A pandemic within a pandemic – intimate partner violence during Covid-19

As Covid-19 cases surged in the US in March 2020, stay-at-home orders were put in place. Schools have closed, and many workers have been furloughed, laid off or told to work from home. With personal movement restricted and people confined to their homes, advocates have expressed concern about the potential increase in intimate partner violence (IPV). Stay-at-home orders, intended to protect the public and prevent the spread of infection, have left many IPV victims trapped with their abusers. Domestic violence hotlines were set up to increase demand for services as states enforced these mandates, but many organizations faced the opposite. In some areas, the number of calls has fallen by more than 50%.1 Experts in the field knew that IPV rates were not dropping, but rather that victims could not safely connect with services. Although restrictions on movement have been lifted in most regions, the epidemic and its effects remain, and there is widespread agreement that areas that have seen a decline in cases are likely to experience a second surge. This pandemic has reinforced important facts: Inequality related to the social determinants of health is magnified during a crisis, and providing shelter does not cause the same hardship to all people.

1 in 4 women and 1 in 10 men suffer from IPV, and violence can take many different forms: it can be physical, emotional, sexual or psychological.2 People of all races, cultures, genders, sexual orientations, socioeconomic classes, and religions experience IPV. However, this violence has a disproportionate impact on communities of color and other marginalized groups. Economic instability, unsafe housing, neighborhood violence, and a lack of safe and stable childcare and social support can exacerbate already fragile situations. IPV cannot be treated without also addressing social factors, particularly in the context of a pandemic that is causing significant isolation.

Economic independence is a critical factor in preventing violence. For many people with IPV, the financial entanglement with an abusive partner is too complex to break without an alternative source of economic support. The pandemic has exacerbated the financial entanglement by causing increased job losses and unemployment, particularly among women of color, immigrants and workers without a college education.3 Public health restrictions put in place to combat the spread of the virus have also limited access to alternative sources of housing: shelters and hotels have reduced or closed capacity, and travel restrictions have limited people’s access to safe havens. Shelters have made valiant efforts to ease overcrowding and help residents move into hotels, long-stay apartments, or the homes of family members and friends. Although some restrictions have been lifted, many shelters remain closed or operating at reduced capacity, creating challenges for people who need alternative housing arrangements.

The closure of schools and childcare facilities has added to the pressure at home. Virtual learning often requires the involvement and supervision of parents and guardians. Some families do not have access to a reliable Internet connection, and childcare obligations may fall to friends, neighbors, or family members while parents work or try to find work. Some parents are considered essential workers and cannot work from home, while others are required to physically work. The added pressure of balancing work, child care, and child education has led to an increase in child abuse.4 Costly reporters, such as teachers, child care providers and doctors, also have fewer interactions with children and families and fewer opportunities to assess, recognize, and report signs of abuse than they did before the pandemic.

There may also be barriers to reporting IPV during a pandemic. The way police reports can be submitted varies for different departments, with some offering online options and others requiring in-person visits. Likewise, individual courts have discretion to determine the procedure for filing injunctions. The lack of a coherent and consistent process for reporting abuse can discourage people who seek help through the legal system. Black and brown people, who have long experienced police persecution and brutality, may be less likely than white people to engage the police when IPV escalates.

Most people with IPV do not seek help. Medical professionals have an opportunity to identify these patients in health care settings, advise and connect people with social services. Medical offices can be safe places for patients to detect abuse. Physical examination results. patient behavior during or while discussing the intimate bodily components of a breast, pelvic, or rectal examination; Or an aggressive partner could be warning signs of potential IPV. In settings such as emergency departments and labor and delivery wards, policies mandate IPV screening when patients are alone. Assessment in a clinic or hospital allows for immediate intervention, including the involvement of social workers, safety planning, and a review of services available to victims and their families. Even this opportunity has often been absent in the era of Covid-19. As offices cancel and reschedule non-urgent clinic visits and move to telemedicine platforms, it is becoming more and more challenging to safely screen patients for IPV. Not only may patients live in areas with unreliable internet or cellular service, but abusers may overhear conversations, leaving patients unable to detect escalating abuse at home.

Some steps could promote more equitable access to services as a second wave of Covid-19 infections approaches. First, societies can ensure equal access to broadband internet in people’s homes. Access can be expanded by a support program that mirrors the FCC’s Lifeline program or by installing wireless access points in public places.5 Such approaches will not only allow for wider access to telehealth, but also allow people with IPV experience to seek resources and maintain their important social contacts.

Providers can continue to screen IPV and discuss safety planning with their patients during telemedicine appointments. Doctors can normalize screening using standardized questions and can provide information to all patients, regardless of whether they detect IPV. Available resources appear in the box. Physicians can also educate themselves about available community resources. If abuse is detected, the clinician and patient can create signals to identify an abusive partner during telemedicine appointments. These cues can include a raised fist in a video call or assigning phrases during an audio call. When it is safe to have an IPV discussion, clinicians can review safety practices, such as deleting web browsing history or texting; save hotline information within other lists, such as a grocery store or pharmacy list; Create a new, confidential email account to receive information about resources or contact physicians.

IPV resources for patients.

Finally, governing bodies must consider the social determinants of health when developing standards for crisis care. Franchising, funding, and access to resources all influence the impact of IPV on patients.

The Covid-19 pandemic has highlighted several ongoing public health crises, including violence within the home. As state mandates relax and people begin to live a new version of normal, clinicians, public health officials and policymakers cannot stop addressing the layers of social inequality in our societies and the ways in which they affect people’s access to care. The pandemic has highlighted the amount of work that needs to be done to ensure that abused people can continue to receive support, shelter and medical care when another public health disaster strikes.

Leave a Reply

Your email address will not be published.