How a pandemic, economic shock, and civil unrest compounded domestic violence risk factors and reduced access to help, especially for women of color
This is a modified excerpt from my MPH capstone for Johns Hopkins Bloomberg School of Public Health. With my advisor, I will be submitting the full paper to an academic journal. However, I don’t just want this work to live in the echo chamber of academia. I’m publishing this here to make this information accessible to all. If you or someone you know is experiencing domestic abuse, please reach out to the National Domestic Violence Hotline.
The statistics are harrowing. More than 10 million people in the US are abused by their partners each year. One in four women will be punched, slapped, burned, kicked, strangled, or otherwise beaten by an intimate partner during her lifetime⁸⁴. In fact, homicide is a leading cause of death for women under 40, and nearly half of these victims are killed by a male intimate partner⁶⁸.
And then came 2020.
The existing problem of domestic violence was simultaneously met with the COVID-19 pandemic, economic shock, and civil unrest in the United States. The intensity and uncertainty of these conditions created a perfect storm for an increase in domestic violence reports nationwide. Not only did record unemployment, a lockdown, and perceived unrest exacerbate existing abusive behaviors, but these same factors also decreased access to help for survivors. That these already heartbreaking statistics worsened in 2020 is a catastrophe for domestic abuse survivors in the United States and worthy of more research, attention, and funding.
That these already heartbreaking statistics worsened in 2020 is a catastrophe for domestic abuse survivors in the United States and worthy of more research, attention, and funding.
Domestic violence — or what public health advocates call intimate partner violence (IPV) — has significant public health and financial consequences. IPV is associated with an increased risk for numerous physical and mental health problems including injury, chronic pain, gastrointestinal and gynecological disorders, sexually transmitted infections, depression, and post-traumatic stress disorder¹⁶. It is also associated with nearly six billion in healthcare costs and lost work productivity annually³⁰.
When controlling for socioeconomic factors, there appears to be no difference in the prevalence of IPV for Hispanic versus non-Hispanic women⁸⁴, and for Black women versus White women⁷³. However, reality does not control for socioeconomic factors, and centuries of systemic racism and oppression in the United States puts Black, Hispanic, and Indigenous women at greater risk for IPV, while reducing their access to care and support services.
I read and documented hundreds of newspaper articles from March to October 2020 to better understand the problem.
The incidence and prevalence of domestic violence is notoriously difficult to measure because cases are underreported. Historically, researchers have looked to data from law enforcement agencies, emergency rooms, domestic violence hotlines, and social service agencies, as well as self-reported victimization surveys.
For the capstone project for my MPH, I created a database to collect city and county-level reports of domestic violence during the time period of March to October 2020. While I read hundreds of articles, I only included those in the database which contained data along with a reference time period. Ultimately, 97 news reports of change in domestic violence calls, cases, charges, and homicides across 41 states were included.
The headlines presented in the word cloud above demonstrate the reality of the link between partner violence and the pandemic, especially the increase in the number of survivors reaching out to the police or social service groups for help in various cities and counties across the US during the 2020 lockdown compared to the same period in 2019. By reading these articles, themes emerged which provided a depth for understanding the complexity and challenges for survivors and response systems during a pandemic and civil unrest.
This database is non-comprehensive, and limited by reporting bias (“no change in domestic violence” perhaps does not make a click-worthy news story). It does not tell us the actual number of cases during 2020, the change in cases nationally, nor the cases and the experiences of the most vulnerable survivors who were not able to seek assistance. It does not show us the difference between first-time abusers versus chronic abusers. And it does not tell us how experiences differ across socio-economic and racial groups. Further research is needed; however, one could argue that funding in domestic violence is better spent on intervention strategies than precisely measuring the problem.
The problem was worse than I thought.
“During the pandemic, domestic violence has killed more people than COVID-19 in rural Alaska”.
Kyle Hopkins, Anchorage Daily News³⁸
An increase in domestic violence reports
Of the 97 news reports included in my database, the vast majority indicated an increase in domestic violence reporting. From a 2.5% increase in domestic violence 911 calls in San Francisco, to a whopping 116% increase in domestic violence cases in Alton, Texas. The average change in cases, calls, or reports overall was a 56% increase.
For example, the Louisa County Sheriff’s Office in Virginia reported in the local paper a 24% increase in domestic violence reports from March to August 2020, compared to the same period in 2019. And domestic violence calls involving weapons increased 62% in that time period²². In Jefferson Parish (Louisiana) Police Reports, there were double the number of domestic violence homicides from January 1st to October 4th, 2020, compared to all of 2019.
The largest increases reported came from the non-profit service organizations. Of the 23 reports from helplines, 21 reported an increase in domestic violence calls, with an average 170% increase in calls and a maximum 2,260% increase to the Illinois Domestic Violence Hotline from March 21st to April 22nd 2020 compared to the same time period in 2019.
These findings are consistent with emerging research which estimates the pandemic led to, on average, 3.4 more domestic violence calls per city every day during the first five weeks after social distancing began. If that number is extrapolated across the US, it would have meant 1,330 more domestic violence calls per day, and a societal cost of tens of millions of dollars daily⁵⁴.
A few cities saw a decrease in domestic violence reports, despite a worsening problem. Here’s why.
Thirteen sources reported a local decrease in domestic violence calls or cases, and all of them shared concern of a worsening problem. The majority pointed to reporting issues (e.g. isolation from supportive others making it difficult for survivors to seek help) that may have been associated with the decrease in case reports.
For example, an executive at a shelter in New Jersey explained the decrease in hotline calls (paraphrased by the journalist):
“Domestic violence didn’t just stop. Just as in other times of crisis, people have turned their attention away from seeking help for themselves to more immediate concerns, like putting food on the table and a roof over their heads.”
In Jefferson County, Kentucky, which saw a 25% drop in domestic violence orders from March to mid-April 2020 compared to 2019, a local shelter director explained:
“A lot of women are sitting on the couch next to their perpetrator right now. He’s monitoring every call she makes, every move she makes.”
In looking at these 13 locations which saw a decrease in domestic violence reports, it’s important to note that the majority (10 of the 13) have higher median incomes than the national average. Existing research shows that domestic violence rates are highest in the poorest neighborhoods¹¹, where women have fewer resources to escape. It’s also important to note that these time frames are mostly early in the pandemic, and not illustrative of what happened in the summer months.
Diving in deeper: five domestic violence risk factors which were amplified during 2020.
Individual risk factors of low income, unemployment, anger and hostility, depression, alcohol and drug use, and insecurity intensified from record unemployment, social isolation, and stress and fear from a pandemic and civil unrest. Relationship factors, including tensions, financial stress, and isolation also magnified risks, along with the increased exposure to perpetrators and reduced privacy and freedom due to the lockdown. Add to the mix an increase in gun sales from March to July 2020, which increased the risk of lethal IPV cases⁵⁵ ⁷⁵.
- Alcohol use
“In the recovery world, there’s an old saying that the opposite of addiction is connection, and when we distance ourselves to stay safe from COVID, we are losing that connection to folks, and oftentimes, people turn in that isolation to alcohol.”
Sara Goldsby, South Carolina Department of Alcohol and Other Drug Abuse Services Director⁸¹
- From March 1st to April 18th, 2020, alcohol was the fastest growing e-commerce category among consumer packaged goods. In fact, in April 2020, alcohol sales online were six times higher than the same period in 20¹⁹⁷². The frequency of drinking, number of drinks, and heavy drinking days increased for men in May and June 2020 compared to 2019, increasing by 10%, 4.5%, and 7.3% respectively⁷⁰.
- Evidence suggests that alcohol use increases the chance and severity of domestic violence⁹². Alcohol use directly affects cognitive and physical function, reducing self-control and leaving individuals less capable of negotiating a non-violent resolution to conflicts within relationships⁹³. As such, alcohol is widely considered to be a key proximal predictor of family violence²⁷.
2. Economic shock
- In February 2020, 6.2 million Americans were unemployed. By May, after COVID-19 had taken a stronghold in the US, the unemployment number surged 230% to 20.5 million Americans. Young workers, immigrants, Hispanic Americans, Black Americans, and those without a college degree were disproportionately affected⁴⁸ ⁸⁹.
- Even after controlling for other factors at the relationship, individual, family, organization, and community levels — economic shock and the multiple associated impacts (including loss of health insurance, loss of income to safely leave a violent situation, and the health impact of increased stress and depression) can increase risk of victimization and perpetration. Sudden macroeconomic downturns create uncertainty and anticipatory anxiety that can increase an abusive man’s controlling behavior toward his romantic partners.¹⁸. Other research suggests that the connection between unemployment and violence may have nothing to do with stress or less resources, but purely opportunity: more unemployment equates to more contact⁶⁰.
3. Stress and anxiety.
“When you think about the crises every community is going through and the stress it brings onto the household with their children being pulled from schools, people working from home, and, in some cases, being let go … it can push emotional buttons for a lot of families.”
Major Ronnie Roberts, Louisa County Sheriff’s Chief Deputy²²
- A May 2020 poll by the American Psychological Association showed Americans experienced considerable stress related to COVID-19. The average reported stress level for US adults related to the pandemic was 5.9, up from 4.9 in 2019. The stress level for parents with children under 18 was 6.7, and nearly half of parents (46%) reported a high stress level (between 8 and 10 on a 10-point scale where 10 means “a great deal of stress”).⁴
- Natural disasters and crises are known to provoke immense stress responses that correlate with increases in domestic violence²⁸. Stress and anxiety can trigger anger, mood swings, and irritability. Research suggests this occurs when exposure to acute stress alters hormones, including testosterone and cortisol⁵⁷. A combination of high testosterone levels and low cortisol levels (a high “T/C ratio”) has been linked to increased dominant and aggressive behaviors. Therefore, the provocation of stress may increase proneness to violence by altering hormones⁷⁶.
4. Increase in gun purchases
- The increase in gun purchases in 2020 was alarming. One study⁷⁸ estimated a 2.1 million excess in gun purchases from March through May 2020, which is a 64.3% increase over expected volume. The Brookings Institute estimated that almost three million more guns were sold from March to July 2020 than would have ordinarily been sold during those months, with half of the increase occurring in June at the height of protests against police brutality⁵⁵.
- Guns kept in the home are associated with an increase in the risk of homicide by a family member or acquaintance. In fact, the presence of guns in the home is associated with a five-fold increased homicide risk within the home⁶⁵. And in homes with previous domestic violence incidents, the chances of homicide are 20 times as high⁴⁵.
“We are not used to this type of an environment where the most dangerous place for a victim is the only place they can go.”
Amanda Pyron, The Network Executive Director⁵⁹
- Lastly, there was the isolation. The ‘stay home, save lives’ mantra, meant to protect the public from COVID-19 infection, was a paradox in the context of domestic violence. By April 20th, at least 316 million people in the US were urged or mandated by government officials to stay home⁶³.
- Isolation plays a major role in domestic violence, as it is used as a tool to control a victim’s activities and interactions with the outside world. Isolation is one of eight tactics on the power-and-control wheel of how abusive partners gain control within their relationships. Isolation is considered a risk factor for domestic violence, whereas social support is considered protective for victimization¹⁸.
At the same time, it became harder for domestic violence survivors to seek help.
Constant surveillance made it harder for victims to call for help. The combination of more time at home and less work made it easier for perpetrators to strip their victims of freedom and privacy, and prevented survivors from help-seeking. One shelter employee in Virginia described it²²:
“If you’re in that situation and the abuser is there, it’s harder to reach out for help if they are watching you, listening to the calls you make and monitoring your every move.”
A YWCA spokesperson in Salt Lake City similarly said³⁵:
“Our guess is that people who would have normally called while their abusive partner was out of the house no longer have that flexibility. And so we are actually concerned that people are experiencing more danger and are at higher risk, but haven’t yet figured out how to reach out.”
Fear of exposure was used by abusers as a tool to keep victims isolated at home and away from social contact⁷⁷. This was especially problematic because social networks and in-person interaction is paramount to identifying, and ultimately helping, survivors of domestic abuse. This includes informal networks (coworkers, friends, family members, neighbors) and formal networks (nurses, doctors, teachers, police officers, social workers). But the majority of these interactions came to a halt during the lockdown of 2020, as survivors were stuck at home with their abusers and likely reached out for support only when the violence became increasingly severe.
- Closed schools. State Child Protective Services (CPS) agencies receive millions of referrals each year, with educational personnel serving as the largest percentage of reporters (20.5%)⁸⁰. The closing of most schools in the US in 2020 made it more difficult for these teachers and school counselors to screen a child for abuse. Even for schools that moved to a virtual classroom, advocates say children are less likely to confide in teachers virtually, especially if the child has no privacy at home⁴².
- Challenges accessing healthcare, and loss of health coverage. Healthcare providers are also often the first line of response for a survivor. In fact, the USPSTF recommends that clinicians screen and provide counseling on domestic violence in all women of reproductive age⁹⁰. But access to healthcare providers was hampered during the 2020 lockdown as health systems cancelled non-essential appointments and procedures to focus on the COVID-19 pandemic². Furthermore, roughly 6.2 million workers lost access to employer-based health insurance during this time period¹⁰. Since ACA-compliant plans must cover essential health benefits, this meant 6.2 million Americans lost free access to preventive and mental health services, including domestic and interpersonal violence screening and counseling for women.
- Financial inequality has oppressed women for centuries, and is the reason women today earn just 81% of the salary men earn for the same job¹⁴. Financial inequality has shaped the dynamics within marriages and diminished women’s autonomy. It also makes it more likely a woman is financially dependent on her spouse, especially if she has taken “time off” to have children (“time off” is in quotes because only 17% of US workers have access to paid family leave¹⁴). Evidence suggests economic dependence significantly influences women to remain with an abusive partner. The economic shock that occurred in 2020 therefore made it even more difficult for survivors of domestic abuse to leave. Women faced higher unemployment than men, at 14.3% compared to 11.9%. And Hispanic women faced the highest rate of unemployment in May, 2020, of 19.5%⁴⁸.
Concurrently, systemic racism and the ensuing civil unrest in 2020 made it especially difficult for Black, Hispanic, and Indigenous women to seek support from the criminal justice system. Historic police racism and violence negatively influence the willingness of a domestic abuse survivor to call police or cooperate with the criminal justice system in prosecuting a partner¹.
For some women, calling the police to report domestic violence may be the riskiest option, as it may incite more violence from the perpetrator, result in economic insecurity or homelessness after the perpetrator’s arrest, lead to the separation of children, or put her life at risk³⁶. In fact, women experiencing domestic violence are two to three times more likely to experience abuse or a neglectful response from law enforcement³⁶, and Black women in particular are more likely to be arrested by the police just for reporting domestic violence⁴¹. Furthermore, non-White mothers are more likely to be referred to child protective services (CPS) for domestic violence-related concerns relative to White mothers who are more likely to be referred for mental health services²⁴.
“Stories of police brutality, the over incarceration of Black men, coupled with historical and present day oppression makes many [Black women] survivors reluctant to turn partners over to a criminal justice system.”
Zoë Flowers, Domestic Violence Advocate¹³
This distrust of police, especially among Black women, hit a boiling point in 2020. While police brutality of Black women is not a new issue, the rise of the #SayHerName movement, sparked in part by the death of Breonna Taylor, created a more widespread conversation of the issue. At the same time, the #BlackLivesMatter social justice movement broadened the conversation of the ways in which Black people are affected by violence, police misconduct, and injustice.
What we can do it about it.
There is an increased focus on violence prevention rather than the traditional focus on response to cases of domestic violence. The review of the evidence and news reports has demonstrated that known determinants of domestic violence have been drastically impacted during 2020, and are not easily amenable to a single public health intervention. Unemployment, access to weapons, alcohol consumption, isolation, and eroding trust of the justice system can markedly affect risk of domestic violence, but are complex and multifaceted. They require significant investment, and an intersectional response to racial, economic, health, and gender inequity. Therefore, we should seek multi-sectoral interventions focused on the spectrum of prevention, primary to tertiary prevention of violence, in households and communities.
- First and foremost, we must address isolation and create protective environments for survivors of domestic violence.
Perhaps the most dramatic change of 2020 was forced isolation. Not only did this give more exposure to abusers, but it also reduced access to formal and informal support networks and made it more difficult for survivors to seek help. We must strengthen the individual knowledge and skills of informal networks (family, friends, neighbors, coworkers, classmates) and formal networks (hotlines, technology based resources, telehealth) about how to support survivors of domestic violence.
The vast majority of survivors disclose abuse to at least one informal support person, with family and friends being among the most utilized and generally considered the most helpful and supportive⁸⁶. This is especially true for survivors of marginalized backgrounds due to the disparate and racist treatment they may receive from formal sources of support, such as the criminal justice system or social service agencies⁵⁶.
While teachers and healthcare providers offer an important first line response in many cases, we know that in states where these formal networks are “mandatory reporters” (required by law to report), it often reduces survivors’ ability to receive the support they seek, and may make the situation worse for survivors⁵⁶. On the other hand, survivors’ satisfaction with their informal support network has been shown to be a predictor of self-esteem, emotional health, level of loneliness, and quality of life, and can be a protective factor against future abuse³³. Therefore, activating the informal network in this unprecedented time of stress and isolation would be a more pragmatic approach.
2. Second, we must restrict people with a history of violence against women from owning any type of firearm.
The Brookings Institute estimated that almost three million more guns were sold from March to July 2020 than would have ordinarily been sold during those months, but there is no way to know exactly how many many of these guns were sold to purchasers with a history of violence against women⁵⁵.
“All too often, the only difference between a battered woman and a dead woman is the presence of a gun.”
Senator Paul Wellstone²²
There are existing federal laws that ban those convicted of domestic violence from purchasing a gun, but there are problematic policy loopholes that have not been universally addressed. First, federal law only bans abusers who were married to the victim, have a child with the victim, or live with the victim. This is called the “boyfriend loophole” because many boyfriends or flings who have been convicted of domestic violence can still buy or own a gun. Second, federal law does not prohibit the purchase or possession of a gun by those subject to temporary domestic violence restraining orders (often called ex parte or emergency orders) even though the most dangerous time for a victim of domestic violence is when they leave their abuser. Finally, federal law requires background checks for gun purchases from licensed arms dealers, but not from private sellers. This is called the “private transfer loophole” that allows known abusers to circumvent the gun-ownership ban.²⁵ ⁶⁰
Since we know access to guns by known domestic violence abusers increases the risk of intimate partner murder 20-fold compared with unarmed abusers, policies restricting access to guns by domestic abusers can reduce the prevalence of domestic violence.⁴⁵ ⁶⁵
3. Support non-profits working on the ground.
As part of a fundraising campaign earlier this year, we were able to give $10K grants to each of the following organizations supporting survivors of abuse:
- Ohio-based WomenSafe provides emergency shelter, counseling, and case management for domestic violence survivors throughout Northeast Ohio for 40 years. With a mandatory shelter-in-place, the need for a safe space has increased greatly because of COVID-19. Our donation provided 200 nights of emergency shelter to women in need.
- Children are at higher risk for sexual abuse by their family members during quarantine. Darkness to Light is creating training videos featuring survival strategies and how to avoid isolation while quarantining.
- Step By Step’s Emergency Relief Fund is helping to pay the bills of young, single moms in Lexington, KY so they can remain safely in their homes with their children, and avoid stress-related child abuse.
- The Voices of Women mobilizes survivors of domestic violence in New York City to address the systematic breakdown that victims are facing as a result of the COVID-19 outbreak.
- S.O.U.L Sisters, operating in both Miami and Brooklyn, used this grant to support vulnerable youth and their caregivers with basic needs, family conflict de-escalation, and socio-emotional support during the quarantine.
- Ladies of Hope Ministries serves women and girls — and their families. Their primary service population is formerly incarcerated women who have experienced incredible trauma in their lives, from sexual violence, homelessness, food insecurity, and the compounding health effects of those circumstances. This grant directly supported basic needs like food and necessary items.
- Dallas-based Poetic provides intensive aftercare for girls who have been exploited and trafficked. With their in-person programming cancelled due to COVID-19, they are now delivering goods (food, supplies) and support (therapy, case work) to 74 young women and families.
I found ample evidence that risk factors for domestic violence were amplified in 2020 due to a pandemic, civil unrest, and economic shock. While it is difficult to measure the actual prevalence of domestic violence nationwide, evidence exists that risk factors including unemployment, stress and anxiety, alcohol consumption, gun purchases, and isolation were increased in 2020. Police and shelter reports of domestic violence during this time period corroborated the research and practice evidence with reported domestic violence cases, arrests, and homicides.
The factors that led to an increase in risk factors for domestic violence also made it more difficult for survivors to seek help. “Stay at home” orders further disconnected survivors from people who could have potentially intervened. Systemic racism and civil unrest in 2020 made it especially difficult for Black, Hispanic, and Indigenous women to seek support from the criminal justice system. And economic shock in 2020 meant the most vulnerable, poor survivors were further entrapped in abusive situations.
Using this time as an opportunity to work with experts and community members most impacted by domestic violence, we must advocate for prevention and response services fundings, increasing resources for prevention campaigns targeting social and traditional media outlets, and increasing prevention and response interventions. This includes increasing resources for safe housing, financial assistance including unemployment supplements, childcare, access to health care providers for care and support and free, rapid testing for COVID-19, safety planning for survivors in the relationships and those planning to end the relationship, and increased access to mental health and addiction programs.
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