literature review on gender based violence

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A Systematic Review of Gender-Based Violence Prevention and Response Interventions for HIV Key Populations: Female Sex Workers, Men Who Have Sex With Men, and People Who Inject Drugs

Affiliations.

1 Department of Population, Family and Reproductive Health, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
2 Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
3 Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
4 Continuum of Prevention, Care and Treatment of HIV/AIDS with Most at Risk Populations in Cameroon, CARE International, Yaoundé, Cameroon.
5 Continuum of Prevention, Care and Treatment of HIV/AIDS with Most at Risk Populations in Cameroon, CARE USA, New York City, NY, USA.
PMID: 35144502
DOI: 10.1177/15248380211029405

Gender-based violence (GBV) is that perpetrated based on sex, gender identity, or perceived adherence to socially defined gender norms. This human rights violation is disproportionately experienced by HIV key populations including female sex workers (FSW), people who inject drugs (PWID), and men who have sex with men (MSM). Consequently, addressing GBV is a global priority in HIV response. There is limited consensus about optimal interventions and little known about effectiveness. Our systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in International Prospective Register of Systematic Reviews. Peer-reviewed and non-peer-reviewed literature were searched for articles that described a GBV prevention or response intervention specifically for key populations including FSW, PWID, and MSM. Results were organized by level(s) of implementation and pillars of a comprehensive GBV response: prevention, survivor support, and accountability/justice. Of 4,287 articles following removal of duplicates, 32 unique interventions (21 FSW, seven PWID, and nine MSM, not mutually exclusive) met inclusion criteria, representing 13 countries. Multisectoral interventions blended empowerment, advocacy, and crisis response with reductions in violence. Individual-level interventions included violence screening and response services. Violence-related safety promotion and risk reduction counseling within HIV risk reduction programming reduced violence. Quantitative evaluations were limited. Violence prevention and response interventions for FSW, PWID, and MSM span individual, community, and multisectoral levels with evidence of promising practices at each level. The strongest evidence supported addressing violence in the context of sexually transmitted infection/HIV risk reduction. As interventions continue to emerge, the rigor of accompanying evaluations must simultaneously advance to enable clarity on the health and safety impact of GBV prevention and response programming.

Keywords: HIV; gender-based violence; interventions; key populations; systematic review.

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v.12(6); 2022

Estimating the global health impact of gender-based violence and violence against children: a systematic review and meta-analysis protocol

Cory n spencer.

1 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA

María Jose Baeza

2 School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA

Jaidev Kaur Chandan

3 Warwick Medical School, University of Warwick, Coventry, UK

Alexandra Debure

Molly herbert, teresa jewell.

4 University Libraries, University of Washington, Seattle, Washington, USA

Mariam Khalil

Rachel qian hui lim.

5 Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

Sonica Minhas

Joht singh chandan.

6 Institute of Applied Health Research, University of Birmingham, Birmingham, UK

Emmanuela Gakidou

Nicholas metheny, associated data.

bmjopen-2022-061248supp001.pdf

bmjopen-2022-061248supp002.pdf

Introduction

Exposure to gender-based violence (GBV) and violence against children (VAC) can result in substantial morbidity and mortality. Previous reviews of health outcomes associated with GBV and VAC have focused on limited definitions of exposure to violence (ie, intimate partner violence) and often investigate associations only with predefined health outcomes. In this protocol, we describe a systematic review and meta-analysis for a comprehensive assessment of the impact of violence exposure on health outcomes and health-related risk factors across the life-course.

Methods and analysis

Electronic databases (PubMed, Embase, CINAHL, PsycINFO, Global Index Medicus, Cochrane and Web of Science Core Collection) will be searched from 1 January 1970 to 30 September 2021 and searches updated to the current date prior to final preparation of results. Reviewers will first screen titles and abstracts, and eligible articles will then be full-text screened and accepted should they meet all inclusion criteria. Data will be extracted using a standardised form with fields to capture study characteristics and estimates of association between violence exposure and health outcomes. Individual study quality will be assessed via six risk of bias criteria. For exposure–outcome pairs with sufficient data, evidence will be synthesised via a meta-regression—Bayesian, regularised, trimmed model and confidence in the cumulative evidence assessed via the burden of proof risk function. Where possible, variations in associations by subgroup, that is, age, sex or gender, will be explored.

Ethics and dissemination

Formal ethical approval is not required. Findings from this review will be used to inform improved estimation of GBV and VAC within the Global Burden of Disease Study. The review has been undertaken in conjunction with the Lancet Commission on GBV and the Maltreatment of Young People with the aim of providing new data insights for a report on the global response to violence.

PROSPERO registration number

CRD42022299831.

Strengths and limitations of this study

This review is the first effort to systematically identify and assess all health-related impacts of multiple and overlapping forms of gender-based violence and violence against children.
Data analysis plans include meta-regression and burden of proof frameworks to synthesise all available evidence and provide policy-direct interpretations of associations.
Findings from the review will be incorporated in the Global Burden of Disease Study, the most comprehensive observational epidemiological study to date and a critical tool for researchers, advocates and decision-makers.
Challenges remain in the comparability of definitions of exposure to gender-based violence and violence against children and availability of high quality data for under-studied forms of violence (ie, cyberviolence, stalking, elder abuse).

Gender-based violence (GBV) (including but not limited to intimate partner violence (IPV), elder abuse and violence against women (VAW)) and violence against children (VAC) are global public health issues associated with a substantial burden of morbidity and mortality. It is well known that the immediate consequences of both VAC and GBV in adulthood include physical injuries and death. 1 However, the medium-term and longer-term consequences are less well understood, but have shown to span a variety of physical, mental, sexual and reproductive health issues. 2 3 Until recently, the fields of VAC and GBV were largely siloed, stunting our understanding of how different exposures to violence influence each other across the lifespan. To address these challenges, the Sexual Violence Research Initiative, UNICEF Innocenti and the World Health Organization (WHO) have recently developed a framework of guiding principles encouraging interaction of research in the field of violence epidemiology. 4 As international advocacy and research organisations push for the integration of these fields, a more fulsome understanding of the health impacts of violence across the life-course is needed. 5 6

The Global Burden of Diseases (GBD), Injuries and Risk Factors Study has quantified the global disease and disability burden of two violence-related risk factors, IPV and childhood sexual abuse (CSA), within a comparative risk assessment framework since 2010. 7–10 An advantage of the comparative risk assessment framework is the ability to compare the relative contribution to disease and disability among several health risk factors. Indeed, country-specific and age-specific findings from the GBD have shown IPV to account for more overall disability-adjusted life-years (DALYs) in women ages 15–49 than more traditionally highlighted health risk factors such as smoking. 11 12 On a global scale, IPV was estimated to account for 6.44 million (95% uncertainty interval (UI), 3.55–9.87 million) DALYs among this group in 2019 while, by comparison, smoking contributed to 4.52 million (95% UI 3.87–5.23 million) DALYs in the same population in 2019. 8 Much of the estimated health impact stems from GBD meta-analyses of scientific literature, which have found IPV exposure to be associated with a 54% increased risk of depression and 60% increased risk for HIV infection. 8 Likewise, those exposed to CSA have been estimated to be 2.21 times as likely to experience alcohol use disorder (relative risk (RR)=2.21, 95% UI=1.15–4.04) and 1.56 times as likely to experience depression (RR=1.56, 95% UI=1.30–1.86), accounting for 3.67 million (95% UI, 1.75–6.56 million) global DALYs among males and females of all ages in 2019. 8 While these findings provide a basis for understanding the impact of violence on health, the lack of a comprehensive analysis of the longitudinal literature has so far precluded the ability to expand the types of violence included in the GBD as well as the specific health outcomes that comprise the final estimates of burden. A more complete understanding of the adverse health outcomes associated with exposure to more types of GBV and VAC, and the magnitude of these associations, is needed to capture the negative health and societal impacts of GBV and VAC.

Beyond the estimates provided by the internationally comparative GBD studies, existing reviews assessing the health impacts of GBV and VAC have typically focused on the impact of a single type of violence (eg, IPV) on a specific health outcome (eg, HIV). In 2013, the WHO, London School of Hygiene and Tropical Medicine, and South African Medical Research Council conducted a systematic review and meta-analysis of a variety of health effects related to specific forms of GBV, measured as physical and/or sexual IPV or non-partner sexual violence (NPSV). 2 Across studies identified, women exposed to IPV were 1.5 times as likely to become infected with HIV/AIDS and 1.97 times as likely to experience depression, among other adverse health outcomes. 2 A lack of comparable studies prevented meta-analysis for NPSV. 2 Following the publication of 2013 report, the WHO curated an extensive database of studies describing the literature explaining the relationship between VAW and VAC with subsequent health outcomes. 13 However, the database has not updated summaries of high-quality evidence on the health impacts of GBV (VAW/IPV) since 2013, which is urgently needed to inform global health policy. In 2018, Bacchus et al additionally reviewed cohort studies that reported on all health outcomes and behaviours related to recent physical and sexual IPV exposure, finding evidence of a positive, bidirectional relationship between these types of IPV and depressive symptoms. 14 Yet, there are fewer reviews investigating exposure types beyond physical and sexual IPV (eg, psychological violence, coercive control, financial abuse, stalking), and those available often define even finer scopes by investigating relationships between narrowly defined forms of violence and narrowly defined health outcomes, for example, mental health and gynaecological morbidity. 15 16

Similar to GBV, there have been attempts to synthesise the literature exploring the breadth of consequences following exposure to VAC and highlighting the relationship between exposure to childhood maltreatment (including CSA) and a wide variety of psychosocial and health outcomes. 17 18 Research into the consequences of VAC has more recently overlapped with the burgeoning literature base describing health outcomes secondary to adverse childhood experiences (ACEs), two of which include direct exposure to violence and the witnessing of parental IPV. 19 A recent comprehensive review highlighted the pervasive harms that ACEs place on health throughout the life-course 20 and in a secondary analysis found that within Europe and North America, a 10% reduction in ACE prevalence could equate to annual savings of 3 million DALYs or US$105 billion. 21 However, despite these efforts to capture the literature on VAC through either exploring childhood maltreatment, CSA or ACEs as the marker of exposure, included studies are often limited to exposure in high-income countries and exclude other forms of violence such as female genital mutilation, trafficking, forced marriage and cyberviolence.

While the existing literature has illuminated the significant health impacts of violence, critical evidence gaps remain. These include the quantification of the health burden of less-studied forms of violence, the health burden of violence in in lower-income and middle-income settings, as well as the integration of violence in childhood and adulthood as an intergenerational issue that could be more effectively measured using a life-course approach. The life-course approach as outlined in the Minsk Declaration essentially recognises that all stages of a person’s life are intricately intertwined with each other, with the lives of other people in society, and with past and future generations of their families. 22 23 In order to do adopt this approach effectively when considering the health effects of GBV/VAC, we must consider that violence can occur at any stage in one’s life (preconception to death) but also that the impact of such event can be inter-generational and societal. Additionally, as highlighted through the reviews cited above, the current research trajectory often creates distinctions between GBV/VAC and other forms of life-course violence such as elder-abuse. 24 However, considering that GBV and VAC share risk factors, co-occur and can lead to compounding consequences across the life-course, there is a clear need to examine these phenomena in unison.

We present a systematic review and meta-analysis protocol to generate estimates of a comprehensive range of health impacts associated with exposure to GBV and VAC. Findings will contribute to the assessment of risk-outcome relationships and attributable burdens of disease within the GBD. To our knowledge, there has been no other systematic review and meta-analysis conducted with such a life-course approach across multiple types of violence.

The presentation of our review design follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines ( online supplemental material 1 ). 25

Supplementary data

Aims of the review.

The aim of this review is to identify and synthesise all available data on the health impacts of exposure to any form of GBV and VAC. This data can then be used to assess risk–outcome relationships and quantify their contribution to global disease and disability burdens.

Specific review questions

How does exposure to GBV and/or VAC impact health across the life-course?
What is the strength of evidence on the associations between exposure to GBV and VAC and different health impacts?
Do estimates of association vary by characteristics of the violence, global region, characteristics of the perpetrator and/or characteristics of the victim?

Definitions

Definitions of violence.

We include in our searches the following terms describing exposure to GBV and/or VAC:

IPV, partner abuse/violence, wife/spouse abuse, dating abuse/violence.
Sexual abuse, rape, forced sex, sexual assault, sexual coercion, sexual exploitation.
Reproductive coercion.
Female genital mutilation, female genital cutting, female circumcision.
Sex trafficking, child, early and forced marriage.
Physical abuse.
Psychological abuse, emotional abuse, verbal abuse.
Economic abuse, financial abuse.
Cyberviolence, cybervictimisation.
Domestic violence/abuse.
ACEs that include direct exposure to and witnessing of violence.
Child maltreatment, molestation, child abuse.
Elder abuse, senior abuse, aged abuse.
Stalking, cyberstalking.
Dehumanisation, torture.
Workplace violence, student abuse, sexual harassment.
GBV perpetrated with a firearm.

We expect author definitions and methods used to measure exposure to vary and will accept all definitions, documenting study definitions and measurement techniques as a part of study-level quality assessment.

Health outcomes

We did not restrict searches to predefined health outcomes and aim to accept all literature reporting an association between violence exposure and health. Definitions of health outcomes and health-related risk factors will be guided by cause, injury and risk factor case definitions from the GBD study. 8 26 Studies that report on certain biomarkers without accompanying clinical diagnoses (ie, neural connectivity patterns, salivary cortisol as a stress response, DNA characteristics) will not be eligible for inclusion. Similarly, studies that report on the presence or number of disease symptoms without an accompanying diagnosis of a health outcome will not be eligible for inclusion. Reviewers will meet regularly to raise questions about eligible health outcomes, with consensus decisions documented and circulated via written guidelines. Differences in measurement methods or case definitions of eligible health outcomes will be documented as a part of quality assessment as well. Final selection of associations to be synthesised will depend on the availability of studies that examine the association between a comparable form of exposure and reported health outcome.

Criteria for considering studies for this review

Study design: case–control, cohort or case-crossover studies.
Participants: Studies conducted in participant groups likely to be generalisable to the population of interest. Exposed groups are defined as any individual who has experienced a form of GBV and/or VAC throughout the lifetime. Comparators will be non-exposed control groups, or study groups without reported exposure to a form of GBV and/or VAC.
Outcomes: Studies reporting an estimate of association (either RR, risk ratio, odds ratio, hazard ratio or similar) or reporting cases and non-cases among those exposed and unexposed. If not provided directly, studies providing enough information to allow an estimate of RR to be calculated will meet inclusion criteria.
Study design: Cross-sectional, ecological, case series or case studies. We exclude cross-sectional studies in accordance with GBD study risk factor analyses, which typically do not include cross-sectional studies. This exclusion reason is related to the inability to assess temporality between exposures and outcomes in cross-sectional studies. We do not anticipate there to be any experimental studies, however, these will also be excluded.
Participants: Studies conducted in subgroups identified only by convenience sampling or subgroups identified via a shared characteristic that is likely related to risk of exposure to violence or the reported health outcome (eg, domestic violence shelter residents).
Exposure measurement: Studies that report only an aggregate measure of exposure combining exposure to a form of violence with other, non-eligible exposures (eg, reports a composite ACE score only) will be excluded. For these studies, we are unable to disentangle the effect of violence exposure from the effects of other hardships or exposure types, preventing their inclusion in our review.
Does not meet minimum reporting criteria: Studies missing essential data, that is, those that do not report effect sizes and uncertainty information (confidence intervals, sample sizes) or the data needed to impute an effect size with uncertainty information.
Studies reporting on the same exposure and outcome using the same data: The study with the longest follow-up time period or most complete dataset will be included.

Search strategy for identifying relevant studies

PubMed, Embase, CINAHL, PsycINFO, Global Index Medicus, Cochrane and Web of Science Core Collection will be searched using controlled vocabulary and keyword search terms. All relevant studies published between 1 January 1970 and 30 September 2021 will be considered, regardless of language of publication or study setting. Immediately prior to preparing final results from the review and meta-analysis, searches will be updated to the current month to retrieve for inclusion any further studies identified. The search strategy for PubMed is provided in table 1 . The search terms for Embase, CINAHL, PsycINFO, Global Index Medicus, Cochrane and Web of Science are provided in online supplemental tables 1–6 , respectively ( online supplemental material 2 ).

Search terms and strategy for PubMed

Search terms	Concept
1. “Sex Offenses”(mh).	Violence exposure
2. “Violence”(mh:noexp).
3. “Domestic Violence”(mh).
4. “Gender-Based Violence”(mh).
5. “Intimate Partner Violence”(mh).
6. “Physical Abuse”(mh).
7. “Rape”(mh).
8. “Torture”(mh).
9. “Workplace Violence”(mh).
10. “Gun violence”(mh).
11. “Battered Women”(mh).
12. “Adult Survivors of Child abuse”(mh).
13. “Exposure to Violence”(mh).
14. “Emotional Abuse”(mh).
15. “Sexual Harassment”(mh).
16. “Harassment, Non-Sexual”(mh:noexp).
17. “Emotional abuse”(mh).
18. “Aggression”(mh:noexp).
19. “Dehumanization”(mh).
20. “stalking”(mh).
21. “adverse childhood experiences”(mh).
22. violence(tiab).
23. “sexual assault”(tiab).
24. “sexual harassment”(tiab).
25. “sexual abuse”(tiab).
26. “sex abuse”(tiab).
27. rape(tiab).
28. “forced sex”(tiab).
29. “sexual coercion”(tiab).
30. “reproductive coercion”(tiab).
31. “sex trafficking”(tiab).
32. “sexual exploitation”(tiab).
33. “forced marriage”(tiab).
34. “child marriage*”(tiab).
35. “early marriage*”(tiab).
36. “child bride*”(tiab).
37. CEFM(tiab).
38. infibulation*(tiab).
39. clitoridectom*(tiab).
40. clitorectom*(tiab).
41. “ritual female genital surger*”(tiab).
42. FGM(tiab).
43. “female genital mutilation”(tiab).
44. “female genital cutting”(tiab).
45. “female circumcision”(tiab).
46. “female genital circumcision”(tiab).
47. “physical abuse”(tiab).
48. “psychological abuse”(tiab).
49. “emotional abuse”(tiab).
50. “economic abuse”(tiab).
51. “financial abuse”(tiab).
52. “verbal abuse”(tiab).
53. maltreatment(tiab).
54. “violent discipline”(tiab).
55. “corporal punishment”(tiab).
56. “adverse childhood experience*”(tiab).
57. molestation(tiab).
58. “child abuse”(tiab).
59. “partner abuse”(tiab).
60. “dating abuse”(tiab).
61. “wife abuse”(tiab).
62. “spouse abuse”(tiab).
63. “domestic abuse”(tiab).
64. “elder abuse”(tiab).
65. “senior abuse”(tiab).
66. “aged abuse”(tiab).
67. victimization(tiab).
68. dehumanization(tiab).
69. victimisation(tiab).
70. dehumanisation(tiab).
71. stalking(tiab).
72. cyberviolence(tiab).
73. cybervictimization(tiab).
74. cyberstalking(tiab).
75. Or/1–74
76. Case-Control Studies(mh).	Study type
77. Cross-Over Studies(mh).
78. Cohort Studies(mh).
79. Systematic Review(pt).
80. Meta-Analysis(pt).
81. “Twin Study”(pt).
82. “systematic review”(tiab).
83. “meta-analysis”(tiab).
84. “cohort”(tiab).
85. “cross-over”(tiab).
86. “case-control”(tiab).
87. “prospective”(tiab).
88. “retrospective”(tiab).
89. “longitudinal”(tiab).
90. “follow-up”(tiab).
91. “followup”(tiab).
92. Or/76–91
93. “Statistics as Topic”(mh).	Risk
94. Risk(mh).
95. Odds Ratio(mh).
96. “risk*”(tiab).
97. “odds”(tiab).
98. “cross-product ratio*”(tiab).
99. “hazards ratio*”(tiab).
100. “hazard ratio*”(tiab).
101. statistic*(tiab).
102. “HR”(tiab).
103. “RR”(tiab).
104. “aOR”(tiab).
105. relation*(tiab).
106. correlat*(tiab).
107. associat*(tiab).
108. likel*(tiab).
109. Or/93–108
110. “1970/01/01”(PDat). : “2021/09/30”(PDat).	Date restriction—all available literature since 1970
75 AND 92 AND 109 AND 110

Data management and extraction

Search results will be merged and duplicates removed using the systematic review management software Covidence. 27 All reviewers will initially screen the first 50 search results and meet to compare screening decisions and clarify any questions with regard to the inclusion criteria. The first two-thirds of titles and abstracts will be screened by two independent reviewers, and JSC, NM and CNS will review and resolve all conflicts that arise during screening decisions. Upon confirmation of a low rate of conflicts (less than 10%) in the first two-thirds of double-screened articles, the remaining third of articles will be screened by a single reviewer. This approach balances the priorities of independent review and completing our review in a timely manner. Non-English publications will be reviewed using the language fluencies (Spanish, French and Portuguese) of the reviewers. Should articles in other languages be retrieved and eligible for extraction, the reviewers will contact colleagues fluent in these languages for assistance.

Reviewers will complete title and abstract screening of all articles before the team proceeds to full-text screening. Studies that met inclusion criteria in title and abstract screening will additionally be full-text screened and excluded if found to meet any of the exclusion criteria. Following the PRISMA guideline, each exclusion will include documentation of a specific exclusion reason. Within Covidence, there are several built-in exclusion reasons (ie, wrong study design, wrong setting, etc) as well as the possibility to create custom exclusion reasons. Reviewers will meet to discuss the addition of custom exclusion reasons prior to beginning full-text review, and will iteratively meet to discuss addition of new reasons as necessary. For full text review, 10% of articles will be reviewed by two independent reviewers and a meeting held to resolve misunderstandings and ensure all reviewers clearly understand inclusion and exclusion criteria. The remaining 90% of articles will be reviewed by one independent reviewer. If reviewers are unable to access the full text of a publication, the reviewers will reach out directly to the corresponding author and wait a maximum of 1 month for response, after which point the article will be excluded.

Data extraction will occur in parallel with full-text review, with some team members beginning to extract data once a sufficient number of full-text articles have been accepted. Before any reviewer begins data extraction, the entire review team will conduct a consensus building exercise in which all reviewers extract data from the same 10 accepted articles. In a group meeting, extractions will be compared and any questions resolved. Reviewers will extract data from accepted articles using a standardised form created in Covidence. 27 The data extraction form will include variables related to (1) characteristics of the study, (2) characteristics of the study population, (3) exposure and outcome measurement, (4) effect size and uncertainty, (5) risk of bias (quality assessment). 28 29 Data items are provided in table 2 .

Variables to be collected in the data extraction process

Category	Data items
1. Study characteristics
2. Population characteristics
3. Exposure and outcome measurement
4. Effect size and uncertainty
5. Risk of bias (quality assessment)

If a study reports on multiple forms of violence exposure, multiple associated health outcomes or reports findings by subgroup or model specification, data pertaining to each subanalysis will be extracted in addition to any aggregate results. In the case of a study reporting effect sizes for multiple model specifications, the most appropriately adjusted model will be selected for inclusion in meta-analysis.

Risk of bias in individual studies

Sources of bias will be assessed and collected during data extraction. Following the Grading of Recommendations, Assessment, Development and Evaluations approach, 29 risk of bias criteria for individual studies include:

Exposure measurement: How exposure to violence was assessed (whether standard, acts-based and specific questions were asked, eg, ‘Have you ever been shoved, slapped, hit, or kicked by an intimate partner?’ versus questions that rely on participants’ own definition of abuse, eg, ‘Have you ever experienced domestic abuse?’). In addition, whether exposure was based on self-reports or another source (eg, health records).
Outcome measurement: How reported health outcome(s) were measured (by physician diagnosis, diagnostic survey instruments, or electronic health records).
Representativeness of study population: If a study sample was based on the general population or if study results are reported from a sub-group for which there are prior reasons to believe that findings would be different.
Control for confounding: If a study statistically controlled for confounding using all major known confounders, including age, sex, education, income and other critical determinants of the health outcome.
Selection bias: If a study is at risk of selection bias, based on per cent follow-up for longitudinal study designs and based on the percentages of cases and controls for which exposure data can be ascertained for case–control designs.
Reverse causation: If a study is at risk of reverse causation, evaluated through study design and opportunity for recall bias (ie, case–control studies). 30

Data synthesis

If there are at least three studies identified with a comparable form of exposure and reported health outcome, we will synthesise effect sizes using a meta-regression—Bayesian, regularised, trimmed (MR-BRT) model. 8 31

For each risk–outcome pair identified, we will use the MR-BRT tool to perform a meta-regression analysis of the risk of the given outcome for those exposed to the violence type relative to the reference category of those not exposed to the violence type. For risk–outcome pairs with sufficient data points, we will introduce likelihood-based trimming to detect and remove outliers before fitting the model, with an inlier fraction of 90%. 31

For each risk–outcome pair meta-analysis, we will consider study-level covariates with the potential to bias the study’s reported effect size estimates and adjust for these covariates if they are found to significantly bias the estimated RR. The MR-BRT tool includes an automated covariate selection process using a Lasso strategy to identify statistically significant covariates at a significance threshold of 0.05. 31 32

The MR-BRT tool quantifies between-study heterogeneity by accounting for heterogeneity uncertainty and small numbers of studies. 31 In this approach, the Fisher information matrix is used to estimate uncertainty of the between-study heterogeneity parameter, γ. 31 33 The final uncertainty estimate reflects both the posterior uncertainty corresponding to the fixed effect and the 95% quantile of γ, which is sensitive to the number of studies, study design and reported uncertainty of the effect size. 31

For each risk-outcome pair, we will additionally test for and report publication bias in the input data based on the Egger’s Regression strategy, which tests the degree to which standard error is correlated with effect size in the data, and present funnel plots. 34 35

Additional analyses

If meta-analysis is not possible with all studies, we will synthesise the included study findings graphically 36 following the systematic review without meta-analysis guidance. This will include forest plots, which will graphically depict all study effect estimates using a single metric (eg, percent change) for each available health outcome and type of violence. 37 To produce the forest plots, we will transform effect estimates to a comparable metric wherever possible (ie, where the necessary data are available in the paper or from the authors). Harvest plots will demonstrate where inequities based on, for example, age of exposure, low-income and middle-income country versus high-income country, gender identity, ethnicity/race, sexual orientation, urban–rural location, exist in the available data. 38 When the necessary data are missing, all study effect estimates will be summarised in supplementary tables and discussed as relevant in text. If the necessary data are available (standardised effect estimate, p value) we will also consider albatross plots to summarise results. 39

Confidence in cumulative evidence

Confidence in risk–outcome pair results will be assessed via the burden of proof risk function (BPRF) methdology developed by GBD 2020 Risk Score Collaborators (unpublished methods). For a harmful risk, the BPRF is the 5% quantile risk function interpreted as the lowest level of risk consistent with available evidence. The average BPRF values across exposure observed in the studies will be summarised into star-rating categories, which are a policy-direct way to interpret the evidence for risk-outcome pairs, with higher star-ratings indicating stronger evidence of an association.

Narrative synthesis

Narrative synthesis will be conducted by grouping studies according to exposure type and health outcome. We will explore the breadth of available evidence across groupings as well as highlight the health outcomes and violence types for which there is stronger evidence than others, drawing on results from meta-analyses and star-rating categories. The description of these patterns will allow us to make recommendations for future research as well as discuss the ways in which distinct types of violence affect health.

Patient and public involvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

The proposed review does not require formal ethical approval. Findings from this review will contribute to GBD estimates of the health impact of GBV and VAC. The GBD includes data on morbidity and mortality from 1990 to present in 204 countries and territories for 369 diseases and injuries and 87 risk factors. 40 It is the most comprehensive worldwide observational epidemiological study to date and a critical tool used by clinicians, policy-makers and researchers. Review findings will inform the GBD assessment of new risks and/or risk–outcome relationships and revisions to the magnitude of currently included associations. Updated global health estimates of the impact of GBV and VAC will be highlighted in consequent GBD releases and accompanying capstone publications.

In addition, this review is being conducted in conjunction with the Lancet Commission on GBV and the Maltreatment of Young People. 41 The aim of the commission is to complete a path breaking report on the global response to violence across the life-course, complete with new data insights and concrete policy and research recommendations that are informed by survivors and advocates. This report will be published by The Lancet in an effort to initiate debate, offer insight and explanation, and influence decision makers across the globe regarding GBV and VAC.

Supplementary Material

Contributors: The initial PubMed search strategy was developed by CNS and refined and adapted to other databases by TJ. The writing and methodological plan for this protocol was developed by CNS, JSC, NM and EG. Further revisions to the protocol were made by all remaining authors (MJB, AD, MH, TJ, JKC, MK, RQHL and SM) and the final copy of the manuscript was approved by all authors.

Funding: This work was supported by the Bill & Melinda Gates foundation grant number INV-018617.

Disclaimer: The funders of had no role in the review design or the writing of the report.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Ethics statements

Patient consent for publication.

Not applicable.

Open access
Published: 03 May 2023

Gender-based violence against women during the COVID-19 pandemic: recommendations for future

Abbas Ostadtaghizadeh 1 ,
Mozhdeh Zarei 1 ,
Nadia Saniee 2 &
Mohammad Aziz Rasouli 3

BMC Women's Health volume 23 , Article number: 219 ( 2023 ) Cite this article

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Gender-based violence (GBV) includes any physical, sexual, psychological, economic harms, and any suffering of women in the form of limiting their freedom in personal or social life. As a global crisis, COVID-19 has exposed women to more violence, which requires serious actions. This work aims to review the most critical dimensions of the GBV against women, effective factors on it, and strategies for combating it during the COVID-19 pandemic in order to provide recommendations for future pandemics.

This study was conducted based on PRISMA-ScR. First, PubMed, Embase, Scopus, Web of Science, ProQuest, and Google Scholar were searched in April 2021 with no time limitation and location using the related keywords to COVID-19 and GBV. The searched keywords were COVID-19, gender-based violence, domestic violence, sexual violence, women, violence, abuse, and their synonyms in MESH and EMTREE. Duplicates were removed, titles and abstracts were screened, and then the characteristics and main results of included studies were recorded in the data collection form in terms of thematic content analysis.

A total of 6255 records were identified, of which 3433 were duplicates. Based on inclusion criteria 2822 titles and abstracts were screened. Finally, 14 studies were eligible for inclusion in this study. Most of these studies were conducted in the United States, the Netherlands, and Iran, mostly with interventional and qualitative methods.

Conclusions

Strengthening ICT infrastructure, providing comprehensive government policies and planning, government economic support, social support by national and international organizations should be considered by countries worldwide. It is suggested that countries provide sufficient ICT infrastructure, comprehensive policies and planning, economic support, social support by collaboration between national and international organizations, and healthcare supporting to manage incidence of GBV against women in future pandemics.

Peer Review reports

Introduction

International definitions of gender-based violence(GBV) and violence against women have emerged since the early 1990s [ 1 ]. GBV is a phenomenon deeply rooted in gender inequality, and continues to be one of the most notable human rights violations within all societies [ 2 ]. GBV as a main violence against women includes any physical, sexual, psychological, economic, and also any suffering of women in the form of restricting their freedom in personal or social life [ 3 ]. Most sexual violence is related to interpersonal relationships includes domestic violence, sexual violence, forced marriage, female genital mutilation, harassment, violence and abuse, and human trafficking [ 3 , 4 ].

As an example of the impact of GBV on women, the results of studies from 2000 to 2018 showed that more than one in four women (27%) between the ages of 15 and 49 had ever have had a sexual partner, experienced physical or sexual violence, or both, since the age of 15 [ 5 , 6 ].

In the past, crises have been associated with increased cases of GBV in natural disasters, including the earthquake in Haiti in 2007, Hurricane Katrina in 2005, and the eruption of Mount St. Helens in the 1980s due to unemployment, family, and other stressors has been reported [ 7 , 8 , 9 , 10 ]. According to researchers, epidemics cannot be excluded from this [ 11 ]. Recent outbreaks such as Ebola, Cholera, Zika, and Nipah have also led to an increase in cases of domestic violence [ 12 ]. Also, cases of sexual assault, violence against women, and rape also increased during the Ebola outbreak in West Africa [ 13 ].

GBV, already a global crisis before the pandemic, has intensified since the outbreak of COVID-19. Lockdowns and other mobility restrictions have left many women trapped with their abusers, isolated from social contact and support networks [ 14 ].

Health guidelines on quarantine and “stay home” during COVID-19 pandemic expose women to further damages. In this situation, many countries around the world, such as the United States, Ireland, China, the United Kingdom, and African have experienced a dramatic increase in domestic violence, which is one of the dimensions of GBV [ 4 ]. The results of studies have shown that China has witnessed a three-fold increase in domestic violence cases after the imposition of quarantine, and an increase of 21 to 35% in domestic violence was also reported in different states of the United States [ 15 ].

In the absence of a vaccine or effective treatment for Covid-19, quarantine for various periods of time has been used as an option by most countries, leading to lifestyle changes [ 16 ]. Most of the work is done from home and efforts are made to maintain social distance. These measures are critical to protecting health care systems [ 17 ]. However, positive efforts to combat COVID-19 have negative consequences associated with them. These negative consequences include the risk of job loss, economic vulnerabilities, and mental health issues due to isolation, loneliness, and uncertainty [ 16 , 17 ].

Considering the importance of maintaining the safety and health of women as half of a society and their key roles in the family, especially during pandemics and crises, and looking at existing studies shows that different research have been carried out by one of the methods of literature review regarding one aspect of GBV against women. Organizations, researchers and civil society representatives have warned of an increase in reports of GBV against women during the Covid-19 pandemic. Concerns about this issue have been expressed through official and unofficial networks, and they have emphasized the need to create effective interventions to prevent and combat this phenomenon. The urgency of this situation requires an analysis of the available scientific literature on strategies and recommendations to deal with GBV against women in the context of social distancing measures adopted as a response to the COVID-19 pandemic.

This scoping review is directly aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Check- list [ 18 ]. The present study seeks to answer the following questions:

What were the most important dimensions of the gender-based violence against women during the COVID-19 pandemic?

What were the effective factors on increasing the gender-based violence against women during the COVID-19 pandemic?

What were the most important strategies to combat the gender-based violence against women during the COVID-19 pandemic?

Which strategies are recommended to manage the gender-based violence in future pandemics?

Protocol and registration

We utilized the scoping review framework by Arksey and O’Malley (2005), as well as recent guidance to increase rigor and reporting of scoping reviews [ 19 ]. The a priori protocol for this review was drafted using the PRISMA extension for Scoping Reviews [ 18 ]. Due to the rapid nature of this review, the protocol for this review was not published, but can be accessed by contacting the authors.

Eligibility criteria

The inclusion criteria were: Original articles, narrative reviews, short communications, and grey literature related to the GBV against women during the COVID-19 pandemic; Availability of Full-text; Published in the English.

The exclusion criteria were: Case studies, notes, letter to the editor, editorials, comments, conference papers, perspectives, systematic reviews, meta-analysis; and scoping reviews: studies related to domestic violence and sexual violence alone; studies focusing on the GBV against children and men.

Information sources

We searched PubMed, Embase, Scopus, Web of Science, Proquest databases, and Google Scholar in April 2021 without time limitation and locations. The searched keywords were COVID-19, gender-based violence, domestic violence, sexual violence, women, violence, abuse, and their synonyms in MESH and EMTREE. The search strategies were provided by NS and approved by MZ. The search strategy for each database is mentioned in Appendix 1. The references of included documents were also reviewed to identify more related articles.

Selection of sources of evidence

All searched records were imported into EndNote-8. After removing duplicates, the title and abstract of studies were screened. Finally, related full-texts were selected and then confirmed them. The most important reason for removing studies in the screening phase was focusing on other kinds of violence than GBV.

Data extraction

A data extraction form was developed using Excel spreadsheet and bibliographic characteristics of each document including the first author, year of the research, research method, dimensions of the GBV against women, effective factors on it, and strategies for preventing it were recorded by MZ and approved by NS.

Synthesis of results

The data analysis steps included familiarizing with the concept, determining primary codes, searching for semantic units in the text, reviewing semantic units, defining and naming semantic units, and reporting [ 20 ]. First, the gender-based violence was considered as a main theme. Second, dimensions of the GBV, effective factors on it, and key strategies for combating it during the COVID-19 pandemic were determined as sub-themes, then overlapping themes were merged together. Finally, narrative methods were applied to synthesize the extracted results and main strategies were recommended for future pandemics.

After performing the search, a total of 6,255 records was identified, of which 3,433 were duplicates. In terms of inclusion criteria, 2822 titles and abstracts were screened. After studying 22 full texts, 14 ones were eligible for including in the study (Fig. 1 ).

PRISMA diagram of search and selection process

Quality assessment

The quality assessment of studies was not done due to the different methodology of the included studies and the type of review (Scoping reviews) [ 21 ].

Measure characteristics

The bibliographic characteristics of these studies are presented in Table 1 . The results showed that Turkey, the United Kingdom, the United States, and South Africa had the highest number of studies with two articles, and Indonesia, Italy, Nigeria, Colombia, Ecuador, and Brazil had the lowest number of studies with one study. Eight of these studies were conducted in the form of literature review and analysis of government documents, while two studies were survey, two studies were qualitative, one was observational, and one was a mixed methods study. A total of 12 studies were conducted in 2020 and two studies in 2021.

Psychometric evaluation

In this section, we answer the research questions and then recommend main strategies for combating gender-based violence against women in future pandemics.

Dimensions of gender-based violence against women during the COVID-19 pandemic

The review of the literature showed that GBV against women is more in the form of verbal, emotional, psychological, physical, sexual, family, structural (government and community), economic, inheritance, online and dating, access to health, deprivation of liberty in community and personal life, femicide, and ultimately suicide.

Yenilmez stated that during the COVID-19 pandemic, the most important forms of GBV against women were physical, psychological, and sexual violence by their sexual partners, so that one in three women has faced this violence. Home quarantine is one of the factors that have contributed to this issue [ 4 , 22 ]. Violence against women can be structural and direct. Structural violence is created through social and governmental laws and makes women economically dependent on men, while direct violence is related to family relationships and in the form of sexual violence and death. There are six types of GBV against women in Colombian society, including sexual, physical, psychological, inheritance, economic, and digital. This violence occurs at the level of family, workplace, university, community, organization, and in the form of genocide. In the private sector, this violence is emotional, physical, economic, and sexual, occurring in the scientific environment, workplace, community, and family. Violence against women is not just a matter of appearance; it is also in the form of placing them second to men. Violence against women in countries like Colombia and Mexico is not just related to family relations or marriage; it also includes criminal and drug-related violence. Thus, violence is divided into two categories: sexual partner violence and non-sexual partner violence [ 23 ].

Magezi stated that most GBV against women is in the form of physical, psychological, economic, and sexual violence perpetrated by sexual partners. Synonymous terms for violence by an emotional partner include “wife beating “, “beating”, and “domestic violence” [ 24 ]. The GBV is defined by Jatmiko as physical, sexual-psychological violence, suffering and social exclusion. Social networks created another type of gender-based violence as online gender-based violence. The justification for this online GBV is institutionalized patriarchy in cyberspace. This culture naturalizes GBV against women and ignores men’s mistakes in the form of online rape. Many cases of online gender-based violence include; virtual chats, rape videos, sex chat, taking photos of model women and broadcasting them in cyberspace or threatening to broadcast them if they do not have sex, and selling pornographic photos as an illegal trade have been reported by women [ 25 ].

Factors affecting the incidence of gender-based violence during the COVID-19 pandemic

According to the literature, the most important factors affecting the incidence of GBV against women during the COVID-19 pandemic were quarantine and social distancing and the resulting stress; lack of access to social support for women and girls, women’s employment in the private and informal sectors; gender inequality and patriarchal social norms; failure to investigate cases of GBV by police and not prosecuting criminals, economic problems due to quarantine and unemployment of men, women’s unemployment and women’s economic dependence on men, women’s employment; alcohol and substance abuse by sexual partners and spouses, the digital gap in e-learning and access to social networks, the lack of transparent rules and registration system of real cases of GBV against women, age and level of education of women; no basic government regulations; the perception of violence against women as hallmark by the family and society, previous abusive relationships; dependence on children, threatening to kill women and children by men and not prosecuting online criminals. GBV against women increased with the beginning and continuation of quarantine and social distancing in COVID-19 pandemic [ 4 , 22 , 24 , 26 , 27 , 28 , 29 , 30 ]. Violence against women is more common in public [ 3 , 26 ], but during the quarantine, gender-based violence against women was more prevalent in the home and less in public. This has imposed a great psychological burden on women [ 24 , 27 , 28 , 29 ]. No accurate reporting of violence against women causes does not receive much attention from governments. Women themselves may refuse to report it. Irregular distribution of this phenomenon in the whole population also causes the “classical elusive phenomenon”, which will affect the data collection. Violence against women is stigmatized by the family and society, and women refuse to report it [ 23 ]. The absence of clear internal rules and registration systems for GBV causes the lack of knowledge about the real cases of GBV against women and the confrontation of governments with it [ 3 , 27 ].

The presence of men in the home does not mean their participation in household chores; men’s lack of cooperation in household chores, raising children and caring for the disabled and the elderly has imposed a great psychological burden on women and prevented them from earning money. Also, the laws and patriarchy have influenced the employment of women, especially during COVID-19 pandemic. So, women cannot play their political, social, and economic roles [ 22 , 23 ]. Women horizontal inequality includes political inequality, inequality in access to education, and fertility rates that can lead to economic inequality and consequently violence against women. In terms of gender, this inequality places women in the minority group. Thus, the economic, social, and cultural implications of COVID-19 have made women the main victims of this pandemic [ 23 ].

Valencia et al. reported that declining political and economic role of women, unfavorable working conditions, women economic dependence on men, have led to sexual, physical, and psychological violence against women and even their death in the public and private sectors. So, government and social laws have encouraged this violence [ 23 ]. Lack of attention to menstrual health needs during quarantine in developing societies has also affected sexual health and reproduction in vulnerable women. The closure of schools during the pandemic and the online education has caused many problems for female students. Marginalization, mental health problems, digital gap, the stress of working at home, and uncertainty about the future affected female students during the pandemic. Also, quarantine financial pressures on families led to girls’ employment or early marriage [ 23 ].

Lack of services such as women’s rights network, health workers and teachers, in the pandemic lockdown has led to an increase in violence. Womens’ working in the informal sector reduces access to care and treatment facilities [ 4 , 23 ]. Magezi stated that the weak economy, alcohol consumption at home, lack of access to socio-psychological support from religious and non-religious counselors, relationship with the abusive partner and staying with him for a long time during quarantine, lack of income and stress and economic dependence on spouse have led to an increase in GBV during the pandemic in Zimbabwe. In this country, most GBV is perpetrated by spouses. These women are eventually killed or commit suicide due to emotional depression, restrictions and beating. Concerns about children and fear of losing them due to divorce, lack of income, separation from family and friends, lack of access to social resources and religious centers, and lack of support from them, cultural and religious concepts instilled in women that they are inferior to men, threatening to kill their wives or children or themselves, as well as threatening women to leave home or exposing their husbands’ abuse, are factors associated with the increase of GBV against women during the COVID-19 pandemic [ 24 ].

Lund et al. reported that lack of access to shelters due to their conversion into medical centers or closure to prevent the spread of the disease is reason for the increase of the GBV [ 27 ]. In a study by Afu, quarantine and being long hours at home, economic problems, anti-woman norms in society, and alcohol consumption were presented as the main causes of GBV against women in Nigeria [ 31 ]. John et al. also reported that quarantine ,lack of access to services needed by women and girls and the use of existing services to prevent the transmission of COVID-19, economic problems of families, lack of police intervention and imprisonment of aggressors due to fears of outbreaks, turning the women’s shelter into a shelter for homeless people, the lack of accommodation for new people in the women’s shelter due to concerns about the spread of the disease and expressed anti-woman social norms as the factors that increase GBV against women [ 30 ]. Speed et al. stated that essential reasons for gender-based violence against women are the result of inequality of women’s power due to patriarchal social structures. Also, the stress, anxiety, and economic strain caused by a pandemic can contribute to this. Drug and alcohol use, inability to support family expenses, isolation of women, and overcrowding during the quarantine have increased GBV. The closure of asylums and non-accepting new people in accordance with government policies or at the request of the residents of these settlements has reduced the access of victims of sexual violence to these places during COVID-19 pandemic. This will have an adverse effect due to the increase in domestic violence cases and the decrease in the budget for refugees. As a result, the income of support organizations will decrease and their performance will be unfavorable in the future [ 3 ]. Lack of access to communication devices such as mobile phones and Internet are other aggravating factors [ 4 ].

Research and practice recommendations

Social support.

Marceline Naudi, chair of the Council of Europe’s Group of Experts declared that guidelines are among the most important ways to reduce GBV against women. Examples of these guidelines were developed by the European Convention on Prevention and Control in Turkey. Providing welfare and support services such as information centers and active helplines, including the numbers and addresses of local caregivers, and raising awareness among young women and girls are other ways to combat violence against women during pandemics. Italy, for example, used the number “1522” as a helpline for victims of sexual violence during the COVID-19 pundemic. Providing support lines in Australia, France, and the United Kingdom are another cases. Providing anti-violence policies is another approach used by France, Italy, and Spain. Providing shelter for victims, such as hotels, and providing care and accurate recording of violence against women have been other ways of combating GBV. In Italy, according to the law, criminals must leave the family, not the victims. Canada has also announced Sexual Victim Care Centers as part of its support package [ 4 , 22 ]. Colombia has also set up special hotlines to record and track GBV against women. The calls are usually made to the public emergency. It is necessary to teach young women and girls in urban and rural areas how to use these lines. Women’s advocacy movements can also be effective in exposing violence against women and strengthening existing policies [ 23 ].

Establishing women’s advocacy centers in the form of legal, psychological, and health protections, establishing transparent government laws to protect women during pandemics, establishing local support systems, reviewing court rulings, and strengthening social support networks for families could be effective for women under GBV [ 22 , 23 ]. The provision of these services should be based on maintaining the confidentiality of victims’ information and increasing their ability and life expectancy of their children. With a comprehensive approach, governmental and non-governmental organizations can work together to provide these services [ 32 ]. For example, UNICEF uses the AAAQ (Availability, Accessibility, Acceptability, and Quality) framework to measure victims’ access to social services through some questions. Supporting organizations should report the list of types of violence and lines of communication through websites, radio, television, and social networks [ 28 ].

Due to the impact of alcohol consumption on violence against women, South Africa has banned the sale of alcohol in clubs. Another strategy to support women was to provide support packages for women during COVID-19 pandemic, so-called “dignity kits”. People in the community should feel responsible for each other and receive the necessary training in this regard [ 4 , 22 ]. Supporting organizations should increase the number of hours and days of service delivery and inform about this. These services include social support (food packages, emergency housing payments for families and providing toy packages for children), provision of educational packages for schools and training individuals and organizations that may be contacted by victims during COVID-19 pandemic [ 3 , 32 ].

Community-based services can be effective in improving gender roles and determining the extent and nature of gender-based violence. The provision of refugees support services, such as accommodation in hotels and hospitals, has been provided by countries such as France, the United Kingdom, and Germany. Speed mentioned the establishment of a suitable accommodation for refugees and performing COVID-19 diagnostic tests, a 6 to 12-month support services after quarantine, and preparing a guide for appearing in court and police cooperation [ 3 ]. Humanitarian organizations can also provide services and collect the necessary data [ 32 ]. Churches can support women and even change men’s behavior by providing spiritual support [ 24 ]. Emergency housing for homeless women, providing individual sexual, physical, and psychological care services, training psychologists to provide basic services to victims, developing protocols and guidelines for combating GBV, women’s violence support centers in the form of psychological support, providing counseling services to couples on the adverse effects of GBV, educating and holding training seminars for girls in schools on marriage and the causes of sexual violence, and the importance of marital relations compared to other relations and trying to maintain it were stated as the most important strategies to deal with GBV [ 29 , 31 , 33 ].

Providing online counseling services and creating a safe environment can be effective in promoting women’s mental and psychological health. Also, health workers and psychologists need to be trained and equipped [ 4 , 22 ]. Caregivers must also have the skills, knowledge, and patience to help victims. Health care professionals need to be aware of the dangers and consequences of GBV and provide the necessary patient care, such as post-traumatic care. For older, disabled, poor women and minority, it is better to use tele-medicine [ 32 ]. Cooperation between health organizations and non-governmental organizations to support women in order to protect women who are under gender-based violence is also necessary [ 27 ]. Providing tele-medicine services is helpful to assist women and girls in preventing pregnancy or miscarriage, as well as providing online guidance and training for them [ 30 ].

Government support

Amendments to government laws protecting the family must be considered. These laws include electronic control, the suspension of prison sentences, the creation of online crime registration and payment portals, the creation of virtual services to support sexually abused women, financial support for women, and women’s participation in charity [ 4 , 22 ]. Governments also need to prioritize their work and provide services to victims [ 28 ]. Governments’ planning to support women and create a safe work environment for them is necessary. Government actions include the provision of primary care, efficient and adequate health care infrastructure and manpower, adequate resources, and support services (telephone and Internet lines, counseling, and shelters for women subjected to gender-based violence). Governments need to learn from previous pandemic experiences and find ways to reduce the harm to women in future pandemics. Police cooperation is another solution by providing advice and creating a safe space in the house without the access of intruders [ 32 ]. Cooperation and participation of governmental and non-governmental organizations at the national and international levels such are other solutions used. Providing homework assignments during the pandemic, food and social security programs, especially for bisexuals who are more prone to gender-based violence are among solutions used [ 24 ]. In the United Kingdom, the government supported GBV organizations during COVID-19 pandemic by allocating financial packages. Evidence shows that providing funding and a financial recording system for small victim advocacy organizations can be helpful. Government financial support for women can take the form of employment and participation in charity activities, such as making face mask [ 4 , 22 ]. In Bangladesh, evidence has shown that households who offered interest-free loans to expedite men immigration have reduced spouses’ physical and sexual violence by 3.5% during six months. Also, women’s employment and income can reduce financial dependence and violence against them. Therefore, governments need to plan to support women and create a safe work environment for them. The use of evidence-based programs and policies to support women entrepreneurship and advocacy organizations is another strategy [ 32 ].

Information and communication technology

Using the code in France, Italy, and Spain for reporting suspicious cases is a protective measure. The covert mobile apps to show signals that abusive people are close has been used in the United Kingdom and Italy. Working with these mobile-based applications should be easy and the incident can be reported to the police with just one click [ 4 , 22 ]. Another option was to set up pop-up booths by organizations supporting women under GBV in supermarkets and pharmacies. In Colombia, creating a safe space for victims in supermarkets and pharmacies in the form of telephone counseling rooms was on the agenda. These hotlines have been used for forced marriage counseling, sexual violence, men’s counseling, and domestic violence counseling in the United Kingdom. Maintaining confidentiality and privacy in the consulting lines particularly in the web environment is necessary [ 3 ]. Supporting organizations are advised to provide a list of violence types and ways of communication through websites, radio, television, and social media [ 28 , 33 ]. The Home Secretary’s “You Are Not Alone” campaign was another initiative in the UK. The campaign was designed to inform at-risk individuals so that they can access to support services and the police. Other initiatives included providing online victim support and Fujitsu security support to provide IT infrastructure for smaller charities. Remote court services can also be used to hear statements made by victims of gender-based violence. The service was used in the UK via Skype and the cloud video platform. Complaints and follow-up guidelines should be posted on the websites of organizations supporting women victims of gender-based violence, legal centers, and social media. Security and definition of access on these platforms is important. The police can also receive the statements of victims and witnesses by phone and receive confirmation of the statements by electronic or non-electronic signature via email or mail. Also, virtual interviews or virtual and face-to-face interviews can be used depending on the importance of the issue. Many women are also uncomfortable holding these sessions at home due to the presence of children; in this case, it is necessary that family courts to be held in the short session. Information on courts and available legal centers during the pandemic should to be provided. Support counseling in the form of online services is of particular importance [ 3 , 27 , 30 , 32 ]. An example of such services is CEPAM-Guayaquil Telephone Consulting in Ecuador. In Italy, the National Network of Domestic Violence Shelters has provided support services via Skype and telephone [ 30 ].

Launching campaigns to combat GBV against women, such as the “Red Mask” campaign, was another strategy. The campaign was launched first in Spain, then in France, Chile, and Argentina under the code “Mask 19”. Argentina used WhatsApp, mobile, and emails to connect more with victims. Public and private campaigns prevented more victims from being at risk by using silent methods such as codes. Another campaign was to raise awareness among rapists about the consequences of GBV. But there was no national system for accessing resources. Access to information on actions taken by governmental and non-governmental organizations to combat gender-based violence can contribute to evidence-based policies [ 28 ]. Creating an accessible service database for victims of gender-based violence is essential. An example of this database in the UK is the “Companies House or the Charity Commission”. This database provides easy access to services for victims and payment to organizations in a convenient way. Holding webinars and online training programs can affect the staff cooperation of sponsoring organizations. Community-based services can also be effective in improving healthy gender roles and determining the extent and nature of GBV. Speed suggested government support for educating charities to attend online and provide training programs for victims [ 3 ]. In order to get acquainted with the needs and barriers to providing services to them, women also should be involved in service decisions. Collected data during the crisis should be segregated by age and gender [ 30 ]. Based on this scoping review, we recommended strategies for managing GBV against women in future pandemics is as follows (Fig. 2 ).

Recommended strategies for managing GBV against women in future pandemics is as follows

In this scoping review, we provided a comprehensive synthesis of the published literature on GBV against women in the COVID-19 era. Results of this work showed, the COVID-19 as an emerging disease spread rapidly, and then many problems arose for the people worldwide, one of these challenges was the increase of violence against women. Dealing with GBV against women required identifying its dimensions, effective factors on it, and strategies to reduce it, which was done in the present study.

We found that the most common GBV against women were physical, sexual, psychological, emotional, economic, digital and virtual, substance use, structural (society and law), verbal, deprivation in personal or social life, femicide and suicide. Stark study showed that the common forms of GBV were sexual partner violence, physical violence, sexual violence, and rape that it mostly happens outside the house [ 34 ]. In a study by Mittal, the most common forms of GBV were physical, sexual, emotional, domestic and female genital mutilation which was similar to this study [ 16 ]. Results of other study showed that most common types of violence against women are psychological/verbal, physical, and sexual, respectively. There was a significant relationship between couples’ age gap, forced marriage, husband addiction, income, and history of violence experienced by the husband with domestic violence against women [ 35 ]. Also, study in Uganda reveals several factors associated with increased risk and vulnerability to GBV during COVID19. Socio-economic status particularly linked to low education achievement (primary education) and the need for assistance to access health care was associated with higher likelihood to experience increased risk and vulnerability to GBV [ 2 ].

These studies showed that the incidence of violence against women had increased due to quarantine conditions and social distancing during the COVID-19 pandemic.

The most GBV before COVID-19 occurred outdoors. In other words, the type of GBV against women during the quarantine is different from before, this can be due to the presence of men at home for more times because of job loss and mental and emotional distress caused by economic problems. Also, the difference between types of GBV among countries can be caused by cultural differences and their level of development. This requires the development of livelihood packages and financial assistance managed by the policy makers of a country.

A review of the existing literature showed that the most common factors influencing the incidence of GBV against women in the COVID-19 era were: lack of access to social support for women and girls, women’s employment in the private and informal sectors, gender inequality and patriarchal social norms, failure of the police to deal with cases of gender-based violence and the prosecution of perpetrators, economic problems due to quarantine and unemployment of men, women’s unemployment and women’s economic dependence on men, alcohol and substance abuse by sexual partners and spouses, the digital gap in e-learning and access to social networks, lack of clear laws and a system for recording real cases of gender-based violence against women, age and level of education of women, lack of basic government regulations, the perception of violence against women as hallmark by the family and society, previous abusive relationships, dependence on children and failure to prosecute online perpetrators of gender-based violence. However, quarantine has been effective in reducing disease transmission, but because of job losses, economic and psychological problems, loneliness and insecurity violent behaviors such as gender-based violence against women have increased. In Mittal study, they pointed out the lack of accurate reporting of cases of GBV during the pandemics, which shows that countries do not pay enough attention to this issue in critical situations [ 16 ]. In addition, results of other studies revealed an association between female sex and more risk for burnout [ 36 ]. Based on literature, females have a tendency to be more susceptible to experiencing the signs of stress particularly, nurses [ 37 ].

Therefore, the establishment of comprehensive national systems for recording and addressing cases of GBV should be on the agenda of governments.

Besides, the laws and traditions that govern society are other causes of GBV against women. Patriarchal societies place women second to men, and this provides the basis for all kinds of GBV against them [ 38 ]. In order to reduce GBV against women, it is suggested that in traditional societies where women have less freedom, arrangements should be made to educate them from school age so that they become familiar with their basic rights. It is necessary that supporting legal institutions follow up and deal with any violence in countries. These trainings should not be limited only to women, but it needs to take action in the whole society regarding any kind of violence against women, and every person should consider himself responsible in this regard. These necessities must be prepared before any crisis, especially pandemics. The issue of government financial support should also be paid to the attention of countries in order to create a sense of financial security in difficult situations. The lack of financial security can lead to all kinds of violence in society, the majority of which will be directed at women.

Arthur and Clark stated that one of the reasons for the increase in GBV against women is their economic dependence on men, which is exacerbated by quarantine due to women’s employment in the private and informal sectors [ 39 ]. Also, women have fewer remote working conditions than men, which make it difficult for them to adapt [ 14 ]. This not only increases the risk of GBV but also makes it impossible to leave spouses and sexual partners. Accordingly, it is necessary for governments to pay attention to the financial needs of women in a pandemic situation and put women distance working on their agenda to reduce their financial dependence on their spouse. The increase in refugees due to the economic problems caused by the pandemic will cause them to be unable to meet their daily needs and as a result the GBV against them will increase. This requires countries’ policies and financial planning to control and reduce the influx of refugees to manage their access to health care services, psychological counseling, courts, police and housing.

On the other hand, outbreaks of pandemics such as influenza, swine flu, and SARS have caused psychological problems in the form of substance and alcohol use, anxiety, and depression that have persisted since the end of the pandemic [ 40 , 41 ]. Results of systematic review showed that the prevalence of postpartum depression in women was relatively high during COVID-19 [ 42 ].

These psychological problems caused by pandemics lead to a variety of violence such as gender-based violence [ 43 ]. Therefore, it is necessary to provide psychological health care services and training for resilience in such situations for women and young girls. Due to pandemic conditions it is better to provide these services in the form of distance counseling and education. However, gender-based violence against women is not limited to pandemic conditions; it also occurs in natural disasters such as floods, earthquakes, and hurricanes [ 44 , 45 ]. According to the Yasmin study, cases of sexual violence in the form of rape and sexual abuse increased significantly during the Ebola outbreak in South Africa [ 46 ]. Given the distinction between different crises caused by natural disasters, war, or the prevalence of diseases and their specific characteristics, it needs to conduct studies to provide a model and solution to combat violence against women.

This review showed that during the COVID-19 pandemic, various measures have been taken to combat and reduce GBV against women by countries, which can be a guide for similar events in future pandemics. The main strategies were divided into five categories: government support in the form of policies and planning, social and humanitarian institutions support, government economic support, health organizations support and using cyberspace to provide health care, remote courts, remote police, online counseling and training of under GBV women. According to Campell, the most important step in combating gender-based violence is to raise people awareness about the importance of gender-based violence [ 44 ]. Other effective measures are the establishment of communication channels through telephone and the Internet to report cases of gender-based violence, counseling, training and follow-up [ 47 ]. The current study revealed the emphasis of the studies on this issue. However, educating individuals should not be limited to victims; rather, all members of society should be responsible, report cases of gender-based violence and help victims voluntarily [ 48 ]. Health care providers should also be trained in identifying and addressing symptoms of violence and taking effective and timely action for victims [ 49 ]. Social media can also help to educate victims by publishing guidelines, advertisements and raising awareness [ 50 ]. This review showed that legal and accountable centers such as the police and medical and social support centers can publish details of access to services through their websites or social networks and help victims. Another measure is the establishment of emergency hotline to support victims. Various studies have pointed to the training and use of staff who are specialized in psychology, psychiatry, social, and legal services, as well as emergency alert systems in grocery stores and pharmacies, cloud and online platforms, online text chat, online courts, shelters, policy-making and government funding [ 16 , 51 ]

Overall, one of the strengths of this study was to provide a comprehensive perspective on the dimensions of GBV against women, factors affecting it, and ways to deal with it during the COVID-19 era, which had not been done before in the form of a scoping review.

Limitations

However, this study also had some limitations that one of them was the lack of access to the full-text of numerous studies, which was attempted to be accessed through correspondence with their authors on social networks. Another limitation of this study was not including studies such as proceeding papers, perspectives, commentaries, articles and grey literature in other languages. Also, the lack of quality assessment of the studies was another limitation of this research, which was not done because of different methodology of the included studies. Therefore, due to the lack of serious attention and almost ignoring the issue of gender-based violence against women in critical situations such as pandemics, it is suggested that researchers in different countries investigated effect of the recommended strategies to combat gender-based violence that can be used in future pandemics and crises.

The results showed that GBV against women accrues more in the form of verbal, emotional, psychological, physical, sexual, family, structural, economic, inheritance, online and dating, access to health, deprivation of liberty in community and personal life, femicide, and suicide. Various factors affected the occurrence of GBV against women during the COVID-19 era such as quarantine and social distancing, lack of access to social support, women’s employment in the private and informal sectors; gender inequality, economic problems, alcohol and substance abuse, the digital gap, no basic government regulations, etc. It is suggested that countries provide sufficient ICT infrastructure, comprehensive policies and planning, economic support, social support by collaboration between national and international organizations, and healthcare supporting to manage incidence of GBV against women in future pandemics. The consequences of GBV for its victims are long-lasting and rampant for responses that are often inadequate. Hence, it is important to maintain urgency in cases of GBV even in critical situations. Based on the results of the reviews, the need for a comprehensive response model to address the issue of gender-based violence during current and possible future pandemics is essential. The opinions of health professionals, formal and informal media, and community efforts must be combined to effectively address the issue of gender-based violence. Additionally, continued and serious efforts are needed to end the stigma associated with gender-based violence.

Data Availability

The data that support the findings of this study are available from the corresponding author but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the corresponding author.

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The authors thank collaboration the Clinical Research Development Unit, Kowsar Hospital, Sanandaj, Iran.

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Ostadtaghizadeh, A., Zarei, M., Saniee, N. et al. Gender-based violence against women during the COVID-19 pandemic: recommendations for future. BMC Women's Health 23 , 219 (2023). https://doi.org/10.1186/s12905-023-02372-6

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Addressing Gender-Based Violence: A Critical Review of Interventions

Andrew Morrison (corresponding author) is a lead economist in the Gender and Development Group at the World Bank; his email address is [email protected] .

Mary Ellsberg is senior advisor for Gender, Violence, and Human Rights at PATH; her email address is [email protected] .

Sarah Bott is an independent consultant; her email address is [email protected] .

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Andrew Morrison, Mary Ellsberg, Sarah Bott, Addressing Gender-Based Violence: A Critical Review of Interventions, The World Bank Research Observer , Volume 22, Issue 1, Spring 2007, Pages 25–51, https://doi.org/10.1093/wbro/lkm003

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This article highlights the progress in building a knowledge base on effective ways to increase access to justice for women who have experienced gender-based violence, offer quality services to survivors, and reduce levels of gender-based violence. While recognizing the limited number of high-quality studies on program effectiveness, this review of the literature highlights emerging good practices. Much progress has recently been made in measuring gender-based violence, most notably through a World Health Organization multicountry study and Demographic and Health Surveys. Even so, country coverage is still limited, and much of the information from other data sources cannot be meaningfully compared because of differences in how intimate partner violence is measured and reported. The dearth of high-quality evaluations means that policy recommendations in the short run must be based on emerging evidence in developing economies (process evaluations, qualitative evaluations, and imperfectly designed impact evaluations) and on more rigorous impact evaluations from developed countries.

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CAUSES AND EFFECTS OF GENDER-BASED VIOLENCE. A CRITICAL LITERATURE REVIEW

December 2021
Journal of Gender Related Studies 2(1):43-53
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Social intervention that facilitates recovery from gender-based violence: dialogic reconstruction of memory.

1. Introduction

2. materials and methods, 2.1. information extraction techniques, 2.2. participants, 2.3. analysis, 3.1. dialogic reconstruction of memory: dialogues that break emotional dependence.

A: And I questioned whether or not he was an abuser, because talking to friends, who are no longer friends, they said to me, “Are you sure that he was? Are you sure that he abused you?” And I felt very questioned. I didn’t see him as an abuser and so that made me doubt a lot whether he really was or wasn’t. (Woman survivor of violence, 50 years)

So for me, for example, in my case, what helped me a lot is that she (friend) made me think, that is, instead of telling me directly, she said to me, “but do you think that if this happened, he would support you?” In other words, she put me in the position of thinking, and I said, “Jeez, this is not normal”. Because in the end you normalise your relationship so much, because you don’t see it from another perspective, from the outside, that it makes you realise that if this were happening to someone else, it wouldn’t be normal. So, she would give me those examples, and she would give me cases that I realised, so she would give me cases and I would start to open my eyes, and she would tell me, “He is mistreating you psychologically, I have been seeing you for years, you are getting sadder and sadder, you are no longer you”, and that was when I started to realise the mistreatment. (Woman survivor of violence, 36 years)

3.1.1. Characteristics of Interactions in the Dialogical Reconstruction of Memory with Women Victims of Gender-Based Violence

She doesn’t help me by saying, “You have to do this”. What she does is try to get me to think, to reconsider… (…) She never tells me, “You have to do this”. No, she makes me think, reflect, both with me and with my daughters. (Woman survivor of violence, 44 years)

In my ignorance, I thought, “They’re going to make me crazy with the feminist stuff, that he’s the bad guy…” Of course, I still didn’t have a clear idea that I had been mistreated, so I thought, “They’re going to beat him up or I’m going to beat him up, and he doesn’t deserve it”. In other words, I had a totally wrong idea about associations, totally wrong about what they are. And now, I’m talking about empowerment; for me, power and empowerment before was, “Men are the bad guys, let’s go after them…”. But I didn’t see it as something personal, as saying, “I feel empowered, I feel strong, I feel alive”; I had a very different concept. (Woman survivor of violence, 50 years)

3.1.2. Changing the Image of the Abuser

[referring to conversations with people who help you]. They dismantle you, they take away your guilt, they take away your sorrow (…) One very good thing I had was a memory… they remembered things that I had said maybe three months ago, “because you had said this”. And maybe I didn’t even remember that I had lived through that and she remembered. Because, of course, it was normal for me to say, “When you go into the street, I’m going to take you, and I’m going to throw a stone at you. You’re going to get a stone in the head, and you won’t know where it’s coming from”. As I was used to that every day, as if I didn’t know… She remembered everything and took away my sorrow, the blame and took it all away from me. (Woman survivor of violence, 36 years)

And look, it’s funny, I’ve always seen him “uhhhhhh”, but, “uhhhh” of “my God1” [referring to the attraction I felt for him].

I hadn’t seen him for a long time, and when we had the trial about child custody and all these things, I don’t know if it had been ten months or a year since I had seen him. When I saw him in court, he had shrunk in size; he was smaller, you know what I mean? But really smaller in height, I mean, at what point was he so tall? (…)

So, when I left the court, I deduced that he had come down because I had put him on a pedestal. And I had grown up because I felt very small next to him, I was always very small, very little, very small, tiny. And I had grown up because I was worth it, and he had come down from where he was mounted, I don’t know where I had put him. (Woman survivor of violence, 44 years)

3.1.3. Decoupling Love from Violence

(when asked if he considered that what he had in his relationship was love) Man, obviously it wasn’t, I mean, but I recognise it now. Look, you have to idealise love to the maximum in order to be able to put up with everything that person does to you, I mean, I’ve explained myself in a few words. You have to idealise it, and you are so, so in love and you love him so much that you have to put up with it, because if you don’t love him so much, you can’t put up with it, you run away. (Woman survivor of violence, 36 years)

And she says, “My friend says I’m suffering from gender-based violence, but I told her I’m not”. She had all the symptoms, and yet the friend from the outside had seen them at first glance; she had told her, “He is mistreating you”, and she said, “No because he doesn’t hit me”. We have the feeling that if he doesn’t hit you, he doesn’t mistreat you; if he doesn’t hit you, he doesn’t do anything to you, you know? (Family member of woman survivor of violence, 44 years)

4. Discussion and Conclusions

Author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

4 between 18–30

18 between 30–50

8 between 51–65

2 more than 65

7 compulsory basic education studies

2 baccalaureate

3 vocational training (intermediate level)

1 vocational training (higher level)

7 degree

3 doctorate and/or master’s degree

9 no qualification recorded

4 single

1 married

4 separate

12 divorced

3 widow

8 not stated

4 socio-health

3 unemployed

3 administrative

3 teacher

2 cleaner

2 security guard

1 retired

1 telephone operator

1 billing technician

1 tourism technician

1 waitress

1 teacher’s assistant

1 social worker

1 social educator

1 architect

1 psychologist

5 not stated

23 do have

9 do not have

Entity Code	Year of Creation	People Served	Areas of Work	Description
1	1998	Women in situations of gender-based violence	Training, psychological support, counselling, awareness-raising, prevention, assistance.	Organisation that offers psychological and social support, and aims to provide accompaniment that enhances individual personal skills. It also links women in leisure, social, training and work activities, encouraging their participation in them.
2	2014	Women at risk or victims of forced marriage	Awareness-raising, psychological, health, labour, training, legal, academic, community.	Organisation that offers psychological-emotional support with the aim of accompanying them in their process towards emotional wellbeing. They also have a temporary housing resource and work in a network with the services of the territory with the aim of achieving a comprehensive recovery through coordinated work.
3	2002	Women at risk of gender-based violence and sexual exploitation. As well as their children	Awareness-raising, vocational training, academic training, psychosocial intervention, legal support	Organisation that offers psychosocial support to women in situations of gender-based violence, with legal assistance and training and employment support services.
4	2014	Women at risk of gender-based violence and their children	Counselling, support mechanisms, awareness-raising, employment entrepreneurship, legal support, psychological care, family care, educational training.	Organisation that offers comprehensive care through psychological care, legal advice, care for minors, care for family members, search for resources and group sessions.
5	1990	Women at risk of gender-based violence, family members and minors, men and women	Education, adult education, gender equality, awareness-raising, community work, prevention, legal assistance, sport, health, leisure, etc.	Organisation that carries out campaigns for the prevention of gender violence. Provides comprehensive care for victims of gender-based violence.
6	2015	Women at risk of gender-based violence and family members	Psychosocial support, legal assistance, job training, awareness raising	Organisation that provides shelter for women in situations of gender-based violence, accompaniment, for example, to court. It also offers support for reintegration into the labour market, protection for minors and training for empowerment. At the same time, they raise awareness through conferences, talks…
7	2008	Women in situations of gender-based violence	Psychological accompaniment, legal advice, community accompaniment.	Organisation that accompanies women in situations of gender violence. It also offers comprehensive care through psychological care, legal advice and collective and leisure activities.
8	1991	Women in situations of gender-based violence and their children	Psychological, social, legal care	Recovery centre, where women in a situation of gender violence and their children find comprehensive care, through psychological support, legal, social and educational counselling.

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Melgar, P.; Serradell, O.; Hereu, C.; Racionero-Plaza, S.; Mut, E. Social Intervention That Facilitates Recovery from Gender-Based Violence: Dialogic Reconstruction of Memory. Soc. Sci. 2024 , 13 , 417. https://doi.org/10.3390/socsci13080417

Melgar P, Serradell O, Hereu C, Racionero-Plaza S, Mut E. Social Intervention That Facilitates Recovery from Gender-Based Violence: Dialogic Reconstruction of Memory. Social Sciences . 2024; 13(8):417. https://doi.org/10.3390/socsci13080417

Melgar, Patricia, Olga Serradell, Claudia Hereu, Sandra Racionero-Plaza, and Elena Mut. 2024. "Social Intervention That Facilitates Recovery from Gender-Based Violence: Dialogic Reconstruction of Memory" Social Sciences 13, no. 8: 417. https://doi.org/10.3390/socsci13080417

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Literature review on school-related gender-based violence: how it is defined and studied

A review of the SRGBV literature serves several purposes. First, it identifies overarching SRGBV types or categories with the intent to assist researchers and the international development community to align more closely around common SRGBV definitions. Greater definitional agreement will contribute to the expansion of the evidence on effective SRGBV interventions and will allow for greater comparability of research, and the identification of research gaps. Second, this review provides a global overview of the common methodologies observed across SRGBV studies and evaluations and contributes to a clearer understanding of the research trends, strengths, and weaknesses for consideration when conducting studies and evaluations of SRGBV. The findings serve to better inform SRGBV prevention activities, future investigations of SRGBV and more effective measurement of SRGBV. Third, this review is informing USAID's development of a companion document, Conceptual Framework for Measuring School-Related Gender-Based Violence, that will provide development partners and researchers with a conceptual framework and measurement tools to inform programming and research protocols. Finally, a review of the methodologies used to examine SRGBV may provide guidance to policymakers, other program designers and researchers in many countries who are grappling with the same set of issues around SRGBV. The wide variety of sectors where SRGBV is studied underscores the comprehensive nature of the SRGBV issue and the broad base of factors that mediate its occurrence, manner of presentation, and intensity. Tapping into this broad literature base is important because it will extend the frame from which researchers and implementers design further investigations and prevention programs.

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(USAID)-supported literature review, one of a series of eleven literature reviews contributing to Agency efforts to better understand gender-based violence (GBV) and its impact on the empowerment of girls and women, addresses the research question presented below. Are women working in the informal sector more exposed to or face greater violence?

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A Systematic Review of Gender-Based Violence Prevention and Response Interventions for HIV Key Populations: Female Sex Workers, Men Who Have Sex With Men, and People Who Inject Drugs

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