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Journal Article

Citation

Evans ML, Lindauer M, Farrell ME. New Engl. J. Med. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Massachusetts Medical Society)

DOI

10.1056/NEJMp2024046

PMID

32937063

Abstract

s Covid-19 cases surged in the United States in March 2020, stay-at-home orders were put in place. Schools closed, and many workers were furloughed, laid off, or told to work from home. With personal movement limited and people confined to their homes, advocates expressed concern about a potential increase in intimate partner violence (IPV). Stay-at-home orders, intended to protect the public and prevent widespread infection, left many IPV victims trapped with their abusers. Domestic-violence hotlines prepared for an increase in demand for services as states enforced these mandates, but many organizations experienced the opposite. In some regions, the number of calls dropped by more than 50%.1 Experts in the field knew that rates of IPV had not decreased, but rather that victims were unable to safely connect with services. Though restrictions on movement have been lifted in most regions, the pandemic and its effects rage on, and there is widespread agreement that areas that have seen a drop in caseloads are likely to experience a second surge. This pandemic has reinforced important truths: inequities related to social determinants of health are magnified during a crisis, and sheltering in place does not inflict equivalent hardship on all people.

One in 4 women and one in 10 men experience IPV, and violence can take various 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, such violence has a disproportionate effect on communities of color and other marginalized groups. Economic instability, unsafe housing, neighborhood violence, and lack of safe and stable child care and social support can worsen already tenuous situations. IPV cannot be addressed without also addressing social factors, especially in the context of a pandemic that is causing substantial isolation.

Economic independence is a critical factor in violence prevention. For many people who experience IPV, the financial entanglement with an abusive partner is too convoluted to sever without an alternative source of economic support. The pandemic has exacerbated financial entanglement by causing increased job loss and unemployment, particularly among women of color, immigrants, and workers without a college education.3 The public health restrictions put in place to combat the spread of the virus have also reduced access to alternative sources of housing: shelters and hotels have reduced their capacity or shut down, and travel restrictions have limited people's access to safe havens. Shelters have made valiant efforts to ease crowding and to help residents move into hotels, extended-stay apartments, or the homes of family members and friends. Though some restrictions have been lifted, many shelters remain closed or are operating at reduced capacity, which creates challenges for people who need alternative housing arrangements.

Closures of schools and child care facilities have added to the stress at home. Virtual learning often requires the involvement and supervision of parents and guardians. Some families don't have access to a reliable Internet connection, and child care obligations may fall to friends, neighbors, or family members while parents work or attempt to find work. Some parents are considered essential workers and cannot work from home, and others are required to work virtually. The added stress of balancing work, child care, and children's education has led to a rise in child abuse.4 Mandated reporters, such as teachers, child care providers, and clinicians, 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 the pandemic. The way in which police reports can be filed varies among precincts, with some offering online options and others requiring in-person visits. Similarly, individual trial courts have discretion to determine...


Language: en

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