustrate the experiences of African women who migrate to a developed country and encounter IPV. Appendix IV shows the findings and illustrations of each study.

Synthesized finding 1: The influence of cultural and gender norms, religion, and women’s perceptions of IPV

Traditional gender and cultural norms, whereby male authority is absolute, continued among migrant Africans and influenced women’s perceptions of IPV, normalizing the abuse. Religion was viewed as an enabler of IPV, as it enforced women’s subservient role to their husbands, exposing them to further abuse. These influences are presented separately, but they are inherently inter-related. This synthesized finding was derived from 34 unequivocal findings forming 4 categories (Table 2).

Table 2.

Synthesized finding 1—The influence of cultural and gender norms, religion, and women’s perceptions of IPV

Finding	Category	Synthesized finding
Importance of marriage for the family and African society	Cultural norms	The influence of cultural and gender norms, religion, and women’s perceptions of IPV
Preserving the ideal image of African immigrants
Prior to resettlement, men also occupied a traditional role of “breadwinner” for their family
		Traditional gender and cultural norms, whereby male authority is absolute, continued among migrant Africans and influenced women’s perceptions of domestic violence, normalizing the abuse. Religion was viewed as an enabler of IPV, as it enforced women’s subservient role to their husbands, exposing them to further abuse.
Patriarchal cultural norms
Practices of forced or arranged marriages, dowry, bride price
The role of cultural expectations for marriage and divorce
Marriage is the standard whereby a woman’s success can be measured
Perception of what violence is and entails
As West African women integrate into the Western culture, many more experiences of IPV would be reported
The larger Ethiopian community responds to domestic violence just as they did in Ethiopia
Abusive men may divorce their “old” wives here and bring young wives to the United States
Payment being made directly to women was a cause for great angst for many men	Gender inequality
Women perceived that men felt there was no need to continue their responsibility for caring for their family in any form
Some women in particular were thankful for a system that they believed treated everyone equally
Male authority was absolute
Marital relationships should include love, mutual help, support, equality, and respect
Domestic violence in the context of gender inequality
Men blame the U.S. system for favoring women over men
Men manipulate women through the system
Male privilege
Men have more freedom in the United States
Church or ethnic community first	Religious aspect
Distrust of religious institutions
Personal relationship with God and spirituality
Comfort in their personal relationship with God
Belief in forgiveness
Women expressed their deep commitment to their religious beliefs and indicated that these beliefs offered them emotional comfort during periods of stress
Several women also pointed to the role of religion in enforcing patriarchal cultural norms that hold women subservient to men, exposing them to risks for future abuse
Religion helped women address their abusive situations
The experiences of IPV included physical abuse, threats of violence, and emotional abuse	Perceptions of IPV
Multiple instances of abuse
Reluctance to report their IPV experience might be due to their low level of integration into the Western culture
Not a shared community understanding of domestic violence
Some women perceived violence as a part of women’s lives

Note: All findings were rated unequivocal.

IPV, intimate partner violence

Category 1.1: Cultural norms

The first category brings together 11 findings that explain African cultural expectations, norms, and roles in marriage relationships. Marriage is important for women in African culture; it is the standard whereby a woman’s success is measured. As a result, migrant women prefer to remain in violent marriage relationships and retain their status as married women. Patriarchal cultural norms pervade whereby men are seen as the breadwinners for their families, creating the potential for abuse to be normalized. Examples of findings from this category include the following:

Marriage is the standard whereby a woman’s success can be measured (U)

Forced marriage…still exists in Libya and I heard that a family forced their girl to get married just to ensure she got a chance to be married. They prefer a girl to live a miserable life rather than to reach her 30s without marriage.31^(p.2087)

Patriarchal cultural norms (U)

In Africa they believe that even if your husband is treating you bad, he’s your husband and he has a right.34^(p.348)

Category 1.2: Gender inequality

In the second category, we combined 10 findings that highlight gender inequality as a key explanation for IPV. Men are portrayed as privileged, enjoy absolute authority, and manipulate women through the system. Because of this, government social security payments to women trigger anger and abuse from men. Examples of findings from this category include the following:

Payment being made directly to women was a cause for great angst for many men (U)

Everyone here [in Australia] is equal rights; nobody is higher than any other person—we are all equal, the children, the man, the woman and eventually through the system here, it’s like the women, ah, have more responsibilities because, like Centrelink with the income…28^(p.841)

Male authority was absolute (U)

Yes, the man has an upper hand and that is the tradition they have been brought up with, the man has the final say and the women has been brought up to say yes.23^(p.1662)

Male privilege (U)

I work outside. When I get in the house there is a lot of work to be done and problems are waiting for me. Men have the privilege to relax in the house. They can humiliate us.They think they are the only humans that have full right.30^(p.931)

Category 1.3: Religious aspect

The third category combines 8 findings that explain women’s perception of the crucial contradictory role of religion in the experiences and management of IPV. The contradictory roles mean that while religion-enforced patriarchal cultural norms lead to distrust of religious institutions, a personal relationship with God offers emotional comfort during periods of stress and in addressing their abusive situations. Examples of findings from this category include the following:

Several women also pointed to the role of religion in enforcing patriarchal cultural norms that hold women subservient to men, exposing them to risks for future abuse (U)

The church doesn’t allow most of our residents to just get divorced for example … She’s a female so she has to keep her family—she needs to be strong … She pretends to be okay while she’s not okay.29^(p.489)

Personal relationship with God and spirituality (U)

I said [to him] that God knows the truth and God will pay you back … I believe in God. I believe that God will bring justice one day to this man for what he has done to me … God will punish him. I told him that, and he said to shut up. He did not want to hear about God.32^(p.43)

Women expressed their deep commitment to their religious beliefs and indicated that these beliefs offered them emotional comfort during periods of stress (U)

When I kneel down and cry to the Lord, I get up with relief. When I wake up thinking, … about stuff, abusing me, scaring me … I jump up from bed, go to my knees, call up the Lord and cry to the Lord. It has help me a lot.29^(p.489)

Category 1.4: Perceptions of IPV

The fourth category groups together 5 findings that describe women’s understanding of IPV. To them, there is no shared community understanding of IPV. Some presented societal perception of violence as a part of women’s lives, thus all threats and acts of violence are often seen as a family issue, and women are socialized to accept and tolerate it. Examples of findings from this category include the following:

Not a shared community understanding of domestic violence (U)

After we are separated, they beg us to get back together again. He comes with his friends and say, “I will never do this again. Please give me another chance.” It is not easy to turn your back when you lived with a person and experience a lot of things together. Our community does not understand what domestic violence is.30^(p.927)

Some women perceived violence as a part of women’s lives (U)

… For Libyan women it is a shameful to speak out about it and women will be blaming themselves.31^(p.2085)

Synthesized finding 2: Control and the cone of silence

The cone of silence surrounding migrant African women’s IPV experience means they are suffering and smiling. The control the husbands have over their lives, including being listed as the primary visa applicant, limiting independence and social interaction, controlling the finances, threatening to kill and take their children away, made women reluctant to report the IPV and instills in them a sense of helplessness and self-blame. This second synthesized finding was derived from 20 findings forming 2 categories (Table 3).

Table 3.

Synthesized finding 2—Control and the cone of silence

Finding	Category	Synthesized finding
Fear of the consequent isolation	Control	Control and the cone of silence
Strategy to keep the women in abusive relationships		The cone of silence surrounding migrant African women’s IPV experience means they are suffering and smiling. The control the husbands have over their lives, including being positioned as primary visa applicant, limiting independence and social interaction, controlling the finances, threatening to kill and take their children away, made women reluctant to report the IPV and instills in them a sense of helplessness and they blame themselves.
Financial obligation
Decision making regarding leaving
Partners’ behaviors such as threats to kill her or her family, threats to take away children
Seeking outside resources could lead to separation from their children and/or deportation
Community conflict resolution favored men
Not allowing women to leave the house
Dependency and losing one’s self
Put on superficial smiles to hide their experiences
Husbands were in control of the family’s finances and controlled all other aspects of their lives
Women experienced intimidation because of their husband’s position as the primary visa applicant
Women may be forbidden to leave the home
Involving his friends or the larger community as a feature of their abuse
Profound levels of isolation
Abusive partners control the household money
Being on a dependent spouse visa, financial dependence on a spouse, and language barriers placing women at greater risk for IPV
Physical and emotional abuse … often saw it as a family issue	Cone of silence
Ignoring the perpetrator when they were abusive
Suffering and smiling

Note: All findings were rated unequivocal.

IPV, intimate partner violence

Category 2.1: Control

The fifth category brings together 17 findings that highlight control as the strategy used by men to keep women in abusive relationships. The control was over household finances, women’s movements in and out of the house, and decision-making. Examples of findings from this category include the following:

Strategy to keep the women in abusive relationships (U)

He didn’t want me to go to church or make friends with other African ladies; he said they’d gossip about us. I didn’t have any of my own friends.27^(p.825)

Financial obligation (U)

I had no working permit; my husband, he arranged it for me to go work at a hair salon, but the owner gave to him the money I earned; he told me the owner could only pay him since I was not legal. I could get arrested. I could not open a bank account.27^(p.827)

Seeking outside resources could lead to separation from their children and/or deportation (U)

He said that he has the money to take a lawyer, I have no money and he has his papers. I can’t do anything, he can do whatever he wants. So when he talk like that, me too, I was scared … he went to the Family courts, said that I was the one who left, leaving him with children.33^(p.121)

Category 2.2: Cone of silence

The sixth category combines 3 findings that highlight the layers of understanding that perpetuate the culture of silence around IPV. These layers included societal perception of violence and women’s covering of abusive experiences with smiles. An example of a finding from this category includes the following:

Ignoring the perpetrator when they were abusive (U)

A Congolese woman reported, … to keep myself safe, I just keep my mouth shut and things are fine. If I don’t ask anything, we are okay.36^(p.802)

Synthesized finding 3: Psychological and emotional impact of IPV and ways of coping

The psychological and emotional impact on these women meant that they self-imposed social isolation due to their sense of self-blame and shame. They had numerous concerns about raising their children without the fathers and felt not heard by the immediate families and religious community. Coping mechanisms included active denial and continued hope that their experience of IPV would naturally come to an end. African migrant women focused on the future and had a hopeful outlook with a few considering leaving their abusive relationships. This synthesized finding was derived from 16 findings forming 2 categories (Table 4).

Table 4.

Synthesized finding 3—Psychological and emotional impact of IPV and ways of coping

Finding	Category	Synthesized finding
Shame at being a victim	Psychological and emotional impact	Psychological and emotional impact of IPV and ways of coping
Self-blame and isolation
Rationalizing		The psychological and emotional impact on these women meant that they self-imposed social isolation due to their sense of self blame and shame. They had numerous concerns about raising their children with the fathers and felt not heard by the immediate families and religious community. Coping mechanisms included active denial and continued hope that their experience of IPV would naturally come to an end. African migrant women focused on the future and had a hopeful outlook with a few considering leaving their abusive relationships.
Self-imposed social isolation
Children are aware of abuse in the home
Feelings of depression and despondency
Concerned about raising their children without fathers
Wishful thinking	Coping mechanisms
Focusing on the future
Acceptance
A place to escape
Active denial
Ability to survive the abusive
Hopeful outlook
Being pregnant and having children was protective
Ignoring abuse in the relationship

Note: All findings were rated unequivocal.

IPV, intimate partner violence

Category 3.1: Psychological and emotional impact

The seventh category combines 7 findings that highlight women’s self-reported psychological and emotional impact of IPV experience not only on them but also on the children. They reported that the children carry the precarious trauma of seeing their mothers being beaten, emotionally degraded, and ridiculed. The impacts underscore feelings of self-blame, self-imposed social isolation, and shame at being a victim. These led to feelings of depression, rationalizing, and despondency with ongoing concern about raising children without the fathers. Examples of findings from this category include the following:

Feelings of depression and despondency (U)

… like the end of the world. For us it is like living in the dark. When they abused us, it is really living in hell. I don’t know what I have been through. It is bad.30^(p.931)

Children are aware of abuse in the home (U)

Our kids have problem dealing with us. When we argue and fight in front of them, when they see our husbands humiliating, beating, and cursing us, they will get affected. They will learn everything they see.30^(p.928)

Concerned about raising their children without fathers (U)

Our brothers are becoming gang members. They do not have father in the house; we could not control them. They are going to kill each other. The system is so hard for us to understand. The government knows that kids will be gangsters when there is no father in the house.30^(p.935)

Category 3.2: Coping mechanisms

With regard to the eighth category, 9 findings on diverse coping strategies for IPV were explicated. Among the diverse coping strategies include hopeful outlook, wishful thinking, focusing on the future, and active denial. Examples of findings from this category include the following:

Hopeful outlook (U)

I believe, as far as you are faithful, being good, not doing anything bad to others, there will be justice one day.32^(p.44)

Wishful thinking (U)

I had hope he would change since in my family, my father had changed. We went to live with my grandparents when my father was abusing my mother. They talked to my father, and he changed. He stopped, so I had hope my husband would too. Some men do. I believed it was possible.35^(p.351)

Focusing on the future (U)

I told myself that I was staying for the green card [legal immigration status]. When the papers come through, then I can leave with my children. I can get working papers, support myself and the kids then.35^(p.351)

Active denial (U)

I used to think that my husband, he’s so controlling that I thought it was showing me he loved me.35^(p.353)

Synthesized finding 4: Support for women who are victims of IPV

Support for women who are victims of IPV varied, with some finding comfort in social support networks and verbal support from their families. They felt that support was different to that of Africa where the elders and families blamed the women for being responsible for the abuse. Most victims sought informal support first due to their difficulty with integrating into a developed country’s culture, limited English skills, and lack of awareness of available services. Formal support was sought as a last resort due to associated complexities such as the women’s visa/migration status and child welfare. This fourth synthesized finding was derived from 25 findings forming 2 categories (Table 5).

Table 5.

Synthesized finding 4—Support for women who are victims of IPV

Finding	Category	Synthesized finding
Formal help seeking	Formal and informal support	Support for women who are victims of IPV
Preservation of the institution of marriage
Verbal and emotional support from the family		Support for women who are victims of IPV varies, with some finding comfort in social support networks and verbal support from their families. They felt that support was different to that of Africa where the elders and families blamed the women for being responsible for the abuse. Most victims sought informal support first due to difficulty with integrating into a developed country’s culture, limited English skills, and lack of awareness of available services. Formal support was sought as a last resort due to associated complexities such as the women’s visa/migration status and child welfare.
Women’s families were not always supportive of them leaving their abusive spouses, for fear of being expected to repay these bride prices
Women who reported experiences of IPV or depression or post-traumatic stress symptoms related to violence or traumatic events were at risk of being ostracized from their community
There was a sense that women were becoming stronger, felt more able to speak up about the violence in their lives
Police were a protective resource
Elders in the community resolved issues
Reported feeling unsupported by the family
The elders blamed them, did nothing to assist them
A strong social network, support, and prayers
Elders are not available to help solve marital problems
Non-Ethiopian neighbors for help
Significant barriers to accessing available assistance
Women who had used domestic violence shelters found them to be very helpful
Survivors playing an active role in helping each other
Children need services and support
Lack of knowledge about IPV
Lack of knowledge about available services	Seeking support
Garnering the courage to utilize support services
Seeking outside help for IPV was not acceptable
Finding out about available services made seeking help possible
Limited English skills prohibit women
Unaware of domestic violence services
Providing women with information on domestic violence

Note: All findings were rated unequivocal.

IPV, intimate partner violence

Category 4.1: Formal and informal support

The ninth category drew inferences from findings that reported on the women’s belief in the preservation of the institution of marriage and how this belief informed their utilization of a formal and informal network of support. Accessing formal support for depression or post-traumatic stress symptoms related to violence resulted in the risk of being ostracized from the community. While survivors actively helped each other, they also relied on strong social networks and prayer. These findings were combined with those that highlighted the use of formal avenues such as shelters and the police force. Examples of findings from this category include the following:

Verbal and emotional support from the family (U)

My sisters, they say, “If it gets too much, don’t stay there; just leave,” although other people were saying they should not tell me that.35^(p.354)

Women who reported experiences of IPV or depression or post-traumatic stress symptoms related to violence or traumatic events were at risk of being ostracized from their community (U)

Ethiopians are not encouraged to disclose problems. Especially when it comes to violence it is considered a taboo or a shame thing. It’s considered as a thing that shouldn’t be disclosed with outsiders.29^(p.489)

Category 4.2: Seeking support

Finally, the tenth category brings together findings that express a lack of knowledge about available services. Limited English language skills were identified as a significant barrier; however, finding out about available services made seeking help possible. Examples of findings from this category include the following:

Lack of knowledge about available services (U)

They told him to leave the house, that deportation was not their concern. Then, I realized he was not right, he’s lying, that he was threatening to get me deported all the time, but the police wouldn’t deport me … that I had rights.27^(p.830)

Limited English skills prohibit women (U)

If you can be able to educate us how to get different services and teach us the English language it will be easy for us.30^(p.931)

Discussion

African migrant women experience IPV in developed countries. This is fostered by the traditional gender and cultural norms of their home countries and the perceived enabling role of religion. In the studies included in this review, women reported the controlling behavior of their husbands, the grip of helplessness, and suffering, yet were reluctant to speak out. Despite the psychological and emotional impact of IPV, there were limited avenues for support, including verbal informal support and formal services, which were used as a last resort.

The first synthesized finding provides an understanding of the root causes of African migrant women’s experience of IPV in their new countries. The findings highlight that patriarchal gender norms and roles, as well as religious tenets that position women as subordinates to their husbands, are key elements for their experiences of IPV. This finding is similar to a previous report on Nigerian migrant women in the USA4 that identified traditional male authority as germane to their experience of IPV. It is notable that all the eligible studies in this review focused on IPV perpetrated by men against women, and there were none on African migrant women in a same-sex marriage. Patriarchal gender roles have consistently been central to migrant women’s experience of IPV even for women who held strong views against it.37

The second synthesized finding revealed that control and a cone of silence pervaded African migrant women’s experience of IPV in developed countries. Resorting to silence was also reported as a central theme in a qualitative study among Latina migrant women in the USA.38 Just as silence means multiple things, including suffering and smiling, to African migrant women, it means different things to different people, including not sharing their experiences despite obvious evidence of IPV. There is a need to know more about the cone of silence that surrounds African migrant women’s experience of IPV.

African migrant women in this review spoke about their inner struggle with their abusive husbands. These struggles included their husbands’ control over their lives, particularly regarding finances. All these struggles have previously been reported among migrant women living with IPV in developed countries.39,40 Latina migrant women in the USA reported running out of options after trying everything possible to leave an abusive relationship, to no avail.38 South-Asian women in the USA are also at a crossroads as they put in every effort to please their abusive husbands and avert IPV, without success.40

In the third synthesized finding, African migrant women had a hopeful outlook for the IPV experience coming to an end in the future. This was also the case with South-Asian migrant women in the USA40 who held onto the hope that their husbands or the IPV situation would change. The African migrant women in this review spoke about their personal efforts to ensure a better future they hoped for. These efforts could have been influenced by cultural expectations that marriages should be made to work as previously reported in migrant communities.23

The review also revealed women’s self-imposed social isolation, self-blame, and shame. These are important indicators of the high risk of mental health issues for African migrant women living with IPV in developed countries. Poor mental health issues such as depressive symptoms have been previously reported in a maternity setting among migrant and refugee women with IPV in Australia.41 African migrant women’s self-imposed isolation may be due to low mood, which is a depressive symptom.

The fourth finding suggests that African migrant women seek formal support as a last resort. Similarly, the help-seeking behavior of South-Asian migrant women in the USA40 and Korean-American women39 suggest an enormous effort to seek formal help. For both African migrant women in this review and the South-Asian migrant women in the USA,40 help-seeking started with informal social support networks of families and communities. An informal network of family members and community networks was identified as a conduit for South-Asian women in their awareness and accessing formal support in the USA.40 This provides insight into the facilitating role that informal networks have in connecting migrant women to the available support services in their new countries. However, this insight was not reported by any of the African migrant women in the current review.

In this review, explanations for the reluctance to seek formal support included visa status, language difficulties, and child welfare. These are similar to the various barriers of language, economic isolation, and social isolation reported for the Korean Americans39 and migrant women in Australia.42

Limitations of this review

Although this systematic review was undertaken to provide insight into the experiences of African migrant women living with IPV in developed countries, the included studies were mainly conducted among African migrant women from a West-African background. This reduces the transferability of the findings. However, important inferences can be drawn from findings of this review for creating targeted and meaningful interventions for African migrant women in developed countries and other ethnic groups of migrant women. It is possible that including studies only reported in English may have limited the identification of additional relevant studies.

Conclusion

IPV is an ongoing issue for African migrant women in developed countries. The African traditional gender norms and values that surround marital relationships are upheld by the women and their husbands despite being in developed countries. The women in this review reported that their husbands continued with controlling behavior, particularly relating to emotions and finances—behavior that was accepted in their country of birth. These husbands had an additional advantage of being the primary visa holders in their developed countries. The experience of IPV was exacerbated for the women who did not have access to the informal network of extended family members to open up to and who also faced practical barriers in accessing available formal support. This heightened experience, negative attitudes of their fellow community of African migrants toward IPV, and feelings of helplessness left the women in a cone of silence, suffering and smiling. This situation suggests an urgent need to address IPV in this migrant population.

The cone of silence can be broken by health care providers through screening of migrant women for IPV during every health care encounter, including maternity care, community home visiting, and presentations to general practitioner clinics. Also, IPV prevention strategies need to target educational approaches that encourage open dialogue and remove IPV from the list of taboo topics. Furthermore, community and religious leaders, whom African migrant women in developed countries tend to trust and access, should be equipped to adequately support the women and not to blame.

Recommendations for policy

Patriarchal gender norms were strongly reiterated in all the studies included in this systematic review. This suggests that any intervention or policy aimed at addressing IPV in migrant and refugee communities needs to focus on patriarchal gender norms. The entrenched traditional male dominance exacerbated African migrant women’s hesitance to speak out. This has implications for policymakers who should be intentional in funding projects that will empower African migrant women and other women to report and seek support when experiencing IPV. Religious organizations and their injunctions were identified among the avenues that foster IPV. Policies that promote gender equality in every sector of life, including faith-based settings at local, state, and national levels, should be promulgated. Working in partnership with this community and religious leaders may elicit practical, culturally sensitive solutions to IPV. Also, the media can be engaged to direct the attention of the public to the pivotal role that religious organizations can play in addressing IPV among African migrants in Australia and other countries where African migrant women may be experiencing IPV.

African migrant women living with IPV mentioned some of their sources of strength and hope in dealing with their experience of IPV. Policymakers can enforce the adoption of strength-based approaches, such as IPV peer-support networks and learning circles, by all the services they fund to support African migrant women and other women living with IPV. This may further serve as a way of empowering the women to liberate themselves from the shackles of IPV.

Recommendations for practice

Health care providers are in the frontline of care provision, and they occupy an important position in creating an enabling environment for migrant women to access support. Although African migrant women accessed formal support avenues as a last resort, these avenues were still found to be valuable. This is particularly so, given the blame they received from informal close family members and religious leaders. Based on the synthesized findings of this review, we provide the following recommendations for practice. The recommendations have been graded according to the JBI grades of recommendations.43

• i)There is the need for formal IPV services to identify and ameliorate the practical barriers that make available formal support unattractive as the first point of call in their new countries. A list of available support services, including for those in same-sex marriages and for those in heterosexual marriages, can be generated by women’s health centers, community health centers, and general practitioners; and made accessible to community-based organizations and members (Grade A).

• ii)Attention needs to be paid to providing information in the women’s native language. This will assist in addressing language barriers to help-seeking. (Grade A).

• iii)It is important for service providers who support African migrant women experiencing IPV in developed countries to be aware of the influence of religious perspectives on the women experiencing IPV. Religious leaders can be engaged in meaningful conversations during targeted community health outreaches (Grade A).

Recommendations for research

The current review has implications for urgent IPV research among African migrant women in developed countries and the increasing global migrant population. Due to civil unrest and the pursuit of greener pastures, human mobility and migration are increasing. The challenges of being a migrant in a new country and the associated higher risk of IPV suggest that no stone must be left unturned in researching and addressing IPV in all migrant populations.

The important role of an informal network of families, friends, and communities (previously reported as conduits for connecting migrant women to formal services) needs to be explored further in African migrant communities. Future research can focus on best practices on empowering informal networks to play positive roles in the prevention of IPV and early intervention. These informal networks to be empowered should include African migrant women in same-sex marriages and those in heterosexual marriages. IPV is complex and multidimensional; therefore, a multidimensional approach where everyone plays a part in its prevention will be beneficial.

The African migrant women in this review spoke about a cone of silence and their self-imposed isolation. Future research that reports on the culture of silence and secrecy around IPV among African migrant women needs to probe further on what silence means to these women. Gaining insight into these meanings will inform targeted, culturally sensitive programs and interventions aimed at breaking the silence and raising awareness. Furthermore, focused research on the mental health of African migrants living with IPV is urgently needed. This is important to prevent chronic mental health issues in this growing population of migrants and to reduce future strain on health care costs and budget.

The review also reported some positive attitudes held by the African migrant women that the IPV would come to an end. Empirical research is recommended on sources of hope for migrant women generally, and African migrant women specifically, who may be living with the hopeless situation of IPV in their new countries.

The experience of IPV among African migrant women in same-sex marriage in developed countries is lacking in research and requires urgent attention. A robust insight of IPV encountered by African migrant women in developed countries cannot be obtained without the voices of this cohort. Furthermore, we suggest that future research is still needed to better understand African migrant women’s IPV experiences, help-seeking behaviors, availability of resources, as well as the need for tailored prevention and intervention initiatives.

Appendix I: Search strategy

CINAHL (EBSCOhost)

Search conducted: February 26, 2023

Search ID	Search terms	Records retrieved
S1	(MH “Intimate Partner Violence”)	12,199
S2	(MH “Battered Women”)	4230
S3	(MH “Immigrants”) OR (MH “Undocumented Immigrants”) OR (MH “Emigration and Immigration”)	23,737
S4	S1 OR S2	13,970
S5	S3 AND S4	416
S6	S9 ((Limiters -Publication Date 1998- Feb 2023; Language: - English)	415

Embase

Search conducted: February 26, 2023

Search ID	Search terms	Records retrieved
S1	Intimate partner violence.mp. or partner violence/	15,297
S2	domestic violence.mp. or domestic violence/partner abuse/battered women	14,223
S3	Immigrant and Emigrant	14,058
S4	S1 OR S2	3110
S5	S3 AND S4	3663
S6	S15 ((Limiters-Publication date: 1998-Feb.2003; Language:—English	250

MEDLINE (Ovid)

Search conducted: February 26, 2023

Search ID	Search terms	Records retrieved
S1	Domestic Violence/ or Intimate Partner Violence/ or Spouse Abuse/ or Sexual Partners/	36,979
S2	Battered Women/	2709
S3	“Emigrants and Immigrants"/	14,830
S4	S1 OR S2	37,601
S5	S3 AND S4	244
S6	S10 ((Limiters -Publication Date: 1998- Feb 2023; Language: - English)	243

PsycINFO (OvidSP)

Search conducted: February 26, 2023

Search ID	Search terms	Records retrieved
S1	DE “Intimate Partner Violence” OR DE “Domestic Violence” OR DE “Gender Violence” OR DE “Sexual Violence”	25,381
S2	DE “Refugees” OR DE “Migrant Workers”	8593
S3	S1 AND S2	115
S4	S3 ((Limiters -Publication Date:1998 – Feb 2023; Language: - English)	108

Scopus

Search conducted: February 26, 2023

Search ID	Search terms	Records retrieved
S1	TITLE-ABS-KEY ('intimate AND partner AND violence' )	18,373
S2	(TITLE-ABS-KEY (immigrant) OR TITLE-ABS-KEY (immigration) OR TITLE-ABS-KEY ('undocumented AND immigrants'))	159,260
S3	S1 AND S2	467
S5	S3 ((Limiters -Publication Date:1998- Feb 2023; Language: - English)	453

ProQuest Dissertations and Theses

Search conducted: February 26, 2023

Search ID	Search terms	Records retrieved
S1	(intimate partners abuse) OR (women abused by intimate partners) OR (intimate spouse abuse) OR (Intimate Partner Violence) OR (Intimate Partner Sexual Violence)	230,961
S2	Immigrants OR (African immigrants)	323,096
S3	S1 AND S2 ((Limiters -Publication Date:1998- Feb 2023; Language: - English; Index term (keyword): Women; Domestic violence; Intimate partner violence)	344

International Office of Migration

Search conducted: February 26, 2023

Search ID	Search terms	Records retrieved
S1	(intimate partners abuse) OR (women abused by intimate partners) OR (intimate spouse abuse) OR (Intimate Partner Violence) OR (Intimate Partner Sexual Violence)	1610
S2	Immigrants OR (African immigrants)	37,675
S3	S1 AND S2 ((Limiters -Publication Date:1998- Feb 2023; Language: - English; Index term (keyword): Women; Domestic violence; Intimate partner violence)	1

Foundation for Research and Women’s Health website

Search conducted: February 26, 2023

Search ID	Search terms	Records retrieved
S1	(intimate partners abuse) OR (women abused by intimate partners) OR (intimate spouse abuse) OR (Intimate Partner Violence) OR (Intimate Partner Sexual Violence)	230,961
S2	Immigrants OR (African immigrants)	323,096
S3	S1 AND S2 ((Limiters -Publication Date:1998- Feb 2023; Language: - English; Index term (keyword): Women; Domestic violence; Intimate partner violence)	0

Appendix II: Studies ineligible following full-text review

1. Hyman I, Guruge S, Mason R, Gould J, Stuckless N, Tang T, et al. Post-migration changes in gender relations among Ethiopian couples living in Canada. Can J Nurs Res. 2004;36:74–89.

Reason for exclusion: Ineligible phenomena of interest

2. Muuo S, Muthuri SK, Mutua MK, McAlpine A, Bacchus LJ, Ogego H, et al. Barriers and facilitators to care-seeking among survivors of gender-based violence in the Dadaab refugee complex. Sex Reprod Health Matters. 2020;28:1–17.

Reason for exclusion: Ineligible context

3. Natan MB. Perceived factors affecting decision to report incidents of domestic violence among Ethiopian women in Israel. J Trauma Nurs. 2011;18:121–6.

Reason for exclusion: Ineligible context

4. Nilsson JE, Brown C, Russell EB, Khamphakdy-Brown S. Acculturation, partner violence, and psychological distress in refugee women from Somalia. J Interpers Violence. 2008;23:1654–63.

Reason for exclusion: Ineligible study design

5. Ogbonnaya IN, Fawole OI, Rizo CF. Domestic violence and sexual assault service providers’ perspectives on Nigerian immigrants’ domestic violence experiences. Violence Against Women. 2021;27(12-13):2255-72.

Reason for exclusion: Ineligible study design

6. Owoaje ET, Olaolorun FM. Intimate partner violence among women in a migrant community in Southwest Nigeria. Int Q Community Health Educ. 2007;25(4):337–49.

Reason for exclusion: Ineligible context

7. Rasmussen A, Chu T, Akinsulure-Smith AM, Keatley E. The social ecology of resolving family conflict among West African immigrants in New York: a grounded theory approach. Am J Community Psychol. 2013;52:185–96.

Reason for exclusion: Ineligible phenomena of interest

8. Wachter K, Dalpe J, Heffron LC. Conceptualizations of domestic violence–related needs among women who resettled to the United States as refugees. Soc Work Res. 2019;43:207–19.

Reason for exclusion: Ineligible participant characteristics

9. Wachter K, Horn R, Friis E, Falb K, Ward L, Apio C, et al. Drivers of intimate partner violence against women in three refugee camps. Violence Against Women. 2018;24(3):286–306.

Reason for exclusion: Ineligible context

10. Yohani S, Okeke-Ihejirika P. Pathways to help-seeking and mental health service provision for African female survivors of conflict-related sexualized gender-based violence. Women Ther. 2018;41:380–405.

Reason for exclusion: Ineligible participant characteristics

Appendix III: Characteristics of included studies

Citation	Methodology and data analysis	Phenomenon of interest	Setting/context/culture	Participant characteristics and sample size	Description of main results
Akinsulure-Smith et al.,33 2013 USA	Phenomenological approach	Experiences of intimate partner violence or coping strategies among West African immigrants in USA.	Heterosexual West African immigrants who migrated to the USA	32 heterosexual West African immigrants (19 females and 13 males) from 9 West African countries	Women’s and men’s reports of IPV Options for resolution of IPV within the West African community follow a specific line of steps Community-based reactions were that resolution favored men
	Purposive recruitmentFocus groups and individual interviewsData were analyzed using a grounded theory approach
				9 participants were Muslims; 13 were Christians
				The majority had forced immigrant status
Corley and Sabri,29 2021 USA	Qualitative study	Pre- and post-migration stressors experienced by African women who had migrated to the USA	African women who migrated to the USA	39 African-born women, over the age of 18 years, who have experienced trauma (2 or more lifetime experiences of violence)	Stressful and traumatic life experiences Pre-migration stressors: political and armed conflict, IPV Post-migration stressors: IPV, uncertain migration status, discrimination, lack of community support for disclosure of abuse or its impact Personal resources used in coping: exercise, religious faith, artistic expression External resources used in coping Resources to address emotional needs Social support Positive and negative psychosocial outcome resulting from traumatic life experiences
	An adapted version of Taylor and Aspinwall’s Psychosocial Stress Model guided the data collection and analysis of qualitative themes
	Semi-structured interviews and focus group
El Abani and Pourmehdi,31 2021 UK	Exploratory study	To explore community knowledge of, and attitudes toward, domestic violence against women among Libyans in Manchester, UK	Libyans who migrated to Manchester, UK	20 individuals (13 women and 7 men) with ages ranging from 31 to 54 years	Understanding of domestic violence against women among the men in the study was brief, casual, and generic Understanding of violence against women among the women in the study was that it is a deprivation of women’s rights and that they experienced physical and sexual violence Perception of different types of domestic violence against women differ and vary Early and forced marriage Generational differences in the perception of domestic violence against women
	Snowball samplingFace-to-face, semi-structured individual interviewsMethod of data analysis not stated
				Mean and median age for the women was 41 years
				Mean and median age for the men was 39 years
Fisher,28 2013 Australia	Participatory qualitative design	Inter-relationships between changed and changing cultural norms and expectations around gender and family roles and responsibilities	Africans who migrated to Australia	24 males and 30 females, 18 to 56 years of age	Male loss of breadwinner role and status Financial independence Mismatch between formal response and expectations
	Purposive sampling
	Interviews and focus groups
	Constant comparison method for data analysis
Njie-Carr et al.,36 2020 USA	Grounded theory	To increase understanding of immigrant and refugee women’s response to IPV in the context of acculturating in the USA	Immigrant and refugee women who migrated to the USA and who experienced IPV, representing 3 geographic regions: Africa, Asia, and Latin America	26 African migrant and refugee women who were aged 18 to 64 years, and reported experiencing IPV (physical, emotional, psychological, sexual abuse) in the past 12 months	Engendering resilience to survive Finding a way to survive Losing self and independence Finding love and relevance Taking control to survive Finding a safe space and peace Getting help and support
	Purposive sampling
	Semi-structured individual interviews
	Constant comparative method for data analysis
Ogunsiji et al.,23 2012 Australia	A qualitative naturalistic inquiry design	IPV experiences of West African women in Australia	West African women who migrated to Australia	21 West African–born women	Suffering in silence Reluctance to seek help
				71% aged 18 to 40 years
	Convenience sampling
	Semi-structured interviews
	Thematic analysis
Sabri et al.,34 2018 USA	Qualitative methods	To identify multilevel perceived risk and protective factors for repeat and severe IPV and intimate partner homicide, as well as safety planning intervention strategies	Adult immigrant and refugee survivors of IPV who identified as Asian, Latina, or African who had migrated to the USA	23 African women who were 18 years or older who had experienced abuse in the past 2 years	Common risk and protective factors of IPV and intimate partner homicide at the societal, individual, relationship, and community level Culturally specific risk of IPV or intimate partner homicide at different levels Acculturation leading to knowledge and access to resources
	In-depth interviews
Sullivan et al.,30 2005 USA	Participatory action research model	Experiences of Amharic-speaking (Ethiopian) women survivors of domestic violence	Ethiopian women refugees and immigrants who migrated to the USA	18 women; mean age 31 years	Community awareness and attitudes toward domestic violence Descriptions of abuse Responding to abuse Survivor needs Use of services Importance of same culture and language provider Children and teens: needs and issues Women’s ideas for addressing domestic violence in the community
				Average length of time in USA: 4 years
	Purposive sampling
	Focus groups
	Coding and analysis of the data
Ting,35 2010 USA	Qualitative description	Coping strategies of African immigrant women survivors of IPV	More than 75% of women were from West Africa; however, women also immigrated from Central, East, and South Africa to the USA	15 immigrant women (28 to 52 years of age); time in the USA ranged from 1 to 17 years	Initially women hoped the men will change Most endured the abuse for the sake of their children Seeking God’s help and finding comfort in prayer and faith Others did nothing (stoicism, fatalism, and acceptance of fate) Using behavioral distraction (focusing on the children) Avoidance, denying, minimizing abuse Support and affirmation from family Seeking formal services
				Length of marriages: less than 6 months to 33 years
	Purposive sampling
	In-depth interviews
	Line-by-line coding and the constant comparison method
Ting and Panchanadeswaran,27 2009 USA	Phenomenological approach	The study identified many barriers, some that were systemic and others that were intrinsic, but all of which posed formidable challenges in their efforts to seek help	Women from sub-Saharan countries and migrated to the USA	15 immigrant women (28 to 52 years of age); time in the USA ranged from 1 to 17 years ago Length of marriages: less than 6 months to 33 years	Cultural norms and traditional value placed on marriage for African women and, consequently, the desire to keep their marital relationships intact Shame of a failed marriage was another barrier to help-seeking Self-blame was another important factor preventing women from seeking timely help Loyalty and concern for their husbands was a barrier that kept women in abusive relationships and resulted in respondents rationalizing and attributing their husband’s abusive behaviors Fear manifested itself in many forms; the fear of not being believed by others and fear of the consequent isolation were common Lack of knowledge about their legal status and rights or information on services available to survivors Lack of financial resources Lack of housing Concerns for the safety and well-being of children
	Purposive sampling
	Interviews
	Line-by-line coding and the constant comparison method for data analysis
Ting and Panchanadeswaran,32 2016 USA	Phenomenological approach	African women’s experiences and perceptions of help-seeking with faith-based leaders, and the role of spirituality in the lives of African immigrant women who experience IPV	More than three-fourths of the women who had migrated to the USA were from West Africa; the others were from Central, East, and South Africa	15 immigrant women (28 to 52 years of age)	Congregating with others in places of worship was an important first step in establishing possible sources of social support Many participants perceived their religion and God as benevolent Despite women’s reports of being connected to God, many reported not actively seeking help from their religious leaders as they found religious leaders not supportive, with little knowledge of IPV Many women suffered self-imposed isolation The strong belief in forgiveness, and viewing their experiences of violence as a challenge from God to women
				Mean length of time in the USA was 7.3 years
	Purposive sampling
	Interviews
				All the participants had children; 5 had college degrees; 3 did not finish high school; more than half were employed; 60% were Christians; 40% were Muslims
				Husbands were generally older, more educated, and employed and legally residing in USA
	Line-by-line coding and the constant comparison method for data analysis

IPV, intimate partner violence

Appendix IV: Study findings with illustrations

Akinsulure-Smith AM, Chu T, Keatley E, Rasmussen A. Intimate partner violence among West African Immigrants. J Aggress Maltreat Trauma. 2013;22(2):109-2.33
Finding 1	Multiple instances of abuse (U)
Illustration	Making love to you any time they want… . Just come and hit you… . They don’t want to know if you like it or not, they just use, like the way they want you—you don’t complain… . You complain, they’re like, I’m your husband and I married you. page 117
Finding 2	Reported feeling unsupported by the family. (U)
Illustration	And my mother over there, they will come every day and talk to her, cause her, tell her like, “Your daughter is a prostitute, she went to America and put the guy in the, in jail.” … All type of things… So my mother falling sick. So, when I call and try to explain to her, she don’t listen. She like, “Why you do it?” I said, “Because, he want to kill me. His brother beat me up, I have all the pictures, everything.” Nobody said nothing. page 118-9
Finding 3	The elders blamed them, did nothing to assist them (U)
Illustration	You know, because it was not healthy for me anymore. But, it’s just the same thing, you know, they tell you to pray to God and that, he changes, you know, nobody wants to be the one to … you know to tell you to leave, because they think that’s a very big responsibility, and … religious-wise, they see that as a very bad thing to do because they could get punished by God or something. page 120
Finding 4	Seeking outside resources could lead to separation from their children and/or deportation (U)
Illustration	He said that he has the money to take a lawyer, I have no money and he has his papers. I can’t do anything, he can do whatever he wants. So when he talk like that, me too, I was scared … he went to the Family courts, said that I was the one who left, leaving him with children. page 121
Finding 5	Community conflict resolution favored men (U)
Illustration	For example, a husband would get to community leaders and present his case first, so that by the time his partner arrived, there was already a bias against her. page 121
Corley A, Sabri B. Exploring African immigrant women’s pre- and post-migration exposures to stress and violence, sources of resilience, and psychosocial outcomes. Issues Ment Health N. 2021;42(5):484-94.29
Finding 1	The experiences of IPV included physical abuse, threats of violence, and emotional abuse (U)
Illustration	I slept with my eyes open all night. I had to lock him in a room and sleep in the living room … My mother was calling me by the minute, like are you okay. He will probably kill you before you go to America. page 487
Finding 2	Women’s families were not always supportive of them leaving their abusive spouses, for fear of being expected to repay these bride prices (U)
Illustration	If he’s an abuser, when it comes to divorce or separation or the woman plans to leave, the family of that women, they don’t want to refund whatever this man paid. page 488
Finding 3	Being on a dependent spouse visa, financial dependence on a spouse, and language barriers placing women at greater risk for IPV (U)
Illustration	… Even if he hurts her, even if he beats her, she doesn’t tell anything. She doesn’t have any solution outside … Where would she go? Where would she turn to then? page 488
Finding 4	Women who reported experiences of IPV or depression or post-traumatic stress symptoms related to violence or traumatic events were at risk of being ostracized from their community (U)
Illustration	Ethiopians are not encouraged to disclose problems. Especially when it comes to violence it is considered a taboo or a shame thing. It’s considered as a thing that shouldn’t be disclosed with outsiders. page 489
Finding 5	Women expressed their deep commitment to their religious beliefs and indicated that these beliefs offered them emotional comfort during periods of stress (U)
Illustration	When I kneel down and cry to the Lord, I get up with relief. When I wake up thinking, … about stuff, abusing me, scaring me … I jump up from bed, go to my knees, call up the Lord and cry to the Lord. It has help me a lot. page 489
Finding 6	Role of religion in enforcing patriarchal cultural norms that hold women subservient to men, exposing them to risks for future abuse (U)
Illustration	The church doesn’t allow most of our residents to just get divorced for example … She’s a female so she has to keep her family- she needs to be strong … She pretends to be okay while she’s not okay. page 489
El Abani S, Pourmehdi M. Gender and educational differences in perception of domestic violence against women among Libyan migrants in Manchester. J Interpers Violence. 2021;36(5-6):2074-96.31
Finding 1	Some women perceived violence as a part of women’s lives (U)
Illustration	… For Libyan women it is a shameful to speak out about it. page 2085
Finding 2	Physical and emotional abuse … often saw it as a family issue (U)
Illustration	Rape is also violence and is a very dangerous type of DVAW. This rape could be from a family member not just a stranger and women do not speak about this. page 2084
Finding 3	Not allowing women to leave the house (U)
Illustration	There are many types of violence … [in Libya] I knew of a woman’s case in which her husband used to abuse her. She had a severe injury by her husband, she was asking for divorce, and she got it. The problem is that some women after a while they go back to their house without any case, or withdrawing the case from the lawyer. page 2086
Finding 4	Marriage is the standard whereby a woman’s success can be measured (U)
Illustration	Forced marriage … still exists in Libya and I heard that a family forced their girl to get married just to ensure she got a chance to be married. They prefer a girl to live a miserable life rather than to reach her 30s without marriage. page 2087
Fisher C. Changed and changing gender and family roles and domestic violence in African refugee background communities post-settlement in Perth, Australia. Violence Against Wom. 2013;19(7):833-47.28
Finding 1	Prior to resettlement, men also occupied a traditional role of breadwinner for their family (U)
Illustration	My husband is not happy here in Australia for several reasons. He has not any job to do. The new cultural change and the new language that he need to learn. He is not any longer someone who look after and support his family, especially financially. page 839
Finding 2	Payment being made directly to women was a cause for great angst for many men (U)
Illustration	Everyone here [in Australia] is equal rights; nobody is higher than any other person—we are all equal, the children, the man, the woman and eventually through the system here, it’s like the women, ah, have more responsibilities because, like Centrelink with the income… page 841
Finding 3	Women perceived that men felt there was no need to continue their responsibility for caring for their family in any form (U)
Illustration	One of the differences in men these days, I mean for my partner he doesn’t care to do anything in the home because he say that because me and the kids’ [money] come on … me so, I mean, he just don’t care about doing anything … page 841
Finding 4	Some women in particular were thankful for a system that they believed treated everyone equally (U)
Illustration	Well in Africa women have not much to say, but we, the women, say thanks God because here women are given priority by being able to talk to your husband and giving him your opinions. page 843
Finding 5	Women were becoming stronger, felt more able to speak up about the violence in their lives (U)
Illustration	The fighting which has been happening between myself and my husband has changed a bit. He can no longer fight me because he can smell the problem if he fights me. page 843
Njie-Carr VPS, Sabri B, Messing JT, Suarez C, Ward-Lasher A, Wachter K, et al. understanding intimate partner violence among immigrant and refugee women: a grounded theory analysis. J Aggress Maltreat Trauma. 2021;30(6):792-810.36
Finding 1	Normalizing abuse (U)
Illustration	I get challenges through my community with neighbors, when I go walking around, they kind of talk to me badly, so they think it’s very bad because, in my culture, I’m not supposed to leave my husband. Even if he’s abusing me, I have to stay in that relationship, which, I think, it’s not fair for me. page 801
Finding 2	Dependency and losing one’s self (U)
Illustration	… He tries to control me. He still tries to control me. He says that he is not going to—he threatens that if I don’t go back to him, he was not going to help me. page 801
Finding 3	A strong social network, support, and prayers (U)
Illustration	It was a beautiful experience connecting with [the] church, mainly because I was coming from a place where no one loved me. Going to church and having people say things like, “God bless you. You look beautiful today,” and they welcomed me with open arms. Coming here was a good experience for me. page 801
Finding 4	Ignoring the perpetrator when they were abusive (U)
Illustration	A Congolese woman reported, “… to keep myself safe, I just keep my mouth shut and things are fine. If I don’t ask anything, we are okay.” page 802
Finding 5	Garnering the courage to utilize support services (U)
Illustration	A halfway house, like a shelter, counseling to regain self-esteem, helping to become self-sufficient, such as job training, learning English. Maybe if they’re there, that will keep them going and survive. page 803
Ogunsiji O, Wilkes L, Jackson D, Peters K. Suffering and smiling: West African immigrant women’s experience of intimate partner violence. J Clin Nurs. 2012;21(11-12):1659-65.23
Finding 1	Suffering and smiling (U)
Illustration	For example, if your husband has just beaten you mercilessly and someone knocks at your door, you pretend as if you are the sweetest couple in the whole world. page 1661
Finding 2	Put on superficial smiles to hide their experiences (U)
Illustration	African women are just smiling but they are suffering inside and I am telling you that a lot of African women have all the reason to divorce but for one way or the other, they can’t. page 1661
Finding 3	Husbands were in control of the family’s finances and controlled all other aspects of their lives (U)
Illustration	The first area of control that an African man will try to take charge is the finance, once they are in control of the finance, they believe that they can make every other person dance to their tunes, everyone else will be happy when they choose to be happy and everybody has to be sad when they are sad. page 1662
Finding 4	Male authority was absolute (U)
Illustration	Yes, the man has an upper hand and that is the tradition they have been brought up with, the man has the final say and the women has been brought up to say yes. page 1662
Finding 5	Women experienced intimidation because of their husband’s position as the primary visa applicant (U)
Illustration	I brought you here so you don’t have any right. To me, whatever I say is what you are going to obey. That is African men for you. page 1662
Finding 6	Reluctance to report their IPV experience might be due to their low level of integration into the Western culture (U)
Illustration	There was a time I did feel helpless and I felt like leaving my husband because it seems as if I was getting a lot of encouragement from a few Australian friends that I met here. They were telling me that if I leave him, the government will take care of you, you will get a lot of government support, lot of money and so on. page 1662
Finding 7	As West African women integrate into the Western culture, many more experiences of IPV would be reported (U)
Illustration	The way out is far, but we are getting there. Why I said that is that the women are now getting their freedom gradually because by the time you have a friend that is an Australian, you will be able to share your mind with her. And that Australian friend or lady will be able to tell you the way and will take you to where the problem (IPV experience) can be solved. page 1662
Finding 8	Seeking outside help for IPV was not acceptable (U)
Illustration	All these agencies will not bring you together; rather, it will even make it worse. Why do you need to go and report to them or seek their help when you know it’s not going to help … because it (IPV) is acceptable, no one sees anything wrong with it. page 1662
Sabri B, Nnawulezi N, Njie-Carr VPS, Messing J, Ward-Lasher A, Alvarez C, et al. Multilevel risk and protective factors for intimate partner violence among African, Asian, and Latina immigrant and refugee women: perceptions of effective safety planning interventions. Race Soc Probl. 2018;10(4):348-65.34
Finding 1	Patriarchal cultural norms (U)
Illustration	In Africa they believe that even if your husband is treating you bad, he’s your husband and he has a right. page 348
Finding 2	Religion helped women address their abusive situations (U)
Illustration	The imam (religious leaders) will just explain to them (abusers) what the religion says, that they don’t own her blood. page 348
Finding 3	Police were a protective resource (U)
Illustration	Sometimes police will help. For example, if there had been some argument and I would be outside with the kids. The police would come, and they would remove him. page 348
Finding 4	Partners’ behaviors such as threats to kill her or her family, threats to take away children (U)
Illustration	One time I tried to call the police, he said that he will take the kid away from me, and I will never see him again, so I was scared to do that. page 356
Finding 5	Being pregnant and having children was protective (U)
Illustration	At one point, God helped me. Eventually, I got pregnant. The time I had my first baby, I felt like I was catching a break a little bit. After three years, his family started accusing me of refusing to get pregnant again. page 365
Finding 6	Ignoring abuse in the relationship (U)
Illustration	I think forgiveness is what has put me to that point. I kept on forgiving him, and saying, Okay, he’s the father of my kids. He made a mistake. Let me move on. Let me do the right thing. page 365
Finding 7	Forced or arranged marriages, dowry, bride price (U)
Illustration	Forcing the girl––a woman to marry a guy that she is not in love with. page 359
Finding 8	Cultural expectations for marriage and divorce (U)
Illustration	[Community and family] don’t divorce. Instead, they tell you that’s how it goes in marriage. It’s up to you to work on it and make it better. You stay, thinking things will get better. page 360
Finding 9	Elders in the community resolved issues (U)
Illustration	There is a Burundian community called Baho… .these are people.who…help them to resolve their problems without involving the law enforcement. page 360
Sullivan M, Senturia K, Negash T, Shiu-Thornton S, Giday B. For us it is like living in the dark: Ethiopian women’s experiences with domestic violence. Interpers Violence. 2005;20(8):922-40.30
Finding 1	Children are aware of abuse in the home (U)
Illustration	Our kids have problem dealing with us. When we argue and fight in front of them, when they see our husbands humiliating, beating, and cursing us, they will get affected. They will learn everything they see. page 928
Finding 2	Women may be forbidden to leave the home (U)
Illustration	We Ethiopian women do not get enough information like the men do. The reason is because our husbands do not let us socialize with our neighbours. They are the one[s] who get more information and have more friends. They know the law very well. We stay in the house with our kids and cook food for them. We are hopeless. They beat and use the system. They hurt their women. page 929
Finding 3	Abusive men may divorce their “old” wives here and bring young wives to the United States (U)
Illustration	When they bring their new wives what they do is hide them not to meet their old friends. Ethiopian men can marry to an underage girl. For example, my ex-husband married an 18-years-old girl. Mind you he has a 15-year-old girl (daughter)… . They bring in underage girls maybe 16 and 17 or 20 years of age and abused them. I feel sorry for my Ethiopian sisters. Something has to be done. page 930
Finding 4	Involving his friends or the larger community as a feature of their abuse (U)
Illustration	I was afraid to appear for the hearing, I was afraid of his group. He has a lot of friends to support him. They lied for him, but the police saw blood on my face when that incident happened. His friend tried everything to let him free. My only friends were my kids. All our friends were turning their back on me. It was too much for me. page 930
Finding 5	Abusive partners control the household money (U)
Illustration	My husband works and makes money for himself. He never gave me a penny. page 931
Finding 6	Profound levels of isolation (U)
Illustration	There are men who do not want their wives to go out of the house. They do not want them to go to school. page 930
Finding 7	Male privilege (U)
Illustration	I work outside. When I get in the house there is a lot of work to be done and problems are waiting for me. Men have the privilege to relax in the house. They can humiliate us.They think they are the only humans that have full right. page 931
Finding 8	Men have more freedom in the United States (U)
Illustration	They do not even remember where we came from. I mean before we came together to America, we suffered together. We worked hard together. They don’t care for their wife sister. Once America is a free country all they do is making them happy. page 931
Finding 9	Feelings of depression and despondency (U)
Illustration	Like the end of the world. For us it is like living in the dark. When they abused us, it is really living in hell. I don’t know what I have been through. It is bad. page 931
Finding 10	Finding out about available services made seeking help possible (U)
Illustration	If I knew about the service before, I would not sit there and be abused for a long time. page 931
Finding 11	Limited English skills prohibit women (U)
Illustration	If you can be able to educate us how to get different services and teach us the English language it will be easy for us. page 931
Finding 12	Significant barriers to accessing available assistance (U)
Illustration	I had no money. I had no choice but to call the police [911]. They came and asked me what happened. I told them what he did to me and asked them to get my money from him. Unfortunately, they told me that they could not do that. They advised me to get a restraining order from court. page 933
Finding 13	Unaware of domestic violence services (U)
Illustration	I believe most Ethiopian women do not know that there is help out there. They do not even know what ReWA is. page 934
Finding 14	Women who had used domestic violence shelters found them to be very helpful (U)
Illustration	I was at the women’s shelter. People thought that shelters are only for drug addicts or homeless. Most Ethiopians think that way, too. When I started living in the shelters, I found it more than I expected. It felt that I am with my immediate family. We helped each other. We also discussed our problems. page 934
Finding 15	Concerned about raising their children without fathers (U)
Illustration	Our brothers are becoming gang members. They do not have father in the house; we could not control them. They are going to kill each other. The system is so hard for us to understand. The government knows that kids will be gangsters when there is no father in the house. page 935
Finding 16	Providing women with information on domestic violence (U)
Illustration	There should be a way for these women, I mean for newcomers, some kind of education that there is help out there for them. Before they come to America, you should be able to reach these women and teach them how they can solve these kinds of problems. It would be perfect if they can be reached before they get their visa in Ethiopia. If they come here without any knowledge their sponsors will lead them their way. page 936
Finding 17	Survivors playing an active role in helping each other (U)
Illustration	If I have the money for those women who have problems and lonely like me, I will help them to have their own business. If they cannot drive, I will help them to learn. page 936
Finding 18	Children need services and support. (U)
Illustration	I will open more activity centers for kids with domestic violence. They need a peace of mind for what they have been through. page 936
Finding 19	Men manipulate women through the system (U)
Illustration	He never cares for his own kids. Men are free. Some of them buy two town cars and make a lot of money while we are suffering with little income. They are living a good life. Their kids are in a dangerous situation, and they don’t care. page 929
Finding 20	Not a shared community understanding of domestic violence (U)
Illustration	After we are separated, they beg us to get back together again. He comes with his friends and say, “I will never do this again. Please give me another chance.” It is not easy to turn your back when you lived with a person and experience a lot of things together. Our community does not understand what domestic violence is. page 927
Finding 21	Marital relationships should include love, mutual help, support, equality, and respect (U)
Illustration	We are their wives. We should love and help each other. We should not be abused. Our men believe they are superiors, and women are inferiors. That is not right… . We have no right. The men should be educated. page 927
Finding 22	Domestic violence in the context of gender inequality (U)
Illustration	I do not want this to happen to Ethiopian sisters. There should be a woman rights organization to stop this abusive relationship. page 927
Finding 23	Elders are not available to help solve marital problems (U)
Illustration	It is better back home. The pressure is less. The old people get the solution for our problems. page 928
Finding 24	Non-Ethiopian neighbors for help (U)
Illustration	My neighbors are from this country, so they understand my problem and give me some advice. Ethiopians don’t live in my neighborhood, they live far away. My neighbors are American. They are supporting me for what I did. Nobody understands what we are going through. page 928
Finding 25	Men blame the U.S. system for favoring women over men (U)
Illustration	What they [men] do is going to friend’s house and tell them, “Our women are on welfare. They live in low-income housing. They kicked us out from the house, if you do not be careful, this will happen to you.” They are teaching them not to respect and love their wives. Not only their relationship with their family is messed up, but also they are brainwashing other men not to have a good life with their families. They are pretending as if their wives are abusing them. page 928
Finding 26	The larger Ethiopian community responds to domestic violence just as they did in Ethiopia (U)
Illustration	Our culture is totally different. When the woman is complaining about her husband, there will be an arbitration committee to tell us what to do next. They would say “Get along together,” that is it page 927
Ting L. Out of Africa: coping strategies of African immigrant women survivors of intimate partner violence. Health Care Women International. 2010;31(4):345-64.35
Finding 1	Wishful thinking (U)
Illustration	I had hope he would change since in my family, my father had changed. We went to live with my grandparents when my father was abusing my mother. They talked to my father, and he changed. He stopped, so I had hope my husband would too. Some men do. I believed it was possible. page 351
Finding 2	Focusing on the future (U)
Illustration	I told myself that I was staying for the green card [legal immigration status]. When the papers come through, then I can leave with my children. I can get working papers, support myself and the kids then. page 351
Finding 3	Comfort in their personal relationship with God (U)
Illustration	I prayed; I felt comfort in praying. At night I read the Bible where it said, “that I will be with you, as you travel, when you are suffering, I am with you.” So that was comforting me, that God was with me. page 351
Finding 4	Acceptance (U)
Illustration	The sooner you learn this, the easier it will be for you. page 352
Finding 5	A place to escape (U)
Illustration	“I work with adults with disabilities. I tell myself I am not suffering as much as they are, in wheelchairs: they can’t walk.” Others work in adult day care: “I am busy all day, changing diapers, helping them. There’s no time to think.” page 353
Finding 6	Active denial (U)
Illustration	I used to think that my husband, he’s so controlling that I thought it was showing me he loved me. page 353
Finding 7	Ability to survive the abusive (U)
Illustration	I tell myself that I will be strong, that I am not going to let him break me. page 353-4
Finding 8	Verbal and emotional support from the family (U)
Illustration	My sisters, they say, “If it gets too much, don’t stay there; just leave,” although other people were saying they should not tell me that. page 354
Finding 9	Formal help seeking (U)
Illustration	I walked in the court building; I didn’t know anything or who to talk to. I just walked in and said, “I’m suffering; my husband is mistreating me. Is there any place here that can help me?” page 353-4
Ting L, Panchanadeswaran S. Barriers to help-seeking among immigrant African women survivors of partner abuse: listening to women’s own voices. J Aggress Maltreat Trauma. 2009;18(8):817-38.27
Finding 1	Importance of marriage for the family and African society (U)
Illustration	Women are to be married. Maybe when you get to be older, like 50s or if your children are grown, but otherwise, you need to get married again. Single women are not seen as good women. Men think if you don’t want to get married, you are not good, like, you like many men, like you are a prostitute. page 821
Finding 2	Shame at being a victim (U)
Illustration	I didn’t want my family, my mother and father, to know that I had made a mistake; they didn’t want me to marry him, and I did; he is not of my class. In my country, I would not have even dated someone like him, no, no, no! But my mother, she didn’t want to say anything to me because she thought I must be pregnant already. page 822
Finding 3	Self-blame and isolation (U)
Illustration	I thought if I act nicer to him, he wouldn’t get so angry. page 823
Finding 4	Rationalizing (U)
Illustration	He did not get love as a child. His mother used drugs and his father was in jail. My husband lived with many, many relatives and they did not treat him right. He was beaten and abused. page 823
Finding 5	Preserving the ideal image of African immigrants (U)
Illustration	Don’t take it any further, don’t go public. We can work this out. We [Africans] don’t want any publicity. page 824
Finding 6	Fear of the consequent isolation (U)
Illustration	My husband, he threatened me, yes, to deport me. He said, “I will tell the police you are illegal, and they will send you away. They will not let you take the children.” page 825
Finding 7	Strategy to keep the women in abusive relationships (U)
Illustration	He didn’t want me to go to church or make friends with other African ladies; he said they’d gossip about us. I didn’t have any of my own friends. page 825
Finding 8	Financial obligation (U)
Illustration	I had no working permit; my husband, he arranged it for me to go work at a hair salon, but the owner gave to him the money I earned; he told me the owner could only pay him since I was not legal. I could get arrested. I could not open a bank account. page 827
Finding 9	Decision making regarding leaving (U)
Illustration	He bribed them with computer games, presents. My 10-year-old last year said he would kill himself if I left his father. What can I do? page 829
Finding 10	Lack of knowledge about available services (U)
Illustration	They told him to leave the house, that deportation was not their concern. Then, I realized he was not right, he’s lying, that he was threatening to get me deported all the time, but the police wouldn’t deport me … that I had rights. page 830
Ting L, Panchanadeswaran S. The interface between spirituality and violence in the lives of immigrant African women: implications for help seeking and service provision. J Aggress Maltreat Trauma. 2016;25(1):33-49.32
Finding 1	Preservation of the institution of marriage (U)
Illustration	Even pastor[s], they tell you to listen to your husband, be good to him, don’t stress him, his job in America is hard, be a support. Women must give in, in marriage. page 40
Finding 2	Church or ethnic community first (U)
Illustration	“Oh, you people are church people; don’t take this thing too far. Let’s solve it here as families and all that.” So, I went to court and cancelled the protection. page 40
Finding 3	Lack of knowledge about IPV (U)
Illustration	They tell the women, “You must listen to him, he’s your husband,” and, “You will apologize,” when we’re the one who’s bruised and beaten. We don’t deserve to be beaten. page 41
Finding 4	Distrust of religious institutions (U)
Illustration	I have not told the pastor, even they will talk. They will talk about you, not believe you did not do anything. Some people will not believe that you are innocent. page 42
Finding 5	Self-imposed social isolation (U)
Illustration	They don’t think divorce is so good, and [they think it is] too easy here, too many people divorce. Women wanting divorces. What do women want to be single for? … Single women are seen as up to no good [as prostitutes]. page 42
Finding 6	Personal relationship with God and spirituality (U)
Illustration	I said [to him] that God knows the truth and God will pay you back … I believe in God. I believe that God will bring justice one day to this man for what he has done to me … God will punish him. I told him that, and he said to shut up. He did not want to hear about God. page 43
Finding 7	Hopeful outlook (U)
Illustration	I believe, as far as you are faithful, being good, not doing anything bad to others, there will be justice one day. page 44
Finding 8	Belief in forgiveness (U)
Illustration	My God tells you to love other people and be nice to them and forgive them for their wrongs, so I forgive him… . I think God gives us all personal burdens, we all have to carry and I have mine. page 44

U, unequivocal; DVAW, domestic violence against women; IPV, intimate partner violence