Lessons Never Learned: Crisis and gender‐based violence

Abstract

The COVID‐19 pandemic exposes underlying inequalities in our socio‐economic and health systems, such as gender‐based violence (GBV). In emergencies, particularly ones that involve quarantine, GBV often increases. Policymakers must utilize community expertise, technology and existing global guidelines to disrupt these trends in the early stages of the COVID‐19 epidemic. Gender norms and roles relegating women to the realm of care work puts them on the frontlines in an epidemic, while often excluding them from developing the response. It is critical to value women’s roles in society and include their voices in the decision‐making process to avoid unintended consequences and ensure a comprehensive response that caters to the needs of the most vulnerable groups.

1. INTRODUCTION

Public health measures in a pandemic such as quarantines, school closures and channeling resources towards emergency service provision, expose structural realities of women and girls’ lives globally, as well as point to inequities and weaknesses in our gendered socio‐economic and health systems. While these policies may be essential and critical, there is need to address the context of women and girls’ lives lest we cause more harm than anticipated. The spike in violence against women and children during humanitarian and public health emergencies is a manifestation of these inequalities and vulnerabilities.1 This paper will discuss the COVID‐19 pandemic and GBV in the context of lessons learned from prior emergencies to avoid ongoing missteps and urge the inclusion of women in all COVID‐19 decision‐making processes.

Data from over 80 countries suggest that 1 in 3 women who have been in a relationship have experienced physical and/or sexual violence by an intimate partner at some point in their lives.2 Moreover, women endure multiple and compounding forms of violence in emergency settings. In these contexts, at least 1 in 5 displaced women have experienced sexual violence.3 In South Sudan, decades of war has meant that over 50 to 65 percent women have experienced intimate partner violence in their lifetime, while 1 in 3 women have experienced non‐partner sexual assault.4 Women’s and girls’ vulnerability in crises are further exacerbated by the lack of access to their regular social networks and sources of social support, as well as health and other support services. Their exposure to violence increases as perpetrators might lash‐out due to the economic strain caused by a pandemic, while their chances of leaving or resisting abusive relationships diminish. As service machinery operate in crisis mode to contain a pandemic, other critical services, particularly those needed by women and girls, often become unavailable or are de‐prioritized and deemed non‐essential. Moreover, fear of infection, restriction of movement and public unrest, as well as violence and mistreatment may prevent women from seeking health services during an epidemic.

In recent times, the Ebola epidemic in West Africa highlighted how gender dynamics cannot be set‐aside in the frenzy of an epidemic, to be dealt with later. Beyond paying attention to the gendered patterns of disease transmission and susceptibility, policymakers and researchers must be attentive to how societies are organized as we shape policy and programmatic response. As school closures and quarantines were enforced during the 2014‐2016 Ebola outbreak in West Africa, women and girls experienced more sexual violence, coercion and exploitation.5 Reports of violence were de‐prioritized, uncounted and unrecognized.6 Furthermore, young women and adolescent girls were unable to attend community meetings and receive instruction on how to protect themselves from the disease.7 However, while women and girls were facing increased abuse and violence, failure to prioritize GBV funding alongside a failing health system and lack of coordination, the availability of services for survivors were severely affected in these countries. For example, in Sierra Leone, GBV services in the public health system were severely disrupted as resources and personnel were redirected. However, a handful of GBV service centers managed by INGOs remained open and saw a 19% increase in women and girls accessing their health, counselling and case management services compared to the months before the crisis.8 In Liberia, many GBV survivors were denied access to basic public health services out of fear that health workers would get infected. Police and justice systems were overwhelmed, which could have led to further increase in GBV as an ‘atmosphere of impunity’ was created.9 In Liberia over 27% of people saw the police and justice systems as failing to handle GBV cases properly. Moreover, lack of access to basic sexual and reproductive health services (SRH) led to a 75 percent increase in maternal mortality in Guinea, Liberia and Sierra Leone, as unintended pregnancy increased among young women in West Africa.10

2. COVID‐19 RESPONSE

The COVID‐19 pandemic is no different with early reports suggesting an increase in domestic violence and disruption of essential GBV and SRH services for women and girls when they need them most. Early evidence from China suggests that domestic violence has dramatically increased: a police station in China’s Hubei Province recorded a tripling of domestic violence reports in February 2020 during the COVID‐19 quarantine.11 Groups working on domestic violence have reported that measures such as quarantines and social distancing have increased women’s exposure to violence as confinement in physical spaces along with economic and health shocks have increased household stress levels. However, support services are heavily strained due to the outbreak, particularly the healthcare and police services. Reports suggest that police have been reluctant to intervene and detain perpetrators due to COVID‐19 outbreaks in prisons.12 In some locations, authorities have reportedly converted women’s shelters into homeless shelters.13 UN Women has expressed concern that vital GBV health services may be diverted to deal with the outbreak.14 Similarly, GBV prevention groups in South Africa are seeing increases in new cases as restrictions are being imposed to tackle the COVID‐19 emergency but women have no recourse.15 Shelters are making hard decisions and refusing new clients unless they have proof of testing negative to avoid spreading the virus to the existing clients. In Oregon, US, domestic violence hotlines are seeing increasing use of their services as COVID‐19 is spreading in the state. Callers are worried that they will not be able to obtain or extend restraining orders against their perpetrators with reduced court access and police services.16

Underpinning these inequities are the ways we view and value women and men’s roles and labor in society. Gender norms and roles relegate women to the realm of care work ‐ which includes household labor, care of children and sick people ‐ that are needed for the sustenance of families, communities and health systems but are invisible, non‐monetized or under‐paid.17 The duties of care are highly feminized across multiple levels, be it formal or informal care, public or private sector.18 This feminized care economy ends up being a “shock absorber” in periods of crisis, further subsidizing care services as states and families can no longer pay for them, while increasing the duties, exposure and susceptibility of women to diseases.19 Globally women perform three‐quarters of unpaid care work, including household disease prevention and care for sick relatives, and there is not a country in the world where men provide an equal share of unpaid care work.20 90% of frontline healthcare workers in China’s Hubei province as in many other parts of the world are women.21 There is also evidence of frontline healthcare workers, especially women being harassed and mistreated in China22 and Singapore,23 whereas the Italian national healthcare workers union raised concerns about the additional stress COVID‐19 is placing on healthcare workers.24 However, while women clearly are in the frontlines and performing several core roles, absorbing the stress and violence, they remain “conspicuously” invisible to policy makers, and their voices and needs are not included in a comprehensive response.25

The COVID‐19 pandemic is still in its early stages in several countries and it is not too late to include the voices of women in tackling the epidemic as well as ensuring services critical to women continue to be available. UN agencies such as UN Women and UNFPA have developed guidelines that governments can use to incorporate gender considerations into their response.26 ^, 27 Others are paving the way and showing how technology can be leveraged to ensure women continue to receive essential services when they need them most. In USA, the National Domestic Violence Hotline is offering services via online chat or texting, to make it easier for victims to seek out help while at home with their abusers.28 In Ecuador, a local organization dedicated to achieving gender equality and preventing GBV – CEPAM‐Guayaquil – quickly adapted its business to the COVID‐19 outbreak and started offering counseling services over the phone.29 In Italy, the national network of domestic violence shelters have kept their emergency telephone and Skype support services open: approximately 60 out of 80 local domestic violence organizations have emergency cell phones and are answering calls.30 A judicial court in Beijing is using online court hearing and cloud‐based platforms to handle GBV cases during the epidemic.31 Similarly, telemedicine should be considered an alternative and secure way to provide women and girls access to contraceptives and abortion medication.

In addition, women’s organization and other agencies are providing guidance on how to generate awareness and provide services in emergency context. Women’s groups are publishing manuals and organizing livestream workshops that provide guidance on how to protect oneself during a crisis, including how to access legal aid.32 They are organizing campaigns in social media to raise awareness as well as setting up support networks to help survivors. A network called ‘Vaccines Against Domestic Violence’ has over 2000 volunteers, who provide counseling and support families to resolve conflicts peacefully.33 Similarly, international agencies that have experience working in humanitarian contexts such as the International Rescue Committee have guidelines on how to respond rapidly and set up mobile and/or remote GBV services.34 Other strategies such as incorporating GBV training as part of cash transfers are showing promise.35

3. CONCLUSION

We have another opportunity to do this right. The examples above clearly show that service provision as well as GBV prevention work is possible, and crises cannot be used as an excuse to disrupt/divert essential services and increase the vulnerabilities of those already hard hit by the situation. The UN Office for Disaster Risk Reduction explicitly recognized the need to better integrate gender perspectives into emergency preparedness.36 In the WHO 2019 Health Emergency and Disaster Risk Management Framework, 37 GBV and SRH services should be provided as part of the package of essential services provided during any emergency. These services should be prioritized at the earliest stage of the crisis to minimize risk to women and girls, as well as new technologies used to prevent violence from taking place in the first place. Moreover, it is critical to include women in decision‐making processes, so their needs and barriers are understood and incorporated into a comprehensive response that works for everyone. Data collected during the crisis should be disaggregated by sex and age. Recognizing, valuing, supporting women’s roles and giving them a voice in global health governance can go a long way in avoiding unintended consequences, building resilient healthcare systems, and reducing intersectional inequalities and vulnerabilities across gender, race, class and geography.

Biographies

Neetu John , PhD, is an Assistant Professor at the Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health. Her research investigates the relationships between gender, violence and household dynamics, reproductive and economic empowerment, and health.

Sara E Casey , DrPH, is an Assistant Professor at the Heilbrunn Department of Population and Family Health, Columbia University. She uses sound data collection and analysis to improve the availability and quality of sexual and reproductive health services in countries whose health systems have been weakened by war or natural disaster.

Giselle Carino is a change maker and feminist activist. She is the CEO & Regional Director for the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR), where she leads a network of 46 autonomous local partners that work to guarantee that sexual and reproductive health and rights are a human right for all.

Terry McGovern is the Harriet and Robert H. Heilbrunn Professor and Chair of the Heilbrunn Department of Population and Family Health at Columbia University Mailman School of Public Health. Her research focuses on health and human rights, sexual and reproductive rights and health, gender justice, and environmental justice. McGovern also directs the Program on Global Health Justice and Governance.

John N, Casey SE, Carino G, McGovern T. Lessons Never Learned: Crisis and gender‐based violence. Developing World Bioeth. 2020;20:65–68. 10.1111/dewb.12261