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‐
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.
Methods
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:
1.
What were the most important dimensions of the gender-based violence against women during the COVID-19 pandemic?
2.
What were the effective factors on increasing the gender-based violence against women during the COVID-19 pandemic?
3.
What were the most important strategies to combat the gender-based violence against women during the COVID-19 pandemic?
4.
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.
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.
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.
Discussion
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.
Conclusion
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.
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